Clinical utility of diagnosis

Abstract

There is evidence of overlap between psychiatric and general medical constructs for clinical utility particularly for variability of outcomes; use of diagnostic criteria decided by committees of experts and use of clinical information apart from the diagnosis. For psychiatric diagnostic constructs there is evidence of some differences in outcomes and responses to treatments between different diagnostic constructs. On the other hand, it is easier to directly measure variables relevant for clinical purposes in general medicine. Therefore, for all the questions the conclusion of some (not near total overlap) seems fairest. Psychiatric diagnostic constructs can have clinical utility if there is useful information attached e.g. on likely range of outcomes or likely responses to treatments. Psychological formulation has utility but is unlikely to be helpful in all clinical scenarios or ways of working. Dimension or symptom based classification may have greater validity, still involve categorical choices and have limitations in clinical utility. Alternative classifications have compatibility problems with the healthcare system for collective administrative data, statistics or for other social functions such as access to benefits.