Institutional differences and case typicality as related to diagnosis, symptom severity, prognosis, and treatment

Abstract

Abstract The diagnostic classification system has an important function for scientific purposes in the field of psychiatry. The importance of diagnosis is to enable the clinician to reach a standard and a coimnan language not only in the treatment but in research and in training as well. Despite the agreed on importance of the diagnosis among clinicians, still a debate continues. In the present study diagnostic decision and its shortcomings were discussed by mentioning the effects of institutional differences on diagnosis and symptomatology. In relation with the diagnostic and symptom perceptual differences among the institutions, the impacts of these differences on treatment choice and prognostic decision were also taken into consideration. In order to investigate the impact of institutional differences on these variables, 55 clinicians from five different institutions participated in the study. Three video-taped actual cases were shown to the clinicians, and were asked to write down: (1) their diagnosis according to the short form of Diagnostic and Stastical Manual III, (2) their symptom ratings according to the Modified Brief Psychiatric Eating Scale, (3) their prognostic decision, and (4) their choice of treatment for each case. In this study, the first two cases were typical examples of their diagnostic categories, whereas the third case was an atypical one. Institutional comparisons regarding the 1four dependent variables have been carried out for those three cases. The results indicated that institutional differences play an important role especially in the atypical case on all dependent variables, namely; diagnostic decision, perception of symptom severity, prognostic decision and treatment choice of the clinicians. The standart diagnostic criteria seemed to be short of creating a precise agreement especially in the cases of an ambigious nature.