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Chapter 2 - Assessment, Formulation and Diagnosis

Published online by Cambridge University Press:  04 April 2024

By
David Kingdon ,
George Stein  and
Paul Rowlands
Edited by
David Kingdon ,
Paul Rowlands  and
George Stein
David Kingdon
Affiliation:
University of Southampton
Paul Rowlands
Affiliation:
Derbyshire Healthcare NHS foundation Trust
George Stein
Affiliation:
Emeritus of the Princess Royal University Hospital
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Summary

Collaborative psychiatric management is founded on a person-centred, holistic assessment leading to a diagnostic formulation that guides decision making. Formulation around the individual person, including their unique history and worldview, can be described with presenting, precipitating, predisposing, perpetuating and protective factors as well as the life context for the individual patient. Allied with this, diagnosis – in which the patient’s unique presentation can be evaluated as sharing characteristics and patterns with other patients – can allow for the individual plan to be guided by a wider frame of reference and knowledge. Such diagnostic frameworks have been developed over millennia and across cultures. As well as being important for individual patient care, they are essential for research and service planning. The development of these diagnostic frameworks is discussed with particular reference to the main international classifications of ICD-11 and DSM-5. It is common for people to have more than one diagnosis, and diagnostic hierarchies are considered. Criticisms of the construct of psychiatric diagnosis are reviewed, and an approach to conducting and describing collaborative psychiatric assessment is described.

Keywords

assessmentdiagnosisformulationholisticcollaborativeperson-centred
Type
Chapter
Information
Seminars in General Adult Psychiatry , pp. 30 - 63
Publisher: Cambridge University Press
Print publication year: 2024

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References

Tuke, DH. A Dictionary of Psychological Medicine: Giving the Definition, Etymology and Synonyms of the Terms Used in Medical Psychology with the Symptoms, Treatment, and Pathology of Insanity and the Law of Lunacy in Great Britain and Ireland. Philadelphia: Blakiston; 1892.Google Scholar
Jaspers, K. General Psychopathology (trans. Hoenig, J and Hamilton, MW 1963). Manchester: Manchester University Press; 1959:826.Google Scholar
Scadding, JG. Diagnosis: the clinician and the computer. Lancet 1967;2(7521):877–82.Google ScholarPubMed
Mindham, RH, Scadding, JG, Cawley, RH. Diagnoses are not diseases. British Journal of Psychiatry 1992;161:686–91.CrossRefGoogle Scholar
Linnaeus, C. Systema naturae. Leiden; 1735.Google Scholar
Linnaeus, C. Genera morborum. Upsaliae: CE Steiner; 1763.Google Scholar
de Sauvages, FB. Nosologie metodique, dans la quelle les maladies sont rangées par classes, suivant le systême de Sydenham & l’ordre des botanistes. Tome second. chez Hérissant, le Fils; 1771.Google Scholar
Cullen, W. Synopsis nosologiae methodicae, exhibens clariss. virorum Sauvagesii, Linnaei, Vogelii, Sagari, et Macbridii systemata nosologica. Sumptibus Joannis Antonii Pezzana; 1787.Google Scholar
Shorter, E. The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders. Dialogues in Clinical Neuroscience 2015;17(1):59–67.CrossRefGoogle ScholarPubMed
Kendler, KS. Toward a scientific psychiatric nosology: strengths and limitations. Archives of General Psychiatry 1990;47(10):969–73.CrossRefGoogle Scholar
Stengel, E. Classification of mental disorders. Bulletin of the World Health Organization 1959;21(4–5):601.Google ScholarPubMed
Morel, B. Traitsé des Maladies Mentales. American Journal of Psychiatry 1860;17(2):199–211.CrossRefGoogle Scholar
Bucknill, JC, Tuke, DH. A Manual of Psychological Medicine, Containing the Lunacy Laws: the Nosology, Aetiology, Statistics, Description, Diagnosis, Pathology, and Treatment of Insanity, with an Appendix of Cases. Philadelphia: Lindsay and Blakiston; 1879.Google Scholar
Griesinger, W. Mental Pathology and Therapeutics. London: New Sydenham Society; 1845.Google Scholar
Jaspers, K. General Psychopathology (trans. Hoenig, J and Hamilton, MW 1963). Manchester: Manchester University Press; 1959.Google Scholar
Kraepelin, E. Psychiatrie: Рипол Классик. Leipzig: Verlag Von Johan Ambrosius Barth; 1927.Google Scholar
Kraepelin, E. Dementia Praecox and Paraphrenia (trans. Barclay, RM and Robertson, GM). Edinburgh: Livingstone; 1919.Google Scholar
Jablensky, A. The 100-year epidemiology of schizophrenia. Schizophrenia Research 1997;28(2–3):111–25.CrossRefGoogle ScholarPubMed
Bleuler, E. Textbook of Psychiatry (trans. Brill, AA). New York: Macmillan; 1951.Google Scholar
Ohler, N. Blitzed: Drugs in Nazi Germany. London: Penguin; 2016.Google Scholar
Healy, D. The Creation of Psychopharmacology. Harvard: Harvard University Press; 2002.CrossRefGoogle Scholar
Kramer, M. Some problems for international research suggested by observations as differences in first admission rates to mental hospitals of England & Wales, and of the United States. Proceedings of the Third World Congress of Psychiatry 1961;3:153–60.Google Scholar
Kendell, RE, Cooper, JE, Gourlay, AJ, et al. Diagnostic criteria of American and British psychiatrists. Archives of General Psychiatry 1971;25(2):123–30.CrossRefGoogle ScholarPubMed
Wing, JK. The use of the Present State Examination in general population surveys. Acta Psychiatrica Scandinavica 1980;62:230–40.CrossRefGoogle Scholar
World Health Organization. Report of the International Pilot Study of Schizophrenia: Geneva: World Health Organization; 1973.Google Scholar
Bridgman, PW. The Logic of Modern Physics. New York: Macmillan; 1927.Google Scholar
Hempel, CG. Paper delivered by Carl G. Hempel. Morning Session: Introduction to Problems of Taxonomy. Field Studies in the Mental Disorders: Proceedings of the Work Conference on Problems in Field Studies in the Mental Disorders, February 15–19, 1959, under the Auspices of the American Psychopathological Association. Grune & Stratton; 1961.Google Scholar
Feighner, JP, Robins, E, Guze, SB, et al. Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 1972;26(1):57–63.CrossRefGoogle ScholarPubMed
Spitzer, RL, Endicott, J, Robins, E. Research diagnostic criteria: Rationale and reliability. Archives of General Psychiatry 1978;35(6):773–82.CrossRefGoogle ScholarPubMed
Virchow, R. Über die culturgeschichtliche Stellung des Kaukasus: unter besonderer Berücksichtigung der ornamentirten Bronzegürtel aus transkaukasischen Gräbern. Königl: Academie der Wissenschaften; 1895.Google Scholar
Bolton, D, Gillet, G. The Biopsychosocial Model of Health and Disease. London: Palgrave Macmillan; 2019.CrossRefGoogle ScholarPubMed
Kendell, RE. The Role of Diagnosis in Psychiatry. Oxford: Blackwell Scientific; 1975.Google Scholar
Kräupl, Taylor F. The Concepts of Disease, Illness and Morbus. Cambridge: Cambridge University Press; 1979.Google Scholar
Royal College of Psychiatrists. Core Values for Psychiatrists CR204. London: Royal College of Psychiatrists; 2017.Google Scholar
Szasz, TS. The Myth of Mental Illness. New York: Harper & Row; 1961.Google Scholar
Bloch, S. Delusions of reformism – Dissent or madness? World Medical Journal 1979;26(3):36–8.Google ScholarPubMed
Szasz, T. The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement. Syracuse: Syracuse University Press; 1997.Google Scholar
Foucault, M. Madness and Civilization: A History of Insanity in the Age of Reason (trans. Howard, R). New York: Vintage; 1965.Google Scholar
Horwitz, A. DSM: A History of Psychiatry’s Bible. Baltimore: Johns Hopkins University Press; 2021.CrossRefGoogle Scholar
Shorter, E. The Rise and Fall of the Age of Psychopharmacology. New York: Oxford University Press; 2021.CrossRefGoogle Scholar
Moncrieff, J, Cooper, RE, Stockmann, T, et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry 2022;20. doi.org/10.1038/s41380-022-01661-0.Google Scholar
Laing, RD, Esterson, A. Sanity, Madness and the Family. Vol. 1, Families of Schizophrenics. London: Tavistock; 1964.Google Scholar
Clare, A. Psychiatry in Dissent: Controversial Issues in Thought and Practice, 2nd ed. London: Routledge; 2012.CrossRefGoogle Scholar
Mezzich, JE, Kirmayer, LJ, Kleinman, A, et al. The place of culture in DSM-IV. Journal of Nervous and Mental Disease 1999;187(8):457–64.CrossRefGoogle ScholarPubMed
Mezzich, JE, Caracci, G, Fabrega, H, et al. Cultural formulation guidelines. Transcultural Psychiatry 2009;46(3):383–405.CrossRefGoogle ScholarPubMed
World Health Organisation. Fact Files. www.who.int/news-room/facts-in-pictures/detail/mental-health (accessed May 2014).Google Scholar
World Health Organisation. Investing in Mental Health. Geneva: WHO; 2013.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association; 2013.Google Scholar
Kingdon, D, Taylor, L, Ma, K, et al. Changing name: changing prospects for psychosis. Epidemiology and Psychiatric Sciences 2013;22(4):297–301.CrossRefGoogle ScholarPubMed
Kingdon, D. DSPD or ‘don’t stigmatise people in distress’. Advances in Psychiatric Treatment 2007;13(5):333–5.Google Scholar
Jablensky, A, Kendell, R. Criteria for assessing a classification in psychiatry. In: Maj, M, Gaebel, W, López-Ibor, J, et al. (eds.) Psychiatric diagnosis and classification. West Sussex: John Wiley and Sons Ltd.; 2002: 1–24.Google Scholar
Johnstone, L. Psychological formulation as an alternative to psychiatric diagnosis. Journal of Humanistic Psychology 2018;58(1):30–46.CrossRefGoogle Scholar
Bolton, D, Gillet, G. The Biopsychosocial Model of Health and Disease. Switzerland: Palgrave Macmillan; 2019.CrossRefGoogle ScholarPubMed
Kirby, G. Guide for History Taking and Clinical Examination of Psychiatric Cases. Albany: New York State Hospital Commission; 1921.Google Scholar
World Health Organization. ICD-11: International classification of diseases (11th revision). Geneva: World Health Organization, 2019.Google Scholar
Farr, W. Letter to the registrar general. First Annual Report of the Registrar General; 1839.Google Scholar
d’Espine, M. Essai analytique et critique de statistique mortuaire compare. Geneva: Cherbuliez & Leidecker; 1858.Google Scholar
American Public Health Association. The Bertillon Classification of Causes of Death. Lansing: R. Smith Print Company; 1890.Google Scholar
War Department. Nomenclature of psychiatric disorders and reactions: War Department Technical Bulletin, Medical 203. Journal of Clinical Psychology 1946;2:289–96.Google Scholar
Chodoff, P. Psychiatric Diagnosis: A 60-Year Perspective. psychnews.psychiatryonline.org/doi/full/10.1176/pn.40.11.00400017a (accessed 20 March 2023).Google Scholar
Fulford, B. Karl Jaspers and General Psychopathology. In: Fulford, B, Thornton, T, Graham, G (eds.) Oxford Textbook of Philosophy and Psychiatry. Oxford: Oxford University Press; 2006: 160–79.CrossRefGoogle Scholar
Meyer, A. Psychobiology; a Science of Man. Oxford, England: Charles C Thomas; 1957.Google Scholar
Fish, FJ. Fish’s Clinical Psychopathology: Signs and Symptoms in Psychiatry. Bristol: John Wright; 1985.Google Scholar
Mayer-Gross, W, Slater, E, Roth, M (eds.). Clinical Psychiatry, 3rd ed. London: Williams and Wilkins; 1969.Google Scholar
Ewing, JA. Detecting alcoholism: the CAGE questionnaire. Jama 1984;252(14):1905–07.CrossRefGoogle ScholarPubMed
David, A, Buchanan, A, Reed, A, et al. The assessment of insight in psychosis. British Journal of Psychiatry 1992;161(5):599–602.CrossRefGoogle ScholarPubMed
Healthcare Safety Investigation Branch (HSIB). Care Delivery within Community Mental Health Teams. www.hsib.org.uk/investigations-and-reports/care-delivery-within-community-mental-health-teams/care-delivery-within-community-mental-health-teams/ (accessed 25 March 2023).Google Scholar
Sanati, A. Matthew Large. BJPsych Bulletin 2021;45(3):190–2.CrossRefGoogle ScholarPubMed
McHugh, CM, Corderoy, A, Ryan, CJ, et al. Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value. BJPsych Open 2019;5(2):e18.CrossRefGoogle ScholarPubMed
Academy of Medical Royal Colleges. Please, Write to Me: Writing Outpatient Clinic Letters to Patients. London: Academy of Medical Royal Colleges; 2018.Google Scholar
James, G. Report of the Independent Inquiry into the Issues Raised by Paterson. London: Government of the United Kingdom; 2020.Google Scholar
Royal College of Psychiatrists. Writing Clinic letters: College Guidance on Improving Engagement with Patients. London: Royal College of Psychiatrists; 2021.Google Scholar
Health Education England. Multi-professional Framework for Advanced Clinical Practice in England. www.hee.nhs.uk/sites/default/files/documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf (accessed 5 March 2023).Google Scholar
Department of Health. New Ways of Working for Psychiatrists: Enhancing Effective, Person-Centred Services through New Ways of Working in Multidisciplinary and Multiagency Contexts. London: Department of Health; 2005.Google Scholar

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