DSM-5 round-up: Lane on “DSM-5 Facts” site, Frances on DSM-5, Kupfer on Frances

DSM-5 round-up: Lane on new “DSM-5 Facts” site, Frances on DSM-5, Kupfer on Frances

Post #176 Shortlink: http://wp.me/pKrrB-2cQ

What we were waiting for were the “full results” of the reliability data from the DSM-5 field trials.

What we got was a public relations sticking plaster.

Christopher Lane reported in Side Effects on the American Psychiatric Association’s new platform DSM-5 Facts – a website launched, last week, to “correct the record, highlight key omissions – and provide essential perspective so that the public has a complete and accurate view…

Side Effects

Christopher Lane, Ph.D. | June 4, 2012

The APA’s PR Problem
Why is the American Psychiatric Association hiring a PR company to market DSM-5?

As the news tumbled out last week that the American Psychiatric Association had hired GYMR, an expensive PR company, to help the organization “execute strategies that include image and alliance building, public education campaigns or media relations to harness the formidable forces of Washington and produce successful results for clients” (services that GYMR brags about in its mission statement), it became clearer than ever that the APA has more than an image-problem with DSM-5

Read on

In a long interview with Allen Frances, Stephen M. Strakowski asks: What’s wrong with DSM-5 and what needs to be done to put it right?

Medscape Psychiatry

What’s Wrong With DSM-5?

Stephen M. Strakowski, MD; Allen J. Frances, MD | June 1, 2012

Addressing Prescription Drug Abuse: Introduction
The Biggest Problems With DSM-5?
What Would Dr. Frances Do?
A Safe, Credible DSM-5 by 2013?

…The reliability-test results for stage 1 show that DSM-5 badly flunked and that stage 2 is desperately needed. The leadership lowered expectations with statements indicating that they are willing to accept diagnostic agreements far below historical levels and include proposals achieving diagnostic agreements that are little better than chance. This is simply not acceptable and should not be accepted…

…it is discouraging that DSM-5 has not accepted the need for external review, is going forward with poorly written and unreliable criteria sets, and still contains so many unsafe and scientifically unsound proposals. It remains to be seen whether DSM-5 will be responsive to what is certain to be increasing external pressure to trim its sails and improve its quality. If it attempts to hang tough, I think DSM-5 will no longer be used much (if at all) overseas and will also lose much of its following in the United States…

Task Force Chair, David J. Kupfer, MD, responds:

Medscape Psychiatry

Dr. Kupfer Defends DSM-5

David J. Kupfer, MD | June 1, 2012

Editor’s Note:
In a recent Medscape interview with Dr. Stephen Strakowski, DSM-IV Task Force Chair Dr. Allen J. Frances expressed serious concerns about a number of proposals being considered for inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scheduled for release in May 2013. Below, DSM-5 Task Force Chair Dr. David Kupfer defends the proposed revision.

A DSM-5 Defense
Will DSM-5 Inflate Prevalence?

A third Medscape report from the APA’s Annual Conference by Nassir Ghaemi, MD:

Medscape Psychiatry

DSM-5: Finding a Middle Ground

Nassir Ghaemi, MD | June 1, 2012

Professor of Psychiatry, Tufts University School of Medicine; Director, Mood Disorders Program, Psychiatry Department, Tufts Medical Center, Boston, Massachusetts

DSM-5: Validity vs Reliability
But DSM-IV Has Limitations, Too

Two more commentaries from 1 Boring Old Man on DSM-5 process and field trial Kappa results:

the APA Trustees must intervene in the DSM-5…

1 Boring Old Man | June 4, 2012

and will…

1 Boring Old Man | June 3, 2012

Two proposed changes dropped from DSM-5: Media round-up

Two proposed changes dropped from DSM-5: Media round-up

Post #169 Shortlink: http://wp.me/pKrrB-28a

Pharma Blog

Should A Federal Agency Oversee The DSM?

Ed Silverman | May 15, 2012

…Frances proposes that a federal agency ought to assume the job of developing the DSM, although he believes a new organization would be required, one that could be housed in the US Department of Health and Human Services, the Institute of Medicine or the World Health Organization. An equivalent of the FDA is needed to “mind the store,” as he puts it.

This may raise a different set of objections, of course. To what extent, for instance, should a federal agency delve deeply into determining diagnoses and definitions? On the other hand, perhaps this would remove the concerns over self-interest and conflict that have tainted the process. What do you think?

Should a Federal Agency Run The DSM?

Psych Central

An Epidemic of Mental Disorders?

John M. Grohol, PsyD, Founder & Editor-in-Chief | May 15, 2012

Psychiatric Times

COMMENTARY

Is There Really an “Epidemic” of Psychiatric Illness in the US?

Ronald W. Pies, MD | May 1, 2012

Epidemic: (from epidēmos, prevalent : epi-, epi- + dēmos, people) “…an epidemic refers to an excessive occurrence of a disease.”–from Friis & Sellers, Epidemiology for Public Health Practice, 4th ed, 2010

If claims in the non-professional media can be believed, there is a “raging epidemic of mental illness” in the US¹, if not world-wide—and, in one version of this narrative, psychiatric treatment itself is identified as the culprit. There are several formulations of the “epidemic narrative,” depending on which of psychiatry’s critics is writing. In the most radical version, it is psychiatric medication that is fueling the supposed burgeoning of mental illness, particularly depression and schizophrenia.² More subtle variants suggest that there is a “false epidemic” of some psychiatric disorders, driven by dramatically rising rates of “false positive” diagnoses.³…

Time Healthland

Mental Health

DSM 5 Could Mean 40% of College Students Are Alcoholics

Maia Szalavitz | May 14, 2012

Most college binge drinkers and drug users don’t develop lifelong problems. But new mental-health guidelines will label too many of them addicts and alcoholics…

Side Effects at Psychology Today

DSM-5 Is Diagnosed, with a Stinging Rebuke to the APA
The regrettable history of the DSM

Christopher Lane, Ph.D. | May 14, 2013

…Among the fiercest critics quoted is Mark Rapley, a clinical psychologist at the University of East London, who puts it this way: “The APA insists that psychiatry is a science. [But] real sciences do not decide on the existence and nature of the phenomena they are dealing with via a show of hands with a vested interest and pharmaceutical industry sponsorship.” Despite commending the DSM-5 authors for “reconsidering some of their most unfortunate mistakes,” clinical psychologist Peter Kinderman of the University of Liverpool adds that the manual remains, at bottom, a bad and faulty system. “The very minor revisions recently announced do not constitute the wholesale revision that is called for,” he is quoted as saying. “It would be very unfortunate if these minor changes were to be used to suggest that the task force has listened in any meaningful way to critics….”

The New American

Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses

Alex Newman | May 13, 2012

Allen J Frances lecture

Published on 11 May 2012 by tvochannel

Psychiatrist and author, Allen J. Frances, believes that mental illnesses are being over-diagnosed. In his lecture, Diagnostic Inflation: Does Everyone Have a Mental Illness?, Dr. Frances outlines why he thinks the DSM-V will lead to millions of people being mislabeled with mental disorders. His lecture was part of Mental Health Matters, an initiative of TVO in association with the Centre for Addiction and Mental Health.

Podcast http://bit.ly/KhLuhd

57:36 mins | 19 MB

As part of Mental Health Matters Week, Big Ideas presents a lecture by Allen J Frances, MD, who had chaired the DSM-IV Task Force.

Website http://a2zn.com/?p=3507

News wire

May 6, 2012 University of Toronto

Produced in collaboration with the Center for Addiction and Mental Health

Allen J Frances lecture

Diagnostic inflation. Does everyone have a mental illness?

Big Ideas – May 12 and 13 at 5 pm ET

TVO’s lecture series will present special guest speaker Dr. Allen J. Frances, who will outline why he believes that mental illnesses are being over-diagnosed these days and why he thinks the fifth and latest version of the psychiatrist’s bible, Diagnostic and Statistical Manual of Mental Disorders will lead to millions of people being mislabeled with mental disorders.

The lecture will be recorded May 6 at University of Toronto’s Hart House.

1 Boring Old Man

the dreams of our fathers I…

1 Boring Old Man |  May 12, 2012

University Diaries

“Diagnostic Exuberance”…

Margaret Soltan | May 13, 2012

BMJ News

More psychiatrists attack plans for DSM-5

BMJ 2012; 344 doi: 10.1136/bmj.e3357 (Published 11 May 2012)

Geoff Watts

The authors of the 5th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due to be published in May 2013, have responded to previous criticisms of their text by announcing a further series of changes.1

But far from mollifying their critics, these concessions have served to ignite a further and still more vituperative barrage of dissent.

The list of topics under reconsideration or already subject to change can be found on the DSM-5 website.2 It includes the proposed “attenuated psychosis syndrome,” which is slated for further study, and also major depressive disorder. Here the authors have added a footnote “to …

Access to the full text of this article requires a subscription or payment

Scientific American Blogs

Why Are There No Biological Tests in Psychiatry?

By Ingrid Wickelgren | May 11, 2012 | 2

Part 5 of a 5-part series Allen Frances

New York Times

Op-Ed Contributor

Diagnosing the D.S.M.

Allen Frances | May 11, 2012

“…All mental-health disciplines need representation — not just psychiatrists but also psychologists, counselors, social workers and nurses. The broader consequences of changes should be vetted by epidemiologists, health economists and public-policy and forensic experts. Primary care doctors prescribe the majority of psychotropic medication, often carelessly, and need to contribute to the diagnostic system if they are to use it correctly. Consumers should play an important role in the review process, and field testing should occur in real life settings, not just academic centers.

Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists. They will always be an essential part of the mix but should no longer be permitted to call all the shots…”

MedPage Today

DSM-5: What’s In, What’s Out

John Gever, Senior Editor, MedPage Today |  May 10, 2012

   …The final drafts are to be completed by August, then they must be approved by a scientific review committee and the task force leadership, and finally by the APA’s governing bodies.

Kupfer said the final version has to be completed by December, when it’s set to go to the printer. Its formal release is planned for the APA’s annual meeting next May in San Francisco.

Here’s a brief overview of the changes you can expect…

WHAT’S OUT
WHAT’S IN (or STILL IN)
WHAT DIDN’T MAKE IT
WHAT TO LOOK FORWARD TO

Reuters 1

Two proposed changes dropped from psychiatric guide

Julie Steenhuysen | Reuters CHICAGO | May 9, 2012

CHICAGO (Reuters) – Two proposed psychiatric diagnoses failed to make the last round of cuts in the laborious process of revising the Diagnostic and Statistical Manual of Mental Disorders — an exhaustive catalog of symptoms used by doctors to diagnose psychiatric illness.

Gone from the latest revision are “attenuated psychosis syndrome,” intended to help identify individuals at risk of full-blown psychosis, and “mixed anxiety depressive disorder”, a blend of anxiety and depression symptoms. Both performed badly on field tests and in public comments gathered by the group in its march toward the May 2013 publication deadline.

Both have been tucked into Section III of the manual — the place reserved for ideas that do not yet have enough evidence to make the cut as a full-blown diagnosis.

What has survived, despite fierce public outcry, is a change in the diagnosis of autism, which eliminates the milder diagnosis of Asperger syndrome in favor of the umbrella diagnosis of autism spectrum disorder.

But that, too, could still be altered before the final manual is published, the group says. The APA opened the final comment period for its fifth diagnostic manual known as DSM-V on May 2, and it will accumulate comments through June 15.

Dr. David Kupfer, who chairs the DSM-5 Task Force, said in a statement that the changes reflect the latest research and input from the public.

Dr. Wayne Goodman, professor and chairman of the department of psychiatry at Mount Sinai Medical Center in New York, said he’s glad the task force is responding to feedback from professionals and the public.

“I think they are trying to listen,” he said.

Goodman agrees with the decisions to drop both of the two disorders in the latest revision.

With the “mixed anxiety and depressive disorder,” he said there was a risk that it would capture a number of people who did not qualify under a diagnosis of depression or anxiety alone.

“It could lead to overdiagnosis,” Goodman said.

He said the “attenuated psychosis syndrome” diagnosis would have been useful for research purposes to help identify those at risk of psychosis, but there was a concern that it might label people who were just a bit different as mentally ill.

“The predictive value is not clear yet,” he said. “I think it’s reasonable not to codify it until we have better definition of its predictive value.”

Goodman, who worked on DSM-4, the last revision of the manual published in 1994, and is working on the Obsessive Compulsive Disorder section of the current revision of DSM-5, said the strength of the process is that it can offer a reliable way for psychiatrists across the country to identify patients with the same sorts of disorders.

The weakness, he said, is that it largely lacks biological evidence — blood tests, imaging tests and the like — that can validate these diagnoses.

“DSM-5 is a refinement of our diagnostic system, but it doesn’t add to our ability to understand the underlying illness,” he said.

Dr. Emil Coccaro, chairman of the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago Medicine, said typically changes in the DSM occur because of new data.

Coccaro, who is contributing to the new section in the DSM-5 on Intermittent Explosive Disorder, said there is no question that many people aren’t convinced that some of the diagnoses need to be changed, or that there need to be new ones added.

“This also happened the last time when they did DSM-4,” he said, but that was nearly 20 years ago.

“You can keep waiting but at certain point you have to fish or cut bait and actually come out with a new edition. That is what is happening now,” he said.

Comments to the manual can be submitted at www.DSM5.org

(Reporting By Julie Steenhuysen)

Reuters 2

Experts unconvinced by changes to psychiatric guide

Kate Kelland | Reuters LONDON | May 10, 2012

(Reuters) – Many psychiatrists believe a new edition of a manual designed to help diagnose mental illness should be shelved for at least a year for further revisions, despite some modifications which eliminated two controversial diagnoses.

The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) is due out this month, the first full revision since 1994 of the renowned handbook, which is used worldwide and determines how to interpret symptoms in order to diagnose mental illnesses.

But more than 13,000 health professionals from around the world have already signed an open letter petition (at dsm5-reform.com) calling for DSM 5 to be halted and re-thought.

“Fundamentally, it remains a bad system,” said Peter Kinderman, a professor of clinical psychology at Britain’s Liverpool University.

“The very minor revisions…do not constitute the wholesale revision that is called for,” he said in an emailed comment.

The American Psychiatric Association (APA), which produces the DSM, said on Wednesday it had decided to drop two proposed diagnoses, for “attenuated psychosis syndrome” and “mixed anxiety depressive disorder”.

The former, intended to help identify people at risk of full-blown psychosis, and the latter, which suggested a blend of anxiety and depression, had been criticized as too ill-defined.

With these and other new diagnoses such as “oppositional defiant disorder” and “apathy syndrome”, experts said the draft DSM 5 could define as mentally ill millions of healthy people – ranging from shy or defiant children to grieving relatives, to people with harmless fetishes.

“SIMPLY NOT USABLE”

Robin Murray, a professor of psychiatric research at the Institute of Psychiatry at Kings College London, said it was a great relief to see the changes in the draft, particularly to the attenuated psychosis diagnosis.

“It would have done a lot of harm by diverting doctors into thinking about imagined risk of psychosis (and) it would have led to unnecessary fears among patients that they were about to go mad,” he said in a statement.

But Allen Frances, emeritus professor at Duke University in the United States, said: “This is only a first small step toward desperately needed DSM 5 reform. Numerous dangerous suggestions remain.”

Frances, who chaired a committee overseeing the DSM 4, added that the DSM 5 “is simply not usable” and should be delayed for a year “to allow for independent review, to clean up its obscure writing, and for retesting”.

Diagnosis is always controversial in psychiatry, since it defines how patients will be treated based on a cluster of symptoms, many of which occur in several different types of mental illness.

Some argue that the whole approach needs to be changed to pay more attention to individual circumstances rather than slotting them into predefined categories.

“(The DSM) is wrong in principle, based as it is on redefining a whole range of understandable reactions to life circumstances as ‘illnesses’, which then become a target for toxic medications heavily promoted by the pharmaceutical industry,” said Lucy Johnstone, a consultant clinical psychologist for the Cwm Taf Health Board in Wales.

“The DSM project cannot be justified, in principle or in practice. It must be abandoned so that we can find more humane and effective ways of responding to mental distress.”

Others, however, are pushing more for the manual to be reviewed more thoroughly to allow for more accurate diagnosis and, in theory, more appropriate treatment.

One of the proposed changes that has survived in the draft DSM 5 – despite fierce public outcry – is in autism. The new edition eliminates the milder diagnosis of Asperger syndrome in favor of the umbrella diagnosis of autism spectrum disorder.

(Editing by Myra MacDonald)

New York Times

Psychiatry Manual Drafters Back Down on Diagnoses

Benedict Carey | May 8, 2012

In a rare step, doctors on a panel revising psychiatry’s influential diagnostic manual have backed away from two controversial proposals that would have expanded the number of people identified as having psychotic or depressive disorders.

The doctors dropped two diagnoses that they ultimately concluded were not supported by the evidence: “attenuated psychosis syndrome,” proposed to identify people at risk of developing psychosis, and “mixed anxiety depressive disorder,” a hybrid of the two mood problems.

They also tweaked their proposed definition of depression to allay fears that the normal sadness people experience after the loss of a loved one, a job or a marriage would be mistaken for a mental disorder.

But the panel, appointed by the American Psychiatric Association to complete the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., did not retreat from another widely criticized proposal, to streamline the definition of autism. Predictions by some experts that the new definition will sharply reduce the number of people given a diagnosis are off base, panel members said, citing evidence from a newly completed study.

Both the study and the newly announced reversals are being debated this week at the psychiatric association’s annual meeting in Philadelphia, where dozens of sessions were devoted to the D.S.M., the standard reference for mental disorders, which drives research, treatment and insurance decisions.

Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and the chairman of the task force making revisions, said the changes came in response mainly to field trials — real-world studies testing whether newly proposed diagnoses are reliable from one psychiatrist to the next — and also public commentary. “Our intent for disorders that require more evidence is that they be studied further, and that people work with the criteria” and refine them, Dr. Kupfer said…

CBS News

Panel suggests DSM-5 psychiatry manual drops two disorders, keeps new autism definition

Michelle Castillo | May 10, 2012

(CBS News) – A panel of doctors reviewing the much-debated Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) have recommended to drop two controversial diagnoses.

The panel announced that attenuated psychosis syndrome — which identifies people at risk of developing psychosis — and mixed anxiety depressive disorder — a diagnosis which combines both anxiety and depression — should not be included in the manual’s upcoming version, the New York Times reported.

Proposed changes to autism definition may mean new diagnoses for people with Asperger’s

However, a controversial definition for autism, which will delete diagnoses for Asperger’s syndrome and pervasive developmental disorder and combine severe cases into the broader definition of autism, will remain…

MedPage Today

Autism Criteria Critics Blasted by DSM-5 Leader

John Gever, Senior Editor | May 08, 2012

PHILADELPHIA — The head of the American Psychiatric Association committee rewriting the diagnostic criteria for autism spectrum disorders took on the panel’s critics here, accusing them of bad science.

Susan Swedo, MD, of the National Institute of Mental Health, said a review released earlier this year by Yale University researchers was seriously flawed. That review triggered a wave of headlines indicating that large numbers of autism spectrum patients could lose their diagnoses and hence access to services…

Nature

Psychosis risk syndrome excluded from DSM-5

Benefits of catching psychosis early are deemed to come at too high a price.

Amy Max | May 9, 2012

A controversial category of mental illness will not be included in the revised fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association (APA) has said. Attenuated psychosis syndrome, also known as psychosis risk syndrome, had been intended mainly for young adults who have heard whispers in their heads, viewed objects as threatening or suffered other subtly psychotic symptoms…

Scientific American Blogs

Trouble at the Heart of Psychiatry’s Revised Rule Book

Ingrid Wickelgren | May 9, 2012

Part 3 in a series

Huffington Post | Allen Frances Blog

Psychiatric Mislabeling Is Bad for Your Mental Health

Allen Frances, MD | May 9, 2012

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

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

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

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

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

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

PLoS Blogs

Speaking of Medicine

Conflicts of interest and DSM-5: the media reaction

Clare Weaver | March 26, 2012

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

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

Read full post

Psychiatric Times

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

      Commentary Takes Issue with Criticism of New Autism Definition

APA Rebuts Study on Autism

DSM-5 Experts Call Study Flawed

Laurie Martin, Web Editor | 30 March 2012

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

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

Read full article by Laurie Martin, Web Editor

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

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

The Sun Interview

March 2012

Side Effects May Include

Christopher Lane On What’s Wrong With Modern Psychiatry

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

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

Read Arnie Cooper interview with Christopher Lane

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

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

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

Update @ March 20, 2012

Medscape Medical News > Psychiatry

APA Criticized Over DSM-5 Panel Members’ Industry Ties

Megan Brooks | March 20, 2012

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

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

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

Read on

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

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

Frances asks:

Am I A Dangerous Man?

No, but I do raise twelve dangerous questions

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

published in response to:

TIME Magazine

What Counts As Crazy?

John Cloud | Online March 14, 2012

Print edition | March 19, 2012

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

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

Full article available to subscribers

Pharmalot

Should APA Purge DSM Panels With Pharma Ties?

Ed Silverman | March 15, 2012

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

Read on

Statement from John M. Oldham, M.D.

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

Read Dr Oldham’s statement here in PDF format:

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

or full text below:

March 15, 2012

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

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

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

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

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

• 7 percent reported receiving honoraria.

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

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

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

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

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

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

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

Or open     PDF here

Long article from Sandra G. Boodman for Washington Post

Antipsychotic drugs grow more popular for patients without mental illness

Sandra G. Boodman | March 12, 2012

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

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

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

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

Read on

Financial Times

New autism diagnostic criteria may encourage symptomatic approach to drug use

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

MedPage Today

DSM-5 Critics Pump Up the Volume

John Gever, Senior Editor | February 29, 2012

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

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

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

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

Read full Medpage Today article

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

    PDF

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

Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

Post #141 Shortlink: http://wp.me/pKrrB-1TL

On February 9, psychiatrist, Prof Nick Craddock, and psychologist, Prof Peter Kinderman, discussed the implications of proposals for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) at a Science Media Centre press briefing for invited journalists.

There has been significant UK and international media interest in mental health professionals’ concerns for a range of controversial proposals for DSM-5. Press coverage is being collated in this Dx Revision Watch post:

Media coverage of UK concerns over DSM-5 (Science Media Centre press briefing)

Commentaries from Allen Frances, MD, today, on Huffington Post:

Can the Press Save DSM 5 from Itself? 

“…The intense press scrutiny of DSM 5 is really just beginning. I know of at least 10 additional reporters who are preparing their work now for publication in the near future. And many of the journalists whose articles appeared during these last few weeks intend to stay on this story for the duration — at least until DSM 5 is published, and probably beyond. They understand that DSM 5 is a document of great individual and societal consequence — and that its impact and risks need a thorough public airing…”

and Christopher Lane, Ph.D. on Side Effects at Psychology Today

DSM-5 Controversy Is Now Firmly Transatlantic

Why the APA’s lower diagnostic thresholds are causing widespread concern.

“Proposed draft revisions to the DSM, which the American Psychiatric Association recently made available on its website, are stirring major controversy on both sides of the Atlantic…”  Read on

 

Science Media Centre has very kindly given permission to publish, in full, the comments provided by research and clinical professionals for use by the press:

DSM5: New psychiatry bible broadens definitions of mental illness to include normal quirks of personality

10.02.2012

Round-up comments

Tim Carey, Associate Professor at the Centre for Remote Health and Central Australian Mental Health Service, said:

“The DSM does not assist in understanding psychological distress nor in treating it effectively. It does not “carve nature at its joints” as it were. It is a collection of symptom patterns that have no underlying form or structure. It is akin to an anthology of the constellations in the night sky. While it does not assist in understanding or treating psychological distress, it has generated phenomenal revenues for the APA, expanded the market for pharmaceutical companies, assisted in promulgating and maintaining a disease and illness model of psychological suffering, and constrained the focus of research activity. Are these the activities a humane and scientific society should seek to promote?

“The authors of the DSM themselves acknowledge the inadequacy of the DSM diagnostic system.

“On page xxxi of the latest edition of the DSM it states: ‘there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder. There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways’.

“So, according to the DSM authors, the boundaries demarcating ‘schizophrenia’ (for example) don’t separate ‘schizophrenia’ from ‘depression’ (or social phobia or intermittent explosive disorder or post-traumatic stress disorder or …) or (perhaps most importantly) the boundaries don’t separate ‘schizophrenia’ from ‘no schizophrenia’.

“One would have to ask: if the function of creating particular categories is not to separate these categories from each other or from their absence, what exactly are they for?”

David Pilgrim, Professor of Mental Health Policy, University of Central Lancashire, said:

“It’s hard to avoid the conclusion that DSM-5 will help the interests of the drug companies and the wrong-headed belief of some mental health professionals (mainly most psychiatrists, but sadly all too often others as well). Some patients and many relatives also gain some advantages from diagnosis some of the time because it reduces the reality of the complexity of their experiences and their responsibilities within those existential struggles.

“Madness and misery exist but they come in many shapes and sizes and so they need to be appreciated in their very particular biographical and social contexts. At the individual level this should mean replacing diagnoses with tailored formulations, and for research purposes we should be either looking at single symptoms or shared predicaments of those with mental health problems and their significant others. I worry that we risk treating the experience and conduct of people as if they are botanical specimens waiting to be identified and categorised in rigid boxes – in my opinion that would itself be a form of collective madness for all those complicit in the continuing pseudo-scientific exercise.”

Dr Felicity Callard, Senior Research Fellow, Service User Research Enterprise, Institute of Psychiatry, King’s College London, said:

“The ongoing chaos surrounding the development of DSM-5 has intensified rather than lessened fears that this project is ill-conceived and founded on a weak evidence base. People’s lives can be altered profoundly – and, we should bear in mind, sometimes ruinously – by being given a psychiatric diagnosis. In my opinion, that the architects of DSM-5 are pressing on with such a flawed framework undermines their claim that they wish to produce a DSM that is ‘useful to all health professionals, researchers and patients’.”

Dr Paul Keedwell, Honorary Consultant Psychiatrist and Clinical Lecturer in the Neurobiology of Mood Disorders, Cardiff University, said:

“New findings arising from genetics and brain imaging studies hint at biological mechanisms, and challenge the way we classify disorders: syndromes (like bipolar and unipolar depression) might merge, while others (like “the schizophrenias”) might diverge. However a few more decades will pass before we radically change our existing classifications.

“Where the proposed DSMV is particularly controversial is in its addition of more disorders, like “Apathy Syndrome” and “Disruptive Mood Dysregulation Disorder”, which suggest a worrying trend toward medicalising normal variation in behaviour.

“Every new diagnosis implies a new treatment, suiting vested interests in the health industry. Nothing should enter the final version of DSMV without sound research evidence of the need for professionals to intervene.

“Also, every mental health professional should remember that classification systems are a guide to diagnosis only: they do not necessarily map on to the complex needs of an individual in real practice, and they are definitely not a guide to treatment.”

Allen Frances, Emeritus Professor at Duke University and Chair of the DSM-4 Steering Committee, said:

“DSM 5 will radically and recklessly expand the boundaries of psychiatry by introducing many new diagnoses and lowering the thresholds for existing ones. As an unintended consequence, many millions of people will receive inaccurate diagnosis and inappropriate treatment. Costs include: the side effects and complications of unnecessary medication; the perverse misallocation of scarce mental health resources toward those who don’t really need them (and may actually be harmed) and away from those who do most desperately require help; stigma; a medicalization of normality, individual difference, and criminality; and a reduced sense of personal responsibility. The publication of DSM 5 should be delayed until it can be subjected to a rigorous and independent review, using the methods of evidence based medicine, and meant to ensure that it is both safe and scientifically sound. New diagnoses can be as dangerous as new drugs and require a much more careful and inclusive vetting than has been provided by the American Psychiatric Association. Future revisions of psychiatric diagnosis can no longer be left to the sole responsibility of just one professional organization.”

David Elkins, Professor Emeritus of Psychology, Pepperdine University, Los Angeles, and Chair of the Division 32 Task Force for DSM-5 Reform, said:

“My committee and I remain very concerned the DSM-5, as currently proposed, could result in the widespread misdiagnosis of hundreds of thousands of individuals whose behaviour is within the continuum of normal variation. If this occurs, it means these individuals will be labelled with a mental disorder for life and many will be treated with powerful psychiatric drugs that can have dangerous side effects.

“We are also alarmed that the DSM-5 Task Force seems unresponsive to the concerns of thousands of mental health professionals and dozens of mental health associations from around the world.

“My committee recently asked the DSM-5 Task Force to submit the controversial proposals for review by an outside, independent group of scientists and scholars. Our request was denied.

“My committee launched the Open Letter/Petition Website which has now gathered more than 11, 000 individual signatures and endorsements from more than 40 from mental health associations including 13 other Divisions of the American Psychological Association.”

Dr Kevin Morgan, Senior Lecturer, Department of Psychology, University of Westminster, said:

“The proposed revisions to the diagnosis of schizophrenia i.e. the elimination of subtypes and the use instead of symptom dimensions, is an example of how DSM5 may prove to be more clinically beneficial than the current version of the manual. I wait with great interest to see the final agreed set of changes.”

Til Wykes, Professor of Clinical Psychology and Rehabilitation, Institute of Psychiatry, Kings College London, said:

“The proposals in DSM 5 are likely to shrink the pool of normality to a puddle with more and more people being given a diagnosis of mental illness. This may be driven by a health care system that reimburses only if the individual being treated has a recognised diagnosis – one in the DS manual. Luckily in the UK we have the NHS which treats people on the basis of need, not if they fit a diagnostic system.

“It isn’t just a health care system that is subverted by the spreading of diagnostic labels into normality, research will also be changed. Most research studies that reach the widest readership get published in US journals which will expect these diagnostic labels to have been used.

“We shouldn’t use labels unless we are clear they have some benefit. Saying someone is at risk of a mental illness (in some categories of DSM5) puts a lot of pressure on the individual and their family. When we do not have a good enough prediction mechanism, this is too high a burden.”

Dr David Harper, Reader in Clinical Psychology, University of East London, said:

“The American Psychiatric Association’s revisions of the DSM have become as regular as updates for Microsoft Windows and about as much use. It has facilitated an increasing medicalisation of life (the number of disorders the DSM covers has increased exponentially from its first edition in 1952 to 357 in 2000) and is hugely costly (the text revision of DSM IV made $44m in revenue between 2000 and 2006). The problem is not simply the revisions proposed in DSM 5 but the idea that psychological distress matches its diagnostic categories – people’s experiences of distress cluster in an entirely different manner. This is why most people end up with more than one diagnosis, why the ‘not otherwise specified’ category is massively over-used and why ratings of agreement between psychiatrists continue to be poor. The DSM represents a massive failure of imagination: most clinicians and researchers know the system is flawed but try to convince themselves, despite the evidence, that it aids communication, research and treatment. It does not. The frustrating thing is that there are other viable alternatives – for example, a focus on homogenous experiences of distress would aid research, the use of case formulation would aid treatment. Unfortunately, the pharmaceutical industry can see little profit in either alternative and, instead, continue to swing their considerable weight behind the DSM.”

Richard Bentall, Chair of Clinical Psychology at the University of Bangor, said:

“I share the widespread concerns about the proposed revisions to the DSM diagnostic system. Like earlier editions, this version of the manual is not based on coherent research into the causes or nature of mental illness. For example, it treats ‘schizophrenia’ and ‘bipolar disorder’ as separate conditions despite evidence that this is, at best, an over-simplification. It also looks set to widen some of the diagnostic criteria, for example by removing the grief exclusion from major depression, and by expanding the range of psychotic disorders to include an ‘attenuated psychosis syndrome’ (my own research on this, in press, shows that only about 10% of people meeting the attenuated or prodromal psychosis criteria are likely to go on to develop a full-blown psychotic illness). As there is no obvious scientific added value compared to DSM-IV, and as there are some obvious risks associated with this expansion of diagnostic boundaries, one is bound to ask why there is a need for this revision, or who will benefit from it. It seems likely that the main beneficiaries will be mental health practitioners seeking to justify expanding practices, and pharmaceutical companies looking for new markets for their products.”

Dr Lucy Johnstone, Consultant Clinical Psychologist, Cwm Taf Health Board, Mid Glamorgan, South Wales, said:

“The DSM debate is all about how we understand mental distress. DSM and the proposed revisions are based on the assumption that mental distress is best understood as an illness, mainly caused by genetic or biochemical factors. It is important to realise that, with the exception of a few conditions such as dementia, there is no firm evidence to support this. On the contrary, the strongest evidence is about psychological and social factors such as trauma, loss, poverty and discrimination. In other words, even the more extreme forms of distress are ultimately a response to life problems. We need a paradigm shift in the way we understand mental health problems. DSM cannot be reformed – it is based on fundamentally wrong principles and should be abandoned.”

Dr Warren Mansell, Reader in Psychology & Clinical Psychologist, University of Manchester, said:

“Contemporary research across genetics, neuroscience, psychology and culture all point to the fact that the majority of psychiatric disorders share the same underlying processes and are treated by very similar interventions. Therefore in further emphasising different categories of mental health problems, DSM5 is heading in completely the opposite direction from the most pioneering research across the field of mental health.”

Simon Wessely, Professor of Epidemiological and Liaison Psychiatry at the Institute of Psychiatry, King’s College London:

“We need to be very careful before further broadening the boundaries of illness and disorder. Back in 1840 the Census of the United States included just one category for mental disorder. By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision. Do we really need all these labels? Probably not. And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.”

Professor Sue Bailey, President of the Royal College of Psychiatrists, said:

“We recognise the importance of accurate and prompt diagnosis in psychiatry. The classification system used in NHS hospitals and referred to by UK psychiatrists is the World Health Organisation’s International Classification of Disease (ICD). Therefore, the publication of DSM-V will not directly affect diagnosis of mental illness in our health service.”

The British Psychological Society has released a statement on the DSM-5 which can be found here: BPS Statement on DSM-5

* The fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be published in May 2013 by the American Psychiatric Association.

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

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.orgwww.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

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