The six most essential questions in psychiatric diagnosis: a pluralogue: conceptual and definitional issues in psychiatric diagnosis Parts 1 and 2

April 27, 2012 by

The six most essential questions in psychiatric diagnosis: a pluralogue: conceptual and definitional issues in psychiatric diagnosis, Parts 1 and 2

Post #161 Shortlink: http://wp.me/pKrrB-248

Below, I am posting the Abstract and Introduction to Parts 1 and 2 of Philos Ethics Humanit Med Review “The six most essential questions in psychiatric diagnosis: a pluralogue: conceptual and definitional issues in psychiatric diagnosis.”

Part 1 of this Review was published on January 13, 2012; Part 2 was published (as a provisional PDF) on April 18, 2012. I will post Part 3 when it becomes available.

Below Parts 1 and 2, I have posted the PDFs for Phillips J (ed): Symposium on DSM-5: Part 1. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 2010, 17(1):1–26 and Phillips J (ed): Symposium on DSM-5: Part 2. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 2010, 17(2):1–75 out of which grew the concept for the Philos Ethics Humanit Med Review Parts 1 and 2.

This is an interesting series of exchanges which expand on conceptual and definitional issues discussed in these two Bulletins but these are quite lengthy documents, 29 and 30 pp, respectively; PDFs are provided rather than full texts.

Review Part One

The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305603/

Philos Ethics Humanit Med. 2012; 7: 3.
Published online 2012 January 13. doi: 10.1186/1747-5341-7-3 PMCID: PMC3305603

Copyright ©2012 Phillips et al; licensee BioMed Central Ltd.
Received August 15, 2011; Accepted January 13, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

      The six most essential questions Part 1

or: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305603/pdf/1747-5341-7-3.pdf

Html: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305603/

or http://www.peh-med.com/content/7/1/3

James Phillips,corresponding author1 Allen Frances,2 Michael A Cerullo,3 John Chardavoyne,1 Hannah S Decker,4 Michael B First,5 Nassir Ghaemi,6 Gary Greenberg,7 Andrew C Hinderliter,8 Warren A Kinghorn,2,9 Steven G LoBello,10 Elliott B Martin,1 Aaron L Mishara,11 Joel Paris,12 Joseph M Pierre,13,14 Ronald W Pies,6,15 Harold A Pincus,5,16,17,18 Douglas Porter,19 Claire Pouncey,20 Michael A Schwartz,21 Thomas Szasz,15 Jerome C Wakefield,22,23 G Scott Waterman,24 Owen Whooley,25 and Peter Zachar10
 
1Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA
2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC 27710, USA
3Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH 45219, USA
4Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
5Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
6Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
7Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT 06320, USA
8Department of Linguistics, University of Illinois, Urbana-Champaign 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL 61801, USA
9Duke Divinity School, Box 90968, Durham, NC 27708, USA
10Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL 36117, USA
11Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago IL, 60654, USA
12Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal H3T1E4 Quebec, Canada
13Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, USA
14VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
15Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY 13210, USA
16Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
17New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY 10032, USA
18Rand Corporation, 1776 Main St Santa Monica, California 90401, USA
19Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA 70113, USA
20Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320 Philadelphia, PA 19104, USA
21Department of Psychiatry, Texas AMHSC College of Medicine, 4110 Guadalupe Street, Austin, Texas 78751, USA
22Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA
23Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY 10016, USA
24Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, Vermont 05405, USA
25Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St., New Brunswick, NJ 08901, USA

Abstract

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

General Introduction

This article has its own history, which is worth recounting to provide the context of its composition.

As reviewed by Regier and colleagues [1], DSM-5 was in the planning stage since 1999, with a publication date initially planned for 2010 (now rescheduled to 2013). The early work was published as a volume of six white papers, A Research Agenda for DSM-V [2] in 2002. In 2006 David Kupfer was appointed Chairman, and Darrel Regier Vice-Chairman, of the DSM-5 Task Force. Other members of the Task Force were appointed in 2007, and members of the various Work Groups in 2008.

From the beginning of the planning process the architects of DSM-5 recognized a number of problems with DSM-III and DSM-IV that warranted attention in the new manual. These problems are now well known and have received much discussion, but I will quote the summary provided by Regier and colleagues:

Over the past 30 years, there has been a continuous testing of multiple hypotheses that are inherent in the Diagnostic and Statistical Manual of Mental Disorders, from the third edition (DSM-III) to the fourth (DSM-IV)… The expectation of Robins and Guze was that each clinical syndrome described in the Feighner criteria, RDC, and DSM-III would ultimately be validated by its separation from other disorders, common clinical course, genetic aggregation in families, and further differentiation by future laboratory tests–which would now include anatomical and functional imaging, molecular genetics, pathophysiological variations, and neuropsychological testing. To the original validators Kendler added differential response to treatment, which could include both pharmacological and psychotherapeutic interventions… However, as these criteria have been tested in multiple epidemiological, clinical, and genetic studies through slightly revised DSM-III-R and DSM-IV editions, the lack of clear separation of these syndromes became apparent from the high levels of comorbidity that were reported… In addition, treatment response became less specific as selective serotonin reuptake inhibitors were found to be effective for a wide range of anxiety, mood, and eating disorders and atypical antipsychotics received indications for schizophrenia, bipolar disorder, and treatment-resistant major depression. More recently, it was found that a majority of patients with entry diagnoses of major depression in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study had significant anxiety symptoms, and this subgroup had a more severe clinical course and was less responsive to available treatments… Likewise, we have come to understand that we are unlikely to find single gene underpinnings for most mental disorders, which are more likely to have polygenetic vulnerabilities interacting with epigenetic factors (that switch genes on and off) and environmental exposures to produce disorders. [[2], pp. 645-646]

As the work of the DSM-5 Task Force and Work Groups moved forward, a controversy developed that involved Robert Spitzer and Allen Frances, Chairmen respectively of the DSM-III and DSM-IV Task Forces. The controversy began with Spitzer’s Letter to the Editor, “DSM-V: Open and Transparent,” on July 18, 2008 in Psychiatric Times [3], detailing his unsuccessful effort to obtain minutes of the DSM-5 Task Force meetings. In ensuing months Allen Frances joined him in an exchange with members of the Task Force. In a series of articles and blog postings in Psychiatric Times, Frances (at times with Spitzer) carried out a sustained critique of the DSM-5 work in which he focused both on issues of transparency and issues of process and content [4-16]. The latter involved the Task Force and Work Group efforts to address the problems of DSM-IV with changes that, in Frances’ opinion, were premature and not backed by current scientific evidence. These changes included new diagnoses such as mixed anxiety-depression, an expanded list of addictive disorders, the addition of subthreshold conditions such as Psychosis Risk Syndrome, and overly inclusive criteria sets – all destined, in Frances’ judgment, to expand the population of the mentally ill, with the inevitable consequence of increasing the number of false positive diagnoses and the attendant consequence of exposing individuals unnecessarily to potent psychotropic medications. The changes also included extensive dimensional measures to be used with minimal scientific foundation.

Frances pointed out that the NIMH was embarked on a major effort to upgrade the scientific foundation of psychiatric disorders (described below by Michael First), and that pending the results of that research effort in the coming years, we should for now mostly stick with the existing descriptive, categorical system, in full awareness of all its limitations. In brief, he has argued, we are not ready for the “paradigm shift” hoped for in the 2002 A Research Agenda.

We should note that as the DSM-5 Work Groups were being developed, the Task Force rejected a proposal in 2008 to add a Conceptual Issues Work Group [17] – well before Spitzer and Frances began their online critiques.

In the course of this debate over DSM-5 I proposed to Allen in early 2010 that we use the pages of the Bulletin of the Association for the Advancement of Philosophy and Psychiatry (of which I am Editor) to expand and bring more voices into the discussion. This led to two issues of the Bulletin in 2010 devoted to conceptual issues in DSM-5 [18,19]. (Vol 17, No 1 of the AAPP Bulletin will be referred to as Bulletin 1, and Vol 17, No 2 will be referred to as Bulletin 2. Both are available at http://alien.dowling.edu/~cperring/aapp/bulletin.htm. webcite) Interest in this topic is reflected in the fact that the second Bulletin issue, with commentaries on Frances’ extended response in the first issue, and his responses to the commentaries, reached over 70,000 words.

Also in 2010, as Frances continued his critique through blog postings in Psychiatric Times, John Sadler and I began a series of regular, DSM-5 conceptual issues blogs in the same journal [20-33].

With the success of the Bulletin symposium, we approached the editor of PEHM, James Giordano, about using the pages of PEHM to continue the DSM-5 discussion under a different format, and with the goal of reaching a broader audience. The new format would be a series of “essential questions” for DSM-5, commentaries by a series of individuals (some of them commentators from the Bulletin issues, others making a first appearance in this article), and responses to the commentaries by Frances. Such is the origin of this article. (The general introduction, individual introductions, and conclusion are written by this author (JP), the responses by Allen Frances.

For this exercise we have distilled the wide-ranging discussions from the Bulletin issues into six questions, listed below with the format in which they were presented to commentators. (As explained below, the umpire metaphor in Question 1 is taken from Frances’ discussion in Bulletin 1.)…

Full document in PDF format

 

Review Part Two

(Note: Part Two was published on April 18, 2012 and addresses Questions 3 and 4. The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production. I will replace with the final version when available.)

The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

Philosophy, Ethics, and Humanities in Medicine 2012, 7:8 doi:10.1186/1747-5341-7-8

http://www.peh-med.com/content/7/1/8/abstract

Published: 18 April 2012

      The six most essential questions Part 2 Provisional

The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

James Phillips, Allen Frances, Michael A Cerullo, John Chardavoyne, Hannah S Decker, Michael B First, Nassir Ghaemi, Gary Greenberg, Andrew C Hinderliter, Warren A Kinghorn, Steven G LoBello, Elliott B Martin, Aaron L Mishara, Joel Paris, Joseph M Pierre, Ronald W Pies, Harold A Pincus, Douglas Porter, Claire Pouncey, Michael A Schwartz, Thomas Szasz, Jerome C Wakefield, G Scott Waterman, Owen Whooley and Peter Zachar

Abstract (provisional)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 

Symposium on DSM-5: Parts 1 and 2

      Bulletin Vol 17 No 1

Phillips J (ed): Symposium on DSM-5: Part 1. Bulletin of the Association for the
Advancement of Philosophy and Psychiatry 2010, 17(1):1–26

      Bulletin Vol 17 No 2

Phillips J (ed): Symposium on DSM-5: Part 2. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 2010, 17(2):1–75

 

One focus for this site has been the monitoring of the various iterations towards the revision of the Somatoform Disorders categories of DSM-IV, for which radical reorganization of existing DSM categories and criteria is proposed.

As the DSM-5 Development site documentation currently stands (April 27, 2012), the “Somatic Symptom Disorders” Work Group (Chaired by Joel E. Dimsdale, M.D.) proposes to rename Somatoform Disorders to “Somatic Symptom Disorders” and to fold a number of existing somatoform disorders together under a new rubric, which the Work Group proposes to call “Complex Somatic Symptom Disorder.”

Complex Somatic Symptom Disorder (CSSD) would include the previous DSM-IV diagnoses of somatization disorder [DSM IV code 300.81], undifferentiated somatoform disorder [DSM IV code 300.81], hypochondriasis [DSM IV code 300.7], as well as some presentations of pain disorder [DSM IV code 307].

There is a more recently proposed, Simple Somatic Symptom Disorder (SSSD), which requires symptom duration of just one month, as opposed to the six months required to meet the CSSD criteria. There is also an Illness Anxiety Disorder (hypochondriasis without somatic symptoms); and a proposal to rename Conversion Disorder to Functional Neurological Disorder and possibly locate under Dissociative Disorders.

There is some commentary on the Somatoform Disorders in DSM-IV in this discussion from Bulletin 1:

Bulletin Vol 17 No 1, Page 19:

Doing No Harm: The Case Against Conservatism

G. Scott Waterman, M.D. David P. Curley, Ph.D.

Department of Psychiatry, University of Vermont College of Medicine

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-V, Functional Somatic Syndrome (FSS), MUS, Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , , ,

CFSAC announces dates of Spring meeting

April 26, 2012 by

CFSAC announces dates of Spring meeting

Post #160 Shortlink: http://wp.me/pKrrB-240

Chronic Fatigue Syndrome Advisory Committee (CFSAC)

http://www.hhs.gov/advcomcfs/index.html

The Chronic Fatigue Syndrome Advisory Committee (CFSAC) provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Department of Health and Human Services on issues related to chronic fatigue syndrome (CFS). These include:

• factors affecting access and care for persons with CFS;
• the science and definition of CFS; and
• broader public health, clinical, research and educational issues related to CFS.

Administrative and management support for CFSAC activities is provided by the Office of the Assistant Secretary for Health (OASH). However, staffing will continue to be provided primarily from the Office on Women’s Health, which is part of OASH.

Dr. Nancy C. Lee, Deputy Assistant Secretary for Health – Women’s Health, is the Designated Federal Officer for CFSAC.

Chronic Fatigue Syndrome Advisory Committee (CFSAC) Spring Meeting

http://www.hhs.gov/advcomcfs/advcomcfs-cfsacmeeting.html

The Chronic Fatigue Syndrome Advisory Committee (CFSAC), 2012 spring meeting will be held on Wednesday, June 13, 2012 from 9:00 a.m. until 5:00 p.m. EST and Thursday, June 14, 2012 from 9:00 a.m. until 5:00 p.m. EST.

The meeting will be held at the U.S. Department of Health and Human Services, Hubert Humphrey Building, 200 Independence Avenue, S.W., Room 800, Washington, D.C. 20201. For directions please visit
http://www.hhs.gov/about/hhhmap.html .

The meeting will be webcast live and available by audio (listening-only). Additional information and the CFSAC agenda will be posted to the CFSAC website by June 4, 2012.

Update: May 24, 2012

Above notice now reads:

The meeting will provide a live video stream and be available by audio (listening only). Additional information and the CFSAC agenda will be posted to the CFSAC website by June 4, 2012. Instructions for public testimony will be provided at a later date in a Federal Register Notice. We are not accepting requests or testimony at this time.

 

Related material

Most recent CFSAC postings:

CFSAC November 8-9, 2011 meeting: Minutes and Recommendations to HHS posted (January 14, 2012)

CFSAC November 2011 meeting: videos, presentations and Day One Agenda item (December 27, 2011)

International Classification of Diseases – Clinical Modification (ICD-CM): Presentation by Donna Pickett, RHIA, MPH, National Center for Health Statistics (NCHS)

Filed under CFSAC meetings, Clinical Modification, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5 draft proposals, HHS, ICD-10-CM Tagged with , , , , , , , , ,

Update on timelines: DSM-5, ICD-11, ICD-10-CM

April 8, 2012 by

Update on timelines: DSM-5, ICD-11, ICD-10-CM

Post #155 Shortlink: http://wp.me/pKrrB-21N

Update @ April 10, 2012: CMS issues press release – proposes one year delay for ICD-10-CM compliance

See: http://wp.me/pKrrB-22q for press release and full Proposal document

I will update as more information becomes available.

DSM-5

The DSM-5 clinical settings field trials, scheduled to complete by December, last year, but extended in order that more participants might be recruited, were expected to conclude this March. (Source: DSM-5 Disorganization, Disarray, and Delays, Dr Dayle Jones, American Counseling Association, January 3, 2012)

In November, DSM-5 Task Force Vice-chair, Darrel Regier, MD, predicted the pushing back of the final public review and comment period for revised draft diagnostic criteria from January-February to “no later than May 2012,” in response to DSM-5 timeline slippage and delays in completion of the field trials. (Source: APA Answers DSM-5 Critics, Deborah Brauser, November 9, 2011)

The timeline on the DSM-5 Development site was updated to reflect a “Spring” posting of draft diagnostic criteria but thus far, APA has released no firm date for a final public review and feedback exercise in May.

The second release of draft proposals was posted on May 4, last year, with no prior announcement or news release by APA and caught professional bodies, patient organizations and advocates unprepared.

It is hoped that APA will give reasonable notice before releasing their third and final draft – though how much influence professional and public feedback might have at this late stage in the DSM-5 development process is moot.

DSM-5 is slated for publication in May 2013.

Extract from revised Timeline

Spring 2012: Revised draft diagnostic criteria will be posted on http://www.dsm5.org and open to a third public feedback period for 2 months. Feedback will be shared directly with work group members, and further edits to proposals will be made as needed.

The full DSM-5 Timeline (as it stands at April 8, 2012) can be found here.

 

ICD-11

The current timeline schedules presentation of the ICD-11 to the World Health Assembly in May 2015 – a year later than the 2009 timeline.

According to a paper published by Christopher Chute, MD, (Chair, ICD-11 Revision Steering Group) et al, implementation of ICD-11 is now expected around 2016. (Source: Chute CG, Huff SM, Ferguson JA, Walker JM, Halamka JD. There Are Important Reasons For Delaying Implementation Of The New ICD-10 Coding System. Health Aff March 2012 DOI: 10.1377/hlthaff.2011.1258) 

The ICD-11 Beta drafting platform is scheduled to be launched and open to the public this May for comment and interaction. It will be a work in progress – not a final Beta draft. The final Beta draft isn’t scheduled until 2014.

No announcement that the Beta platform remains on target for a May release has been issued by WHO or ICD-11 Revision Steering Group and no date is given on the ICD Revision website for the launch.

The publicly viewable version of the Alpha drafting platform (the ICD-11 Alpha Browser) can be accessed here. The various ICD-11 Revision Topic Advisory Groups work on a separate, more layered multi-author drafting platform.

NB: The Alpha drafting platform is a work in progress. It is incomplete, in a state of flux, updated daily and subject to WHO Caveats.

ICD-11 Alpha Browser User Guide here.

Foundation view here.

Linearization view here.

PDFs of Draft Print versions of the Linearization are available from the Linearization tab to logged in users.

The ICD-11 timeline (as it stands at April 8, 2012) can be found on the WHO website here.

 

ICD-10-CM

Note: ICD-10-CM is the forthcoming US specific “Clinical Modification” of the WHO’s ICD-10. Following implementation of ICD-10-CM, the US is not anticipated to move on to ICD-11, or a Clinical Modification of ICD-11, for a number of years after global transition to ICD-11.

On February 16, Health and Human Services Secretary, Kathleen G. Sebelius, announced HHS’s intent to initiate a process to postpone the date by which certain health care entities have to comply with ICD-10-CM diagnosis and procedure codes. (Source: CMS Public Affairs/HHS Press Release, February 16, 2012)

The final rule adopting ICD-10-CM as a standard was published in January 2009, when a compliance date of October 1, 2013 had been set – a delay of two years from the compliance date initially specified in the 2008 proposed rule.

CMS plans to announce a new ICD-10 implementation date sometime this April, according to CMS Regional Office, Boston. (Source: Healthcare News: CMS targets April for release of new ICD-10-CM/PCS implementation date, March 20, 2012)

It is anticipated that CMS will make an announcement in the Federal Register, take public comment for 60 days, consider feedback on its proposed ruling, then issue a final rule.

For developments on the new ICD-10-CM compliance date, watch the CMS site or sign up for CMS email alerts: http://www.cms.hhs.gov/Medicare/Coding/ICD10/Latest_News.html

 

Related information:

DSM-5 Development

ICD-11 Revision

ICD10 Watch

Federal Register

CMS Latest News

DHHS Newsroom

ICD-10-CM CDC Site

Filed under Criticism of DSM-V, DSM-5, DSM revision process, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, ICD-10-CM, ICD-10-CM compliance, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation Tagged with , , , , , , , , ,

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

April 2, 2012 by

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

Filed under American Psychiatric Association (APA), Conflicts of interest, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-5 timeline, DSM-V, Linda Cosgrove Tagged with , , , , , , , , ,

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

March 17, 2012 by

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

Post #152 Shortlink: http://wp.me/pKrrB-20e

Update @ March 20, 2012

Medscape Medical News > Psychiatry

APA Criticized Over DSM-5 Panel Members’ Industry Ties

Megan Brooks | March 20, 2012

March 20, 2012 — Two researchers have raised concerns that the upcoming Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has been unduly influenced by the pharmaceutical industry, owing to financial conflicts of interest (FCOI) among DSM-5 panel members.

In an essay published in the March issue of PLoS Medicine, Lisa Cosgrove, PhD, from the Edmond J. Safra Center for Ethics, Harvard University, Cambridge, Massachusetts, and Sheldon Krimsky, PhD, from the Department of Public Health and Community Medicine, Tufts University, Boston, say the FCOI disclosure policy does not go far enough and has not been accompanied by a reduction in the conflicts of interest of DSM-5 panel members.

However, John M. Oldham, MD, President of the American Psychiatric Association (APA), “strongly” disagrees.

Read on

At DSM5 in Distress, Allen Frances, MD, who had chaired the task force for DSM-IV, writes:

According to this week’s Time magazine, the American Psychiatric Association has just recruited a new public relations spokesman  who previously worked at the Department of Defense. This is an appropriate choice for an association that substitutes a fortress mentality and  warrior bluster for substantive discussion. The article quotes him as saying: “Frances is a ‘dangerous’ man trying to undermine an earnest academic endeavor.”

Frances asks:

Am I A Dangerous Man?

No, but I do raise twelve dangerous questions

Allen Frances, M.D. | March 16, 2012

published in response to:

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

Pharmalot

Should APA Purge DSM Panels With Pharma Ties?

Ed Silverman | March 15, 2012

As publication of the next version of the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5, approaches in May 2013, the so-called bible of psychiatrists is generating increasing scrutiny. The reason, of course, is that classification of various illnesses can help psychiatrists determine how to pursue treatment, which can involve prescribing medications that can ring registers for drugmakers…

Read on

Statement from John M. Oldham, M.D.

Mr Silverman’s report quotes from a statement issued on March 15 by John M. Oldham, M.D., President of the American Psychiatric Association (APA), in response to the Cosgrove and Krimsky PLoS Medicine Essay, “A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists.”

Read Dr Oldham’s statement here in PDF format:

    PDF statement John M Oldham, M.D., March 15, 2012

or full text below:

March 15, 2012

Statement for John M. Oldham, M.D., President of the American Psychiatric Association:

In their article, “A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists,” which appeared in the March issue of the journal Public Library of Science, and which ABC and other news outlets quoted, Cosgrove and Krimsky question the work of DSM-5’s volunteer Task Force and Work Group members because of publicly disclosed relationships with the pharmaceutical industry. Although we appreciate that Cosgrove and Krimsky acknowledge the commitment the American Psychiatric Association (APA) has already made to reducing potential financial conflicts of interest, we strongly disagree with their analysis and presentation of APA’s publicly available disclosure documents. Specifically, the Cosgrove-Krimsky article does not take into account the level to which DSM-5 Task Force and Work Group members have minimized or divested themselves from relationships with the pharmaceutical industry.

In 2012, 72 percent of the 153 members report no relationships with the pharmaceutical industry during the previous year. The scope of the relationships reported by the other 28 percent of member varies:

• 12 percent reported grant support only, including funding or receipt of medications for clinical trial research;

• 10 percent reported consultations including advice on the development of new compounds to improve treatments; and

• 7 percent reported receiving honoraria.

Additionally, since there were no disclosure requirements for journals, symposia or the DSM-IV Task Force at the time of the 1994 release of DSM-IV, Cosgrove and Krimsky’s comparison of DSM-IV and DSM-5 Task Force and Work Group members is not valid. In assembling the DSM-5’s Task Force and Work Groups, the APA’s Board of Trustees developed an extensive process of written disclosure of potential conflicts of interest. These disclosures are required of all professionals who participate in the development of DSM-5. An independent APA committee reviews these disclosure documents, which are updated annually or whenever a member’s financial interests change. Individuals are only permitted to serve on a work group or the Task Force if they are judged to have no significant financial interests.

The Board of Trustees’ guiding principles and disclosure policies for DSM panel members require annual disclosure of any competing interests or potentially conflicting relationships with entities that have an interest in psychiatric diagnoses and treatments. In addition, all Task Force and Work Group members agreed that, starting in 2007 and continuing for the duration of their work on DSM-5, each member’s total annual income derived from industry sources would not exceed $10,000 in any calendar year. This standard is more stringent than requirements for employees at the National Institutes of Health and for members of advisory committees for the Food and Drug Administration. And since their participation in DSM-5 began, many Task Force members have gone to greater lengths by terminating many of their industry relationships.

Potential financial conflicts of interest are serious concerns that merit careful, ongoing monitoring. The APA remains committed to reducing potential bias and conflicts of interest through our stringent guidelines.

A number of stories followed the publication of the Cosgrove and Krimsky PLoS Medicine Essay. Links for selected reports in this March 14 Dx Revision Watch post:

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

Full text of Essay available here on PLoS site under “Open-access”:

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

Or open     PDF here

Long article from Sandra G. Boodman for Washington Post

Antipsychotic drugs grow more popular for patients without mental illness

Sandra G. Boodman | March 12, 2012

Adriane Fugh-Berman was stunned by the question: Two graduate students who had no symptoms of mental illness wondered if she thought they should take a powerful schizophrenia drug each had been prescribed to treat insomnia.

“It’s a total outrage,” said Fugh-Berman, a physician who is an associate professor of pharmacology at Georgetown University. “These kids needed some basic sleep [advice], like reducing their intake of caffeine and alcohol, not a highly sedating drug.”

Those Georgetown students exemplify a trend that alarms medical experts, policymakers and patient advocates: the skyrocketing increase in the off-label use of an expensive class of drugs called atypical antipsychotics. Until the past decade these 11 drugs, most approved in the 1990s, had been reserved for the approximately 3 percent of Americans with the most disabling mental illnesses, chiefly schizophrenia and bipolar disorder; more recently a few have been approved to treat severe depression.

But these days atypical antipsychotics — the most popular are Seroquel, Zyprexa and Abilify — are being prescribed by psychiatrists and primary-care doctors to treat a panoply of conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia. These new drugs account for more than 90 percent of the market and have eclipsed an older generation of antipsychotics. Two recent reports have found that youths in foster care, some less than a year old, are taking more psychotropic drugs than other children, including those with the severest forms of mental illness…

Read on

Financial Times

New autism diagnostic criteria may encourage symptomatic approach to drug use

Anusha Kambhampaty in New York, Abigail Moss in London | March 15, 2012

MedPage Today

DSM-5 Critics Pump Up the Volume

John Gever, Senior Editor | February 29, 2012

…In a conversation with MedPage Today, APA President John Oldham, MD, and DSM-5 task force chairman David Kupfer, MD, defended their handling of the revision and argued that many of the criticisms were off-base.

For starters, Kupfer said, the proposed revisions were still open to change or abandonment. The DSM-5 will assume its near-final form in June or July, he said – meaning that the APA’s annual meeting in May would provide another forum to debate the changes.

“[The proposals] are still open to revision,” he said. “The door is still very much open…”

[Ed: A third and final stakeholder review and comment period is anticipated in “May at the latest.”  Benedict Carey reported for New York Times, January 19, “The revisions are about 90 percent complete and will be final by December, according to Dr. David J. Kupfer…chairman of the task force making the revisions.”]

Read full Medpage Today article

Psychiatric News Volume 47, Number 4, February 17, 2012 publishes the preliminary schedule for the APA’s May annual meeting:

    PDF

APA’S 165TH ANNUAL MEETING, PHILADELPHIA, MAY 5-9, 2012
Preliminary Schedule

Filed under Allen Frances, American Psychiatric Association (APA), Bereavement, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-5 Petitions, DSM-5 timeline, Linda Cosgrove Tagged with , , , , , , , , ,

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

March 14, 2012 by

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

Filed under American Psychiatric Association (APA), Conflicts of interest, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-5 timeline, DSM-V, Linda Cosgrove, New Scientist Tagged with , , , , , , , , ,

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