Psychiatric Manual Revision Pushes Ahead Amid Continued Concerns (APA issues update on status of DSM-5)

Psychiatric Manual Revision Pushes Ahead Amid Continued Concerns (APA issues update on status of DSM-5)

Post #115 Shortlink: http://wp.me/pKrrB-1qV

Wall Street Journal Health Blog

WSJ’s blog on health and the business of health

Psychiatric Manual Revision Pushes Ahead Amid Continued Concerns

Shirley S. Wang | November 23, 2011

The American Psychiatric Association’s years-long efforts to revamp its big book of diagnoses has been fraught with controversy.

Critics have said that the committee charged with the fifth full revision of the Diagnostic and Statistical Manual for Mental Disorders, known as the DSM, is being too secretive and trying to make too many changes, among other concerns.

Read full article

On November, 23, the American Psychiatric Association posted a statement “Update on the Status of DSM-5″ (dated November 22, 2011) on its main website.

Open PDF here: APA Update on the Status of DSM-5 11.22.11

or open on the APA’s website here

Text version follows:

APA Provides Update on Status of DSM-5

The development of DSM-5, more than a decade in process, has been the object of immense public and professional interest. APA hopes that the following information about the process and substance of the emerging diagnostic manual—which will be published in 2013 and at this point is by no means a finished product—will be useful and clarifying. Certainly, everyone with an interest in DSM-5 should visit its open access Web site, www.dsm5.org/Pages/Default.aspx, which has comprehensive information about the developing manual.

The process of developing DSM-5 began in 1999, when APA and the National Institute on Mental Health (NIMH) convened a conference to begin creating a research agenda for the new diagnostic manual. In 2002, APA published A Research Agenda for DSM-5. In the ensuing years, APA worked with multiple agencies—NIMH, the World Health Organization (WHO), the World Psychiatric Association, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism—involving hundreds of participants and resulting in hundreds of publications and monographs, most of which are available on the DSM-5 Web site, regarding current state of knowledge, gaps in research, and recommendations for further research.

The DSM-5 Task Force was formed in 2007, with 13 work groups composed of world-renowned leaders in psychiatric research, diagnosis, and treatment. Since then, the 160 members of the task force and work groups have reviewed more than a decade of research on specific topics and diagnoses under consideration for the new manual. APA granted work group members permission to publish their literature reviews, and nearly all have been published in peer-reviewed journals (again, many of them available for public review on the DSM-5 Web site). In 2009 guidelines were developed to ensure the standardization of presentations by all work group members as they prepared draft diagnostic criteria and rationales for task force review.

These guidelines were subsequently adopted to facilitate reviews by the Scientific Review Committee.

Importantly, members of the work groups are not APA employees, are not under contract with APA, and are not paid by APA. They are free to leave the work group if at any time they are not satisfied that the process is unbiased or if they believe the results are lacking in scientific integrity.

Work group members come from widely diverse backgrounds and represent academic and mental health institutions throughout the world. Ninety-seven members are psychiatrists, 47 are psychologists, two are pediatric neurologists, three are statistician/epidemiologists, and there is one representative each from pediatrics, social work, pediatric nursing, speech and hearing specialties, and consumer groups. There are also more than 300 outside advisors selected for their particular expertise. Together, all of these professionals have every incentive to ensure the work, and the ultimate product, is based on science and empirical evidence.

Moreover, APA has welcomed the public’s input by making all of the drafts of the evolving document available on the DSM-5 Web site. The drafts that APA has put out for review by the public are posted to elicit comments from others in the field and from patients and family members who may be impacted by changes. APA has received through the Web site alone more than 10,000 comments—each of which has been considered and evaluated by the work groups.

The task force is working on including “dimensional and cross-cutting assessments” in order to diagnose psychiatric disorders in a more detailed and nuanced way and to recognize the frequent comorbidities that exist with many mental illnesses. The measurement instruments used in these assessments are modeled on proven instruments, such as the NIH-developed Patient Reported Outcome Measurement Information System (PROMIS), the PHQ-9 for Major Depression, PHQ-8 for somatic symptoms, the Swanson SNAP scale for attention, the Stringaris scale from NIMH for irritability, and the Altman scale for bipolar disorder. All of these scales are being subjected in field trials to extensive tests of reliability and clinical utility.

The definition of mental disorder used in DSM-IV is undergoing a thorough review by the DSM-5 Task Force. Throughout the review process, APA has assimilated input from around the world and across disciplines and is reformulating its recommendations for the definition of a mental disorder. The task force continues to work toward a definition of mental disorder that is evidence-based and acceptable to the mental health community at large, and APA welcomes comments on the revised definition when it is posted in the third round of revisions expected to come out in the spring.

Throughout this process, APA has been committed to transparency. DSM-5 Task Force and work group members have presented and participated in open discussions at hundreds of psychiatric and other major medical meetings around the world and have received permission whenever requested to publish on the proposed changes in DSM-5 without regard to their point of view. (A list of those meetings and publications is available for review on the DSM-5 Web site.)

APA has asked those involved in the DSM-5 process to sign a member acceptance form that has been the subject of some misunderstanding. The confidentiality portion of the member acceptance form is not intended to promote secrecy, but rather to facilitate the verbal process of deliberation. Most, if not all, scientific institutions—including the National Institutes of Health, the Institute of Medicine, WHO, and all scientific journal preparations and reviews—share results of research and explanations for their conclusions, but do not fully open the deliberative process itself for comment. This is crucial in order to ensure the free-exchange of ideas during deliberation.

The Scientific Review Committee was appointed by the Board of Trustees of APA and charged with the ultimate approval of the final DSM-5 recommendations. As part of that charge, the committee will evaluate the strength of the evidence in support of proposed revisions. This separate peer-review process will provide important guidance to the Board. The committee’s contributions will be reflected in the final criteria of DSM-5. Another committee, the Clinical and Public Health Committee, has recently been appointed by the Board to consider clinical utility and public health issues that are not being reviewed by the Scientific Review Committee.

In addition, APA has worked with WHO on an ongoing basis to develop harmonization between disorders included in both DSM-5 and ICD-11. Public comment has twice been solicited on proposed diagnostic criteria, and a third public comment period is planned for 2012.

APA believes the extensive process of development for DSM-5 will result in a scientifically and clinically useful new edition of the diagnostic manual, and the Task Force is indebted to the hundreds of experts who are contributing to its content.

November 22, 2011

Related information:

1] DSM-5 Development website

2] American Counseling Association releases letter: Calls for external review of DSM-5

3] Coalition for DSM-5 Reform Tab page on Dx Revision Watch site

4] Coalition for DSM-5 Reform website

5] Open Letter and iPetition

American Psychiatric Association responds to letter from American Counseling Association

American Psychiatric Association responds to American Counseling Association’s letter, calling for external review of DSM-5

Post #114 Shortlink: http://wp.me/pKrrB-1qt

On November 17, the American Counseling Association, which represents 20% of all mental health professionals, published a letter to the American Psychiatric Association, calling for external review of DSM-5.  For a PDF and text copies of the ACA’s letter see this Dx Revision Watch post:

American Counseling Association releases letter: Calls for external review of DSM-5

 

Today, the American Psychiatric Association (APA) has issued a 7 page response to the ACA’s concerns.

It should be noted that the APA does not publish the names of the 300 external advisors to the DSM-5 Development process.

Open American Psychiatric Association’s response to ACA in PDF below, followed by text version

or on the APA’s DSM-5 Development site here

          APA letter to ACA 11.21.11

American Psychiatric Association
1000 Wilson Boulevard Suite 1825
Arlington, VA 22209
Telephone 703.907.7300 Fax 703.907.1085
Email apa@psych.org Internet www.psych.org

November 21, 2011

Don W. Locke, Ed.D.
President
American Counseling Association 5999 Stevenson Avenue
Alexandria, VA 22304

Dear Dr. Locke:

Thank you for outlining the American Counseling Association’s (ACA) concerns with proposed revisions for the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We value the role of professional counselors in the delivery of mental health care, and we welcome the comments of mental health care providers on DSM. We share the goal of producing a DSM that is useful to all health professionals, researchers and patients so that the American Psychiatric Association (APA) can continue to play its longstanding role in advancing the understanding, diagnosis and treatment of mental disorders.

A great deal of misinformation about DSM-5 has been circulating on the internet, so APA appreciates your direct inquiry and the opportunity to dispel myths generated from these sources. We address each of your concerns below.

Empirical Evidence and Independent Review. It is useful to review the most recent draft version of DSM-5 to truly understand the breadth of evidence collection and review that has taken place during its development. This process actually began in 1999 when APA and the National Institute of Mental Health (NIMH) sponsored a conference to begin creating a research agenda for the next DSM. Additional conferences sponsored by APA, NIMH, the World Health Organization (WHO) and the World Psychiatric Association took place in 2000, all of which resulted in the 2002 publication of A Research Agenda for DSM-V. Additional groups were commissioned in 2003 to further examine infant and young child, late-life and gender issues resulting in the 2007 publication of Age and Gender Considerations in Psychiatric Diagnosis: A Research Agenda for DSM-5.

APA, WHO, NIMH, and two other NIH agencies—the National Institute on Drug Abuse (NIDA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) —held 13 conferences between 2004 and 2008, involving nearly 400 participants representing 39 countries. Over half of the participants were non-U.S. residents. The work resulted in the creation of 10 monographs and hundreds of published journal articles regarding the current state of knowledge, gaps in research, and recommendations for additional research in many fields.

After the DSM-5 Task Force was formed in 2007, and based on the work described above, APA established 13 work groups, each with 8-15 members who are leading clinicians and researchers in the field, to address various areas for review. Since then, the 160 members of the DSM-5′s 13 work groups have sought to review nearly two decades of research published since the introduction of DSM-IV. Work group members selected specific diagnoses on which to focus their individual reviews of the literature in support of or against each specific topic. APA granted work group members permission to publish all of their literature reviews and nearly all have been accepted for publication in peer-reviewed scientific journals. The 2009 guidelines you referenced were developed to ensure the standardization of presentations by all work group members as they prepared draft diagnostic criteria and rationales for Task Force review. These guidelines were subsequently adopted to facilitate reviews by the Scientific Review Committee (SRC).

ACA’s call for an “independent, third party review” of the DSM process and evidence has already been answered in the establishment of these work groups and the close coordination APA has with other national and international scientific groups. The members of the work groups are not APA employees, they are not paid by APA and are not under contract with APA. Their participation is strictly voluntary, based upon their interest in advancing the field of psychiatry and better serving patients. They are free to leave the work group if at any time they are not satisfied that the process is unbiased or believe that the results are lacking in empirical evidence. Attachment A lists the institutions from which work group members are drawn. As you can see, they represent academic and mental health institutions throughout the world. No more than two members of any one institution are represented on any one work group in order to achieve diversity of opinion. It should be noted that although many of these participants are affiliated with universities, the vast majority of them also engage in clinical practice.

The work group members include multiple types of mental health practitioners. Approximately one third of the work group members hold PhDs and 30 percent are international professionals. Ninety-seven members of the work groups are psychiatrists, 47 members are psychologists, 2 are pediatric neurologists, 3 are statisticians/epidemiologists and there is one representative each from pediatrics, social work, psychiatric nursing, speech and hearing specialists, and consumer groups. In addition, there are more than 300 outside advisors — each selected because of a specific and well-recognized expertise in a particular field. These individuals represent an independent group of volunteer medical and mental health professionals who are also leaders in their respective fields and who have every conceivable incentive to ensure that the work they produce is soundly based in science and supported by empirical evidence.

Every proposed change in DSM-5 is guided by a review of scientific literature, analyses of relevant data sets and full discussion by the work group members. In an unprecedented move, the APA has opened the DSM-5 development process to the public to further ensure that the widest range of opinion and information could be sought and all clinical and “real world” implications of the diagnostic criteria could be considered. The drafts that APA has put out for review by the public are posted to elicit comments from others in the field and from patients and family members who may be impacted by changes. APA has received through its website alone more than 10,000 comments—each of which has been considered and evaluated by the work groups.

Dimensional and Cross-Cutting Assessments. These assessments were introduced in order to diagnose psychiatric disorders in a more detailed way and to recognize the frequent co-morbidities in persons who suffer from mental illness. Level 1 crosscutting assessments are based on the model of the brief two-question screener for depression, adopted by the U.S. Task Force for Preventive Services, to assess the presence of significant symptoms in 12 different psychological domains—a total of 23 questions that permit a rapid review of mental systems. If positive symptoms are present, level 2 cross-cutting measures are modeled on the NIH-developed Patient Reported Outcome Measurement Information System (PROMIS) that has been extensively tested. Where PROMIS measures were not available, we used the most widely tested comparable measures to cover other domains such as the NIDA developed ASSIST scale.

Severity measures for individual diagnoses include well-documented and publicly available measures such as the PHQ-9 for Major Depression, PHQ-8 for somatic symptoms, the Swanson SNAP scale for Attention, the Stringaris scale from NIMH for irritability, the Altman scale for bipolar disorder, and others that were developed specifically by the DSM-5 work group experts that are built on past instruments and are being tested in the field trials.

All of these scales are being subjected in field trials to test-retest reliability assessments, patient evaluations of their utility, and clinician assessments of their feasibility and utility in identifying symptomatic areas such as substance abuse or suicidal risk, which might otherwise be overlooked. External validators will include correlates with diagnoses as well as other measures of impairment and disability. Regarding the cross-cutting disability measure, the WHO Disability Assessment Scale (WHO-DAS) is one of the most widely tested disability measures in the world—developed by NIH and WHO with over a decade of testing.

Field Trials/Validity of Diagnoses. With regard to the critique of our field trials, we were pleased to see that you referenced Dr. Helena Kraemer, who serves on the DSM-5 Task Force. Dr. Kraemer helped design the field trials and authored the referenced paper as part of the DSM-5 conference series on the integration of dimensional and categorical diagnosis. As Dr. Kraemer notes in the referenced paper, a field trial is not the forum in which validity can be fully assessed, and as in every field of medicine, diagnostic criteria reflect the best scientific understanding at the time, but they continue to develop and evolve as more scientific research comes to light.

Definition of Mental Disorder. The definition of mental disorder that is used in DSM-IV is undergoing a thorough review by the DSM-5 Task Force. There have been two revised definitions proposed: one, as you mention, by Stein et al. published in Psychological Medicine, the other proposed by the DSM-5′s Study Group on Impairment and Disability Assessment. Neither definition has been accepted by the Task Force at this time. There is no intent on the part of the Task Force to overstate the psychobiological advances in mental disorders; all other paradigms are being considered as well. Through the review process, APA assimilated input from around the world and across disciplines and is reformulating its recommendations for the definition of a mental disorder. Many other proposals have been revised after consideration of public comments as well. We continue to work towards a definition of mental disorder that is evidence-based and acceptable to the mental health community at large. We will look forward to your comments on the revised definition when it is posted in the third round of revisions expected to come out in the spring—when we plan to open another public comment period on our website.

Transparency. The APA asked those involved in the DSM-5 process to sign a member acceptance form. The form contains a confidentiality provision that has been the subject of much misunderstanding and which APA has addressed in detail in the past. This form is not intended to restrict the free discussion of ideas on the issues involved in revising DSM and developing new diagnostic criteria. In fact, DSM-5 Task Force and work group members have presented and participated in open discussions at hundreds of psychiatric and other major medical meetings around the world. Work group members have requested and received permission whenever requested to publish on the proposed changes in DSM-5 without regard to their point of view. (A list of those meetings and publications is available for review on the DSM-5 website.)

Indeed, we encourage members to have open discussions with knowledgeable colleagues just as APA has encouraged comments from those interested in mental health on its website. It is only through broad and diverse opinions that we can, as scientists and clinicians, come to a consensus on how to interpret the data that are available. Further, by widely discussing these issues, APA hopes to stimulate funding for further research into areas that are not sufficiently developed to date to be included in the main body of DSM. Thus, our publication and review process has been beneficial in defining various mental disorders and also in defining and developing interest in additional areas in the field of mental health that require further study.

The confidentiality portion of the member acceptance form is not intended to promote secrecy. Instead, APA sought confidentiality to facilitate the verbal process of deliberation. Most, if not all scientific institutions of which APA is aware, including NIH, the Institute of Medicine, WHO, and all scientific journal preparations and reviews share results of research and explanations for their conclusions, but do not fully open the deliberative process itself for comment. This is crucial in order to ensure the free-exchange of ideas. While the work groups are following this established model in our own deliberations, we also made an important decision to make our proposed revisions to the diagnostic criteria, while still in draft form, available for public review both nationally and internationally.

The Scientific Review Committee. The SRC was appointed by the Board of Trustees of APA which is charged with the ultimate approval of the final DSM-5 recommendations. The SRC’s charge is to evaluate the strength of the evidence in support of proposed revisions, based on a specific template of validators. This separate peer-review process will provide important guidance to the Board. While the ongoing feedback from the SRC to work groups on specific disorders will not be made available during the DSM-5 development process (as is the case for the deliberations of NIH study sections), summaries of the committee’s final decisions will be incorporated into DSM-5 “source books.” The SRC’s contributions will be reflected in the final criteria of DSM-5. Another committee, the Clinical and Public Health (CPH) Committee, has recently been appointed by the Board to consider clinical utility and public health issues that are not being reviewed by the SRC.

In addition, the APA has worked with the World Health Organization on an ongoing basis to develop harmonization between disorders included in both DSM-5 and ICD-II . Public comment has twice been solicited on proposed diagnostic criteria, and a third public comment period is planned for 2012. Work group members review each comment submitted through the DSM-5 website and consider revisions to criteria based on this input from other health professionals, consumer advocates, patients and families, and other members of the public.

The APA believes that the extensive process of development for DSM-5 will result in a scientifically and clinically useful new edition of the diagnostic manual, and we are indebted to the hundreds of experts who have contributed to its content. We are grateful, as well, for the valuable input from concerned individuals and organizations, and we appreciate the opportunity to respond to the concerns of the American Counseling Association.

Sincerely,
John Oldham, MD President
Attachment

Attachment A: DSM-5 Task Force and Work Group Member Affiliations

2 APA
1 Boston College
1 Brown University 1 Cardiff University
1 Case Western Reserve University
1 The Chinese University of Hong Kong
9 Columbia University
1 Dartmouth Medical School
3 Duke University
1 Emory University
1 Federal University of Rio Grande do Sul
1 Florida State University
1 Free University Medical Center, Amsterdam
1 Hamburg University 9 Harvard University
1 Heinrich Heine University
3 Johns Hopkins University
1 Karolinska Institute
4 King’s College London
1 Maastricht University
2 Mayo Clinic College of Medicine
1 McGill University 1 MDDA-RI
1 The Menninger Clinic
1 Mt Sinai School of Medicine
1 George Washington University/Howard University
1 NICHD
5 NIMH
1 NIAAA
1 NIDA
1 New York Medical College
2 New York University
1 Oregon Health Sciences University
1 Robert Wood Johnson Medical School
1 Rutgers University
4 Stanford University
1 Texas A&M University
1 Tulane University
1 Uniformed Services University
1 Universidad Autonoma Metropolitana-Xochimilco
1 University College London
1 University Hospital of Freiburg
1 University Medical Center Groningen
1 University of Alabama, Birmingham
1 University of Bordeaux 1 University of Dresden
1 University of Amsterdam
2 University of Arizona/Sunbelt Collaborative
1 University of Arkansas for Medical Sciences
2 University of British Columbia
4 University of California, Los Angeles
1 University of California, Berkeley
1 University of California, Davis
5 University of California, San Diego
1 University of Cape Town
1 University of Cincinnati
2 University of Colorado
1 University of Connecticut
1 University of Florida
2 University of Illinois at Chicago
3 University of Iowa
1 University of Laval
1 University of Manchester 1 University of Maryland
1 University of Michigan 1 University of Minnesota
1 University of Naples
2 University of New Mexico 1 University of New Orleans
3 University of New South Wales
1 University of North Carolina
2 University of North Dakota
1 University of Notre Dame
1 University of Oxford
3 University of Pennsylvania
5 University of Pittsburgh
2 University of Puerto Rico
2 University of Rochester 1 University of San Diego 1 University of South Carolina
1 University of Southampton
3 University of Toronto
2 University of Washington 1 Vanderbilt University
1 Viersprong Institute
1 Virginia Commonwealth University
4 Washington University
1 Weill Cornell Medical College
1 Wesleyan University
2 Yale School of Medicine

[Letter ends]

 

Related information:

1] DSM-5 Development website

2] American Counseling Association releases letter: Calls for external review of DSM-5

3] Coalition for DSM-5 Reform Tab page on Dx Revision Watch site

4] Coalition for DSM-5 Reform website

5] Open Letter and iPetition

American Counseling Association releases letter: Calls for external review of DSM-5

American Counseling Association releases letter: Calls for external review of DSM-5

Post #113 Shortlink: http://wp.me/pKrrB-1pF

       

The Coalition for DSM-5 Reform Petition can be viewed here iPetition

 

ACA In The News

Press Release 11.17.11

ACA Expresses DSM-5 Concerns to the American Psychiatric Association

Yesterday, November 17, the American Counseling Association (ACA) released a letter from ACA President Don W. Locke to the to the American Psychiatric Association on behalf of professional counselors expressing current concerns about the DSM-5 revision process. The letter focuses on the need for better empirical evidence, the lack of information about proposed dimensional and cross cutting assessments, problems with the ongoing field trials, concerns about the biological emphasis of the revised definition of mental disorders, and the need for greater transparency.

To view the ACA letter sent to American Psychiatric Association President John Oldham, open here in PDF format:

            ACA letter to DSM-5 Task Force November 2011

Full text below, with brief commentary from Dr Allen Frances, MD, who had chaired the DSM-IV Task Force.

 

DSM-5 Blog

Counselor’s Turn Against DSM-5: Can APA Ignore 120,000 Users?

Allen Frances, MD | 17 November 2011

The users’ revolt against DSM-5 marches on and just became a much, much bigger parade. There are 120,000 counselors in the US — more than 20% of all mental health professionals — and DSM-5 is integral to their daily work. The American Counseling Association DSM-5 Task Force, skillfully led by Dr Dayle Jones, has made a meticulous study of DSM-5 and is alarmed by many of its suggestions.

The following open letter from the ACA president to the president of the American Psychiatric Association, quoted in full, was just posted. It nicely summarizes what is wrong with DSM-5 and recommends essential corrective actions. How long can DSM-5 afford to battle with its users?

***

Dear Dr. Oldham:

I am sending this letter on behalf of the American Counseling Association (ACA), the world’s largest association for professional counselors. There are 120,000 licensed professional counselors in the United States; as such, we represent the second largest group that routinely uses the DSM.

ACA appreciates the efforts of the American Psychiatric Association (APA) and the Task Force to update the manual according to new scientific evidence. However, professional counselors have voiced several concerns about the DSM-5 development process and they have reservations about many of the proposed revisions. We believe resolving these issues are critical to counselors’ continued confidence in the DSM as a tool for competent and ethical diagnosis of psychopathology. Our concerns focus on empirical evidence, dimensional and cross-cutting assessments, field trials, the definition of mental disorder, and transparency.

Empirical Evidence. While we appreciate APA’s commitment to quality research, counselors are concerned that a number of the DSM-5 proposals have little basis in empirical studies. A systematic and independent review of the research base is critical when revising diagnostic criteria. Unfortunately, guidelines for conducting evidence-based reviews (eg, Kendler et al., 2009) were not provided to work groups until approximately 18 months after revisions had begun. The rationales posted on the DSM-5 website provide either incomplete or insufficient empirical evidence to support many of the proposed revisions. Reportedly in response to this, the DSM-5 Task Force appointed a Scientific Review Committee (SRC) charged with reviewing the empirical evidence supporting the proposed revisions. While we strongly applaud this decision, we would like more information as to how the SRC will conduct their review so that those outside the process can be assured of the solidity of the empirical evidence behind the proposals.

Dimensional and Cross-Cutting Assessments. ACA members were initially supportive of the idea of using dimensional and cross-cutting assessments, but our review of the proposed assessments on the DSM-5 website causes us considerable worry. Little information regarding scale development has been provided and, according to the field trial protocols, there is no evaluation using external validators. Furthermore, more than half the disorders—including important disorders such as attention-deficit/hyperactivity disorder and conduct disorder—have no assessments posted on the website, so we cannot effectively evaluate all of the measures being proposed.

Field Trials. Evaluating diagnostic validity using “a variety of external criteria” is essential in developing or revising diagnostic criteria (Kraemer, 2007, p. S9). Yet, the DSM-5 field trial protocols focus exclusively on reliability, feasibility, and user acceptability. There is an absence of external validators (i.e., evaluation of validity using external criterion measures); thus, there is no way of determining whether any of the proposed changes improve the validity of the DSM. Furthermore, since the DSM-IV and DSM-5 criteria are not being simultaneously applied to the same clients, there is no way to assess the impact of changes on prevalence rates of the various mental disorders.

Definition of Mental Disorder. The DSM-5 Task Force has proposed a new definition of mental disorder which includes, “A behavioral or psychological syndrome or pattern that occurs in an individual that reflects an underlying psychobiological dysfunction” (APA, 2011). Using the term psychobiological implies that all mental disorders have an underlying biological component. Although advances in neuroscience have greatly enhanced our understanding of psychopathology, the current science does not fully support a biological connection for all mental disorders. We therefore request that the definition of mental disorder be amended to indicate that mental disorders may not have a biological component.

Transparency. Although the DSM-5 Task Force has described its development process as “open, transparent and free of bias” (Kupfer and Regier, 2009, p. 40), all work group members were required to sign confidentiality agreements that prohibit them from divulging information about the DSM-5 process, even after it is published. Most problematic, the reports of the DSM-5 SRC are not available for public inspection, which is a violation of one of the most basic and vital tenets of science—open access to data and/or processes for independent evaluation and critique. Without full transparency and openness, counselors may have difficulty having confidence in and trusting the DSM-5.

In conclusion, based on these issues, professional counselors have expressed uncertainty about the quality and credibility of the DSM-5. Therefore, to ensure continued trust and confidence in the

DSM-5, we ask that the APA carry out the following recommendations:

1. Make public all empirical evidence submitted to the DSM-5 Scientific Review Work Group, as well as the group’s evaluations and recommendations.

2. Submit all evidence and data (from work groups and field trials) for review by an external, independent group of experts in evidenced-based decision-making and make the results of this review public.

3. Remove any DSM-5 proposed revisions deemed to lack strong empirical evidence by external, independent review, or add them to the Appendix for Criteria Sets Provided for Further Study.

4. Eliminate any dimensional or cross-cutting assessments that lack supportive reliability and validity evidence, limited feasibility and poor clinical utility.

We appreciate and value the work APA has done in developing a diagnostic classification system that is used by over half a million non-psychiatric mental health professionals in the United States. However, to produce a credible diagnostic manual, it is essential that the DSM-5 be based on research that involves rigorous, systematic, and objective procedures; an open process; and independent, objective scientific review.

Sincerely,
Don W. Locke, PhD
ACA President

References [as they appear in Dr Locke’s open letter, located at http://www.counseling.org/Resources/pdfs/ACA_DSM-5_letter_11-11.pdf ]

American Psychiatric Association (APA). (2011). Definition of mental disorder. Retrieved from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=465

Kendler K, Kupfer D, Narrow W, Phillips K, Fawcet J. (2009). Guidelines for making changes to DSM-V. Retrieved from http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf

Kraemer HC. (2007) DSM categories and dimensions in clinical and research contexts. International Journal of Methods in Psychiatric Research, 16(S1), S8-S15

Kupfer DJ, Regier DA. (2009). Counterpoint: Toward credible conflict of interest policies in clinical psychiatry. Psychiatric Times, 26(1), 40-41.

——————

The letter to John M. Oldham, MD, APA President, has been CCd to

Dilip V. Jeste, MD, President-Elect
Roger Peele, MD, Secretary
David Fassler, MD, Treasurer
Carol Ann Bernstein, MD, APA Past President
Alan F. Schatzberg, MD, APA Past President
Nada L. Stotland, MD,  MPH APA Past President
Joyce A. Spurgeon, MD, APA ECP Trustee-at-large
Frederick J. Stoddard Jr, MD, APA Area 1 Trustee
James E. Nininger, MD, APA Area 2 Trustee
Brian Crowley, MD, APA Area 3 Trustee
John J. Wernert III, MD, APA Area 4 Trustee
James A. Greene, MD, APA Area 5 Trustee
Marc David Graff, MD, APA Area 6 Trustee
William M. Womack, MD, APA Area 7 Trustee
Ann Marie T. Sullivan, MD, APA Speaker
R. Scott Benson, MD, APA Speaker-Elect
Sarah B. Johnson, MD, APA Member-in-training Trustee
Alik S. Widge, MD, PhD, APA Member-in-training Trustee-Elect
Brian Hurley, MD, APA/Public Psychiatry Fellow
Kimberly Gordon, MD, APA/SAMHSA Fellow
Sarah Faad, MD, American Psychiatric Leadership Fellow
James H. Scully Jr, MD, Medical Director & CEO

Coalition for DSM-5 Reform: Petition Update 1

Coalition for DSM-5 Reform: Petition Update 1

Post #112 Shortlink: http://wp.me/pKrrB-1n4

For the most recent updates and media coverage see Coalition for DSM-5 Reform tab page.

All enquiries relating to the Coalition for DSM-5 Reform, the Open Letter and associated iPetition should be addressed to Dr David Elkins and the Coalition for DSM-5 Reform Committee.

Coalition for DSM-5 Reform: Petition Update 1

The Petition was launched on 22 October by three committee members of Division 32:

David N. Elkins, Ph.D.      Email:  David Elkins
President, Society for Humanistic Psychology, Division 32 of the American Psychological Association

Brent Dean Robbins, Ph.D.      Email:  Brent Dean Robbins
Secretary, Division 32, Society for Humanistic Psychology, American Psychological Association

Sarah R. Kamens, M.A.  
Doctoral Candidate in Clinical Psychology, Fordham University, Student Representative, Division 32

The committee has co-opted

Jonathan D. Raskin, Ph.D.     Email:  Jonathan D. Raskin
Fellow, Society for Humanistic Psychology, Division 32, American Psychological Association;
Fellow, Society for Theoretical and Philosophical Psychology, Division 24, American Psychological Association; Member, American Counseling Association

Donna Rockwell, Ph.D.

Frank Farley, Ph.D.

Media enquiries

Media enquiries and enquiries from professional organizations who would like to discuss endorsement of the Coalition’s Open Letter should be addressed to David Elkins and Brent Dean Robbins.

 

The Open Letter and Petition sponsored by the Society for Humanistic Psychology (Division 32 of the American Psychological Association), in alliance with several other APA Divisions, has attracted nearly 10,000 signatures since launching quietly, on 22 October.

26 mental health professional bodies are now endorsing the Open Letter which is highly critical of many of the draft criteria and categories being proposed for the revision of DSM-IV by the American Psychiatric Association’s  13 DSM-5 Work Groups. See the Coalition for DSM-5 Reform website for a list of organizations endorsing the Petition.

The American Psychiatric Association has scheduled a third and final stakeholder review for early 2012 with the next version of the Diagnostic and Statistical Manual of Mental Disorders slated for publication in May 2013.

Alarmed by the potential dangers they see in many of the current proposals, released in May 2011, the Petition sponsors are inviting mental health professionals and mental health organizations to sign up in support of their Open Letter to the American Psychiatric Association’s DSM-5 Development Task Force.

The Coalition for DSM-5 Reform is calling for the American Psychiatric Association to submit DSM-5 to independent scientific review or drop its most controversial proposals.

You can view the Open Letter and sign the iPetition here.

Of particular concern to the Sponsors are:

(1) The lowering of diagnostic thresholds, which may artificially inflate the prevalence of numerous disorders. By increasing the number of people who qualify for a diagnosis, DSM-5 may lead to the excessive medicalization and stigmatization of normative or transient distress.

(2) The potential consequences of lowered thresholds and new disorder categories on vulnerable populations such as children and the elderly. These populations are already at risk for excessive and inappropriate treatment with medications that have dangerous side effects. We are particularly concerned about the overuse of medications for “Attenuated Psychosis Syndrome,” “Disruptive Mood Dysregulation Disorder,” “Mild Neurocognitive Disorder,” Attention Deficit/Hyperactivity Disorder, and Generalized Anxiety Disorder.

(3) The lack of scientific evidence substantiating many of these new proposals.

 

The Coalition for DSM-5 Reform has opened a number of platforms

Open Letter and iPetition

Coalition for DSM-5 Reform on Twitter    @dsm5reform

Coalition for DSM-5 Reform on Facebook 

Coalition for DSM-5 Reform website 

This initiative is also being covered on

The Society for Humanistic Psychology Blog

The Society for Humanistic Psychology on Twitter    @HumanisticPsych

The Society for Humanistic Psychology Blog on Facebook 

Media coverage is being collated under the Coalition for DSM-5 Reform tab (far right of navigation tabs)

Developments

On November 4, the Special Projects Manager, Office of Communications & Public Affairs, American Psychiatric Association, sent a letter via email from the DSM-5 Task Force to the Editor of Psychiatric Times. 

Curiously, the letter (incorrectly dated “October 4″) was unsigned by either Task Force Chair, David Kupfer, MD, or Vice-chair, Darrel Regier, MD. And although it was addressed to both Melba J.T. Vasquez, Ph.D., President American Psychological Association, and David N. Elkins, Ph.D., President, Society for Humanistic Psychology and chair of the Open Letter and Petition committee, neither had been sent a copy by the Task Force or by the American Psychiatric Association’s Office of Communications & Public Affairs.

In the absence of clarification, we can only surmise that the Task Force had submitted their letter to the Editor of Psychiatric Times with a view to publication.

The American Psychiatric Association subsequently published a copy of the Task Force’s response to the Open Letter and Petition, here on the DSM-5 Development website (with the date amended).

Or open a PDF version of the Task Force’s letter  here:

             DSM-5 Task Force response to Society for Humanistic Psychology 11.04.11

Text version follows:

American Psychiatric Association

1000 Wilson Boulevard
Suite 1825
Arlington, VA 22209
Telephone 703.907.7300
Fax 703.907.1085
E-mail apa@psych.org
nternet www.psych.org

November 4, 2011

Melba J.T. Vasquez, Ph.D., President
American Psychological Association
750 First Street, N.E.
Washington, DC 20002-4242

David N. Elkins, Ph.D., President
Society for Humanistic Psychology
750 First Street, N.E.
Washington, DC 20002-4242

Dear President Vasquez and President Elkins,

We are appreciative of the thoughtful concerns expressed in the Open Letter about the introduction of new diagnoses, proposals for modifying criteria definitions and thresholds for existing diagnoses. The current draft of the DSM-5 diagnostic criteria, still more than a year away from publication, is continually being refined and reworked by the DSM-5 Task Force and Work Group members. Final decisions about proposed revisions will be made on the basis of field trial data as well as on a full consideration of other issues such as those raised by the signatories to this petition, the 10,000 individuals who responded to the February 2010 and April 2011 postings of draft criteria on DSM5.org, other internal reviews by a Scientific Review Committee, the DSM-5 Task Force, and the APA Board of Trustees.

This level of both internal and external review and field trial exposure has never before been undertaken by any previous DSM or ICD revision proposals.

We wish to clarify several specific issues you raise. Several disorders that were mentioned, such as Parental Alienation Syndrome, were proposed by outside groups but have not been proposed for inclusion by the Task Force. Some of the newer diagnoses, including Disruptive Mood Dysregulation Disorder (DMDD), Attention Deficit Hyperactivity Disorder (ADHD), Attenuated Psychosis Syndrome Disorder (APSD), Complex Somatic Symptom Disorder (CSDD) [sic], Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and Personality Disorders are all being tested in the 11 large academic field trial centers that have enrolled over 2,000 patients in a rigorous test-retest design to assess the reliability and clinical utility of proposed criteria. Based on the results of these field trials the DSM-5 Task Force and Work Groups will review the criteria for any necessary changes.

The definition of a mental disorder that is contained in DSM-IV is also undergoing thorough review by the Task Force, which has not adopted the proposed revision that was published by Stein et al. in Psychological Medicine. There is certainly no intent on the part of the DSM-5 Task Force to diminish the importance of environmental and cultural exposure factors as etiological contributors to mental disorders – as indicated by an active study group charged with developing a cultural formulation section as well as culture specific expression issues for individual diagnoses.

We should also note that the DSM-5 Task Force and Work Groups include a multi-disciplinary mix of clinical and research experts in which psychologists are prominent members. There is also another field trial taking place in Routine Clinical Practice settings that will include psychiatrists and approximately 500 of each mental health specialty group of psychologists, social workers, psychiatric nurses clinical counsellors, and marriage and family counselors. The full range of disorders will be assessed in this field trial and the findings will contribute to the final decisions about the diagnoses.

We wish to express our appreciation to all of the clinicians and research investigators who have invested such intense interest and energy in assuring that the next revision of DSM will be based on the best available clinical experience and research evidence in an effort to improve patient care and our understanding of mental illnesses. We hear your concerns and are aware of those from others in the mental health field, and take them under serious consideration in our deliberations.

Please continue to visit and review the DSM-5 website for changes to the criteria, the rationale for proposed changes from DSM-IV, and an extensive set of research analyses on www.dsm5.org. We will be opening the website for public comment on the draft criteria and chapter organization one final time in 2012. We invite you all to submit your comments during that time so they can be reviewed thoroughly and systematically by the DSM-5 Task Force and Work Group members.

We would be most appreciative if you would share this information with your members.

Sincerely,

DSM-5 Task Force Members

[Ends]

On November 7, the Coalition for DSM-5 Reform responded to the Task Force:

Open the letter here in PDF format:

            Response to DSM-5 Task Force 11.07.11

Text version follows:

Response to Letter from DSM-5 Task Force and the American Psychiatric Association:

Society of Humanistic Psychology

November 7, 2011

ATTENTION:
David J. Kupfer, M.D., Chair of DSM-5 Task Force
Darrel A. Ragier [sic], M.D., M.P.H., Vice Chair of DSM-5 Task Force
John M. Oldham, M.D., President of the American Psychiatric Association
Dilip V. Jeste, M.D., President-Elect of the American Psychiatric Association
Roger Peele, M.D., Secretary of the American Psychiatric Association

To the DSM-5 Task Force and the American Psychiatric Association:

Thank you for your response to the Open Letter that was composed by the Society for Humanistic Psychology (Division 32 of the American Psychological Association) and endorsed by over 4,600 individuals and 17 organizations, including nine other divisions of the American Psychological Association. In this context, it should be noted that the American Psychological Association itself has not taken a position on this matter other than to encourage its members to participate in the DSM-5 development process. It is our understanding that President Melba Vasquez will be responding to your letter separately on behalf of the American Psychological Association. We are writing on behalf of the Society for Humanistic Psychology Open Letter Committee to express our gratitude that the Task Force has opened a public dialogue about these issues and to let you know that we are happy to share your letter with our membership. We are pleased that the Task Force will consider the issues we described in our Open Letter as well as those raised by others in the mental health field.

However, we remain deeply concerned about the issues we raised and find that your response did not adequately address them. Our main concerns include:

(1) The lowering of diagnostic thresholds, which may artificially inflate the prevalence of numerous disorders. By increasing the number of people who qualify for a diagnosis, DSM-5 may lead to the excessive medicalization and stigmatization of normative or transient distress.

(2) The potential consequences of lowered thresholds and new disorder categories on vulnerable populations such as children and the elderly. These populations are already at risk for excessive and inappropriate treatment with medications that have dangerous side effects. We are particularly concerned about the overuse of medications for “Attenuated Psychosis Syndrome,” “Disruptive Mood Dysregulation Disorder,” “Mild Neurocognitive Disorder,” Attention Deficit/Hyperactivity Disorder, and Generalized Anxiety Disorder.

(3) The lack of scientific evidence substantiating many of these new proposals.

Our rationale for these concerns can be found in our open letter, which is available at http://www.ipetitions.com/petition/dsm5/ for all interested mental health professionals to sign.

Although we appreciate your explanations of the Task Force’s activities, we did not find them sufficient to address our concerns for the following reasons:

A single set of field trials, no matter how large and diverse the sample size, is not an adequate replacement for a body of scientific literature that is built over time through the contributions of multiple and independent researchers. Many of the newly proposed disorder categories lack this important and critically necessary body of scientific support.

Though reliability and utility are important, we are also concerned about validity and potential social consequences. As you know, increasing the number of people who qualify for a psychiatric diagnosis may lead to epidemiological inflation and, as a consequence, the inappropriate medication and stigmatization of individuals with normative conditions. It also leads to ethical and moral concerns about our professions.

Though we are pleased to learn you are not considering the inclusion of several conditions proposed by outside sources (such as Parental Alienation Disorder), it would help to avoid confusion if you removed these conditions from the list of DSM-5 considerations at your website (where they still appear as of 11/7/11):

http://www.dsm5.org/proposedrevision/Pages/Conditions-Proposed-by-Outside-Sources.aspx

We do not assume that the Task Force is intentionally deemphasizing social and psychological explanations. However, the proposed language deemphasizes social and psychological explanations and may lead to the pathologization of sociopolitical deviance. We emphasize again that the Stein et al. definition of mental disorder would result in the scientifically unsubstantiated reduction of all DSM-defined disorders to biological bases.

We are aware that the DSM-5 Task Force and Work Groups include not only psychiatrists but also some psychologists and other mental health professionals. However, these teams represent a highly selective and circumscribed group of academic mental health professionals whose experiences differ from those of mental health professionals working in the field on an everyday basis. The purpose of the open letter is to represent the wide spectrum of voices in our community.

We believe it is important that the Task Force give serious consideration to the public feedback by thousands of mental health professionals and others who have signed the open letter to date. The open letter’s list of individual and organizational signatories continues to grow. As of today, we have over 4,600 individual signatures as well as endorsements from the following organizations: Behavioral Neuroscience and Comparative Psychology (Division 6 of the American Psychological Association), the Division of Developmental Psychology (Division 7 of the American Psychological Association), the Society for Community Research and Action: Division of Community Psychology (Division 27 of the American Psychological Association), Psychotherapy (Division 29 of the American Psychological Association), the Society for the Psychology of Women (Division 35 of the American Psychological Association), the Division of Psychoanalysis (Division 39 of the American Psychological Association), Psychologists in Independent Practice (Division 42 of the American Psychological Association), the Society for Group Psychology and Psychotherapy (Division 49 of the American Psychological Association), the Society for the Psychological Study of Men & Masculinity (Division 51 of the American Psychological Association), the Association for Women in Psychology, the Society for Personality Assessment, the Society for Descriptive Psychology, the UK Council for Psychotherapy (UKCP), the Constructivist Psychology Network (CPN), the Taos Institute, Psychoanalysis for Social Responsibility (Section IX of Division 39 of the American Psychological Association), and the Association for Counselor Education and Supervision (Division of the American Counseling Association). In addition, some are now considering a consumer petition that could tap into the concerns of hundreds of thousands of consumers. We believe you are also aware that the British Psychological Society (nearly 50, 000 members), the American Counseling Association (45,000 members), and two previous chairs of DSM Task Forces have also raised concerns about the current proposals for DSM-5.

Again, we appreciate the Task Force’s assurance that the concerns expressed in our open letter will be taken into consideration. However, we believe these concerns to be of sufficient gravity to warrant more than confidential deliberations among those who invented and supported the problematic proposals. Further, the scientific review of DSM-5 conducted by the American Psychiatric Association was internal, and both the methods and findings of that review remain completely undisclosed to the public.

In view of the above concerns, as well as the unprecedented level of criticism of DSM-5 as currently proposed, we respectfully request an external review of the DSM-5 proposals by scientists and scholars who are not appointed by or affiliated with the American Psychiatric Association. We believe that only such an external review (alongside the implementation of any revisions recommended by the reviewers) will assure the mental health professions that DSM-5 is credible and safe to use.

For the future welfare of our clients/patients, as well as for the credibility of our professions, we hope you will submit the DSM-5 to independent, comprehensive, and scientific review.

Yours sincerely,

David N. Elkins, Ph.D.
President, Society for Humanistic Psychology, Division 32 of the American Psychological Association

Brent Dean Robbins, Ph.D.
Secretary, Division 32, Society for Humanistic Psychology, American Psychological Association

Sarah R. Kamens, M.A.
Doctoral Candidate in Clinical Psychology, Fordham University, Student Representative, Division 32

On November 8, the Coalition for DSM-5 Reform issued a press release:

Scientists and Clinicians Warn about Dangerous Implications of DSM-5

For Immediate Release: November 8, 2011 – It started as a small committee of three persons from the Society for Humanistic Psychology (SHP) who were alarmed about the potential dangers they saw in the proposed DSM-5. Of particular concern were increased risks to vulnerable populations of children and the elderly, possible increases in the number of people who will be diagnosed with a mental disorder, and the lack of scientific basis behind some of the proposals. But what could three people do?

So far, they have generated almost 5000 signatures from mental health professionals from around the world, supporting an Open Letter to the DSM-5 Task Force and the American Psychiatric Association, posted in an online petition

(http://www.ipetitions.com/petition/dsm5/).

Additionally, to date 10 Divisions of the American Psychological Association and 7 other psychology organizations have also endorsed the letter and signed the petition.

The DSM-5 Task Force responded to the Open Letter, but the SHP committee was not satisfied with explanations offered by the Task Force. Thus, the committee has written a response (see below and attached). The letter (goo.gl/gusMy) explains why the response of the task force was not adequate, reiterates the potential dangers of the DSM-5, and requests that the DSM-5 proposals be submitted for independent review by scholars and scientists not selected by, nor affiliated with, the DSM-5 Task Force and the American Psychiatric Association which publishes the manual.

The SHP committee hopes that an independent review will result in revisions to the proposed DSM-5 that will more accurately reflect the scientific literature and help ensure that vulnerable populations are not inappropriately diagnosed with mental disorders and treated with psychiatric drugs that have dangerous side effects.

David N. Elkins, President of the Society of Humanistic Psychology and Chair of the Open Letter Committee stated, “If the proposed DSM-5 is not changed, I am concerned that hundreds of thousands of normal individuals – including children and the elderly – will be diagnosed with a mental disorder and inappropriately treated with powerful psychiatric drugs. I hope the leaders of the DSM-5 Task Force listen to our concerns and insist that changes be made. Mental health professionals, who are the major purchasers and users of the DSM, have a right to know that the manual is credible and safe to use.”

LETTER AND LINK TO BLOG: goo.gl/gusMy

CONTACT INFO:
Email: Brent Dean Robbins
Phone: 716-982-8594

Rather than respond in a letter, Darrel Regier, DSM-5 Task Force Chair, was interviewed by journalist, Deborah Brauser,  for Medscape Medical News:

(Free registration is required in order to view this Medscape article.)

Medscape Medical News > Psychiatry

APA Answers DSM-5 Critics

Deborah Brauser | November 9, 2011

 

On November 11, Allen Frances, MD, who had chaired the DSM-IV Task Force, published this commentary on Dr Regier’s responses, as part of series of commentaries on DSM-5:

Psychology Today

DSM5 in Distress

The DSM’s impact on mental health practice and research.

DSM 5- ‘Living Document’ or ‘Dead on Arrival: ‘untested ‘scientific hypotheses’ must be dropped

Allen J. Frances, MD | November 11, 2011

News flash From Medscape Medical News—“APA Answers DSM-5 Critics”—a defense of DSM-5 offered by Darrel A. Regier, MD, vice-chair of the DSM-5 Task Force. Wonderful news that the American Psychiatric Association (APA) is attempting to address the fact that DSM-5 alarms many of its potential users—it is long past time for an open dialog.

Unfortunately, however, Dr Regier dodges the concerns that must be addressed if DSM-5 is to become a safe and credible document. Five simple questions were previously posed to APA with a request for straight answers…

Read on here

 

In his interview for Medscape, Darrell Regier, APA’s director of research and Task Force vice-chair, made some chilling statements. According to Dr Regier:

“Our plan is that these [judgements] will be immediately tested once the DSM is official, and then one will be able to see if revisions can be made…”

“Our workgroups are struggling with this balance…for what might be the most appropriate fix. Some of these fixes are not as well studied as others and we recognize that. But we can’t move forward without some of these put into practice. So we think this is a much more testable set of scientific hypotheses…”

“And that’s what the DSM is — a set of scientific hypotheses that are intended to be tested and disproved if the evidence isn’t found to support them….”

“We’re thinking of having a DSM-5.1, DSM-5.2, etc, in much the same way is done with software updates…”

So come May 2013, the APA plans to publish an unvalidated beta version, as though it were the next release of Firefox, test out its pet theories on vulnerable patients and use children as guinea pigs, then release post publication “patches” to fix a flawed and potentially damaging product.

 

On November 9, Dr Melba T Vasquez, PhD, President, American Psychological Association responded in a letter to the Task Force:

            Response from Melba T Vasquez to DSM-5 Task Force 11.09.11

Updates and media coverage are also being collated under the Coalition for DSM-5 Reform tab page.

CFSAC November Meeting Agenda and Call-in Information

CFSAC November Meeting Agenda and Call-in Information

Post #111 Shortlink: http://wp.me/pKrrB-1mG

CFSAC Meetings Page: http://www.hhs.gov/advcomcfs/meetings/index.html

CFSAC November meeting Call-in Information

http://www.hhs.gov/advcomcfs/meetings/agendas/cfsac20111108_callininfo.html

CFSAC Fall 2011 Meeting (November 8-9)
Audio Call-In Information

The Meeting of the Chronic Fatigue Advisory Committee will be available via AUDIO Lines. The following call-in information will provide access to the meeting via audio lines:

Please dial the participant dial-in number:
Participant Dial-In Number: (866) 395-4129

Please use the following passcodes for each day:
Passcodes:

Tuesday, November 8: 24756185
Wednesday, November 9: 24759937

Please note, each caller can press *0 at any time during the call tocontact the operator for support.

There will be an operator on the line to welcome you and each caller will be asked their name and email address (this is not a requirement). You will be placed into the conference.

During the lunch hour, callers may hold the line or choose to call back to access the conference.

The CFSAC meeting will begin from 9:00 am – 5:30 pm Tuesday, November 8 and 9:00 am – 4:30 pm on Wednesday, November 9.

November 8-9 2011 Meeting Agenda

http://www.hhs.gov/advcomcfs/meetings/agendas/cfsac20111108_agenda.html

CFSAC Fall 2011 Meeting (November 8-9)

Day One

Agenda – CFSAC Fall 2011 Meeting
November 8, 2011

9:00 am Call to Order
Opening Remarks
Christopher R. Snell Chair, CFSAC

Roll Call, Housekeeping
Nancy C. Lee, M.D., Designated Federal Officer

9:10 am International Classification of Diseases-Clinical Modification (ICD-CM)
Donna Pickett, RHIA, MPH, National Center for Health Statistics

10:00 am Public Comment Public

11:15 am Break

11:30 am Welcome Statement from the Assistant Secretary for Health Howard K. Koh, M.D., Ph.D

12:00 pm Agency Updates: AHRQ, CMS, FDA, HRSA
Ex Officio Members

1:00 pm Subcommittee Lunch Subcommittee Members

2:00 pm Public Comment Public

2:45 pm Break

3:00 pm Future Interdisciplinary Research for CFS Utilizing a Variety of Scientific Disciplines, Gailen Marshall, M.D., Ph.D.
Committee Discussion

4:00 pm Committee Discussion

Past CFSAC Recommendations Committee Members

5:00 pm Adjourn

Day Two

Agenda – CFSAC Fall 2011 Meeting
November 9, 2011

9:00 am Call to Order
Opening Remarks
Christopher R. Snell, Chair, CFSAC

Roll Call, Housekeeping
Nancy C. Lee, M.D., Designated Federal Officer

9:15 am HHS Office on Disability
Rosaly Correa-de-Araujo, M.D, M.Sc., Ph.D, Deputy Director, HHS Office on Disability

10:00 am Centers for Disease Control and Prevention Webpage
Eileen Holderman
Nancy G. Klimas, M.D.
Ermias Belay, M.D.

10:30 am Break

10:45 am Agency Updates: CDC, SSA, NIH
Ex Officio Members

11:45 am Minimal Elements for Papers
Leonard A. Jason, Ph.D.

12:15 pm Subcommittee Lunch
Subcommittee Members

1:15 pm Public Comment
Public

2:15 pm Break

2:30 pm Committee Discussion

Finalize Recommendations Committee Members

4:30 pm Adjourn

[ENDS]

Related information and posts:

1] Coding CFS in ICD-10-CM: CFSAC and the Coalition4ME/CFS initiative: http://wp.me/pKrrB-1hd

2] Minutes of May 10-11 2011 CFSAC meeting (Extract: Discussion of concerns re coding of CFS for ICD-10-CM)

3] A Summary of Chronic Fatigue Syndrome and Its Classification in the International Classification of Diseases CDC, 2001.

4] CFS orphaned in the “R” codes in US specific ICD-10-CM

5] Forthcoming US “Clinical Modification” ICD-10-CM (starts half way down page)

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