Psychiatric Diagnosis and Classification - ResearchGate

CRITERIA FOR ASSESSING A CLASSIFICATION IN PSYCHIATRY 13
allowing separate and independent assessment of psychopathological
syndromes, personality characteristics, somatic morbidity, psychosocial
precipitants or complicating factors, cognitive functioning and overall impairment
or disability, should be capable of ``individualizing'' the diagnostic
assessment sufficiently to satisfy most clinicians and researchers.
However, the content and ``packaging'' of the information to be recorded
on individual axes will require substantial refinement. For example, the axes
that are particularly problematic in the present ICD and DSM multiaxial
systems are those concerned with personality. Both ICD-10 and DSM-IV
provide categories for personality disorders but lack provisions for assessing
and recording clinically relevant personality traits or dimensions. The
ICD-10 code Z73.1 ``accentuation of personality traits'' is clearly inadequate;
DSM-IV offers no better alternative. While most contemporary clinicians are
likely to explore aspects of premorbid or current personality in the clinical
work-up of a caseÐbecause they appreciate the importance of personality
traits as risk factors, modifiers of symptomatology, or predictors of outcomeÐthey
lack a conceptual framework and vocabulary to integrate this
information into their diagnostic assessment.
Lastly, the system should be adaptable to different settings and should
perform adequately in in- and out-patient services, primary care, emergencies,
and the courtroom. In addition, it should be ``user-friendly'', i.e. sufficiently
simple and clear in its overall organization to allow entry at different
levels for different users, including non-professional health workers.
Reliability
Before the 1970s, psychiatric research and communication among clinicians
were badly hampered by the low reliability of diagnostic assessment and by
the fact that key terms like schizophrenia were used in different ways in
different countries, or even in different centres within a single country [35].
The situation has changed radically since then, and particularly since the
publication of DSM-III in 1980 and the research version of ICD-10 in 1993.
Clearly, this has been largely the result of the introduction of explicit or
``operational''* diagnostic criteria.
One of the earliest examples of explicit diagnostic criteria in medicine was
the SNOP Standardized Nomenclature of Pathology) adopted by the American
Heart Association in 1923. In psychiatry, Bleuler's list of fundamental
* The term ``operational'' originates in modern physics [36] where the definition of the ``essence''
of an object has been replaced by a description of the operations e.g. measurement)
required to demonstrate the object's presence and identity in the context of an experiment. This
term may be too demanding for psychiatry, where it may be more appropriate to speak of
``explicit'' rather than ``operational'' diagnostic criteria.