Measuring Psychopathology is a much more informative and intelligent, and also risky, title for this interesting publication than ‘the use of measuring instruments in psychiatry’ would have been, and it boldly begs the question: can psychopathology be measured? The authors make a good case, which carries the reader most of the way, for a positive answer. It is thorough, practical and rewards careful reading.
Having defined what psychopathology is, the need for its classification and measurement, and discussed the concept of disease, there is an account of symptoms and signs in psychiatry, covering all areas of the mental state examination. There is also a useful glimpse at developmental psychopathology.
The chapter on classifications and operational definitions in psychiatry is clear, and there are comments on validity, reliability and the selection of appropriate measuring scales. An excellent and enlightening chapter traces a secure path through the quagmire of diagnostic interviews. This is followed by a brief account of poly-diagnostic approaches, computerised methods and best-estimate diagnoses which gives the reader some help in knowing what these techniques can provide.
Rating scales and questionnaires are covered with clarity and accurate descriptions. In particular, the range of use in different clinical circumstances such as primary care or medically ill subjects is helpful, although I would have welcomed a little more dogmatism from the authors here – which scales are good to use and which are rubbish? The account of measurements in different subject groups, such as children and adolescents, those with learning disabilities, after childbirth, for cognitive decline in the elderly and those manifesting alcohol and other substance misuse, is informative.
There is a clear chapter on measurement of personality and personality disorder. This is a controversial and highly topical subject, and it benefits from the authors’ objective, non-combative style. They combine psychological and psychiatric approaches (necessarily different) admirably.
The concluding chapter is on psychopathology in the 21st century. This stimulated me into pondering whether the time has come for general practitioners to give a certificate ‘off work owing to stress’, only after administering a standardised instrument. Should the psychiatrist giving or recommending cognitive–behavioural therapy for depressive symptoms routinely carry out a quantified assessment first? Is there greater scope for measurement in medico-legal reports to demonstrate the presence of psychiatric disorder? I am doubtful whether these questions should yet receive a positive answer. The interpretation of results will remain crucial.
Measuring Psychopathology will enhance the practice of the up-to-date psychiatrist. When the book goes to reprint, which it certainly deserves, I hope that the large number of irritating typographical errors will be eliminated. Apart from this, anankastic criticism, the book is highly recommended.
eLetters
No eLetters have been published for this article.