Pub Date : 2019-05-01DOI: 10.1093/MED/9780198807254.003.0011
A. Huda
Psychiatric diagnostic constructs often have no zones of rarity between different diagnostic constructs, and they often co-occur. This happens even where clear disease processes are involved, such as the dementias. They may represent different areas of a spectrum of illness/condition and/or be part of a spectrum of illnesses/conditions. However, they share both these characteristics with many general medical diagnostic constructs. For spectrums of illness/condition this may be because there are no natural boundaries but that it is important or seems obvious to recognize different areas of the spectrum for reasons of clinical utility (such as different prognostic implications or treatments) or different clinical pictures. For spectrums of illnesses/conditions the reason for co-occurrence may be because different diagnostic constructs have similar causes/mechanisms. On the other hand, these problems of lack of boundaries are not present as commonly in general medical diagnostic constructs. Alternative mental health classifications do not have the same issues with co-occurrence. They may be more useful in research to discover reasons why co-occurrence of symptoms may occur but have pragmatic drawbacks for other classification functions.
{"title":"Spectrums of conditions","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0011","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0011","url":null,"abstract":"Psychiatric diagnostic constructs often have no zones of rarity between different diagnostic constructs, and they often co-occur. This happens even where clear disease processes are involved, such as the dementias. They may represent different areas of a spectrum of illness/condition and/or be part of a spectrum of illnesses/conditions. However, they share both these characteristics with many general medical diagnostic constructs. For spectrums of illness/condition this may be because there are no natural boundaries but that it is important or seems obvious to recognize different areas of the spectrum for reasons of clinical utility (such as different prognostic implications or treatments) or different clinical pictures. For spectrums of illnesses/conditions the reason for co-occurrence may be because different diagnostic constructs have similar causes/mechanisms. On the other hand, these problems of lack of boundaries are not present as commonly in general medical diagnostic constructs. Alternative mental health classifications do not have the same issues with co-occurrence. They may be more useful in research to discover reasons why co-occurrence of symptoms may occur but have pragmatic drawbacks for other classification functions.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133395038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1093/MED/9780198807254.003.0005
A. Huda
Patients have many needs and not all can be met using the medical model, hence the necessity of multiple therapeutic models and multidisciplinary working. Doctors’ sapiental role relies on evidence from research which can vary in quality. Quantitative and qualitative research are both useful. Randomized controlled trials with blinded assessments are the best method of assessing treatment effectiveness. Objectives of treatment should be jointly decided between doctor and patient and are often not simply about cure. Mechanisms of action of intervention do not always reverse disease progress but may involve other processes such as indirect compensation. Medication has many complex effects, both therapeutic and adverse. The medical model allows doctors to see many patients and work in emergency situations including providing overnight cover. This is because after the initial assessment, further assessments can be brief and if medication is used it is usually taken outside consultations. This ability to see many patients at all hours means mental health services will often include doctors using the medical model.
{"title":"Multidisciplinary working, evidence, treatment, and decision-making in medicine","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0005","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0005","url":null,"abstract":"Patients have many needs and not all can be met using the medical model, hence the necessity of multiple therapeutic models and multidisciplinary working. Doctors’ sapiental role relies on evidence from research which can vary in quality. Quantitative and qualitative research are both useful. Randomized controlled trials with blinded assessments are the best method of assessing treatment effectiveness. Objectives of treatment should be jointly decided between doctor and patient and are often not simply about cure. Mechanisms of action of intervention do not always reverse disease progress but may involve other processes such as indirect compensation. Medication has many complex effects, both therapeutic and adverse. The medical model allows doctors to see many patients and work in emergency situations including providing overnight cover. This is because after the initial assessment, further assessments can be brief and if medication is used it is usually taken outside consultations. This ability to see many patients at all hours means mental health services will often include doctors using the medical model.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121934483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1093/MED/9780198807254.003.0002
A. Huda
Organization of knowledge is needed to help doctors learn and recall information in their clinical practice. Diagnostic constructs help, providing prototypes against which doctors can diagnose patient conditions. They then seek to confirm or disprove this diagnosis by searching for relevant information. Attached to these diagnostic constructs are information such as causes, prognosis, and treatment. Diagnostic constructs are provisional and should be changed if information suggests they are incorrect. They also aid communication between professionals for teaching and research, and have important social functions such as providing access to healthcare, determining eligibility for welfare, offering administrative and payment functions, and collecting health statistics. Some social effects of diagnostic constructs can be harmful, such as stigma. Diagnostic constructs are included in broad diagnostic formulations including relevant clinical information.
{"title":"The role of diagnosis in medical practice and society","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0002","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0002","url":null,"abstract":"Organization of knowledge is needed to help doctors learn and recall information in their clinical practice. Diagnostic constructs help, providing prototypes against which doctors can diagnose patient conditions. They then seek to confirm or disprove this diagnosis by searching for relevant information. Attached to these diagnostic constructs are information such as causes, prognosis, and treatment. Diagnostic constructs are provisional and should be changed if information suggests they are incorrect. They also aid communication between professionals for teaching and research, and have important social functions such as providing access to healthcare, determining eligibility for welfare, offering administrative and payment functions, and collecting health statistics. Some social effects of diagnostic constructs can be harmful, such as stigma. Diagnostic constructs are included in broad diagnostic formulations including relevant clinical information.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115880020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1093/MED/9780198807254.003.0003
A. Huda
Classification is essential in medicine to help doctors acquire, learn, and recall clinically useful information about problems coming to healthcare professionals’ attention. There problems include both essentialist diagnostic constructs (where all examples share a quality and are distinct from other constructs) and nominalist diagnostic constructs (used to describe clinically useful concepts not necessarily separate from other constructs). Diagnostic constructs may be recognized using defined criteria and/or as prototypical examples. They are based on similarities in clinical picture, mechanisms/processes, and/or causes. They may be used to identify clinically important situations, diseases/clear-cut syndromes, spectrums of health, illness(es)/and condition(s), injuries, and other situations of interest to healthcare professionals. Thresholds established on the basis of clinical utility (e.g. level of distress or risk of complications) may be used to define conditions. Care must be taken to guard against over-medicalization of problems or situations.
{"title":"The nature of diagnostic constructs","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0003","url":null,"abstract":"Classification is essential in medicine to help doctors acquire, learn, and recall clinically useful information about problems coming to healthcare professionals’ attention. There problems include both essentialist diagnostic constructs (where all examples share a quality and are distinct from other constructs) and nominalist diagnostic constructs (used to describe clinically useful concepts not necessarily separate from other constructs). Diagnostic constructs may be recognized using defined criteria and/or as prototypical examples. They are based on similarities in clinical picture, mechanisms/processes, and/or causes. They may be used to identify clinically important situations, diseases/clear-cut syndromes, spectrums of health, illness(es)/and condition(s), injuries, and other situations of interest to healthcare professionals. Thresholds established on the basis of clinical utility (e.g. level of distress or risk of complications) may be used to define conditions. Care must be taken to guard against over-medicalization of problems or situations.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125729087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1093/MED/9780198807254.003.0012
A. Huda
There is often a lack of identified causal biological mechanisms or biological differences of structure or process for many psychiatric diagnostic constructs. There is a lack of useful biomarkers common to all people who meet criteria for a psychiatric diagnostic construct that differentiates them from the healthy population. This can also be the case for general medical conditions for both aetiology and differences in structure or process and sometimes lack of useful biomarkers but this occurs to a lesser extent. There are also occasions when medical conditions cause mental health problems directly. For this reason doctors will always be involved in mental health to some degree and will use diagnostic constructs to describe these conditions as they are familiar with diagnosis in their medical practice. There are examples of clear biological abnormalities that are often detected accidentally that do not require treatment. Medically unexplained or functional symptoms/syndromes are commonly seen in general medicine, although the term ‘medically unexplained’ is contentious. Many diagnostic constructs—medical or psychiatric—involve complex polygenetic interactions with the environment.
{"title":"Biological factors and health","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0012","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0012","url":null,"abstract":"There is often a lack of identified causal biological mechanisms or biological differences of structure or process for many psychiatric diagnostic constructs. There is a lack of useful biomarkers common to all people who meet criteria for a psychiatric diagnostic construct that differentiates them from the healthy population. This can also be the case for general medical conditions for both aetiology and differences in structure or process and sometimes lack of useful biomarkers but this occurs to a lesser extent. There are also occasions when medical conditions cause mental health problems directly. For this reason doctors will always be involved in mental health to some degree and will use diagnostic constructs to describe these conditions as they are familiar with diagnosis in their medical practice. There are examples of clear biological abnormalities that are often detected accidentally that do not require treatment. Medically unexplained or functional symptoms/syndromes are commonly seen in general medicine, although the term ‘medically unexplained’ is contentious. Many diagnostic constructs—medical or psychiatric—involve complex polygenetic interactions with the environment.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131022593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1093/MED/9780198807254.003.0008
A. Huda
Reliability of a diagnosis can be measured as either agreement with a reference criterion or agreement between clinicians as to a diagnosis. Most psychiatric and some general medical diagnostic constructs are identified on the basis of a clinical picture, not using a reference criterion such as laboratory tests. Most psychiatric diagnostic constructs have moderate to substantial reliability in research studies. They are likely to be less reliable in clinical practice. Measures such as standardizing interviews can improve reliability. General medical diagnostic constructs have similar reliability to psychiatric diagnostic constructs in research studies and are also likely to be less reliable in clinical practice. Even with laboratory tests, some medical conditions are hard to distinguish due to similarities in their clinical pictures. For alternative mental health classifications, psychological formulation—except psychodynamic formulation—is less reliable than psychiatric diagnosis. Symptom-based classification has at least equal reliability to psychiatric diagnosis. Dimension-based classification has equivalent reliability to psychiatric diagnosis. These may be combined with diagnosis but may have less usefulness on their own for other functions, e.g. administrative.
{"title":"Reliability of diagnosis","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0008","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0008","url":null,"abstract":"Reliability of a diagnosis can be measured as either agreement with a reference criterion or agreement between clinicians as to a diagnosis. Most psychiatric and some general medical diagnostic constructs are identified on the basis of a clinical picture, not using a reference criterion such as laboratory tests. Most psychiatric diagnostic constructs have moderate to substantial reliability in research studies. They are likely to be less reliable in clinical practice. Measures such as standardizing interviews can improve reliability. General medical diagnostic constructs have similar reliability to psychiatric diagnostic constructs in research studies and are also likely to be less reliable in clinical practice. Even with laboratory tests, some medical conditions are hard to distinguish due to similarities in their clinical pictures. For alternative mental health classifications, psychological formulation—except psychodynamic formulation—is less reliable than psychiatric diagnosis. Symptom-based classification has at least equal reliability to psychiatric diagnosis. Dimension-based classification has equivalent reliability to psychiatric diagnosis. These may be combined with diagnosis but may have less usefulness on their own for other functions, e.g. administrative.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122539018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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