Tests, testing, and tested - we need to critically evaluate the meaning of tests in psychiatry

Abstract

This article describes clinical pitfalls in our concepts of what it means for an illness, diagnosis, or evaluation and treatment methods to say that they have been “tested”. This articles begins with the problems encountered in newborn testing for Krabbe Disease of the nervous system in New York State over the last few years as an example of a test that did not live up to its promise to help the society. Next, the article gives 3 examples of testing in psychiatry, 1. Psychological testing to make treatment decisions in children with depression, 2. Patient's and parents who have been told, or believe, that they have Asperger's disorder, and 3. The conclusions made about the efficacy of cognitive behavioral therapy based on clinical studies. The article's conclusion sums up these examples as reasons why we need to have a more practical and scientific approach to our understanding and implementation of tests used in our field.

Screening for disease, psychological testing, and psychotherapy Looking behind the mirror

“…Berger[1] describes the results in New York of screening for Krabbe disease, an inborn error of metabolism. Only 24 babies tested positive out of about a million tested.…”

“…[12] The other is that fluoxetine is the only antidepressant with a safety-efficacy profile that has resulted in approval for use in the treatment of pediatric depression. [13] Neither of these caveats emerged in Berger's[1] viewpoint; happily, the therapeutic trial with low-dose escitalopram proved successful.…”

“…With regard to Berger's[1] view on the differential diagnosis and possible accompaniments of a popular diagnosis of Asperger's disorder, some acknowledgement is necessary that Asperger's syndrome not amounting to a disorder may be far more common than realized, and that autistic traits are probably continuously distributed in the population. [14]…”

“…In his viewpoint, Berger[1] implies that psychotherapy has not been measured by the same yardstick as antidepressants, that psychotherapy has not been validated in patients with vegetative symptoms, a strong family history, and a chronic course, and that psychotherapy has not been tested with remission as the primary outcome. He adds that the very validation of psychotherapy as an effective treatment is flawed because psychotherapy trials cannot be blinded and effectively placebo-controlled.…”

“…In this issue of the Journal, Berger[1] presents his personal viewpoint on matters related to screening for future disease in the population, use of psychological tests for clinical purposes, and the limitations of psychotherapy as a clinical intervention. All the issues raised are important, and in this editorial we consider additional theoretical and practical matters that arise from the points that he makes.…”