Explore chapters and articles related to this topic
Overview of the Integration of Gastroenterology and Psychiatry
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
The need to classify psychiatric diagnoses on an “operational,” basis—i.e., on the basis of observable behaviors—led Feighner to propose a strategy for validating diagnostic criteria. Feighner’s work generated great interest in psychiatry. The “Feighner criteria” established a process for validating existing and future psychiatric diagnoses (36). In 1987, the DSM-III succeeded the DSM-II. The DSM-III differed from its predecessors in that the expert panels used, for the first time, the techniques proposed by Feighner to develop these operational definitions to classify the various mental disorders. This use of operational definitions to create and validate criteria led to a process of continuous evaluation and validation of psychiatric diagnoses. The continuous collection of data to affirm or negate the validity of specific diagnostic criteria made the DSM-III a “living document,” subject to continuous revision as criteria became better defined or, in some cases, rejected as not supportable. The DSM-III Revised (DSM-IIIR), published in 1987, and most recently the DSM-IV, published in 1994, were testaments to this continuing process of validation (37,38).
Psychiatric Diagnosis: The State of the Art
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Robert Moreines, Irl Extein, Mark S. Gold
DSM III,1 the Diagnostic and Statistical Manual of Mental Disorders, third edition, has been developed by an American Psychiatric Association task force of leading clinicians and researchers under the chairmanship of Dr. Robert Spitzer. It is an achievement of great scholarship and thoughtfulness which brings more consistency and comprehensiveness to the classification of mental disorders. The project involved a good deal of debate and compromise in order to devise a system that was acceptable to clinicians of diverse backgrounds and techniques of treatment. Most important, the Manual introduces to general practice a rigorous approach to diagnosis previously limited to research in descriptive psychiatry. Starting with the Feighner criteria2 proposed by the Washington University group and continuing with the Research Diagnostic Criteria (RDC),3 there had been developed specific criteria for the standardization of diagnosis and the progressive identification of more homogeneous subgroups of patients. At the very least, DSM III facilitates the communication of information and enables clinicians to incorporate research gains into their treatment strategies of individual patients.
The Problems of Nosology in Alcoholism Treatment and Research
Published in Edith S. Lisansky Gomberg, Current Issues in Alcohol/Drug Studies, 2019
Thomas P. Beresford, Frederic C. Blow, Kirk J. Brower, Jack G. Modell, Cindy Kracht
One way of understanding attempts at nosology is to consider a dichotomy between the subjective experience of alcoholism as manifested by the history of symptoms that any given patient may bring to a clinical situation, as opposed to those phenomena, such as the longitudinal course, the drug of choice, and others, that may be more readily observed by objective means. For purposes of discussion, we have presented the existing nosologic systems using this dichotomy in Tables 1 and 2. The reader may note that some nosologic systems for alcoholism, such as the St. Louis (Feighner) criteria and the Research Diagnostic Criteria are not present in this list. We have elected not to include these since, in clinical usage, the DSM-III-R (1987) system has all but supplanted these earlier attempts at a similar diagnostic approach. On the other hand, we have included the concept of juvenile delinquency as researched by the Gluecks (1950, 1968) in order to provide a historical counterbalance for a trend in the current literature: later researchers have rediscovered or verified, depending on one’s point of view, the characteristic natural histories of persons who abuse alcohol and who present pre-existing character problems consistent with sociopathy or conduct disorder, depending on age of onset (Cloninger, 1987). We believe this is an unfortunate trend that serves to obscure rather than to enlighten the usefulness of nosologies in alcoholism. We beg the readers’ pardon if we have omitted one or another nosological system with which the reader may be familiar. Our attempt has been to examine those that appear to have the widest use in clinical practice as well as the widest empirical basis, judging from present clinical reports.
Conceptual and historical evolution of psychiatric nosology
Published in International Review of Psychiatry, 2021
The DSM-III based its classification system on the descriptions of clinical presentations which could – it was hoped – be reliably recognized by psychiatrists, no matter their theoretical leanings with regards to the aetiology of psychiatric disorders (American Psychiatric Association, 1980). The putatively atheoretical attitude was reflective of the pragmatic view that reliance on speculative aetiological theories is to be avoided for scientific and operational reasons (Aragona, 2014). Outside of a narrow aetiological sense, it is clear that DSM-III and its successors are deeply embedded within the panoply of theoretical assumptions. Building on the Feighner criteria proposed in 1972 (Feighner et al., 1972), DSM-III enumerated operational criteria for diagnostic categories to enhance interrater reliability, which was then empirically tested in field trials (Aragona, 2014). While the concern for reliability itself was not new (DSM-II and prior manuals had been concerned about it as well), the focus on criterion variance as the target for tackling reliability by means of operationalized criteria was novel (Aragona, 2014). In line with the Kraepelinian aspiration, it was hoped that increased reliability would pave the way for increased validity (Aragona, 2014). DSM-III also utilized a multiaxial system, assigning developmental and personality disorders, medical condition, social factors, and a general assessment of functioning independent axes in order to emphasize their importance in an overall diagnostic assessment.