Psychiatric classification — structured clinical viva

This viva tests whether you can reject both naive reification ("manuals are nature") and nihilism ("abandon diagnosis"). Markers want the R-V-U split, dual-system fluency, honest reliability data, correct placement of HiTOP/RDoC as research frameworks, ICD-11 psychosis updates, and formulation/risk after the label.[1][4][8]

Three purposes: clinical communication and care pathways; research sampling and trial eligibility; public health statistics and service planning (ICD). Diagnosis is a working construct with criteria, duration, impairment, exclusions — not automatically a single biomarker disease.[1][3]

Reliability = agreement (test–retest/inter-rater; DSM-5 field trials showed variable kappas). Validity = construct/predictive truth. Utility = usefulness for care. Modest reliability does not automatically abolish utility; high reliability does not prove validity.[1][2]

Both support a primary psychotic disorder / schizophrenia spectrum working diagnosis after organic and substance contributions are assessed. ICD-11 emphasises spectrum of primary psychotic disorders with updated duration/course concepts and less privilege for first-rank symptoms as pathognomonic. DSM-5-TR schizophrenia spectrum criteria remain polythetic with duration and impairment rules. Cannabis may warrant substance-induced or dual coding depending on temporal relation — keep provisional if unclear. State which system you apply.[6][3]

HiTOP: hierarchical dimensional spectra explaining comorbidity structure — research/measurement advance, not a billing manual. RDoC: domains × units of analysis research framework for mechanisms/precision psychiatry — not a clinical codebook. Neither replaces ICD coding or guideline-based acute care today.[4][5][7]

Diagnosis selects evidence (antipsychotic, early intervention model). Formulation explains vulnerability, cannabis, sleep, family EE, strengths. Risk assessment is separate (suicide, violence, vulnerability). Abandoning manuals would harm communication and access; worshipping manuals without formulation harms care.[8][1]

"I will not abandon clinical classification: it enables care, research, and statistics. I will not reify it: reliability is imperfect, validity partial, and utility must be earned. I use ICD-11/DSM-5-TR dual fluency, dimensional severity where available, HiTOP/RDoC as research lenses, and formulation plus risk as the bridge from label to this person."[1][4][8]