The WPA Institutional Program on Psychiatry for the Person: from Clinical Care to Public Health (IPPP), ap- proved by the 2005 General Assembly, involves a WPA ini- tiative affirming the whole person of the patient in context as the... more
The WPA Institutional Program on Psychiatry for the Person: from Clinical Care to Public Health (IPPP), ap- proved by the 2005 General Assembly, involves a WPA ini- tiative affirming the whole person of the patient in context as the center and goal of clinical care and health promo- tion, at both individual and community levels. This in- volves the articulation
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The causes of wellbeing and illbeing interact with feedback dynamics resulting in the same set of traits giving rise to a variety of health outcomes (multi-finality) and different traits giving rise to the same health outcome... more
The causes of wellbeing and illbeing interact with feedback dynamics resulting in the same set of traits giving rise to a variety of health outcomes (multi-finality) and different traits giving rise to the same health outcome (equi-finality). As a result, a full understanding of health and its disorders must be in terms of a complex adaptive system of causes, rather than in terms of categorical diagnoses or sets of symptoms. The three domains of person-centered integrative diagnosis (PID) are considered here as interacting components of a complex adaptive system comprised of health status (functioning/wellness versus disability/disorder), experience of health (self-awareness/fulfillment versus misunderstanding/suffering) and contributors to health (protective versus risk factors). The PID domains thereby allow healthcare and health promotion to be understood in terms of measurable components of a complex adaptive system. Three major concepts of health are examined in detail to ident...
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Declarations are relevant tools to frame new areas in health care, to raise awareness and to facilitate knowledge-to-action. The International College on Person Centered Medicine (ICPCM) is seeking to extend the impact of the ICPCM... more
Declarations are relevant tools to frame new areas in health care, to raise awareness and to facilitate knowledge-to-action. The International College on Person Centered Medicine (ICPCM) is seeking to extend the impact of the ICPCM Conference Series by producing a declaration on every main topic. The aim of this paper is to describe the development of the 2013 Geneva Declaration on Person-centered Health Research and to provide additional information on the research priority areas identified during this iterative process. There is a need for more PCM research and for the incorporation of the PCM approach into general health research. Main areas of research focus include: Conceptual, terminological, and ontological issues; research to enhance the empirical evidence of PCM main components such as PCM informed clinical communication; PCM-based diagnostic models; person-centered care and interventions; and people-centered care, research on training and curriculum development. Disseminat...
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Global inequalities contribute to marked disparities in health and wellness of human populations. Many opportunities now exist to provide health care to all people in a person- and people-centered way that is effective, equitable, and... more
Global inequalities contribute to marked disparities in health and wellness of human populations. Many opportunities now exist to provide health care to all people in a person- and people-centered way that is effective, equitable, and sustainable. We review these opportunities and the scientific, historical, and philosophical considerations that form the basis for the International College of Person-centered Medicine's 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. Using consistent time-series data, we critically examine examples of universal healthcare systems in Chile, Spain, and Cuba. In a person-centered approach to public health, people are recognized to have intrinsic dignity and are treated with respect to encourage their developing health and happiness. A person-centered approach supports the freedom and the responsibility to develop one's life in ways that are personally meaningful and that are respectful of others and the env...
Research Interests: Health inequality, Philosophy of Medicine, Health Inequalities, Global Health, Public Health, and 10 moreGlobal Health Policy, Global Public Health, Global Health and Higher Education Policy, Person centered care, Health care inequalities, Person centered approach, International health, World Health Organization, International Health, and Person Centered Medicine
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... Copyright World Psychiatric Association. News from the WPA Secretariat. JOHN COX 1. 1 WPA Secretary General. Other Sections▼: The institutional ... to be further extended by our helpful hosts (Geneva University Hospitals) to include... more
... Copyright World Psychiatric Association. News from the WPA Secretariat. JOHN COX 1. 1 WPA Secretary General. Other Sections▼: The institutional ... to be further extended by our helpful hosts (Geneva University Hospitals) to include an additional office, cloakroom and kitchenette ...
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The multiaxial diagnostic model, consisting in the systematic formulation of a patient's condition according to separate clinical variables of aspects, is receiving increasing attention in several parts of the world. This... more
The multiaxial diagnostic model, consisting in the systematic formulation of a patient's condition according to separate clinical variables of aspects, is receiving increasing attention in several parts of the world. This innovative model promises to improve diagnostic reliability and validity and involves many methodological challenges. This paper reviews patterns and issues in the conceptualization of axial content, number and organization of axes, dimensional versus categorical scaling, and evaluation and further development of multiaxial systems.
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A large sample of adolescents brought for psychiatric evaluation to a public University based facility are the subjects of the study. Material incorporated in a DSM-III multiaxial formulation plus symptoms constituted the dependent... more
A large sample of adolescents brought for psychiatric evaluation to a public University based facility are the subjects of the study. Material incorporated in a DSM-III multiaxial formulation plus symptoms constituted the dependent variables. Analyses concentrated on ethnic differences, with variation associated with gender and social class controlled statistically. Caucasians showed comparatively greater clinical morbidity: higher number of Axis I definite diagnoses and level of symptoms. Eating disorder diagnoses were more common in Caucasians. There were no significant differences pertaining to level of stress or social impairment. Blacks showed higher levels of symptoms scored as "social aggression" and diagnosed as conduct disorders. The pattern of results raised the question of a possible referral bias, with blacks shunted to the psychiatric facility with lower levels of standard clinical psychopathology, but higher levels of social oppositional behavior. Further research is needed to verify if such a bias does exist.
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In the present study, the effectiveness and utility of DSM-III axis III in terms of adequate identification of physical disorders in psychiatric outpatients is appraised empirically. To this effect, the presence of physical disorders in... more
In the present study, the effectiveness and utility of DSM-III axis III in terms of adequate identification of physical disorders in psychiatric outpatients is appraised empirically. To this effect, the presence of physical disorders in diagnostic statements recorded in clinical charts is compared in a large medical center for two psychiatric outpatient samples, one from the nonmultiaxial DSM-II era and one after the implementation of the multiaxial DSM-III. In the earlier sample, 11% of the patients were diagnosed as having physical disorders. In the DSM-III sample, 42% of the patients were so diagnosed. The latter figure is consistent with the 40% average prevalence of physical disorders reported in careful studies of the physical condition of ambulatory psychiatric patients.
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A review of the literature on the comprehensive description of depressive patients revealed prominent concern with syndromic subtypes, course of illness, and personality factors, followed by severity, concomitant physical disorders,... more
A review of the literature on the comprehensive description of depressive patients revealed prominent concern with syndromic subtypes, course of illness, and personality factors, followed by severity, concomitant physical disorders, psychosocial stressors, and adaptive functioning. The descriptive value of multiaxial approaches for depression was illustrated through the application of an extended DSM-III formulation to all 3455 depressive (bipolar depression, major depression, dysthymic disorder, and atypical depression) and 7837 nondepressive patients of all ages and sexes presenting for evaluation and care at the Psychiatric Institute of the University of Pittsburgh during a period of 53 months. Twenty-six percent of the depressive patients received an additional diagnosis in axis I, the most frequent of which were substance use disorder, anxiety disorder, and condition not attributable to a mental disorder. In axis II, depressive patients presented a differentially higher frequency of dependent personality disorder and the "anxious/fearful" cluster of personality disorders. In axis III, 47% of the depressive vs. 40% of the nondepressive patients had a positive diagnosis of physical illness, with a significantly higher frequency among depressive patients attained by acquired hypothyroidism, migraine, essential hypertension, unspecified abdominal hernia, and unspecified arthropathies. Specific stressors differentially more frequent among depressive patients were those of conjugal, parenting, and occupational types and those reflecting the impact of physical illness. Overall stressor severity was at severe, extreme, or catastrophic levels for 42% of the depressive and 31% of the nondepressive patients. The highest level of adaptive functioning in the past year was good, very good, or superior for 44% of the depressive and 29% of the nondepressive patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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There are five categories of psychiatric disorders in DSM-III that embrace depressive moods: adjustment disorder with depressed mood (group 1), bipolar depression (group 2), major depression (group 3), dysthymic disorder (group 4), and... more
There are five categories of psychiatric disorders in DSM-III that embrace depressive moods: adjustment disorder with depressed mood (group 1), bipolar depression (group 2), major depression (group 3), dysthymic disorder (group 4), and atypical depression (group 5). A large sample of patients seen in a metropolitan university psychiatric referral center, with these categories as primary diagnoses in axis I, constitute the subjects studied (N = 2988). The study includes a comparison of the cross-sectional clinical properties of these patients, including an inventory of psychopathological symptoms, entries in axes II to V (i.e., as described in DSM-III, plus a sixth axis measuring current adjustment) and immediate dispositions rendered by clinicians. This study addresses the descriptive validity of DSM-III diagnostic categories of depression. A clustering of depressions based on a continuum of severity is uncovered as well as unique features of certain subtypes that point to categorical aspects of DSM-III mood disorders. The nature and implication of these findings are discussed.
Research Interests: Psychology, Cognitive Science, Psychometrics, Bipolar Disorder, Personality Disorders, and 14 moreHumans, Hospitalization, Female, Male, Depressive Disorder, Differential Diagnosis, Social Adjustment, Clinical Sciences, Middle Aged, Adult, Nervous, Adjustment Disorders, Ambulatory Care, and Psychiatric Status Rating Scales
This paper reports on the predictive validity of the physical disorders axis (axis III) of the DSM multiaxial diagnostic system at 3-year follow-up. A total of 515 general psychiatric patients were assessed with a semistructured procedure... more
This paper reports on the predictive validity of the physical disorders axis (axis III) of the DSM multiaxial diagnostic system at 3-year follow-up. A total of 515 general psychiatric patients were assessed with a semistructured procedure that covers all DSM-III diagnoses and axes, and were subsequently followed up for 3 years. Outcome was assessed with several measures of adaptive functioning. Baseline axis III was analyzed according to a) presence of any physical disorder, b) the number of these, c) presence of major chronic physical disorders (MCPD), and d) the number of these. Prediction of impairment in functioning (Strauss-Carpenter Scale), derived from baseline axis III, ranged from a correlation coefficient of .18 when expressed as the presence of any physical disorder to .35 when represented by the number of MCPD. Furthermore, within patients with specific psychiatric disorders, it was found that number of MCPD reached a predictive validity of .55 for patients with dysthymic disorders, .44 for those with anxiety disorders, and .41 for those with major depression. Comparative multiple regression analyses, controlling for demographic and clinical variables, showed that the number of MCPD at baseline was the most important predictor of functioning outcome among patients with dysthymic disorders and major depression. The number of MCPD experienced by general psychiatric patients seems to be an important predictor of future functioning, particularly for patients with certain psychiatric disorders. This points out the importance of considering the relationship between psychiatric and MCPD when conducting systematic clinical assessments towards the prediction of course and outcome.
Research Interests: Psychology, Cognitive Science, Psychometrics, Depression, Prediction, and 19 moreAdolescent, Comorbidity, Probability, Humans, Chronic Disease, Female, Predictive Validity, Male, Regression Analysis, Follow-up studies, Depressive Disorder, Mental Disorders, Clinical Sciences, Middle Aged, Adult, Prognosis, Reproducibility of Results, Predictive value of tests, and Psychiatric Status Rating Scales
Level of cognitive function is usually conceptualized as a feature of organic psychiatric disorders. Classically, its assessment is part of the mental status examination. Standardized tests, such as the Folstein battery, are used to... more
Level of cognitive function is usually conceptualized as a feature of organic psychiatric disorders. Classically, its assessment is part of the mental status examination. Standardized tests, such as the Folstein battery, are used to screen for organic disorders by measuring level and possible impairment of cognitive function through the stipulation of cutoff points. However, contemporary definitions of psychiatric disorders do not embrace such a categorical view of cognitive function. It is important to measure the level of cognitive function in all types of psychiatric disorders in relation to demographic characteristics. Consequently, it is better to view cognitive function as a continuous variable. The Cognitive Function Inventory (CFI), which can also yield a Folstein score, was used to assess cognition in patients diagnosed as having nonorganic psychiatric disorders. A number of different parameters of cognitive function are examined. Differences associated with demographic background and type of disorder are reported. The implications of these results are discussed.
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A one patient-one illness paradigm is implicit in the history and theory of psychiatry, and in basic research. Yet, in clinical practice and treatment populations in general, more than one diagnosis per patient is frequently encountered.... more
A one patient-one illness paradigm is implicit in the history and theory of psychiatry, and in basic research. Yet, in clinical practice and treatment populations in general, more than one diagnosis per patient is frequently encountered. How clinicians formulate comorbidity by means of DSM-III has rarely been investigated. In this study, the ideas of clinical condition and that of its diagnostic complexity are used to analyze descriptive features of a large number of patients seen in an intake setting. Axis I of DSM-III is used to measure diagnostic complexity. Complexity is analyzed in relation to demographic variables, to ratings entered in the remaining axes of DSM-III formulations, to symptom levels of patients, and to decisions involving disposition. Results indicate that analysis of diagnostic complexity by means of DSM-III yields a definable structure and that it can be related meaningfully to clinical factors. The idea of information uncertainty in diagnosis, i.e., the opacity versus transparency of a clinical condition, is also used to explain results. The ideas introduced and studied are shown to have value for social psychiatric research.
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A first comprehensive description of the clinical features of patients with the rare diagnosis of organic hallucinosis (OH) is presented, based on information from 11 OH patients among 14,889 patients who presented for evaluation over a... more
A first comprehensive description of the clinical features of patients with the rare diagnosis of organic hallucinosis (OH) is presented, based on information from 11 OH patients among 14,889 patients who presented for evaluation over a 5-year period at our institution. This characterization is of particular current relevance to diagnosticians and clinicians because of the proposed major changes in the diagnostic system for OH in the upcoming DSM-IV and because of the virtual total lack of published information concerning this syndrome. This description includes a listing of the prevalence and mean severity of each symptom. The severity of the symptoms of OH are then compared with those of its crude "functional" equivalent of schizophrenia to determine which symptoms distinguish between these categories. Associated factors are also presented concerning demographics, modes of treatment, level of functioning, and current physical problems associated with OH.
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Research Interests: Comorbidity, Antisocial Personality Disorder, Drug Use, Race, Humans, and 20 moreAfrican American, Major Depressive Disorder, Alcoholism, Female, Male, Depressive Disorder, Incidence, Pennsylvania, Socioeconomic Status, African Americans, Clinical Sciences, Middle Aged, Comprehensive, Adult, Ethnic Group, European Continental Ancestry Group, Clinical Presentation, Cross Sectional Studies, Substance-Related Disorders, and Socioeconomic Factors
Research Interests: Epidemiology, Depression, Sex, Antisocial Personality Disorder, Humans, and 14 moreAlcoholism, Female, Male, Depressive Disorder, Pennsylvania, Clinical Sciences, Prevalence, Major Depression, Comprehensive, Adult, Sex Factors, Analysis of Variance, Clinical Presentation, and Severity of Illness Index
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Research Interests: Depression, Humans, Substance Use, Alcoholism, Female, and 16 moreMale, Pennsylvania, Clinical Sciences, Middle Aged, Comprehensive, Adult, Antisocial Behavior, Age effect, Age Factors, Depressive Symptoms, Social Behavior Disorders, Clinical Presentation, Cross Sectional Studies, Cognition disorders, Severity of Illness Index, and Cognitive dysfunction
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... 1979, 1980) and to provide sounder grounds for the subse-quent preparation of a comprehensive treatment plan. ... REASON FOR REFERRAL AND EVALUATION: (Including chief complaint) ... psychiatric illness: o Continuous or single episode... more
... 1979, 1980) and to provide sounder grounds for the subse-quent preparation of a comprehensive treatment plan. ... REASON FOR REFERRAL AND EVALUATION: (Including chief complaint) ... psychiatric illness: o Continuous or single episode 7. LOSS OF LIBIDO 2 3 4 lack of ...
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This study examined gender differences of age and race-matched group of bipolar disorder (BPO) patients with comorbid alcohol dependence (AD; n = 65; males = 35, females = 30) to a group of BPO patients without comorbid AD (n = 61; males... more
This study examined gender differences of age and race-matched group of bipolar disorder (BPO) patients with comorbid alcohol dependence (AD; n = 65; males = 35, females = 30) to a group of BPO patients without comorbid AD (n = 61; males = 22, females = 39). The two groups were also similar on marital status and frequency of BPO subtypes. The results revealed that female bipolar alcoholic patients were more likely to report depressive symptoms as compared to either male bipolar alcoholics or both male and female non-alcoholic bipolar patients. When compared to male bipolar alcoholics, they had higher frequency of depressed mood, slow motor behavior, low self-esteem, decreased libido, decreased appetite, and higher general anxiety symptoms. On the other hand, female bipolar alcoholics differed from female non-alcoholic bipolar patients on reports of mood lability, depressed mood, low self-esteem, suicidal indicators, decreased libido, and general anxiety symptoms. These results raise the question of whether alcohol increases the frequency of depressive symptoms among female bipolar patients.
Research Interests: Psychology, Depression, Bipolar Disorder, Sex, Statistical Analysis, and 18 moreComparative Study, Appetite, Humans, Age, Alcoholism, Female, Male, Gender Difference, Frequency, Middle Aged, Alcohol dependence, Adult, Sex Factors, Addictive Behaviors, Depressive Symptoms, Motor Behavior, Self Esteem, and Marital Status
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The World Health Organization Short Disability Assessment Schedule (WHO DAS-S) is an instrument for clinicians' assessment and rating of difficulties in maintaining personal care, in performing occupational tasks and in functioning in... more
The World Health Organization Short Disability Assessment Schedule (WHO DAS-S) is an instrument for clinicians' assessment and rating of difficulties in maintaining personal care, in performing occupational tasks and in functioning in relation to the family and the broader social context due to mental disorders. The WHO DAS-S was developed and underwent preliminarily testing in the context of two international field trials of the multiaxial presentation of ICD-10 for use in adult psychiatry. The instrument was found to be useful, user-friendly and reasonably reliable for use by clinicians belonging to different schools of psychiatry and psychiatric traditions. Further work on the WHO DAS-S should include development of national adaptations of the instrument, studies of concurrent validity of the instrument and modification of the instrument to accommodate changes in the next edition of the International Classification of Impairments, Disabilities and Handicaps (ICIDH).
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The Personal Health Scale is a concise instrument for comprehensive culture-informed and self-rated assessment of general health status and well-being. It is composed of 10 questions that appraise different health dimensions collated from... more
The Personal Health Scale is a concise instrument for comprehensive culture-informed and self-rated assessment of general health status and well-being. It is composed of 10 questions that appraise different health dimensions collated from the international literature, including aspects ranging from somatic and psychological domains to social functioning and insight. In this investigation, results of a study conducted in Southern Brazil to test and validate the Portuguese version of the Personal Health Scale (PHS-Pt) are presented. This study analyzes data from a sample of 120 Brazilian volunteers (90 patients and 30 health care professionals). All patients completed the Portuguese version of the Personal Health Scale under a minimal guidance by trained examiners, who followed standardized instructional procedures. The internal consistency of the PHS-Pt attained a Cronbach's a of 0.75 among patients and of 0.69 among health care professionals. The test-retest reliability correlation coefficient yielded a score of 0.82. Furthermore, the PHS-Pt was able to detect a significant discriminating validity between the 2 evaluated samples (P < .001). The original English version of the Personal Health Scale was successfully adapted to Portuguese as methodologically demonstrated herein. The PHS-Pt constitutes a reliable and trustworthy research instrument for evaluating health status in Brazil, since it is appropriately designed to distinguish different groups of volunteers regarding their health status.
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In this article, the authors review patterns and challenges in the conceptualization, implementation, and academic support of the mental health services of Hispanic Americans. A critical analysis was conducted on information obtained... more
In this article, the authors review patterns and challenges in the conceptualization, implementation, and academic support of the mental health services of Hispanic Americans. A critical analysis was conducted on information obtained through manual and computerized searches of published literature and conference reports. New clinical care approaches include the DSM-IV's cultural formulation with its complement of standardized multiaxial diagnosis, integration of services across clinical disorders or conditions and across sources of care, as well as pluralistic criteria and judges for service outcome appraisal. Emerging clinical approaches offer an opportunity to enhance the mental health care of Hispanic Americans within an increasingly multicultural U.S. society.
Research Interests: Mental Health, Quality of Mental Health Care, Treatment Outcome, Cultural Diversity, Humans, and 9 moreUnited States, Mental Disorders, Mental health services, Mental Health Care, Socioeconomic Factors, attitude to health, cultural characteristics, Health Services Accessibility, and Hispanic American
To deal effectively with the understanding, description and classification of mental morbid conditions, we must address the intricate concept of disease, illness or disorder in mental health. To do so, one needs to consider biological,... more
To deal effectively with the understanding, description and classification of mental morbid conditions, we must address the intricate concept of disease, illness or disorder in mental health. To do so, one needs to consider biological, psychological and social frameworks. These levels of analysis can offer avenues for greater understanding of the bases of illness as well as better ways of formulating its description and classification. Conceptual, epistemological and empirical data analyses are relevant and necessary. All these efforts should be aimed at serving and advancing the main purposes of classification and diagnosis, the chief encompassing one being enhancement of clinical care and public health. Although no definition of mental disorder may strictly embrace every condition of concern, some flexible definitional guidelines within a biopsychosocial framework may be helpful for advancing psychiatric nosology.
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Emerging efforts at developing new international classification and diagnostic systems require a careful and fresh review and conceptualization of the meanings, purposes and models of diagnostic systems. Such meanings include both an... more
Emerging efforts at developing new international classification and diagnostic systems require a careful and fresh review and conceptualization of the meanings, purposes and models of diagnostic systems. Such meanings include both an informative statement as well as a process or activity. The purposes of diagnostic systems can be clustered under understanding of a case and planning effective clinical care and public health interventions. The models designed to give form to a diagnostic system must pay attention to the informational domains to be covered (from illness to positive health), the descriptive or measurement tools to be utilized (categories, dimensions, narratives), the evaluators to be engaged (clinicians, patient, family) and the structural schemas (single- or multilevel) required to accommodate meanings and purposes of interest.
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CONTEXT AND OBJECTIVE: The interconnections between quality of life and health status as assessed via questionnaires have not been thoroughly investigated. The objective of this study was to investigate a possible correlation between the... more
CONTEXT AND OBJECTIVE: The interconnections between quality of life and health status as assessed via questionnaires have not been thoroughly investigated. The objective of this study was to investigate a possible correlation between the constructs of general health status and quality of life as assessed by the Portuguese versions of two questionnaires recently adapted and tested in Brazil. DESIGN AND SETTING: This was a cross-sectional study in which two self-administered questionnaires were used. This investigation was conducted at healthcare services associated with the Universidade de Caxias do Sul, Brazil. METHODS: This study presents data from a sample of 120 volunteers who completed the Portuguese versions of the Personal Health Scale and the Multicultural Quality of Life Index questionnaires. Bivariate linear regression analysis and Pearson correlation coefficients were generated from the scores of the two questionnaires. RESULTS: A significant correlation between the concep...
Research Interests: Psychometrics, Nonparametric Statistics, Quality of life, Brazil, Linear models, and 15 moreHumans, Female, Male, Young Adult, Translating, Health Status, Aged, Middle Aged, Questionnaires, Self Assessment, Adult, Reproducibility of Results, Southern Brazil, Cross Sectional Studies, and cultural characteristics
OBJETIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global... more
OBJETIVE: The Multicultural Quality of Life Index is a concise instrument for comprehensive, culture-informed, and self-rated assessment of health-related quality of life. It is composed of 10 items (from physical well-being to global perception of quality of life). Each item is rated on a 10-point scale. The objective was to evaluate the reliability (test-retest), internal structure, discriminant validity, and feasibility of the Multicultural Quality of Life Index in Lima, Peru. METHOD: The reliability was studied in general medical patients (n = 30) hospitalized in a general medical ward. The Multicultural Quality of Life Index was administered in two occasions and the correlation coefficients ("r") between both interviews were calculated. Its discriminant validity was studied statistically comparing the average score in a group of patients with AIDS (with presumed lower quality of life, n = 50) and the average score in a group of dentistry students and professionals (wi...
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Several interesting surveys on the use of diagnostic systems have been conducted over the past two decades, initially focused on ICD-9 and DSM-III and then on more recent editions of these systems. They have reported on the extent and... more
Several interesting surveys on the use of diagnostic systems have been conducted over the past two decades, initially focused on ICD-9 and DSM-III and then on more recent editions of these systems. They have reported on the extent and perceived value of their use as well as offered recommendations for future systems. The widest survey to date is that on ICD-10 and related systems recently conducted by the WHO Committee on Evaluating and Updating the ICD-10 Mental Health Component and the WPA Section on Classification and Diagnostic Assessment. It involved the participation of 205 psychiatrists from 66 different countries across all continents. Comparing the two most visible diagnostic systems, it found that ICD-10 was more frequently used and more valued for clinical diagnosis and training and that DSM-IV was more valued for research. Accessibility to diagnostic manuals and training appeared limited, particularly concerning the research criteria, primary care, and multiaxial versions of ICD-10. It also elicited structural and strategic recommendations for the elaboration of new diagnostic systems. It is suggested that it may be useful to widen the scope of future surveys, to additionally include policy makers, patients and families, and to conduct naturalistic studies of clinical care.
Research Interests: Cognitive Science, Primary Care, Psychiatry, Psychometrics, Mental Health, and 13 morePsychopathology, Cross-Cultural Comparison, Humans, Surveys, Data Collection, Mental Disorders, Clinical Sciences, International Classification of Diseases, World Health Organization, Reproducibility of Results, Perceived Value, Clinical Diagnosis, and Psychiatric Status Rating Scales
Positive health combines with pathology or illness to yield a broader concept of health, etymologically anchored on the concept of wholeness and enshrined in WHO's constitution. The most... more
Positive health combines with pathology or illness to yield a broader concept of health, etymologically anchored on the concept of wholeness and enshrined in WHO's constitution. The most recognized aspects of positive health include functioning/resilience, resources/supports and quality of life. Systematic assessments of positive health are being incorporated into comprehensive diagnostic models that by attending to the totality of the person who consults may enhance effectiveness and ethics in diagnosis and care. Health, a precious human concern, constitutes a wide-ranging condition and experience. However, pathology, one of its important domains, has tended to monopolize attention when professionals discuss health and carry out health care. This short paper examines the concept of positive health, as opposed to ill-health, as well as some of its aspects or dimensions and its implications for comprehensive diagnosis and care.
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A discussion of the objectives of diagnosis, participants and architecture leads to the consideration of diagnostic schemas of increasing complexity. Examined first is the conventional case of single-label diagnosis. The case of multiple... more
A discussion of the objectives of diagnosis, participants and architecture leads to the consideration of diagnostic schemas of increasing complexity. Examined first is the conventional case of single-label diagnosis. The case of multiple illness formulation is considered concerning the plurality of mental disorders as well as of general medical disorders. The formulation of a whole clinical condition where contextualized pathology and problems are described is then followed by the consideration of positive aspects of health as well as quality of life. Finally, a comprehensive diagnostic model is reviewed. It integrates a standardized multiaxial formulation (illness, disabilities, contextual factors and quality of life) and an idiographic personalized formulation (culturally informed and contextualized clinical problems, patient's assets pertinent to care, and expectations of health restoration and promotion as jointly understood by clinician, patient and family). Such integrative diagnostic schemas may offer a richer informational basis for clinical description and care as well as a more effective focus for the surveillance of population health.
Research Interests: Cognitive Science, Psychometrics, Quality of life, Forecasting, Psychopathology, and 10 morePopulation Health, Comorbidity, Humans, Mental Disorders, Mental Disorder, Clinical Sciences, International Classification of Diseases, Reproducibility of Results, Patient Participation, and Psychiatric Status Rating Scales
Our purpose was to examine the use of classification and diagnostic systems in the field of psychiatry (CDSP) from a bibliometric perspective, over the period 1980-2005. We selected (in EMBASE and MEDLINE databases) documents that... more
Our purpose was to examine the use of classification and diagnostic systems in the field of psychiatry (CDSP) from a bibliometric perspective, over the period 1980-2005. We selected (in EMBASE and MEDLINE databases) documents that contained, in any of their sections, the descriptors 'psychiatr*', 'DSM*', 'ICD*', or 'diagnostic criteria',as well as other more specific descriptors. As a bibliometric indicator of production we applied Price's law. We also calculated the national participation index (PI) and correlated it with overall PI in biomedical and health sciences, and with PI in the discipline of psychiatry. We obtained 20,564 original documents; 15,743 referred to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and 3,106 to the International Classification of Diseases (ICD). Our results indicate non-fulfilment of Price's law, since scientific production on CDSP does not undergo exponential growth (correlation coefficient r = 0.9651, vs. r = 0.9927 after linear adjustment). Of the 10 journals with the highest impact factor in the field of psychiatry, the Journal of Clinical Psychiatry has the highest PI in the DSM subgroup (PI = 14.77), and the British Journal of Psychiatry in the ICD subgroup (PI = 1.54). The principal producer country is the United States (PI = 37.9), though in proportion to its production in the psychiatric field the ranking is headed by Finland. Only 10 countries, of the 20 major producers in health sciences, surpass their own PI in the field of psychiatry (Brazil, Italy, Japan, Austria, Spain, Germany, France, India, Switzerland, and China). Over recent years, the use of CDSP (basically the DSM or ICD) in the scientific literature has increased. Nevertheless, the abstracts to these studies, included in the principal databases, should always specify the diagnostic criteria employed, with a view to increasing information levels and reliability for the reader.
Research Interests: Cognitive Science, Psychiatry, Bibliometrics, Psychopathology, Impact Factor, and 13 moreHumans, United States, Health Science, Mental Disorders, Mental Disorder, Clinical Sciences, International Classification of Diseases, Exponential Growth, Drug Therapy, Correlation coefficient, Indexation, Scientific Production, and Diagnostic Criteria
The past decade has shown interesting attempts to articulate the cultural framework of psychiatric diagnosis. Most distinctive in this regard has been the culture presence in DSM-IV. Less substantial concerning culture has been the core... more
The past decade has shown interesting attempts to articulate the cultural framework of psychiatric diagnosis. Most distinctive in this regard has been the culture presence in DSM-IV. Less substantial concerning culture has been the core ICD-10. Of high cultural interest are the national and international adaptations of ICD-10 because of their aim at articulating universality with local realities and needs. The WPA International Guidelines for Diagnostic Assessment exhibits an innovative diagnostic system that combines standardized multiaxial and personalized idiographic formulations with pointed attention to culture considerations. Finally, this article outlines some culture-informed recommendations for the development of future diagnostic systems.