The Geezer’s Triumvirate for Psychiatric Diagnosis

I just got my copy of “Systematic Psychiatric Evaluation: A Step-by-Step Guide to Applying The Perspectives of Psychiatry”  by Chisolm and Lyketsos [1]. It’s based on McHugh and Slavney’s book, “The Perspectives of Psychiatry” as the title suggests. Most of my contemporaries and I who were trained at The University of Iowa and at Johns Hopkins were raised, so to speak, on the perspectives approach to psychiatric diagnostic assessment.

There are now 3 guides to psychiatric diagnostic assessment which, in my view, are essential for trainees and clinicians in psychiatry; call them the Geezer’s triumvirate for psychiatric diagnosis:

  1. “Essentials of Psychiatric Diagnosis” by Dr. Allen Frances, MD, whose 12 tips on diagnostic assessment I’ve codified in a Dirty Dozen, The Dirty Dozen on Dr. Allen Frances’ General Tips for Psychiatric Diagnosis – The Practical Psychosomaticist.
  2. “Systematic Psychiatric Evaluation” by Drs. Chisolm and Lyketsos.
  3. The DSM-5.

I don’t think it makes any sense to prefer one exclusively over the other two. They are complementary. I think the trick will be integrating the pearls from all three into my daily work as a psychiatrist, while remaining aware of their limitations. What are your favorites?

1. Chisolm, M. S., M. E. Peters, et al. (2012). “Clinical excellence in psychiatry: a review of the psychiatric literature.” Prim Care Companion CNS Disord 14(2).

Objective: The provision of excellent patient care is a goal that physicians would like to achieve in caring for all patients, all of the time. Until recently, clinical excellence had not been defined, and the extent to which this recently published definition applies to the care of patients with psychiatric illness is not known. This article sets out to consider how the paradigm for clinical excellence applies to the field of psychiatry. Data Source: PubMed, Ovid MEDLINE, and PsycINFO were searched (1962 through December 2010) combining the keywords psychiatry (or psychiatrist) and clinical excellence, limiting the output to English-language case reports. In subsequent searches, the term clinical excellence was replaced by each of the components of the definition: communication and interpersonal skills, professionalism and humanism, diagnostic acumen, skillful negotiation of the health care system, knowledge, scholarly approach to clinical practice, exhibiting a passion for patient care, explicitly modeling mastery to medical trainees, and collaborating with investigators to advance science and discovery. Study Selection: The search yielded 218 case reports. All of the case reports were reviewed, and a consensus was reached on the 8 exemplars and 1 teaching model to be presented in the article. Careful consideration was given as to whether any aspects of the framework for clinical excellence were missing or not applicable for psychiatry.Results Every case report reviewed touched on 1 or more of the domains of clinical excellence. None of the case reports uncovered new aspects of clinical excellence that were not described in the existing definition.Conclusions: This review of the case reports published in psychiatry reveals that the definition of clinical excellence described in this article may be highly applicable to those caring for patients with psychiatric illness. Clinical Excellence in Psychiatry: A Review of the Psychiatric Literature.

Related post: Clinical Excellence in Psychiatry and Integrated Care: Can We Have Both? – The Practical Psychosomaticist