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Reivew Article

Clinical judgment in psychiatry. Requiem or reveille?

, M.D.
Pages 1-10 | Accepted 07 Jun 2012, Published online: 23 Jul 2012
 

Abstract

Background: There is increasing awareness of a crisis in psychiatric research and practice. Psychopathology and clinical judgment are often discarded as non-scientific and obsolete methods. Yet, in their everyday practice, psychiatrists use observation, description and classification, test explanatory hypotheses, and formulate clinical decisions. Aim: The aim of this review was to examine the clinical judgment in psychiatry, with special reference to clinimetrics, a domain concerned with the measurement of clinical phenomena that do not find room in customary taxonomy. Methods: A MEDLINE search from inception to August 2011 using the keywords “clinical judgment” and “clinimetric” in relation to psychiatric illness for articles in English language was performed. It was supplemented by a manual search of the literature. Choice of items was based on their established or potential incremental increase in clinical information compared with use of standard diagnostic criteria. The most representative examples were selected. Results: Research on clinical judgment has disclosed several innovative assessment strategies: the use of diagnostic transfer stations instead of diagnostic endpoints using repeated assessments, subtyping versus integration of different diagnostic categories, staging, macro-analysis, extension of clinical information beyond symptomatic features. Evidence-based medicine does not appear to provide an adequate scientific background for challenges of clinical practice in psychiatry and needs to be integrated with clinical judgment. Conclusions. A renewed interest in clinical judgment may yield substantial advances in clinical assessment and treatment. A different clinical psychiatry is available and can be practiced now.

Acknowledgements

This paper is based on a lecture delivered at the Annual Finnish Psychiatric Association meeting in Helsinki, 2011.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.

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