Memoirs of a Psychiatrist: From Straight Jackets through Pseudoscience to Precision Medicine

“For what purpose is differential diagnosis, if not at least partly, to predict clinical course and treatment response?” asks Donald Klein MD, He further emphasizes the importance of validity in diagnosis along Neuropsychiatric clinical pathways, accounting for nearly all “high-utilizers” and, therefore, one-half of all primary health care utilization. “The advent of psychotropic drugs has enormously improved psychiatric care.....It has been repeatedly shown that the majority of patients with psychiatric illness go undiagnosed, and even if diagnosed, they are inappropriately or ineffectively treated, both by psychiatrists and primary care practitioners. ...The DSM process improved clinicians' ability to communicate with each other by explicit inclusion and exclusion criteria. Nonetheless, our eventual goal is diagnostic validity, which means that diagnoses have practical value. In this context, the use of one diagnostic criteria set rather than another should lead to a superior ability to prescribe, treat, and render a secure prognosis. Here there has been only moderate progress. A clinician's problem is deciding what treatments to select for a particular patient and how to do it. Diagnosis alone is not sufficient, although usually necessary. “(15) What's new? Klein?D, et al:?Clinical psychopharmacological practice, the need of developing a research base.?Arch???Gen Psychiatry 50: l993

"Accurate medical-surgical diagnosis at the point of entry into the health care system is non-controversial and self-evident. Nonetheless, nearly 50% of hospital-admitted psychiatric inpatients (80) and 10% of psychiatric outpatients have physical illnesses that caused or aggravated their psychiatric disorders. Most of these patients have been medically screened before referral. (81). The health care costs, unnecessary suffering and risk in the neuropsychiatric, medical, and surgical population alone is enough to justify objective, computer-supported diagnostics for all identifiable psychiatric patients at points of entry to the mental health and correction systems."

80????Hall R,?et al. Physical illness presenting as psychiatric disease.?Arch Gen Psychiatry 35: 1315,??1978

81 Koranyi E:?Morbidity and rate of undiagnosed physical illness in a psychiatric clinic population.?Arch?Gen Psychiatry 36: 414, l979.