Diagnostic Reasoning In Psychiatry Research Articles

Increasing the Role of Phenomenology in Psychiatric Diagnosis-The Clinical Staging Approach.

Recent editions of diagnostic manuals in psychiatry have focused on providing quick and efficient operationalized criteria. Notwithstanding the genuine value of these classifications, many psychiatrists have argued that the operationalization approach does not sufficiently accommodate the rich and complex domain of patients’ experiences that is crucial for clinical reasoning in psychiatry. How can we increase the role of phenomenology in the process of diagnostic reasoning in psychiatry? I argue that this could be done by adopting a clinical staging approach in diagnostic reasoning in psychiatry. The approach has the resources to include the progressive nature of patients’ experiences to a much greater degree than is currently practiced. It can address the recent plea for increasing the role of phenomenology in psychiatric diagnosis by offering a model for clinical reasoning that goes beyond the operationalized, static criteria of diagnostic manuals, without depriving us of their benefits.

Diagnostic Reasoning in Psychiatry: Acknowledging an Explicit Role for Intersubjective Knowing

Diagnostic Reasoning in Psychiatry: Acknowledging an Explicit Role for Intersubjective Knowing

Drill-Locate-Drill Algorithm for Diagnostic Reasoning in Psychiatry

This paper introduces a top-down algorithm for diagnosing psychiatric illnesses. It is based on the conceptualisation of diagnostic categories, diagnosis, and symptoms as a hierarchical model. The algorithm assumes that there exist a few close-ended clinical questions that can be used during clinical interview to rule in and rule out diagnostic categories, diagnoses and their symptoms. Compared to a more exhaustive bottom-up and recursive algorithm, which the authors have previously introduced, this algorithm has the advantage of being easy to implement requiring a less extensive knowledgebase. It is expected the algorithm will be used as a useful screening tool that increases the detection of psychiatric disorders, which are common but unfortunately currently under-diagnosed.

Improving the accuracy of clinical judgment.

Diagnostic reasoning in psychiatry is as intricate as it is risky (Elstein et al. 1978; Fitzhenry-Coor 1986; Fitzhenry-Coor and Nurcombe 1983; Gauron and Dickinson 1965; Sandifer et al. 1970; Kendell 1973; Nurcombe and Fitzhenry-Coor 1982). During the clinical encounter, the clinician elicits, notes, and verifies pertinent clinical cues. Early in the encounter, from an assembled but incomplete pattern of data, an array of diagnostic hypotheses is generated. Subsequently, in the light of evidence systematically gathered, each diagnostic possibility is progressively refined or deleted until the diagnostic conclusion is reached. The validity of the clinical endeavor, thus, depends upon the pertinence of the hypotheses generated, for it is upon them that deductive reasoning will hinge. It also depends upon the reliability of the history, signs, and investigations that constitute the evidence gathered for or against each of the hypotheses. The purpose of this paper is to propose systematic strategies based on principles of probability and empirical research, with the aim of sharpening clinical reasoning.