Descriptive Psychopathology: The Signs and Symptoms of ...

19 Chapter 1: Beyond the DSM and ICDcircumstances and may elicit poor reliability for several categories in the typicalclinical setting. The validity of many categories is weak. Sole reliance on DSMcriteria and ICD brief descriptions leads to unacceptable false negative and falsepositive misdiagnoses and the overuse of the NOS category. Much discriminatingpsychopathology is not included in the classification, nor are recognized neurologicsyndromes that are commonly seen in patients seeking help at psychiatricservices. The result is that many patients are ill-served.NOTES1 Trimble (2002).2 Mezzich (2002).3 Sartorius et al. (1993, 1995).4 Panzarino (2000); Doctor Taylor has been teaching psychiatry residents since 1969, DoctorVaidya since 1989.5 Hiller et al. (1994a,b); Slade and Andrews (2001); Peralta and Cuesta (2003a); Sorensenet al. (2005).6APA,(1996, 1997).7 See the STAR-D (Rush et al., 2006) “one size fits all” approach to the treatment ofdepressive illness and its report of results only marginally better than placebo (30%remitted in the first drug trial and an additional 18–25% in the second). Also see thetreatment algorithms offered for manic-depressive illness (Nierenberg et al., 2006) andpsychosis (Schneider et al., 2001).8 Many of the DSM syndrome choices have sub-syndrome modifiers bringing the total toover 350 diagnostic options.9 Paul McHugh: Overestimating mental illness in America, in A Nation of Crazy People?The Weekly Standard, Volume 10, Issue 39, 27 June 2005.10 Taylor and Vaidya (2005).11 In contrast, residency programs in the 1960s stressed the recognition of psychopathology.In the first year of residency (following a general internship) one of us (MAT) had a weekly90-min seminar in descriptive psychopathology that ran for 10 months. This course wasseparate from other seminars in psychopathology.12 Bleuler’s Dementia Praecox (17.6%), Kraepelin’s Manic-Depressive Illness (19.1%), Schneider’sClinical Psychopathology (17.6%); four programs (5.9%) used Jasper’s General Psychopathology.One program each used Kahlbaum’s Catatonia and Fish’s Schizophrenia.13 Macaskill et al. (1991).14 Also see Wakefield (1997).15 Reliability was expressed as a kappa statistic which corrects for chance agreement. Kappa isthe proportion of agreement above or below chance. Zero is only agreement by chance.One is perfect agreement, while 0.50 is agreement half-way between chance and perfectagreement. A kappa of 0.7 is considered “good”.