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Prototype diagnosis of psychiatric syndromes.
| Content Provider | Europe PMC |
|---|---|
| Author | WESTEN, DREW |
| Copyright Year | 2012 |
| Description | The method of diagnosing patients used since the early 1980s in psychiatry, which involves evaluating each of several hundred symptoms for their presence or absence and then applying idiosyncratic rules for combining them for each of several hundred disorders, has led to great advances in research over the last 30 years. However, its problems have become increasingly apparent, particularly for clinical practice. An alternative approach, designed to maximize clinical utility, is prototype matching. Instead of counting symptoms of a disorder and determining whether they cross an arbitrary cutoff, the task of the diagnostician is to gauge the extent to which a patient’s clinical presentation matches a paragraph-length description of the disorder using a simple 5-point scale, from 1 (“little or no match”) to 5 (“very good match”). The result is both a dimensional diagnosis that captures the extent to which the patient “has” the disorder and a categorical diagnosis, with ratings of 4 and 5 corresponding to presence of the disorder and a rating of 3 indicating “subthreshold” or “clinically significant features”. The disorders and criteria woven into the prototypes can be identified empirically, so that the prototypes are both scientifically grounded and clinically useful. Prototype diagnosis has a number of advantages: it better captures the way humans naturally classify novel and complex stimuli; is clinically helpful, reliable, and easy to use in everyday practice; facilitates both dimensional and categorical diagnosis and dramatically reduces the number of categories required for classification; allows for clinically richer, empirically derived, and culturally relevant classification; reduces the gap between research criteria and clinical knowledge, by allowing clinicians in training to learn a small set of standardized prototypes and to develop richer mental representations of the disorders over time through clinical experience; and can help resolve the thorny issue of the relation between psychiatric diagnosis and functional impairment. |
| Abstract | The method of diagnosing patients used since the early 1980s in psychiatry,which involves evaluating each of several hundred symptoms for their presenceor absence and then applying idiosyncratic rules for combining them for eachof several hundred disorders, has led to great advances in research over thelast 30 years. However, its problems have become increasingly apparent, particularlyfor clinical practice. An alternative approach, designed to maximize clinicalutility, is prototype matching. Instead of counting symptoms of a disorderand determining whether they cross an arbitrary cutoff, the task of the diagnosticianis to gauge the extent to which a patient’s clinical presentation matchesa paragraph-length description of the disorder using a simple 5-point scale,from 1 (“little or no match”) to 5 (“very good match”).The result is both a dimensional diagnosis that captures the extent to whichthe patient “has” the disorder and a categorical diagnosis, withratings of 4 and 5 corresponding to presence of the disorder and a ratingof 3 indicating “subthreshold” or “clinically significantfeatures”. The disorders and criteria woven into the prototypes canbe identified empirically, so that the prototypes are both scientificallygrounded and clinically useful. Prototype diagnosis has a number of advantages:it better captures the way humans naturally classify novel and complex stimuli;is clinically helpful, reliable, and easy to use in everyday practice; facilitatesboth dimensional and categorical diagnosis and dramatically reduces the numberof categories required for classification; allows for clinically richer, empiricallyderived, and culturally relevant classification; reduces the gap between researchcriteria and clinical knowledge, by allowing clinicians in training to learna small set of standardized prototypes and to develop richer mental representationsof the disorders over time through clinical experience; and can help resolvethe thorny issue of the relation between psychiatric diagnosis and functionalimpairment. |
| Related Links | https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC3266765&blobtype=pdf |
| ISSN | 17238617 |
| Volume Number | 11 |
| PubMed Central reference number | PMC3266765 |
| Issue Number | 1 |
| PubMed reference number | 22294998 |
| Journal | World Psychiatry |
| DOI | 10.1016/j.wpsyc.2012.01.004 |
| Language | English |
| Publisher | Elsevier Italy |
| Publisher Date | 2012-02-01 |
| Access Restriction | Open |
| Subject Keyword | Prototype diagnosis classification ICD-11 DSM-5 categorical diagnosis dimensional diagnosis comorbidity |
| Content Type | Text |
| Resource Type | Article |
| Subject | Psychiatry and Mental Health |
