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DIAGNOSTIC UNCERTAINTY AND THERAPEUTIC DECISION

The importance of differential diagnosis depends on the possibilities given for a safer therapeutic decision and a better judgement of prognosis. It is of only trifling interest to distinguish between adjacent states without alternative therapies or different courses, and the nosological model gets its significance in this connection. We choose our information for the description of disease to get a better prediction of therapy and prognosis. Many authors have emphasized the slight coherence between psychiatric diagnosis and therapy, as Overall et al. (1972) formulate it: “The diagnostic classification of psychiatric patients is, at best, an indirect and only moderate relevant basis for selection of drug treatment.” The certainty of diagnosis must therefore often be based on a concensus of psychiatrists, which is a rather unsatisfying state of affairs. Also in the psychiatric field, diagnosis ought to be a valid argument for decisions and based on reliable information. See also Wittenborn (1972) and Little (1968). In the present paper we will try to evaluate the validity of our diagnostic decisions for therapy, and the consistency of our implicit decision rules (Bross (1965)).