Diagnostic decision making in psychiatry

Abstract

The purpose of this article is to examine the consequences of and possible responses to uncertainty in psychiatric diagnosis. Uncertainty is inevitable because of the overlap in characteristics, or test results, between populations with and without a psychiatric disorder. As a result, there is never one correct method of identifying cases and noncases (i.e., case definition). In this paper principles of decision analysis and clinical epidemiology are used to develop a framework for thinking about the consequences of different diagnostic schema and for choosing among them. The framework illustrated here involves choosing an external validator, choosing a separator, and choosing a cutoff. This framework is applied to the problems facing three hypothetical researchers, and the consequences for their research of different diagnostic choices are explored. It is demonstrated how the relevance of research to clinicians and policy makers rests on the choice of the case definition process. The prevalent use of structured psychiatric interviews has not been accompanied by adequate attention to the problem of determining a diagnosis once the information is obtained. It is argued that more attention must be given to this process if we are to make optimal use of available resources for research and treatment.

The 14-item short health anxiety inventory (SHAI-14) used as a screening tool: appropriate interpretation and diagnostic accuracy of the Swedish version

“…Depending on the specific need in the clinical or research context, a cut-off point that maximizes sensitivity is sometimes preferred, even if that means a limited specificity [ 51 ]. This is often the case when a scale is used for screening purposes and if the test is inexpensive and simple.…”

The Impact of Medical Terminology in Self-Triage Decision-Making

“…Medical decision-making is a very complex task (Higgs and Jones, 2000;Eva, 2005) and even expert clinicians have difficulty with the ambiguity inherent in many clinical symptoms (Brooks et al, 1991(Brooks et al, , 2000Zarin and Earls, 1993;Hatala et al, 1999;LeBlanc et al, 2001LeBlanc et al, , 2002Groves et al, 2003). Issues of symptom identification and medical decision-making exist for patients as well, as we all have to decide whether something is "strange" or "bad enough" to seek medical attention, and patients often have to make health decisions without the benefit of medical expertise (Redelmeier et al, 1993;MacKichan et al, 2017).…”

Table_1.DOCX

“…First, based on the relevant literature on clinical ways of thinking (16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and ML (26)(27)(28)(29)(30)(31)(32), we have differentiated the process of clinical judgment into four main stages. Such a translational effort allows to analytically detail each step of the two modes of clinical and computational reasoning.…”