Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-18T05:44:41.127Z Has data issue: false hasContentIssue false
  • English
  • Français

Limitations of the symptom-oriented approach to psychiatric research

Published online by Cambridge University Press:  03 January 2018

Ramin Mojtabai  and
Ronald O. Rieder
Ramin Mojtabai
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
Ronald O. Rieder
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

We critically reviewed the arguments of the symptom-oriented researchers who propose to replace syndromes and diagnostic categories with symptoms as units of analysis in psychiatric research.

Method

Three central arguments were examined: (a) current diagnostic categories lack reliability and validity; (b) using diagnostic categories leads to misclassification and confounding; and (c) symptom-oriented theories are clearer, easier to test, and more likely to lead to an explanation of psychopathology. These arguments are based on three assumptions respectively: (a) symptoms have higher reliability and validity; (b) underlying pathological processes are symptom-specific; and (c) elucidation of the process of symptom development will lead to (and must precede) the discovery of the causes of syndromes.

Results

We found little evidence supporting these assumptions and arguments based on them.

Conclusion

There are no clear advantages in replacing syndromes with symptoms as units of analysis for psychiatric research.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 173 , Issue 3 , September 1998 , pp. 198 - 202
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (DSM–III) (3rd edn). Washington, DC: APA.Google Scholar
Andreasen, N. C. McDonald-Scott, P. Grove, W. M. et al (1982) Assessment of reliability in multicenter collaborative research with a videotape approach. Approach Journal of Psychiatry, 139, 876–882.Google ScholarPubMed
Andreasen, N. C. Flaum, M. & Arndt, S. (1992) The comprehensive assessment of symptoms and history (CASH): An instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615–623.CrossRefGoogle ScholarPubMed
Andreasen, N. C. Arndt, S. Alliger, R. et al (1995) Symptoms of schizophrenia. Archives of General Psychiatry, 52, 341–351.CrossRefGoogle ScholarPubMed
Bentall, R. P. (1990) The syndromes and symptoms of psychosis: Or why you can't play twenty questions’ with the concept of schizophrenia and hope to win. In Reconstructing Schizophrenia (ed. Bentall, R. P.), pp. 23–60. London: Routledge.Google Scholar
Bentall, R. P. (1992) The classification of schizophrenia. In Schizophrenia: An Overview and Practical Handbook (ed. Kavanagh, D. J.), pp. 23–44. London: Chapman and Hall.Google Scholar
Bentall, R. P. & Slade, P. D. (1985) Reality testing and auditory hallucinations: A signal detection analysis. British Journal of Clinical Psychology, 24, 159–169.Google Scholar
Bentall, R. P. Kinderman, P. & Kaney, S. (1994) The self, attributional processes and abnormal beliefs: Towards a model of persecutory delusions. Behavioural Research and Therapy, 32, 331–341.Google Scholar
Berenbaum, H. Oltmanns, T. F. & Gottesman, I. I. (1987) A twin study perspective on positive and negative symptoms of schizophrenia. In Positive and Negative Symptoms of Psychosis (eds Harvey, P. D. & Walker, E. F.), pp. 50–67. Hillside, NJ: Lawrence Eribaum.Google Scholar
Blashfield, R. K. & Livesley, W. J. (1991) Metaphorical analysis of psychiatric classification as a psychological test. Journal of Abnormal Psychology, 100, 262–270.Google Scholar
Carpenter, W. T. Bartko, J. J. Strauss, J. S. et al (1978) Signs and symptoms as predictors of outcome: A report from the International Pilot Study of Schizophrenia. American Journal of Psychiatry, 135, 940–944.Google ScholarPubMed
Costello, C. G. (1992) Research on symptoms versus research on syndromes: Arguments in favour of allocating more research time to the study of symptoms. British Journal of Psychiatry, 160, 304–308.CrossRefGoogle Scholar
Costello, C. G. (1993) Advantages of the symptom approach to schizophrenia. In Symptoms of Schizophrenia (ed. Costello, C. G.). pp. 1–26. New York: Wiley.Google Scholar
Crichton, P. (1996) First-rank symptoms or rank-and-file symptoms? British Journal of Psychiatry, 169, 537–540.CrossRefGoogle ScholarPubMed
Endicott, J. Nee, J. Fleiss, J. et al (1982) Diagnostic criteria for schizophrenia. Archives of General Psychiatry, 39, 884–889.CrossRefGoogle ScholarPubMed
Feighner, J. P. Robins, E. & Guze, S. B. (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57–63.Google Scholar
Fibiger, H. C. (1991) The dopamine hypotheses of schizophrenia and mood disorders: Contradictions and speculations. In The Mesolimbic. Dopamine System: From Motivation to Action (eds Willner, P. & Scheel-Krüger, J.), pp. 615–637. New York: Wiley.Google Scholar
Frith, C. D. & Done, J. (1988) Towards a neuropsychology of schizophrenia. British Journal of Psychiatry, 153, 437–443.CrossRefGoogle ScholarPubMed
Gottesman, I. I. (1991) Schizophrenia Genesis. New York: W H. Freeman.Google Scholar
Helzer, J. E. Brockingham, I. F. & Kendell, R. E. (1981) Predictive validity of DSM–III and Feighner definitions of schizophrenia: A comparison with Research Diagnostic Criteria and CATEGO. Archives of General Psychiatry, 38, 791–797.CrossRefGoogle ScholarPubMed
Huq, S. F. Garety, P. A. & Hemsley, D. R. (1988) Probabilistic judgements in deluded and non-deluded subjects. Quarterly Journal of Experimental Psychology, 40, 801–812.Google Scholar
Hwu, H. G. Wu, Y. C. Lee, S. F. C. et al (1997) Concordance of positive and negative symptoms in coaffected sib-pairs with schizophrenia. American Journal of Medical Genetics, 74, 1–6.Google Scholar
Johnstone, E. C. Crow, T. J. Frith, C. D. et al (1978) Mechanism of the antipsychotic effect in the treatment of acute schizophrenia. Lancet, i, 848–851.Google Scholar
Kendler, K. S. (1990) Towards a scientific psychiatric nosology: Strengths and limitations. Archives of General Psychiatry, 47, 969–973.Google Scholar
Kendler, K. S. Karkowski-Shuman, L. O'Neill, F. A. et al (1997) Resemblance of psychotic symptoms and syndromes in affected sibling pairs from the Irish study of high-density schizophrenia families: Evidence for possible etiologic heterogeneity. American Journal of Psychiatry, 154, 191–198.Google Scholar
Persons, J. B. (1986) The advantages of studying psychological phenomena rather than psychiatric diagnoses. American Psychologist, 41, 1252–1260.CrossRefGoogle ScholarPubMed
Pope, H. G. & Lipinski, J. F. (1978) Diagnosis in schizophrenia and manic–depressive illness. Archives of General Psychiatry, 35, 811–828.CrossRefGoogle ScholarPubMed
Rieder, R. O. (1974) The origins of our confusion about schizophrenia. Psychiatry, 37, 197–208.Google Scholar
Robins, E. & Guze, S. B. (1970) Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. American Journal of Psychiatry, 126, 107–111.CrossRefGoogle ScholarPubMed
Rosenhan, D. L. (1973) On being sane in insane places. Science, 179, 250–258.Google Scholar
Slater, E. (1971) Psychotic and neurotic illnesses in twins. In Man, Mind and Heredity: Selected papersof Eliot Slater on Psychiatry and Genetics (eds Shields, J. & 1.1. Gottesman). pp. 88–130. Baltimore, MD: Johns Hopkins Press.Google Scholar
Spitzer, R. L. (1975) On pseudoscience in science, logic in remission, and psychiatric diagnosis: A critique of Rosenhans “on being sane in insane places”. Journal of Abnormal Psychology, 84, 442–452.Google Scholar
Strauss, J. S. (1969) Hallucinations and delusions as points on continua function: Rating scale evidence. Archives of General Psychiatry, 21, 581–586.Google Scholar
Torrey, E. F. Bowler, A. E. Taylor, E. H. et al (1994) Schizophrenia and Manic-Depressive Disorder. New York: Basic Books.Google Scholar
Van Praag, H. M. (1997) Over the mainstream: Diagnostic requirements for biological psychiatric research. Psychiatry Research, 72, 201–212.CrossRefGoogle ScholarPubMed
Wing, J. K. Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. London: Cambridge University Press.Google Scholar
Winokur, G. & Tsuang, M. T. (1996) The Natural History of Mania, Depression and Schizophrenia. Washington, DC: American Psychiatric Press.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.