BESONDERE VERANSTALTUNGEN 57
d0, 27. 11. 2014
13.30 – 14.30 Uhr
|
Saal A6
E
U
D
Diagnostic systems in psychiatry: utility, use,
limitations and future prospects
Vorsitz:
Wolfgang Gaebel, Düsseldorf
Fritz Hohagen, Lübeck
Referent:
Mario Maj, Neapel (Italien)
The recent publication of the DSM-5 has revived the debate on the utility and limitations
of diagnostic systems in psychiatry. This presentation summarizes the problems with the
reliability of psychiatric diagnosis which prompted the development of the DSM-3 and
ICD-9; provides a picture of the current use of the DSM and ICD in ordinary practice world-
wide; discusses the need to assess systematically the pros and cons of the operational and
prototype approaches to psychiatric diagnosis, with a special focus on their applicability
in ordinary practice and clinical utility; considers different views about what qualifies as
mental disorder and how the boundary between pathology and normality should be fi-
xed for each mental disorder; reviews the role of laboratory tests as applied in medicine,
emphasizing that most of them are probabilistic, not pathognomonic, markers of disease,
and that their availability has not prevented some non-psychiatric conditions which are on
a continuum with normality to become the subject of controversy as to the appropriate
“threshold” for the diagnosis. Finally, it summarizes the promise and limitations of the Rese-
arch Domain Criteria project, aiming to “transform psychiatric diagnosis”, and the currently
ongoing efforts to develop a dialogue between that project and the process of revision of
the ICD-10. (e.g. MMPI, NEO-PI), personality disorders (e.g. SCID-II) or the most frequent
mental disorders (e.g. MINI, SCID) will not cover all possibilities. Skilled psychiatrists with
additional training in psychology and neuropsychiatry have unique potentials to provide
crucial information that may help to understand extreme violence. This presentation will
be illustrated with case-stories elucidating how the mix of some of the factors mentioned
above have lead to extreme acts of violence.
