Click on this link for the actual concept map. A click on the diagram will zoom it for viewing. Another click will zoom out. Navigate by mouse wheel or scroll bars. It should print out onto one standard sheet of paper in a landscape view.
I am interested in feedback from psychiatrists on what aspects they would modify. If you have suggestions about what should be modified post them in the comments section or send me an e-mail.
The concept map may also be useful for explaining some findings that are commonly held up as "problems" with the diagnosis such as low reliability. A common ( and purely hypothetical) example would be the 35 year old patient with a clear diagnosis of depression as a teenager, no history of remission of symptoms and multiple antidepressant trials who develops a polysubstance dependence (alcohol, cocaine, heroin) problem who is being seen in various states of withdrawal for the treatment of depression, insomnia and suicidal ideation. At this point does the patient have major depression, dysthymia, substance induced depression, or depression due to withdrawal symptoms? What would tell you more about this patient's problems - a psychiatric diagnosis or a PHQ-9 score? What would be more helpful in developing a treatment plan?
This answer to that question is the difference between medical quality and a term that is frequently substituted by governments and managed care companies. That term is "value". Governments and managed care companies apparently believe that giving someone an antidepressant medication for a PHQ-9 score is a better value than a psychiatric evaluation.
George Dawson, MD, DFAPA