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Re: experts say...ditch schizophrenia label

Posted by alexandra_k on October 10, 2006, at 20:21:12

In reply to Re: experts say...ditch schizophrenia label alexandra_k, posted by Squiggles on October 10, 2006, at 16:18:05

Categorical vs Dimensional Approaches to Nosology

The DSM is categorical. There are a number of different categories (disorders) like 'Bi-Polar' and 'Schizophrenia' and 'Borderline Personality Disorder'. They are 'all or none' in the sense that one either has that condition (meets the criteria) or one does not.

It has been suggested that the DSM would be more useful for research and treatment if it moved from a categorical approach to a dimensional approach. There are different ways the dimensional approach could go. Here is one suggestion.

The symptoms that feature in the DSM could be listed. The clinician assesses whether the symptom is present in the individual, and notes (where appropriate) whether the symptom is mild or moderate or severe. This better reflects the notion that some symptoms are had by other members of the population, it is just the DEGREE that they are present that is problematic.

Currently... What tend to happen... Is that once someone has been given a categorical diagnosis clinician's have a tendency to ASSUME rather than ASSESS whether the person meets the other symptoms associated with the diagnosis or not. They call this 'a useful heuristic' but it is only useful if accurate and it is inaccurate more often than accurate because there is often more variation in symptoms between people of the same category than there is variation in symptoms between people of different categories.

One would be better able to assess progress over time. Whether symptoms lessen in severity or aren't present anymore. Whether new symptoms emerge.

If they did that for a while... They might start noticing that certain symptoms do occur clustered together. That would be a significant empirical finding. If we found that then the way would be paved to enumerate REAL diagnostic categories that carve nature at its joints and these diagnostic categories are much more likely to be useful for research and treatment purposes.

Medication seems to work on symptoms rather than diagnostic categories anyway. Instead of looking for the medication that helps the most people with schizophrenia they are likely to have more luck looking for the medication that helps the most people with a certain symptom like delusion.

The same is likely to go for neurology. The same is likely to go for genetics.

The possible downside is that if we listed all the symptoms that are present in the DSM and the clinician had to specifically consider all of them... How long would diagnosing take? I think it could be made manageable but... It is often said that even though the current approach suggests mental illness is all or none clinician's aren't so naieve. But whether or not this is the case the system is inadequate.

> I think therapy is always helpful, in
> comforting a person who falls into these
> strange states, in themselves frightening
> and difficult to cope with.

They have had fairly good success with treating delusions with CBT as well...

> These states are biological
> but the nomenclature makes them sound like a
> particular *cognitive* disease, when they may
> be biological diseases (e.g. endocrinological
> or physiological disorders)...

But therapy works precisely by making neurological / biological alterations in the brain...




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