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Viewpoint
March 11, 2020

Assessment of Psychopathology: Is Asking Questions Good Enough?

Author Affiliations
  • 1Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
  • 2Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
JAMA Psychiatry. Published online March 11, 2020. doi:10.1001/jamapsychiatry.2020.0108

The evaluation and success of our efforts to prevent, detect, and treat mental illness depend on the assessment of psychopathology. Almost all psychiatric assessments consist of asking questions, through questionnaires or interviews, about behaviors and experiences. We either ask the person being assessed or someone who knows them well. Based on the answers, we diagnose, recommend treatment, and monitor outcome. Regardless of who is reporting, overreporting and underreporting are common. People may overreport or underreport on purpose when they are hoping for benefits associated with a diagnosis (eg, educational support, time off work, or access to medication), or fearing the consequences of diagnosis, including stigma or adverse effects of medication. Beliefs about mental illness not being real, concerns about privacy, health insurance cost, and implications for custody of children are also reasons for underreporting.

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    1 Comment for this article
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    How Can I Help You: Response to Pavlova and Uher
    Leon Hoffman, MD | New York Psychoanalytic Society and Institute and Icahn School of Medicine at Mount Sinai
    Pavlova and Uher’s (1) Viewpoint article, “Assessment of Psychopathology: Is Asking Questions Good Enough?,” illustrates the problem with contemporary psychiatry. The authors conclude that diagnostic reliability would be increased by “incorporating objective and unbiased
    assessment in the work flow of research and clinical practice” (page E2).

    Contemporary psychiatry in its goal to becoming a more “scientific” profession has devalued the centrality of the doctor-patient relationship and the value empathic history-taking as a diagnostic tool. Ohm, et al (2) studied how medical students need to learn empathic communication as well as how to ask relevant clinical information during history-taking. In
    their review of the literature, they report a variety of studies that demonstrate that between 75 and 80% of diagnoses can be made with a good history, including citing the experience of Nobel Peace Price laureate Bernard Lown (page 2).

    Unfortunately, psychiatry has devalued the diagnostic role as well as the healing power of the doctor-patient relationship. Instead of asking a patient, before speaking with them, to first fill out a myriad of checklists and undergo a variety of standardized tests, the psychiatrist should first ask, “How can I help you” (3).

    (1) Pavlova B, Uher R. Assessment of Psychopathology: Is Asking Questions Good Enough? JAMA Psychiatry. Published online March 11, 2020. doi:10.1001/jamapsychiatry.2020.0108
    (2) Ohm, F., Vogel, D., Sehner, S. et al. Details acquired from medical history and patients’ experience of empathy – two sides of the same coin. BMC Med Educ 13, 67 (2013). https://doi.org/10.1186/1472-6920-13-67
    (3) Hoffman, L. How Can I Help You? Dimensional versus Categorical Distinctions in the Assessment for Child Analysis and Child Psychotherapy. Journal of Infant, Child, and Adolescent Psychotherapy, 19:1, 1-15, DOI: 10.1080/15289168.2019.1701866
    CONFLICT OF INTEREST: None Reported
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