Editing Mental disorder (section)

==Diagnosis==
Psychiatrists seek to provide a [[medical diagnosis]] of individuals by an assessment of [[symptoms]], [[medical signs|signs]] and impairment associated with particular types of mental disorder. Other mental health professionals, such as clinical psychologists, may or may not apply the same diagnostic categories to their [[clinical formulation]] of a client's difficulties and circumstances.<ref>{{cite journal | vauthors = Kinderman P, Lobban F |doi= 10.1017/S1352465800003118 |title=Evolving Formulations: Sharing Complex Information with Clients |year=2000 |journal=Behavioural and Cognitive Psychotherapy |volume=28 |issue=3 |pages=307–10|citeseerx=10.1.1.500.5290 |s2cid= 16787375 }}</ref> The majority of mental health problems are, at least initially, assessed and treated by family physicians (in the UK [[general practitioners]]) during consultations, who may refer a patient on for more specialist diagnosis in [[acute (medicine)|acute]] or [[chronic (medicine)|chronic]] cases.

Routine diagnostic practice in mental health services typically involves an interview known as a [[mental status examination]], where evaluations are made of appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of other professionals, relatives, or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. [[Psychological testing]] is sometimes used via paper-and-pen or computerized questionnaires, which may include [[algorithms]] based on ticking off standardized diagnostic criteria, and in rare specialist cases neuroimaging tests may be requested, but such methods are more commonly found in research studies than routine clinical practice.<ref>Payne, Kattie. (2004). [http://health.yahoo.com/topic/mentalhealth/symptoms/medicaltest/healthwise/tp16780 Mental Health Assessment.] {{webarchive|url=https://web.archive.org/web/20060626070720/http://health.yahoo.com/topic/mentalhealth/symptoms/medicaltest/healthwise/tp16780 |date=26 June 2006 }} Yahoo! Health. Boise: Healthwise, Inc.</ref><ref>{{cite journal | vauthors = Davies T | title = ABC of mental health. Mental health assessment | journal = BMJ | volume = 314 | issue = 7093 | pages = 1536–9 | date = May 1997 | pmid = 9183204 | pmc = 2126757 | doi = 10.1136/bmj.314.7093.1536 }}</ref>

Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.<ref>{{cite journal | vauthors = Kashner TM, Rush AJ, Surís A, Biggs MM, Gajewski VL, Hooker DJ, Shoaf T, Altshuler KZ | title = Impact of structured clinical interviews on physicians' practices in community mental health settings | journal = Psychiatric Services | volume = 54 | issue = 5 | pages = 712–8 | date = May 2003 | pmid = 12719503 | doi = 10.1176/appi.ps.54.5.712 }}</ref> It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in [[Evidence based assessment|evidence-based assessment]] methods, and that inaccurate diagnosis may be common in routine practice.<ref>{{cite journal | vauthors = Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA, Hanekamp M | title = Diagnosis of nonpsychotic patients in community clinics | journal = The American Journal of Psychiatry | volume = 157 | issue = 4 | pages = 581–7 | date = April 2000 | pmid = 10739417 | doi = 10.1176/appi.ajp.157.4.581 | doi-access = free }}</ref> In addition, [[comorbidity]] is very common in psychiatric diagnosis, where the same person meets the criteria for more than one disorder. On the other hand, a person may have several different difficulties only some of which meet the criteria for being diagnosed. There may be specific problems with accurate diagnosis in developing countries.

More structured approaches are being increasingly used to measure levels of mental illness.
* HoNOS is the most widely used measure in English mental health services, being used by at least 61 trusts.<ref>{{cite web |title=What is HoNOS? |url=http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/courses/honos/whatishonos.aspx |website=Royal College of Psychiatrists |access-date=13 May 2013 |archive-date=1 July 2017 |archive-url=https://web.archive.org/web/20170701113022/http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/courses/honos/whatishonos.aspx |url-status=live }}</ref> In HoNOS a score of 0–4 is given for each of 12 factors, based on functional living capacity.<ref>{{cite web |title=Introduction to HoNOS |url=http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/courses/honos/workingageadults/introduction.aspx |website=Royal College of Psychiatrists |access-date=13 May 2013 |archive-date=1 July 2017 |archive-url=https://web.archive.org/web/20170701120237/http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/courses/honos/workingageadults/introduction.aspx }}</ref> Research has been supportive of HoNOS,<ref>{{cite journal | vauthors = Pirkis JE, Burgess PM, Kirk PK, Dodson S, Coombs TJ, Williamson MK | title = A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures | journal = Health and Quality of Life Outcomes | volume = 3 | issue = 1 | page = 76 | date = November 2005 | pmid = 16313678 | pmc = 1315350 | doi = 10.1186/1477-7525-3-76 |doi-access=free}}</ref> although some questions have been asked about whether it provides adequate coverage of the range and complexity of mental illness problems, and whether the fact that often only 3 of the 12 scales vary over time gives enough subtlety to accurately measure outcomes of treatment.<ref>{{cite journal | vauthors = Audin K, Margison FR, Clark JM, Barkham M | title = Value of HoNOS in assessing patient change in NHS psychotherapy and psychological treatment services | journal = The British Journal of Psychiatry| issn = 0007-1250 | eissn = 1472-1465 | lccn = 89649366 | oclc = 1537306 | volume = 178 | issue = 6 | pages = 561–6 | date = June 2001 | pmid = 11388975 | doi = 10.1192/bjp.178.6.561 | doi-access = free }}</ref>

===Criticism===
{{Primary sources section|find=criticism|find2=psychiatric diagnosis|date=July 2021}}
Since the 1980s, [[Paula Caplan]] has been concerned about the subjectivity of psychiatric diagnosis, and people being arbitrarily "slapped with a psychiatric label." Caplan says because psychiatric diagnosis is unregulated, doctors are not required to spend much time interviewing patients or to seek a second opinion. The ''Diagnostic and Statistical Manual of Mental Disorders'' can lead a psychiatrist to focus on narrow checklists of symptoms, with little consideration of what is actually causing the person's problems. So, according to Caplan, getting a psychiatric diagnosis and label often stands in the way of recovery.<ref>{{cite news |url=https://www.washingtonpost.com/opinions/psychiatrys-bible-the-dsm-is-doing-more-harm-than-good/2012/04/27/gIQAqy0WlT_story.html |title=Psychiatry's bible, the DSM, is doing more harm than good |vauthors=Caplan PJ |author-link=Paula Caplan |date=28 April 2012 |newspaper=Washington Post |department=Opinions |access-date=4 September 2017 |archive-date=3 June 2019 |archive-url=https://web.archive.org/web/20190603024110/https://www.washingtonpost.com/opinions/psychiatrys-bible-the-dsm-is-doing-more-harm-than-good/2012/04/27/gIQAqy0WlT_story.html |url-status=live }}</ref>

In 2013, psychiatrist [[Allen Frances]] wrote a paper entitled "The New Crisis of Confidence in Psychiatric Diagnosis", which said that "psychiatric diagnosis... still relies exclusively on fallible subjective judgments rather than objective biological tests." Frances was also concerned about "unpredictable overdiagnosis".<ref name=frana>{{cite journal | vauthors = Frances A | title = The new crisis of confidence in psychiatric diagnosis | journal = Annals of Internal Medicine | volume = 159 | issue = 3 | pages = 221–2 | date = August 2013 | pmid = 23685989 | doi = 10.7326/0003-4819-159-3-201308060-00655 | quote = Unfortunately, the extensive research has had no effect on psychiatric diagnosis, which still relies exclusively on fallible subjective judgments rather than objective biological tests. … In the past 20 years, the rate of attention-deficit disorder tripled, the rate of bipolar disorder doubled, and the rate of autism increased more than 20-fold (4). The lesson should be clear that every change in the diagnostic system can lead to unpredictable overdiagnosis. | department = Ideas and Opinions | author1-link = Allen Frances | doi-access = free }}</ref> For many years, marginalized psychiatrists (such as [[Peter Breggin]], [[Thomas Szasz]]) and outside critics (such as [[Stuart A. Kirk]]) have "been accusing psychiatry of engaging in the systematic medicalization of normality." More recently these concerns have come from insiders who have worked for and promoted the American Psychiatric Association (e.g., [[Robert Spitzer (psychiatrist)|Robert Spitzer]], Allen Frances).<ref name=stuarta>{{cite book | vauthors = Kirk SA, Gomory T, Cohen D |author1-link=Stuart A. Kirk |title=Mad Science: Psychiatric Coercion, Diagnosis, and Drugs |year=2013 |publisher=Transaction Publishers |page=185}}{{ISBN needed}}</ref> A 2002 editorial in the ''[[British Medical Journal]]'' warned of inappropriate medicalization leading to [[disease mongering]], where the boundaries of the definition of illnesses are expanded to include personal problems as medical problems or risks of diseases are emphasized to broaden the market for medications.<ref name=Moynihan>{{cite journal | vauthors = Moynihan R, Heath I, Henry D | title = Selling sickness: the pharmaceutical industry and disease mongering | journal = BMJ | volume = 324 | issue = 7342 | pages = 886–91 | date = April 2002 | pmid = 11950740 | pmc = 1122833 | doi = 10.1136/bmj.324.7342.886 | department = Education And Debate; Commentary }}</ref>

Gary Greenberg, a psychoanalyst, in his book "''the Book of Woe"'', argues that mental illness is really about [[suffering]] and how the DSM creates diagnostic labels to categorize people's suffering.<ref>{{Cite book| vauthors = Greenberg G |url = https://archive.org/details/bookofwoedsmunma0000gree_t5n8 | isbn = 978-0-399-15853-7 | oclc = 827119919 |location = New York |publisher = Blue Rider Press|title=Book of Woe|year = 2013 }}</ref> Indeed, the psychiatrist Thomas Szasz, in his book "''the Medicalization of Everyday Life''", also argues that what is psychiatric illness, is not always biological in nature (i.e. social problems, poverty, etc.), and may even be a part of the human condition.<ref>{{cite book | vauthors = Szasz T |title=The Medicalization of Everyday Life: Selected Essays |date=2007 |publisher=Syracuse University Press |isbn=978-0-8156-0867-7 }}{{page needed|date=June 2022}}</ref>

===Potential routine use of MRI/fMRI in diagnosis===
in 2018 the [[American Psychological Association]] commissioned a review to reach a consensus on whether modern clinical [[MRI]]/[[fMRI]] will be able to be used in the diagnosis of mental health disorders. The criteria presented by the APA stated that the [[Biomarker (medicine)|biomarkers]] used in diagnosis should:
# "have a sensitivity of at least 80% for detecting a particular psychiatric disorder"
# should "have a specificity of at least 80% for distinguishing this disorder from other psychiatric or medical disorders"
# "should be reliable, reproducible, and ideally be noninvasive, simple to perform, and inexpensive"
# proposed biomarkers should be verified by 2 independent studies each by a different investigator and different population samples and published in a peer-reviewed journal.

The review concluded that although [[neuroimaging]] diagnosis may technically be feasible, very large studies are needed to evaluate specific biomarkers which were not available.<ref>{{cite journal | vauthors = First MB, Drevets WC, Carter C, Dickstein DP, Kasoff L, Kim KL, McConathy J, Rauch S, Saad ZS, Savitz J, Seymour KE, Sheline YI, Zubieta JK | title = Clinical Applications of Neuroimaging in Psychiatric Disorders | journal = The American Journal of Psychiatry | volume = 175 | issue = 9 | pages = 915–916 | date = September 2018 | pmid = 30173550 | pmc = 6583905 | doi = 10.1176/appi.ajp.2018.1750701 }}</ref>