Year : 2015  |  Volume : 57  |  Issue : 4  |  Page : 436-

Delving into the perpetual debate in psychiatry


Sujata Sethi, Vijay Walia 
 Department of Psychiatry, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India

Correspondence Address:
Sujata Sethi
Department of Psychiatry, Pt. B.D. Sharma PGIMS, Rohtak, Haryana
India




How to cite this article:
Sethi S, Walia V. Delving into the perpetual debate in psychiatry.Indian J Psychiatry 2015;57:436-436


How to cite this URL:
Sethi S, Walia V. Delving into the perpetual debate in psychiatry. Indian J Psychiatry [serial online] 2015 [cited 2020 May 27 ];57:436-436
Available from: http://www.indianjpsychiatry.org/text.asp?2015/57/4/436/171853


Full Text

Sir,

Article titled “Age of onset of dependence-Does it help our understanding of opioid dependence by generating categories or by acting as a useful dimension? A critical examination of the classic debate in psychiatry"[1] made an interesting reading. The debate about the categorical versus dimensional approach to diagnosis in psychiatry was termed as the classical debate by Kraemer et al.,[2] the debate that would help us to understand the nature and etiology of psychiatric disorders. Using the case of age of onset of opioid dependence (AOOD) authors have attempted to analyze this debate. As suggested by the authors, AOOD is indeed a very simple and clinician friendly variable. Previously De et al.[3] also used the same variable to classify the patients into two subtypes: Early onset (EO) with a mean AOOD 21 years and late onset (LO) with mean AOOD 27 years. Based on this finding, authors divided the study sample into two groups: EO <20 years and LO >22 years, omitting the year 21 just because the study by De et al.[3] showed that AOOD tended to peak around age 21 years. This omission brings in a methodological issue of creating “categories” out of a continuous variable of age. Recall bias is a common problem, and when two groups have almost no gap, that is, 20 years versus 22 years, one can easily fall into the “other” category. [Table 4] of the article [1] depicts this nicely and also points out the problem of recall bias, that is, age of onset of opioid use and AOOD are not very different, especially for EO group.

Further such narrow (age wise) categories were bound to yield no difference. It is very understandable that age gap of 1 or 2 years would not affect the variables under study. Wider age gaps probably would have given us more insight into the issue at hand, as well as a very simple variable AOOD, would have settled the classical debate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Basu D, Ghormode D, Madan R, Mattoo S, Nehra R, Prabhakar S. Age of onset of dependence: Does it help our understanding of opioid dependence by generating meaningful categories or by acting as a useful dimension? A critical examination of the classic debate in psychiatry. Indian J Psychiatry 2014;56:228-37.
2Kraemer HC, Noda A, O'Hara R. Categorical versus dimensional approaches to diagnosis: Methodological challenges. J Psychiatry Res 2004;38:17-25.
3De B, Mattoo SK, Basu D. Role of age of onset of opioid dependence in subtyping opioid dependent educated male patients. Am J Addict 2003;12:336-45.