Wired magazine: Inside the Battle to Define Mental Illness, Gary Greenberg

December 31, 2010 by

Wired magazine: Inside the Battle to Define Mental Illness, by Gary Greenberg, 27 December 2010

Post #55 Shortlink: http://wp.me/pKrrB-S8

Updated @ 4 January 2011: Added DSM-5: Dissent From Within by Allen Frances, MD, Psychiatric Times

 

An interesting article in Wired by Gary Greenberg with Allen Frances, MD, who had chaired the DSM-IV Task Force.

“Wired is a full-color monthly American magazine and on-line periodical, published since March 1993, that reports on how technology affects culture, the economy, and politics. Owned by Condé Nast Publications, it is published in San Francisco, California.”

http://www.wired.com/magazine/2010/12/ff_dsmv/

Inside the Battle to Define Mental Illness
By Gary Greenberg
27 December 2010

Wired January 2011

“We made mistakes that had terrible consequences,” [Frances] says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs…

…At stake in the fight between Frances and the APA is more than professional turf, more than careers and reputations, more than the $6.5 million in sales that the DSM averages each year. The book is the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research. It is as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians. Outside the profession, too, the DSM rules, serving as the authoritative text for psychologists, social workers, and other mental health workers; it is invoked by lawyers in arguing over the culpability of criminal defendants and by parents seeking school services for their children. If, as Frances warns, the new volume is an “absolute disaster,” it could cause a seismic shift in the way mental health care is practiced in this country. It could cause the APA to lose its franchise on our psychic suffering, the naming rights to our pain.

Read full article

Note that at the time of writing, the link for “APA” (Wired article, third paragraph) has been incorrectly given as http://www.apa.org/ which is the site of the American Psychological Association. 

The correct link should be http://www.psych.org/ – it is the American Psychiatric Association that is publisher of the Diagnostic and Statistical Manual of Mental Disorders (current edition known as DSM-IV). Go here for the American Psychiatric Association’s DSM-5 Development website. 

Psychiatric Times

http://www.psychiatrictimes.com/dsm-5/content/article/10168/1770993 

DSM-5: Dissent From Within
By Allen Frances, MD
03 January 2011

 Many people associated with DSM-5 have privately expressed their serious doubts to me, but felt muzzled into public silence by constraining confidentiality agreements and loyalty to the process. Gary Greenberg’s recent DSM-5 piece in Wired offers a set of dispirited quotes from discouraged Work Group members–but again he elicited them only under the promise of strict anonymity. Until now, the only people connected to DSM-5 to express public displeasure were the two who have resigned from it.

John Livesley, a highly respected member of the Personality Disorders (PD) Work Group, has now broken this fortress defensiveness and enforced wall of silence. He has published a brilliantly reasoned critique titled “Confusion and Incoherence in the Classification of Personality Disorder: Commentary on the Preliminary Proposals for DSM-5.”

Read full article

Another recent commentary on the development of DSM-5 from John Gever, Senior Editor, MedPage Today:

MedPage Today

http://www.medpagetoday.com/Psychiatry/DSM-5/24046 

Year in Review: More Bumps in Road to DSM-V
By John Gever, Senior Editor, MedPage Today
26 December 2010

As part of the Year in Review series, Medpage Today reporters are revisiting major news stories and following up with an analysis of the impact of the original report, as well as subsequent news generated by the initial publication. Here’s what’s happened on the DSM-5 front since we published the first 2010 piece on the topic.

Read full article

Note the projected period for public comment on the beta draft is much shorter than the public review period for the alpha draft had been – which had been around 10 weeks.

APA research director, Darrel Regier, MD, told MedPage Today’s senior editor, John Gever, that an update of the central DSM-5 website, where current versions of the draft may be seen, is likely to take place in January. The Task Force anticipates that all the revisions going into the field trials will be posted and that the site will reflect the new classification scheme envisioned for the final 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 in the media, DSM-V

Allen Frances and Robert Spitzer on DSM-5 Scientific Review Work Group and DSM-5 Field Trials and deadlines

December 18, 2010 by

Allen Frances, MD and Robert Spitzer, MD write to the APA Board of Trustess re DSM-5 Scientific Review Work Group; Frances on DSM-5 Field Trials and deadlines

Post #54 Shortlink: http://wp.me/pKrrB-Ru

On 10 December 2009, the American Psychiatric Association (APA) issued a news release announcing a revised timeline for the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The anticipated release date for DSM-5 was being shifted from May 2012 to May 2013.

According to the DSM-5 Development Timeline:

[Timeline superceded by revised Timeline]

But field trials are barely underway.

Allen Frances, MD, currently professor emeritus at Duke, had chaired the DSM-IV Task Force. Frances maintains the blog DSM5 in Distress at Pyschology Today and also writes for Psychiatric Times where he’s been documenting and commenting on the development of DSM-5 since June 2009. Robert Spitzer had chaired the DSM-III Task Force.

Links to two recent commentaries by Allen Frances on DSM-5 deadlines and a joint letter by Frances and Spitzer to the APA Board of Trustees in response to the APA’s appointment of a DSM-5 Scientific Review Work Group, below:

DSM5 in Distress

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

Letter To Board Of Trustees of the American Psychiatric Association sent December 6, 2010

Published on December 13, 2010

We are delighted that you have appointed a DSM-5 Scientific Review Work Group and charged it with assessing the quality of evidence supporting the DSM 5 proposals. This is great news, probably the last hope to weed out proposals that could do great harm to the Association, our field, and to our patients. Our relief and hope are tempered only by several problems with the process as you have established it:

CONTINUED SECRECY: Given all of the negative publicity surrounding the DSM-5 confidentiality agreements, we are amazed to see the following statement in the charge to the Scientific Review committee: “Deliberations and reports to the BOT will be confidential. The existence of the committee (work group) will be public.” Why on earth is this case? What is the possible harm of making this esteemed committee’s final report public? While we can appreciate the need for the committee to be able to deliberate candidly and not feel constrained by the possibility that every aspect of their deliberations will be made public, it is essential that the final report containing the committee’s assessment of the scientific merits of the proposals be made public.

COMPOSITION OF WORK GROUP: The announcement makes an ambitious claim, namely, that this review will be equivalent to an independent NIMH peer review. This desirable standard cannot possibly be met by the DSM-5 Scientific Review Work Group as you have constituted it. The people chosen are all well-respected, but all but two of the committee members have been involved with DSM 5 or its oversight. To have credibility, a review committee must be completely unattached to the work that has already been done on DSM 5. Preferably, APA should contract out the review process to experts in evidence based medicine who would be both fully independent and also able to apply the standards of scientific proof used across all medical specialties. At the very least, the membership of the committee needs to be broadened to guarantee both the reality and the appearance of a truly unbiased and independent review process.

CHARGE: Although labeled a “Scientific Review Work Group”, the charge needs to go beyond just being a scientific review and include a thorough risk/ benefit analysis of all suggestions. That such an analysis is planned in suggested by the statement in the charge that “issues of clinical utility, public health, and potential impact on patients should also be considered.” We applaud this plan to conduct a risk/benefit analysis but are concerned that such a review requires broader experience in primary care, public policy, health economics, and forensics that goes beyond the current composition of the Workgroup. At a minimum, close consultation with such experts should be part of the planned review process.

METHOD: It appears the assessments will be limited to evidence already generated by the work groups, with no check to determine if their reviews have been comprehensive and balanced. Since there was no standard operating procedure in the literature review process, the work group reviews are variable in quality and method. A recheck to ensure that all pertinent references have been included is necessary.

TIMING: This scientific review is occurring unbelievably late in the DSM 5 process- it should have been completed more than a year ago, not after the field trials have already begun. There is little purpose to be doing expensive field testing on proposal likely to be eliminated because of limited scientific support. Every step in the DSM 5 process has missed its deadline, sometimes by a year or more. We are concerned that the momentum of the DSM 5 process and limited time left for its review will result in the rushed inclusion of proposals that are both risky and unsupported by evidence.

All these serious concerns notwithstanding, The DSM 5 Scientific Review Work Group has our very best wishes. It is in a key position to do a great service for our field and for our patients and to save APA from further embarrassment.

Robert Spitzer and Allen Frances

DSM5 in Distress

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

DSM 5 Field Trials-Part 1 Missed Deadlines Have Troubling Consequences
DSM 5 is falling far behind its schedule.

Published on November 15, 2010

This is a sad tale of completely unrealistic timetables, poorly executed work effort, consistently missed deadlines, and what will undoubtedly be a rushed and botched DSM 5. It all started at the annual meeting of the American Psychiatric Association in May 2009, when the DSM 5 leadership blithely announced it was ready to begin field testing in the early summer of 2009…

…It was patently obvious from the moment of its announcements that the new DSM 5 field test timetable was also a product of fantasy that would not be met in the real world. First off, it should have been clear that the field trials could not possibly start on time two months after their announcement. Recruiting the sites, training the personnel, gaining human rights approvals, and pilot testing always take at least six months. Predictably, we are already in mid Nov 2010 and it is still not at all clear when the DSM 5 field tests will actually begin to enroll patients at all its sites.

Read full commentary: DSM 5 Field Trials-Part 1 Missed Deadlines Have Troubling Consequences

DSM5 in Distress

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

The DSM 5 Field Trials, Part 2: Asking The Wrong Question Will Lead To Irrelevant Answers
A waste of talent, time, and money.

Published on November 23, 2010

…Field tests also fail to account for the pressures that will lead to systematic, future misuse-especially the drug company marketing of mental disorders that leads to over-diagnosis.

…What do I mean? DSM 5 has made a number of radical suggestions for change, particularly the inclusion of many new diagnoses at the threshold of normality. These have the potential to reclassify as mentally disordered tens of millions of people currently considered normal. The only relevant questions are the overall rates of these disorders in the general population and the risks of false negative over-diagnosis.

…At the end of the DSM 5 field trials, we will have no idea whatever whether its suggestions will create false epidemics of misidentified pseudo-patients.

Read full commentary: Part 2: Asking The Wrong Question Will Lead To Irrelevant Answers

ICD-11

Implementation of the WHO’s ICD-11 is scheduled for 2014. Earlier this year, I asked ICD Revision to clarify for stakeholders whether any form of Alpha Draft for ICD-11 will be placed in the public domain, when this will be released and in what formats. 

In October, ICD Revision stated via its Facebook site, that there will be no publication of an ICD-11 Alpha Draft for public scrutiny and that a public Beta Draft is still targeted for May 2011.

ICD-11 targets also slipping 

According to the September iCamp2 meeting PowerPoint presentation, Frequent Criticisms and this iCamp2 YouTube, targets for the population of content for the ICD-11 Alpha Draft had not been reached.   

Less that 80% of Terminology Definitions had been uploaded to the iCAT and less than the 20% target for full Content Model completion for the thousands of diseases and disorders classified within ICD had been met at that point. [The Content Model identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.] Not all Topic Advisory Groups were at a similar developmental stage and ICD-11 Beta Plans were behind schedule.   (See Post #48)

International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders

The APA participates with the WHO in the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and the DSM-ICD Harmonization Coordination Group.

The International Advisory Group for the Revision of the ICD-10 Chapter for Mental and Behavioural Disorders (currently ICD-10 Chapter V but will be Chapter 5 in ICD-11) was constituted by the WHO with the primary task of advising the WHO on all steps leading to the revision of the mental and behavioural disorders classification in ICD-10, in line with the overall ICD revision process.

The Group is chaired by Steven E Hyman, MD, Harvard University, Cambridge, Massachusetts. Steven E Hyman, MD is also a member of the APA’s DSM-5 Task Force.

There is already a degree of correspondence between DSM-IV and Chapter V of ICD-10. For the next editions, the APA and the WHO have committed as far as possible:

To facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria.

with the objective that

The WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.

The Advisory Group has published no Summary Reports of its meetings since its fourth meeting in December 2008. A fifth meeting of the group was held on 28 – 29 September 2009.  Over a year later, no Summary Report has been published for that meeting. It is uncomfirmed whether any meetings of the Advisory Group were held in 2010.

Topic Advisory Group for Neurology

The lead WHO Secretariat for Topic Advisory Group (TAG) for Neurology is Dr Tarun Dua, Management of Mental and Brain Disorders, Department of Mental Health and Substance Abuse, WHO, Geneva.

The TAG for Neurology is chaired by Raad Shakir, MD, Imperial College London. For further information on TAG Neurology see this page.

Filed under American Psychiatric Association (APA), Clinical Modification, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-V, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, Psychiatric Times, WHO (World Health Organization)

No publication of an ICD-11 Alpha Draft for public scrutiny

November 19, 2010 by

There will be no publication of an ICD-11 Alpha Draft for public scrutiny

Post #53 Shortlink: http://wp.me/pKrrB-QL

For some time now, I have been trying to establish whether ICD Revision intends to release any form of ICD-11 Alpha Draft for public scrutiny. An Alpha Draft had originally been scheduled for May 2010.

On 6 August, ICD Revision on Facebook had stated:

“The ICD-11 Alpha Drafting process has been ongoing since the first iCamp that was held in Geneva, Switzerland in September 2009. A draft print version will be available in September 2010.”

On 29 September, I asked:

“Clarification would be welcomed on whether an Alpha Draft will be available this month for internal use only or whether it is intended for public viewing, and if for public viewing, in what format(s)?”

which received no response.

On 6 October, I asked, again:

“On 6 August, ICD Revision on Facebook stated that “A draft print version will be available in September 2010”. Other than what can be seen on the iCAT collaborative authoring platform, will ICD Revision please clarify for stakeholders, whether any form of Alpha Draft for ICD-11 is going to be placed in the public domain, when this will now be released, and in what formats?”

On 15 October, ICD Revision on Facebook responded: 

“Indeed a print version is available but as an alpha draft it is not for public consumption. Public draft ( beta draft) was and (is still) targeted for MAY 2011. iCAT authoring platform is not open to public and should be only seen by designated authors. — This is not something opaque. any project of this size and complexity has to pass through stages. In May 2011 more user-friendly software and easy-to-view options will be available…”

At that point, it was in fact the case that both the iCAT authoring platform server and the iCAT demo and training platform had been viewable by the public, although only WHO, ICD Revision Steering Group, ICD Revision IT technicians and Topic Advisory Groups (TAGs) had editing access.

The iCAT production server is at: http://icat.stanford.edu/
The iCAT demo and training platform is at: http://icatdemo.stanford.edu/

In early November, access to viewing the iCAT and the iCAT demo platform was closed to the public. 

Topic Advisory Group (TAG) members now require a password login for both browsing and editing the iCAT or importing data and the public can no longer view the iCAT and the population of ICD Title Categories and Content, at all.

Filed under iCAT, ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 consultation, ICD-11 revision docs, Somatic Symptom Disorder, Somatoform Disorders, WHO (World Health Organization)

The Development, Evolution, and Modifications of ICD-10: Challenges to the International Comparability of Morbidity Data

October 29, 2010 by

The Development, Evolution, and Modifications of ICD-10: Challenges to the International Comparability of Morbidity Data

Post #52 Shortlink: http://wp.me/pKrrB-QX

Keywords
ICD, WHO, morbidity, ICD-10 clinical modifications, administrative data

Medical Care

POST AUTHOR CORRECTIONS, 25 October 2010
doi: 10.1097/MLR.0b013e3181ef9d3e
Original Article: PDF Only

The Development, Evolution, and Modifications of ICD-10: Challenges to the International Comparability of Morbidity Data

Published Ahead-of-Print

Abstract

Background: The United States is about to make a major nationwide transition from ICD-9-CM coding of hospital discharges to ICD-10-CM, a country-specific modification of the World Health Organization’s ICD-10. As this transition occurs, the WHO is already in the midst of developing ICD-11. Given this context, we undertook this review to discuss: (1) the history of the International Classification of Diseases (a core information “building block” for health systems everywhere) from its introduction to the current era of ICD-11 development; (2) differences across country-specific ICD-10 clinical modifications and the challenges that these differences pose to the international comparability of morbidity data; (3) potential strategic approaches to achieving better international ICD-11 comparability.

Literature Review and Discussion: A literature review and stakeholder consultation was carried out. The various ICD-10 clinical modifications (ICD-10-AM [Australia], ICD-10-CA [Canada], ICD-10-GM [Germany], ICD-10-TM [Thailand], ICD-10-CM [United States]) were compared. These ICD-10 modifications differ in their number of codes, chapters, and subcategories. Specific conditions are present in some but not all of the modifications. ICD-11, with a similar structure to ICD-10, will function in an electronic health records environment and also provide disease descriptive characteristics (eg, causal properties, functional impact, and treatment).

Conclusion: The threat to the comparability of international clinical morbidity is growing with the development of many country-specific ICD-10 versions. One solution to this threat is to develop a meta-database including all country-specific modifications to ensure more efficient use of people and resources, decrease omissions and errors but most importantly provide a platform for future ICD updates.

(C) 2010 Lippincott Williams & Wilkins, Inc.

Ed note: The forthcoming US “Clinical Modification”, ICD-10-CM, is country specific; it does not apply outside the US.

Current proposals for the US Clinical Modification ICD-10-CM, which is scheduled for implementation in October  2013, propose classifying Chronic fatigue syndrome in ICD-10-CM Chapter 18 at R53.82.

The proposed U.S. classification ICD-10-CM separates CFS and Postviral fatigue syndrome into mutually exclusive categories. “Chronic fatigue, unspecified | Chronic fatigue syndrome not otherwise specified” appear in Chapter XVII under R53.82.

“Postviral fatigue syndrome | Benign myalgic encephalomyelitis” appear in Chapter VI under G93.3.

The Chronic Fatigue Syndrome Advisory Committee (CFSAC) had previously recommended CFS to be placed under the same neurological code as ME and PVFS, G93.3.

For the most recent ICD-10-CM proposals see:

CDC site: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) [1]:

http://www.cdc.gov/nchs/icd/icd10cm.htm

The Zipped file for the “2010 ICD-10-CM Tabular List of Diseases & Injuries” is not that easy to locate on the CDC site.

A non Zipped PDF of the most recent proposals can be downloaded here:

http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp#TopOfPage

http://www.cms.gov/ICD10/Downloads/6_I10tab2010.pdf

Page 325:

G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis
Excludes1: chronic fatigue syndrome NOS (R53.82)

Page 1165:

R53.82 Chronic fatigue, unspecified
Chronic fatigue syndrome NOS
Excludes1: postviral fatigue syndrome (G93.3)

The Canadian Clinical Modification (ICD-10-CA) has all three terms classified in Chapter VI: Diseases of the nervous system at G93.3:

Version 2009 ICD-10-CA Tabular List, Volume 1 PDF (4.9MB):

http://secure.cihi.ca/cihiweb/en/downloads/ICD-10-CA_Vol1_2009.pdf

Other disorders of the nervous system

(G90-99)

[…]

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome
Includes: Benign myalgic encephalomyelitis
Chronic fatigue syndrome

Excludes: fatigue syndrome NOS (F48.0)

[1] Although this release of ICD-10-CM is now available for public viewing, the codes in ICD-10-CM are not currently valid for any purpose or use.

[2] More information on US “Clinical Modification” ICD-10-CM here, on DSM-5 and ICD-11 Watch site: http://wp.me/pKrrB-Ka

Filed under Clinical Modification, ICD revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 in the media, WHO (World Health Organization)

Web Protégé: Supporting the Creation of ICD-11 and iCAMP2 YouTubes

October 26, 2010 by

Web Protégé: Supporting the Creation of ICD-11 and iCAMP2 YouTubes

Post #51 Shortlink: http://wp.me/pKrrB-Qv

http://iswc2010.semanticweb.org/pdf/502.pdf

Web Protégé: Supporting the Creation of ICD-11

Sean M. Falconer, Tania Tudorache, Csongor Nyulas, Natalya F. Noy, Mark A. Musen

Stanford Center for Biomedical Informatics Research, Stanford University, US

1 Introduction

The International Classification of Diseases (ICD) is a public global standard that organizes and classifes information about diseases and related health problems [4]. Health offcials use ICD in all United Nations member countries to compile basic health statistics, to monitor health-related spending, and to inform policy makers. In the United States, use of the ICD is also a requirement for all medical billing. ICD has therefore a major impact on many aspects of health care all over the world.

In 2007, the WHO initiated the 11th revision of ICD. Several ambitious goals were set for this version (details in [2]). One such goal is to allow the ICD to become a multi-purpose classification for a much larger number of usages. Previous versions of ICD were strictly classification hierarchies used for statistical purposes. To meet the new revision goals, ICD-11 will use OWL to create a rich formal representation. Another key diference between ICD-11 and previous versions is that the development process of ICD-11 will use a Web-based open process powered by collaboration and social features. That is, similar to Wikipedia, the WHO hopes that a large number of medical experts will contribute to the content of ICD-11.

Our group has been working closely with the WHO to provide the technical support for these ambitious goals. We have created a customized version of Protégé specifcally designed to support the ICD authoring process. In [2], we discuss in detail the use of Semantic Web technologies for the revision of ICD. Our demo will showcase features of the customized Protégé such as content creation and collaboration. For the remainder of this paper, we present the architecture and highlight features of the user interface…

Full document

————–

iCamp2: 27 September – 1 October 2010

http://sites.google.com/site/icd11revision/home/face-to-face-meetings/icamp2-2010   

The iCamp2 meeting, scheduled for April but postponed due to volcanic ash cloud disruption of air traffic, was held between 27 September – 1 October, in Geneva.   

iCamp2
27 September – 1 October 2010 Geneva, Switzerland WHO Headquarters   

RSG 2010 [Revision Steering Group]
30 September – 1 October 2010 Geneva, Switzerland WHO Headquarters   

The revised Agenda for the meeting can be read here in html on the ICD Revision site.   

Download here as a Word document from the ICD Revision site or open here iCamp2 Agenda September 2010 on DSM-5 and ICD-11 Watch site.   

I will post a link for the minutes, summary or note of this meeting when these are available on the ICD Revision site.

There are two ICD-11 iCamp2 on YouTube   

ICD-11 ICAMP2 Day 5 

WHOICD11’s Channel  | 21  October 2010  |  9.53 mins

iCAMP2 Day 2   

WHOICD11’s Channel  | 29 September 2010  |  7:32 mins    

 

Related information

ICD Revision iCamp2 meeting, new documents and status of the ICD-11 Alpha Draft

Filed under iCAT, ICD on YouTube, ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 revision docs, WHO (World Health Organization), Wikipedia

APA Announces Start of Field Trials for DSM-5; MedPage Today commentary

October 26, 2010 by

APA Announces Start of Field Trials for DSM-5; MedPage Today commentary

Post #50 Shortlink: http://wp.me/pKrrB-QC

APA News Release

PDF: News Release 05.10.10

American Psychiatric Association (APA)

For Information Contact:
Eve Herold, 703-907-8640
press@psych.org
Jaime Valora, 703-907-8562
jvalora@psych.org

For Immediate Release:
Oct. 5, 2010
Release No. 10-65

APA Announces Start of Field Trials for DSM-5

Sites to Test Proposed Diagnostic Criteria in Real-World Clinical Settings

ARLINGTON, Va. (Oct. 5, 2010) – The American Psychiatric Association today announced the start of field trials to test proposed diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Field trials will help assess the practical use of proposed DSM-5 criteria in real-world clinical settings.

The field trials follow a public comment period in which more than 8,000 written comments on the draft diagnostic criteria were submitted to the DSM-5 website by clinicians, researchers and family and patient advocates. Submitted comments were reviewed by DSM-5 Work Groups and resulted in further refinement of the criteria.

Evaluation measures

For the diagnostic criteria that are being evaluated, the results of the field trials will address:

. Feasibility: are the proposed criteria easy for clinicians to understand and to use?
. Clinical Utility: do the proposed criteria do a good job in describing patients’ psychiatric problems and help clinicians make decisions about treatment plans?
. Reliability: are the same conclusions reached consistently when the criteria are used by different clinicians?
. Validity: how accurately do the diagnostic criteria reflect the mental disorders they are designed to describe?

In addition, the field trials will help assess severity measures and cross-cutting dimensional measures.

Severity measures are questionnaires and other tools intended to help clinicians evaluate how severe the symptoms of an individual are on a rating scale.

Cross-cutting dimensional measures are tools for assessing symptoms that occur across a wide range of diagnoses, such as anxiety or sleep problems. Field trials will help determine whether these proposed tools provide useful information for clinicians and their patients, and whether they capture changes in symptoms over time to evaluate progress in treatment.

Two rigorous study designs

Since the DSM is used in many care settings, two standardized and methodologically rigorous study designs were developed by the DSM-5 Research Group to gather data from a wide range of clinicians and settings.

“It is important that the proposed diagnostic criteria are subjected to rigorous and empirically sound field trials before DSM-5 is published in 2013,” said David Kupfer, M.D., chair of the DSM-5 Task Force.

“The two field trial designs will allow us to better understand how the proposed revisions affect clinicians’ practices and, most importantly, patient care.”

One study design was developed for use in academic or other large clinical settings, and will be employed at 11 sites, chosen from among 65 centers that responded to APA’s call for proposals. Another study design was developed for use by individual practitioners and smaller clinical practices. These field trials will be conducted in diverse care settings by 3,900 mental health professionals: 1,400 psychiatrists selected from a randomly selected sample, as well as an additional 2,500 volunteer clinicians, including psychiatrists, psychologists, social workers, and advanced practice psychiatric-mental health nurses.

Participating clinicians must meet eligibility criteria and complete a web-based training seminar.

Clinicians in the field trials will evaluate new and existing patients at different stages of treatment using the proposed DSM-5 diagnostic criteria and measures.

All patients considered for participation in the field trial will receive information about the trial and must give their consent. None of the patients will have their identities revealed in the results of the studies.

In the field trials conducted in the academic and large medical centers, patient evaluations will begin with an initial baseline assessment by a clinician. A different clinician will conduct a second assessment 4 hours to 2 weeks later, to help determine reliability of the diagnostic criteria. This assessment will be repeated in a follow-up visit (4 to 12 weeks after the second evaluation) to test whether the severity and cross-cutting measures are sensitive to changes in treatment progression.

Academic and Large Medical Centers

The 11 large academic medical settings participating in field trials are:

Pediatric Sites

. Baystate Medical Center, Springfield, Mass.
. Columbia University/New York State Psychiatric Institute, Child Psychiatry Division, in collaboration with colleagues at New York Presbyterian

. Hospital/Weill Cornell Medical Center, New York Presbyterian
. Hospital/Westchester Division, and the North Shore Child and Family Guidance Center, Roslyn Heights, New York

. Stanford University, Lucile Packard Children’s Hospital, Palo Alto, Calif.
. The Children’s Hospital, Aurora, Colo.

Adult Sites

. Centre for Addiction and Mental Health, Toronto
. Dallas Veterans Affairs Medical Center
. DeBakey Veterans Affairs Medical Center and Menninger Clinic, Baylor College of Medicine,   Houston
. Mayo Clinic, Rochester, Minn.
. University of California, Los Angeles
. University of Pennsylvania, Philadelphia
. University of Texas Health Science Center, San Antonio

More information on the participating academic large medical centers and the specific disorders being tested in field trials is available on www.dsm5.org .

Disseminating the Field Trial Findings

The DSM-5 Field Trials team will disseminate the results of these initial field trials through presentations at scientific meetings, with professional and consumer groups and in articles published in peer-reviewed scientific journals and DSM-5 source books.

After completion of the first phase of field trials and another period of public comment via the DSM5.org web site, work group members will make any necessary revisions to their draft criteria. This will be followed by a second phase of field trials for further examination of selected criteria, scheduled to take place in 2011 and 2012.

“The process for developing DSM-5 continues to be deliberative, thoughtful and inclusive,” said Darrel Regier, M.D., M.P.H., vice-chair of the DSM-5 Task Force, and APA research director. “Large-scale field trials are the next critical phase in this important process and will give us the information we need to ensure the diagnostic criteria are both useful and accurate in real-world clinical settings.”

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 http://www.psych.org and www.healthyminds.org .

[Ends]

Commentary and previous commentaries on the development of DSM-5 from MedPage Today here:

http://www.medpagetoday.com/Psychiatry/DSM-5/
http://www.medpagetoday.com/Psychiatry/DSM-5/22579

DSM-5 Field Trials Off to Late Start

By John Gever, Senior Editor, MedPage Today
Published: October 05, 2010

“Testing of new diagnostic criteria proposed for DSM-5, the revision of the psychiatric profession’s manual for patient assessment, is finally underway, more than two months behind schedule…”

(With thanks to Kelly Latta for alerting me to the MedPage Today commentary.)

———-

Current proposals by the DSM-5 Work Group for disorders related to the diagnostic category, Somatoform Disorders, can be found here:

http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx 

and here, in Post #17, on Dx Revision Watch site:

Proposed revisions and draft criteria for DSM-5 categories were published by the American Psychiatric Association on 10 February

 

DSM-5 Submissions to the public review process

There were considerable concerns, earlier this year, in response to the proposal of the DSM-5 Work Group for “Somatic Symptom Disorders” to combine several existing somatoform disorder categories into one larger category, Complex Somatic Symptom Disorder (CSSD).

Patient organisations, professionals and advocates submitting comments in the DSM-5 draft proposal public review process were invited to provide copies of their submissions for publication on this page:

http://wp.me/PKrrB-AQ

———-

This table sets out how the current versions of classification systems, DSM-IV and ICD-10, have corresponded for Somatoform Disorders:

Current DSM-IV Codes and Categories for Somatoform Disorders and ICD-10 Equivalents

Source: Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M: Somatoform disorders: time for a new approach in DSM-V. Am J Psychiat. 2005;162:847-855.

 

ICD-11 Alpha Draft

According to sources, in July, a print version of the ICD-11 Alpha Draft was expected to be made available around the time that the rescheduled iCamp2 meeting took place in September.

In August, ICD Revision confirmed that a “draft print version will be available in September 2010”.

iCamp2 has now concluded, but it remains unclear whether a print version has been produced. ICD Revision has been asked to clarify the status and availability of an Alpha Draft, whether it is intended for internal use only or is going to be made available for public scrutiny, and if so, when, and in what format(s).

For update on status and availability of ICD-11Alpha Draft see: Post #53

The publication of DSM-5 is currently timelined for May 2013.

Implementation of ICD-10-CM, the US specific “Clinical Modification” of ICD-10, is scheduled for October 2013.

According to the APA’s DSM-5 website Timeline:

http://www.dsm5.org/about/Pages/Timeline.aspx

[…]

As the Phase 1 field trials are underway, members of the DSM-5 Task Force and Work Group will begin drafting their initial text for DSM-5. During this time, case studies will also be developed, which will be published after DSM-5’s release in a series of case books.

March – April 2011: Revisions to Proposed Criteria. Based on results from the first phase of field trials, the DSM-5 Task Force and Work Group members will make revisions to the proposed DSM-5 diagnostic criteria and dimensional measures. These revised criteria and measures will be tested in a second phase of field trials.

April – May 2011: Review of Revised Criteria. Revised proposed criteria will be subjected to internal review, including a review by the DSM-5 Task Force and Research Group and by other relevant work groups.

May-July 2011: Online Posting of Revised Criteria. Following the internal review, revised draft diagnostic criteria will be posted online for approximately one month to allow the public to provide feedback. This site will be closed for feedback by midnight on June 30, 2011.

[…]

 

Filed under American Psychiatric Association (APA), CFSAC meetings, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-V, Joel Dimsdale, Somatic Symptom Disorder, Somatoform Disorders

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