T. Duckett Jones Memorial Lecture. The Jones criteria and the challenges of clinimetrics.

Guidi²,

Semprini³

et al. 2010

112

102

The concept of allostasis emphasizes that healthy functioning requires continual adjustments to the internal physiological milieu. Allostatic load reflects the cumulative effects of stressful experiences in daily life. When the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine responses exceeds the coping resources of an individual, allostatic overload ensues. So far these issues have been addressed only on pathophysiological terms that do not find application in clinical settings. However, several features that have been described in psychosomatic research may allow the assessment of allostatic load on clinical grounds. Clinimetric criteria for the determination of allostatic overload are suggested. They are based on: (a) the presence of a stressor exceeding individual coping skills, and (b) clinical manifestations of distress. They may provide specification to the fourth axis of DSM, may supplement the Diagnostic Criteria for Psychosomatic Research, and may help discriminate neuroendocrine patterns with important clinical and research implications. A state of allostatic overload is frequently associated with alterations in biological markers and calls for a close medical evaluation of the patient’s condition. The ultimate goal is to be able to prevent or decrease the negative impact of excessive stress on health.

Section: Clinimetric Definition Of Allostatic Loadmentioning

confidence: 99%

Clinical Assessment of Allostatic Load and Clinimetric Criteria

Guidi²,

Semprini³

et al. 2010

112

102

“…The term ‘clinimetrics’ was introduced by Alvan R. Feinstein in 1982 [21]to indicate a domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs, and other distinctly clinical phenomena in medicine. The purpose of clinimetric science was to provide an intellectual home for a number of clinical phenomena, which do not find room in the customary clinical taxonomy.…”

Section: Clinimetric Modelmentioning

confidence: 99%

“…Such phenomena include the types, severity and sequence of symptoms; rate of progression of illness, severity of comorbidity; problems of functional capacity; reasons for medical decisions, and many other aspects of daily life, such as well-being and distress [22]. Examples of clinimetric indexes are the Jones criteria for rheumatic fever [21], the New York Heart Association Functional Classification [23]and Apgar’s method of scoring the newborn’s condition [24]. Clinimetrics has a set of rules which govern the structure of indexes, the choice of component variables, the evaluation of consistency and validity [25].…”

Section: Clinimetric Modelmentioning

confidence: 99%

Psychometric Theory Is an Obstacle to the Progress of Clinical Research

Ruini

Rafanelli³

2004

129

153

Psychometric theory is the basis for the development of assessment instruments in psychiatric research. However, the psychometric model appears to be largely inadequate in the clinical setting because of its lack of sensitivity to change and its quest for homogeneous components. Clinimetrics offers a viable alternative to psychometrics, both from a conceptual and a methodological viewpoint. Current diagnostic entities (DSM) are based on clinimetric principles, but their use is still influenced by psychometric models. Suggestions for switching gears in assessment research are offered.

“…In 1982, Feinstein introduced the term ‘clinimetrics' [17] to indicate a domain concerned with the measurement of clinical issues that do not find room in customary clinical taxonomy. Such issues include the types, severity and sequence of symptoms; rate of progression in illness (staging); severity of comorbidity; problems of functional capacity; reasons for medical decisions (e.g.…”

Section: The Role Of Clinical Judgmentmentioning

confidence: 99%

The Missing Link between Clinical States and Biomarkers in Mental Disorders

Guidi

Grandi

et al. 2014

Current diagnostic definitions of psychiatric disorders based on collections of symptoms encompass very heterogeneous populations and are thus likely to yield spurious results when exploring biological correlates of mental disturbances. It has been suggested that large studies of biomarkers across diagnostic entities may yield improved clinical information. Such a view is based on the concept of assessment as a collection of symptoms devoid of any clinical judgment and interpretation. Yet, important advances have been made in recent years in clinimetrics, the science of clinical judgment. The current clinical taxonomy in psychiatry, which emphasizes reliability at the cost of clinical validity, does not include effects of comorbid conditions, timing of phenomena, rate of progression of an illness, responses to previous treatments, and other clinical distinctions that demarcate major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. Clinimetrics may provide the missing link between clinical states and biomarkers in psychiatry, building pathophysiological bridges from clinical manifestations to their neurobiological counterparts.