[Conceptual foundation of the operational diagnostic approach in psychiatry]

Status und Zukunft psychiatrischer Klassifikationssysteme

Psychiatrische Klassifikationssysteme werden seit jeher kontrovers diskutiert. Kritikpunkte beziehen sich auf konzeptuelle, methodische und anwendungsbezogene Aspekte. In den letzten Jahren wurden zur Lösung dieser Probleme neue Ansätze wie Research Domain Criteria oder Hierarchical Taxonomy of Psychopathology vorgeschlagen. Diese werden vermutlich jedoch erst in Jahren nutzbare Ergebnisse liefern. Existierende Ansätze und Konzepte wie multiaxiale Klassifikation, multimodale Diagnostik, Clinimetrics oder Evidence-Based Assessment können jedoch bereits jetzt genutzt werden, um bestehende Schwächen auszugleichen.

[Deconstructing schizophrenia. Dimensional models or division into subtypes?]

Against the background of the arrangements of ICD-11 and DSM-V, future approaches in order to diagnose schizophrenic psychoses are currently being discussed. In this context, the current concepts of schizophrenia are questioned because attempts at neurobiological validation and validation based on family and follow-up studies have not succeeded. Therefore, dimensional diagnostic models or a division into subtypes are suggested. Both of these proposals would imply a deconstruction of the current concept of schizophrenia. A historical review shows that the psychopathological roots of the current discussion can be traced back to Kurt Schneider's nominalistic concept of schizophrenia which is based upon the so-called first-rank symptoms. In contrast, the psychopathological foundation of dimensional concepts and a division into several subtypes date from contributions of Klaus Conrad and Karl Leonhard. A triaxial diagnostic system with the axes of syndromes, course types and aetiology could provide a bridge between the different approaches.

[The crisis of the operational diagnostic approach in psychiatry]

Based on historical and current contributions, the operational diagnostic approach is examined from a psychopathological point of view. Operational diagnostic systems in psychiatry are characterised by an atomising approach. In this context, psychopathological symptoms are interpreted as elementary entities which can be combined into a specific diagnostic category. Many years before operational diagnostic systems were introduced into psychiatry, however, such an atomising procedure was criticised by authors like Karl Jaspers, Willy Mayer-Gross or Klaus Conrad. Furthermore, validation of diagnostic criteria of operational diagnostic systems has not succeeded so far using biological findings or results of family and follow-up studies. This may be one reason for the fact that categorical approaches in psychiatric diagnosis are questioned increasingly and dimensional diagnostic models are suggested.