Category Archives: DSM-V

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

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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

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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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International media Round up #1: National Institute of Mental Health to re-orientate research away from DSM categories

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International media Round up #1: National Institute of Mental Health to re-orientate research away from DSM categories

Post #243 Shortlink: http://wp.me/pKrrB-2VZ

Update: Additional media coverage on NIMH added (Matthew Herper, Forbes; Deborah Brauser, Medscape Medical News; Ferris Jabr, Scientific America; John M Grohol, PsychCentral; TIME; 1 Boring Old Man), plus details of DSM-5 on BBC R4 radio

BBC R4′s All in the Mind this evening will be discussing the impact of the DSM on UK mental health and asking whether or not we in the UK pay any attention to what it contains. No other details about whom Claudia Hammond will be interviewing:

http://www.bbc.co.uk/programmes/b01s8cpf

BBC Radio 4 | Duration: 28 minutes | Tuesday 07 May 2013 21:00 | Wed 8 May 2013 15:30

Yesterday, American Psychiatric Association press released a rebuttal from DSM-5 Task Force Chair, David J Kupfer, to the announcement, last week, that the world’s largest federal mental health funding agency will be re-orientating research away from DSM categories.

Read Kupfer’s statement here:

Statement, David Kupfer, MD, May 3, 2013 [press@psych.org Release No. 13-33]

Chair of DSM-5 Task Force Discusses Future of Mental Health Research

Click link for PDF document American Psychiatric Association Press Release

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The story is trickling into mainstream media and being picked up internationally. For earlier media and blogger coverage, see Dx Revision Watch post: National Institute of Mental Health (NIMH) to ditch the DSM (May 3).

There has been mixed reaction to this announcement by NIMH’s Director, Thomas Insel, with many welcoming a shift from DSM dominance but scepticism, also, over whether NIMH might realistically achieve its objectives, as set out a couple of years ago.

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Media Round up #1

Forbes

Pharma & Healthcare

Why Psychiatry’s Seismic Shift Will Happen Slowly

Matthew Herper Forbes Staff | May 8, 2013

…I called the NIMH, and was put on the phone with Bruce Cuthbert, the director of the division of adult translational research. I had a pretty simple question. If the NIMH were really rejecting or abandoning the DSM, that would mean the agency wouldn’t accept studies that use DSM-5 criteria. For instance, if you wanted to test a new schizophrenia drug in schizophrenics, you’d have to find some new RDoC way of describing the disease.

Cuthbert said repeatedly that would not be the case. It’s not so much that studies that use the DSM-5 will be excluded and abandoned, but that researchers would now be allowed to apply for grants that would not use the manual’s diagnostic criteria, or subdivided them in new, creative ways…

Medscape Medical News > Psychiatry

NIMH, APA Clash Over Upcoming DSM-5

‘Patients Deserve Better,’ NIMH Director Says

Deborah Brauser | May 7, 2013

Scientific America

No One Is Abandoning the DSM, But It Is Almost Time to Transform It

Ferris Jabr | May 7, 2013

PsychCentral

Did the NIMH Withdraw Support for the DSM-5? No

John M. Grohol, Psy.D. | May 7, 2013

…Will this replace the DSM-5? No, because as Dr. Insel notes, “This is a decade-long project that is just beginning.” If the NIMH effort ever replaces the DSM, it will be a long time from now…

“I also should point out that these comments reflect [only] our translational research portfolios. Our Division of Services and Intervention Research mostly supports research conducted in clinical settings that is relevant to current clinical practice and services delivery. Thus, [...] grants in these areas will continue to be predominantly funded with DSM categories for some time.” [according to Dr. Bruce Cuthbert, director of the Division of Adult Translational Research at the National Institute of Mental Health]

1 Boring Old Man

…groundhog day

1 Boring Old Man | May 7, 2013

TIME

Mental Illness

Mental Health Researchers Reject Psychiatry’s New Diagnostic ‘Bible’

Maia Szalavitz | May 7, 2013

Just weeks before psychiatry’s new diagnostic “bible”—the DSM 5— is set to be released, the world’s major funder of mental health research has announced that it will not use the new diagnostic system to guide its scientific program, a change some observers have called “a cataclysm” and “potentially seismic.” Dr. Thomas Insel, the director of the National Institute on Mental Health, said in a blog post last week that “NIMH will be re-orienting its research away from DSM categories.”

The change will not immediately affect patients. But in the long run, it could completely redefine mental health conditions and developmental disorders. All of the current categories — from autism to schizophrenia — could be replaced by genetic, biochemical or brain-network labeled classifications. Psychiatrists, who are already reeling from the conflict-filled birth of the fifth edition of the Diagnostical and Statistical Manual of Mental Disorders, are feeling whipsawed…

…The NIMH has outlined a new diagnostic system — called Research Domain Criteria (RDoC) — that could ultimately replace the DSM, but it’s not yet ready for prime time. For the time being, NIMH and the psychiatrists who use the manual will continue to abide by existing classifications for diagnosing patients and getting treatment reimbursed. “Some people have the idea that we’re trying to ditch or diss the DSM and that’s not a fair assessment,” says Insel…

New York Times

Psychiatry’s Guide Is Out of Touch With Science, Experts Say

Pam Belluck and Benedict Carey | May 6, 2013

…“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

…Dr. Insel said in the interview that his motivation was not to disparage the D.S.M. as a clinical tool, but to encourage researchers and especially outside reviewers who screen proposals for financing from his agency to disregard its categories and investigate the biological underpinnings of disorders instead. He said he had heard from scientists whose proposals to study processes common to depression, schizophrenia and psychosis were rejected by grant reviewers because they cut across D.S.M. disease categories.

“They didn’t get it,” Dr. Insel said of the reviewers. “What we’re trying to do with RDoC is say actually this is a fresh way to think about it.”

He added that he hoped researchers would also participate in projects funded through the Obama administration’s new brain initiative.

Dr. Michael First, a psychiatry professor at Columbia who edited the last edition of the manual, said, “RDoC is clearly the way of the future,” although it would take years to get results that could apply to patients. In the meantime, he said, “RDoC can’t do what the D.S.M. does. The D.S.M. is what clinicians use. Patients will always come into offices with symptoms.”

For at least a decade, Dr. First and others said, patients will continue to be diagnosed with D.S.M. categories as a guide, and insurance companies will reimburse with such diagnoses in mind…

Science Insider

NIMH Won’t Follow Psychiatry ‘Bible’ Anymore

Emily Underwood | May 6, 2013

…Helena Kraemer, a biostatistician at Stanford University in Palo Alto, California, who was responsible for field trials of diagnostic categories proposed for DSM-5, says that Insel is right that the NIMH’s new program, called Research Domain Criteria (RDoC) is “the direction we have to go.” However, she says, “he’s wrong in saying that DSM-5 is to be set aside.” When it comes to validity, there now is no gold standard, she says. “The DSM is a series of successive approximations.” Kraemer’s vision is that future versions of the manual will not have to wait 10 to 15 years for revision, but incorporate new scientific data from RDoC as it emerges. She says that a meeting is scheduled in June to discuss the possibility of converting the DSM into an electronic document that could incorporate those changes. “Everybody I’ve talked to about it thinks that’s a good idea.”

…Implementing RDoC will present some practical challenges, [William] Carpenter acknowledges. “This does shift the paradigm.” Rather than excluding all study subjects who do not fit a DSM diagnosis, such as major depression, for example, the new approach might include a range of participants with different diagnoses who all demonstrate anhedonia, the impaired ability to experience pleasure, and might look for underlying brain abnormalities that they share in common. “I bet that the rough spots are overcome pretty quickly,” Carpenter says, “but of course we have to see how well that actually works out…”

The Globe and Mail [Canada]

American Psychiatric Association rebuked over new diagnostic manual

Wency Leung | May 6, 2013

…[Gary] Greenberg says that while he believes that this change in the institute’s research direction will generate a huge amount of science on mental health, he is skeptical that researchers will be able to boil down the extraordinarily complex workings of the brain into sound and specific diagnostic criteria.

In response to Insel, the APA issued a statement on Saturday by David Kupfer, chair of the DSM-5 task force, noting that it has been waiting for decades for reliable biological and genetic markers on which to base precise diagnoses. “We are still waiting,” Kupfer said.

In the meantime, the DSM is the “strongest system currently available for classifying disorders,” he said.

“Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders,” Kupfer said. “But they cannot serve us in the here and now, and they cannot supplant DSM-5…”

Psychology Today Blog Mood Swings

NIMH: A Requiem for DSM – and its Critics
A new generation will reject DSM, and the anti-biological critics of DSM too

Dr. Nassir Ghaemi in Mood Swings | May 5, 2013

Update: Response from Gary Greenberg and further comment from Bernard Carroll, MD

Wetenschap 24 News [Netherlands]

Psychiaters verwerpen psychiatriebijbel

Door: Nadine Böke | mei 03, 2013

De grootste onderzoeksinstelling voor geestelijke gezondheidszorg ter wereld, het Amerikaanse NIMH (National Institute for Mental Health) verwerpt ‘psychiatriebijbel’ DSM.

LaPresse [French Canadian]

Le blogue santé

DSM-5: une bible controversée

Valérie Simard | 6 mai 2013

Agence Science-Presse [French Canadian]

Recherche: désaveu de la bible des psychiatres

Agence Science-Presse |  le 6 mai 2013

(Agence Science-Presse) L’ouvrage qu’on décrit sans cesse comme la «bible» des maladies mentales, et dont la nouvelle édition, après des années d’attente, doit paraître ce mois-ci, vient d’être écarté par rien de moins que le plus gros organisme subventionnaire de la recherche sur les maladies mentales au monde.

De Morgen [Belgium]

Something rotten in de psychiatrie

OPINIE − 07/05/13

De labelingmachine van de DSM 5 is mensonwaardig.
Wat doet de overheid, vraagt Marc Calmeyn. Calmeyn is psychiater en psychoanalyticus. Hij werkt in Brugge.

For earlier media and blogger coverage, see Dx Revision Watch post: National Institute of Mental Health (NIMH) to ditch the DSM.

Kupfer (APA) statement on National Institute of Mental Health (NIMH) announcement

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Kupfer (APA) statement on National Institute of Mental Health (NIMH) announcement

Post #242 Shortlink: http://wp.me/pKrrB-2VO

David J Kupfer, Chair, DSM-5 Task Force, has issued a statement in response to the April 29 announcement by NIMH’s Thomas Insel:

 Click link for PDF document   American Psychiatric Association Press Release

Text:

For Information Contact:

Eve Herold, 703-907-8640 May 3, 2013

press@psych.org Release No. 13-33

Erin Connors, 703-907-8562

econnors@psych.org

Statement by David Kupfer, MD

Chair of DSM-5 Task Force Discusses Future of Mental Health Research

The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting. In the absence of such major discoveries, it is clinical experience and evidence, as well as growing empirical research, that have advanced our understanding of disorders such as autism spectrum disorder, bipolar disorder, and schizophrenia.

This progress will soon be recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new manual, due for release later this month, represents the strongest system currently available for classifying disorders. It reflects the progress that we have made in several important areas.

• A revised chapter organization signals how disorders may relate to each other based on underlying vulnerabilities or symptom characteristics.

• Disorders are framed in the context of age, gender, and cultural expectations, in addition to being organized along a valuable developmental lifespan within each chapter.

• Key disorders were combined or reorganized because the relationships among categories clearly placed them along a single continuum, such as substance use disorder and autism spectrum disorder.

• A new section introduces emerging measures, models and cultural guidance to assist clinicians in their evaluation of patients. For the first time, self-assessment tools are included to directly engage patients in their diagnosis and care.

DSM, at its core, is a guidebook to help clinicians describe and diagnose the behaviors and symptoms of their patients. It provides clinicians with a common language to deliver the best patient care possible. And through content such as the new Section III, the next manual also aims to encourage future directions in research.

Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders. But they cannot serve us in the here and now, and they cannot supplant DSM-5. RDoC is a complementary endeavor to move us forward, and its results may someday culminate in the genetic and neuroscience breakthroughs that will revolutionize our field. In the meantime, should we merely hand patients another promissory note that something may happen sometime? Every day, we are dealing with impairment or tangible suffering, and we must respond. Our patients deserve no less.

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

ENDS

National Institute of Mental Health (NIMH) to ditch the DSM

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National Institute of Mental Health (NIMH) to ditch the DSM

Post #241 Shortlink: http://wp.me/pKrrB-2UL

An edited version of the post published on May 3

DSM5NIMH to ditch DSM

Earlier this week, in a blog dated April 29, Thomas Insel, National Institute of Mental Health’s Director, quietly drove another nail into the coffin of DSM-5.

NIMH, part funders of the 13 DSM-5 Research Planning Conferences held between 2004 and 2008 and the monographs that resulted out of them, announced that NIMH “will be re-orienting its research away from DSM categories.”

I don’t have figures for how much funding NIMH has sunk into the development of DSM-5.

This announcement comes just three weeks before the American Psychiatric Association launches its next edition of the Diagnostic and Statistical Manual of Mental Disorders, with a clutch of spin off publications scheduled for release in May and September.

APA has yet to issue a statement or comment in the press.

At the end of this post are links to the NIMH Research Domain Criteria (RDoC) posted in 2011, and a commentary by James Phillips, MD, for Psychiatric Times, from April 2011: “DSM-5 and the NIMH Research Domain Criteria Project.”

You can read Thomas Insel’s announcement in full, below, followed by a round up of media coverage.

Additional coverage and commentary is being added, as it comes in, below the NIMH announcement in the pale blue box.

Most recently added: Dr Tad; Neurocritic BlogSpot

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On April 24, in Mental health: On the spectrum, Nature had reported:

“Research suggests that mental illnesses lie along a spectrum — but the field’s latest diagnostic manual still splits them apart…

“…The APA claims that the final version of DSM-5 is a significant advance on the previous edition and that it uses a combination of category and dimensional diagnoses. The previously separate categories of substance abuse and substance dependence are merged into the new diagnosis of substance-use disorder. Asperger’s syndrome is bundled together with a handful of related conditions into the new category called autism-spectrum disorder; and OCD, compulsive hair-pulling and other similar disorders are grouped together in an obsessive–compulsive and related disorders category. These last two changes, Regier says, should help research scientists who want to look at links between conditions. “That probably won’t make much difference to treatment but it should facilitate research into common vulnerabilities,” he says.

“The Research Domain Criteria project is the biggest of these research efforts. Last year, the NIMH approved seven studies, worth a combined US$5 million, for inclusion in the project — and, Cuthbert says, the initiative “will represent an increasing proportion of the NIMH’s translational-research portfolio in years to come”. The goal is to find new dimensional variables and assess their clinical value, information that could feed into a future DSM.

“One of the NIMH-funded projects, led by Jerzy Bodurka at the Laureate Institute for Brain Research in Tulsa, Oklahoma, is examining anhedonia, the inability to take pleasure from activities such as exercise, sex or socializing. It is found in many mental illnesses, including depression and schizophrenia.

“Bodurka’s group is studying the idea that dysfunctional brain circuits trigger the release of inflammatory cytokines and that these drive anhedonia by suppressing motivation and pleasure. The scientists plan to probe these links using analyses of gene expression and brain scans. In theory, if this or other mechanisms of anhedonia could be identified, patients could be tested for them and treated, whether they have a DSM diagnosis or not.

“One of the big challenges, Cuthbert says, is to get the drug regulators on board with the idea that the DSM categories are not the only way to prove the efficacy of a medicine. Early talks about the principle have been positive, he says. And there are precedents: “Pain is not a disorder and yet the FDA gives licences for anti-pain drugs,” Cuthbert says.

“Going back to the drawing board makes sense for the scientists, but where does it leave DSM-5? On the question of dimensionality, most outsiders see it as largely the same as DSM-IV. Kupfer and Regier say that much of the work on dimensionality that did not make the final cut is included in the section of the manual intended to provoke further discussion and research. DSM-5 is intended to be a “living document” that can be updated online much more frequently than in the past, Kupfer adds. That’s the reason for the suffix switch from V to 5; what comes out next month is really DSM-5.0. Once the evidence base strengthens, he says, perhaps as a direct result of the NIMH project, dimensional approaches can be included in a DSM-5.1 or DSM-5.2…”

National Institute of Mental Health (NIMH) announcement

Transforming Diagnosis

By Thomas Insel on April 29, 2013

Thomas R. Insel, M.D., is Director of the National Institute of Mental Health (NIMH).

“…Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system…”

“…That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system….”

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Dr Tad Blog

Paradigms lost: NIMH, McGorry & DSM-5’s failure

Dr Tad | May 4, 2013

Neurocritic Blogspot

RDoC Dimensional Approach for Research vs. DSM-5 for Diagnosis

Neurocritic | May 5, 2013

Article in Romanian

DESCOPERĂ

Cea mai importantă ştiinţă a minţii umane, psihiatria, se transformă în urma unei decizii importante

Article in French

Psychomédia

Le National Institute of Mental Health (NIMH) américain se distance du DSM-5 de l’American Psychiatric Association

Soumis par Gestion le 3 mai 2013

“Le National Institute of Mental Health (NIMH) américain réoriente ses recherches en se distançant du DSM, le Diagnostic and Statistical Manual of Mental Disorders, dont la cinquième édition sera lancée par l’American Psychiatric Association le 22 mai, explique son directeur, Thomas Insel, dans un billet publié le 29 avril…”

Article in Turkish

Psikiyatristler DSM tanı kriterlerini terk ediyor!

Dünyadaki en büyük ruh sağlığı araştırma kurumlarından ABD Ulusal Sağlık Kurumu (NIMH), psikiyatrik rahatsızlıkların semptomlara bağlı olarak belirlenmesine dayanan tanı yöntemini terk ediyor.

Pazar, 05 Mayıs 2013

Scientific American John Horgan Blog

Psychiatry in Crisis! Mental Health Director Rejects Psychiatric “Bible” and Replaces With… Nothing

“NIMH director Insel doesn’t mention it, but I bet his DSM decision is related to the big new Brain Initiative, to which Obama has pledged $100 million next year.”

John Horgan | May 4, 2013

Psychology Today
Side Effects | Christopher Lane Ph.D.

The NIMH Withdraws Support for DSM-5
The latest development is a humiliating blow to the APA.

Christopher Lane, Ph.D. | May 4, 2013

Government Health IT

NIMH moving beyond DSM

Anthony Brino, Associate Editor | May 3, 2013

1 Boring Old Man

old news…

1 Boring Old Man | May 3, 2013

Previously posted

Mindhacks blog

National Institute of Mental Health abandoning the DSM

“In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.

As a result the NIMH will now be preferentially funding research that does not stick to DSM categories…”

New Scientist

Psychiatry divided as mental health ‘bible’ denounced

Andy Coghlan and Sara Reardon | May 3, 2013

“The world’s biggest mental health research institute is abandoning the new version of psychiatry’s “bible” – the Diagnostic and Statistical Manual of Mental Disorders, questioning its validity and stating that “patients with mental disorders deserve better”. This bombshell comes just weeks before the publication of the fifth revision of the manual, called DSM-5…”

“…We cannot succeed if we use DSM categories as the gold standard,” says Insel. “That is why NIMH will be reorienting its research away from DSM categories,” says Insel. Prominent psychiatrists contacted by New Scientist broadly support Insel’s bold initiative. However, they say that given the time it will take to realise Insel’s vision, diagnosis and treatment will continue to be based on symptoms.

“Insel is aware that what he is suggesting will take time – probably at least a decade, but sees it as the first step towards delivering the “precision medicine” that he says has transformed cancer diagnosis and treatment. “It’s potentially game-changing, but needs to be based on underlying science that is reliable,” says Simon Wessely of the Institute of Psychiatry at King’s College London. “It’s for the future, rather than for now, but anything that improves understanding of the etiology and genetics of disease is going to be better [than symptom-based diagnosis].”

New Scientist opinion piece

One manual shouldn’t dictate US mental health research

“The new edition of the DSM “bible” is so flawed that the US National Institute of Mental Health is right to abandon it, says Allen Frances”

Allen Frances, MD | May 3, 2013

@AllenFrancesMD on Twitter

@AllenFrancesMD: @dxrevisionwatch Hype alert. The NIMH dx approach is a necessary, but guarantees nothing in the future and offers nothing in the present.

The Verge

Federal institute for mental health abandons controversial ‘bible’ of psychiatry

Katie Drummond | May 3, 2013

“In a surprising move, the US government institute responsible for overseeing mental health research is distancing itself from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM has, for several decades, been perceived as the “bible” that delegates how psychiatric illnesses are defined, diagnosed, and treated.”

“The National Institute of Mental Health (NIMH) — which funds more research into mental illness than any other agency in the world — this week announced a plan to re-orient its investigations “away from DSM categories.” The move comes mere weeks before the publication of the DSM-5, an update to the manual that’s been mired in controversy because of several contentious changes to existing diagnostic criteria…”

CBS News

National Institute of Mental Health no longer will use DSM diagnoses in studies

Stephanie Pappas | Livescience.com | May 3, 2013

Pharmalive

NIMH Director Says The Bible Of Psychiatry Lacks Validity

Ed Silverman | May 3, 2013

MIT Technology Review

NIMH Will Drop Widely Used Psychiatry Manual

Susan Young | May 3, 2013

Science 2.0

NIMH Delivers A Kill Shot To DSM-5

By Hank Campbell | May 3, 2013

Pacific Standard [Not on NIMH announcement]

Psychiatry’s Contested Bible: How the New DSM Treats Addiction

The 1,000-page psychiatrists’ Big Book will redefine addiction. Critics are already demanding a boycott.

Michael Dhar | May 3, 2013

Drug Rehab [Not on NIMH announcement]

Somatic Symptom Disorder

drugrehab in Mental Health | April 30, 2013

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Related material

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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DSM-5 Round up: April #2

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DSM-5 Round up: April #2

Post #232 Shortlink: http://wp.me/pKrrB-2IU

Update at April 13:

Slate

Abnormal Is the New Normal

Why will half of the U.S. population have a diagnosable mental disorder?

Robin S Rosenberg | April 12, 2013

Via Patrick Landman @landman35635068

News of a forthcoming event about the ”medicalization of childhood” and the consequences of DSM-5. The organizers belong to the STOP DSM international movement.

6-8 June, 2013  Palais Rouge, Buenos Aires, Agentina

and

Fundación Sociedades Complejas

La FUNDACION SOCIEDADES COMPLEJAS. PROYECTOS EN SALUD Y EDUCACION se instituye con el objeto de promover el desarrollo, la capacitación, la formación, la investigación y el perfeccionamiento continuo de todos aquellos profesionales de la salud, la educación y la cultura que trabajan con bebes, niñas…

See also guest editorial by Patrick Landman on Side Effects at Psychology Today

Why DSM-5 Concerns European Psychiatrists

A guest contributor from Paris explains why the manual’s power is misplaced

Published on March 18, 2013 by Christopher Lane, Ph.D. in Side Effects

Patrick Landman, Université de Paris VII

http://www.stop-dsm.org

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The New Yorker

The D.S.M. and the Nature of Disease

Gary Greenberg | April 9, 2013

…The D.S.M. has enormous impact on the public health. It determines which conditions insurers will cover, which drugs regulators will approve, which children will receive special-education services, and which criminal defendants will be able to stand trial and, in some cases, how they will be sentenced. Psychiatry has already reached far into our daily lives, and it’s not by virtue of the particulars of any given D.S.M. It’s because the A.P.A., a private guild, one with extensive ties to the drug industry, owns the naming rights to our pain. That so significant a public trust is in private hands, and on such questionable grounds, is what we ought to worry about.

Continue reading →

American Psychiatric Association Annual Meeting: May 18-22, 2013, San Francisco

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American Psychiatric Association 166th Annual Meeting: May 18-22, 2013, San Francisco, CA

Post #209 Shortlink: http://wp.me/pKrrB-2wB

The American Psychiatric Association (APA) has announced its 166th Annual Meeting, scheduled for May 18-22, 2013, San Francisco, CA.

REGISTRATION DATES

EARLY BIRD REGISTRATON

Member November 1, 2012 – January 24, 2013

Nonmember November 15, 2012 – January 24, 2013

ADVANCE REGISTRATION January 25 – April 19, 2013

ONSITE REGISTRATION April 20 – May 22, 2013

Meeting website

Scientific Program

Annual Meeting Information Guide   [9MB PDF at foot of this page]

Program Highlights Preview

(Described as roughly half of the scientific program with the full program to be posted when scheduling is complete) [Click on the image at foot of page to load 9 MB PDF or download PDF from this link PREVIEW]

The DSM-5 Track starts on Page 12 of the PDF. 

 

It is planned that the DSM-5 will be released at this meeting

APA President’s Message on DSM-5  [Video 5:52 mins]

APA President Dilip Jeste, MD discusses the final stages of DSM-5 development.

Changes to content on DSM-5 Development site (1)

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Changes to content on DSM-5 Development site (1)

Post #189 Shortlink: http://wp.me/pKrrB-2jn

 

Content embargo

According to American Psychiatric Association’s recently published, highly restrictive DSM-5 Permissions Policy – following closure of the third and final public review, the content of DSM-5 will be under strict embargo until the manual is published.

DSM-5 is expected to be finalized by December 31 for publication in May 2013.

APA closed its third stakeholder review of draft proposals for DSM-5 categories and criteria on June 15 and issued a Press Release on June 26 – write-up from Deborah Brauser for Medscape Medical News, below.

Between closure of the final review and Wednesday, June 27, the DSM-5 Development site stated that although comments on proposals could no longer be submitted through the website the site would remain viewable with the draft proposals until DSM-5′s publication.

That line of text was deleted from the DSM-5 Development site home page yesterday, Thursday, June 28.

It remains unconfirmed whether it is now APA’s intention to remove the draft as it stood at the third review from the DSM-5 Development site at some point between now and the slated publication date.

 

Categories and criteria text frozen during final revisions

According to DSM-5 Development home page text, revisions to categories and criteria will continue to be made between now and the end of 2012 in response to stakeholder feedback; continued analysis of DSM-5 Field Trial results; scrutiny by the DSM-5 Scientific Review Committee which will review scientific validating evidence for revisions; an extensive peer review process; review by an Assembly DSM-5 committee and an overall final review by the DSM-5 Task Force.

Disorder categories and criteria texts as they currently stand on the website are now frozen and the site content will not be updated to reflect any further revisions and edits made between June 15 and submission of final texts, later this year, for approval by APA Board of Trustees.

None of the manual’s extensive textual content that will accompany the new categories has been out on public review.

The remainder of the development process is set out on the Home Page under “Next Steps” and in the APA Board Materials Packet – December 10-11, 2011. This document sets out the DSM-5 Development program from December 2011 until May 2013:

Open here: Item 11.A – DSM Task Force Report

 

From Medscape Medical News > Psychiatry

Last DSM-5 Public Review Period Ends With 2000 Comments

Deborah Brauser | June 26, 2012

June 26, 2012 — The latest and final public comment period for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) ended on June 15 — but not before logging 2298 responses from around the world, the American Psychiatric Association (APA) reports.

This was the third public comment period that has been opened for online feedback regarding the manual’s proposed criteria changes. To date, there have been a total of 15,000 public comments posted…

Read full report

Ed: Free registration required for access to most parts of Medscape site.

 

Comment on closure of third and final draft review from 1 Boring Old Man

1 Boring Old Man

missed opportunity…

Wednesday, June 27, 2012

 

Related material

1] APA News Release June 26, 2012

2] DSM-5 Development Timeline

3] DSM-5 Development Permissions Policy

4] DSM-5 Terms and Conditions of Use

My Debate With The DSM 5 Chair: More Translations From ‘Newspeak’ by Allen Frances

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My Debate With The DSM 5 Chair: More Translations From ‘Newspeak’ by Allen Frances, M.D.

Post #186 Shortlink: http://wp.me/pKrrB-2iI

Allen Frances, M.D. is professor emeritus at Duke University and chaired the task force that had oversight of the development of DSM-IV.

My Debate With The DSM 5 Chair
More Translations From ‘Newspeak’

Allen Frances M.D. | June 25, 2012

Recently, I voiced my concerns about DSM 5 in a Medscape interview with Dr Stephen Strakowski. DSM-5 Task Force Chair David Kupfer then entered the debate and provided his defense.

Here is my reply to Dr Kupfer:

I think ‘Newspeak’ is the best way to characterize the APA defense of DSM 5. For those who haven’t read George Orwell’s ’1984′ lately, ‘Newspeak’ was his term for the kind of bureaucratic upside-down language that attempts to turn night into day. The idea is that if you say something enough times, the repetition will magically make it so.

Let’s do a quick back-translation from APA ‘newspeak’ to DSM 5 reality.

APA Newspeak: DSM 5 has been open and “transparent to an unprecedented degree.”

DSM 5 Reality: APA forced work group members to sign confidentiality agreements; has kept its ‘scientific’ review committee report secret; tries to censor the internet using bullying threats of trademark litigation; keeps secret the content of public input; and has not, as promised, provided more complete data sets from its failed field testing.

APA Newspeak: DSM 5 has been an “inclusive” process.

DSM 5 Reality: APA has rejected the input of 51 mental health associations requesting an open and independent scientific review of the controversial DSM 5 proposals; has not responded to highly critical editorials in the Lancet, New England Journal, New York Times, and many other publications; has ignored the unanimous opposition by the leading researchers in the field to its unusable personality disorder section; has ignored the opposition of sexual disorder researchers and forensic experts to its forensically dangerous paraphilia section; has brushed off outrage by consumer groups representing the bereaved and the autistic; has not made any changes in DSM 5 that can be associated with outside input- professional or public; and is unresponsive even to its own APA members, dozens of whom have told me they can’t get a straight (or any) answers from a staff whose salaries come from their dues.

APA Newspeak: “The stakes are far reaching: the first full revision since 1994 of the DSM, a document that influences the lives of millions of people around the world.”

DSM 5 Reality: APA quietly cancelled its own planned Stage 2 of field testing. Stage 2 was to provide quality control with much needed editing and retesting to demonstrate improved reliability. Canceling quality control was a crucial mistake and was done for one reason only-money. Because Stage 1 of the field trial was completed 18 months late, DSM 5 was running out of time in meeting its arbitrarily imposed publishing deadline. Given the choice of striving for quality or cashing in on publishing profits, APA went for the cash. Definitely dispiriting, but not surprising. APA is in deficit, has a budget that is totally dependent on the huge publishing profits from its DSM monopoly; and has wasted an absolutely remarkable $25 million in producing DSM 5 (DSM IV cost only one fifth as much). The simple reality is that APA is rushing a poor quality and unreliable DSM 5 to press purely for financial reasons and totally heedless of the detrimental effect this will have on “the lives of millions of people around the world.

APA Newspeak: “Charges that DSM-5 will lower diagnostic thresholds and lead to a higher prevalence of mental disorders are patently wrong. Results from our field trials, secondary data analyses, and other studies indicate that there will be essentially no change in the overall rates of disorders once DSM-5 is in use.”

DSM 5 Reality: DSM 5 made a fatal and unaccountable error in its field testing- it failed to measure the impact of any of its changes on rates and APA therefore has no meaningful data on this most important question. With the exception of autism, all of the suggested DSM 5 changes will definitely raise rates, some dramatically. Adding Binge Eating Disorder by itself would add more than ten million new ‘patients’; adding Disruptive Mood Dysregulation Disorder and Minor Neurocognitive Disorder would add millions; as would removing the bereavement exclusion to MDD and lowering thresholds for ADHD and GAD.

Read the full Medscape exchange for more Newspeak from Dr Kupfer, but you get the idea. It is not at all clear to me if APA talks Newspeak cynically, because of naivete, or because Newspeak is the language its expensive public relations consultants put in its mouth.

It doesn’t really matter why. Newspeak is devastating- not because anyone outside DSM 5 believes it (DSM 5 defenses are too transparently out of touch with reality to fool outsiders), but because APA may believe its own Newspeak or at least acts as if it does. Reflexive Newspeak, substituting for insight, has prevented DSM 5 from the serious self correction that would have saved it from itself. Bob Spitzer presciently predicted five years ago that a secretive, closed, defensive DSM 5 process would lead inevitably to this failed DSM 5 product.

Medscape has opened a physician-only discussion on the proposed DSM revision. If you are an MD and want to add your thoughts, you can do this at:

http://boards.medscape.com/forums/.2a3285ea/39

If you are a non-MD health care worker with an interest in psychiatric diagnosis, please add your thoughts at:

http://boards.medscape.com/forums/.2a32ceea

The public has a big stake in the outcome and can participate by commenting below. DSM 5 is very close to being set in stone. It may or may not do any good to speak up now, but this is a last chance for people to have their say.

Ed: Free registration is required for access to most areas of Medscape Medical News

Allen Frances: “Follow the Money”

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Allen Frances writing on Huffington Post: “Follow the Money”

Post #177 Shortlink: http://wp.me/pKrrB-2e3

Allen Frances, who had oversight of the development of DSM-IV, responds to DSM-5 Inaccuracies: Setting the Record Straight by James H Skully, CEO and Medical Director to the American Psychiatric Association.

Huffington Post Blogs | Allen Frances

Follow the Money

Allen Frances MD | June 9, 2012

…The APA budget depends heavily on the huge publishing profits generated by its DSM monopoly. APA needs the money badly. It is losing paying members; other sources of funding are also on a downward trend; and its budget projections require a big May 2013 injection of DSM-5 cash…

…APA treats DSM-5 like a valuable publishing property, not as a public trust that importantly impacts on people’s lives and public policy. It is excellent at protecting its “intellectual property” with confidentiality agreements and at protecting its trademark and copyright with bullying threats of law suits. But APA has been sadly incompetent and wildly profligate in the day-to-day work of actually producing a safe and scientifically sound DSM-5.

Dr Scully is asking us to believe ten very unbelievable things. My view – if you want to understand why an unreliable and unsafe DSM-5 is being rushed prematurely to market – is to “follow the money…”

Read full commentary on Huff Po