2,418
Views
42
CrossRef citations to date
0
Altmetric
Original Article

Are psychiatric diagnoses of psychosis scientific and useful? The case of schizophrenia

Pages 305-317 | Published online: 16 Jul 2010
 

Abstract

Background: Insurance systems, scientific journals, professional groups, educational initiatives, regulatory bodies and organisation of services appear to be fixed in 19th century diagnostic metaphors for psychosis, providing natural protection against change. Furthermore, the existence of two separate diagnostic systems in psychiatry, DSM and ICD, produces a bias that is conservative rather than anti-conservative, reducing the probability of non-cosmetic change.

Methods: A qualitative review of the validity, usefulness and acceptability of the diagnosis of ‘schizophrenia’, in order to assess possible discrepancies between actual diagnostic practice in mental health services and alternatives dictated by scientific evidence and societal developments.

Results: A 21st century concept of psychotic disorder should refer to an experience that can be understood as a variation of normal human mentation that can be expressed quantitatively. For the purpose of diagnosis, use can be made of scientific evidence of specificity yielding high diagnostic likelihood ratios rather than evidence of weak mean differences yielding low diagnostic likelihood ratios. In the case of psychosis, the evidence appears to favour a syndromal system of classification combining categorical and dimensional representations. The concept of ‘salience’ has the potential to make the public recognise psychosis as relating to an aspect of human mentation and experience that is universal.

Conclusions: The debate about alternatives to diagnose expressions of psychosis is often misunderstood as a misguided attempt to change societal stigma. In reality, however, it is about reduction of iatrogenic stigma occasioned by the use of unscientific and mystifying terminology. Scientific and societal developments have largely caught up with diagnostic traditions applied to psychosis phenotypes and although the traditional diagnostic system is deeply ingrained in all aspects of clinical and academic activities, change is possible if professional bodies actively promote a modern system of evidence-based diagnostic practice.

Acknowledgements

The author is a member of the APA DSM-V Psychotic Disorders Work Group. The views expressed are his own. Parts of this article appeared previously in the British Journal of Psychiatry (refer: van Os, Citation2009a) and Acta Psychiatrica Scandinavica (refer van Os, Citation2009b).

Log in via your institution

Log in to Taylor & Francis Online

PDF download + Online access

  • 48 hours access to article PDF & online version
  • Article PDF can be downloaded
  • Article PDF can be printed
USD 53.00 Add to cart

Issue Purchase

  • 30 days online access to complete issue
  • Article PDFs can be downloaded
  • Article PDFs can be printed
USD 989.00 Add to cart

* Local tax will be added as applicable
 

Related Research

People also read lists articles that other readers of this article have read.

Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine.

Cited by lists all citing articles based on Crossref citations.
Articles with the Crossref icon will open in a new tab.