Psychiatric Diagnosis and Classification - ResearchGate

102 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
Next this information would be formulated and interpreted in terms of
both functional neuroanatomy and psychodynamics. This requires assessment
of the psychobiological functions described in Table 4.2 and applied in
Table 4.4. These formulations should eventually be testable by psychophysiological
tests and functional brain imaging, which are currently
revealing strong relations between specific brain circuits and personality
traits closely related to the psychobiological parameters described here
[67, 68]. Pharmacotherapy and psychotherapy would then be planned
with this functional psychobiology as its basis.
Practically, then, the classification of mental disorders is truly a medical
or neuropsychological specialty, in which expertise is needed in both neurodynamics
and psychodynamics. Functional psychobiology, as envisioned
here, is intended to take psychodynamics from an intellectual or emotional
level to an even more integrated level of awareness with quantum-like
characteristics. Such functional psychobiology should help to improve
the effectiveness of classification and treatment. It would also help to reemphasize
the importance of medical and psychiatric training in the diagnosis
and treatment of mental disorders. We cannot expect others to recognize
the complexity of mental disorders when we rely on outdated systems
of classification and approach treatment as a diagnosis-dependent cookbook.
Furthermore, we cannot expect classification of mental disorders
to be reliable and valid when our system of classification depends on so
many redundant categories that clinicians and researchers find it impractical
to do comprehensive assessments. Fortunately, functional psychobiology
can be assessed in a way that is at once comprehensive, efficient and
practical.
REFERENCES
1. Cloninger C.R., Martin R.L., Guze S.B., Clayton P.J. 1985) Diagnosis and prognosis
in schizophrenia. Arch. Gen. Psychiatry, 42: 15±25.
2. Millon T., Klerman G.L. 1986) Contemporary Directions in Psychopathology: Toward
the DSM-IV. Guilford, New York.
3. Goodwin D.W., Guze S.B. 1996) Psychiatric Diagnosis, 5th edn. Oxford University
Press, New York.
4. Robins E., Guze S.B. 1970) Establishment of diagnostic validity in psychiatric
illness: its application to schizophrenia. Am. J. Psychiatry, 126: 983±987.
5. Woodruff R.A. Jr., Reich T., Croughan J.L. 1977) Strategies of patient management
in the presence of diagnostic uncertainty. Compr. Psychiatry, 18: 443±448.
6. Feighner J.P., Robins E., Guze S.B., Woodruff R.A., Jr., Winokur G., Munoz R.
1972) Diagnostic criteria for use in psychiatric research. Arch. Gen. Psychiatry, 26:
57±63.
7. Boyd J.H., Burke J.D., Gruenberg E., Holzer L.E. III, Rae D.S., George L.K., Karno
M., Stoltzman T., McEvoy L., Nestadt G. 1984) Exclusion criteria for DSM-III: a