November 2016 – The Cognitive Kitchen


The Mental Health Cognitive Kitchen – Recipes for a better understanding of Mental Health conditions.

The Ingredients of the Diagnosis

How do we determine if someone has a medical condition?  We use tests such as MRIs and X-rays. From those tests medical conditions can be discerned and then treated appropriately. With a mental health condition there are no X-rays, lab tests or MRIs.

The “X-rays” for mental health conditions are the criteria for each condition found in the Diagnostic and Statistical Manual 5 (DSM 5).  Accurately diagnosing mental health conditions is complex. You talk with the patient about their symptoms. Use caution: people can under-report or over-report symptoms. They may even avoid telling the truth (e.g., I am just a social drinker…). Psychosocial factors impact self-report and motivation of the patient. Job dissatisfaction or workplace performance are factors that can impact the veracity of a self-report. If the provider can obtain collateral information that adds to the accuracy of the diagnosis.

There is a significant challenge with diagnosing mental health conditions; time.  How many providers have time to meet with a patient for an hour to obtain this information? Typically, medical providers such as the family physician render the diagnosis in about 5-10 minutes. How does that affect accuracy?

Time and adequacy of assessments have been studied in worker’s compensation. In 2009, Dr. Pamela Warren published research on assessments for mental health conditions. She found 22% had an adequate assessment, 48% had a superficial assessment and 30% had no assessment.  This is due to the experience of the provider (mental health provider compared to medical provider) and time available to conduct the assessment.  This suggests there is a high probability the diagnosis will not be accurate.

The recipe then for a good diagnosis are based on several key pieces.

The first ingredient is sage; which provider renders the diagnosis. While both psychiatrists and psychologists are mental health specialists, generally psychiatrists have limited time available due to patient load. The structure for the psychologists’ work is a clinical hour. Psychologists are specially trained in utilizing the DSM 5. The diagnosis can be well thought out with enough time. The diagnosis is provided after one to two clinical hours.

The second ingredient is salt or pepper; the administration of tests such as the Beck Depression Inventory, Beck Anxiety Inventory.  They have some limitations, as they are based on self-report. The patient can under or over-report symptoms. However, these tests can add a nice flavor (validation) to the diagnostic impression.

The third ingredient is spice; collateral contact with others. Spouses, significant others, family or friends aid in verifying the patient’s self-report.  How they see the patient rounds out the diagnostic picture. This is of particular value when the diagnosis may be substance abuse, bipolar disorder or a personality disorder.

The final ingredient is the cooking time; it varies somewhat. However, when the diagnosis is “slow cooked” or “simmered” the end result is a much more robust full diagnostic picture. From that picture, the next recipe can be prepared; treatment for the condition.

See Part II.

Kate Harri can be contacted at


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