DSM-5 controversy: Lane on “SAD”, Frances Follows the Money, Spitzer et al on Kappa reliability

June 12, 2012 by

DSM-5 controversy round up:

Lane on “SAD”; Frances “Follows the Money”; Spitzer et al on Kappa reliability; A Closer Look at Pending Changes to the Future of Psychiatric Diagnosis June issue The Journal of Nervous and Mental Disease

Post #178 Shortlink: http://wp.me/pKrrB-2em

Side Effects at Psychology Today

From quirky to serious, trends in psychology and psychiatry.

Christopher Lane, Ph.D. | June 11, 2012

Naming an Ailment: The Case of Social Anxiety Disorder”

“Social phobia” vs. “Social anxiety disorder”: What’s in a name?

…“Using data collected from a telephone survey of residents of New York State,” the letter writers continue, “we investigated whether the disorder name affects the perceived need for treatment. Random-digit dialing was used to obtain phone numbers … In total, 806 people participated.”

“Respondents heard a brief vignette describing a person who experiences discomfort in social situations and often avoids social events. These symptoms were labeled as either social phobia or social anxiety disorder, and respondents indicated whether the person should seek mental health treatment.”

The results are dubious to say the least…

Read full commentary

Psychology Today

DSM 5 in Distress | Allen Frances

Follow The Money
APA puts publishing profits above public trust

Allen Frances MD | June 11, 2012

…APA treats DSM-5 like a valuable publishing property, not as a public trust that importantly impacts on people’s lives and public policy. It is excellent at protecting its “intellectual property” with confidentiality agreements and at protecting its trademark and copyright with bullying threats of law suits. But APA has been sadly incompetent and wildly profligate in the day-to-day work of actually producing a safe and scientifically sound DSM-5.

Dr Scully is asking us to believe ten very unbelievable things. My view – if you want to understand why an unreliable and unsafe DSM-5 is being rushed prematurely to market – is to “follow the money…”

Read full commentary at DSM-5 in Distress

Newswire

http://ajp.psychiatryonline.org/article.aspx?articleid=1109031

The American Journal of Psychiatry, VOL. 169, No. 5

Letters to the Editor | May 01, 2012

Standards for DSM-5 Reliability

Robert L. Spitzer, M.D.; Janet B.W. Williams, Ph.D.; Jean Endicott, Ph.D.
Princeton, N.J. New York City

Am J Psychiatry 2012;169:537-537. 10.1176/appi.ajp.2012.12010083

TO THE EDITOR: In the January issue of the Journal, Helena Chmura Kraemer, Ph.D., and colleagues (1) ask, in anticipation of the results of the DSM-5 field trial reliability study, how much reliability is reasonable to expect. They argue that standards for interpreting kappa reliability, which have been widely accepted by psychiatric researchers, are unrealistically high…

A Closer Look at Pending Changes to the Future of Psychiatric Diagnosis

Released: 6/7/2012 9:00 AM EDT
Source: Wolters Kluwer Health: Lippincott Williams & Wilkins

Articles Have Potential to Affect Final DSM-5 Standards as Public comment Period Ends

Newswise — New York, NY (June 7, 2012) – The June issue of The Journal of Nervous and Mental Disease (JNMD) features a special section focused on the impending release of the revised Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an update to psychiatric diagnosis standards. JNMD is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

The Journal of Nervous and Mental Disease Editor-in-Chief John A. Talbott, MD, (a past APA president and DSM-III collaborator) comments in his editorial, “The timing of this special section on DSM-5, therefore, is particularly auspicious because it provides the potential for these articles to affect the final DSM-5 decisions.” The DSM-5 manual, currently scheduled for publication in May 2013, is going through its final public comment period through June 15, 2012.

Many articles within the section present criticisms of DSM-5 proposals. Specifically, several authors worry that the new DSM-5 standards may open up more opportunities for false-positives – a doctor diagnosing a condition when it is not present, or providing medication when it is not needed.

• “Diagnostic Inflation: Causes and Suggested Cure” by Batstra and Frances displays the authors’ concern that the proposed changes to DSM-5 will result in diagnostic inflation and inappropriate use of medication. They suggest “stepped diagnosis,” which includes a watch-and-wait period before beginning medication, to combat false-positives.

• In “Recurrence of Bereavement-Related Depression: Evidence for the Validity of the DSM-IV Bereavement Exclusion From the Epidemiological Catchment Area Study,” Wakefield and Schmitz contend that the DSM-5 proposal to remove the bereavement exclusion from the definition of a major depressive episode would cause those who are experiencing normal grief after the death of a loved one to be mislabeled as clinically depressed.

Other articles respond to DSM-5 proposals to include new disorders and diagnostic constructs. For example, DSM-5 proposes to reclassify pathological gambling as a behavioral addiction, which may pave the way for other excessive behaviors to be included in this construct in the future.

• Mihordin takes a look at the potential consequences of this change in his article, “Behavioral Addiction V Quo Vadis?” in which he presents hypothetical criteria for the diagnosis of pathological model railroading disorder.

• Good and Burstein respond to the DSM-5 proposal to include a hebephilic subtype to the diagnosis of pedophilia in “Hebephilia and the Construction of a Fictitious Diagnosis”. Additionally, Wakefield examines two DSM-5 proposals on classifying pathological forms of grief as mental disorders in “Should Prolonged Grief Be Reclassified as a Mental Disorder in DSM-5? Reconsidering the Empirical and Conceptual Arguments for Complicated Grief Disorder.”

Included in the special section, “Psychotropic Marketing Practices and Problems: Implication for DSM-5” by Raven and Perry looks at how certain aspects of DSM-5 could be used by the pharmaceutical industry as marketing tools, especially with a wider customer base resulting from false-positive patients. In “A Critique of the DSM-5 Field Trials,” Jones examines problems that may have compromised the usefulness of the DSM-5 field trials.

It is important to note that the articles in the special section of JNMD were written at various points since February 2010 based on the criteria sets posted on the DSM-5 website. Many of these criteria sets have been updated since their initial posting. “Thus, the critiques of certain proposals contained in these articles may no longer be fully relevant to what is actually being proposed for DSM-5,” Dr. Talbott states in his editorial. Visit the DSM-5 website at http://www.dsm5.org/  for the most accurate information on what is being considered for inclusion in DSM-5.

# # #

About The Journal of Nervous and Mental Disease
Founded in 1874, The Journal of Nervous and Mental Disease is the world’s oldest, continuously published independent scientific monthly in the field of human behavior. Articles cover theory, etiology, therapy, social impact of illness, and research methods

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

American Psychiatric Association (APA) Assembly Notes and Full Treasurer’s Report

May 29, 2012 by

American Psychiatric Association (APA) Assembly Notes and Full Treasurer’s Report

Post #174 Shortlink: http://wp.me/pKrrB-2bX

Update @ June 1, 2012

James H. Scully, Jr., M.D., CEO and Medical Director of the American Psychiatric Association, has published a response to Allen Frances’ Huff Po blog of May 30:

DSM-5 Inaccuracies: Setting the Record Straight

Update @ May 30, 2012

1 Boring Old Man

reform, or accept your fate…

1 Boring Old Man | May, 30 2012

Huffington Post Blogs Allen Frances, MD

DSM-5 Costs $25 Million, Putting APA in a Financial Hole

Allen Frances | May 30, 2012

The American Psychiatric Association just reported a surprisingly large yearly deficit of $350,000. This was caused by reduced publishing profits, poor attendance at its annual meeting, rapidly declining membership, and wasteful spending on DSM-5. APA reserves are now below “the recommended amount for a non-profit (reserves equal to a year’s operating expenses).”

APA has already spent an astounding $25 million on DSM-5. I can’t imagine where all that money went. As I recall it, DSM-IV cost about $5 million, and more than half of this came from outside research grants. Even if the DSM-5 product were made of gold instead of lead, $25 million would be wildly out of proportion. The rampant disorganization of DSM-5 must have caused colossal waste. One obvious example is the $3 million spent on the useless DSM-5 field trial, with its irrelevant question, poorly conceived design, and embarrassing results…

Full commentary

On May 8, in an article for Medscape Medical News, Deborah Brauser reported:

     …Members of the task force said they hope to publish the full results [of the DSM-5 field trials] “within a month.” However, the third and final public comment period for the manual opened last week and ends on June 15. Although the entire period is 6 weeks long, the public may only have 2 weeks to comment after the publication of the field trials’ findings. DSM-5 Field Trials Generate Mixed Results

With less than three weeks to go before the stakeholder and public comment period closes, there is still no sign of a report on the DSM-5 field trials.

If the Task Force does not get a report out soon, stakeholders will be obliged to submit feedback without the benefit of data from the trials to inform their comments. Once again, this third and final stakeholder review smacks of a purely tokenistic exercise.

For the two previous draft reviews, some disorders were accompanied by PDF documents expanding on new and revised disorder descriptions and work group rationales.

For the Somatic Symptom Disorders, no updated “Disorder Descriptions” or “Rationale/Validity” documents have been published that reflect substantial revisions made to proposals and criteria between the second and third drafts. The documents as published for the second review have been taken down from the DSM-5 Development site but have not been revised and reissued.

I have twice contacted APA Media and Communications for clarification of whether the Work Group intends to publish revised documents before the end of the comment period. Evidently APA Media and Communications don’t wish to provide me with a response.

 

I will update if and when a report on the field trials emerges from the Task Force.

In the meantime, here are two public domain documents that may be of interest to APA watchers:

APA Assembly Notes Spring 2012

or download here:

http://alabamapsych.org/wp-content/uploads/2012/02/apa_assembly_notes_may_2012.pdf

APA Treasurer’s Report May 2012  [.ppt compatible PowerPoint reader required]

or view here:

https://docs.google.com/file/d/0BzWdENl1wkVSYk5aXzRZelFYUjA/edit?pli=1

Filed under American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, Darrel Regier, David Kupfer, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 third draft, DSM-5 timeline Tagged with , , , , , , , , ,

DSM-5 Somatic Symptom Disorders: Differences between second and third draft for CSSD

May 9, 2012 by

DSM-5 Somatic Symptom Disorders: Differences between second and third draft for CSSD

Post #168 Shortlink: http://wp.me/pKrrB-27y

A reminder that the third and final DSM-5 comment period closes on June 15 and that I am collating submissions on this site.

Comments are open to professional and lay stakeholders. Please alert clinicians, researchers, allied health professionals, social workers, lawyers, educationalists, therapists, patient advocacy groups to these proposals.

Full proposals, criteria and rationales for the Somatic Symptom Disorders are set out in this post:

DSM-5 proposals for Somatoform Disorders revised on April 27, 2012

According to DSM-5 Task Force Chair, David Kupfer, MD, “After the comment period closes, visitors will no longer be able to submit feedback through the site, and the site will not reflect any further revisions to the draft manual in anticipation of its publication in May 2013. However, the site will remain live and viewable.”

 

Somatic Symptom Disorders Work Group proposals:

Two PDF Disorder Descriptions and Rationale/Validity Propositions PDF documents had accompanied the first and second drafts. There are no revised PDFs reflecting the most recent proposals available on the DSM-5 Development website and the documents published with the second draft have been removed.

I have asked the APA’s Media and Communications Office to clarify whether the Somatic Symptom Disorder Work Group intends to publish revised Disorder Descriptions or Rationale/Validity Propositions documents during the life of the stakeholder review period or whether these documents are being dispensed with for this third draft.

Should updated documents be added to the site during the comment period I will post links.

 

Notes on differences between the second and third draft proposals for CSSD

As with the first and second drafts, the intention remains to rename the Somatoform Disorders section to Somatic Symptom Disorders.

The proposal continues to combine the existing DSM-IV categories:

Somatization Disorder
Hypochondriasis
Undifferentiated Somatoform Disorder
Pain Disorder

into a single new category, Somatic Symptom Disorder.

For the second draft, the work group had suggested two separate diagnoses, Complex Somatic Symptom Disorder CSSD) and Simple Somatic Symptom Disorder (SSSD).

Following evaluation of the results of the DSM-5 field trials, the Somatic Symptom Disorders Work Group has decided that Simple Somatic Symptom Disorder  is “a less severe variant of CSSD.”

The Work Group now proposes merging CSSD and SSSD into a single category called Somatic Symptom Disorder (SSD) and is suggesting dropping the word “Complex” from the category term.

The latest proposed category names for the revision of the DSM-IV’s Somatoform Disorders now look like this:

Somatic Symptom Disorders

J 00 Somatic Symptom Disorder – with the option for specifying:

Mild Somatic Symptom Disorder
Moderate Somatic Symptom Disorder
Severe Somatic Symptom Disorder

J 01 Illness Anxiety Disorder |
J 02 Conversion Disorder (Functional Neurological Symptom Disorder) |
J 03 Psychological Factors Affecting Medical Condition |
J 04 Factitious Disorder |
J 05 Somatic Symptom Disorder Not Elsewhere Classified |

Revised Criteria, Rationale and Severity texts for the above can be found at the links above or on this webpage:

http://www.dsm5.org/ProposedRevision/Pages/SomaticSymptomDisorders.aspx

These are the criteria for J00 Somatic Symptom Disorder

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=368

J 00 Somatic Symptom Disorder

Updated April-27-2012

Proposed Revision

Somatic Symptom Disorder

Note that the criteria for CSSD in the previous draft, released in May 2011, had read:

“B. Excessive thoughts, feelings, and behaviors related to these somatic symptoms or associated health concerns: At least two of the following must be present.”

But for the third draft, this has been reduced to

“B. Excessive thoughts, feelings, and behaviors related to these somatic symptoms or associated health concerns: At least one of the following must be present.”

This is presumably to accommodate Simple Somatic Symptom Disorder within what had been the criteria for CSSD.

(Last year, for the second draft, the criteria for CSSD had required two from (1), (2) and (3) and a symptom duration of greater than 6 months, whereas the criteria for SSSD had required only one from (1), (2) and (3) and a symptom duration of greater than one month.)

 

Note also that the option for three Severity Specifiers for J00 Somatic Symptom Disorder category: Mild, Moderate, Severe, might potentially be intended to correspond to three newly proposed categories in the ICD-11 Chapter 5: Somatoform Disorders section.

In the ICD-11 Alpha drafting platform (which is a work in progress and comes with caveats), the Somatoform Disorders categories are currently proposed to be renamed to Bodily Distress Disorders. There are three new categories listed:

6R0 Mild bodily distress disorder
6R1 Moderate bodily distress disorder
6R2 Severe bodily distress disorder

These three new category suggestions have no definitions or descriptive parameters visible in the ICD-11 Alpha draft so it isn’t possible to determine at this stage what disorders these newly suggested terms might be intended to capture; nor how they would relate to the existing somatoform disorders categories that still remain listed beneath them in this section of the Alpha draft.

For comparison, this is how the corresponding section of ICD-11 categories currently displays:

ICD-11 Alpha draft:

BODILY DISTRESS DISORDERS [Formerly Somatoform Disorders]

6R0 Mild bodily distress disorder
6R1 Moderate bodily distress disorder
6R2 Severe bodily distress disorder
6R3 Somatization disorder
6R4 Undifferentiated somatoform disorder
6R5 Somatoform autonomic dysfunction
6R6 Persistent somatoform pain disorder
     6R6.1 Persistent somatoform pain disorder
     6R6.2 Chronic pain disorder with somatic and psychological factors [not in ICD-10]
6R7 Other somatoform disorders
6R8 Somatoform disorder, unspecified

Hypochondriacal disorder [ICD-10: F45.2] is currently listed in ICD-11 Chapter 5 as Illness Anxiety Disorder under 6L5 ANXIETY AND FEAR-RELATED DISORDERS > 6L5.6 Illness Anxiety Disorder.

Dissociative (Conversion disorders) [ICD-10: F44] is currently listed in ICD-11 Chapter 5 under Neurotic, stress-related and somatoform disorders > 7A5 Dissociative [conversion] disorders.

There had been discussions by the SSD and Dissociative Disorders work groups for potentially locating Conversion Disorder under the DSM-5 Dissociative Disorders section, for congruency with its location within ICD-10.

For the third draft, it appears that the groups with oversight of the revision of conversion disorder have decided that this category should be renamed to Conversion Disorder (Functional Neurological Symptom Disorder) and classified as a Somatic Symptom Disorder.

In a future post, for ease of comparison, I will post a table comparing DSM-5 third draft proposals with current listings for ICD-11.

 

Links:

1] Somatic Symptom Disorders Third draft proposals:
http://www.dsm5.org/ProposedRevision/Pages/SomaticSymptomDisorders.aspx

2] Bodily Distress Disorders” to replace “Somatoform Disorders” for ICD-11?
http://wp.me/pKrrB-1Vx

3] DSM-5 proposals for Somatoform Disorders revised on April 27, 2012
http://wp.me/pKrrB-24D

4] Submissions to SSD Work Group May 2011 are archived here:
http://wp.me/PKrrB-19a

5] Submissions to SSD Work Group May 2012 are being collated here:
http://wp.me/PKrrB-1Ol

Filed under Bodily Distress Disorders, DSM revision process, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, DSM-5 third draft, ICD-11 Alpha Draft, Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , , ,

More Kappa data from DSM-5 field trials

May 9, 2012 by

More Kappa data from DSM-5 field trials

Post #167 Shortlink: http://wp.me/pKrrB-27D

Further data from the DSM-5 field trials results have been released in a report by Deborah Brauser for Medscape Medical News.

You can read Ms Brauser’s report from the American Psychiatric Association’s annual conference here, though you may need to register for the site:

Medscape Medical News > Psychiatry

DSM-5 Field Trials Generate Mixed Results

Deborah Brauser | May 8, 2012

…Members of the task force said they hope to publish the full results “within a month.” However, the third and final public comment period for the manual opened last week and ends on June 15. Although the entire period is 6 weeks long, the public may only have 2 weeks to comment after the publication of the field trials’ findings.

…“No previous field trial had such a sophisticated design. And it has resulted in more statistically significant data for specific disorders,” said Dr. Regier.

The current DSM-5 field trials, as well as field trials for past manuals, use Kappa score as a statistical measure of criteria reliability. A Kappa score of 1.0 was considered perfect, a score of greater than .8 was considered almost perfect, a score of .6 to .8 was considered good to very good, a score of .4 to .6 was considered moderate, a score of .2 to .4 was considered fair and could be accepted, and a score of less than .2 was considered poor.

 At adult sites, schizophrenia was shown to have a pooled Kappa score of .46. However, that is down from the .76 and .81 Kappa scores found in the DSM-IV and DSM-III, respectively, and it is less than the .79 score found in the International Classification of Diseases, Tenth Revision (ICD-10).

“It’s important to realize in some ways that the Kappa in the current field trial was from a totally different design…,” said Dr. Regier

Full report

This table has some of the results:


Reconstructed from data published by A Frances, DSM 5 in Distress, Psychology Today, 05.06.12

 

1 Boring Old Man has updated an earlier table here on his blog which incorporates additional data from the Medscape report: 

updated table
1 Boring Old Man | May 9, 2012

There are further, detailed commentaries from 1 boring old man on the DSM-5 field trial results and Kappa values here:

major depressive disorder κ=0.30?…     May 6, 2012

a fork in the road…     May 7, 2012

Village Consumed by Deadly Storm…     May 8, 2012

box scores and kappa…     May 8, 2012

Included in Ms Brauser’s report are data for “Complex somatic disorder”:

The field trials for the new proposed category Complex Somatic Symptom Disorder (CSSD) were held at Mayo. According to one of several tables within Ms Brauser’s report, the following data have been released for “Complex somatic disorder” [sic]:

Extract from DSM-5 Field Trials Generate Mixed Results, Deborah Brauser,  May 8, 2012

Disorder DSM-5 (95% CI) DSM-IV ICD-10 DSM-III
Major neurocognitive disorder .78 (.68 – .87) — .66 .91
ASD .69 (.58 – .80) .59 – .85 .77 -.01
PTSD .67 (.59 – .74) .59 .76 .55*
Child ADHD .61 (.51 – .72) .59 .85 .50
Complex somatic disorder .60 (.41 – .78) — .45 .42

CI, confidence interval; ASD, autism spectrum disorder; PTSD, posttraumatic stress disorder; ADHD, attention-deficit/hyperactivity disorder

*From the DSM-III-R.

CSSD is a new category for DSM-5 which redefines and replaces some, but not all of the existing DSM-IVSomatoform Disorders categories under a new rubric with a new definition and criteria.

It’s a mashup of the existing categories:

Somatization Disorder
Hypochondriasis
Undifferentiated Somatoform Disorder
Pain Disorder

Following evaluation of the field trials, this new category, Complex Somatic Symptom Disorder is now proposed to drop the “Complex” descriptor, be named Somatic Symptom Disorder and absorb Simple Somatic Symptom Disorder (SSSD) – a separate diagnosis that had been introduced for the second draft, with criteria requiring fewer symptoms than for a diagnosis of CSSD and shorter chronicity.

In order to accommodate SSSD, criteria and Severity Specifiers for CSSD have been modified since the second draft. (More on this in the next post.)

Since CSSS (or SSD, as is now proposed) did not exist as a category in DSM-IV, or in ICD-10 or DSM-III, it’s unclear and unexplained by the table what data for which existing somatoform disorders have been used for Kappa comparison for this new category with data for ICD-10 and DSM-III, and how meaningful comparison between them would be.

You can find out more about how the field trials were conducted on the DSM-5 Development site.

 

Delay in publication of field trial results and no key documents in support of proposals

Stakeholders may not get to scrutinise a report on the field trials until as late as a couple of weeks before the public comment period closes.

There are no Disorder Descriptions and Rationale/Validity Propositions PDF documents that expand on category descriptions and rationales (at least not for the Somatic Symptom Disorders) and reflect revisions to proposals between the release of the second and third draft.

Yesterday, I contacted APA’s Communications and Media Office to enquire whether the Somatic Symptom Disorders work group intends to publish either a Disorder Descriptions or Rationale/Validity Propositions document, or both, to accompany this latest draft during the life of the stakeholder review period or whether these key documents are being dispensed with for the third draft.

I’ll update if and when APA Media and Communications provides clarification.

 

Related post:

Make Yourself Heard! says DSM-5’s Kupfer – but are they listening?

Filed under Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-5 third draft, Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , , ,

Make Yourself Heard! says DSM-5’s Kupfer – but are they listening?

May 6, 2012 by

Make Yourself Heard! says DSM-5’s Kupfer – but are they listening?

Post #166: Shortlink: http://wp.me/pKrrB-26L

Four further commentaries from 1 boring old man on DSM-5 field trial results and Kappa values:

major depressive disorder κ=0.30?…

May 6, 2012

a fork in the road…

May 7, 2012

Village Consumed by Deadly Storm…

May 8, 2012

box scores and kappa…

May 8, 2012

MedPage Today

Most DSM-5 Revisions Pass Field Trials

John Gever, Senior Editor | May 07, 2012

“…Darrel Regier, MD, the APA’s research director, explained that the trials were intended primarily to establish reliability – that different clinicians using the diagnostic criteria set forth in the proposed revisions would reach the same diagnosis for a given patient. The key reliability measure used in the academic center trials was the so-called intraclass kappa statistic, based on concordance of the “test-retest” results for each patient. It’s calculated from a complicated formula, but the essence is that a kappa value of 0.6 to 0.8 is considered excellent, 0.4 to 0.6 is good, and 0.2 to o.4 “may be acceptable.” Scores below 0.2 are flatly unacceptable.

Kappa values for the dozens of new and revised diagnoses tested ranged from near zero to 0.78. For most common disorders, kappa values from tests conducted in the academic centers were in the “good” range:

Bipolar disorder type I: 0.54
Schizophrenia: 0.46
Schizoaffective disorder: 0.50
Mild traumatic brain injury: 0.46
Borderline personality disorder: 0.58

In the “excellent” range were autism spectrum disorder [0.69], PTSD [0.67], ADHD [0.61], and the top prizewinner, major neurocognitive disorder [better known as dementia], at 0.78. But some fared less well. Criteria for generalized anxiety disorder, for example, came in with a kappa of 0.20. Major depressive disorder in children had a kappa value of 0.29. A major surprise was the 0.32 kappa value for major depressive disorder. The criteria were virtually unchanged from the version in DSM-IV, the current version, which also underwent field trials before they were published in 1994. The kappa value in those trials was 0.59.

But a comparison is not valid, Regier told MedPage Today…”

Read full report

DSM5 in Distress
The DSM’s impact on mental health practice and research.

Newsflash From APA Meeting: DSM 5 Has Flunked its Reliability Tests
Needs To Be Kept Back For Another Year

Allen J. Frances, M.D. | May 6, 2012

“…The results of the DSM 5 field trials are a disgrace to the field. For context, in previous DSM’s, a diagnosis had to have a kappa reliability of about 0.6 or above to be considered acceptable. A reliability of .2-4 has always been considered completely unacceptable, not much above chance agreement…”

Reconstructed from data published by A Frances, DSM 5 in Distress, Psychology Today, 05.06.12

“…No predetermined publication date justifies business as usual in the face of these terrible Field Trial results (which are even more striking since they were obtained in academic settings with trained and skilled interviewers, highly selected patients, and no time pressure. The results in real world settings would be much lower). Reliability this low for so many diagnoses gravely undermines the credibility of DSM 5 as a basis for administrative coding, treatment selection, and clinical research…”

Read full commentary

Scientific American

Field Tests for Revised Psychiatric Guide Reveal Reliability Problems for Two Major Diagnoses

Ferris Jabr | May 6, 2012

“…The kappa for generalized anxiety disorder was about 0.2 and the kappa for major depressive disorder was about 0.3.

“…These numbers are way too low according to the APA’s own scales—and they are much lower than kappas for the disorders in previous versions of the DSM. Regier and other members of the APA emphasized that field trial methodology for the latest edition is far more rigorous than in the past and that kappas for many diagnoses in earlier editions of the DSM were likely inflated. But that doesn’t change the fact that the APA has a problem on its hands: its own data suggests that some of the updated definitions are so flawed that only a minority of psychiatrists reach the same conclusions when using them on the same patient. And the APA has limited time to do something about it…”

“…Until the APA officially publishes the results of the field trials, nobody outside the association can complete a proper analysis. What I have seen so far has convinced me that the association should anticipate even stronger criticism than it has already weathered. In fairness, the APA has made changes to the drafts of the DSM-5 based on earlier critiques. But the drafts are only open to comment for another six weeks. And so far no one outside the APA has had access to the field trial data, which I have no doubt many researchers will seize and scour. I only hope that the flaws they uncover will make the APA look again—and look closer…”

Read full report

Psychiatric News | May 04, 2012
Volume 47 Number 9 page 1a-28
American Psychiatric Association
Professional News

DSM Field Trials Providing Ample Critical Data

David J. Kupfer, M.D.

This article is part a series of commentaries by the chair of the DSM-5 Task Force, which is overseeing the manual’s development. The series will continue until the release of DSM-5 in May 2013.

As of this month, the 12-month countdown to the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) officially begins. While the developers of DSM-5 will continue to face several deadlines over the coming year, the progress that has been made since APA’s 2011 annual meeting has been nothing short of remarkable.

One of the most notable and talked-about recent activities of the DSM revision concerns the implementation and conclusion of the DSM-5 Field Trials, which were designed to study proposed changes to the manual…

Read on

From the same article and note that

“After the comment period closes, visitors will no longer be able to submit feedback through the site, and the site will not reflect any further revisions to the draft manual in anticipation of its publication in May 2013. However, the site will remain live and viewable.”

Make Yourself Heard!

The DSM-5 Web site (www.dsm5.org) is open to a third and final round of feedback. For six weeks, patients and their loved ones, members of the profession, and the general public can submit questions and comments via the Web site. All will be read by members of the appropriate DSM-5 work groups.

A summary of changes made to the draft diagnostic criteria since the last comment period (May-July 2011) will help guide readers to important areas for review, but visitors are encouraged to comment on any aspect of DSM-5. After the comment period closes, visitors will no longer be able to submit feedback through the site, and the site will not reflect any further revisions to the draft manual in anticipation of its publication in May 2013. However, the site will remain live and viewable.

Psychiatrists can use this important opportunity to express their opinions about proposed changes and how they may impact patient care. Since http://www.dsm5.org was first launched in February 2010, the work groups have discussed— and in many cases, implemented draft changes in response to—the feedback received from the site. This final comment period presents a historic opportunity for APA members to take part in the DSM-5 revision process and help impact the way in which psychiatric disorders are diagnosed and classified in the future.

David J. Kupfer, M.D., is chair of the DSM-5 Task Force and a professor of psychiatry at the University of Pittsburgh Medical Center and Western Psychiatric Institute and Clinic.

Commentary on Dr Kupfer’s report from 1 boring old man

self-evident…

I boring old man | May 6,  2012

Further commentary from 1 boring old man on DSM-5 controversy

not a good time…

1 boring old man | May 5, 2012

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

APA Press Release: DSM-5 Draft Criteria Open for Public Comment

May 2, 2012 by

APA Press Release: DSM-5 Draft Criteria Open for Public Comment

Post #164 Shortlink: http://wp.me/pKrrB-20I

Commentaries and media, followed by APA Press Release No. 24

(Not specific to DSM-5 third draft: Ethics complaints filed against APA.)

Psychology Today

Science Isn’t Golden
Matters of the mind and heart

Patients Harmed by Diagnosis Find Their Voices
Victims of psychiatric labeling file ethics complaints.

Paula J. Caplan, Ph.D. | April 28, 2012

The American Psychiatric Association’s 2012 Annual Meeting

This coverage is not sanctioned by, nor a part of, the American Psychiatric Association.

From Medscape Medical News > Conference News
DSM-5 Field Trial Results a Hot Topic at APA 2012 Meeting

Deborah Brauser | May 3, 2012

May 3, 2012 — Telepsychiatry, neuromodulation, the role of genetics, and updates for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are just some of the hot items on the agenda of this year’s American Psychiatric Association’s 2012 Annual Meeting in Philadelphia…

(Not specific to DSM-5 third draft: Letter, AJP re DSM-5 field trial reliability and kappas.)

American Journal of Psychiatry

Letters to the Editor | May 01, 2012
Standards for DSM-5 Reliability

Am J Psychiatry 2012;169:537-537. 10.1176/appi.ajp.2012.12010083

Robert L. Spitzer, M.D.; Janet B.W. Williams, Ph.D.; Jean Endicott, Ph.D.
Princeton, N.J.
New York City

DSM5 in Distress
The DSM’s impact on mental health practice and research.

DSM 5 Rejects ‘Hebephilia’ Except for the Fine Print

Alan Frances MD | May 3, 2012

Scientific American blogs

APA Announces New Changes to Drafts of the DSM-5, Psychiatry’s New “Bible”

Ferris Jabr | May 3, 2012

Observations

Opinion, arguments & analyses from the editors of Scientific American

“…This year, the APA is holding its annual meeting from May 5 to 9 in Philadelphia, where much of the discussion will focus on the drafts of the DSM-5 and the results of “Field Trials”—dry runs of the new diagnostic criteria in clinical settings. I am attending the conference to learn more and, next week, my colleague Ingrid Wickelgren at Scientific American MIND and I will bring you a series of blogs about the DSM-5 authored by ourselves and some well-known researchers and psychiatrists. For the duration of next week, we will also publish my feature article about DSM-5 in its entirety on our website. After next week, you can still read the feature in the May/June issue of MIND. Stay tuned!”

About the Author: Ferris Jabr is an associate editor focusing on neuroscience and psychology.

1 boring old man

1 boring old man | May 3, 2012

the future of an illusion IV½…

and

the future of an illusion IV

1 boring old man | May 2, 2012

Psychology Today | DSM 5 in Distress

Wonderful News: DSM 5 Finally Begins Its Belated and Necessary Retreat
Perhaps this will be the beginning of real reform.

Alan Frances MD | May 2, 2012

MindFreedom International Newswire

Protesters, Rejecting Mental Illness Labels, Vow to “Occupy” the American Psychiatric Association Convention

MindFreedom International
Last modified: 2012-05-01T16:46:46Z
Published: Tuesday, May. 1, 2012 – 9:46 am

PHILADELPHIA, May 1, 2012 — /PRNewswire-USNewswire/ — On Saturday, May 5, 2012, as thousands of psychiatrists congregate for the American Psychiatric Association (APA) Annual Meeting, individuals with psychiatric labels and others will converge in a global campaign to oppose the APA’s proposed new edition of its “bible,” the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scheduled for publication in 2013. Occupy the APA will include distinguished speakers from 10 a.m. to noon at Friends Center (1515 Cherry Street, Philadelphia), and a march at approximately 12:15 p.m. to the Pennsylvania Convention Center (12th and Arch Streets), where the group will protest from approximately 1 p.m. while the APA meets inside…

http://www.psychiatry.org/advocacy–newsroom/newsroom/dsm-5-draft-criteria-open-for-public-comment

Wed May 02, 2012

Contact: For Immediate Release                                  
Eve Herold, 703-907- 8640 Release No. 24
press@psych.org
Erin Connors, 703-907-8562
econnors@psych.org

DSM-5 Draft Criteria Open for Public Comment
Mental health diagnostic manual available for final online comment period

ARLINGTON, Va. (May 2, 2012) – For a third and final time, the American Psychiatric Association (APA) invites public comment on the proposed criteria for the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). DSM is the handbook used by health care professionals as an authoritative guide to the diagnosis of mental disorders.

The public comment period will last six weeks, beginning May 2 and continuing until June 15. All responses submitted via the DSM-5 website will be considered by the DSM-5 Work Groups, which are charged with assessing the latest scientific evidence and recommending the disorder definitions and criteria to be included in the manual. Nearly 10,800 comments from health care professionals, mental health advocates, families and consumers were submitted in the first two public comment periods in 2010 and 2011.

“The comments we have received over the past two years have helped sharpen our focus, not only on the strongest research and clinical evidence to support DSM-5 criteria but on the real-world implications of these changes,” said APA President John M. Oldham, M.D. “We appreciate the public’s interest and continued participation in the DSM-5 development process.”

In preparation for this final comment period, members of the DSM-5 Task Force and Work Groups have updated their proposals for diagnostic criteria. The revised criteria reflect recently published research, results from DSM-5 field testing of the criteria and public comments received since 2010.

Key changes posted for this round of public review include:

• Revised proposals to place Attenuated Psychosis Syndrome and Mixed Anxiety Depressive Disorder in Section III of the manual, covering conditions that require further research before their consideration as formal disorders

•  Added language to Major Depressive Disorder criteria to help differentiate between normal bereavement associated with a significant loss and a diagnosis of a mental disorder

• Added rationale for changes to Personality Disorders, with field trial data now supporting the reliability of dimensional measures and the categorical diagnosis of Borderline Personality Disorder

• Modified diagnostic criteria for Pedophilic Disorder to make the category more consistent with the World Health Organization’s International Classification of Diseases

• Condensed diagnoses within Communication Disorders to only include Language Disorders and Speech Disorders

• A proposal for a new diagnosis of Suicidal Behavioral Disorder

• Modified diagnostic criteria for numerous disorders, including some in the Neurocognitive Disorders and Anxiety Disorders chapters

• A proposed Cultural Formulation Interview, which includes specific questions to help clinicians more effectively assess cultural aspects of psychiatric diagnosis

• A detailed list of changes made to draft proposals since July 2011 can be found on www.DSM5.org .

Revisions to DSM reflect scientific advances in the field and new knowledge gained since the last manual was published in 1994. Since 1999, more than 500 mental health and medical researchers and clinicians from the United States and abroad have been involved in the planning, review and deliberations for DSM-5. Field trials in both large academic medical centers and routine clinical practices have tested select criteria.

Feedback to the proposed diagnostic criteria can be submitted through www.DSM5.org , which will be available until the comment period ends June 15. After that, the site will remain viewable but will be closed to comments as the Work Groups and Task Force complete revisions and submit criteria for evaluation by the Scientific Review Committee and the Clinical and Public Health Committee. The Task Force will then make final recommendations to the APA Board of Trustees. The final version of DSM-5 is expected to go before the Board of Trustees in December 2012.

“As with every stage in this thorough development process, DSM-5 is benefiting from a depth of research, expertise and diverse opinion that will ultimately strengthen the final document,” noted David J. Kupfer, M.D., chair of the DSM-5 Task Force.

Publication of DSM-5 is expected in May 2013.

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.psychiatry.org  and www.HealthyMinds.org .

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

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