DSM III and consultation-liaison psychiatry: toward a comprehensive medical model of the patient

Abstract

The descriptive and multiaxial approaches in DSM III encourage comprehensive conceptualization of the patient. The use of explicit criteria for diagnosing syndromes facilitates communication between psychiatry and general medicine. The DSM III category Psychological Factors Affecting Physical Condition should be further elaborated into (a) Psychiatric Factors Affecting Physical Condition, and (b) Physical Condition Affecting Psychiatric Disorder. In addition, the phase of the illness these factors affect should be specified, i.e., the precipitation, course, and recovery. Somatoform Disorder should not be a diagnosis of exclusion, and the diagnostic criteria should clearly specify that conversion symptoms may be superimposed on a pre-existing physical disorder. The DSM III axes are not coherent: they include diagnostic categories, statements concerning possible relationships, and factors that might affect outcome. We propose an alternative to the DSM III Axes based on the Patient Evaluation Grid (PEG), a system comprised of four axes, including Biological Dimension, Personal Dimension, Environmental Dimension, and Assessment of Interaction Among Dimensions. Developing a comprehensive diagnostic model for both medical and psychiatric patients that can be shared by all physicians may be an important function of the liaison psychiatrist.