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

April 27, 2012 by

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

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

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

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

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

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

Review Part One

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

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

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

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

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

      The six most essential questions Part 1

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

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

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

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

Abstract

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

General Introduction

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

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

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

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

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

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

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

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

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

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

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

Full document in PDF format

 

Review Part Two

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

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

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

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

Published: 18 April 2012

      The six most essential questions Part 2 Provisional

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

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

Abstract (provisional)

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

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

 

Symposium on DSM-5: Parts 1 and 2

      Bulletin Vol 17 No 1

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

      Bulletin Vol 17 No 2

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

 

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

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

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

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

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

Bulletin Vol 17 No 1, Page 19:

Doing No Harm: The Case Against Conservatism

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

Department of Psychiatry, University of Vermont College of Medicine

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

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

April 8, 2012 by

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

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

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

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

I will update as more information becomes available.

DSM-5

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

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

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

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

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

DSM-5 is slated for publication in May 2013.

Extract from revised Timeline

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

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

 

ICD-11

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

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

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

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

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

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

ICD-11 Alpha Browser User Guide here.

Foundation view here.

Linearization view here.

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

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

 

ICD-10-CM

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

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

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

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

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

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

 

Related information:

DSM-5 Development

ICD-11 Revision

ICD10 Watch

Federal Register

CMS Latest News

DHHS Newsroom

ICD-10-CM CDC Site

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

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

April 2, 2012 by

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

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

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

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

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

PLoS Blogs

Speaking of Medicine

Conflicts of interest and DSM-5: the media reaction

Clare Weaver | March 26, 2012

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

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

Read full post

Psychiatric Times

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

      Commentary Takes Issue with Criticism of New Autism Definition

APA Rebuts Study on Autism

DSM-5 Experts Call Study Flawed

Laurie Martin, Web Editor | 30 March 2012

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

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

Read full article by Laurie Martin, Web Editor

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

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

The Sun Interview

March 2012

Side Effects May Include

Christopher Lane On What’s Wrong With Modern Psychiatry

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

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

Read Arnie Cooper interview with Christopher Lane

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

Part Two: William Heisel: Slap: American Psychiatric Association Targets One DSM5 Critic, Ignores Others

February 29, 2012 by

Part Two: William Heisel: Slap: American Psychiatric Association Targets One DSM5 Critic, Ignores Others

Post #150 Shortlink: http://wp.me/pKrrB-1Z6

Update @ March 1, 2012

Additional commentary:

Neurobonkers, March 1, 2012

APA Shut Down DSM-5 Blogger

—————-

Knight Science Journal Tracker, Paul Raeburn, March 1, 2012

Psychiatrists issue legal threat, silencing blogger critical of diagnostic manual.

also

National Association of Science Writers

—————-

On Monday, investigative health reporter, William Heisel, published Part One of his report on the two “cease and desist” letters served to me on December 22, on behalf of the publishing arm of the American Psychiatric Association.

You can view these letters and correspondence here:

    APA correspondence

 

Read Part One of William Heisel’s report here:

Slap: American Psychiatric Association Pressures Brit DSM5 Blogger Suzy Chapman

 

Today, William Heisel continues the story:

Reporting on Health

William Heisel’s Antidote Investigating Untold Health Stories

William Heisel | February 29, 2012

Slap: American Psychiatric Association Targets One DSM5 Critic, Ignores Others

From the way the American Psychiatric Association threatened UK writer Suzy Chapman, one would think APA is fighting legal battles everywhere to protect its trademarks.

But Chapman appears to be in an elite category. Antidote wrote Monday about how APA forced Chapman to change the name and URL of her DSM-5 and ICD-11 Watch site, saying it infringed on APA’s trademark for its main guidebook, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

But similar sites and uses of APA trademarks abound. Why hasn’t the APA gone after them?

Read on

 

Related posts:

Earlier commentaries:

Media coverage: American Psychiatric Association (APA) “cease and desist” v DSM-5 Watch website; Legal information and resources for bloggers and site owners

Is DSM 5 A Public Trust Or An APA Cash Cow? Commercialism And Censorship Trump Concern For Quality by Allen Frances APA forces domain name change for DSM-5 and ICD-11 Watch site

Pity the poor American Psychiatric Association, Parts 1 and 2: Gary Greenberg

DSM 5 Censorship Fails: Support From Professionals and Patients Saves Free Speech by Allen Frances


Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-V, Internet censorship, SLAPP suit Tagged with , , , , , , , , ,

William Heisel’s Antidote: Slap: American Psychiatric Association Pressures Brit DSM5 Blogger Suzy Chapman

February 27, 2012 by

William Heisel’s Antidote: Slap: American Psychiatric Association Pressures Brit DSM5 Blogger Suzy Chapman

Post #149 Shortlink: http://wp.me/pKrrB-1Yx

On December 22, I was served with two “cease and desist” letters on behalf of the publishing arm of the American Psychiatric Association, publishers of the Diagnostic and Statistical Manual of Mental Disorders – the DSM.

Which disorders go into the next DSM and how those disorders are defined is a public interest issue. Public interest and public trust are best served by an open and transparent development process – not by issuing threats of legal action against those providing internet platforms on which patients and professionals rely for timely and accurate information around the DSM-5 development process and how they might participate in that process, as stakeholders.

The American Psychiatric Association’s publishing arm has the right to protect its intellectual property and pursue trademark infringements where a case for improper use can be made. But employing heavy-handed, punitive, partial and legally questionable tactics against “fair use” of the DSM 5 mark, forcing internet site owners to change web addresses, is putting commercial interests before public participation – a PR fail and a disturbing abuse of power.

    APA correspondence

William Heisel takes up the story:

Reporting on Health

William Heisel’s Antidote Investigating Untold Health Stories

Slap: American Psychiatric Association Pressures Brit DSM5 Blogger Suzy Chapman

http://www.bit.ly/ydSocK

William Heisel | February 27, 2012

If you have a serious interest in a brand, product or company, you can, in a few minutes, set up your own website with a clever domain name that includes your target.

Jim Romenesko did this with Starbucks Gossip. A group of unions and activists did this with Making Change at Wal-Mart. And a team of obsessive Clark Kent loyalists did this with the Superman Super Site.

A few years ago, British writer Suzy Chapman started tracking the proposed changes by the American Psychiatric Association (APA) to psychiatry’s guidebook: the Diagnostic and Statistical Manual of Mental Disorders (DSM)…

Read on

Related posts:

Is DSM 5 A Public Trust Or An APA Cash Cow? Commercialism And Censorship Trump Concern For Quality by Allen Frances APA forces domain name change for DSM-5 and ICD-11 Watch site

Media coverage: American Psychiatric Association (APA) ”cease and desist” v DSM-5 Watch website; Legal information and resources for bloggers and site owners

Pity the poor American Psychiatric Association, Parts 1 and 2: Gary Greenberg

DSM 5 Censorship Fails: Support From Professionals and Patients Saves Free Speech by Allen Frances


Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-V, Internet censorship, SLAPP suit Tagged with , , , , , , , , ,

Round-up: Recent commentaries by Allen Frances, MD, on a DSM-5 in distress

February 22, 2012 by

Round-up: Recent commentaries by Allen Frances, MD, on a DSM-5 in distress

Post #146 Shortlink: http://wp.me/pKrrB-1X2

Allen Frances’ Blog at Huffington Post

DSM 5 Freezes Out Its Stakeholders

Allen Frances, MD | February 21, 2012

Scary news. The Chair of the DSM 5 Task Force, Dr. David Kupfer, has indicated that 90 percent of the decisions on DSM 5 have already been made.

Why so scary? DSM 5 is the new revision of the psychiatric diagnosis manual, meant to become official in May 2013. It proposes a radical redefinition of the boundary between mental disorder and normality, greatly expanding the former at the expense of the latter. Understandably, this ambitious medicalization of the human condition has generated unprecedented opposition, both from the public and from mental heath professionals. To top it off, the DSM 5 proposals are poorly written, unreliable, and likely to cause the misdiagnosis and the excessive treatment of millions of people.

Under normal circumstances the DSM 5 team would have taken the many criticisms to heart, gone back to the drawing board, and improved the quality and acceptability of their product. After all, the customer is very often right. But this DSM process has been strangely secretive, unable to self-correct, and stubbornly closed to suggestions coming from outside. As a result, current DSM 5 proposals show very little improvement over poorly done first drafts posted in February 2010.

Is there any hope of a last-minute save? I have gathered opinions from three well-informed DSM 5 watchers. They were asked to assess the current state of DSM 5 and offer suggestions about future prospects. The first comment comes from Suzy Chapman, a public advocate, whose website provides the most comprehensive documentary source on the development of DSM 5 and ICD-11. Ms Chapman writes:

DSM 5 consistently misses every one of its deadlines and then fails to update its website with a new schedule. The Timeline was finally revised a couple of weeks ago, but we are still no nearer to a firm date for the final period of invited public comment. We’ve known since November that DSM 5 is stuffed as far as its planned January-February comment period and that Dr Kupfer now reckons “no later than May” – but all the website says is “Spring.” That’s no use to those of us who need to alert patient groups and their professional advisers…

Psychology Today

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

ICD-10-CM Delay Removes Excuse For Rushing DSM 5 Into Premature Publication: Time needed to avoid harmful document

Allen Frances, MD | February 22, 2012

Until yesterday, there were only two reasons to stick with the projected date of DSM 5 publication (May 2013): 1) the need to coordinate DSM 5 with ICD-10-CM coding, which was scheduled to start Oct 2013; and, 2) the need to protect APA publishing profits in order to meet budget projections.

The first reason just dropped out. Health and Human Services (HHS) Secretary Kathleen G. Sebelius has announced that the start date for ICD-10-CM has been postponed. It is not yet clear for how long, but most likely a year (see http://www.dhhs.gov/news/press/2012pres/02/20120216a.html ).

also on Psychiatric Times

Registration required for access

ICD-10-CM Delay Removes Excuse For Rushing DSM-5 Into Premature Publication

and Education Update

Psychology Today

DSM5 in Distress

DSM 5 to the Barricades on Grief

Defending The Indefensible

Allen Frances, MD | February 18, 2012

The storm of opposition to DSM 5 is now focused on its silly and unnecessary proposal to medicalize grief. DSM 5 would encourage the diagnosis of ‘Major Depressive Disorder’ almost immediately after the loss of a loved one—having just 2 weeks of sadness and loss of interest along with reduced appetite, sleep, and energy would earn the MDD label (and all too often an unnecessary and potentially harmful pill treatment). This makes no sense. To paraphrase Voltaire, normal grief is not ‘Major’, is not ‘Depressive,’ and is not ‘Disorder.’ Grief is the normal and necessary human reaction to love and loss, not some phony disease.

All this seems perfectly clear to just about everyone in the world except the small group of people working on DSM 5. The press is now filled with scores of shocked articles stimulated by two damning editorial pieces in the Lancet and a recent prominent article in the New York Times.

The role of public defender of DSM 5 has fallen on John Oldham MD, president of the American Psychiatric Association…

Psychology Today

DSM5 in Distress

Allen Frances, MD | February 17, 2012

Lancet Rejects Grief As a Mental Disorder: Will DSM 5 Finally Drop This Terrible Idea

The Lancet is probably the most prestigious medical journal in the world. When it speaks, people listen. The New York Times is probably the most prestigious newspaper in the world. Again, when it speaks, people usually listen. The Lancet and The New York Times have both spoken on the DSM-5 foolishness of turning grief into a mental disorder. Will DSM-5 finally listen?

Here are some selected quotes from today’s wonderful Lancet editorial
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60248-7/fulltext

Previous DSM editions have highlighted the need to consider, and usually exclude, bereavement before diagnosis of a major depressive disorder. In the draft version of DSM-5 , however, there is no such exclusion for bereavement, which means that feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than 2 weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction.”

“Medicalising grief, so that treatment is legitimized routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed…”

Psychology Today

DSM5 in Distress

DSM 5 Minor Neurocognitive Disorder: Let’s Wait For Accurate Biological Tests

Allen Frances, MD | February 16, 2012

Within the next 3-5 years, we will likely have biological tests to accurately diagnose the prodrome of Alzheimer’s disease (AD). Much remains to be done in standardizing these tests, determining their appropriate set points and patterns of results, and negotiating the difficult transition from research to general clinical practice. And, given the lack of effective treatment, there are legitimate concerns about the advisability of testing for the individual patient and the enormous societal expense with little tangible benefit. Despite these necessary caveats, there is no doubt that biological testing for prodromal AD will be an important milestone in the clinical application of neuroscience.

How does this impact on the DSM 5 proposal to include a Minor Neurocognitive Disorder as a presumed prodrome to AD…

Psychology Today

DSM5 in Distress

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

Allen Frances, MD | February 09, 2012

In preparing DSM IV, we worked hard to avoid causing confusion in forensic settings. Realizing that lawyers read documents in their own special way, we had a panel of forensic psychiatrists go over every word to reduce the risks that DSM IV could be misused in the courts. They did an excellent job, but all of us missed one seemingly small mistake– the substitution of an ‘or’ for an ‘and’ in the paraphilia section that lead to serious misunderstandings and the questionably constitutional preventive psychiatric detention of sexual offenders.

DSM 5 is about to make a very different, less crucial, but still consequential forensic mistake. The proposed A criterion for PTSD includes the following wording…

Psychology Today

DSM5 in Distress

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

Allen Frances, MD | February 07, 2012

I wrote last week that DSM 5 is so far behind schedule it can’t possibly produce a usable document in time for its planned publication date in May 2013. My blog stimulated two interesting responses that illustrate the stark contrast between DSM 5 fantasy and DSM 5 reality. Together they document just how far behind its schedule DSM 5 has fallen and illustrate why publication must be delayed if things are to be set right.

The first email came from Suzy Chapman of https://dxrevisionwatch.wordpress.com …

also on Psychiatric Times

Registration required for access

Documentation That DSM-5 Publication Must Be Delayed

Additional coverage of DSM-5 controversies

Sidney Morning Herald

About-turn on treatment of the young

Amy Corderoy | February 20, 2012

CONCERNS about the overmedication of young people and rigid models of diagnosis have led the architect of early intervention in Australian psychiatry, Patrick McGorry, to abandon the idea pre-psychosis should be listed as a new psychiatric disorder.

The former Australian of the Year had previously accepted the inclusion of pre-psychosis – a concept he and colleagues developed – in the international diagnostic manual of mental disorders, or DSM, which is being updated this year.

Professor McGorry has been part of a team researching pre- and early-psychosis, and his work in the latter helped secure a massive $222.4 million Commonwealth funding injection for Early Psychosis Prevention and Intervention Centres across Australia…

Sidney Morning Herald

Suffer the children under new rules

Kathryn Wicks | Opinion | February 20, 2012

Canberra Times

A new chapter for psychiatrists’ bible

Amy Corderoy | February 19, 2012

Madness is being redesigned. The Diagnostic and Statistical Manual of Mental Disorders (DSM) will be updated this year, meaning what counts as a psychiatric disorder will change.

Frances, one of the architects of the current manual, DSM-IV, published in 1994, knows the results of his changes to the definitions of mental illness.

“We were definitely modest, conservative and non-ambitious in our approach to DSM-IV,” he says. “Yet we had three epidemics on our watch…”

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

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