Sunday, August 05, 2012

Formulating psychiatric diagnosis

This post is prompted by a comment on a previous post suggesting that psychiatric diagnosis is unscientific and that formulation is a better alternative. I've nothing against formulation. As I indicated in a previous post, it's remarkable how a full assessment in psychiatry is too often seen as almost out-of-date. When I did my membership examination for the Royal College of Psychiatrists, I was asked what my formulation of a clinical case was. This was because it was recognised that assessment was about more than formal psychiatric diagnosis.

So, I do agree that formulation is better than unscientific psychiatric diagnosis that sees diagnosis as an entity or "thing" of some sort. But I have a wider understanding of diagnosis (see eg. my article). And I do see it as scientific to do a full assessment.

I recommend the book edited by Lucy Johnstone and Rudi Dallos on formulation on my book recommendations page. It's also worth looking at Lucy's Users and abusers of psychiatry  (see my review).


Sam Barnett-Cormack said...

I find myself curios, given how critical you are of DSM-III and DSM-IV (and I do not say you are wrong to be so), how you feel about any of the trends in DSM-V. As a patient, and a disability activist, I've been looking in on the public drafts from time to time, and there seem to be some moves away from the patterns you dislike, and moves further into it in other areas.

Much has been written, in many places, of the multiplication of diagnostic labels, and the possible motivations for this (such as the pharmaceutical industry). However, I have some personal interest in somatoform disorders, and the last draft I looked at was taking the step of removing pretty much all mention of the idea of psychogenic somatic symptoms. This removes aetiology, it is true, but it is an assumed aetiology.

Anonymous said...

I disagree - assessment [on the whole] is a means to no end other than diagnosis. Liaison assessments and Care Clusters are no better, in fact I'd say they're worse than ever with entrenched diagnostic stereotypes. It's really easy to be diagnosed in 5 mins flat on the basis of 4-5 questions and physical presentation. You wouldn't see anything as in depth like a Maastricht Interview being used by a CMHT which isn't about diagnosis but understanding. Lucy is very convincing on formulation and has written a book on the subject. We are a long way from describing and understanding in the patients own words within mental health care. As always it comes down to exceptional individuals not entire services