Mental Illness — Comprehensive Evaluation or Checklist?
N Engl J Med 2012; 366:1853-1855May 17, 2012
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- The debate over revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) is of more than intramural interest, for the way in which the promised fifth edition (DSM-5) resolves the debate will shape the nature and scope of psychiatric services for years to come. Now established as the master reference work for U.S. psychiatrists, the DSM initially emerged, like the companion volume for internists, the International Classification of Diseases, with a public health interest in the incidence and prevalence of illnesses. But with its third edition in 1980 (DSM-III), the DSM began prescribing how clinicians should identify psychiatric disorders.The editors of the DSM-III justified this move by noting that the likelihood of diagnostic agreement between any two psychiatrists about the same patient was scarcely better than that achievable by chance. They attributed much of the difficulty to sectarian discord among proponents of psychodynamic, behavioral, and neurobiologic explanations of mental illness. And they concluded that the diagnostic muddle could be cleared up if psychiatrists put aside disputes over causes and instead identified disorders by their symptoms, signs, and clinical course./.../
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