There is no Evidence on the Scientific Accuracy of Psychiatric Diagnoses as well as their Importance towards the Recovery of a Patient.
There has been a serious challenge posed by the reliability of diagnoses in psychiatrics to mental health professionals, psychologists and psychiatrists for many decades (Whitfield, 1993). In the first half of the 20th century, clinicians had not been interested in performing diagnoses in the psychiatric sector since they had inadequate equipment to do so even. At the beginning of the second half of the 20th century, psychiatric nomenclature started expanding gradually due to the tremendous efforts made by the World Health Organization (WHO) as well as the American Psychiatric Association (APA) (Whitfield, 1993). World Health Organization made a publication of the International Classification of Diseases (ICD-6) in 1948, a sixth revision that included a section on mental health illnesses. Some publications of the ICD came with the latest of them being the 10th revision that was published in the year 1993. In the U.S, the APA Statistics and Nomenclature Committee published the first edition of Diagnostic and Statistical Manual in year 1952.
Psychiatry continued towards medicalization and more emphasis was placed on the performance of psychiatric diagnoses as well as application of the psychiatric nomenclature. The application of the psychiatric nomenclature and classification helps in increasing communication between clinicians on etiology, courses of illness, treatment as well as clinical features (Double, 2002). Due to the fact that diagnostic criterion of psychological disorders became detailed as well as specific, different and various interviews have been developed towards the measurement of the symptoms comprising the psychological disorders.
Even though the criteria for diagnosis have been developed together with several structured interviews, there is still a serious problem on the unreliability of psychiatric diagnoses. We will review the unreliability and reasons behind the same as from the 20th century to date, exploring the reasons for the unreliability of these diagnoses as well as look into whatever would be important in helping improve the situation (Yamamoto, 1992).
The major reasons for the unreliability of psychiatric diagnosis have ben researched over and over. There has been a study on helping point out some of the reasons for the disagreement on diagnostics as pertains to psychiatrics (Leff, 1991). There was an interview between an experienced psychiatrist with a patient and a second psychiatrist followed in interviewing the same patient after a few minutes resting period. There was a meeting by the two psychiatrists after the second interview and they both started establishing reasons for a disagreement. The main reasons that came up causing the disagreement after the interview were nomenclatural inadequacy, patients inconsistency as well as the clinicians inconsistency (LLEWELYN, 2004).
Nevertheless, these are not the only reasons behind the disagreement and unreliability of the diagnostic interviews and procedures performed on most mentally ill patients. Some of the patients are able to offer reliable and useful information to the health practitioner. Some of the patients tend to forget vital information that is necessary for the process because of poor concentration, anxiety, as well as poor memory. Some other patients with the problem of disorganization in their thoughts are incapable of providing any important or useful information because of psychosis (Jensen & Weisz, 2002). Some others tend to omit some of the useful information because of denial, fear, shame, fearing some of the legal consequences for obtaining or even avoiding some specific treatments, or even due to other reasons. Patients suffering from disorders relating to their personalities tend to make efforts in manipulating the mental health clinician (Svenaeus, 2013). Some of the factors that are patient related are under no much control of the mental health practitioner whose main role is sourcing and obtaining information from patients, weighing of the same as well as making judgement relating to psychiatric diagnosis.
For those patients who might be unwilling or unable to offer any reliable information on the same, the health practitioner ought to, whenever there is a possibility, move to proxy information, which in most cases will be distorted or even incomplete(Zimmerman, 1988). In such situations, it is anticipated that the proxy information can only obfuscate a dependable diagnosis (Leff, 1991). One other example is including input of the family in a diagnostic interview in early dementia which is often seen as very key. In such a case, the clinical reports offered by the involved family may widely vary dependent on whether they play any basic or even tertiary role in care of the patient (Svenaeus, 2013). The quality of information will tend to be affected by things such as whether the members of the family live with the patient, has daily contact with them, or are limited to reports of the patient. (SPITZER & FLEISS, 1974). Thus, any time the clinician is making use of proxy information, it is crucial that they are able to assess the quality of the information to determine its relative utility.
It so happens that most of the clinicians tend to use the ICD and DSM criteria. A normal presentation can earn itself a definition as a mental disorder meeting the criteria specified under the ICD and DSM manuals. For instance, patients with major episodes of depression ought to have some a period of two-weeks in anhedonia as well as depressed moods including: loss of weight, fatigue, guilt, low concentration, suicidal thoughts as well as a feeling of worthlessness (Jensen & Weisz, 2002).
Most of the clinicians tend to use open-form interviews for evaluation of the mental disorder. The psychiatric diagnoses reliability by the use of this form of routine psychiatric evaluation has already proved low "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)," 2000). There are the main reasons behind this. Mental health practitioners tend to typically focus on the most vivid symptoms, bringing the patient to medical attention at the expense of other hidden symptoms that may seem less acute and dangerous. For instance, a patient may occur to have symptoms of depression in one time and on another time occur to have memories of past abuse and nightmares (Carmines & Zeller, 1979).
The training and background of the clinician has a possible influence on the interpretation of the symptoms. A clinician who has gone through developmental training will in most cases be able to explain hallucinatory experiences in the patient as a part of past abuses posttraumatic experiences (Vase, Amanzio, & Price, 2015). A different clinician having a serious biomedical orientation will in most cases get to explain the same hallucinatory experiences as a part of some process in schizophrenia (Aboraya, Rankin, France, El-Missiry, & John, 2006). This will in most cases explain why some of the clinicians tend to either underuse or overuse some particular diagnosis. Relying on the subjective symptoms of the patient, the interpretation of symptoms by the clinician as well as lack of objective measures such as blood tests often lead to unreliability of the psychiatric diagnosis.
Placebo effect is the change that occurs after an intervention that doesnt have any inherent ability involving an active procedure. It has been believed after research studies that due to infectivity of the psychiatric diagnose, placebo effect has been the main ingredient involved in the recovery of the psychiatric patients (Price & Vase, 2016). The basic reason for the performance of placebo-regulated tests is so as to help control some of the factors such as spontaneous improvement, rater bias as well as regression to the mean.
Far from that, there is a very interesting question on whether the placebo effect is an active intervention in itself (Kaptchuk & Miller, 2015). Even though there has been several open scientific questions pertaining and related to the problem of the placebo effect, this never affects drawing of very simple conclusions on the same to aid medical practices (Kaptchuk & Miller, 2015). The optimum strategy applied in clinical practices may involve combination of active medication with any presentation that will enhance the expectancy of a patient, involving education and exposition of patients to the effectiveness of any prescribed medications as well as the utilization of enthusiastic and confident interpersonal style. Learning and recovery from the placebo effect could mean: Uncertainty. The medical practitioner should never leave the patient unsure on the effects of the method of treatment (Faravelli, 2012). Even though the therapists may feel uncertain concerning the whole diagnosis, it is will be professional and reasonable enough to let the patient understand that whatever treatment has been offered is the best available option. Optimism. The medical practitioners should do their best to make sure they involve optimism and hope. The patients should be told that the prescribed medication will work towards their recovery (Kossowsky & Kaptchuk, 2015). Cognitive reframing. Clinicians ought to help the patient have a clear understanding of the positive changes about to take place whether or not they are related to treatment.
Guidance. The clinicians involved in psychiatric diagnoses and treatment fail to guide the patients. They ought to use a single suggestion to help convey a message full of optimism. They ought to tell their patient how they are supposed to feel. If it is very important, they should also tell the patient what they expect. It is very crucial to let them understand the expected outcome after treatment (Kirkpatrick, 1968). While discussing the intentional application of the placebo effect as an agent of treatment, there is an ethical question in existence so that therapists might not get a chance to mislead the patients. This may as well be talked about concerning psychological placebos like very optimistic promises that may turn out to be true or false. Or the application of suggestion without notifying the patient which has been the trend anyway. It also remains an ethical question on whether it is allowed to let the patient suffer or even let them understand the whole idea behind nocebo effect. It is very ethical to suggest that psychiatrists and therapists ought to get away from nocebo and foster the placebo effects.
Aboraya, A., Rankin, E., France, C., El-Missiry, A., & John, C. (2006). The Reliability of Psychiatric Diagnosis Revisited. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990547/
Carmines, E., & Zeller, R. (1979). Reliability and Validity Assessment. Doi: 10.4135/9781412985642
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). (2000). doi:10.1176/appi.books.9780890423349
Double, D. B. (2002). The history of anti-psychiatry: an essay review. History of Psychiatry, 13(50), 231-236. Doi: 10.1177/0957154x0201305008
Faravelli, C. (2012). Are Psychiatric Diagnoses an Obstacle for Research and Practice? Reliability, Validity and the Problem of Psychiatric Diagnoses. The Case of GAD. Clinical Practice & Epidemiology in Mental Health, 8(1), 12-15. Doi: 10.2174/1745017901208010012
Jensen, A. L., & Weisz, J. R. (2002). Assessing match and mismatch between practitioner-generated and standardized interview-generated diagnoses for clinic-referred child...
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