Fragmento

One of the hallmarks of a classification system is its ability to cover natural features. Imagine entering a flower shop and ordering some tulips, some roses and one third of flowers «not otherwise specified» (NOS). Would that not be poor botany? Linnaeus would turn in his grave. A primary purpose of a diagnostic classification system is to serve the practical needs of GPs and specialists. Unfortunately, we clinicians are confronted with a large number of psychiatric patients who, though treated, do not receive a psychiatric diagnosis, because they suffer from sub-diagnostic syndromes. Large US community studies found that almost half of the psychiatric patients who had been treated in the year before the interview did not meet DSM diagnostic criteria; most of them had emotional, behavioural and stress problems (Druss, Hoff, Rosenheck, 2000). Very little representative epidemiological research has been devoted to this diagnostic deficit or to seeking to apply precise diagnostic criteria to such patients. Until recently, epidemiological interviews were mainly tailored to DSM diagnostic concepts and not to the natural phenomena, making no attempt at more detailed clinical description of NOS disorders. And this despite studies such as the NCS on mild disorders (Kessler et al., 2005) and the large NIMH study of treated depressive patients on so-called «sub-syndromal» depressive syndromes (Judd, Paulus, Akiskal, Rapaport & Kunovac, 1997). There was even a reverse trend, with great concern being expressed about over-diagnosing psychiatric disorders, and efforts made to introduce yet more rigorous criteria for clinical significance (Narrow, Rae, Robins & Regier, 2002). The fact nonetheless remains that a major proportion of the treated psychiatric patients suffer from sub-threshold syndromes, raising the question whether the current diagnostic classification should not be systematically supplemented by well-defined sub-diagnostic groups, while taking all care to minimise false positives.

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2009-04-13   |   978 visitas   |   1 valoraciones

Vol. 32 Núm.1. Enero-Febrero 2009 Pags. 1-2 Salud Ment 2009; 32(1)