DSM-5 released: Media, professional and advocacy reaction: Round up #4

Post #254 Shortlink: http://wp.me/pKrrB-33A

For earlier responses to the release of DSM-5 see Posts #253, #252, #251 and #249

The colour of money

If you want to view the WHO’s ICD-10 “Blue Book” or the “Green Book”, the ICD-10 Tabular List Version: 2010 or the forthcoming US ICD-10-CM you can do so for free, online.

If you want to view the “Purple Book” it’s going to set you back $199 in hardcover and $149 in paperback.

American Psychiatric Association has never given free access to the DSM. According to Task Force chair, David J Kupfer, no change is planned to that policy. An online version is in the pipeline but it won’t be free.

“A digital version is promised within a few months through a secure website and also as mobile device applications. Revisions will be more frequent and most likely would be distributed only electronically…” (APA Leaders Defend New Diagnostic Guide John Gever, Medscape Today, May 18, 2013)

The finalized criteria sets and the texts that accompany the disorder sections are nailed down with copyright permissions and restrictions.

What resources are available for free?

On this page of the American Psychiatric Association’s website, you can view the DSM-5 Table of Contents, a document titled Insurance Implications for DSM-5, Psychiatric News articles, disorder descriptions and rationales fact sheets, videos and a document called Highlights of Changes from DSM-IV to DSM-5. New documents are being added to this page every few weeks.

The DSM-5 Development site, from which the third draft was removed, last November, will remain online. Currently undergoing reorganization, APA says the platform will serve as a resource for clinicians, researchers, insurers, and patients.

There is now a tab page Ask Questions or Provide Feedback with a form for submitting questions and feedback. The page states that as frequent questions are received the answers will be continually added to the FAQ pages.

Down the right hand side of the DSM-5 Development Home Page are links for disorder description and rationale documents for some new and existing disorders. (Note that at the time of writing, not all the links are live links, so you may need to hop to this page, in order to open some of the PDFs.)

At the top of the list of links, there is a new document, Important Coding Corrections and an Insurance Implications FAQ.

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No position statement issued yet from the American Psychological Association, but a Practice Central Update around DSM-5, ICD-10-CM and the cross-walk has been published: Nine frequently asked questions about DSM-5 and ICD-10-CM Practice Research and Policy staff, May 16.

Quick primer on cross-walk from a coding industry site, here: For Mental Health, how do DSM-5, CPT and ICD-10 Codes Interact?

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Medscape Medical News – A Guide to DSM-5

Today, Medscape Medical News has published a 15 section guide highlighting the major additions and revisions in the new DSM-5.

Medscape Medical News from The American Psychiatric Association’s 2013 Annual Meeting

This coverage is not sanctioned by, nor a part of, the American Psychiatric Association.

Medscape Psychiatry: A Guide to DSM-5 Bret S. Stetka, MD, Christoph U. Correll, MD, May 21, 2013


Psychiatric Times > APA Annual Meeting Conference reports

Experts Discuss Changes, Updates in DSM-5

Heidi Anne Duerr, MPH | 22 May 2013

Includes summary of revision of DSM-IV’s Somatoform Disorders to Somatic Symptom and Related Disorders for DSM-5.

“One thing that has not completely changed is the inherent ambiguity in these diagnoses…It will be up to each clinician to determine what “excessive” or “disproportionate” means in terms of pathological response.”

Registration for access to this article may be required.

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Other coverage

Jeffrey A Lieberman gets a little hot under the collar over “misguided and misleading ideologues and self-promoters…spreading scientific anarchy” in a guest blog for Scientific American:

Scientific American Guest Blog | Jeffrey A Lieberman, May 20, 2013

DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice

Dr. Lieberman was installed as President-elect of the American Psychiatric Association (APA); he will serve as APA President from May 2013 to May 2014.

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Three radio and TV broadcasts


PBS Newshour | ANALYSIS AIR DATE: May 20, 2013 | Presenter Judy Woodruff

What DSM-5, Updated Mental Health ‘Bible,’ Means for Diagnosing Patients

Transcript plus Listen again on mp3

SUMMARY

The American Psychiatric Association released a new edition of the DSM, which doctors use to diagnose and treat mental disorders. Judy Woodruff discusses the changes and implications for both patients and professionals with Dr. Michael First of Columbia University and Dr. Steven Hyman of the Broad Institute.


World News Australia Radio | May 22, 2013, 9:00 am – Source: Kerri Worthington, SBS

Controversy over ‘psychiatry bible’

Transcript plus Listen again on mp3

Quotes from Associate Profressor Tim Carey, also Professors Helen Christensen, executive director of the Black Dog Institute, Perminder Sachder and Gordon Parker

An update to a highly influential mental health manual, the so-called bible of psychiatry, has been unveiled to criticism from both within and without the profession.


ABC Australian Broadcasting Corporation | May 20, 2013 | Reporter: Emma Alberici

Normal behaviour defined as mental illness

Transcript plus 15.58 mins Video available to watch again

Allen Frances, MD, talks to Emma Alberici on DSM-5 and diagnostic inflation.

For earlier responses to the release of DSM-5 see Posts #253, #252, #251 and #249

DSM-5 released: Media, professional and advocacy reaction: Round up #3

Post #253 Shortlink: http://wp.me/pKrrB-332

For earlier responses to release of DSM-5 see Posts #252, #251 and #249

The Conversation

Two visions for understanding illness: DSM and the International Classification of Diseases
James Bradley, Lecturer in History of Medicine/Life Science at University of Melbourne, May 22, 2013

DSM-5 tells us more about psychiatry than psychiatrists
Prof, Sir Simon Wessely, Professor of Psychological Medicine at King’s College London, May 20, 2013

Under new psychiatric guidebook we might all be labelled mad
Allen Frances, Professor Emeritus of Psychiatry at Duke University, May 20, 2013

Explainer: What is the DSM?
Peter Kinderman, Professor of Clinical Psychology at University of Liverpool, May 20, 2013

Mental disorders: debunking some myths of the DSM-5
Perminder Sachdev, Scientia Professor of Neuropsychiatry, Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry at University of New South Wales, April 18, 2013

Five new mental disorders you could have under DSM-5, May 20, 2013
Authors: Christopher Fairburn, Professor of Psychiatry at University of Oxford; Christopher Lane, Professor of English at Northwestern University; David Mataix-Cols, Professor and Honorary Consultant Clinical Psychologist at King’s College London; Jon Grant; Professor of Psychiatry and Behavioral Neuroscience at University of Chicago; Karen M. von Deneen, Associate Professor at Xidian University

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The Dana Foundation: Psychiatric Drug Development: Diagnosing a Crisis Steven E Hyman, MD, April 02, 2013

Steven E Hyman, MD, resigned from the DSM-5 Task Force in 2012. Dr Hyman remains listed as Chair of the APA-WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders

Update: Commentary by Bernard Carroll at Health Care Renewal, April 6, 2013


Blogs Psych Central: Video NIMH’s Thomas Insel on a New Understanding of the Brain Sandra Kiume, April 2013

Video: 13:04 mins

NIMH’s Thomas Insel on a New Understanding of the Brain By Sandra Kiume

Director of the National Institute for Mental Health Thomas Insel gives a TED Talk on the new domain criteria research direction, and how an important first step is to reframe mental illness as brain disorders.

By doing so, diverse fields like psychology, cognitive science, molecular neuroscience, genetics, psychiatry, and more can work together toward a new understanding of the mind.


NIMH: Mental Disorders as Brain Disorders: Thomas Insel at TEDxCaltech, April 23, 2013

Video 15:05 mins


Psycritic: What If the NIMH Succeeds? What Then? May 11, 2013

A child psychiatrist takes a critical look at psychiatry, the news, culture, etc


Jonathan Turley: From DSM-I to DSM-5 in the Legal System: Mental Illness Issues in the Courtroom Charlton Stanley (Otteray Scribe), guest blogger, May 19


Canada.com: Infighting, boycotts, resignations: Psychiatry faces another crisis of confidence Sharon Kirkey, Postmedia News, May 17

Includes Allen Frances video


Radio New Zealand: New reference manual issued by Psychiatric Assn May 19


Healio Psychiatric Annals: APA President-Elect: ‘Our time is now’ May 19


Los Angeles Times Review of Books: Andrew Scull on The Book of Woe: The DSM and the Unmaking of Psychiatry and Hippocrates Cried : The Decline of American Psychiatry Andrew Scull, May 19

Delusions of Progress: Psychiatry’s Diagnostic Manual

Essay length article that includes reference to the legal threats issued on behalf of American Psychiatric Publishing against Dx Revision Watch site, in December 2011.


Truth Dig: British Psychologists Find Fault With DSM-V Alexander Reed Kelly, May 16

England’s Division of Clinical Psychology, which represents more than 10,000 practitioners, has criticized the latest edition of the field’s leading diagnostic manual for its categorizing of normal behaviors—such as shyness in children and depression after the death of a loved one—as medical problems treatable with drugs…


New York Post: We’re all mad here, New psychiatry manual turns ordinary American life into mental disorders Allen Frances, MD, May 18

Millions of people who went to sleep last night thinking they were normal woke up this morning with a new mental disorder…


Medscape Medical News, Psychiatry: Use DSM-5 ‘Cautiously, If at All,’ DSM-IV Chair Advises Pam Harrison, May 17

“I believe that the American Psychiatric Association (APA)’s financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product,” Dr. Frances states.

“The problems associated with the DSM-5 prove that the APA should no longer hold a monopoly on psychiatric diagnosis…. The codes needed for reimbursement are available for free on the Internet.”


Spiked Online, UK: Our brains aren’t moulded by abuse Ken McLaughlin. May 16

So, is mental distress caused by faulty genes or by past experiences of childhood abuse? Maybe it’s neither.


For earlier responses to release of DSM-5 see Posts #252, #251 and #249

DSM-5 released: Media, professional and advocacy reaction: Round up #2

Post #252 Shortlink: http://wp.me/pKrrB-32B

For earlier responses to release of DSM-5 see Posts #251 and #249


Medpage Today, US: APA Leaders Defend New Diagnostic Guide John Gever, Deputy Managing Editor,  May 18

…DSM-5 is now on sale for $199 in hardcover and $149 in paperback. The APA has never made the DSM freely available (it is an important source of revenue) and no change in that policy is planned…A digital version is promised within a few months through a secure website and also as mobile device applications. Revisions will be more frequent and most likely would be distributed only electronically, Kupfer said.


Wall Street Journal, US: Revised Psychiatric Manual Faces Mixed Reviews Shirley Wang, May 18

The widely criticized new version of the U.S. psychiatric diagnostic manual due out faces a potentially diminished role in research, which would mark a shift for what has been considered the bible of American psychiatry for 30 years.

…Dr. Kupfer, the DSM leader, said researchers should look at the DSM as “a guide but not necessarily the only framework they should use to carry out basic science.”

“For the DSM to be considered primarily a guide for clinicians is a “dramatic backtracking from their prior position as putting themselves out there as the best basis for research,” said Geoffrey Reed, senior project officer at the World Health Organization…Most of the research funded by the NIMH and published in psychiatry journals in the past 20-plus years had to use DSM diagnostic criteria; otherwise, scientists had no hope of publishing, said Dr. Reed.


The Guardian, UK: New US manual for diagnosing mental disorders published Ian Sample, science correspondent, May 18

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, has divided medical opinion

[Ed: Note according to a WPA-WHO 2011 Survey, around 11% of practising UK psychiatrists and around 23% of practising psychiatrists surveyed globally reported using DSM-IV more than ICD-10.]

…Though not used in the UK, where doctors turn to the World Health Organisation’s International Statistical Classification of Diseases (ICD), the US manual has global influence. It defines groups of patients, and introduces new names for disorders. Those names can spread, and become the norm elsewhere. More importantly, the categories redefine the populations that are targeted by drugs companies.


The Pharmaletter, US: Europe adopting US strategies to diagnose and treat ADHD Industry article, May 16

…Although Europe trails behind the USA in terms of market revenue, ADHD therapeutics markets are expected to show strong growth, with Spain predicted to witness a compound annual growth rate (CAGR) of 8% over 2012-2018, beating the USA’s CAGR of 6% during the same future period. European markets have not yet neared the saturation point that ADHD therapeutics are facing in the USA, and there is an optimistic view for ambitious growth in this region.


Medpage Today, US: DSM-IV Boss Presses Attack on New Revision John Gever, Deputy Managing Editor, May 17

Includes Complimentary Source PDF: http://annals.org/article.aspx?articleid=1688399

…Ironically, DSM-5 has come under attack from the autism community for rewriting the autism spectrum classification in ways that autism advocates have feared will disqualify many children from receiving autism diagnoses — a controversy that Frances did not address…But he did suggest that the DSM in general has become too important after a very modest beginning in the 1950s.

“The DSM … has since acquired perhaps too much real-world influence as the arbiter of who gets what treatment and whether it will be reimbursed; who is eligible for disability benefits, Veterans Affairs benefits, and school and mental health services; and who qualifies to receive life insurance, adopt a child, fly an airplane, or buy a gun,” Frances observed.


Biomedcentral: Patient advocacy and dsm-5 Dan J Stein and Katharine A Phillips, May 17

BMC Medicine 2013, 11:133 doi:10.1186/1741-7015-11-133

Published: 17 May 2013 Abstract (provisional). Complete article is available as free, provisional PDF here

Abstract (provisional)

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback.


Herald Online, PR Newswire: New Social Media Campaign Features Stories Of Individuals Who Rejected Psychiatric Association’s DSM-5

Campaign timed to coincide with rollout of American Psychiatric Association’s DSM-5, Open Paradigm Project

SAN FRANCISCO, May 18, 2013 — /PRNewswire-USNewswire/ — The Open Paradigm Project, in collaboration with MadinAmerica.com, Occupy Psychiatry, and leading organizations in the movement to reform mental health care, announces a social media campaign showcasing video testimonials by individuals negatively impacted by the traditional psychiatric model, which focuses on pathology and illness rather than wellness and recovery. The launch coincides with the American Psychiatric Association’s (APA) rollout of its latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), taking place at the APA’s annual meeting in San Francisco this weekend. In light of National Institute of Mental Health (NIMH) director Thomas Insel’s move away from the DSM (“lack of validity… patients deserve better”) and DSM-5 task force chair David Kupfer’s admission of an absence of biological markers of mental illness (“we’re still waiting”), these stories starkly unveil the failure of, and harm done by, the prevailing model of mental health care…


Vox, Gibraltar: Western Psychiatry in Crisis Vox Editor, May 17

DSM 5 and exclusively biological psychiatry must be completely rethought

The following is an extract of the Mental Health Europe article:

Western psychiatry is in crisis. The direction taken by the new Diagnostic and Statistical Manual of Mental Disorders (DSM 5), due to be published later this week, has received ample criticism. Moreover, in disagreement with the American Psychiatric Association, the United States National Institute of Mental Health (NIMH), the world’s largest research institute, has announced they will no longer fund projects based exclusively on DSM categories. Unfortunately, while Mental Health Europe considers the NIMH decision to be the right one, by focusing almost entirely on neuroscience and on so-called disorders of the brain, the NIMH is missing out on the critical importance of user experiences to psychiatric research and to the practice of psychiatry…

…For more information, please contact MHE Information and Communications Manager Silvana Enculescu at silvana.enculescu@mhe-sme.org. MHE Senior Policy Adviser Bob Grove and MHE Policy Officer Yves Brand will be available for interviews.

    Click link for PDF document   More harm than good – DSM 5 and exclusively biological psychiatry must be completely rethought


BBC: Mental health ‘bible’ update due May 18


Psych Central, US: DSM-5 Released: The Big Changes John M Grohol, Psy.D., May 18


Wired Science, US: A Case That Tells the Weird Tale of DSM – and Other Recommended Reading David Dobbs, May 18

For a single post that shows how weirdly and unevenly psychiatric diagnosis actually works (and fails to work) in this country, and what that means for the new DSM, get over to Maia Svalavitz’s clear-eyed account of her own five diagnoses (and the one she never got)…


Independent, UK: Comment: Despite what the DSM implies, medical intervention is not always the answer to mental health issues Frank Furedi, May 18

You don’t need to be a mental health professional to take an interest in the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

…Recently, the British Psychological Society’s division of clinical psychology has attacked the psychiatric profession for offering a biomedical model for understanding mental distress. But its criticism was not directed at the ethos of medicalisation as such, but only at the tendency to associate mental illness with biological causes. What it offered was an alternative model of medicalisation – one where mental illness was represented as the outcome of social and psychological cause. It seems that medicalization has become so deeply entrenched that even critics of the DSM accept its premise.


OUP Blog (Oxford University Press): Clinician’s guide to DSM-5 Joel Paris, MD, May 18

…The DSM system can be described as flawed but necessary. Clinicians need to communicate to each other, and even a wrong diagnosis allows them to do so.


For earlier responses to release of DSM-5 see Posts #251 and #249

DSM-5 released: Media, professional and advocacy reaction: Round up #1

Post #251 Shortlink: http://wp.me/pKrrB-32h

Eureka Alert: American Psychiatric Association Press Release: American Psychiatric Association releases DSM-5 May 17


Science Media Centre, UK: Press briefing: Has psychiatry gone too far? May 17

Speakers:

Prof Elizabeth Kuipers, Professor of Clinical Psychology, Head of Department of Psychology, King’s College London’s Institute of Psychiatry;
Prof David Clark, Professor of Experimental Psychology, University of Oxford and Honorary Fellow of the British Psychological Society;
Prof Nick Craddock, Professor of Psychiatry, University of Cardiff and Director of the National Centre for Mental Health, Wales;
Prof David Taylor, Royal Pharmaceutical Society expert and spokesperson on mental health medicines and Editor of the Maudsley Prescribing Guidelines;
Andy Bell, Deputy Chief Executive, The Centre for Mental Health


Medscape Medical News from The American Psychiatric Association’s 2013 Annual Meeting: DSM-5: Setting the Record Straight Jeffrey A Lieberman, MD

…The NIMH’s position on the DSM and need for scientific progress in understanding the genetic and neurobiologic basis of mental disorders has not changed. The DSM is an essential guide to clinicians to facilitate accurate diagnosis and treatment. At the same time, biomedical research cannot be confined by traditional diagnostic constructs and their boundaries. Tom and I, and the APA and NIMH, are in complete agreement on this. The DSM is a valuable guide that helps clinicians in the evaluation of patients to establish an accurate diagnosis and facilitate the most effective treatment. It is designed to reflect the latest scientific knowledge and translate this into a “user-friendly” instrument for clinicians and patients…


Medscape Medical News from The American Psychiatric Association’s 2013 Annual Meeting: DSM-5 Officially Launched, But Controversy Persists Caroline Cassels, May 18

…diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.


American Psychological Association: Practice Central Update: Nine frequently asked questions about DSM-5 and ICD-10-CM Practice Research and Policy staff, May 16

APA Practice staff answer questions about billing, determining diagnoses and more related to the two diagnostic classification systems.


Market Place, Health Care, US: How much is the DSM-5 worth? Dan Gorenstein, May 17

It’s 19 years old and it still brings in about $4-5 million a year…with 150,000 pre-orders the DSM-5 is a hot seller. We may do a second printing more quickly than we originally thought,” says Scully. At $199 dollars for the hardcover, $149 for paperback — that’s more than $20 million in sales right there.


BBC Radio 5 live: Friday 10:00, 120 mins

http://www.bbc.co.uk/programmes/b01sf42v

One of the country’s leading psychologists tells this programme that the way mental health conditions are diagnosed in the UK is “deeply flawed” and too many people are being labelled with specific syndromes like post traumatic stress disorder, attention deficit hyperactivity disorder and personality disorders. Dr Lucy Johnstone, from the division of clinical psychology, says we shouldn’t be labelling behaviour as illnesses when in most cases people are just reacting in understandable ways to life experiences. Victoria speaks to Dr Johnstone and to listeners who have been diagnosed with mental health problems.

Clip 14:52: Are we too quick to diagnose mental health illnesses?

http://www.bbc.co.uk/programmes/p0195g8k


RCPSYCH, UK: Troubled waters Blog of the President of the Royal College of Psychiatrists, Prof Sue Bailey


The Monthly, Australia: DSM-5 and the Mental Illness Make-over Prof Nick Haslam, May 2013


ABC News, Australia: Psychiatry bible receives a makeover Sophie Scott, Michelle Brown, Gillian Bennett, May 19


Daily Telegraph, Australia: New psychiatry manual, DSM5, reclassifies previously normal behaviours as illnesses Sue Dunlevy, May 18


Toronto Star, Canada: DSM-5: Controversial changes to psychiatry’s bible Nancy White, May 17


El Confidential, Madrid: El DSM-5, la nueva biblia de los psiquiatras, atacada por los psicólogos May 14

Sinc habla en exclusive con David J. Kupfer


Psychiatric News, US: Ink Meets Paper as DSM-5 Goes to Press Aaron Levin, May 17


Slate, US: The DSM-5 Is Not Crazy, Psychiatry’s new diagnoses of picking, bingeing, and tantrums sound silly, but they’re useful for me and my patients, Marla W Deibler, May 17


Ottowa Citizen, Canada: Infighting, boycotts, resignations: Psychiatry faces another crisis of confidence Sharon Kirkey, Postmedia News, May 17


Independent, UK: Doctors in dispute: What exactly is normal human behaviour? Jeremy Laurance, May 17


Japan Times: Psychiatrists under fire in mental health battle Jamie Doward, May 18


Reuters: Psychiatrists unveil their long-awaited diagnostic “bible” Sharon Begley, May 17

NIMH Director issues joint statement with APA President-elect on DSM’s validity as diagnostic tool

NIMH Director issues joint statement with APA President-elect on DSM’s validity as a diagnostic tool

Post #248 Shortlink: http://wp.me/pKrrB-308

180degrees

Less than two weeks after throwing DSM under the bus, NIMH’s Director, Thomas Insel, has issued a joint statement with APA President-elect, Jeffrey Lieberman.

This week, DSM…

…represents the best information currently available for clinical diagnosis of mental disorders

In a Pharmalot report titled NIMH Director Says The Bible Of Psychiatry Is Valid, After All, Ed Silverman writes:

‘Just 10 short days after trashing the widely regarded bible of psychiatry for lacking validity, National Institutes of Mental Health director Tom Insel has had a change of heart. Along with American Psychiatric Association president-elect Jeff Lieberman, he has now issued a statement saying the forthcoming version…is a valuable diagnostic tool. Their missive amounts to a combination of face saving and damage control…’

Report, here, from Sharon Jayson, for USA Today:

NIH official clarifies criticism of diagnostic manual

‘The groups also make it clear that DSM-5 isn’t going away.

‘DSM-5 and RDoC represent complementary, not competing, frameworks…As research findings begin to emerge from the RDoC effort, these findings may be incorporated into future DSM revisions and clinical practice guidelines,” the statement says. “But this is a long-term undertaking. It will take years to fulfill the promise that this research effort represents for transforming the diagnosis and treatment of mental disorders.”‘

1 Boring Old Man’s take here: a long and winding road…

Gary Greenberg at the New Yorker: The Rats of N.I.M.H.

Tuesday’s joint statement from Thomas Insel and Jeffrey Lieberman, here:

 Click link for PDF document   Joint APA and NIMH Statement

Or here on NIMH site: DSM-5 and RDoC: Shared Interests

Full text APA Release No. 13-37

For Information Contact:
Eve Herold, 703-907-8640 May 14, 2013
press@psych.org Release No. 13-37
Erin Connors, 703-907-8562
econnors@psych.org
DSM-5 and RDoC: Shared Interests
Thomas R. Insel, M.D., director, NIMH
Jeffrey A. Lieberman, M.D., president-elect, APA

NIMH and APA have a shared interest in ensuring that patients and health providers have the best available tools and information today to identify and treat mental health issues, while we continue to invest in improving and advancing mental disorder diagnostics for the future.

Today, the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD) represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5. As NIMH’s Research Domain Criteria (RDoC) project website states, “The diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.”

Yet, what may be realistically feasible today for practitioners is no longer sufficient for researchers. Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories. It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior. This is the focus of the NIMH’s Research Domain Criteria (RDoC) project. RDoC is an attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience, and behavioral science to the problem of mental illness.

The evolution of diagnosis does not mean that mental disorders are any less real and serious than other illnesses. Indeed, the science of diagnosis has been evolving throughout medicine. For example, subtypes of cancers once defined by where they occurred in the body are now classified on the basis of their underlying genetic and molecular causes.

All medical disciplines advance through research progress in characterizing diseases and disorders. DSM-5 and RDoC represent complementary, not competing, frameworks for this goal. DSM-5, which will be released May 18, reflects the scientific progress seen since the manual’s last edition was published in 1994. RDoC is a new, comprehensive effort to redefine the research agenda for mental illness. As research findings begin to emerge from the RDoC effort, these findings may be incorporated into future DSM revisions and clinical practice guidelines. But this is a long-term undertaking. It will take years to fulfill the promise that this research effort represents for transforming the diagnosis and treatment of mental disorders.

By continuing to work together, our two organizations are committed to improving outcomes for people with some of the most disabling disorders in all of medicine.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in diagnosis, treatment, prevention, and research of mental illnesses including substance use disorders.

Visit the APA at www.psychiatry.org
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More on the RDoC from the NIMH website

Research Domain Criteria

The National Institute of Mental Health Strategic Plan Released August 2008

DSM-5 Round up: May #1

Post #245 Shortlink: http://wp.me/pKrrB-2WM

More reports on last week’s announcement by NIMH Director, Thomas Insel

BMJ News [Full report behind paywall]

Director of top research organization for mental health criticizes DSM for lack of validity

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2954 (Published 8 May 2013)

Michael McCarthy, Seattle | May 8, 2013


New Scientist print edition No 2196 May 11, 2013

[The first of these two print edition articles is behind a subscription]

How a scientific DSM will transform psychiatry

Peter Aldhous, Andy Coghlan, additional reporting by Sara Reardon

This article appears in the print edition THIS WEEK section under the headline

A revolution in mental health, Patients deserve better than an unscientific manual, says leading health institute

…don’t expect the landscape of mental illness to change any time soon. Insel accepts that it will take at least a decade to conduct the research necessary to devise a new approach to diagnosis. In the meantime, patients’ illnesses will continue to be diagnosed using the DSM’s symptom-based categories…

…Even the transition in research will be gradual – the NIMH isn’t going to stop funding projects based around DSM diagnoses overnight. But it is clear that new approaches will get priority in future, and with a budget of almost $1.5 billion per year, the NIMH is in a position to call the shots…

This week’s Editorial in the print edition is an edited version of the Allen Frances opinion piece published by New Scientist earlier this week:

Print edition Editorial > Opinion

Don’t count on this manual, The future of psychiatric research lies in simpler questions, by Allen Frances


UK Independent

The Diagnostic and Statistical Manual of Mental Disorders has been updated but should we beware this manual’s diagnosis?

The book which gives doctors a checklist for mental illnesses – as made famous by The Psychopath Test – has been updated. But does it really work?

…An alternative – and free – publication, International Statistical Classification of Diseases (ICD), issued by the World Health Organisation, provides an official international classification system of mental illness that the DSM sometimes borrows. The ICD is used in Europe for clinical treatment in preference to the DSM and without the lurid headlines. The DSM, though, is increasingly influential on our way of thinking about mental health…

Mark Piesing | May 8, 2013

Comment to article from Dx Revision Watch


For global usage of DSM v ICD by practising psychiatrists and country by country breakdown see
Slide 17 Global use of DSM-5 and ICD-10; Slide 18 Use by country breakdown http://www.aaidd.org/media/3192013.pdf
Data from The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification Free full paper

UK Radio

BBC R4 Today programme

Discussion on DSM-5 | Today programme, Thurs, May 9

http://www.bbc.co.uk/iplayer/episode/b01s8qx7/Today_09_05_2013/

1 hr.50 mins in from start |  7 minutes

With James Davies, Lecturer and author of “Cracked” (has also had two articles around his book published in the Times)

Does your child really have a behavioural problem? James Davies, May 6 2013

and Prof Nick Craddock

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BBC R4 All in the Mind [One year left to listen again]

http://www.bbc.co.uk/programmes/p018qfjm

Presenter Claudia Hammond

The new edition of the American Diagnostic and Statistical Manual of Mental Disorders will be launched later this month, Professor Simon Wessely discusses its potential impact in the UK.

Duration: 9 mins at start of 28 min broadcast| Tuesday 07 May 2013 21:00 | Repeated Wed 8 May 2013 15:30

Discussion omitted any reference to, and implications for the WHO/APA International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders commitment to strive as far as possible for harmonization between the mental health chapter of the forthcoming ICD-11 (Chapter 5) and DSM-5.

The Scientist

NIMH to Steer Away from New Manual

The agency will no longer use the newly revised guide to mental disorders to categorize its funding priorities.

Kate Yandell | May 9, 2013

…To better classify mental disease, the NIMH has started the Research Domain Criteria (RDoC) project, which Insel said will “transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.” However, biological biomarkers for mental disease are few, so Insel said that RDoC is more of a framework for future knowledge to fit into than a completed classification system…

…In order to better fill in the gaps, he said that NIMH grant applicants will be asked to think of research projects that cut across diagnoses…

…NIMH is not “ditching” the DSM completely, Insel told Time. DSM diagnostic criteria will continue to be important in the clinic, just not as guides for research.


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Not specific to recent announcement by NIMH’s, Thomas Insel

Huffington Post [Also at Psychiatric Times, Psychology Today]

Hippocratic Humility in the Face of ‘Unexplained’ Medical Problems

Allen Frances, MD | May 7, 2013

With contribution from Dr Diane O’Leary


National Pain Report

Could Fibromyalgia Be Labeled as a Psychiatric Illness?

Celeste Cooper, RN | May 5, 2013

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Related material

National Institute of Mental Health (NIMH) announcement Transforming Diagnosis
Published by Thomas Insel, Director, NIMH, April 29, 2013

Full text of rebuttal statement from David J Kupfer, Chair, DSM-5 Task Force, press released by APA on May 6, 2013
Dx Revision Watch Post #242: http://wp.me/pKrrB-2VO

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DSM-5 and the NIMH Research Domain Criteria Project Psychiatric Times, James Phillips, MD, April 13, 2011

NIMH Research Domain Criteria (RDoC) Draft 3.1: June, 2011

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