Hierarchical and Nonhierarchical Approaches in Psychiatric Diagnosis: A Case Report of Change in Psychiatric Symptoms and Diagnosis Over Time

Aboraya, Ahmed; Stevenson, James; Jacoby, Katherine; Abdallah, Ehab; Barnhart, J.L.

doi:10.1097/00131746-200307000-00010

Cited by 5 publications

(12 citation statements)

References 17 publications

(11 reference statements)

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“…The concept of hierarchy in psychiatric nosology descends from Kraepelin (Aboraya, Stevenson, Jacoby, Abdallah, & Barnhart, 2003; Kendler, 2002). Some disorders, like an organic mental disorder, are considered to have a wider range of signs and symptoms than do some other disorders.…”

Section: The Need For a Paradigm Shift Concerning Symptomsmentioning

confidence: 99%

Psychiatric nosology is ready for a paradigm shift in DSM-V.

Maser¹,

Norman²,

Zisook³

et al. 2009

Clinical Psychology: Science and Practice

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Data since 1980 demonstrate that the DSM-III model requires revisions in its assumptions and format. Problems inherent in the DSM-III model are considered and a paradigm shift toward a mixed categoricaldimensional classification system for DSM-V is recommended. This will reduce comorbidity, allow symptom weighting, introduce noncriterion symptoms, eliminate NOS categories, and provide new directions to biological researchers. We suggest reevaluating the threshold concept and use of quality-of-life assessment. A framework for such a revision is presented. Drawbacks to change include retraining of clinicians, administrative and policy changes, and possible reinterpretation of data collected under the DSM-III model. Nevertheless, clinicians and clinical researchers are ready for a diagnostic system that more accurately reflects the patients that they treat and study.The format and assumptions of the third edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-III , American Psychiatric Association, 1980), have served as a model for all successive editions. The third edition was considered a paradigm shift in nosology (Klerman, 1990), and data since 1980 demonstrate the need for a second paradigm shift. This article will raise issues regarding the assumptions underlying the DSM-III model and format by which psychopathology is presented: inadequate use of dimensions, the threshold concept, discontinuity with normality and subthreshold psychopathology, signs and symptoms and their weighting, comorbidity, and quality-of-life to complement psychosocial functioning. We also discuss some consequences of departing from nearly three decades of hegemony by the DSM-III model.Although space limits the inclusion of dozens of articles that would support the issues addressed, we provide examples of data from this large literature. Excepting one point, the theoretical underpinnings of psychopathology are not discussed. If the theory is supported by data, is heuristic, or is useful in treatment, DSM-V might include some specific etiological theories. Incorporation of evolution theory in DSM-V is discussed elsewhere (Bracha & Maser, 2008).

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Section: The Need For a Paradigm Shift Concerning Symptomsmentioning

confidence: 99%

Psychiatric nosology is ready for a paradigm shift in DSM-V.

Maser¹,

Norman²,

Zisook³

et al. 2009

Clinical Psychology: Science and Practice

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“…Thus, more rigorous instruments, such as clinical diagnostic interviews, are more appropriate to estimate the prevalence of mental health disorders in refugees and asylum seekers (Fazel et al, 2005;Steel et al, 2009). In addition, clinicians' experience in using structured interviews can increase the reliability of symptoms measurement and psychiatric diagnoses even among samples with different cultural backgrounds (Alarcon et al, 1999;Aboraya et al, 2006). Nevertheless, among the structured and semi-structured interviews there may also be some differences in accuracy.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of mental disorders in refugees and asylum seekers: a systematic review and meta-analysis

et al. 2022

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Background Studies have identified high rates of mental disorders in refugees, but most used self-report measures of psychiatric symptoms. In this study, we examined the percentages of adult refugees and asylum seekers meeting diagnostic criteria for major depressive disorder (MDD), post-traumatic stress disorder, bipolar disorder (BPD), and psychosis. Methods A systematic literature search in three databases was conducted. We included studies examining the prevalence of MDD, post-traumatic stress disorder, BPD, and psychosis in adult refugees according to a clinical diagnosis. To estimate the pooled prevalence rates, we performed a meta-analysis using the Meta-prop package in Stata (PROSPERO: CRD42018111778). Results We identified 7048 records and 40 studies (11 053 participants) were included. The estimated pooled prevalence rates were 32% (95% CI 26–39%; I2= 99%) for MDD, 31% (95% CI 25–38%; I2= 99.5%) for post-traumatic stress disorder, 5% (95% CI 2–9%; I2 = 97.7%) for BPD, and 1% (95% CI 1–2%; I2= 0.00%) for psychosis. Subgroup analyses showed significantly higher prevalence rates of MDD in studies conducted in low-middle income countries (47%; 95% CI 38–57%, p = 0.001) than high-income countries studies (28%; 95% CI 22–33%), and in studies which used the Mini-International Neuropsychiatric Interview (37%; 95% CI 28–46% p = 0.05) compared to other diagnostic interviews (26%; 95% CI 20–33%). Studies among convenience samples reported significant (p = 0.001) higher prevalence rates of MDD (35%; 95% CI 23–46%) and PTSD (34%; 95% CI 22–47%) than studies among probability-based samples (MDD: 30%; 95% CI 21–39%; PTSD: 28%; 95% 19–37%). Conclusions This meta-analysis has shown a markedly high prevalence of mental disorders among refugees. Our results underline the devastating effects of war and violence, and the necessity to provide mental health intervention to address mental disorders among refugees. The results should be cautiously interpreted due to the high heterogeneity.

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“…One important aspect of construct validity is content validity, which refers to whether all dimensions (e.g., clinical presentations, demographics, psychological, environmental, and psychosocial factors) that comprise a multidimensional disease are adequately captured by the criteria 3,6,19 . This type of validity is commonly assessed through a consensus study aiming to collect experts’ reviews of the extent to which the content is reflecting the construct 3,6 . Content validity index (CVI) is the most widely reported metric for content validity 20–22 .…”

Section: Standard Psychometric Properties For Diagnostic Criteriamentioning

confidence: 99%

Validity and Diagnosis in Physical and Rehabilitation Medicine

Hassan

Kumbhare²

2021

Am J Phys Med Rehabil

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Obtaining a diagnosis is an essential and integral part of physical and rehabilitation medicine in practice and research. Standardized psychometric properties are required of any classifications, diagnostic criteria, and diagnostic rules used. Physicians and researchers, in physical and rehabilitation medicine, need to understand these properties to determine the accuracy and consistency of their diagnosis. Although chronic musculoskeletal pain disorders are among the highly prevalent disorders seen in physical and rehabilitation medicine, limitations regarding existing diagnostic criteria for chronic musculoskeletal pain disorders still exist. Hence, the quest for developing diagnostic tools for chronic musculoskeletal pain that align with the standard properties remains open. These are discussed with an example for existing diagnostic criteria for fibromyalgia. This article primarily aimed to provide an overview of standard psychometric properties. A secondary aim was to critically appraise the tools currently used to diagnose chronic musculoskeletal pain disorders. The challenges and limitations of existing diagnostic tools are discussed. Potential approaches on how to improve the conceptualization of the construct of musculoskeletal pain disorders are also discussed. Adopting a network perspective, for example, can better constitute the disease instead of a single known underlying etiology for persistent or recurrent pain symptoms.

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Hierarchical and Nonhierarchical Approaches in Psychiatric Diagnosis: A Case Report of Change in Psychiatric Symptoms and Diagnosis Over Time

Cited by 5 publications

References 17 publications

Psychiatric nosology is ready for a paradigm shift in DSM-V.

Psychiatric nosology is ready for a paradigm shift in DSM-V.

Prevalence of mental disorders in refugees and asylum seekers: a systematic review and meta-analysis

Validity and Diagnosis in Physical and Rehabilitation Medicine

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