Person-Centred Integrative Diagnosis: Conceptual Bases and Structural Model

Abstract

Objectives: To review the conceptual bases of Person-centred Integrative Diagnosis (PID) as a component and contributor to person-centred psychiatry and medicine and to outline its design and development. Method: An analysis was conducted of the historical roots of person-centred psychiatry and medicine, tracing them back to ancient Eastern and Western civilizations, to the vicissitudes of modern medicine, to recent clinical and conceptual developments, and to emerging efforts to reprioritize medicine from disease to patient to person in collaboration with the World Medical Association, the World Health Organization, the World Organization of Family Doctors, the World Federation for Mental Health, and numerous other global health entities, and with the coordinating support of the International Network for Person-centered Medicine. Results: One of the prominent endeavours within the broad paradigmatic health development outlined above is the design of PID. This diagnostic model articulates science and humanism to obtain a diagnosis of the person (of the totality of the person's health, both ill and positive aspects), by the person (with clinicians extending themselves as full human beings), for the person (assisting the fulfillment of the person's health aspirations and life project), and with the person (in respectful and empowering relationship with the person who consults). This broader and deeper notion of diagnosis goes beyond the more restricted concepts of nosological and differential diagnoses. The proposed PID model is defined by 3 keys: broad informational domains, covering both ill health and positive health along 3 levels: health status, experience of health, and contributors to health; pluralistic descriptive procedures (categories, dimensions and narratives); and evaluative partnerships among clinicians, patients, and families. An unfolding research program is focused on the construction of a practical guide and its evaluation, followed by efforts to facilitate clinical implementation and training. Conclusions: PID is aimed at appraising overall health through pluralistic descriptions and evaluative partnerships, and leading through a research program to more effective, integrative, and person-centred health care.

The Person-Centered Health model in Intellectual Developmental Disorders/Intellectual Disability

“…Thus, SWB may not be a particularly sensitive measure, but, when it is low, it may be cause for serious concern 20 . The WHO definition of QoL as a subjective construct including the self-reported assessment of both positive and negative facets of life is in agreement with the "experience" domain of the PID model of personcentered health 1 . However the PID has a broader perspective as it highlights the importance of engagement, empathy and partnership in the clinical care process, and sustain the patients' autonomy, responsibility and dignity while advancing the recovery and promotion of wellbeing.…”

“…In 2010 the International Network for Person-centered Medicine proposed a Personcentered Integrative Diagnostic model (PID) defined by broad informational domains, covering both ill health and positive health along three levels: health status (disease/ disability versus wellbeing); experience of health (aspirations, satisfaction, experiences of ill-being and of wellbeing); and contributors to health (risk and protective factors) 1 . According to this model, diagnosis is both a process and a formulation, and it should be oriented by the articulation of science and humanism, the use of a bio-psycho-socialcultural-spiritual framework.…”

Atención clínica centrada en la persona: principios y estrategias

“…También se nota una sustantiva consistencia entre los conceptos y estrategias listadas en este artículo con los campos informativos y aspectos procesales del modelo de Diagnóstico Integral Centrado en la Persona (PID en sus siglas en inglés) (27) . En efecto, sus componentes incluyen claramente la mayoría de los principios y estrategias arriba mencionados.…”

The importance of ternary awareness for overcoming the inadequacies of contemporary psychiatry

“…This bias is attractively disguised in the garb of positivism and operationalism, which appeal to aspirations for status and respect by pretentions to objectivity and rigor. However, contemporary "operationalist" epistemology does not address the crucial need for an appreciation of psychosocial context and subjectivity in psychiatry [24][25][26] . Even the originators of the check-list approach at Washington University had a more personcentered understanding of the process of psychiatric diagnosis than was implemented in DSM in 1980 27 .…”