What do clinicians treat: Diagnoses or symptoms? The incremental validity of a symptom-based, dimensional characterization of emotional disorders in predicting medication prescription patterns

Comprehensive Psychiatry
Monika A WaszczukRoman Kotov

Abstract

Although practice guidelines are based on disorders specified in diagnostic manuals, such as the DSM, practitioners appear to follow symptoms when making treatment decisions. Psychiatric medication is generally prescribed in a transdiagnostic manner, further highlighting how symptoms, not diagnoses, often guide clinical practice. A quantitative approach to nosology promises to provide better guidance as it describes psychopathology dimensionally and its organization reflects patterns of covariation among symptoms. To investigate whether a quantitative classification of emotional disorders can account for naturalistic medication prescription patterns better than traditional diagnoses. Symptom dimensions and DSM diagnoses of emotional disorders, as well as prescribed medications, were assessed using interviews in a psychiatric outpatient sample (N=318, mean age 42.5years old, 59% female, 81% Caucasian). Each diagnosis was associated with prescription of multiple medication classes, and most medications were associated with multiple disorders. This was largely due to heterogeneity of clinical diagnoses, with narrow, homogenous dimensions underpinning diagnoses showing different medication profiles. Symptom dimensions predicted med...Continue Reading

Citations

Dec 19, 2017·European Journal of Psychotraumatology·Cherie ArmourMiranda Olff
Mar 8, 2019·Perspectives on Psychological Science : a Journal of the Association for Psychological Science·Christopher C ConwayNicholas R Eaton
May 13, 2020·World Psychiatry : Official Journal of the World Psychiatric Association (WPA)·Roman KotovUNKNOWN HiTOP Utility Workgroup
Sep 20, 2018·World Psychiatry : Official Journal of the World Psychiatric Association (WPA)·Robert F KruegerJohannes Zimmermann
Aug 28, 2020·Journal of Psychosocial Nursing and Mental Health Services·Barbara J Limandri
Apr 4, 2019·The Behavioral and Brain Sciences·Juyoen HurAlexander J Shackman
Jan 17, 2019·Journal of Personality Disorders·Christopher C ConwayRobert F Krueger
Sep 11, 2021·World Psychiatry : Official Journal of the World Psychiatric Association (WPA)·Dan J SteinMario Maj
Dec 18, 2021·Frontiers in Psychiatry·Jennifer Jane NewsonTara C Thiagarajan

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