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Unrecognized Mental Illness in Primary Care-Reply
Edmund S. Higgins, MD
Medical University of South Carolina Charleston
Arch Fam Med. 1995;4(7):581.
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| Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings. |
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In reply
Samuelson raises a good point about the poor predictive values for tests that are applied to populations with a low prevalence of the disorder. This is even further complicated in psychiatry by the lack of a true gold standard. The psychiatric gold standard has become a structured interview based on the criteria from the third, revised third, or fourth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Unfortunately, the criteria in DSM-III, DSM-III-R, or DSM-IV are based on indirect assessments of the disorders and only represent our best guess about what differentiates the mentally ill from the mentally well. The "fuzzy" nature of the criteria along with the increased false positives, as noted by Samuelson, inflates the estimates of unrecognized psychiatric disorders in primary care patients.
. . . [Full Text PDF of this Article]
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