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

Journal of Mental Health
Jim van Os

Abstract

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. 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. 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...Continue Reading

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Nov 3, 2012·Social Psychiatry and Psychiatric Epidemiology·Lorenza MaglianoNicoletta Oliviero
Jul 20, 2010·Journal of Mental Health·Til Wykes, Felicity Callard
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Feb 1, 2020·The Journal of Medical Humanities·Anke Maatz, Yvonne Ilg

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