APA “Monitor” articles: ICD-11 and DSM-5; Frances, Rajiv Tandon on DSM-5; iCAT Analytics
February 8, 2012
1] ICD-11 (with contributions from WHO’s Dr Geoffery Reed) and DSM-5 articles in February edition of American Psychological Association’s “Monitor”
2] Academic article on DSM-5 by Rajiv Tandon, MD, Professor of Psychiatry, University of Florida
3] Allen Frances (who chaired the DSM-IV Task Force), Suzy Chapman and Dr Dayle Jones on DSM-5
4] Paper: Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology
Post #137 Shortlink: http://wp.me/pKrrB-1QW
1] Two articles in the February edition of the American Psychological Association’s “Monitor”:
American Psychological Association
Monitor
Feature, February 2012, Vol 43, No. 2
Improving disorder classification, worldwide
Rebecca A. Clay | February 2012
With the help of psychologists, the next version of the International Classification of Diseases will have a more behavioral perspective.
Print version: page 40
What’s the world’s most widely used classification system for mental disorders? If you guessed the Diagnostic and Statistical Manual of Mental Disorders (DSM), you would be wrong.
According to a study of nearly 5,000 psychiatrists in 44 countries sponsored by the World Health Organization (WHO) and the World Psychiatric Association, more than 70 percent of the world’s psychiatrists use WHO’s International Classification of Diseases (ICD) most in day-to-day practice while just 23 percent turn to the DSM. The same pattern is found among psychologists globally, according to preliminary results from a similar survey of international psychologists conducted by WHO and the International Union of Psychological Science.
“The ICD is the global standard for health information,” says psychologist Geoffrey M. Reed, PhD, senior project officer in WHO’s Department of Mental Health and Substance Abuse. “It’s developed as a tool for the public good; it’s not the property of a particular profession or particular professional organization.”
Now WHO is revising the ICD, with the ICD-11 due to be approved in 2015. With unprecedented input from psychologists, the revised version’s section on mental and behavioral disorders is expected to be more psychologist-friendly than ever—something that’s especially welcome given concerns being raised about the DSM’s own ongoing revision process. (See “Protesting proposed changes to the DSM”.) And coming changes in the United States will mean that psychologists will soon need to get as familiar with the ICD as their colleagues around the world…
…”Since the rest of the world will be adopting the ICD-11 when it is released in 2015, the CDC will likely make annual updates to gradually bring the ICD-10-CM into line with the ICD-11 to avoid another abrupt shift. But the differences between the DSM and the ICD may grow even greater over time, says Reed, depending on the outcomes of the ICD and DSM revision processes.”
For more information about the ICD revision, visit the World Health Organization.
Rebecca A. Clay is a writer in Washington, D.C.
American Psychological Association
Monitor
February 2012, Vol 43, No. 2
Print version: page 42
Protesting proposed changes to the DSM
When President David N. Elkins, PhD, and two colleagues within APA’s Div. 32 (Society for Humanistic Psychology) heard about the proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), they were alarmed. But what could three people do?
Plenty, as it turns out.
Although their original aim was simply to educate the division’s members, Elkins, Secretary Brent Dean Robbins, PhD, and student representative Sara R. Kamens soon decided to share their concerns in an open letter to the American Psychiatric Association. Thinking it would pack more punch with a few more signatures, they posted it online last October.
The response astounded them. “Within two days, we had more than 1,500 signatures,” says Elkins. So far, more than 10,000 individuals and 40 mental health organizations have signed on, and media outlets as diverse as Nature, USA Today and Forbes have covered the controversy. APA, which has no official position on the controversy, urges its members to get involved in the debate (see APA’s statement in the January Monitor, page 10).
The open letter outlines three major concerns with the proposed draft of the DSM-5, set for publication in 2013…
2] Article by Rajiv Tandon, MD, Professor of Psychiatry, University of Florida:
Vol. 11, No. 02 / February 2012
Getting ready for DSM-5: Part 1
The process, challenges, and status of constructing the next diagnostic manual
Rajiv Tandon, MD | February 2012
Professor of Psychiatry, University of Florida, Gainesville, FLDiscuss this article at www.facebook.com/CurrentPsychiatry
Work on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—scheduled to be published in May 2013—has been ongoing for more than a decade. Momentous advances in genetics and brain imaging since publication of DSM-IV in 1994 have generated optimism that an improved understanding of the neurobiologic underpinnings of psychiatric disorders might lead to a paradigm shift from the current descriptive classification system to a more scientific etiopathophysiological system similar to that used by other medical specialities.1
Some fear that any changes to our current classification system may be premature and could make an already complex system even more unwieldy.2 Scores of articles about the content and process of DSM-5 and several critiques and commentaries on the topic have been published. The American Psychiatric Association (APA) has made the DSM-5 process transparent by posting frequent updates to the DSM-5 Development Web site (www.dsm5.org), seeking feedback from the psychiatric community and the public, and presenting progress reports by members of the DSM-5 Task Force at scientific meetings.
There have been few discussions on the implications of DSM-5 from the practicing clinician’s vantage point, which I seek to present in this series of articles, the remainder of which will be published here, at CurrentPsychiatry.com…
3] Allen Frances, MD, in Psychology Today and Psychiatric Times
Registration required for access to article on Psychiatric Times
PTSD, DSM 5, and Forensic Misuse
DSM 5 would lead to overdiagnosis in legal cases.Allen Frances, MD | February 9, 2012
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Documentation That DSM-5 Publication Must Be Delayed
because DSM 5 is so far behind scheduleAllen Frances, MD | February 7, 2012
Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV, is a former chief of psychiatry at Duke University Medical Center and currently professor emeritus at Duke
Last week, I wrote that DSM-5 is so far behind schedule it can’t possibly produce a usable document in time for its planned publication date in May 2013.¹ My blog stimulated 2 interesting responses that illustrate the stark contrast between DSM-5 fantasy and DSM-5 reality. Together they document why publication must be delayed if DSM-5 is to be set right. The first email came from Suzy Chapman of Dx Revision Watch https://dxrevisionwatch.wordpress.com
Re DSM-5 delays, here is a telling statement made by Dr Darrel Regier, its Vice Chair, on March 9, 2010: “We have just released draft criteria on a website on February 10th at dsm5.org. And we’ll be having a field trial starting in July of this year. We’ll then have another revision based on field trial results going into a second revision or second field trial in July of 2011. As a result, we will not have our final recommendations for the DSM-V probably until early 2011.” She continues,
Please note the dates. Dr Regier’s promised timetable has been missed by more than a year—we still don’t have final recommendations.
Dayle Jones, PhD, is head of the Task Force of the American Counseling Association that monitors DSM-5. She sent in a timeline comparing DSM-5 promised deadlines with actual delivery dates:
The DSM-5 academic/large clinic field trials were designed to have two phases. Phase 1 was first scheduled to begin in June 2009, but had to be postponed for a year because the criteria sets were not ready. The timetable for field trial completion was unrealistic from the start and not surprisingly the end dates have been repeatedly postponed from early 2010 to early 2011, and we’re now already into 2012 with no end in sight. Phase 2, originally scheduled for September 2011 to February 2012, was to re-test those diagnoses that did poorly in Phase 1 and had to be revised. The phase 2 trials were quietly canceled. We still don’t have results from the phase 1 field trials, but the APA leadership has warned us that we must accept reliabilities that are barely better than chance. Without the second stage, uncorrected problem diagnoses will be included in DSM-5.
The separate clinician field trial has been an even worse disaster. Clinicians were originally scheduled to be trained by August 2010, enrolling patients no later than late November 2010, and ending by February, 2011. Training was finally completed 18 months late in December 2011, which means the earliest these trials could possibly end is June 2012—well after most DSM-5 final decisions will have been made. Furthermore, of the over 5000 clinicians who registered to participate, only 70 (1.4%) have begun enrolling patients for the field trial. My guess is that like academic/large clinic Phase 2 field trial, poor planning and disorganization will force cancellation.
Dr Jones concludes,
In my opinion, there is no process and not enough time left to ensure that DSM-5 will attain high enough quality to be used by counselors. Fortunately, we can always bypass it by using ICD-10-CM.
Sobering stuff. Its constant procrastination has at last caught up with DSM-5. Having fallen so far behind schedule, DSM-5 abruptly dropped the second stage of field-testing—without public comment or justification or discussion of what would be the effects on quality and reliability. In fact, the second stage of the field trials was perhaps the most crucial step in the entire DSM-5 process—a last chance for sorely needed quality control to bring a lagging DSM-5 up to acceptable standards. The DSM-5 proposals that were weak performers in the first stage were supposed to be rewritten and retested in the second to ensure that they deserved to be included in the manual.
The American Psychiatric Association (APA) is now stuck with the most unpalatable of choices—protecting the quality of DSM-5 versus protecting the publishing profits to be gained by premature publication. Given all the delays, it can’t possibly do both—a quality DSM-5 cannot be delivered in May 2013.
All along, it was predictable (and predicted), that DSM-5 disorganization would lead to a mad, careless dash at the end. The DSM’s have become far too important to be done in this slapdash way—the high cost to users and the public of this rush to print is unacceptable. Unless publication is delayed, APA will be offering us official DSM-5 criteria that are poorly written, inadequately tested, and of low reliability. The proper alternative is clear: APA should delay publication of DSM-5 until it can get the job done right. Public trust should always trump publishing profits.
Let’s close with a worrying and all too illustrative quote from Dr Regier, just posted by Scientific American.² When asked if revisions to criteria in DSM-5 could be completed by the end of this year, he said “there is plenty of time.” I beg to differ—there is not nearly enough time if the changes are to be done based on a much needed independent scientific review and are to be tested adequately in Phase 2 of the field trial. Without these necessary steps DSM-5 will be flying blind toward the land of unintended consequences.
References
1. Frances A. APA should delay publication of DSM-5. January 31, 2012. Psychiatr Times. http://www.psychiatrictimes.com/blog/frances/content/article/10168/20243942. Jabr F. Redefining autism: will new DSM-5 Criteria for ASD exclude some people? January 30, 2012. Sci Am. http://www.scientificamerican.com/article.cfm?id=autism-new-criteria Accessed February 7, 2012.
4] Paper: Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology
Pragmatic Analysis – iCAT Analytics 2012
Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology
http://kmi.tugraz.at/staff/markus/documents/2012_AAAI_iCATAnalytics.pdf
Jan P¨oschko and Markus Strohmaier, Knowledge Management Institute, Graz University of Technology, Inffeldgasse 21a/II, 8010 Graz, Austria
Tania Tudorache and Natalya F. Noy and Mark A. Musen, Stanford Center for Biomedical Informatics Research, 1265 Welch Road, Stanford, CA 94305-5479, USA
Abstract
While in the past taxonomic and ontological knowledge was traditionally produced by small groups of co-located experts, today the production of such knowledge has a radically different shape and form. For example, potentially thousands of health professionals, scientists, and ontology experts will collaboratively construct, evaluate and maintain the most recent version of the International Classification of Diseases (ICD-11), a large ontology of diseases and causes of deaths managed by the World Health Organization. In this work, we present a novel web-based tool-iCAT Analytics-that allows to investigate systematically crowd-based processes in knowledge-production systems. To enable such investigation, the tool supports interactive exploration of pragmatic aspects of ontology engineering such as how a given ontology evolved and the nature of changes, discussions and interactions that took place during its production process. While iCAT Analytics was motivated by ICD-11, it could potentially be applied to any crowd-based ontology-engineering project. We give an introduction to the features of iCAT Analytics and present some insights specifically for ICD-11.
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