Psychiatric Diagnosis and Classification - ResearchGate

2 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
neuroscience and genetics are setting new, interdisciplinary agendas for
psychiatric research and the results to be expected within the next few
decades are likely to affect profoundly the theoretical basis of psychiatry,
in particular the understanding of the nature and causation of mental
disorders. New treatments targeting specific functional systems in the
brain will require more refined definitions of the clinical populations likely
to benefit from them than is possible at present. Even more importantly, the
realization that, in all societies, mental disorders contribute a much larger
burden of disease than previously assumed [5] will raise critical questions
about cost-benefit, equity, right to treatment, and feasibility of prevention.
The conjunction of these powerful factors is likely to have major implications
for the future of psychiatric classification as a conceptual scaffold of
the discipline. There is little doubt that the classification of mental disorders
will undergo changes whose direction and extent are at present difficult to
predict. Although the prevailing view is that an overhaul of the existing
classification systems will only be warranted when an accumulated ``critical
mass'' of new knowledge makes change imperative, processes aiming at
revisions are already under way and the debates about the future shape of
DSM and ICD are gathering momentum. In the light of this, a discussion of
the basic principles and ``rules of the game'' should be timely. Of course, the
complexity of the subject makes it unlikely that any sort of quality assessment
checklist will soon emerge and become generally accepted in reviewing
new proposals. Nevertheless, a step in that direction is needed if further
progress in consolidating the scientific base of the discipline is to be
achieved.
GENERAL FEATURES OF CLASSIFICATIONS
To clear the ground, we review briefly certain terms and concepts relevant
to the subsequent discussion of specific aspects of classification in psychiatry.
Why Do We Wish To Classify Purposes and Functions of
Classifications
The term classification denotes ``the activity of ordering or arrangement of
objects into groups or sets on the basis of their relationships'' [6]; in other
words, it is the process of synthesizing categories out of the raw material of
sensory data. Modern cognitive science is echoing Kant: ``the spontaneity of
our thought requires that what is manifold in the pure intuition should first
be in a certain way examined, received and connected, in order to produce