WHO iCAMP ICD-ICF Linkages Meeting: New documents on ICD-11 Revision site

WHO iCAMP ICD-ICF Linkages Meeting, Geneva, 28–29 January 2010: New documents on ICD-11 Revision site

Post #12 Shortlink: http://wp.me/pKrrB-v8

A two day iCAMP Face-to-Face Meeting was held on 28 to 29 January, in Geneva, Switzerland.

ICF = International Classification of Functioning, Disability and Health

Wikipedia article

“International Classification of Functioning, Disability and Health, also known as ICF, is a classification of the health components of functioning and disability. The ICF classification complements WHO’s International Classification of Diseases-10th Revision (ICD), which contains information on diagnosis and health condition, but not on functional status. The ICD and ICF constitute the core classifications in the WHO Family of International Classifications (WHO-FIC).”

List of Participants, Meeting Agenda, Background Documentation, PowerPoint presentations and other documents can be found here on the Face-to-Face Meeting page, ICD-11 Revision Site: ICD-ICF Linkages Meeting

Three documents that may be of interest:

Note: It is not yet known how much textual content might be included in ICD-11: Volume 1, and ICD-11: Volume 3: The Alphabetical Index, for the terms that are the focus for this site. But this is the most recent version of this important document and it needs to be scrutinised.

Style Guide for the Content Model of the ICD-11 Alpha draft

The “Content Model” identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.

Most recent version of Content Model Style Guide (at 27.01.10)

Note: Project milestones on Page 5 gives a release date for the ICD-11 Alpha draft as February 2010.  Other current ICD Revision resources give a date of May 2010.

ICD Revision Project Executive Summary

Project milestones and budget, and organizational overview  Page 5

New document: ICD Revision Project Executive Summary (at 25.01.10)

Alpha Drafting Workflow

Sets out lines of responsibility between the various contributors for the alpha drafting phase.
TAG = Topic Advisory Group; RSG = Revision Steering Group.

• TAG members and TAG workgroup members
• Classification Experts. (mainly the experts on the classification with respect to the mortality and morbidity use cases)
• TAG managing Editors
• Reviewers who are asked to review portions of the content in a structured fashion
• TAGs
• RSG
• WHO

Alpha Drafting Workflow (at 06.10.09)

Additional resources and documents are being posted by ICD Revision on a dedicated public access site. Some of these documents are works in progress and subject to internal review and revision. Please refer to the site for the most recent versions. The three documents posted here are as they stood at 28 January 2010.

ICD-11 Revision site  |  Revision and iCAMP meeting resources

ICD-11 Revision site Documents Page  |  Key revision documents

ICD-11 and DSM-V focussed editorials and articles in Advances in Psychiatric Treatment, Jan 10

ICD-11 and DSM-V (DSM-5) focussed editorials and articles in January 2010 edition of Advances in Psychiatric Treatment

Post #11 Shortlink: http://wp.me/pKrrB-up

In the January 2010, Volume 16, Issue 1 edition of Advances in Psychiatric Treatment there are two editorials and an article around ICD-11 and DSM-V (DSM-5) revision classificatory issues.

The Bouch editorial commentary, the Sartorius editorial and the Thornicroft et al article all include brief references to “chronic fatigue syndrome”.

[Subscription or payment required for access to full editorials and articles.]

Adv. Psychiatr. Treat., Jan 2010; 16: 1.

FROM THE EDITOR

Joe Bouch: Classification

[No abstract available]

“….Nevertheless, as diagnosis is intended to be one of the strongest assets of a psychiatrist (Tyrer 2009), clinicians need to think about and be involved in the forthcoming revisions and harmonisation of the two major classifications ICD and DSM. Sartorius (pp. 2-9) gives a behind-the-scenes view of the revision process. There are many vested interests: not just clinicians, but governments and NGOs, lawyers, researchers, public health practitioners, Big Pharma and patient groups. Vast sums are at stake – everything from welfare benefits and compensation claims to research budgets. Concerns include the use of national classifications to facilitate political abuse and of diagnostic labels that are seen as stigmatising or are used to stigmatise. Like Sartorius, Thornicroft (pp. 53-59) singles out chronic fatigue syndrome, bitterly contested in terms of its status as a physical, psychiatric or psychosomatic condition and viewed by healthcare staff as a less deserving category.

“Should the classifications use categories or dimensions? A dimensional approach seems impractical, although dimensions could be used to augment categorical definitions, as with severity of depression…”

Advances in Psychiatric Treatment (2010) 16: 2-9. doi:10.1192/apt.bp.109.007138

Revision of the classification of mental disorders in ICD-11 and DSM-V: work in progress

Editorial: Norman Sartorius

“…In ICD-10 (World Health Organization 1992a), the chapter dealing with mental disorders contains several categories that appear in other chapters as well. Thus, dementia can be found in the chapter of mental disorders, because of its predominantly psychiatric symptoms, and in the chapter of neurological diseases, because it is a brain disease that can be the cause of death. A number of the psychiatric syndromes that occur in the course of other diseases are listed in the chapter of mental disorders as well as in chapters describing other conditions. For example, general paresis is listed in the chapter of mental disorders and in the chapter dealing with syphilis and other contagious diseases. Some of the categories that one would expect to find in a chapter devoted to mental disorders have been placed elsewhere, mainly because of pressures exerted by those who did not want to be labelled by any particular psychiatric diagnosis. Thus, for example, chronic fatigue syndrome, which was listed together with neurasthenia for a long time, is now in the chapter containing infectious diseases which are supposed to be causing it*, and premenstrual dysphoric states are in the chapter dealing with gynaecological disorders…”

*Ed:It’s unclear what Sartorius means, here:

Chronic fatigue syndrome is indexed in Volume 3: The Alphabetical Index to G93.3: Chapter VI: Diseases of the nervous system (G00-G99) > Other disorders of the nervous system (G90-99) > G93 Other disorders of brain > G93.3: Postviral fatigue syndrome; Benign myalgic encephalomyelitis.

Abstract:

Revision of the classification of mental disorders in ICD-11 and DSM-V: work in progress

Norman Sartorius

Norman Sartorius is President of the Association for the Improvement of Mental Health Programmes and holds professorial appointments at the Universities of London, Prague and Zagreb and at several other universities in the USA and China. Dr Sartorius was a member of the WHO’s Topic Advisory Group for ICD-11 and a consultant to the American Psychiatric Research Institute, which supports the work on the DSM-V. He has also served as Director of the Division of Mental Health of the WHO and was the principal investigator of several major international studies on schizophrenia, on depression and on health service delivery. He is a past President of the World Psychiatric Association and of the Association of European Psychiatrists.

Correspondence: Correspondence Professor N. Sartorius, 14, chemin Colladon, 1209 Geneva, Switzerland. Email: sartorius@normansartorius.com

This editorial summarises the work done to prepare ICD-11 and DSM-V (which should be published in 2015 and 2013 respectively). It gives a brief description of the structures that have been put in place by the World Health Organization and by the American Psychiatric Association and lists the issues and challenges that face the two organisations on their road to the revisions of the classifications. These include dilemmas about the ways of presentation of the revisions (e.g. whether dimensions should be added to categories or even replace them), about different versions of the classifications (e.g. the primary care and research versions), about ways to ensure that the best of evidence as well as experience are taken into account in drafting the revision and many other issues that will have to be resolved in the immediate future.

Advances in Psychiatric Treatment (2010) 16: 14-19. doi:10.1192/apt.bp.109.007120

The classification of mental disorder: a simpler system for DSM-V and ICD-11

David Goldberg

Sir David Goldberg is Professor Emeritus and a Fellow of King’s College London. He has devoted his professional life to improving the teaching of psychological skills to doctors of all kinds, and to improving the quality of services for people with severe mental illness. After completing his psychiatric training at the Maudsley Hospital, he went to Manchester, where for 24 years he was Head of the Department of Psychiatry and Behavioural Science. In 1993 he returned to the Maudsley as Professor of Psychiatry and Director of Research and Development.

Correspondence: Correspondence Professor Sir David Goldberg, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK. Email: David.Goldberg@iop.kcl.ac.uk

This article proposes a simplification to the chapter structure of current classifications of mental disorder, which cause unnecessary estimates of ‘comorbidity’ and pay major attention to symptom similarity as a criterion for deciding on groupings. A simpler system, taking account of recent developments in aetiology, is proposed. There is at present no simple solution to the problems posed by the structure of our classification, but the advantages as well as the shortcomings of changing our approach to diagnosis are discussed.

Related material in APT:

Advances in Psychiatric Treatment (2010) 16: 53-59. doi:10.1192/apt.bp.107.004481

Discrimination against people with mental illness: what can psychiatrists do?

Graham Thornicroft, Diana Rose and Nisha Mehta

“…Other diagnostic groups also appear to be less popular with healthcare staff. Chronic fatigue syndrome is bitterly contested in terms of its status as a physical, psychiatric or psychosomatic condition and arouses controversy about its causation and treatment. People who have been given or assumed this diagnosis often describe experiences of rejection by both general and mental health staff Davidson 2005)…”

Discrimination against people with mental illness: what can psychiatrists do?

Graham Thornicroft, Diana Rose and Nisha Mehta

Graham Thornicroft is Professor of Community Psychiatry at the Institute of Psychiatry, King’s College London, and a consultant psychiatrist and Director of Research and Development at the South London and Maudsley NHS Foundation Trust. Diana Rose is a senior lecturer and Co-Director of the Service User Research Enterprise, Institute of Psychiatry, which conducts service-user led research in the field of mental health. Professor Thornicroft and Dr Rose are also members of the National Institute for Health Research Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust/ Institute of Psychiatry, and are supported by the NIHR Sapphire Applied Research Programme. Nisha Mehta is a medical student at the School of Medicine, King’s College London, and is undertaking research related to stigma, discrimination and mental health.

Correspondence: Correspondence Professor Graham Thornicroft, Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK. Email: graham.thornicroft@kcl.ac.uk

This article discusses the evidence that experiences of stigmatisation and discrimination among people with mental illnesses are common and may be severe. Furthermore, there are growing concerns that people with mental illness receive second-class physical healthcare. Beyond this, some aspects of psychiatric practice are reported as being insensitive, disrespectful or even disabling. We consider whether such claims are justified and what psychiatrists can do, directly and indirectly, to reduce stigma and discrimination and improve our practice.

Notes:

1] The APA now plans to publish draft proposals for changes to diagnostic criteria on 10 February. The Alpha Draft for ICD-11 is currently timelined for May 2010.

2] DSM-V Somatic Symptom Disorders Work Group proposals so far can be found at: DSM-5 and ICD-11 Watch at: http://wp.me/PKrrB-hT

3] The Academy of Psychosomatic Medicine November ’09 Annual Meeting slide presentations here:

Francis Creed, MD, FRCP: Can We Now Explain Medically Unexplained Symptoms?


PDF Creed Presentation Slides (No transcript)

      Creed Presentation Slides

       Creed References

(A lengthy but important slide presentation by DSM-V Somatic Symptom Disorders Work Group member, Francis Creed. No transcript available but please view the slides – there are many references to “Chronic fatigue syndrome”, chronic fatigue and IBS and to the so called “Functional Somatic Syndromes”.)

Lawson Wulsin, MD, FAPM, DSM V for Psychosomatic Medicine: Current Progress and Controversies

      Wulsin Presentation Slides

[No transcript available]

Joel Dimsdale, MD, FAPM, Update on DSM V Somatic Symptoms Workgroup

       Dimsdale text 

[Text version of slides]

4] For detailed information on the proposed structure of ICD-11, the Content Model and operation of iCAT, the collaborative authoring platform through which the WHO will be revising ICD-10, please scrutinise key documents on the ICD11 Revision Google site:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

Three American Psychiatric Association (APA) DSM related pieces

Three American Psychiatric Association (APA) DSM related pieces

Post #10 Shortlink: http://wp.me/pKrrB-pk

Update @ 24 January

Discussion of the Ethan Watters New York Times Magazine article “The Americanization of Mental Illness” here:

Somatosphere

Monday, January 11, 2010
The globalization of biopsychiatry

A collaborative weblog covering the intersections of medical anthropology, science and technology studies, cultural psychiatry and bioethics.

with extracts from this Kirmayer and Sartorius article:

Psychosomatic Medicine 69:832-840 (2007)
© 2007 American Psychosomatic Society

SOMATIC PRESENTATIONS: CULTURE

Cultural Models and Somatic Syndromes   [Full paper]
Laurence J. Kirmayer, MD and Norman Sartorius, MD, PhD

From the Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada.

Update: 22 January
 

New Scientist

23 January 2010

Invasion of the mind-snatchers

Western notions of mental illness are one of the US’s most insideous exports – and they are spreading around the world like a contagion, says Ethan Watters

Ethan Watters is a journalist who writes on social trends for publications that include Wired and The New York Times Magazine. His books include Urban Tribes. This essay is based on his latest book, Crazy Like Us: The globalization of the American psyche (Free Press/Simon and Schuster)

The New Yorker
ANNALS OF MEDICINE

3 January 2010

The Dictionary of Disorder
How one man revolutionized psychiatry

Alix Spiegel

…Robert Spitzer isn’t widely known outside the field of mental health, but he is, without question, one of the most influential psychiatrists of the twentieth century. It was Spitzer who took the Diagnostic and Statistical Manual of Mental Disorders—the official listing of all mental diseases recognized by the American Psychiatric Association (A.P.A.)—and established it as a scientific instrument of enormous power. Because insurance companies now require a DSM diagnosis for reimbursement, the manual is mandatory for any mental-health professional seeking compensation. It’s also used by the court system to help determine insanity, by social-services agencies, schools, prisons, governments, and, occasionally, as a plot device on “The Sopranos.”

Read more: here

 

New York Times Magazine

The Americanization of Mental Illness

8 January 2010

Ethan Watters

Ethan Watters lives in San Francisco. This essay is adapted from his book “Crazy Like Us: The Globalization of the American Psyche,” which will be published later this month by Free Press.

Dr Sing Lee, referred to in this article is a member of the DSM-5 Work Group for “Somatic Symptom Disorders”.

 

Psychiatric Times Blogspot

Western Psychiatric Imperialism, or Something Else?

12 January 2010

Ronald Pies responds to the essay in the New York Times Magazine, The Americanization of Mental Illness.

APA reschedules publication of DSM-5 draft proposals for diagnostic criteria

APA reschedules publication of DSM-5 draft proposals for diagnostic criteria

Post #9 Shortlink: http://wp.me/pKrrB-ns

Update: Some information here on Dr Todd Finnerty’s blog around the launch of the new DSM-5 website and publication of draft criteria: DSM-5 / DSM-V proposals will be ready, the website just needs to be tested

Draft proposals for the revision of DSM-5 diagnostic criteria are not now expected to be published until Wednesday 10 February.

In an announcement yesterday, 15 January, the APA noted on its website that “The new DSM5.org Web site, which will include proposed revisions and draft diagnostic criteria, has been rescheduled for launch on Wednesday, February 10, 2010.”

In Psychiatric News on 1 January 2010, Alan F. Schatzberg, MD, President of the American Psychiatric Association, had written that draft guidelines for diagnostic criteria would be posted on the Web on January 20 with a comment period of “two to three months” and that field trials would commence in July.

In a news release on 10 December, the APA announced that the timeline for the publication of DSM-5 (DSM-V) was being extended from May 2012 to May 2013.

WHO ICD Revision has its Alpha Draft for ICD-11 timelined for 10 May 2010 but has yet to announce a launch date for the iCAT - the wiki-like, collaborative authoring platform through which ICD-10 is being revised.

Read the APA’s 10 December News Release here 

Related material

Psychiatric News January 1, 2010
Volume 45 Number 1 Page 2
ASSOCIATION NEWS
by Jun Yan 

DSM-5 Postponed Until 2013; Field Trials Scheduled for Summer 

FROM THE PRESIDENT
Volume 45 Number 1 Page 3
by Alan F. Schatzberg, MD

Why is DSM-5 Being Delayed?

 

Previously on DSM-5 Watch

APA announces revised timeline for publication of DSM-5  3 January 2010

DSM-5: Revision controversies in New Scientist 3 January 2010

Christopher Lane on DSM revision and New Scientist article 4 January 2010

APM Workshop: DSM-V for Psychosomatic Medicine: Current Progress and Controversies

APM 2009 Annual Meeting Workshop: DSM-V for Psychosomatic Medicine: Current Progress and Controversies

Post #8 Shortlink: http://wp.me/pKrrB-hc

In November, last year, The Academy of Psychosomatic Medicine, Bethesda, Maryland, held its drug company sponsored 56th Annual Meeting in Las Vegas, Nevada.

Three DSM-V Work Group members, Francis Creed, Lawson Wulsin and Joel Dimsdale (Chair, Somatic Symptom Disorders Work Group) gave presentations around “Medically Unexplained Symptoms” (MUS) and DSM-V, and DSM-V proposals and progress. Slides are available, below, for the first two presentations, with text for the third.

This material represents the most recent information around the deliberations of the DSM-V Work Group that is revising the categories currently under DSM-IV “Somatoform Disorders”.

See this Dx Revision Watch page for previous updates from this Work Group.

The APA anticipates publishing draft proposals for DSM-V diagnostic categories on 20 January. (Since rescheduled for 10 February 2010.)

The Academy of Psychosomatic Medicine

Bethesda, Maryland, US
The Organization for Consultation and Liaison Psychiatry
Publishers of Psychosomatics

2009 ANNUAL MEETING in LAS VEGAS
November 11–14, 2009

56th Annual Meeting

“The Academy of Psychosomatic Medicine recognizes and appreciates the significant financial support provided by the following companies for the 56th Annual Meeting.

“AstraZeneca Pharmaceuticals
Bristol-Myers Squibb and Otsuka Pharmaceutical, Inc.
Eli Lilly and Company
Ortho-McNeil Janssen Scientific Affairs, LLC”

PRESENTERS’ SLIDES

Award Lectures

Hackett Award — Friday, 12:45pm – 1:45pm

Francis Creed, MD, FRCP: Can We Now Explain Medically Unexplained Symptoms? [1]

      Creed Presentation Slides

       Creed References

[No transcript available]

Workshops

Workshop 15 — Saturday, 1:45 – 2:45pm

DSM-V for Psychosomatic Medicine: Current Progress and Controversies

Lawson Wulsin, MD, FAPM: DSM V for Psychosomatic Medicine: Current Progress and Controversies [2]

     Wulsin Presentation Slides

[No transcript available]

Joel Dimsdale, MD, FAPM: Update on DSM V Somatic Symptoms Workgroup [3]

       Dimsdale text

[Text version of slides]

Update on DSM V Somatic Symptoms Workgroup

Workshop #15, APM Annual Meeting, 11-14-09
DSM-V for Psychosomatic Medicine: Current Progress and Controversies

The Somatic Symptoms Workgroup was charged with reviewing most somatoform disorders, psychological factors affecting medical condition, and factitious disorders. There is considerable confusion regarding the diagnostic terminology and a reluctance to use these diagnostic labels. In addition to relying on expert opinion and the research literature, the Workgroup has also been conducting studies in an effort to learn how physicians actually use these diagnostic labels.

These diagnoses are rarely coded. In a study of >1,000,000 Virginia Anthem Blue Cross policy holders, Levenson [4] found that there were fewer than 600 patients with such disorders. Of these 600 patients, the largest group of patients were diagnosed with Psychological Factors Affecting Medical Condition.

Four focus groups were held in San Diego and Edinburgh. Psychiatrists from very different practice settings attended these groups (child psychiatrists, forensic psychiatrists, psychopharmacologists, consultation psychiatrists, psychotherapists). Nonpsychiatrist attendees included neurologists, pediatricians, and gastroenterologists. Using themes identified from the focus groups, an anonymous internet poll was designed. Using mailing lists from a variety of professional organizations, physicians were invited to respond to an anonymous poll.

Three hundred thirty-two physicians responded to the poll. Two thirds were psychiatrists; two-thirds were from the United States. While in general, physicians reported that somatoform patients were relatively rare in their practices (i.e. 0-2%), some physicians reported high prevalence of these patients. Over 30% of the physicians regarded the diagnostic guidelines for pain disorder and somatoform disorder not otherwise specified as “unclear.” Similar numbers of doctors regarded these particular disorders as “not useful.” Physicians were uniform in their opinion that patients disapproved of such diagnostic labels. Respondents also felt that there was a great deal of overlap between somatization disorder, pain disorder, hypochondriasis, and somatoform disorder not otherwise specified. In addition, they felt that that there was overlap between the somatoform disorders and anxiety and depressive disorders.

The Somatic Symptoms Workgroup has been struck by the fact that “medically unexplained symptoms” (MUS) comprise the crucial intellectual underpinning of the large group of somatoform disorders; yet MUS designations are perilous. They foster mind-body dualism; they confuse “undiagnosed” with “unexplained”; they contribute to doctor-patient antagonism; and they base a diagnosis on a negative, rather than positive criteria.

The Workgroup is proposing a series of changes to these disorders. First off, such disorders would be grouped together under one rubric entitled “Somatic Symptom Disorders”, which would include somatoform disorders, factitious disorders, and psychological factors affecting medical condition. Second, because of their many common features, the group is proposing that hypochondriasis, pain disorder, somatization disorder, and undifferentiated somatoform disorder be grouped together as “Complex Somatic Symptom Disorder”, with optional specifyers to designate when the predominant presentation is, for instance, hypochondriasis, etc. MUS is de-emphasized for this diagnosis, which would require both prominent somatic symptoms causing distress or dysfunction, as well as positive psychological criteria (behavior, cognition, perception).

A draft description of these and other disorders will be published on the APA’s DSM V website in January, 2010.

In addition, a paper describing the thinking of the workgroup and providing a slightly earlier version of the diagnostic guidelines may be found at:

Dimsdale J , Creed F, and on behalf of the DSM-V Workgroup on Somatic Symptom Disorders. The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV—a preliminary report, J Psychosom Res, 66 (2009) 473–476

[Ed: Free full text here: http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext ]

The workgroup welcomes comments from colleagues about the proposed changes. Are the proposed changes on the right track? Does this proposal represent, all in all, a step forward? Are there major adverse unintended consequences? Workgroup members include: Arthur Barsky, Francis Creed, Javier Escobar, Nancy Frasure-Smith, Michael Irwin, Frank Keefe, Sing Lee, James Levenson, Michael Sharpe [5], Lawson Wulsin, Joel Dimsdale (chair).

Please send comments to Joel Dimsdale via email jdimsdale@ucsd.edu .

[Ends]

[1] Francis Creed, MD, is a member of the DSM-V Somatic Symptom Disorders Work Group (aka Somatic Distress Disorders Work Group) and was a member of the international CISSD Project, co-ordinated by Dr Richard Sykes, PhD. He is a co-editor of the Journal of Psychosomatic Research.

[2] Lawson R. Wulsin, MD, is a member of the DSM-V Somatic Symptom Disorders Work Group.

[3] Joel E Dimsdale, MD, chairs the DSM-V Somatic Symptom Disorders Work Group, is a member of the DSM-V Task Force and was a member of the CISSD Project.

[4] James L Levinson, MD, is a member of the DSM-V Somatic Symptom Disorders Work Group and was a member of the CISSD Project.

[5] Michael Sharpe, MD, Director, University of Edinburgh Psychological Medicine Research Group, is a member of the Somatic Symptom Disorders Work Group, a co-PI of the UK MRC funded PACE Trial and was a member of the CISSD Project.

 

Related information:

The current use of the diagnosis “Psychological Factors Affecting Medical Condition” in DSM-IV is set out here

Francis Creed is currently working with EACLPP colleagues, Henningsen and Fink, on a draft white paper for the EACLPP MUS Study Group called: “Patients with medically unexplained symptoms and somatisation – a challenge for European health care systems”. A copy of the MUS Study Group working draft can be downloaded from the EACLPP site.

The January 2010, Editorial “Is there a better term than “Medically unexplained symptoms?” Creed F, Guthrie E, Fink P, Henningsen P, Rief W, Sharpe M, White P. J Psychoso Res: Volume 68, Issue 1, Pages 5-8, discusses the deliberations of the EACLPP study group. The Editorial also includes references to the DSM and ICD revision processes.

Javier Escobar, MD, Director of the University of Medicine and Dentistry of New Jersey (UMDNJ) – Robert Wood Johnson Medical School (RWJMS) Medically Unexplained Physical Symptoms (MUPS) Research Center, which has been supported with over $4M in funding by the US National Institute of Mental Health (NIMH), is a member of the DSM-V Task Force. Dr Escobar serves as a Task Force liaison to the Somatic Symptom Disorders Work Group and is said to work closely with this group.

In a 2008 Special Report by Marin and Escobar: “Unexplained Physical Symptoms What’s a Psychiatrist to Do?” Psychiatric Times. Vol. 25 No. 9, August 1, 2008, the authors write:

“…Perhaps as a corollary of turf issues, general medicine and medical specialties started carving these syndromes with their own tools. The resulting list of ‘medicalized’, specialty-driven labels that continues to expand includes fibromyalgia, chronic fatigue syndome, multiple chemical sensitivity, and many others.

“…These labels fall under the general category of functional somatic syndromes and seem more acceptable to patients because they may be perceived as less stigmatizing than psychiatric ones. However, using DSM criteria, virtually all these functional syndromes would fall into the somatoform disorders category given their phenomenology, unknown physical causes, absence of reliable markers, and the frequent coexistence of somatic and psychiatric symptoms.”

In Table 1, under the heading “Functional Somatic Syndromes (FSS)” Escobar and Marin list:

“Irritable bowel syndrome, Chronic fatigue syndrome, Fibromyalgia, Multiple chemical sensitivity, Nonspecific chest pain, Premenstrual disorder, Non-ulcer dyspepsia, Repetitive strain injury, Tension headache, Temporomandibular joint disorder, Atypical facial pain, Hyperventilation syndrome, Globus syndrome, Sick building syndrome, Chronic pelvic pain, Chronic whiplash syndrome, Chronic Lyme disease, Silicone breast implant effects, Candidiasis hypersensivity, Food allergy, Gulf War syndrome, Mitral valve prolapse, Hypoglycemia, Chronic low back pain, Dizziness, Interstitial cystitis, Tinnitus, Pseudoseizures, Insomnia, Systemic yeast infection, Total allergy syndrome”

Marin and Escobar August 2008 Special Report here on Psychiatric Times site.

APA confirms publication date for draft proposals for DSM-5 diagnostic criteria

APA confirms publication date for draft proposals for DSM-5 diagnostic criteria

Post #7 Shortlink: http://wp.me/pKrrB-dL

American Psychiatric Association President, Alan F. Schatzberg, MD, has confirmed that the APA anticipates publishing draft proposals for DSM-5 criteria on Wednesday, 20 January. (Since rescheduled for 10 February 2010.)

It remains unclear how long the public consultation period will be – the only indication is “two to three months”. At the time of publishing, there is no information on the APA’s website around the consultation process.

Psychiatric News January 1, 2010
Volume 45 Number 1 Page 2
ASSOCIATION NEWS
by Jun Yan 

DSM-5 Postponed Until 2013; Field Trials Scheduled for Summer 

Psychiatrists and the public will be able to view and submit comments on proposed DSM-5 criteria this month and after extensive field trials.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders will be released in May 2013, APA announced last month…

and on Page 3 

FROM THE PRESIDENT
by Alan F. Schatzberg, MD

Why is DSM-5 Being Delayed?

The draft guidelines for diagnostic criteria will be posted on the Web on January 20 with a comment period of two to three months. The field trials will commence in July…

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