The introduction of modern operationalized classification systems for mental disorders has led to the issue of subthreshold disorders. Definitions for illness do not at the same time define health, e.g., in the sense of the World Health Organization (WHO) definition from 1947. The threshold not only to define disorders but also to define health is open to discussion. So-called subthreshold disorders require the definition of 2 thresholds. Empirical research has suggested that these "between-threshold disorders" are associated with increased disability and many other negative consequences. Part of the problem with subthreshold disorders is methodological in nature. Psychopathology and the Gestalt characteristic of psychopathological signs are ignored, and categorical instead of dimensional concepts are used. Thus, the distinction between syndromes and disorders, as well as the hierarchical structure of disorders, is not taken into account, and statistical problems with the prognostic power, which is dependent on the epidemiological distribution, are not solved. Variations in threshold definitions have important consequences for the individual and for society, be it because of the negative effects of "diagnostic labeling" or because of the costs to the health care system. Treatment options are presently rather insufficient, although modern sequential treatment algorithms and newer treatments (e.g., selective serotonin reuptake inhibitors [SSRIs] and Saint-John's-wort) promise interesting perspectives. Also in this context, self-help should become an important area of medical treatment research.

Anxiety Disorders↗

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Mutual patient-psychiatrist communication and the therapeutic contract.

The increasing complexity and subspecialization of medicine make the patient feel lost in the anonymity and strange complexity of modern hospitals, lead to a misunderstanding of the increasing risks and impact of modern treatments, and restrict personal communication due to the prevalence of a knowledge-oriented approach, to a shortage of time, and to insufficient communication skills. All of this may cause increasing dissatisfaction and complaints of patients. Therefore, it is a future task (1) to develop a concept of medicine and psychiatry well-balanced for science-based knowledge and the value-based art of communication, (2) to change the framework of communication in medical and psychiatric practice, and (3) to improve the training of physicians in communication skills in order to fulfill the therapeutic contract successfully.

Communication↗

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[Application of the AMDP system in diagnosis and prediction].

Starting from general considerations on the value of the AMDP-System in the diagnostic process, the authors summarize evaluation criteria which seem to be fulfilled within this System. They discuss possible diagnostic applications with regard to ICD-9 and operational diagnostic criteria; they present examples of syndromal diagnosis; they exemplify the possibility of a multiaxial diagnosis with the AMDP-System, and its place in prediction research. Finally, the diagnostic power of the AMDP-System and perspectives of future research and applications are presented.

Depressive Disorder↗

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[Classification and diagnostic problems of neuroses and psychosomatic disorders].

On the occasion of the 9th Revision of the International Classification of Diseases (ICD), the classification and diagnostic problems of neuroses and psychosomatic illnesses were discussed. First, the fundamental difficulties in the classification of mental illnesses were elucidated on the basis of the contrary nature of the nomothetic and idiographic approach. Next, practical problems were discussed with reference to a clinical case study; these problems arise due to the differing professional basic education and experience of the examiners, and they are amplified by the special nature of the term neurosis compared to other psychic disorders. Then, particular difficulties in the classification of psychosomatic illnesses were referred to. Finally, suggestions for future revisions in the ICD were worked out.

Diagnosis, Differential↗