Psychiatric Diagnosis and Classification - ResearchGate

Psychiatric Diagnosis and Classification. Edited by Mario Maj, Wolfgang Gaebel, Juan Jose LoÂpez-Ibor and Norman Sartorius
Copyright # 2002, John Wiley & Sons, Ltd. ISBNs: 0±471±49681±2 Hardback); 0±470±84647±X Electronic)
Preface
The next editions of the two main systems for the diagnosis and classification
of mental disorders, the ICD and the DSM, are not expected before the
year 2010. The most frequently alleged reasons for this long interval are: 1)
the satisfaction with the performance of the systems as they are now, since
they are achieving their goals of improving communication among clinicians
and ensuring comparability of research findings; 2) the concern that
frequent revisions of diagnostic systems may undermine their assimilation
by clinicians, damage the credibility of our discipline, and hamper the
progress of research by making the comparison between old and new
data more difficult, impeding the collection of large patient samples, and
requiring a ceaseless update of diagnostic interviews and algorithms); 3)
the presentiment that we are on the eve of major research breakthroughs,
which may have a significant impact on nosology. There is a further reason,
however, for the current hesitation to produce a new edition of the above
diagnostic systems, which is seldom made explicit, but is probably not the
least important: i.e. the gradually spreading perception that there may have
been something incorrect in the assumptions put forward by the neo-Kraepelinian
movement at the beginning of the 1970s, which have guided the
development of the modern generation of diagnostic systems.
That current diagnostic categories really correspond to discrete natural
disease entities is appearing now more and more questionable. Psychiatric
``comorbidity'', i.e. the coexistence of two or more psychiatric diagnoses in
the same individual, seems today the rule rather than the exception. Thirty
years of biological research have not been able to identify a specific marker
for any of the current diagnostic categories and genetic research is now
providing evidence for the possible existence of vulnerability loci which are
common to schizophrenia and bipolar disorder). Also the therapeutic profile
of newly developed psychotropic drugs clearly crosses old and new
diagnostic boundaries e.g. new generation antipsychotics appear to be as
effective in schizophrenia and in bipolar disorder, and new generation
antidepressants are effective in all the various disorders identified by current
classification systems in the old realm of neuroses).
The fact that current diagnostic categories are unlikely to correspond to
discrete natural disease entities has been taken as evidence that the neo-
Kraepelinian or neo-Pinelian) model was intrinsically faulty, i.e. that psychopathology
does not consist of discrete disease entities. This has been