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

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

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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:

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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

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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…

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Medscape Medical News > Psychiatry

NIMH, APA Clash Over Upcoming DSM-5

‘Patients Deserve Better,’ NIMH Director Says

Deborah Brauser | May 7, 2013

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Scientific America

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

Ferris Jabr | May 7, 2013

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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]

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1 Boring Old Man

…groundhog day

1 Boring Old Man | May 7, 2013

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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…

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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…

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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…”

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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…”

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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

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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.

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LaPresse [French Canadian]

Le blogue santé

DSM-5: une bible controversée

Valérie Simard | 6 mai 2013

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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.

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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.

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