APA “Monitor” articles: ICD-11 and DSM-5; Frances, Rajiv Tandon on DSM-5; iCAT Analytics

February 8, 2012 by

1] ICD-11 (with contributions from WHO’s Dr Geoffery Reed) and DSM-5 articles in February edition of American Psychological Association’s “Monitor”

2] Academic article on DSM-5 by Rajiv Tandon, MD, Professor of Psychiatry, University of Florida

3] Allen Frances (who chaired the DSM-IV Task Force), Suzy Chapman and Dr Dayle Jones on DSM-5

4] Paper: Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology

 

Post #137 Shortlink: http://wp.me/pKrrB-1QW

1] Two articles in the February edition of the American Psychological Association’s “Monitor”:

American Psychological Association

Monitor

Feature, February 2012, Vol 43, No. 2

Improving disorder classification, worldwide

Rebecca A. Clay  |  February 2012

With the help of psychologists, the next version of the International Classification of Diseases will have a more behavioral perspective.

Print version: page 40

What’s the world’s most widely used classification system for mental disorders? If you guessed the Diagnostic and Statistical Manual of Mental Disorders (DSM), you would be wrong.

According to a study of nearly 5,000 psychiatrists in 44 countries sponsored by the World Health Organization (WHO) and the World Psychiatric Association, more than 70 percent of the world’s psychiatrists use WHO’s International Classification of Diseases (ICD) most in day-to-day practice while just 23 percent turn to the DSM. The same pattern is found among psychologists globally, according to preliminary results from a similar survey of international psychologists conducted by WHO and the International Union of Psychological Science.

“The ICD is the global standard for health information,” says psychologist Geoffrey M. Reed, PhD, senior project officer in WHO’s Department of Mental Health and Substance Abuse. “It’s developed as a tool for the public good; it’s not the property of a particular profession or particular professional organization.”

Now WHO is revising the ICD, with the ICD-11 due to be approved in 2015. With unprecedented input from psychologists, the revised version’s section on mental and behavioral disorders is expected to be more psychologist-friendly than ever—something that’s especially welcome given concerns being raised about the DSM’s own ongoing revision process. (See “Protesting proposed changes to the DSM”.) And coming changes in the United States will mean that psychologists will soon need to get as familiar with the ICD as their colleagues around the world…

…”Since the rest of the world will be adopting the ICD-11 when it is released in 2015, the CDC will likely make annual updates to gradually bring the ICD-10-CM into line with the ICD-11 to avoid another abrupt shift. But the differences between the DSM and the ICD may grow even greater over time, says Reed, depending on the outcomes of the ICD and DSM revision processes.”

For more information about the ICD revision, visit the World Health Organization.

Rebecca A. Clay is a writer in Washington, D.C.

Read full article here

American Psychological Association

Monitor

February 2012, Vol 43, No. 2

Print version: page 42

Protesting proposed changes to the DSM

When President David N. Elkins, PhD, and two colleagues within APA’s Div. 32 (Society for Humanistic Psychology) heard about the proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), they were alarmed. But what could three people do?

Plenty, as it turns out.

Although their original aim was simply to educate the division’s members, Elkins, Secretary Brent Dean Robbins, PhD, and student representative Sara R. Kamens soon decided to share their concerns in an open letter to the American Psychiatric Association. Thinking it would pack more punch with a few more signatures, they posted it online last October.

The response astounded them. “Within two days, we had more than 1,500 signatures,” says Elkins. So far, more than 10,000 individuals and 40 mental health organizations have signed on, and media outlets as diverse as Nature, USA Today and Forbes have covered the controversy. APA, which has no official position on the controversy, urges its members to get involved in the debate (see APA’s statement in the January Monitor, page 10).

The open letter outlines three major concerns with the proposed draft of the DSM-5, set for publication in 2013…

Read full article here

2] Article by Rajiv Tandon, MD, Professor of Psychiatry, University of Florida:

Current Psychiatry

Vol. 11, No. 02 / February 2012

Getting ready for DSM-5: Part 1

The process, challenges, and status of constructing the next diagnostic manual

Rajiv Tandon, MD  |  February 2012
Professor of Psychiatry, University of Florida, Gainesville, FL

Discuss this article at www.facebook.com/CurrentPsychiatry

Work on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—scheduled to be published in May 2013—has been ongoing for more than a decade. Momentous advances in genetics and brain imaging since publication of DSM-IV in 1994 have generated optimism that an improved understanding of the neurobiologic underpinnings of psychiatric disorders might lead to a paradigm shift from the current descriptive classification system to a more scientific etiopathophysiological system similar to that used by other medical specialities.1

Some fear that any changes to our current classification system may be premature and could make an already complex system even more unwieldy.2 Scores of articles about the content and process of DSM-5 and several critiques and commentaries on the topic have been published. The American Psychiatric Association (APA) has made the DSM-5 process transparent by posting frequent updates to the DSM-5 Development Web site (www.dsm5.org), seeking feedback from the psychiatric community and the public, and presenting progress reports by members of the DSM-5 Task Force at scientific meetings.

There have been few discussions on the implications of DSM-5 from the practicing clinician’s vantage point, which I seek to present in this series of articles, the remainder of which will be published here, at CurrentPsychiatry.com…

Read on here

 

3] Allen Frances, MD, in Psychology Today and Psychiatric Times

Registration required for access to article on Psychiatric Times

DSM5 in Distress

PTSD, DSM 5, and Forensic Misuse
DSM 5 would lead to overdiagnosis in legal cases.

Allen Frances, MD | February 9, 2012

————————————————————

Documentation That DSM-5 Publication Must Be Delayed
because DSM 5 is so far behind schedule

Allen Frances, MD | February 7, 2012

Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV, is a former chief of psychiatry at Duke University Medical Center and currently professor emeritus at Duke

Last week, I wrote that DSM-5 is so far behind schedule it can’t possibly produce a usable document in time for its planned publication date in May 2013.¹ My blog stimulated 2 interesting responses that illustrate the stark contrast between DSM-5 fantasy and DSM-5 reality. Together they document why publication must be delayed if DSM-5 is to be set right. The first email came from Suzy Chapman of Dx Revision Watch https://dxrevisionwatch.wordpress.com

Re DSM-5 delays, here is a telling statement made by Dr Darrel Regier, its Vice Chair, on March 9, 2010: “We have just released draft criteria on a website on February 10th at dsm5.org. And we’ll be having a field trial starting in July of this year. We’ll then have another revision based on field trial results going into a second revision or second field trial in July of 2011. As a result, we will not have our final recommendations for the DSM-V probably until early 2011.”  She continues,

Please note the dates. Dr Regier’s promised timetable has been missed by more than a year—we still don’t have final recommendations.

Dayle Jones, PhD, is head of the Task Force of the American Counseling Association that monitors DSM-5. She sent in a timeline comparing DSM-5 promised deadlines with actual delivery dates:

The DSM-5 academic/large clinic field trials were designed to have two phases. Phase 1 was first scheduled to begin in June 2009, but had to be postponed for a year because the criteria sets were not ready. The timetable for field trial completion was unrealistic from the start and not surprisingly the end dates have been repeatedly postponed from early 2010 to early 2011, and we’re now already into 2012 with no end in sight. Phase 2, originally scheduled for September 2011 to February 2012, was to re-test those diagnoses that did poorly in Phase 1 and had to be revised. The phase 2 trials were quietly canceled. We still don’t have results from the phase 1 field trials, but the APA leadership has warned us that we must accept reliabilities that are barely better than chance. Without the second stage, uncorrected problem diagnoses will be included in DSM-5.

The separate clinician field trial has been an even worse disaster. Clinicians were originally scheduled to be trained by August 2010, enrolling patients no later than late November 2010, and ending by February, 2011. Training was finally completed 18 months late in December 2011, which means the earliest these trials could possibly end is June 2012—well after most DSM-5 final decisions will have been made. Furthermore, of the over 5000 clinicians who registered to participate, only 70 (1.4%) have begun enrolling patients for the field trial. My guess is that like academic/large clinic Phase 2 field trial, poor planning and disorganization will force cancellation.

Dr Jones concludes,

In my opinion, there is no process and not enough time left to ensure that DSM-5 will attain high enough quality to be used by counselors. Fortunately, we can always bypass it by using ICD-10-CM.

Sobering stuff. Its constant procrastination has at last caught up with DSM-5. Having fallen so far behind schedule, DSM-5 abruptly dropped the second stage of field-testing—without public comment or justification or discussion of what would be the effects on quality and reliability. In fact, the second stage of the field trials was perhaps the most crucial step in the entire DSM-5 process—a last chance for sorely needed quality control to bring a lagging DSM-5 up to acceptable standards. The DSM-5 proposals that were weak performers in the first stage were supposed to be rewritten and retested in the second to ensure that they deserved to be included in the manual.

The American Psychiatric Association (APA) is now stuck with the most unpalatable of choices—protecting the quality of DSM-5 versus protecting the publishing profits to be gained by premature publication. Given all the delays, it can’t possibly do both—a quality DSM-5 cannot be delivered in May 2013.

All along, it was predictable (and predicted), that DSM-5 disorganization would lead to a mad, careless dash at the end. The DSM’s have become far too important to be done in this slapdash way—the high cost to users and the public of this rush to print is unacceptable. Unless publication is delayed, APA will be offering us official DSM-5 criteria that are poorly written, inadequately tested, and of low reliability. The proper alternative is clear: APA should delay publication of DSM-5 until it can get the job done right. Public trust should always trump publishing profits.

Let’s close with a worrying and all too illustrative quote from Dr Regier, just posted by Scientific American.² When asked if revisions to criteria in DSM-5 could be completed by the end of this year, he said “there is plenty of time.” I beg to differ—there is not nearly enough time if the changes are to be done based on a much needed independent scientific review and are to be tested adequately in Phase 2 of the field trial. Without these necessary steps DSM-5 will be flying blind toward the land of unintended consequences.

References
1. Frances A. APA should delay publication of DSM-5. January 31, 2012. Psychiatr Times. http://www.psychiatrictimes.com/blog/frances/content/article/10168/2024394

2. Jabr F. Redefining autism: will new DSM-5 Criteria for ASD exclude some people? January 30, 2012. Sci Am. http://www.scientificamerican.com/article.cfm?id=autism-new-criteria  Accessed February 7, 2012.

 

4] Paper: Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology

     Pragmatic Analysis – iCAT Analytics 2012

Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology

http://kmi.tugraz.at/staff/markus/documents/2012_AAAI_iCATAnalytics.pdf

Jan P¨oschko and Markus Strohmaier, Knowledge Management Institute, Graz University of Technology, Inffeldgasse 21a/II, 8010 Graz, Austria

Tania Tudorache and Natalya F. Noy and Mark A. Musen, Stanford Center for Biomedical Informatics Research, 1265 Welch Road, Stanford, CA 94305-5479, USA

Abstract

While in the past taxonomic and ontological knowledge was traditionally produced by small groups of co-located experts, today the production of such knowledge has a radically different shape and form. For example, potentially thousands of health professionals, scientists, and ontology experts will collaboratively construct, evaluate and  maintain the most recent version of the International Classification of Diseases (ICD-11), a large ontology of diseases and causes of deaths managed by the World Health Organization. In this work, we present a novel web-based tool-iCAT Analytics-that allows to investigate systematically crowd-based processes in knowledge-production systems. To enable such investigation, the tool supports interactive exploration of pragmatic aspects of ontology engineering such as how a given ontology evolved and the nature of changes, discussions and interactions that took place during its production process. While iCAT Analytics was motivated by ICD-11, it could potentially be applied to any crowd-based ontology-engineering project. We give an introduction to the features of iCAT Analytics and present some insights specifically for ICD-11.

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, iCAT, ICD-11 Tagged with , , , , , , , , ,

The Trouble with Timelines: DSM-5 round up

January 31, 2012 by

The Trouble with Timelines: DSM-5 round up

Post #136 Shortlink: http://wp.me/pKrrB-1LJ

In a November 9, 2011 interview with Deborah Brauser for Medscape Medical News, Darrel Regier, MD, APA Director of Research and Task Force Vice-chair, uttered some chilling statements.

According to Dr Regier:

“Our plan is that these [judgements] will be immediately tested once the DSM is official, and then one will be able to see if revisions can be made…

“Our workgroups are struggling with this balance…for what might be the most appropriate fix. Some of these fixes are not as well studied as others and we recognize that. But we can’t move forward without some of these put into practice. So we think this is a much more testable set of scientific hypotheses…”

“And that’s what the DSM is — a set of scientific hypotheses that are intended to be tested and disproved if the evidence isn’t found to support them…”

“We’re thinking of having a DSM-5.1, DSM-5.2, etc, in much the same way is done with software updates…”

So come May 2013, does APA plan to publish an unvalidated beta as though it were the next release of Firefox, test out its pet theories then release post publication “patches” to fix the flaws?

 

First up, Allen Frances blogging, today, on Psychology Today:

Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV, is a former chief of psychiatry at Duke University Medical Center and currently professor emeritus at Duke

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

APA Should Delay Publication Of DSM 5 until it can achieve adequate reliability and quality

Allen Frances, MD | January 31, 2012

“…With less than a year remaining before DSM 5 is scheduled to go to print, the signs are clear that it cannot possibly be completed on time unless we are willing to settle for a third rate product. The unmistakable red flag is the recent embarrassing admission that DSM 5 will accept diagnoses that achieve reliabilities as unbelievably low as 0.2-0.4 (barely beating the level of chance agreement two monkeys could achieve throwing darts at a diagnostic board). This dramatic departure from the much higher standards of previous DSM’s is a sure tip-off that many DSM 5 proposals must be failing to achieve adequate diagnostic agreement in the much delayed and yet to be reported field trials. Unable to meet expected standards, the DSM 5 Task Force is drastically and desperately trying to lower our expectations…”

“…The wise, safe, and responsible thing for APA to do now is to delay publication of DSM 5 until the missing second stage of rewriting and retesting can be completed. The wordings that do poorly in the first stage of field testing should be rewritten to finally attain the clarity and consistency necessary in an official manual of psychiatric diagnosis. The newly revised (and hopefully final) versions should then undergo the second stage of field testing as originally envisaged to ensure that they now work…”

“…Will APA do what is needed to protect us from a poor quality DSM 5 and instead provide us with one that is safe and scientifically sound? It seems unlikely. The DSM 5 publishing profits that are essential to APA budget projections require there be a May 2013 debut of the manual in bookstores, come hell or high water. So instead of getting DSM 5 up to minimal standards of quality, DSM 5 is trying to drop the standards to minimal – 0.2-0.4 will have to do.

“What about the DSM 5 claim that its field trials so rigorous that we should entertain only the lowest possible expectations of them? This is nonsense. The DSM 5 field trials were in fact conducted under very privileged circumstances that would guarantee much higher levels of reliability than could ever be achieved in everyday clinical practice: 1) Testing was performed in academic centers with a homogeneous corps of well trained raters interested in psychiatric diagnosis and trying their best because judgments were being observed; 2) Raters had access to the results of a computerized self report instrument, thus reducing information variance; 3) Each site specialized in a limited number of target diagnoses that were known to the raters who would therefore be on the watch for them; 4) The unrealistically high prevalences of target disorders in the sites made agreement much easier than the more needle-in-haystack situation of routine practice; 5) Academic settings attract a selected group of the more severely ill patients who are easier to diagnose reliably; and 6) The time allotted for diagnostic interviews exceeded what is typical in clinical practice…”

“…The May 2013 publication date appears to be completely unrealistic unless we are to settle for a DSM 5 so poorly done that its reliabilities will return us to the dark ages of DSM II. DSM 5 is in a very deep hole with very few remaining options.

“My recommendations: 1) Make the publication date flexible and contingent on delivery of a quality product that the field can trust; 2) Subject the current drafts and texts to extensive editing for clarity and consistency; 3) Drop the controversial suggestions that risk harmful unintended consequences or at least subject them to external scientific review; 4) Have the rewritten drafts reviewed word for word by many experts in the clinical, research, and forensic uses of DSM 5; and 5) Field test again to make sure the new versions work adequately…”

Full commentary here on DSM5 in Distress

 

On Monday, William E. Narrow, MD, in a Q & A for Pittsburgh Post Gazette:

William E. Narrow, M.D., M.P.H., is Associate Director, Division of Research, Research Director, DSM-5 Task Force for American Psychiatric Association

Q&A with Dr. William Narrow, research director for the DSM 5 Task Force

William Narrow | January 30, 2012

The Pittsburgh Post-Gazette asked the American Psychiatric Association to comment on the DSM 5:

Q: Do you think the final form of the DSM-V will differ substantially from the current draft version?

A: There is currently no draft version of DSM-5. The information on the DSM-5 Web site consists of proposed DSM-5 diagnostic criteria and assessment instruments, along with rationales for all changes that have been proposed. The first draft version of the DSM-5, which also includes explanatory text for each disorder and introductory chapters, is currently being developed. We anticipate that many of the proposed changes will be officially adopted. Most notable among these is the proposed change in chapter organization to better reflected a developmental, lifespan approach as well as purported neuroscientific and genetic linkages between diagnostic categories (e.g., placement of the psychosis chapter alongside the bipolar disorders chapter, then followed by the mood disorders chapter). We also anticipate that the proposed inclusion of dimensional assessments will be accepted for DSM-5, although these too were field tested and results are currently being examined. Proposed changes that are considered minimal (e.g., minor changes in wording or criteria) that did not require field testing and, at this point, appear to be sufficiently supported by findings from the literature have a high likelihood of being adopted.

Read the rest of Dr Narrow’s responses here

 

From January 6, John M. Oldham, M.D., President, American Psychiatric Association comments on the APA’s December Board of Trustees meeting, in Psychiatric News:

Psychiatric News | January 06, 2012
Volume 47 Number 1 page 4-6
© American Psychiatric Association

From the President

Your Board’s Agenda Focuses on the Future

John M. Oldham, M.D.

At the  foot of Dr Oldham’s Board meeting commentary you will find a link for a collection of PDF files of meeting materials available to download as a “Board packet”. (This bundle of PDFs may take a while to load.)

See file 11 Item 11.A – DSM Task Force Report.pdf   Retrieved: 01.31.12

Item: 11.A
Board of Trustees
December 2011

DSM-5 TASK FORCE AND WORK GROUP UPDATE

APA Division of Research Report to the APA Board of Trustees
Submitted by: David J. Kupfer, M.D. and Darrel A. Regier, M.D., M.P.H.

———–

This report contains:

An overview of DSM-5 text development activities;
Current progress and timeline for the DSM field trials;
Scientific Oversight Committee’s (SOC) current progress and timeline for DSM field trials;
Scientific Oversight Committee’s progress in reviewing proposed DSM-5 disorders;
Overview of a Clinical and Public Health (CPH) review process that is to take place in conjunction with the Scientific Oversight Committee’s review;
Plans for the remainder of 2011 and for 2012.

Under Plans for 2012 it reports:

That the primary focus for 2012 will be on completion of initial draft text for all proposed DSM-5 disorders and data analysis of information gathered from the Large Academic Site and the Routine Clinical Practice (RCP) Field Trials.

That all of the text will receive editorial review throughout December and January.

That a penultimate draft of DSM-5 will be presented to the DSM-5 Task Force for their recommendations by February 1, though portions, it says, will be provided beginning in December, as these become available.

That the SOC and CPH will continue to conduct reviews through Spring of 2012.

That DSM criteria and text will continue to undergo changes based on reviews and recommendations of these various parties as well on comments received from a third public posting of the DSM-5 criteria on the DSM5.org web site, slated for May, 2012.

That the final draft of DSM-5 will be submitted to the APA Assembly and to the Board of Trustees in Fall of 2012 and submitted to APPI press for publication by December 31.

This report provides further confirmation that in December, it was anticipated that the third and final public review of proposals for changes to DSM-IV categories and criteria would be held in May, this year. (Note that the DSM-5 Development website Timeline was updated a few days ago but gives, only vaguely, “Spring”, as the date for a two month public review and comment period).

 

On January 29, Gary Greenberg, author of Inside the Battle to Define Mental Illness, Wired, December 2010, for NYT Op-Ed:

Op-Ed Contributor

Not Diseases, but Categories of Suffering

Gary Greenberg | January 29, 2012

“…On the other hand, given that the current edition of the D.S.M. has earned the association — which holds and tightly guards its naming rights to our pain — more than $100 million, we might want to temper our sympathy. It may not be dancing at the ball, but once every mental health worker, psychology student and forensic lawyer in the country buys the new book, it will be laughing all the way to the bank…”

The Autism Society and Autistic Self Advocacy Network have put out a joint statement on DSM-5:

“The Autism Society and Autistic Self Advocacy Network encourage other organizations and groups to join with us in forming a national coalition aimed at working on issues related to definition of the autism spectrum within the DSM-5.”

The joint statement by the Autistic Self Advocacy Network and the Autism Society of America on the DSM-5 can be read here

 

Benjamin Nugent, Op-Ed piece, NYT:

New York Times

Op-Ed Contributor

I Had Asperger Syndrome. Briefly.

Benjamin Nugent | January 31, 2012

“FOR a brief, heady period in the history of autism spectrum diagnosis, in the late ’90s, I had Asperger syndrome…”

Filed under Allen Frances, American Psychiatric Association (APA), DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-5 timeline, DSM-V Tagged with , , , , , , , , ,

American Psychiatric Association rejects call for independent review of DSM-5 proposals

January 29, 2012 by

American Psychiatric Association rejects psychologists’ call for independent review of controversial DSM-5 proposals

Post #135 Shortlink: http://wp.me/pKrrB-1KF

On January 9, 2012, the Coalition for DSM-5 Reform, an ad hoc committee of the Society for Humanistic Psychology (Division 32 of the American Psychological Association), sent another call to the American Psychiatric Association’s Board of Trustees and DSM-5 Task Force to submit controversial proposals for DSM-5 to independent scrutiny.

American Psychiatric Association president, John Oldham, M.D., issued a response last Friday, January 27.

“…There is in fact no outside organization that has the capacity to replicate the range of expertise that DSM-5 has assembled over the past decade to review diagnostic criteria for mental disorders. In addition, the posting of the criteria on the www.dsm5.org Web site for an international review; the ongoing consultation and coordination with the WHO Mental Disorder Advisory Group for ICD-11; and the several internal reviews provided by the Scientific Review Committee, a Clinical and Public Health Committee review, and the Task Force as a whole, collectively provide the most far reaching review ever undertaken for any DSM revision…”   

                        John Oldham M.D. President, on behalf of American Psychiatric Association

For a copy of the Coalition’s letter see Post #126: Psychologists call for independent review of DSM-5    

Full response from John Oldham, M.D., on behalf of the American Psychiatric Association, here:

      APA Response on 01.27.12 to Coalition for DSM-5 Reform letter of 01.09.12

 

Text

American Psychiatric Association

1000 Wilson Boulevard
Suite 1825
Arlington, VA 22209
Telephone 703.907.7300
Fax 703.907.1085
Email apa@psych.org
Internet www.psych.org

David N. Elkins, Ph.D.
President
Society for Humanistic Psychology
750 First Street, N.E.
Washington, DC 20002Ͳ4242

January 27, 2012

Dear President Elkins:

We appreciate the January 9, 2012, open letter from you and the members of the Division 32 Open Letter Committee to the American Psychiatric Association and developers of DSM-5 regarding the need for a more thorough external review process in revising the manual.

We echo your desire to ensure that “the proposed DSM-5 is safe and credible.” To that end, the DSM-5 Task Force and Work Groups have been purposefully assembled to include clinicians and researchers with diverse backgrounds and expertise, representing nearly 100 different academic and medical institutions from around the world. Our November 21, 2011, letter to the American Counseling Association provides a more complete listing of the steps we have taken to obtain an independent review of the DSM-5 proposals.

(This can be viewed at: https://dxrevisionwatch.com/wp-content/uploads/2011/11/apa_letter_to_aca_11-21-11.pdf)

[Ed: URL provided in Dr Oldham’s letter returns 404, substituting file from Dx Revision Watch.]

There is in fact no outside organization that has the capacity to replicate the range of expertise that DSM-5 has assembled over the past decade to review diagnostic criteria for mental disorders. In addition, the posting of the criteria on the www.dsm5.org

Web site for an international review; the ongoing consultation and coordination with the WHO Mental Disorder Advisory Group for ICD-11; and the several internal reviews provided by the Scientific Review Committee, a Clinical and Public Health Committee review, and the Task Force as a whole, collectively provide the most far-reaching review ever undertaken for any DSM revision. However, we recognize that there will not be universal agreement with all of the final decisions made in response to these reviews. As with all scientific classifications applied to clinical practice, research will continue to refine our understanding of these disorders, and revisions to the DSM-5 as a living document will be made after publication of DSM-5 in 2013.

Since there is no “gold standard” for defining mental disorders and many other medical disorders without pathognomonic biological markers, each revision of diagnostic criteria has been seen as the best current set of diagnostic criteria that are meant to be used in clinical practice and tested for their validity. Validity criteria first published by Robins and Guze in 1970 for the Feighner criteria have formed the basic framework for testing the Research Diagnostic Criteria, DSM-III, DSM-III-R, DSM-IV, and the ICD-10. The work groups and the review groups have closely attended to these and an expanded set of validity criteria that are contained in the Guidelines for Making Changes to DSM on the http://www.dsm5.org website: (http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf).

The work groups are accessing more than 30 years of research since the DSM-III was first published in making their recommendations. Some of the proposed changes, such as the inclusion of more dimensional components, have been recommended by members of previous Task Forces and by many participants in the National Institutes of Health-sponsored conference series leading up to the Task Force. We will also have empirical data from our field trials on how these and other proposed changes are working. Final decisions about the revisions will only be made after all of these reviews are completed.

We hope that this additional information is responsive to your members, colleagues, and individuals who use mental health services to clarify that we are undertaking an exceptionally extensive review process involving an international and multidisciplinary clinical and scientific group of experts.

As we continue to refine the proposals for DSM-5 and further progress to development of DSM-5.1 and beyond, we look forward to maintaining an open and ongoing dialogue with your organization, colleagues, and the mental health field at large.

Sincerely,

John M. Oldham, M.D.
President

 

Resources

Coalition for DSM-5 Reform on Dx

Open Letter and iPetition

Coalition for DSM-5 Reform on Twitter    @dsm5reform

Coalition for DSM-5 Reform on Facebook

Coalition for DSM-5 Reform website

This initiative is also being covered on

The Society for Humanistic Psychology Blog

The Society for Humanistic Psychology on Twitter    @HumanisticPsych

The Society for Humanistic Psychology on Facebook

Filed under American Psychiatric Association (APA), Coalition for DSM-5 Reform, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-5 Petitions Tagged with , , , , , , , , ,

Timeline revised but no firm date for DSM-5 third and final stakeholder review and comment period

January 26, 2012 by

Timeline revised but still no firm date for the DSM-5 third and final stakeholder review and comment period

Post #134 Shortlink: http://wp.me/pKrrB-1JL

According to yesterday’s report from Deborah Brauser for Medscape Medical News (Concern Over Changes to Autism Criteria Unfounded, Says APA, January 25, 2012), the portion of the DSM-5 field trials conducted at academic centers concluded at the end of October.

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

In November, DSM-5 Task Force Vice-chair, Darrel Regier, MD, predicted the pushing back of the final public feedback period from January–February, to “no later than May 2012” (APA Answers DSM-5 Critics, Deborah Brauser, November 9, 2011), in response to timeline slippage.

I noticed, today, that the Timeline on the DSM-5 Development site has finally been updated to reflect a “Spring” posting of draft diagnostic criteria, for a two month long stakeholder review and comment period.

No dates appear to being publicly released, at this point, for this third and final public review.

The lack of advance dates presents barriers to public and professional participation.

Patient advocacy organizations need to alert their constituencies and their professional advisers whose opinions will inform consumer group submissions. Professional organizations and bodies who submit feedback in consultation with their memberships will also need to plan the sending out of timely alerts via newsletters and membership publications.

The second release of draft proposals was posted on May 4, last year, with no prior announcement or news release by APA and left many organizations and advocates, including myself, unprepared.

It is hoped that APA will give reasonable notice before releasing this 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.

Full revised Timeline here

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

DSM-5 media round up: Grief, autism spectrum disorder, Paraphilias Sub workgroup, medical ethics

January 26, 2012 by

DSM-5 media round up: Grief, autism spectrum disorder, Paraphilias Sub workgroup, medical ethics

Post #133 Shortlink: http://wp.me/pKrrB-1J8

The Coffee Klatch

Allen Frances talked to The Coffee Klatch Parents strand on January 25, 2012
 
Audio
 
Dr Allen Frances Chair of the DSM-IV Task Force returns to discuss the confusion and concerns over the soon to be released DSMV.  How will the changes impact your child?  What do the changes mean for your childs accommodations? Why are so many additions and revisions causing so much controversy?  

New York Times

When does a broken heart become a diagnosis?

Grief Could Join List of Disorders

Benedict Carey | January 24, 2012

In a bitter skirmish over the definition of depression, a new report contends that a proposed change to the diagnosis would characterize grieving as a disorder and greatly increase the number of people treated for it.

The criteria for depression are being reviewed by the American Psychiatric Association, which is finishing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., the first since 1994. The manual is the standard reference for the field, shaping treatment and insurance decisions, and its revisions will affect the lives of millions of people for years to come.

In coming months, as the manual is finalized, outside experts will intensify scrutiny of its finer points, many of which are deeply contentious in the field. A controversy erupted last week over the proposed tightening of the definition of autism, possibly sharply reducing the number of people who receive the diagnosis. Psychiatrists say current efforts to revise the manual are shaping up as the most contentious ever…

Full article

Psychiatric News

APA Responds to N.Y. Times Article on Proposed DSM Change

Psychiatric News Alert | January 25, 2012

…The proposed elimination of the bereavement exclusion—which like all proposals for DSM-5 is still being reviewed—is the subject of an article in the New York Times today citing researchers at Columbia who claim that removing the exclusion would medicalize normal grief.

But Jan Fawcett, M.D., chair of the work group, told Psychiatric News that people who develop the symptoms and the level of impairment associated with major depression should have access to treatment. And he wondered: Is there any difference between depression that occurs in response to grief and that which occurs in response to any other life stress? “Where do you draw the line?” he asked…

Full article

Bloomberg News

Psychiatric Group Push to Redefine Mental Illness Sparks Revolt

Elizabeth Lopatto | January 24, 2012

An effort that promises to broaden the definitions of mental illnesses is spurring a revolt among health-care professionals in the U.S. and the U.K…

…The October letter and the June criticism by the British Psychological Association, have a spirited exchange that resulted this month in the critics calling for an independent scientific review of the more controversial diagnosis changes.

“It really isn’t possible to identify what kind of outside group would have the expertise and range of discipline and disorders we’re covering to do that kind of outside review,” Regier said by telephone. Still, he said the panel members are interested in the criticisms of their proposals and “we’re not taking them lightly.”

Full article here

Response from Allen Frances, MD

DSM5 in Distress

The DSM’s impact on mental health practice and research.

Defenses From DSM 5 Get ‘Curiouser and Curiouser’
Trying to defend the indefensible

Allen Frances, MD | January 24, 2012

Elizabeth Lopatto has written an excellent piece in today’s Bloomberg News summarizing concerns that DSM 5 will expand the boundaries of psychiatry, increase the already existing diagnostic inflation, and promote the excessive use of medications to treat life problems that don’t really require them.

The Vice Chair of the DSM 5 Task Force tries to defend DSM 5 but with statements that have a strange Alice-in-Wonderland out-of-touch-with-reality quality…

Full article

Allen Frances on Huffington Post

Don’t Confuse Grief with Depression | January 27, 2012

The Autism Controversy Revisited | January 22, 2012

Why Are Kids Suddenly So Sick? | January 20, 2012

Preventive Psychiatry Can Be Bad for Our Health | January 19, 2012

America Is Over Diagnosed and Over Medicated | January 09, 2012

Lifespan News

The Impact Of Deleting Five Personality Disorders In The New DSM-5

January 24, 2012

“When it comes to revising the official diagnostic classification system, the guiding principle should be that criteria should not be changed in the absence of research demonstrating that the new approach is superior to the old in either validity or clinical utility, preferably both,” Zimmerman states. “Despite assurances that only data-driven modification would be made, with each new edition of the DSM, we have witnessed repeated instances of changes being made in the absence of sufficient data demonstrating the new criteria is superior…”

…Zimmerman comments, “The findings of the present study highlight our concerns about adopting changes in the diagnostic manual without adequate empirical evaluation beforehand. To be sure, there are problems with the classification of personality disorders, however, the identification of a problem is only the first step of a process resulting in a change to diagnostic criteria.”

He concludes, “The classification of personality disorders would not be improved if the new criteria or diagnostic material were more clinically useful but less reliable and valid.”

Full article

Sexual Abuse: A Journal of Research and Treatment

A Guest Blog by DSM-5 Paraphilias Subworkgroup Chair Dr. Ray Blanchard on Proposed Criteria for Pedophilic Disorder

Ray Blanchard PhD | January, 24 2012

NOTE: This guest blog comes to you authored by Ray Blanchard, Ph.D., who is an Adjunct Professor, Department of Psychiatry, University of Toronto and an Affiliate Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. He is also the Chair of the Paraphilias Subworkgroup for the DSM-5 Work Group on Sexual and Gender Identity Disorders and was the 2010 recipient of ATSA’s Significant Achievement Award.

The Proposal to Add Intense or Preferential Sexual Interest in Early Pubescent Children to the DSM-5 Diagnosis of Pedophilic Disorder

Ray Blanchard, Ph.D.

The proposal of the DSM-5 Work Group on Sexual and Gender Identity Disorders to extend the definition of Pedophilic Disorder to include preferential attraction to children in the early stages of puberty has prompted an extraordinarily vigorous and often misleading rhetorical campaign by its opponents. Although debate on this topic may be healthy, deliberate distortion and disinformation are not. I am therefore writing this piece to give an accurate account of the Work Group’s reasons for this proposal. All of the arguments in it have previously been made in conference presentations, in print documents (usually authored by members of the Paraphilias Subworkgroup of the Work Group on Sexual and Gender Identity Disorders), and in on-line sources (http://www.dsm5.org/). This piece simply puts these arguments together in one convenient and readily accessible place.

Full article

 

DSM-5 proposals and autism spectrum disorder (ASD)

A good deal published over the last week around DSM-5 proposals and autism spectrum disorder (ASD) which can be pulled up via Google News. Selected items:

American Psychiatric Association put out this News Release (Release No. 12.03) on January 20, 2012:

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

ARLINGTON, Va. (Jan. 20, 2012)—The American Psychiatric Association (APA) has proposed new diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for autism. While final decisions are still months away, the recommendations reflect the work of dozens of the nation’s top scientific and research minds and are supported by more than a decade of intensive study and analysis. The proposal by the DSM-5 Neurodevelopmental Work Group recommends a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.

The proposal asserts that symptoms of these four disorders represent a continuum from mild to severe, rather than a simple yes or no diagnosis to a specific disorder. The proposed diagnostic criteria for autism spectrum disorder specify a range of severity as well as describe the individual’s overall developmental status–in social communication and other relevant cognitive and motor behaviors.

Dr. James Scully, Medical Director of the American Psychiatric Association said, “The proposed criteria will lead to more accurate diagnosis and will help physicians and therapists design better treatment interventions for children who suffer from autism spectrum disorder.”

The draft DSM-5 criteria will provide a more useful dimensional assessment to improve the sensitivity and specificity of the criteria. This change will help clinicians more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, rather than providing general labels that tend not to be consistently applied across different clinics and centers.

Proposed DSM-5 criteria are being tested in real-life clinical settings known as field trials. Field testing of the proposed criteria for autism spectrum disorder does not indicate that there will be any change in the number of patients receiving care for autism spectrum disorders in treatment centers–just more accurate diagnoses that can lead to more focused treatment.

Criteria proposed for DSM-5 are posted on the DSM-5 website and will be open for additional public comment this spring. More information on the process for developing DSM-5 is also available on the website. Final publication of DSM-5 is planned for May 2013.

DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process. For more information, go to www.dsm5.org .

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses including substance use disorders. Visit the APA  at www.psych.org, www.psychiatryonline.org, and www.HealthyMinds.org.

and published this Alert on Psychiatric News website:

Autism Spectrum Disorder Proposed for DSM-5 Would Cover Those With Asperger’s

January 20, 2012

After much study, the DSM-5 Neurodevelopemental Disorders Work Group has concluded that there is no evidence to support continued separation of autism spectrum disorder (ASD) diagnoses, Susan Swedo, M.D., the work group chair, told Psychiatric News. “That is why we’ll be recommending that DSM-5 utilize a single diagnosis—ASD.”

The move to a single diagnosis of autism spectrum disorder would eliminate Asperger’s disorder and pervasive developmental disorder-not otherwise specified as separate diagnoses. They are included in DSM-IV. The possible elimination of Asperger’s has proven controversial, as evidenced by an article in the New York Times yesterday suggesting that the proposed change would narrow the definition and exclude people in need of a diagnosis and treatment. But in fact, adults or children diagnosed with Asperger’s according to DSM-IV criteria would meet criteria for autism spectrum disorder, with “specifiers” that help clinicians identify patients who have individual differences…

Full News Alert

New York Times

From Benedict Carey for NYT:

New Definition of Autism Will Exclude Many, Study Suggests

Benedict Carey | January 19, 2012

Proposed changes in the definition of autism would sharply reduce the skyrocketing rate at which the disorder is diagnosed and might make it harder for many people who would no longer meet the criteria to get health, educational and social services, a new analysis suggests.

The definition is now being reassessed by an expert panel appointed by the American Psychiatric Association, which is completing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, the first major revision in 17 years. The D.S.M., as the manual is known, is the standard reference for mental disorders, driving research, treatment and insurance decisions. Most experts expect that the new manual will narrow the criteria for autism; the question is how sharply…

Amy Harmon contributed reporting.

Full article

From Amy Harmon for NYT:

A Specialists’ Debate on Autism Has Many Worried Observers

Amy Harmon | January 20, 2012

Full article

A debate among medical professionals over how to define autism has spilled over into the public domain, stirring anger and fear among many parents and advocates of those with the neurological disorder, even as some argue that the diagnosis has been too loosely applied.

A study reported on Thursday found that proposed revisions to the American Psychiatric Association’s definition would exclude about three-quarters of those now diagnosed with milder forms of autism called Asperger syndrome or “pervasive developmental disorder, not otherwise specified,” also known as P.D.D.-N.O.S. These are people who have difficulties with social interaction but do not share the most severe impairments of children with classic autism.

From Deborah Brauser for Medscape Medical News

From Medscape Medical News > Psychiatry

Concern Over Changes to Autism Criteria Unfounded, Says APA

Deborah Brauser | January 25, 2012

January 25, 2012 — Concerns that proposed changes to autism criteria in the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) will exclude many individuals from diagnosis and treatment are unfounded, says the American Psychiatric Association (APA)…

Full article

Dr. William Narrow Gives Update on DSM-5

William Narrow, M.D., provides an update on the progress of DSM-5.

3:02 mins | Uploaded January 17, 2012

Dr William Narrow is DSM-5 Research Director

Virtual Mentor

American Medical Association Journal of Ethics

December 2011, Volume 13, Number 12: 873-879.

STATE OF THE ART AND SCIENCE

Patient-Centered Revisions to the DSM-5

Emily A. Kuhl, PhD, David J. Kupfer, MD, and Darrel A. Regier, MD, MPH

The forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 [1]) will mark the first time in nearly 2 decades that the field has overhauled the way mental illnesses are diagnosed and classified. Anticipation of the DSM-5 has been high, and recent discussions about changes likely to be adopted have focused largely on the manual’s increased integration of scientific and clinical evidence in support of proposed revisions [2, 3]. An equally important, though perhaps less frequently heard, voice in this dialogue concerns the potential ethical consequences of the DSM-5’s draft revisions.

The therapeutic alliance between psychiatrist and patient is unique and requires constant vigilance on ethical matters of self-harm or harm to others, confidentiality, legal aspects of diagnosis and treatment (e.g., competency), patient autonomy, involvement of third parties, dual agency and dual relationships, and patient stigma. This last issue is of particular concern; perhaps more so than in any other area of medicine, stigma has become a routine aspect of the lived experience for many people with mental illnesses.

PDF or Open here on Dx Revision Watch Patient-Centred Revisions to the DSM-5

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

DSM 5 and Diagnostic Inflation: Reply To Misleading Comments From Task Force: Allen Frances

January 24, 2012 by

Post #132 Shortlink: http://wp.me/pKrrB-1IP

Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV, is currently professor emeritus, Duke University.

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

DSM 5 and Diagnostic Inflation
Reply To Misleading Comments From The Task Force

Allen Frances, MD | January 23, 2012

My biggest concern regarding DSM-5 is that it will dramatically increase the rates of mental disorder by cheapening the currency of psychiatric diagnosis—arbitrarily and carelessly reducing thresholds for existing disorders and introducing new disorders with high prevalence. This would create millions of newly mislabeled “patients,” resulting in unnecessary and potentially harmful treatment, stigma, and wasteful misallocation of scarce resources…

Read on

also at

Psychiatric Times

DSM-5 and Diagnostic Inflation: Reply to the DSM-5 Task Force
Allen Frances, MD | January 23, 2012

Free registration required to access Psychiatric Times article.

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

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