Diagnosis: harmonising knowledge of the field with the uniqueness of the patient

The patient is not the illness

Prof Michael Musalek (Anton Proksch Institute, Austria) spoke of dehumanisation - when the patient is reduced to a disorder to fix instead of an ill person. But the patient is not the illness.

The patient’s current state does not define them. It is not enough to just record symptoms. Clinicians are part of the process of growth and development.

‘The challenge in the therapeutic process is not only to recognise the significance of the disorders' pathology but also to find ways out of the imagined impossibilities by opening up new possibilities and uncovering resources of the suffering human’ Michael Musalek.

Biomarkers

Prof Christiane Montag (Charité – Universitätsmedizin Berlin, Germany) concluded that there is a lack of validated methods to measure potential biomarkers. There is not enough evidence to include biomarkers in the classification process, or in clinical diagnostics or response prediction.

One world, one language

This was the theme of the 1996 World Congress of Psychiatry in Madrid. Twenty years later in the same historic city, the message of the 2016 EPA congress is strikingly similar - towards a common language in European psychiatry.

Prof Marianne Kastrup (speciallæge i psykiatri, Denmark) discussed the importance of a common language in psychiatry that takes cultural dimensions into account. During diagnosis, the patient’s diversity must be considered - how they express mental distress, and their social and cultural context.

The use of the Cultural Formulation - developed as part of DSM-IV - aims to explore cultural, religious and social background. It seeks to understand the patient’s perception and expression of illness, and their treatment expectations. Importantly, it contributes to diagnostics by including cultural factors and their significance. This model supports a review of culture and context in diagnosis.

Two people in the room

Prof Levent Küey (Istanbul Bilgi University, Turkey) shared his experience of his first interview with a psychiatry patient. After more than an hour, his patient commended him for working hard and pointed out that he was sweating. It struck him that while he was observing his patient; his patient was also observing him. There were two people in the room.

‘Harmonise knowledge of the field with the uniqueness of the patient’ Levent Küey.

The first goal of the clinical encounter and interaction should be setting a strong therapeutic alliance. This relationship improves treatment adherence and outcome.

No reductionism

Prof Küey emphasised that we need to move away from linear reductionism in which the patient comes into the clinic, is diagnosed and given pills, and then drops out. Clinical work should be a joint, ongoing, reconstruction process.

Prof Montag also addressed the need to move away from reductionism. Personalised psychiatry should target personhood.