APA to release DSM-5 at Annual Meeting (May 18-22): What next?

Post #249 Shortlink: http://wp.me/pKrrB-313

Media coverage following release of DSM-5 is compiled in Posts #251 and #252


Update: APA issued this press release today

Click link for PDF document   APA Press Release No. 13-31 May 17, 2013

American Psychiatric Association Releases DSM-5, Publication of diagnostic manual culminates 14-year development process


Purpleblue1DSM-5 is scheduled for release at the 2013 American Psychiatric Association Annual Meeting (May 18-22), in San Francisco. The official APA publication date is May 22.

Amazon US had been quoting a release and shipping date of May 22, but the site currently gives May 27 for both hardback and paperback editions. Amazon UK currently gives the release and shipping date for both hardback and paperback as May 31.

APA is anticipated to release DSM-5 on Saturday, May 18, with an early morning press briefing.

No heads-up yet from UK Science Media Centre, but SMC New Zealand has already put out press briefing materials here.

Australian SMC DSM-5 background briefing materials and presentation here:
BACKGROUND BRIEFING: DSM 5 – Psychiatric bible or fatally flawed?

DSM-5 will launch; a lot of stuff will be written about it.

What next?

On Monday, May 13, the Division of Clinical Psychology, a division of the British Psychological Society, published a “Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses, Time for a Paradigm Shift.”

You can download a copy of this document here: Position Statement on Diagnosis.

Two new platforms for discussion launched this week:

The first, Dx Summit website. Article on Mad in America here DxSummit Officially Launches, by Jonathan Raskin, May 15.

http://dxsummit.org/

DxSummit Officially Launches

by Diagnostic Summit Committee

DSM-5 Is Widely Criticized, and Pursuit Of Alternatives in Mental Health Care Is Underway

For Immediate Release:

The latest edition of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association is being released on May 22, 2013. It is the fifth revision of this widely influential manual for diagnosing mental distress and illness, and has been the subject of national and international criticism for the quality of its science, its criteria for defining disorders and categories, its rationale for inclusion or exclusion of particular symptoms or features, and the considerable inflation in its number of diagnosable disorders since the original DSM was published in the 1950s. Over the past several decades, there has been sharp criticism of the various DSM revisions, but in the case of DSM-5, a critical mass of scholarly opposition has reached a tipping point, including an unprecedented rebuke by the U.S. government’s National Institute of Mental Health, which has stated it will be reorienting away from research that involves the DSM-5. For many mental health professionals it seems clear that fresh thinking–about ways to possibly improve the DSM, prospects for developing possible alternatives to it, and what those prospects might look like–are called for. Regardless of where one stands on these issues, it is clear that new approaches to diagnosis are sorely needed, as both a national and global health concern.

To that end, a new website (dxsummit.org) has been launched to help create an on-line, on-going global forum for scholarly and professional dialogue of humane approaches to mental health diagnosis. Sponsored by the Diagnostic Summit Committee (DSC), a national committee of concerned psychologists, this collaborative effort provides an opportunity for the widest possible input and deliberation of mental health diagnosis from the ground-up. Offering blogs, discussion posts, and psychiatric and psychological articles by stakeholders and leaders in the field, dxsummit.org will open up the discussion of diagnosis to its full range of possibilities, from brain science to cultural variations to the examination of normal human responses to difficult life challenges. The website, underwritten by the efforts of the Society for Humanistic Psychology (SHP) will be a platform for international debate and consensus of comprehensive and valid approaches to mental health diagnosis.

Media inquiries should be directed to Dr. Frank Farley, co-chair of the DSC, and former President of the American Psychological Association and the SHP, at frank.farley@comcast.net or (215) 668-7581; or Dr. Donna Rockwell.

+++
The second new platform is Tom Nickel’s DSMOOC, introduced by Allen Frances, MD, in a May 16 blog at Huffington Post:

DSM-5: Where Do We Go From Here? 

Dr Frances writes:

“That’s why I am so pleased that Thomas Nickel Ph.D., Head of Continuing Education at Alliant International University, has set up a new interactive DSMOOC web site that will undoubtedly become the focal point for diagnostic discussion and remediation. Check it out.

Dr. Nickel writes:

“Now that DSM-5 is about to be released, it is time to determine how best to reduce, if not entirely eliminate, the risk that people will be misdiagnosed and improperly treated.”

“Solutions will not come from one group or one project. As one of what will hopefully be many initiatives, we have developed a MOOC (Massive Open Online Conversation) to bring together concerned clinicians and the public in order to give voice to the many different perspectives about psychiatric diagnosis.”

“Our intention is to stimulate conversations that will lead to useful products. People will find each other and work together to produce materials that can empower patients and influence practitioners. Suggestions for guidelines, practice standards, public policy, and research will hopefully emerge. Certainly, we will make every effort to facilitate this.”

“Previous MOOCs have resembled traditional university courses with lectures and quizzes on technical topics like artificial intelligence or mechanical engineering. Until now, MOOCs have not been closely linked to events happening in the world, nor have they been a channel for real world action. In this regard, a MOOC focused on DSM-5 may be pioneering.”

“Our MOOC will consist of about 15 channels, each one dedicated to one area of significant change or controversy in DSM-5. Each will provide background information; videotaped discussions by leading experts and consumer advocates; references; links; vivid portrayals of psychiatric diagnosis in films and fiction; and an opportunity for discussion. There are even Google Hangouts all set up for study groups to use.”

“Our DSMOOC should be equally interesting for professionals and consumers- and will provide a uniquely open forum for interaction between them.”

“We hope that you will roll up your virtual sleeves, join us at: http://discuss.thementalhealthmanual.com

Follow DSMOOC on Twitter @RethinkingDSM

+++

DSM-5 Development site

The APA’s DSM-5 Development site will remain online.

On May 15, the Home Page text was revised and the site’s content is being reorganized. As everything on the site is nailed down with Licensing and Permissions clauses, you will need to visit the site to read what new text has gone up so far. No doubt APA would like to register the trademark rights to hex #260859, too.

See: UNDER CONSTRUCTION: DSM-5 Implementation and Support

According to what little text is currently displaying, the site will be reorganized to serve as a resource for stakeholders: providers, payers, researchers and patients.

New content is planned to include FAQs, information on implementation of the manual and a mechanism for submitting questions and feedback. Professional users will be able to provide feedback on online assessment measures; there will be links to educational webinars and training courses for US and other countries. The site will list DSM-5 corrections.

+++
Additional media coverage from this week

Too much to include this week, so just a few links:

Concern for the implications of DSM-5‘s new Somatic Symptom Disorder was highlighted by Allen Frances in a Diane Rehm radio broadcast, on May 14. The programme also included an interview with DSM-5 Task Force Chair, David J Kupfer, MD, on the understanding that he would not be engaging with Dr Frances.

The Diane Rehm Show May 14, 2013: http://tinyurl.com/byxupm6

Transcript

Listen again: http://thedianerehmshow.org/audio-player?nid=17729  [51.40 mins including listener phone in]

The site page includes an excerpt from the book “Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life” by Allen Frances. Published by William Morrow. Copyright © 2013 by Allen Frances. Reprinted with permission.


Somatic Symptom Disorder also featured in a Susan Donaldson James’ article, for ABC News Health, on May 14:

Brain Science Upstages DSM-V, So-Called Mental Health ‘Bible’


Christopher Lane, Ph.D., published The Distortion of Grief on May 14, which has been widely syndicated.


DSM-5: Mental Health Professionals, Critics Face Off Over Upcoming Psychiatric Manual by Lindsey Tanner at Huffington Post, May 15:

“The psychiatric industry, allied with Big Pharma, have massively misled the public,” the Occupy Psychiatry group contends. Organizers include Alaska lawyer Jim Gottstein, who has long fought against overuse of psychiatric drugs.

“The new manual “will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication,” says the website for the Committee to Boycott the DSM-5, organized by New York social worker Jack Carney.”


More on Occupy APA from Jack Carney, DSW, for Mad in America, May 17:
Occupy APA in San Francisco: Joined in Spirit

Advertisement

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
###

 

More on the RDoC from the NIMH website

Research Domain Criteria

The National Institute of Mental Health Strategic Plan Released August 2008

Division of Clinical Psychology (DCP) calls for paradigm shift away from ‘disease model’

British Division of Clinical Psychology (DCP) calls for paradigm shift away from ‘disease model’

Post #247 Shortlink: http://wp.me/pKrrB-2Zj

Update: Prof Richard Bentall on BBC Radio 4 Start the Week, Monday, May 13, 2013

http://www.bbc.co.uk/programmes/b01sd3jq

Lucy Johnstone on BBC Radio 4 Today programme, Monday, May 13, 2013 | 2 hours 50 mins in from start

http://www.bbc.co.uk/programmes/b01sd3jn

Lucy Johnstone article at Mad in America, May 13, 2013:

UK Clinical Psychologists Call for the Abandonment of Psychiatric Diagnosis and the ‘Disease’ Model

Lucy Johnstone World Service interview  | MP3 file | 8.2 MB at Dropbox (no Dropbox account required)

+++

Update: Statement released: May 13, 2013

Division of Clinical Psychology

Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses

Time for a Paradigm Shift

Click link for PDF document   Position Statement on Diagnosis

+++

Today’s Observer reports on the release, tomorrow, of a Position Statement by the British Division of Clinical Psychology (DCP), a sub-division of the British Psychological Society, calling for the abandonment of diagnosis and the ‘illness/disease’ model.

Observer

Psychiatrists under fire in mental health battle
(British) Psychological Society to launch attack on rival profession, casting doubt on biomedical model of mental illness

Jamie Doward | May 12, 2013

“…In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a “paradigm shift” in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems”, used by psychiatry…”

Also in today’s Observer, opposing positions from Oliver James and Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King’s College London, in which he defends the need to create classification systems for mental disorder and downplays the influence of the DSM:

Do we need to change the way we are thinking about mental illness?
Experts on both sides of the debate over the classification of mental disorders make their case

The Observer | Oliver James | Prof Sir Simon Wessely | Sunday 12 May 2013

Comment from Allen Frances, MD, on Huffington Post, on today’s Observer report:

[Note the position statement is issued by the Division of Clinical Psychology (DCP), a sub-division of the British Psychological Society (BPS) and is not the official position of the BPS.]

 The Inmates Seem to Have Taken Over the Asylum

“…Then the NIMH recklessly renounced all syndromal DSM diagnosis as invalid. But NIMH has nothing to offer now in its place except an oversold and undeliverable promise of some future strictly biological model of mental illness that will take decades to deliver — assuming it can ever be delivered at all…

“…Now the British Psychological Society has produced its own brand of extremist posturing, offering its own quixotic paradigm shift..”


Further mainstream media coverage of the DSM debate

An Editorial and an Opinion piece in the New York Times:

Editorial

Shortcomings of a Psychiatric Bible

The Editorial Board | May 11, 2013

Opinion

Why the Fuss Over the D.S.M.-5?

Sally Satel | May 11, 2013


Nature | News

Psychiatry framework seeks to reform diagnostic doctrine

Critics say clinical manual unfit for mental-health research.

Heidi Ledford | May 10, 2013

Quotes from NIMH’s director, Thomas Insel; epidemiologist, Jane Costello, who resigned from the DSM-5 Work Group for Child and Adolescent Disorders in 2009, and Steven Hyman, a former NIMH director and a former DSM-5 Task Force member, who has chaired the APA-WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders [Members].


New Scientist Print edition

Feature article This Week

How a scientific DSM will transform psychiatry

Peter Aldhous, Andy Coghlan and Sara Reardon | May 8, 2013

This article appears in the print edition under the headline “A revolution in mental health, Patients deserve better than an unscientific manual, says leading health institute.”

Also in this week’s New Scientist print edition:

Editorial Opinion

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

Allen Frances, MD | May 8, 2013

A longer version of this Allen Frances opinion piece appeared online, earlier in the week, here

Something rotten in the state of Denmark: Karina Hansen’s story

Clarification notice
Reports and updates on Dx Revision Watch site on the Hansen family’s situation are being published as provided by, and in consultation with, Rebecca Hansen, Chairman, ME Foreningen, Danmark (ME Association, Denmark), or edited from reports as provided by Ms Hansen.
Dx Revision Watch site has no connection with any petitions or initiatives, or with any social media platforms or other platforms set up to promote petitions or initiatives, or to otherwise raise awareness of the Hansen family’s situation. The use of any links to content on Dx Revision Watch does not imply endorsement of, or association with any initiatives other than the ME Foreningen, Danmark (ME Association, Denmark) Postcard to Karina Campaign.
All enquiries in relation to petitions or other initiatives, social media platforms, or any other platforms associated with them should be addressed directly to the organizers, sponsors or owners responsible for them.

+++
For update to this post see:

Human Rights denied: Something rotten in the state of Denmark: Karina Hansen’s story: Update 1: http://wp.me/pKrrB-35o

Menneskerettighederne nægtet: Noget råddent i staten Danmark: Karina Hansen: Opdater 1: http://wp.me/pKrrB-36e  (Update reports in English and Danish)
+++

“How can I get out of here? I can’t take this.”

+++
KH5

+++
Something rotten in the state of Denmark:

Karina Hansen’s story

Karina Hansen is 24. She has been completely bedridden since 2009.

In February, this year, Karina was forcibly removed from her home and committed to a hospital. The family is still waiting for a legal explanation for why she was removed.

Karina suffers from severe ME and her family believes she is getting worse.

Karina removed from home

On February 12, 2013, five policemen from Holstebro county, Denmark, arrived at Karina’s house and forcibly removed her from her bedroom.

Two doctors, a locksmith and two social workers were also present.

Karina called for her mother’s help, but her mother was blocked by the police from aiding her. Karina used her mobile phone for the first time in years to call her mother, her father, her cousin and her sister, Janni. Karina is so ill that she can usually only speak in one or two word sentences, but during her removal she managed to call her father and say: Help Dad, in my room, and to her sister: Help, Janni I don’t know where they are taking me.

Karina’s mother could not answer her phone because she was surrounded by policemen.

Karina was driven off to a hospital in an ambulance. Her parents were not told where she was being taken or why they were taking her away. They were given no paperwork.

Later that day, her parents received a phone call. They were told that Karina was at Hammel Neurocenter and that someone would call them every day at 10am to tell them how Karina was doing and that no one would be allowed to visit their daughter for 14 days.

On the morning of February 13, Karina managed to call her mother from her mobile phone. She said: How can I get out of here? I can’t take this. (Hvordan kan jeg komme væk herfra? Jeg kan ikke klare det.) Then the connection was cut.

A few days later, Karina’s parents received a letter from a psychiatrist, Nils Balle Christensen, which said that he would be in charge of Karina’s treatment at Hammel Neurocenter. He also wrote that because “of her condition,” Karina was not allowed visitors for two weeks. That ban on visitors was later extended to three weeks because Dr Christensen was on vacation.

Nils Balle Christensen works at the Aarhus Research Clinic for Functional Disorders and Psychosomatics. He and his boss, Per Fink, believe that ME is a functional disorder. The treatments the clinic recommends are graded exercise therapy (GET), cognitive behavioural therapy (CBT), “mindfulness therapy,” and in some cases, antidepressants. In Denmark, a functional disorder is understood to be a psychosomatic illness.

The psychiatrists at this clinic are considered to have no experience with severely ill ME patients and the Hansen family and ME Foreningen, Danmark fear that if Karina is being treated incorrectly this may lead to a severe and permanent worsening of her condition.

Karina’s parents have not been permitted to see their daughter for three months

The family visited the Neurocenter on April 1 to try to visit Karina, but the parents were not allowed to see her. Karina’s sister, Janni, who is a nurse, was allowed to see Karina for a few minutes. A staff member followed Janni into the room. Janni said that Karina was extremely pale, was unable to talk, and did not show signs that she recognized her sister.

In Janni’s opinion, Karina’s condition is worse now than before she was hospitalized.

Why was Karina forcibly removed?

Karina’s parents and lawyer have yet to receive any official paperwork from any government body or clinician about the reason for her removal. They have received no treatment plan or copies of Karina’s medical reports.

No charges have been made against Karina’s parents. The case has never been heard by a court.

Karina’s parents do not know if or when they will be allowed to see their daughter or if or when she will be allowed to come home. Her parents and her lawyer have obtained power of attorney for Karina, but this is being ignored.

The regional state administrations for Mid-Jutland (Statsforvaltningen Midtjylland) are trying to appoint someone as guardian for Karina.

The only information the family receives comes from Jens Gyring, senior doctor at Hammel Neurocenter. He now calls Karina’s father twice a week and tells him how Karina is.

But the parents are finding it difficult to trust what they are told because they are being given conflicting information. Dr Christensen says Karina is improving every day, but Jens Gyring says there is no change.

Karina’s sister, Janni, thinks her sister is deteriorating.

Jens Grying says he is taking instructions about Karina’s care from Dr Christensen and that the treatment given is a rehabilitation programme.

+++
There are many unanswered questions

Karina’s mother was paid by the county to take care of her daughter and there was never any report of neglect. After Karina was taken away, her mother was fired from her job on the grounds that the caregiver duties were no longer needed.

Which authority gave the order to remove Karina and by whom was it authorized?
What legislation was used to remove and detain her as an involuntary patient in a hospital?
Why are the parents and their lawyer not permitted to see paperwork about the case?
Why have the parents not been allowed to visit?
Are there any charges levelled against the parents?
What is the treatment plan for Karina? The hospital requires that a treatment plan be made on admission.
Why all the secrecy?

+++
Meeting with Liselott Blixt

On April 4, Karina’s parents and two representatives from ME Foreningen, Danmark met with parliament member, Liselott Blixt, who agreed to help to get answers to the many questions in this case.

ME Foreningen, Danmark had been waiting to publish information about Karina’s case until her parents and lawyer had received the official documents. But it is now obvious that these documents will not be released unless pressure is placed on the officials.

+++

ME Foreningen, Danmark campaign

A campaign was launched by ME Foreningen, Danmark for May 12th ME Awareness Week for sending postcards to Karina and also signing a petition in support of the Hansen family’s situation:

http://www.ipetitions.com/petition/postcardtokarina/

For information on where to send your postcard go to ME Foreningen, Danmark on Facebook

If you have a blog or a website, please link to this post or contact ME Foreningen, Danmark for a copy of the account and publish your own blog post. Post a link to this post on Facebook, Twitter, Listservs and forums.

Timeline

Karina Hansen was born in November 1988. She is now 24.

2004/5: Karina contracts mononucleosis, after which she succumbs to countless infections, including sinus infections, as well as severe gastritis. She received many courses of antibiotics. Her activity became very limited because of post exertional malaise. In 2006, Karina had a serious sinus infection and never fully recovered.

2008: Karina receives a diagnosis of Myalgic Encephalomyelitis/ME (ICD-10 G93.3) while at a Danish arthritis hospital, where she was admitted for rehabilitation: exercise and cognitive behavioural therapy (CBT). She was there for 17 days and could never do more than one hour of activity a day.

During the course of her illness, Karina was examined several times by psychiatrists who found no evidence of mental illness. One psychiatrist wrote that her symptoms were most likely caused by the mononucleosis.

Autumn 2009: Karina has an influenza vaccine after which she becomes completely bedridden. In March 2010, Karina’s mother took leave from work to take care of her daughter.

May 2010: Karina’s GP pressured her parents into admitting her to hospital for rehabilitation. By this time, Karina was so ill that she cried from the headaches when they talked to her. There appears to have been an attempt to detain her at the hospital by declaring her mentally unfit. But the medical officer wrote that the “psychiatry law enforcement provisions cannot be used.” She was allowed to go home after three days. Karina’s condition deteriorated after this hospitalization.

May 2010: Karina is seen for the first time by Dr Isager, who confirms the diagnosis of ME. Dr Isager is a Danish doctor who has seen hundreds of ME patients in his long career and has made home visits to many severely ill patients. In 2001, the Danish Ministry of Health wrote that Dr Isager was the Danish doctor with the most experience of ME and had about 250 patients at that time.

March 2011: Karina is seen by another doctor with experience in severe ME. This doctor reconfirmed the ME diagnosis. Karina’s parents worked with her new GP, with Dr Isager, and a nutritionist to try to give Karina the best treatment possible at home. Gut function tests were sent to the USA to try to find a treatment for Karina. There is no hospital in Denmark equipped to take care of severely ill ME patients.

A request was made to have a saline IV started in the home but the county did not cooperate. Karina received a special protein powder and a high iron diet to ensure her nutritional needs were met. Many ME patients do not tolerate iron supplements in pill form.

June 2011: Karina’s mother is hired by the county to be Karina’s caregiver.

May 2012: Sundhedssytrelsen (Danish National Board of Health) contacts two psychiatrists, Per Fink and Jens Nørbæk, about Karina. Karina’s case was presented to them over the phone and Jens Nørbæk stated that Karina must be in an insane-like state: “sindsyglignende tilstand.” These two psychiatrists are considered to have no knowledge of severe ME.

Based on these conversations, the Danish Board of Health put pressure on Karina’s GP to declare Karina psychologically ill and to sign commitment papers. Karina’s GP refused because Karina was not mentally ill. Karina’s GP then resigned as her doctor.

The Danish National Board of Health contacted Per Fink, lead clinician at The Research Clinic for Functional Disorders and Psychosomatics, and asked him to take charge of Karina’s case. The case was then given to another psychiatrist from the clinic, Nils Balle Christensen.

Karina and her parents did not want Dr Christensen as Karina’s doctor. They knew about the research clinic and did not feel the doctors had sufficient knowledge about ME to undertake Karina’s medical care. Karina and her parents said many times they did not want the psychiatric treatment that Dr Christensen was offering. They hired a private doctor to assist Dr Isager in Karina’s care. (Dr Isager is retired.)

February 12, 2013: Karina is forcibly removed from her home and put in the hospital under Dr Christensen’s care. She is now forced to receive the “treatment” she does not want.

May 12, 2013: For three months, Karina’s parents have been denied visits to see their daughter; denied documentation; denied answers to their questions.

+++

The Research Clinic for Functional Disorders and Psychosomatics, Aarhus, Denmark

According to a report by ME Foreningen, Danmark:

The Danish government has put this clinic in charge of taking care of all ME patients in Denmark. The doctors employed here are primarily psychiatrists or psychologists. The centre has spent millions of dollars working to create a new diagnosis, Bodily Distress Syndrome (BDS).

For information on Bodily Distress Syndrome see Part Two of Dx Revision Watch Post:
ICD-11 Beta draft and BDD, Per Fink and Bodily Distress Syndrome

They want to place ME and other illnesses like Fibromyalgia, IBS, chronic pelvic pains and PMS under their new diagnosis. Read about BDS, here, in English:

http://funktionellelidelser.dk/en/for-specialists-researchers/doctors/

Per Fink and his colleagues have been lobbying for their BDS concept to be included in revisions of classification systems.

According to ME Foreningen, Danmark, all treatment at this clinic is on a research basis and all patients receive the same treatment: cognitive behavioural therapy (CBT), graded exercise therapy (GET) and antidepressants. ME Foreningen, Danmark says it has contact with many patients who have ME, Fibromyalgia, IBS, etc but when they are referred to this clinic by their GP, their previous diagnosis is ignored and they are given a psychiatric diagnosis.

ME Foreningen, Danmark states it has many examples of patients who have been pressured by their doctors and case workers to go to this clinic. Patients have reported that their doctors or caseworkers believe this clinic has a proven treatment for ME, Fibromyalgia, IBS etc, so benefits will be denied unless this research treatment is tried. In the 14 years for which the clinic has been open, they only have documentation that they have seen 74 patients with chronic fatigue syndrome. Karina is the first severely ill ME patient that the clinic has had contact with.

+++

Report edited from an account provided by ME Foreningen, Danmark, with permission of the Hansen family.
For more information on the ME Association of Denmark’s postcard campaign go here on Facebook
For information on Bodily Distress Syndrome see Part Two of Dx Revision Watch Post:
ICD-11 Beta draft and BDD, Per Fink and Bodily Distress Syndrome
Something rotten in the state of Denmark: Karina Hansen’s story: http://wp.me/pKrrB-2Xc
Noget råddent i staten Danmark: Karina Hansen: http://wp.me/pKrrB-2Xc
Etwas ist faul in Dänemark: Karina Hansens Geschichte: http://wp.me/pKrrB-2Xc
Il y a quelque chose de pourri au royaume du Danemark: l’histoire de Karina Hansen: http://wp.me/pKrrB-2Xc

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

+++
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.


+++
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

+++

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

+++
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

+++

Somatic Symptom Disorder paper in Australian & New Zealand Journal of Psychiatry

Somatic Symptom Disorder paper (Frances and Chapman) published in May edition of Australian & New Zealand Journal of Psychiatry

Post #244 Shortlink: http://wp.me/pKrrB-2Wi

ANZJP is a subscription journal.

Commentary by Frances and Chapman discussing the over-inclusive DSM-5 Somatic Symptom Disorder criteria and potential implications for diverse patient groups. The paper concludes by advising clinicians not to use the new SSD diagnosis.

http://anp.sagepub.com/content/current

Commentaries

DSM-5 somatic symptom disorder mislabels medical illness as mental disorder

Aust N Z J Psychiatry May 2013 47: 483-484, doi:10.1177/0004867413484525

Allen Frances¹, Suzy Chapman²

1 Department of Psychiatry, Duke University
2 DxRevisionWatch.com

http://anp.sagepub.com/content/47/5/483.full
http://anp.sagepub.com/content/47/5/483.full.pdf+html

A further commentary on the Somatic Symptom Disorder criteria by Allen Frances, MD, who had chaired the Task Force for DSM-IV, is in press for the June 2013 edition of The Journal of Nervous and Mental Disease.

+++
A second paper, Catatonia from Kahlbaum to DSM-5, by David Healy, is also published in this month’s edition of ANZJP:

May 2013; 47 (5)

Perspectives

Viewpoint

David Healy

Catatonia from Kahlbaum to DSM-5

Aust N Z J Psychiatry May 2013 47: 412-416, doi:10.1177/0004867413486584

+++
Further reading

APA Somatic Symptom Disorder Fact Sheet

Somatic Chapter Drops Centrality Of Unexplained Medical Symptoms Psychiatric News, Mark Moran, March 1, 2013

Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care David J Kupfer, MD, Chair, DSM-5 Task Force, defends the SSD construct, Huffington Post, February 8, 2013

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill Allen Frances, MD, BMJ 2013;346:f1580 BMJ Press Release

Somatic Symptom Disorder could capture millions more under mental health diagnosis Suzy Chapman, May 26, 2012

Mislabeling Medical Illness As Mental Disorder Allen Frances, MD, Psychology Today, DSM 5 in Distress, December 8, 2012

Why Did DSM 5 Botch Somatic Symptom Disorder? Allen Frances, MD, Psychology Today, Saving Normal, February 6, 2013

New Psych Disorder Could Mislabel Sick as Mentally Ill Susan Donaldson James, ABC News, February 27, 2013

Dimsdale JE. Medically unexplained symptoms: a treacherous foundation for somatoform disorders? Psychiatr Clin North Am 2011;34:511-3. [PMID: 21889675]

%d bloggers like this: