Differential diagnosis and current polythetic classification

Parnas, Josef

doi:10.1002/wps.20239

Cited by 61 publications

(56 citation statements)

References 18 publications

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“…Many authors, in fact, have pointed out that the clinician involved in the first diagnostic evaluation tends to automatically reason in terms of comparing the patient's ‘Gestalt' with acquired ‘prototype' categories [11,20,82]. If we assume that the profiles of subjective experience identified in this study represent prototypical internal reactions, we could hypothesize that those profiles reflect the distinctive impact of prototypical psychopathological entities.…”

Section: Discussionmentioning

confidence: 83%

“…In recent years, the limits of this approach have been increasingly highlighted, both by clinicians and researchers, and many questions about psychiatric diagnosis and its validity, nature, and clinical function have been discussed in the literature [9,10,11]. The issue of validity has been the object of a number of studies [12,13], and has also been questioned by many scholars, who lamented the marginalization of the knowledge of classical psychopathology and the decline in psychiatrists' expertise and capacity for individualized, person-centred assessment and treatment [14,15,16].…”

Section: Introductionmentioning

confidence: 99%

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Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Pallagrosi

Fonzi²,

Picardi³

et al. 2016

Psychopathology

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Background: Classical psychopathology greatly valued the interaction between clinician and patient, and assigned to the clinician's subjective experience a significant role in the diagnostic process. Psychoanalysis, too, ascribed a privileged position to the clinician's feelings and empathic participation in the assessment and deep understanding of the patient. This study aimed at testing the traditional, though still relatively unexplored empirically, tenet that particular diagnostic groups elicit distinct and diagnostically useful reactions from clinicians. Sampling and Methods: The study was performed in several psychiatric inpatient and outpatient units in Rome, Italy. The clinicians completed the Assessment of Clinician's Subjective Experience (ACSE) questionnaire and other standardized assessment instruments when they evaluated a previously unknown patient. All adult patients diagnosed with schizophrenia (n = 119), cluster B personality disorder (n = 114), manic or mixed bipolar I episode (n = 59), and unipolar depression or anxiety disorder (n = 130) were included in the study, for a total of 422 patients evaluated by 35 clinicians. Results: We found a significant and theoretically consistent relationship between the clinicians' pattern of subjective experience during the first visit and patients' clinical diagnoses. Patients with unipolar depression/anxiety showed significantly lower scores than the other groups on all ACSE scales except engagement; patients with schizophrenia displayed significantly higher scores than the other groups on difficulty in attunement, and significantly higher scores than patients with cluster B personality disorder on impotence. Compared with the other groups, the patients with cluster B personality disorder displayed significantly lower scores on engagement, and significantly higher scores on disconfirmation. In multivariate models controlling for patient's age and education, symptom severity, clinician's sex, duration of visit and setting, diagnosis remained a significant predictor of scores on all ACSE scales except for impotence. Conclusions: The main limitations of the study are its reliance on clinical diagnoses and the non-independence of assessments. Further studies based on diagnoses made by a third observer through standardized instruments are needed to provide a most stringent test of the hypothesis that different diagnoses are associated with distinct profiles of clinicians' subjective experience. This study provided intriguing, though preliminary, evidence that the clinician's subjective experience may play a useful role in the diagnostic process. Time may have come to reintroduce the concept of intersubjectivity at the core of the diagnostic process.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Pallagrosi

Fonzi²,

Picardi³

et al. 2016

Psychopathology

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“…Cuarto, el mé-todo de redes con su impresionante y elegante tecnología puede ir en detrimento de análisis cualitativos narrativos y clasificaciones prototípicas más que politéti-cas. Quinto, las redes psicológicas suponen y a la vez tienden a homogeneizar los síntomas, cuando los mismos síntomas podrían ser cualitativamente distintos, aspecto que requiere de un análisis fenomenológico (Parnas, 2015;Pérez Álvarez, 2012;Pérez-Álvarez y García Montes, 2018;Sass, 1992). Sexto, no se debe incurrir en una especie de metodologicismo, esto es, el método debe estar al servicio de los temas y problemas de la psico(pato)lógica y no a la inversa.…”

Section: Figura 6 Medias De Centralidad Para Los íTems Del Cuestionarunclassified

Análisis De Redes en Psicología

Fonseca‐Pedrero¹

2018

Pap. Psicol.

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a psicología, desde sus orígenes, no ha cesado en su empeño por mejorar la comprensión de la conducta humana. Este continuo acicate ha impulsado el desarrollo de diferentes modelos psicológicos que, en esencia, tratan de avanzar en el conocimiento del comportamiento y los procesos psicológicos (en su sentido amplio). Los nuevos modelos teóricos y psicomé-tricos tal vez permitan incorporar un prisma alternativo con el que conceptualizar y repensar los fenómenos psicológicos. El modelo de redes, la teoría del caos o la teoría de los sistemas dinámicos son solo algunos ejemplos que, aunque son temas clásicos en algunas disciplinas científicas, se están incorporando en la ciencia del comportamiento humano (Nelson, McGorry, Wichers, Wigman, y Hartmann, 2017). Especialmente interesante son las aportaciones del modelo de redes para el análisis de variables psico(pato)lógicas (Borsboom, 2017;. Esta nueva forma de comprender e intervenir en la conducta tiene enormes posibilidades ya que puede, entre otros aspectos, motivar formas alternativas de analizar datos, sugerir maneras diferentes de modelar y analizar las relaciones entre variables (p.ej., síntomas, signos, procesos psicológicos, rasgos de personalidad, desencadenantes ambientales, consumo de sustancias, etc.), diseñar nuevas formas de prevención e intervención y/o incluso mejorar la búsqueda de mecanismos etiológicos.Dentro de este contexto el objetivo de este trabajo es realizar una introducción al análisis de redes en psicología. Se trata de presentar el modelo de redes, de forma breve, amena, sencilla y, en la medida de lo posible, alejada de ciertos tecnicismos y el complejo aparataje estadístico. La meta es que sirva de tutorial

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“…the 19 th and 20 th century has today sunk into oblivion. According to Andreasen [6], the operational revolution in psychiatry and DSM's authoritative status have brought about certain unintended consequences, including a profound decline in psychopathological knowledge, which massively contributes to the current state of differentialdiagnostic disarray [7][8][9] and impedes both clinical work and research in psychiatry. If psychiatry is to move beyond this crisis, it seems that a rediscovery of the very bedrock of psychiatry, i.e.…”

Section: Introductionmentioning

confidence: 99%

Clinical Manifestations of Self-disorders in Schizophrenia Spectrum Conditions

Henriksen

Parnas

2017

Current Problems of Psychiatry

Self Cite

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This article explores the phenomenologically informed, theoretical and empirical research direction on self-disorders in the schizophrenia spectrum conditions. First, we describe the concept of 'self' that is operative in the concept of 'self-disorders' and we discuss how this self may be disordered or fragile in the schizophrenia spectrum. Second, we offer a detailed psychopathological presentation and discussion of 3 patients with schizophrenia. The vignettes provide paradigmatic examples of self-disorders in schizophrenia. Third, we summarize the main findings in the current empirical research on self-disorders. These findings consistently indicate that selfdisorders constitute a crucial, trait phenotype of the schizophrenia spectrum.

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Differential diagnosis and current polythetic classification

Cited by 61 publications

References 18 publications

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Análisis De Redes en Psicología

Clinical Manifestations of Self-disorders in Schizophrenia Spectrum Conditions

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