Deutschlandfunk Radio: Wissenschaft Im Brennpunkt: Störungswahn? DSM-5 with Allen Frances

Deutschlandfunk Radio: Wissenschaft Im Brennpunkt: Störungswahn? (DSM-5) with Allen Frances, MD

Post #223 Shortlink: http://wp.me/pKrrB-2EH

Flash:
http://www.dradio.de/dlf/sendungen/wib/1990949

Mp3 (12MB):
http://ondemand-mp3.dradio.de/file/dradio/2013/02/03/dlf_20130203_1630_c745d088.mp3

Deutschlandfunk Radio

http://www.dradio.de/dlf/sendungen/wib/1990949/

27:21 mins

WISSENSCHAFT IM BRENNPUNKT (Science In Focus)
03.02.2013

Störungswahn? (Delusional disorder?)

Psychiater streiten um die Zukunft ihres Fachs (Psychiatrists argue about the future of their profession)

Von Martin Hubert with contributions from Allen Frances, MD, and others

In einigen Monaten erscheint das neue amerikanische Handbuch zur Diagnose psychiatrischer Krankheiten, das “DSM-5”. Aber schon heute erzeugt es heftigen Streit. Denn das “DSM-5” wird die Entwicklung der Psychiatrie auf Jahre hinaus wesentlich beeinflussen.

Kritiker meinen, dass es zu viel neue und überflüssige Störungsbilder enthalte. Außerdem definiere es Störungen oft so weich, dass auch Durchschnittsmenschen künftig zum psychiatrischen Fall würden. Die Verteidiger des Handbuchs kontern: Es habe in der Geschichte immer wieder neue Störungen gegeben, auf die die Psychiater zu reagieren hätten. Außerdem seien weiche Kriterien nötig, um Risikopatienten früh erkennen und therapieren zu können. Wann ist ein Patient wirklich gefährdet – und wann leiden die Psychiater selbst unter Störungswahn? Der Streit zeigt, in welche Richtung sich die Psychiatrie insgesamt entwickeln könnte.

Weiterführende Links:

Seiten des Deutschlandradios:

Links ins Netz:

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DSM-5 Round up: January #2

DSM-5 Round up: January #2

Post #220 Shortlink: http://wp.me/pKrrB-2Ce

Round up of recent media coverage of DSM-5 issues from US and UK spanning January 18 to January 28:

Scientific American

The Newest Edition of Psychiatry’s “Bible,” the DSM-5, Is Complete

The APA has finished revising the DSM and will publish the manual’s fifth edition in May 2013. Here’s what to expect

Ferris Jabr | January 28, 2013

For more than 11 years, the American Psychiatric Association (APA) has been laboring to revise the current version of its best-selling guidebook, the Diagnostic and Statistical Manual of Mental Disorders (DSM) (see “Psychiatry’s Bible Gets an Overhaul” in Scientific American MIND). Although the DSM is often called the bible of psychiatry, it is not sacred scripture to all clinicians—many regard it more as a helpful corollary to their own expertise. Still, insurance companies in the U.S. often require an official DSM diagnosis before they help cover the costs of medication or therapy, and researchers find it easier to get funding if they are studying a disorder officially recognized by the manual. This past December the APA announced that it has completed the lengthy revision process and will publish the new edition—the DSM-5—in May 2013, after some last (presumably minor) rounds of editing and proofreading. Below are the APA’s final decisions about some of the most controversial new disorders as well as hotly debated changes to existing ones, including a few surprises not anticipated by close observers of the revision process…

Update: New material above

New York Times | New Old Age Blogs | Medical Issues

Time to Recognize Mild Cognitive Disorder?

Paula Span| January 25, 2013

Dr. Allen Frances, chairman of the task force that developed the previous Diagnostic and Statistical Manual of Mental Disorders, predicts inclusion of Mild Neurocognitive Disorder in the new version will lead to “wild overdiagnosis.”

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by…

Medscape Medical News Psychiatry

No Impact of DSM-5 Criteria on Alcohol Disorder Prevalence

Deborah Brauser | January 25, 2013

Although criteria used to assess serious alcohol problems will be revised in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), these changes will not likely affect the prevalence of these disorders, new research suggests…

Huffington Post Blogs | Allen Frances, MD

Why Will DSM-5 Cost $199 a Copy?

Allen Frances, MD | January 25, 2013

DSM-5 has just announced its price — an incredible $199 (and the paperback is also no bargain at a hefty $149). Compare this to $25 for a DSM III in 1980; $65 for a DSM IV in 1994; and $84 for a DSM-IV-TR in 2000. The price tag on a copy of DSM is escalating at more than twice the rate of inflation.

What’s going on?

Huffington Post Blogs | Allen Frances, MD

Terrible News: DSM-5 Refuses to Reduce Overdiagnosis of ‘Somatic Symptom Disorder’

Allen Frances, MD | January 18, 2013

Many of you will have read a previous blog prepared by Suzy Chapman and me that contained alarming information about the new DSM-5 diagnosis “somatic symptom disorder” (SSD).

DSM-5 defines SSD so over-inclusively that it will mislabel one in six people with cancer and heart disease, one in four with irritable bowel syndrom and fibromyalgia, and one in 14 who are not even medically ill.

I hoped to be able to influence the DSM-5 work group to correct this in two ways: 1) by suggesting improvements in the wording of the SSD criteria set that would reduce mislabeling, and 2) by letting them know how much opposition they would face from concerned professionals and an outraged public if DSM-5 failed to slam on the brakes while there was still time…

New York Times | New Old Age Blogs | Medical Issues

Grief Over New Depression Diagnosis

Paula Span | January 24, 2013, 6:40 am

The next edition of the Diagnostic and Statistical Manual of Mental Disorders will not only abandon the Roman numerals, but will also leave grief considerations out of diagnoses for depression.
When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue…

TIME | Alcohol

Revisions to Mental Health Manual May Turn Binge Drinkers into ‘Mild’ Alcoholics

Maia Szalavitz | January 23, 2013

Are you an alcoholic— or just a problem drinker? It may not matter, according to the latest version of the DSM, psychiatry’s diagnostic manual.

And now, in a new study of the different levels of alcohol misuse, scientists say the changes made to the DSM-5 may not even represent a significant improvement in the diagnosis of alcoholism. In fact, the revised definition collapses the medical distinction between problem drinking and alcoholism, potentially leading college binge drinkers to be mislabeled as possible lifelong alcoholics. The changes take effect in May, when the DSM-5 will be released…

EurekAlert! Press Release | January 22, 2013

Will Proposed DSM-5 Changes to Assessment of Alcohol Problems Do Any Better?

Proposed changes to the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will affect the criteria used to assess alcohol problems. One change would collapse the two diagnoses of alcohol abuse (AA) and alcohol dependence (AD) into a single diagnosis called alcohol use disorder (AUD). A second change would remove “legal problems,” and a third would add a criterion of “craving.” A study of the potential consequences of these changes has found they are unlikely to significantly change the prevalence of diagnoses…

Medpage Today

Psych Group Posts Glimpses of Final DSM-5

John Gever, Senior Editor, MedPage Today | January 21, 2013

Peeks into the final DSM-5, the controversial new edition of the American Psychiatric Association’s diagnostic manual, are now available from the group prior to the guide’s official May 22 debut…

British Psychological Society

Professor Peter Kinderman writes on DSM-5 for the BBC News website

January 18, 2013

People diagnosed with a mental illness need help and understanding, not labels and medication. That is the message of an article published on the BBC News Health pages today by Professor Peter Kinderman from the University of Liverpool, a former chair of our Division of Clinical Psychology…

[BBC News Health report below]

BBC News Health

‘Grief and anxiety are not mental illnesses’

Peter Kinderman, Professor of Clinical Psychology | January 18, 2013

The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness – but what they need is help and understanding, not labels and medication.

Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we’re unemployed or dislike our jobs…

Psychiatric Times

DSM-5 Field Trials: What Was Learned

James Phillips, MD | January, 8 2013

With DSM-5 now approved by the APA Board of Trustees—and, to the dismay of this reader, all discussion removed from the DSM-5 Web site—how are we to evaluate the results of the field trials for the end product? I suggest beginning with the short piece published in Psychiatric News, “What We Learned from DSM-5 Field Trials.”1 Authors David Kupfer and Helena Kraemer wrote, “We ultimately tested the criteria for 23 disorders. The question we asked was a straightforward one: In the hands of regular clinicians, assessing typically symptomatic patients in no different way than they would during everyday practice, was a particular disorder reliable?”

DSM-5 Round up: January #1

DSM-5 Round up: January #1

Post #218 Shortlink: http://wp.me/pKrrB-2Bs

American Journal of Psychiatry

Editorials | January 01, 2013

The Initial Field Trials of DSM-5: New Blooms and Old Thorns

Robert Freedman, M.D.; David A. Lewis, M.D.; Robert Michels, M.D.; Daniel S. Pine, M.D.; Susan K. Schultz, M.D.; Carol A. Tamminga, M.D.; Glen O. Gabbard, M.D.; Susan Shur-Fen Gau, M.D., Ph.D.; Daniel C. Javitt, M.D., Ph.D.; Maria A. Oquendo, M.D., Ph.D.; Patrick E. Shrout, Ph.D.; Eduard Vieta, M.D., Ph.D.; Joel Yager, M.D.

Am J Psychiatry 2013;170:1-5. 10.1176/appi.ajp.2012.12091189

View Author and Article Information
Copyright © 2013 by the American Psychiatric Association

Article
Figures
References

“A rose is a rose is a rose” (1). For psychiatric diagnosis, we still interpret this line as Robins and Guze did for their Research Diagnostic Criteria—that reliability is the first test of validity for diagnosis (2). To develop an evidence-based psychiatry, the Robins and Guze strategy (i.e., empirically validated criteria for the recognizable signs and symptoms of illness) was adopted by DSM-III and DSM-IV. The initial reliability results from the DSM-5 Field Trials are now reported in three articles in this issue (3–5). As for all previous DSM editions, the methods used to assess reliability reflect current standards for psychiatric investigation (3). Independent interviews by two different clinicians trained in the diagnoses, each prompted by a computerized checklist, assessment of agreement across different academic centers, and a pre-established statistical plan are now employed for the first time in the DSM Field Trials. As for most new endeavors, the end results are mixed, with both positive and disappointing findings…

Full free text

Washington Post

Antidepressants to treat grief? Psychiatry panelists with ties to drug industry say yes

Peter Whoriskey | December 27, 2012

It was a simple experiment in healing the bereaved: Twenty-two patients who had recently lost a spouse were given a widely used antidepressant.

The drug, marketed as Wellbutrin, improved “major depressive symptoms occurring shortly after the loss of a loved one,” the report in the Journal of Clinical Psychiatry concluded.

When, though, should the bereaved be medicated? For years, the official handbook of psychiatry, issued by the American Psychiatric Association, advised against diagnosing major depression when the distress is “better accounted for by bereavement.” Such grief, experts said, was better left to nature.

But that may be changing…

Medscape Medical News > Psychiatry

APA Answers Criticism of Pharma-Influenced Bias in DSM-5

Deborah Brauser | January 4, 2013

The American Psychiatric Association (APA) has fired back a strong response to a recent article by the Washington Post questioning the possibility of pharmaceutical industry influence on decisions regarding the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)…

Ed: Note for watchers of DSM-5’s Timeline. Although the Timeline has the final texts schedule for submission to the publishers by December 2012, in his commentary below, Dr Frances discloses that DSM-5 will go to press at the end of January. The new edition of DSM is slated for release at the APA’s 166th Annual Meeting, May 18-22, 2013, San Francisco.

Psychology Today

DSM5 in Distress
The DSM’s impact on mental health practice and research
by Allen Frances, M.D.

Last Plea to DSM 5: Save Grief From the Drug Companies
Let us respect the dignity of love and loss.

Allen J. Frances, M.D. | January 3, 2013

Psychiatric News
Psychiatric News | January 04, 2013
Volume 48 Number 1 page 7-7
10.1176/appi.pn.2013.1a14
American Psychiatric Association
Professional News

Eating-Disorders Guideline Still Current and Valid, Panel Finds

Mark Moran | January 4, 2013

A review of the 2006 APA practice guideline on eating disorders finds that it is substantially current and is not affected by changes in diagnostic criteria in DSM-5.

Huffington Post

‘Eating Disorders Not Otherwise Specified’: What’s Changing With EDNOS In DSM-5?

Catherine Pearson | January 4, 2013

It took Autumn Whitefield-Madrano more than 20 years to seek treatment for her eating disorder. The writer was 9 when she started having symptoms, primarily binging, and 33 when she finally got help. When she did, the diagnosis surprised her. Whitefield-Madrano had EDNOS, or an “Eating Disorder Not Otherwise Specified…”

Conflicts of interest and DSM-5: the media reaction; APA Rebuts Study on Autism and Christopher Lane On What’s Wrong With Modern Psychiatry

Conflicts of interest and DSM-5: the media reaction; APA Rebuts Study on Autism and Christopher Lane On What’s Wrong With Modern Psychiatry

Post #154 Shortlink: http://wp.me/pKrrB-20T

Links for full text, PDF and further coverage following publication of the PloS Essay by Cosgrove and Krimsky:

March 17, 2012: DSM-5 controversies, Cosgrove and Krimsky on potential COIs, counter statement from APA’s John Oldham and APA May Annual Meeting preliminary program

March 14, 2012: Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties – review identifies potential COIs

PLoS Blogs

Speaking of Medicine

Conflicts of interest and DSM-5: the media reaction

Clare Weaver | March 26, 2012

…Last week PLoS Medicine published an analysis by Lisa Cosgrove and Sheldon Krimsky, who examined the disclosure policy and the panel members’ conflicts of interest, and call for the APA to make changes to increase transparency before the manual’s publication.

Within three days of publication the paper had been viewed over 4000 times, and several major media outlets reported on the authors’ findings and the wider issues they relate to…

Read full post

Psychiatric Times

American Psychiatric Association Press Release No. 12-15: March 27, 2012

      Commentary Takes Issue with Criticism of New Autism Definition

APA Rebuts Study on Autism

DSM-5 Experts Call Study Flawed

Laurie Martin, Web Editor | 30 March 2012

In a recent commentary, the DSM-5 Neurodevelopmental Disorders Work Group responded to a study that challenges the proposed DSM-5 diagnostic criteria on autism spectrum disorder (ASD).1 The commentary, published in the April issue of the Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP), takes issue with the study by James McPartland and colleagues,2 and addresses what it deems “serious methodological flaws.”

The Work Group refutes the authors’ conclusions that the “Proposed DSM-5 criteria could substantially alter the composition of the autism spectrum. Revised criteria improve specificity but exclude a substantial portion of cognitively.” Dr McPartland and colleagues’ research study, titled Sensitivity and Specificity of Proposed DSM-5 Diagnostic Criteria for Autism Spectrum Disorder, also states, “a more stringent diagnostic rubric holds significant public health ramifications regarding service eligibility and compatibility of historical and future research.” The study in question is also published in the April issue of JAACAP…

Read full article by Laurie Martin, Web Editor

Related material: American Psychiatric Association Press Release No. 12-03

      DSM-5 Proposed Criteria for Autism Spectrum Disorder Designed to Provide More Accurate Diagnosis and Treatment  January 20, 2012

The Sun Interview

March 2012

Side Effects May Include

Christopher Lane On What’s Wrong With Modern Psychiatry

by Arnie Cooper
The complete text of this selection is available in our print edition.

Six years ago Lane began to hear from his students at Northwestern University in Evanston, Illinois, that many of them were on psychiatric drugs. They would come to his office to ask for extensions on their assignments, explaining that they were suffering from anxiety or depression but were on medication for it. He had just published Hatred and Civility: The Antisocial Life in Victorian England, for which he had studied the transition from Victorian psychiatry, out of which psychoanalysis was born, to contemporary psychiatry, with its intense focus on biomedicine and pharmacology. He was already skeptical about the emergence in 1980 of dozens of new mental disorders in the DSM-III, the third edition of the manual. Among these new ailments were the curious-sounding “social phobia” and “avoidant personality disorder.” Lane wanted to know how and why those new disorders had been approved for inclusion and whether they were really bona fide illnesses…

Read Arnie Cooper interview with Christopher Lane

Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties

Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties – review identifies potential COIs

Post #151 Shortlink: http://wp.me/pKrrB-1ZM

“Board of Trustee Principles” here:
http://www.dsm5.org/about/Pages/BoardofTrusteePrinciples.aspx

“DSM-V Task Force and Work Group Acceptance Form” here:
Approved by BOT July2006 Amended and Approved by BOT October 2007
http://www.dsm5.org/about/Documents/DSM%20Member%20Acceptance%20Form.pdf

DSM-5 Task Force members’ bios and disclosures here: http://www.dsm5.org/MeetUs/Pages/TaskForceMembers.aspx

DSM-5 Work Group members’ bios and disclosures here: http://www.dsm5.org/MeetUs/Pages/WorkGroupMembers.aspx

(All 13 DSM-5 Work Group Chairs are members of the Task Force, which totals 29 members.)

A number of stories following publication of PLoS Medicine Essay by Linda Cosgrove and Sheldon Krimsky:

A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists

Full text available on PLoS site under “Open-access”

Or open PDF here

Citation: Cosgrove L, Krimsky S (2012) A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists. PLoS Med 9(3): e1001190. doi:10.1371/journal.pmed.1001190

Published: March 13, 2012

 

ABC News

DSM-5 Criticized for Financial Conflicts of Interest

Katie Moisse | March 13, 2012

Controversy continues to swell around the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, better known as DSM-5. A new study suggests the 900-page bible of mental health, scheduled for publication in May 2013, is ripe with financial conflicts of interest.

The manual, published by the American Psychiatric Association, details the diagnostic criteria for each and every psychiatric disorder, many of which have pharmacological treatments. After the 1994 release of DSM-4, the APA instituted a policy requiring expert advisors to disclose drug industry ties. But the move toward transparency did little to cut down on conflicts, with nearly 70 percent of DSM-5 task force members reporting financial relationships with pharmaceutical companies – up from 57 percent for DSM-4.

“Organizations like the APA have embraced transparency too quickly as the solution,” said Lisa Cosgrove, associate professor of clinical psychology at the University of Massachusetts-Boston and lead author of the study published today in the journal PLoS Medicine. “Our data show that transparency has not changed the dynamic.”…

Read on


New Scientist

Many authors of psychiatry bible have industry ties

Peter Aldhous | March 13, 2012

Just as many authors of the new psychiatry “bible” are tied to the drugs industry as those who worked on the previous version, a study has found, despite new transparency rules…

…”Transparency alone can’t mitigate bias,” says Lisa Cosgrove Havard University of Harvard University, who along with Sheldon Krimsky of Tufts University in Medford, Massachusetts, analysed the financial disclosures of 141 members of the “work groups” drafting the manual. They found that just as many contributors – 57 per cent – had links to industry as were found in a previous study of the authors of DSM-IV and an interim revision, published in 1994 and 2000 respectively.

Cosgrove also points out that the $10,000-per-year limit on payments excludes research grants. “Nothing has really changed,” she says…

Read on

Journal reference: PLoS Medicine, DOI: 10.1371/ journal.pmed.1001190

Please note that the petition launched in October by an ad hoc committee of the Society for Humanistic Psychology (Division 32 of the American Psychological Association) referred to in this article is intended for signing by mental health professionals.


Nature | News

Industry ties remain rife on panels for psychiatry manual
Review identifies potential conflicts of interest among those drawing up DSM-5.

Heidi Ledford | March 13, 2012

Potential conflicts of interest among the physicians charged with revising a key psychiatric manual have not declined despite changes to the rules on disclosing ties to industry, says a study published today1.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used to diagnose patients, shape research projects and guide health-insurance claims. The fifth edition of the manual, DSM-5, currently being prepared by the American Psychiatric Association (APA) in Arlington, Virginia, is scheduled for publication in May 2013. But some of the suggested revisions are proving to be contentious. In particular, some psychiatrists worry that the broader diagnostic criteria for selected psychiatric conditions would encroach into the realm of the normal, thereby pathologizing ordinary behaviour and expanding the market for drug prescriptions (see ‘Diagnostics tome comes under fire’ and ‘Mental health guide accused of overreach’)…

Read on


From TIME Magazine:

TIME Magazine

What Counts As Crazy?

John Cloud | Online March 14, 2012

Print edition | March 19, 2012

…The mind, in our modern conception, is an array of circuits we can manipulate with chemicals to ease, if not cure, depression, anxiety and other disorders. Drugs like Prozac have transformed how we respond to mental illness. But while this revolution has reshaped treatments, it hasn’t done much to help us diagnose what’s wrong to begin with. Instead of ordering lab tests, psychiatrists usually have to size up people using subjective descriptions of the healthy vs. the afflicted.

…Which is why the revision of a single book is roiling the world of mental health, pitting psychiatrists against one another in bitter…

Full article available to subscribers


From last week’s New Scientist:

New Scientist

Should we rewrite the autism rule book?

Fred Volkmar and Francesca Happé | March 7, 2012
Magazine issue 2855.

AN EFFORT is under way to update the American Psychiatric Association’s diagnostic guide – the Diagnostic and Statistical Manual of Mental Disorders (DSM). In particular, changes suggested for diagnosis of autism are the focus of much debate.

There are clear reasons for changing and tweaking DSM categories and criteria in the light of new research, but the impact in this case is likely to be major…

Full article available to subscribers


Human Givens

International society removes ‘schizophrenia’ from its title

March 13, 2012

A statement from the ISPS today reveals that the society has voted to remove the word ‘schizophrenia’ from its title due to the term being deemed ‘unscientific and stigmatizing’:

“Members of the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses ( www.isps.org ) have just voted, by an overwhelming majority, to change the society’s name to the International Society for Psychological and Social Approaches to Psychosis. The new logo and letterhead are to be adopted by the end of March…”

Read on

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