Four Core Concepts in Psychiatric Diagnosis

Motives and modifying factors for giving or rejecting psychiatric diagnoses in general medicine and psychiatry - a qualitative interview study

BACKGROUND

There is a discussion among general practitioners and psychiatrists regarding over-diagnosing versus under-reporting of psychiatric diagnoses. A deeper understanding of this topic is relevant for providing reasonable health care and for planning future studies. A crucial factor to understanding this discussion is the difference in the prevalence of a disease in each sector. One way to attain knowledge about such prevalences is the analysis of routine care data of the sector in question. However, diagnosis-related data might be modified by several additional influencing factors.

AIMS

This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings.

METHODS

Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis.

RESULTS

The analysis revealed three major motivational categories for finding a diagnosis: (1) "objective matters" such as "categorisation for research"; (2) "functional and performance-related factors" such as "requirement for medication", "billing aspects" that go with certain diagnoses or "access to adequate care" and (3) "Individual factors" such as the "personality of a physician". Similarly, factors emerged that lead to not making psychiatric diagnoses like "fear of stigmatization among patients" or "detrimental insurance status with psychiatric diagnosis". Additionally participants mentioned other reasons for "not diagnosing a psychiatric diagnosis", such as "coding of other clinical pictures".

CONCLUSION

The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study.

The Dialectics of Altered Experience: How to Validly Construct a Phenomenologically Based Diagnosis in Psychiatry

In this paper, we present how a dialectical perspective on phenomenological psychopathology, called Dialectical Phenomenology (DPh), can contribute to current needs of psychiatric diagnosis. We propose a three-stage diagnostic methodology: first- and second-person stages, and synthetic hermeneutics stage. The first two stages are divided into a pre-dialectical and a dialectical phase. The diagnostic process progresses in a trajectory of increasing complexity, in which knowledge obtained at one level is dialectically absorbed and intertwined into the next levels. Throughout the article, we offer some examples of each step. In overall, the method starts off from the patient's own narrative, proceeds to two stages of phenomenological reduction designed to guarantee the scientific validity of the object, and concludes with a hermeneutical narrative synthesis that is dialectically composed of the patient's and psychopathologist's shared narratives. At the end of this process, the initial first-person narrative is transformed into a specific scientific object, a full dialectical phenomenological psychiatric diagnosis. This form of diagnosis constitutes a comprehensive alternative for an integral assessment of the complexities of human psychological alteration, bringing together both the interpretation of the suffering person and the scientific categories of psychiatry.