Psychiatric diagnostic dilemmas in the medical setting.
OBJECTIVE
To review the problems posed for doctors by the failure of existing taxonomies to provide a satisfactory method for deriving diagnoses in cases of physical/psychiatric comorbidity, and of relating diagnoses on multiple axes.


METHODS
Review of existing taxonomies and key criticisms. The author was guided in selection by his experience as a member of the working parties involved in the creation of the American Psychiatric Association's DSM-IV.


RESULTS
The attempts of the two major taxonomies, the ICD-10 and the American Psychiatric Association's DSM-IV, to address the problem by use of glossaries and multiple axes are described, and found wanting. Novel approaches, including McHugh and Slavey's perspectives of disease, dimensions, behaviour and life story, are described and evaluated. The problem of developing valid and reliable measures of physical/psychiatric comorbidity is addressed, including a discussion of genetic factors, neurobiological variables, target markers and other pathophysiological indicators. Finally, the concept of depression as a systemic illness involving brain, mind and body is raised and the implications of this discussed.


CONCLUSIONS
Taxonomies require major revision in order to provide a useful basis for communication and research about one of the most frequent presentations in the community, physical/psychiatric comorbidity.
Strain
James J
JJ
Division of Behavioral Medicine and Consultation Psychiatry, Mount Sinai/NewYork University Medical Center, Box 1230, New York, New York 10029, USA. jim_strain@hotmail.com
D015897:Comorbidity; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D038801:International Classification of Diseases; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D019965:Neurocognitive Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D011320:Primary Health Care; D011570:Psychiatry; D011602:Psychophysiologic Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D011603:Psychophysiology; D012017:Referral and Consultation