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Clinical utility as a criterion for revising psychiatric diagnoses
Michael B First1, Harold Alan Pincus, John B Levine
1Department of Psychiatry, Colummbia University, New York, NY, USA. mbf2@columbia.edu
The American Journal of Psychiatry
|June 1, 2004
Summary
Future Diagnostic and Statistical Manual of Mental Disorders (DSM) revisions should empirically prove improved clinical utility. This ensures proposed diagnostic criteria changes offer benefits outweighing potential negative consequences.
Area of Science:
- Psychiatry
- Psychological assessment
- Clinical psychology
Background:
- Diagnostic and Statistical Manual of Mental Disorders (DSM) revisions historically prioritized diagnostic validity and reliability.
- While aiming to enhance clinical utility, previous DSM changes lacked formal empirical evaluation of their actual impact.
Purpose of the Study:
- To propose a framework for empirically assessing the clinical utility of proposed changes to the DSM.
- To ensure future DSM revisions demonstrate tangible improvements in clinical utility.
Main Methods:
- Defined clinical utility and outlined evaluation criteria: impact on diagnostic system use, enhancement of clinical decision-making, and improvement of clinical outcomes.
- Suggested methods for measuring user acceptability, accuracy of diagnostic criteria application, adherence to practice guidelines, and patient outcome improvements.
Main Results:
- Evaluating impact on use involves assessing user acceptability (surveys, field trials) and accuracy (comparison to expert assessment).
- Clinical decision-making impact can be measured using adherence to practice guideline evaluation methods.
- Outcome improvement involves tracking symptom severity, functioning, and prevention of negative outcomes.
Conclusions:
- Empirical assessment of clinical utility is crucial for future DSM revisions.
- Proposed methods provide a systematic approach to validate changes aimed at improving clinical utility.