{"title":"Criticism of psychiatric treatment","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0007","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0007","url":null,"abstract":"Criticisms of psychiatric treatment often involve comparison to idealized depictions of general medical treatment. Psychiatric treatments are described as not reversing diseases but many treatments in general medicine also do not reverse disease and some have unknown mechanisms. It is stated that psychiatrists prescribe medication to reverse hypothesized mechanisms, but a survey found they usually prescribed a medication in a clinical situation because research had shown it to be effective, even though the mechanism of action was unclear. Antidepressants are said to be ineffective because of a small overall effect averaged over groups of participants but this ignores evidence that some people will derive a significant clinical benefit. Antipsychotics are effective in preventing relapse of psychosis in research studies; for a variety of reasons, withdrawal-induced psychosis is unlikely to explain enough of this advantage to prove the claim that antipsychotics are ineffective. Although lithium research trials are imperfect, including reporting high rates of lithium withdrawal-induced mania, there is still some evidence of benefit in acute mania and of modest benefit in preventing relapse of bipolar disorder in those who can continue lithium for two years or more. Questions comparing psychiatric and general medical treatments were generated.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122358867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatments in psychiatry compared to general medicine","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0015","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0015","url":null,"abstract":"There is clear overlap in effectiveness between psychiatric treatments and general medicine medications. Both psychiatric treatments and general medicine medications can be harmful. Mechanisms of action of psychiatric treatments are often obscure or unknown. This is less common in general medicine medication but some of the most commonly prescribed drugs used in general medicine do not cure or act directly on disease mechanisms. Evidence-based psychotherapy is an effective treatment for many mental health conditions; its relative effectiveness compared to psychiatric medication varies depending on the condition. If the client is willing and able to participate in bona fide psychotherapy with evidence of effectiveness, it may be preferable to psychiatric medication as it seems to have less serious adverse effects although more research is needed on harmful adverse effects. Psychotherapy combined with medication is often more effective than either used alone and both types of treatment are complementary, even synergistic, in achieving treatment objectives. Access to psychotherapy is often less easy than access to medication as it is labour intensive, and using medication allows doctors to see many more patients (see Chapter 5). For some conditions and situations, for example, for those unable to participate in psychotherapy, psychiatric treatments are still preferred.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"353 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122850195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Variability of clinical picture","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0010","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0010","url":null,"abstract":"Psychiatric diagnostic constructs produce highly variable clinical pictures in patients. Amongst the reasons for this are high rates of co-occurrence of different diagnostic constructs, which themselves are often polythetic in nature. People who meet criteria for a diagnostic construct may have little or even no clinical features in common. These diagnostic constructs rely on people meeting the diagnostic criteria having similar qualities to their condition such as similar likelihoods of outcomes/responses to treatments. These highly variable clinical pictures are seen even when clear disease is involved, such as the dementias. General medical diagnostic constructs can also display highly variable clinical pictures even when clear disease processes have been identified. Polythetic diagnostic criteria decided upon by expert committees are also used for general medical diagnostic constructs which can also result in people meeting the same diagnostic criteria having little in common in their clinical pictures. Co-occurrence is also common in general medicine. Psychological formulation does not have to address the issue of variable clinical pictures. Both symptom-based and dimensional classifications can depict variable clinical pictures more accurately than diagnostic constructs but there are pragmatic issues such as suitability for brief appointments or emergency work.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121912938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Spectrums of health","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0009","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0009","url":null,"abstract":"Many conditions in psychiatry cannot be separated from normality/healthy states (e.g. depression) but even these broad diagnostic constructs may include syndromes like melancholia. There is still a debate as to whether psychotic-like experiences in the community are on a continuum with psychotic symptoms in those meeting diagnostic criteria for psychosis diagnostic constructs. Schizophrenia may exist on a continuum with related conditions (e.g. schizotypal personality disorder). There are differences between people meeting criteria for schizophrenia and healthy controls but none that can be used as a diagnostic test to separate the two, with the possible exception of anomalous self-experiences differentiating schizophrenia spectrum conditions from healthy controls and other diagnostic constructs. Several general medical conditions also exist on a continuum with health with no zones of rarity (e.g. hypertension and type 2 diabetes). Thresholds to meet criteria for these diagnostic constructs are chosen by expert committees often based on risk of developing complications (e.g. myocardial infarctions) and/or whether medical intervention may be beneficial. Even reasonably objective investigations can give abnormal results in healthy people. Concerns about whether thresholds are too low, leading to over-diagnosis, unnecessary treatment, and iatrogenic harm, also exist in general medicine. Other classifications in mental health will need to use thresholds in order to fulfil functions such as administration, research, or access to services. Dimensional classifications are good at representing the many spectrums of mental health.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"123 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131659744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Final conclusions","authors":"A. Huda","doi":"10.1093/med/9780198807254.003.0016","DOIUrl":"https://doi.org/10.1093/med/9780198807254.003.0016","url":null,"abstract":"The medical model in mental health uses diagnostic constructs with attached useful information (e.g. on prognosis or response to treatments) that often identifies areas of spectrums rather than diseases or syndromes. Diagnostic constructs in psychiatry and general medicine overlap for attributes such as clinical utility (e.g. predicting likely outcomes), validity (e.g. whether boundaries exist between different diagnostic constructs), and importance of social factors. There is an overlap in effectiveness between psychiatric and general medicine treatments, and many general medicine medications do not reverse disease processes. Describing the nature of diagnostic constructs can be done by describing the basis of classification and nature of the classified condition. Different mental health classifications have particular strengths and weaknesses for clinical, research, and social functions. Research in mental health may need classifications other than diagnosis to improve understanding of causes and mechanisms and also to develop better diagnostic constructs. As doctors in all specialties will encounter mental health problems there will always be psychiatric diagnostic constructs compatible with their training. The medical model of mental health allows doctors to assess and offer effective treatments to large numbers of patients and provide emergency cover. Mental health research and service provision will always need to address psychosocial issues.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125247977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Criticism of psychiatric diagnosis","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0006","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0006","url":null,"abstract":"Criticisms of psychiatric diagnostic constructs from a clinical/scientific view have been made on several points: reliability, such as how often two clinicians agree on the same diagnosis; validity, such as clear separation between diagnostic constructs or presence of objective validators; utility, such as predicting outcomes and treatment responses; implying an inaccurate conception of mental health problems as diseases that also minimizes the influence of social causative factors, high rates of co-occurrence, and association with negative consequences such as stigma. Many psychiatric diagnostic constructs lack validity but often have clinical utility. This clinical utility depends on how the clinician works therefore psychiatric diagnostic constructs are well suited to the medical model but may have little utility for other mental health professionals who work differently or for researchers testing hypotheses. Diagnostic constructs have utility for administrative purposes. The criticisms can be used to generate a set of questions to evaluate psychiatric diagnostic constructs. Psychiatric diagnostic constructs are best compared with general medical diagnostic constructs because they are used for similar purposes in clinical decision-making. A comparison will be made to see if there is no overlap, some overlap, or near total overlap between general medical and psychiatric diagnostic constructs.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128231442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Explanation of basic concepts of medical terminology","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0001","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0001","url":null,"abstract":"People often compare general medicine to psychiatry using false assumptions or incomplete comparative information. Doctors’ role in healthcare relies in part on their sapiental authority, i.e. their knowledge. This sapiental authority relies on developing a medical model to learn and use information. The medical model relies on standardized terminology to aid communication and learning. The medical model allows them to identify problems and recall information on outcomes and treatments. The medical model may also allow explanation of how problems occur and the biopsychosocial model is preferred. Other models of explanation and intervention may also be used and may be superior for certain functions or explanations. The concepts of disease, illness, and health are not clear-cut and often require professional judgements—influenced by culture—based on distress or risk of adverse outcomes to identify examples of, e.g. disease. Condition may be used instead for states that may require medical attention.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"130 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132228142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The clinical picture, creating diagnostic constructs, and causation","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0004","url":null,"abstract":"The clinical picture is the doctor’s interpretation based on what has happened to the patient and symptoms, signs, and results of investigations that are available to her. It is created by the interaction of causative factors as well as multiple cultural, interactive, and individual factors. The doctor matches the patient’s clinical picture with the diagnostic construct and the most common elements of an attached clinical picture. Diagnostic constructs based on similarity with the clinical picture may have clinical utility by accumulating information about likely outcomes and responses to treatments. Diagnostic constructs based on common mechanisms (such as changes in structure or processes) and/or causes have greater scientific validity and allow more reliable diagnostic investigations and better prospects of developing superior treatments. Most medical conditions are caused by a combination of causative factors. Proving a factor is causative is complex. One of the best known methods is Austen Hill’s framework. Conditions occur due to combinations of causes, characteristics, and contexts.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115394202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Social factors and health","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0013","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0013","url":null,"abstract":"There is increased risk caused by social difficulties and/or childhood trauma for developing both general medical and mental health conditions, with overlap in similarity of magnitude of some increased risks, although intermediary mechanisms may differ. Social factors are the most important determinants of health status. Reducing social adversity and childhood trauma would improve the physical and mental health of the population. Life events and stresses/hassles are a more specific risk factor for mental health problems. Social factors are often inadequate to explain the nature and severity of people’s mental health problems without taking into account psychobiological factors. Given the greater effect of culture on how mental health conditions are expressed, there is some overlap between psychiatric and general medical diagnostic constructs rather than near total overlap. Mental health conditions do seem associated with greater stigma (some of this seems related to the categorical nature of diagnostic constructs) and also with greater use of coercion than for general medical conditions, but this also occurs for general medical conditions hence the conclusion of some overlap.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133130116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical utility of diagnosis","authors":"A. Huda","doi":"10.1093/MED/9780198807254.003.0014","DOIUrl":"https://doi.org/10.1093/MED/9780198807254.003.0014","url":null,"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.","PeriodicalId":106646,"journal":{"name":"The Medical Model in Mental Health","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114937369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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