What do clinicians treat: Diagnoses or symptoms? The incremental validity of a symptom-based, dimensional characterization of emotional disorders in predicting medication prescription patterns
Open accessAbstract
Background Although practice guidelines are based on disorders specified in diagnostic manuals, such as the DSM, practitioners appear to follow symptoms when making treatment decisions. Psychiatric medication is generally prescribed in a transdiagnostic manner, further highlighting how symptoms, not diagnoses, often guide clinical practice. A quantitative approach to nosology promises to provide better guidance as it describes psychopathology dimensionally and its organization reflects patterns of covariation among symptoms.Aim To investigate whether a quantitative classification of emotional disorders can account for naturalistic medication prescription patterns better than traditional diagnoses.Methods Symptom dimensions and DSM diagnoses of emotional disorders, as well as prescribed medications, were assessed using interviews in a psychiatric outpatient sample (N=318, mean age 42.5years old, 59% female, 81% Caucasian).Results Each diagnosis was associated with prescription of multiple medication classes, and most medications were associated with multiple disorders. This was largely due to heterogeneity of clinical diagnoses, with narrow, homogenous dimensions underpinning diagnoses showing different medication profiles. Symptom dimensions predicted medication prescription better than DSM diagnoses, irrespective of whether this was examined broadly across all conditions, or focused on a specific disorder and medication indicated for it.Conclusions Psychiatric medication was prescribed in line with symptoms rather than DSM diagnoses. A quantitative approach to nosology may better reflect treatment planning and be a more effective guide to pharmacotherapy than traditional diagnoses. This adds to a diverse body of evidence about superiority of the quantitative system in practical applications and highlights its potential to improve psychiatric care.
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In a sample of 318 patients, the diagnosis of PTSD was not associated with the prescription of any specific medication class, while symptom clusters were: anticonvulsant prescription was linked to avoidance symptoms, antidepressant prescription to numbing symptoms, anxiolytic prescription to intrusions, and mood stabilizer prescription to hyperarousal.
“For example, in a sample of 318 patients, the diagnosis of PTSD was not associated with the prescription of any specific medication class, while symptom clusters were: anticonvulsant prescription was linked to avoidance symptoms, antidepressant prescription to numbing symptoms, anxiolytic prescription to intrusions, and mood stabilizer prescription to hyperarousal 71 .”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [71]
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- Authors
- Waszczuk, M. A., Zimmerman, M., Ruggero, C., Li, K., MacNamara, A., Weinberg, A., Hajcak, G., Watson, D., & Kotov, R.
- Affiliations
- Stony Brook University (US)
- Brown University (US)
- University of North Texas (US)
- Texas A&M University (US)
- McGill University (CA)
- University of Notre Dame (US)
- Corresponding author
- Kotov, Roman
- ORCID
- Venue
- Comprehensive Psychiatry
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 79
- Pages
- 80-88
- ISSN
- 0010-440X (ISSN-L)
- PMC
- PMC5643213
- OpenAlex
- W2606348847
- Cited by
- 106
- References
- 50
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 11 · 2023: 26 · 2022: 14 · 2021: 13 · 2020: 8 · 2019: 11 · 2018: 2 · 2017: 3
- FWCI
- 8.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Comprehensive Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Feldstein Medical Foundation
- NIMH (K23MH105553)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- symptom dimensions, emotional disorders, incremental validity, outpatient psychiatric care, treatment planning, psychopharmacological treatment
- MeSH terms
- Adolescent, Adult, Aged, Female, Forecasting, Humans, Male, Middle Aged, Outpatients, Physician's Role, Drug Prescriptions, Psychopathology, Reproducibility of Results, Mood Disorders, Young Adult
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