Beyond Diagnostic Categories: Comprehensive Assessment of Psychopathology in Addiction and Mental Health Disorders

By Kumari, Veena | Psychology Today, May 1, 2017 | Go to article overview

Beyond Diagnostic Categories: Comprehensive Assessment of Psychopathology in Addiction and Mental Health Disorders


Kumari, Veena, Psychology Today


To optimize treatment outcomes for people with addiction and mental health disorders, clinicians must first have a better understanding of their psychopathology and individual needs. A brief diagnostic interview to generate a diagnosis is insufficient for formulating or delivering an effective treatment plan. This is particularly problematic in psychiatry given the remarkable overlap of symptoms across formal diagnostic categories. The most appropriate evidence-based therapies are likely to be initiated only if there is reliable and quantifiable information about the presence and severity of specific symptoms.

Recent initiatives (The Kennedy Forum, 2015) have strongly advocated regular and quantifiable assessment of psychopathology in the field of behavioral health. A number of patient- and clinician-rated scales are also available that reliably capture a wide range of disorder-specific and general symptoms, and are sensitive to changes in the frequency and severity of symptoms over time. The use of such rating scales is needed not only to devise and initiate the most appropriate treatment plans for individual patients but also to monitor their clinical progress and adjust the treatment duration and modalities if indicated. Without the systematic monitoring of symptoms, clinicians may fail to detect a worsening of symptoms in their patients in a timely manner and thus miss opportunities to adjust the treatments accordingly. The use of rating scales in routine clinical practice has further advantages. It allows a meaningful evaluation of routine clinical practices, which in turn facilitates quality improvement efforts. Patients who frequently complete symptom rating scales may also, as a result, develop greater insight into their symptoms, improving self-management. In particular, they may learn to monitor their symptoms increasing awareness of potential triggers and warning signs of symptom reoccurrence or relapse; this may empower them to seek treatment without delay or reduce the severity of an acute episode.

A systematic and structured monitoring of symptom changes over time may also generate new knowledge in terms of the dynamics within symptom networks. There may be reciprocal interactions between the symptoms of a disorder (Borsboom & Cramer, 2013). It is plausible that a particular event might trigger one or more specific symptoms, which in turn gives rise to other symptoms, with a modulatory influence on the symptom/s initially triggered. …

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