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An Integrative Paradigm for Mental Health Care pp 127–150Cite as

History-Taking, Assessment, Diagnosis, and Formulation

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Abstract

Current methods in psychiatric assessment and diagnosis are reviewed and critiqued. Problems encountered when evaluating causes and meanings of cognitive, affective, and behavioral symptoms are described. The ambiguous status of “disorder” in psychiatry and problems in the Diagnostic and Statistical Manual are discussed. Criteria used to classify affective, cognitive, and behavioral states as “disorders” vary widely across cultures and there is no consensus definition of what constitutes a “mental disorder.” The goals of the interview and formulation in integrative mental health care are described. Approaches widely used in Western medicine and CAM to assess mental health problems are described and their limitations are pointed out. Most CAM assessment approaches that have been carefully evaluated in Western-style research studies have resulted in findings that are not reproducible, sensitive, or specific. Novel practitioner-centered assessment approaches and emerging technologies will permit future integrative practitioners to capture information that is unattainable using contemporary biomedical assessment approaches. A general methodology is introduced for planning integrative assessment incorporating biomedical and CAM approaches. A methodology is introduced for determining the optimal individualized assessment strategy, that is, the strategy that will most reliably yield accurate and complete information about the causes and meanings of symptoms in a unique patient. Finally, important considerations when making clinical decisions on the type, number, and order of assessment approaches are discussed.

“The value of experience is not in seeing much, but in seeing wisely.”

—Sir William Osler MD

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Authors and Affiliations

  1. Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ, USA

    James H. Lake

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Lake, J.H. (2019). History-Taking, Assessment, Diagnosis, and Formulation. In: An Integrative Paradigm for Mental Health Care. Springer, Cham. https://doi.org/10.1007/978-3-030-15285-7_7

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