DSM-5 Somatic Symptoms Disorders work group publishes SSD field trial data

July 30, 2013 by

Post #272 Shortlink: http://wp.me/pKrrB-3ke

Update: Somatic Symptom Disorder: An important change in DSM. is now published in the September 2013 issue, J Psychosom Res. A subscription or payment is required to access this paper.

http://www.ncbi.nlm.nih.gov/pubmed/23972410

J Psychosom Res. 2013 Sep;75(3):223-8. Epub 2013 Jul 25.
Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J.

DSM-5 Somatic Symptoms Disorders work group publishes SSD field trial data…behind a paywall

Reports on the findings of the DSM-5 field trials have been slow to emerge.

Kappa results trickled out in dribs and drabs; work group chairs presented limited field trial data at the APA’s 2012 Annual Meeting. There remains a paucity of information on field trial study protocols, patient selection, field test results and analysis.

This is of particular concern where radical changes to DSM-IV definitions and criteria were introduced into DSM-5 and are now out there in the field.

A good example is the new DSM-5 “Somatic Symptom Disorder” category, where there is no substantial body of evidence for the reliability, validity, prevalence, safety, acceptability and clinical utility of the implementation of this new disorder construct – though that did not stop them barrelling it through to the final draft.

In its paper, the SSD Work Group acknowledges the “small amount of validity data concerning SSD”; that much “remains to be determined” about the utility and reliability of the specific SSD criteria and its thresholds when applied in busy, general clinical practice and that there are “vital questions that must be answered” as they go forward.

They don’t sound any too confident about what they’ve barrelled through; but neither do they seem overly concerned.

With remarkable insouciance, SSD Work Group Chair, Joel E Dimsdale, told ABC journalist, Susan Donaldson James, “…If it doesn’t work, we’ll fix it in the DSM-5.1 or DSM-6.” (ABC News, February 27, 2013).

Cavia15The implementation of SSD in the DSM-5 is a Beta trial; the public – adults and children – unwitting guinea pigs.

Members of the DSM-5 Somatic Symptoms Disorders Work Group have just published a report – Somatic Symptom Disorder: An important change in DSM.

APA owns the output of the DSM-5 work groups but this report isn’t posted on the APA’s DSM-5 Development site or on the Field Trials or DSM-5 Resources pages.

It’s being published (currently In Press) in the Journal of Psychosomatic Research, for which DSM-5 SSD Work Group member, James Levenson, is a Co-Editor and for which SSD Work Group member, Francis Creed, a past Editor.

Unless you are a subscriber to JPS or have institution access you will need to cough up $30 to access this paper.

DSM-5 Task Force’s Regier and Kupfer have been banging on for years about how transparent the development process for this most recent iteration of the DSM has been. Yet reports on field trial findings and analysis of studies cited in support of the introduction of radical new constructs for DSM are stuffed behind paywalls.

Why are DSM-5 work group reports not being published on the DSM-5 Development website or other APA platforms or published in journals under Creative Commons Licenses, for ease of public accessibility, professional and consumer stakeholder scrutiny and discussion, and for accountability?

The development of ICD-11 is also being promoted by WHO’s Bedirhan Üstün as an open and transparent process.

But emerging proposals from the two working groups charged with making recommendations for revision of ICD-10′s Somatoform Disorders (the Primary Care Consultation Group, chaired by Prof Sir David Goldberg and the WHO Expert Working Group on Somatic Distress and Dissociative Disorders, chaired by Prof Oje Gureje) were also published, last year, in subscription journals and subject to those journals’ respective copyright restrictions [1] [2].

1. Lam TP et al. Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Fam Pract. 2013 Feb;30(1):76-87. [Abstract: PMID:22843638]
2. Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry 2012;24:556-67. [Abstract: PMID: 23244611]

Why are ICD-11 working group progress reports on emerging proposals for potential new ICD disorders and focus group study reports not being published on platforms accessible, without payment, to all classes of ICD stakeholder?

The SSD Work Group paper is authored by Joel E Dimsdale (Chair), Francis Creed, Javier Escobar, Michael Sharpe, Lawson Wulsin, Arthur Barsky, Sing Lee, Michael R. Irwin and James Levenson.

[Although not a member of the SSD Work Group, Javier Escobar is Task Force liaison to the SSD work group and works closely with the group. Francis J Keefe (not included in the paper’s authors) is a member of the SSD Work Group. Nancy Frasure-Smith (not included in the paper’s authors) served as a member of the Work Group from 2007-2011 and was not replaced following withdrawal.]

The paper describes the DSM-5 Work Group’s rationale for the new SSD diagnosis (which replaces four DSM-IV categories); defines the construct, discusses field trial kappa data (inter-rater reliability), presents limited data for validity of SSD, clinical utility and potential prevalence rates, and briefly discusses tasks for future research, education and clinical practice.

http://www.jpsychores.com/

July 2013, Vol. 75, No. 1

In Press

Somatic Symptom Disorder: An important change in DSM

29 July 2013

Joel E. Dimsdale, Francis Creed, Javier Escobar, Michael Sharpe, Lawson Wulsin, Arthur Barsky, Sing Lee, Michael R. Irwin, James Levenson

Received 4 April 2013; received in revised form 27 June 2013; accepted 29 June 2013. published online 29 July 2013.

Corrected Proof

doi:10.1016/j.jpsychores.2013.06.033

Abstract: http://www.jpsychores.com/article/S0022-3999(13)00265-1/abstract [Free]

Full text: http://www.jpsychores.com/article/S0022-3999(13)00265-1/fulltext  [Paywall]

References: http://www.jpsychores.com/article/PIIS0022399913002651/references  [Paywall]

Commentaries on Somatic Symptom Disorder in recent journal papers

In the June 2013 edition of Journal of Nervous and Mental Disorders, Allen Frances, MD, who chaired the Task Force for DSM-IV, discusses his concerns for the loosely defined DSM-5 category, Somatic Symptom Disorder, sets out his suggestions for revising the criteria prior to finalization, as presented to the SSD Work Group chair, in December 2012, and advises clinicians against using the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23719325

DSM-5 Somatic Symptom Disorder.

Frances A.

Department of Psychiatry, Duke University, Durham, NC.

J Nerv Ment Dis. 2013 Jun;201(6):530-1. doi: 10.1097/NMD.0b013e318294827c. No abstract available.

PMID: 23719325

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Commentary by Allen Frances, MD, and Suzy Chapman in the May 2012 issue of Australian and New Zealand Journal of Psychiatry. The paper discusses the over-inclusive DSM-5 Somatic Symptom Disorder criteria and the potential implications for diverse patient groups. The paper concludes by advising clinicians not to use the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23653063

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

Allen Frances¹, Suzy Chapman²

1 Department of Psychiatry, Duke University 2 DxRevisionWatch.com

Aust N Z J Psychiatry. 2013 May;47(5):483-4. doi: 10.1177/0004867413484525. No abstract available.

PMID: 23653063

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The April 22, 2013 edition of Current Biology published a feature article on DSM-5 by science writer, Michael Gross, Ph.D. The article includes quotes from Allen Frances, MD, and Suzy Chapman on potential implications for patients for the application of the new DSM-5 Somatic Symptom Disorder. The article includes concerns for the influence of Somatic Symptom Disorder on proposals for a new ICD category – Bodily Distress Disorder – being field tested for ICD-11.

Current Biology 22 April, 2013 Volume 23, Issue 8

Copyright 2013 All rights reserved. Current Biology, Volume  23, Issue  8, R295-R298, 22 April 2013

doi:10.1016/j.cub.2013.04.009

Feature

Has the manual gone mental?

Michael Gross

Full text: http://www.cell.com/current-biology/fulltext/S0960-9822(13)00417-X

PDF: http://download.cell.com/current-biology/pdf/PIIS096098221300417X.pdf

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In a BMJ opinion piece, published March 2013, Allen Frances, MD, opposes the new Somatic Symptom Disorder, discusses lack of specificity, data from the field trials, and advises clinicians to ignore this new category.

http://www.ncbi.nlm.nih.gov/pubmed/23511949

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill.

Frances A.

Allen Frances, chair of the DSM-IV task force

BMJ. 2013 Mar 18;346:f1580. doi: 10.1136/bmj.f1580. No abstract available.

PMID: 23511949

[PubMed – indexed for MEDLINE]

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Somatic Symptom Disorder is also included in Saving Normal: An Insider’s Revolt Against Out-Of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (pp. 193-6): Allen Frances, William Morrow & Company (May 2013).

Also Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (Chapter 16): Allen Frances, Guilford Press (June 2013).

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Further reading

APA Somatic Symptom Disorder Fact Sheet APA DSM-5 Resources

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]

Filed under American Psychiatric Association (APA), Bodily Distress Disorders, Bodily stress syndrome, Criticism of DSM-V, DSM-5, DSM-5 field trials, ICD-11, Joel Dimsdale, Kappa, Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , , ,

ICD-10-CM Release for 2014 now available

July 12, 2013 by

Post #270 Shortlink: http://wp.me/pKrrB-3iT

ICD-10-CM Release for 2014 now available

Prior to implementation, the codes in ICD-10-CM are not valid for any purpose or use.

The World Health Organization’s (WHO) International Classification of Diseases (ICD-10) was published in 1992 and is used in over a hundred countries worldwide.

A number of countries have been authorized by WHO to develop “Clinical Modifications” – adaptations of ICD-10 for country specific use. These differ in the number of chapters, codes and subcategories. Specific conditions are present in some adaptations but not all clinical modifications [1]. All modifications to the ICD-10 must conform to WHO conventions for ICD.

Canada uses an adaptation called ICD-10-CA, Australia uses ICD-10-AM, Germany uses ICD-10-GM and Thailand uses ICD-10-TM.

The U.S. lags behind most of the rest of the world and is still using a Clinical Modification of the WHO’s long since retired, ICD-9.

A U.S. specific adaptation of ICD-10 has been under development for a considerable length of time but is scheduled for implementation on October 1, 2014.

Transition to ICD-10-CM is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA).

Implementation schedules for Large Practices; Small and Medium Practices; Small Hospitals and Payers can be found on the CMS website, here: Implementation Timelines.

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2014 release of ICD-10-CM

The 2014 release of ICD-10-CM is now available from the CDC website. It replaces the July 2012 release.

Prior to the implementation date of October 1, 2014, the codes in ICD-10-CM are not valid for any purpose or use.

The ICD-10-CM code set is currently subject to partial code freeze. For information on the code freeze see Partial Freeze of Revisions to ICD-9-CM and ICD-10-CM/PCS.

October 1, 2011 was the last major update of ICD-10-CM/PCS until October 1, 2015. Between October 1, 2011 and October 1, 2015, revisions to ICD-10-CM/PCS will be for new diseases/new technology procedures or minor revisions to correct any reported errors in these classifications. Regular (at least annual) updates to ICD-10-CM/PCS will resume on October 1, 2015.

Information on the ICD-9-CM and ICD-10-CM/PCS update and revision processes and the public NCHS/CDC Coordination and Maintenance Committee meetings can be found on this CDC page: Coordination and Maintenance Committee.

Downloading the ICD-10-CM code sets

The ICD-10-CM Preface, Guidelines, Tabular List, Index and associated documentation can be downloaded from this page: http://www.cdc.gov/nchs/icd/icd10cm.htm#10update.

The PDF of the Preface is in a single PDF file here: ICD-10-CM Preface 2014

The PDF of the Guidelines is in a single PDF file here: ICD-10-CM Guidelines

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To access the PDFs for the ICD-10-CM Tabular List and Index, the files need extracting from Zip files from this link:

ICD-10-CM List of codes and Descriptions (updated 7/3/2013)

( ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2014/ )

Select this file, below, on the CDC site and open it. It is a large file of over 15MB so you will need to allow sufficient time for it to fully load:

06/19/2013 08:28AM 15,223,965 ICD10CM_FY2014_Full_PDF.zip

It will unpack these five PDF files, which can be opened and viewed in situ or saved:

ICD10CM_FY2014_Full_PDF_DIndex  4,222 KB  [ICD-10-CM INDEX TO DISEASES and INJURIES]

or open unzipped PDF on Dx Revision Watch: ICD-10-CM 2014 Full Index

ICD10CM_FY2014_Full_PDF_EIndex   [401 KB]  [ICD-10-CM External Cause of Injuries Index]

ICD10CM_FY2014_Full_PDF_TableOfDrugs   [2,193 KB]

ICD10CM_FY2014_Full_PDF_TableOfNeoplasms   [646 KB]

ICD10CM_FY2014_Full_PDF_Tabular   [7, 398 KB]  [ICD-10-CM TABULAR LIST of DISEASES and INJURIES]

or open unzipped PDF on Dx Revision Watch: ICD-10-CM Tabular List

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For five PDF files of Addenda go to this page:

ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2014/

and select this file:

06/19/2013 08:28AM 582,584 ICD10CM_FY2014_Addenda.zip

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Comparison between classifications and codings in ICD-10-CM and ICD-10

The WHO’s ICD-10 Volume 1 The Tabular List isn’t made available as a PDF file but can be accessed on a searchable electronic browser platform here: ICD-10 Version: 2010.

The Tabular List for ICD-10 contains more textual descriptions for the categories in Chapter V (the mental and behavioural disorders chapter) than other chapters in ICD-10.

There are also two “speciality” volumes for ICD-10 Chapter V for Clinical descriptions and diagnostic guidelines (known as the “Blue Book”) and Diagnostic criteria for research (known as the “Green Book”).

The U.S. specific ICD-10-CM will not contain this depth of textual content within its Chapter 5.

CDC’s, Donna Picket, has confirmed that CMS/CDC does not plan to adapt the “Blue Book” specifically for U.S. use in conjunction with Chapter 5 of ICD-10-CM [2]. Nor are there plans for an official CMS/CDC crosswalk between ICD-10-CM’s Chapter 5 classifications and codes and those in ICD-10 Chapter V [3].

In the U.S., since 2003, the ICD-9-CM diagnostic codes have been mandated for third-party billing and reporting by HIPAA for all electronic transactions for billing and reimbursement. Following implementation on October 1, 2014, the ICD-10-CM codes sets will become mandatory.

This also applies to the coding of mental and behavioural disorders. APA’s DSM-IV disorder diagnoses are crosswalked to ICD-9-CM codes, or their nearest equivalent, for billing and reimbursement.

The DSM-5, published in May this year, includes the crosswalk codes for both the existing ICD-9-CM and the forthcoming ICD-10-CM codes.

For comparison between

ICD-10-CM Chapter 5 Mental, Behavioral and Neurodevelopmental disorders (F01-F99)

and ICD-10 Chapter V Mental and behavioural disorders (F00-F99) see the ICD-10 online browser or

The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines (The “Blue Book”)

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References and further resources

1. The development, evolution, and modifications of ICD-10: challenges to the international comparability of morbidity data. Jetté N, Quan H, Hemmelgarn B, Drosler S, Maass C, Moskal L, Paoin W, Sundararajan V, Gao S, Jakob R, Ustün B, Ghali WA; IMECCHI Investigators. Med Care. 2010 Dec;48(12):1105-10. doi: 10.1097/MLR.0b013e3181ef9d3e [PMID: 20978452].

The development, evolution and modifications of ICD-10: challenges to the international comparability of morbidity data: Nathalie Jetté MD, November 2009, Slide Presentation [5 MB].

2. Personal communication.

3. Personal communication.

4. Information for providers, payers and vendors on transition to ICD-10-CM can be found here on the CMS website.

5. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services: ICD-10-CM/PCS MYTHS AND FACTS ICN 902143, April 2013.

6. American Psychological Association: Nine frequently asked questions about DSM-5 and ICD-10-CM, APA Practice staff answer questions about billing, determining diagnoses and more related to the two diagnostic classification systems. Practice Update, May 16, 2013.

7. American Psychiatric Association: Insurance Implications of DSM-5

8. AAPC What is ICD-9-CM?

Filed under CDC, Clinical Modification, CMS, Diagnostic classification, ICD-10, ICD-10-CM, ICD-10-CM compliance, ICD-10-PCS, WHO (World Health Organization), WHO Collaborating Centre Tagged with , , , , , , , , , ,