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

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

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

New Scientist, Prospect magazine and Allen Frances asks: Is Government Intervention Needed to Prevent an Unsafe DSM 5?

New Scientist and Prospect magazine on DSM-5; Allen Frances asks: Is Government Intervention Needed to Prevent an Unsafe DSM 5?

Post #148 Shortlink: http://wp.me/pKrrB-1Yh

Additional recent coverage of DSM-5 controversies:

Daily Mail

Michael Hanlon’s Science Blog | February 28, 2012

The Madness of American psychiatrists

DSM5 in Distress

Do We Need a DSM-V?
No, says an editorial from the Society of Biological Psychiatry

Allen J. Frances, M.D. | February 27, 2012

New Scientist print and online

New Scientist

There’s no sense in revising the psychiatrist’s bible

Online: Liz Else | February 22, 2012

Magazine issue 2853 (Subscription or paywall for access)

Print edition: Page 31 February 25, 2012

One minute with…Nick Craddock

There’s no sense in simply revising the psychiatrist’s diagnostic bible: it will need to be totally replaced to fit the emerging science…

Nick Craddock is professor of psychiatry at the Institute of Psychological Medicine and Clinical Neurosciences at Cardiff University School of Medicine, and is the director of the Welsh National Centre for Mental Health

Full version (Subscription required for online access)

Prospect Magazine

Issue 192, March 2012 (Subscription required for online access)

Mental disorder

By Anjana Ahuja
Anjana Ahuja is a freelance science journalist

In 1973, the American psychologist David Rosenhan sent eight healthy people, and also himself, to visit mental institutions and claim they were hearing voices. All were certified mad; some were incarcerated for a month. Rosenhan’s paper, “On Being Sane in Insane Places,” created a media sensation and a crisis in psychiatry. Doctors, it seemed, unlike suspicious fellow patients, could not tell a lucid stooge from a lunatic.

The ensuing controversy led to the tightening of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM), the “psychiatrists’ bible” that lists mental disorders and their symptoms. The DSM, first published in 1952, is produced by the American Psychiatric Association (APA), which, every decade or two, assembles a hundred or so mental health professionals to review disorders in the light of new science or shifting cultural norms…

Full version (Subscription required for online access)

Huffington Post

Allen Frances, MD | 02.24.12

Is Government Intervention Needed to Prevent an Unsafe DSM 5?

Donna Rockwell, Psy.D. was once a CNN reporter covering Capitol Hill. She is now a psychologist and a member of the petition committee calling for an independent scientific review of DSM 5. With her journalist’s instinct for the crux of any story, Dr. Rockwell has focused on increasing public scrutiny of DSM 5. She hopes to stimulate government intervention to ensure that DSM 5 meets its public trust. Dr Rockwell sent this email on Feb. 17:

You recently described the press as the one last hope to ensure that DSM 5 will be safe and sound. While I certainly agree that the press can do a great deal, there is an additional last hope you didn’t mention, one that could be even more powerful. Don’t discount the role of government intervention as a way of influencing the American Psychiatric Association.

I am currently networking on Capitol Hill and also with the Department of Defense and with the Veterans Administration. My goal is to increase awareness of the risks of DSM 5 and to recruit government assistance in forcing APA to abandon dangerous suggestions.

I tell government officials that DSM 5 will have a big impact on many important public health and public policy decisions that will directly affect their constituents. My short list includes: 1) raising the percentage of our citizens who are considered to be mentally ill — they are surprised to learn that it is already an astounding 50% lifetime; 2) increasing the cost of drug treatments and their harmful side effects; 3) pulling scarce mental health resources away from those who are really ill and most need them; 4) distorting benefit determinations for insurance, disability, compensation, and school services; and 5) creating great confusion in the courts.

The people I speak to all quickly understand the public health and public policy significance of DSM 5 and that government has a big stake in making it safe.

I am especially reaching out to the HELP (Health, Education, Labor & Pensions) committee chaired by Sen. Tom Harkin (D-IA), which oversees mental health issues and to Sen. Charles Grassley (R-IA), who has been very successful in holding doctors accountable. People in government are particularly concerned when I tell them that DSM 5 will have its worst impact on the most vulnerable populations — children, teenagers, and the elderly; veterans; and the severely mentally ill. I think the sentiment is growing that government intervention will be necessary to protect the public interest from the guild interests of the American Psychiatric Association and the economic interests of the drug companies.

I use concrete examples to get my points across. Most alarming, that DSM 5 will increase the already shameful overuse of antipsychotic drugs in kids and thus contribute to the dangerous epidemic of childhood obesity. DSM 5 will also greatly expand the diagnosis and medication treatment of ADD and indirectly facilitate the booming illegal market in prescription stimulants. DSM 5 will turn normal grief into depression. And DSM 5 will scare people into thinking they are on the road to dementia when all they have is the normal forgetfulness of aging. The Hill staffers I talk to all seem understand the risks of DSM 5 and I hope they will soon hold hearings. There is also considerable interest in the risks of DSM 5 at the VA and at DOD, where polypharmacy has been such a big problem.

The general public can help by calling or emailing congressional representatives to request protection from DSM 5. People should demand that DSM 5 be subjected to an outside, unbiased scientific review before accepting the controversial proposals that are getting so much negative press attention. I hope a legislative option can be forged in this battle to protect the nation’s mental health from the excesses of DSM 5.

I do wonder how loudly must the public and the professional mental health community shout, “Stop!”, before reason prevails. We need a government agency or elected official to take the lead in protecting the American people from the impending crisis of medicalised normality and excessive prescription drug use. The government must apply the brakes on DSM-5 before pharmacological over-kill impacts harmfully on even more people.”

As I read this, I find it both sad and silly that DSM 5 has allowed things to degenerate to the point where government intervention may indeed be necessary. DSM 5 has stubbornly ignored the general consensus that many of its suggestions simply make no sense and may cause grave damage both to public health and public policy. The DSM 5 hot potato suggestions should have been dropped long ago. They certainly must be rejected now.

Adding a new diagnoses in psychiatry can be far more dangerous than approving one of the new “me-too” drugs that so often come to market. It is paradoxical and nonsensical for us to carefully vet new drugs through a fairly rigorous FDA procedure but at the same time allow new diagnoses to be introduced through a badly flawed decision-making process completely controlled by just one professional organization that has lost its credibility. The new diagnoses suggested by DSM 5 will lead to widespread misdiagnosis and inappropriate drug use — causing far more damage than could possible be wrought by any new “me-too” drug.

To date, APA has failed to provide appropriate governance. DSM 5 has proven unable to govern itself, is not governed by APA, is not responsive to the heated opposition of mental health professionals and the public, and is insensitive to being shamed repeatedly by the world press. Government intervention may turn out to be the only hope to prevent massive misdiagnosis and all its harmful, unintended consequences.

Over 12,000 individuals and organizations have now signed the Coalition for DSM-5 Reform petition

Mental health professionals and mental health organizations can sign the petition here:

http://www.ipetitions.com/petition/dsm5/

For more information on the petition see: 

https://dxrevisionwatch.wordpress.com/coalition-for-dsm-5-reform/

or go to the petition website, here: Coalition for DSM-5 Reform website

http://dsm5-reform.com/

Please note the Coalition for DSM-5 Reform petition is intended for endorsement by mental health organizations and professional bodies and for signing by mental health professionalsnot intended for signing by patients.

Dx Revision Watch has no connection with the Coalition for DSM-5 Reform, its Open Letter initiative or associated petition. All enquiries relating to the Coalition for DSM-5 Reform should be addressed directly to Dr David Elkins, Ph.D., Chair, Coalition for DSM-5 Reform committee.

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

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…”

The Trouble with Timelines: DSM-5 round up

The Trouble with Timelines: DSM-5 round up

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

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

According to Dr Regier:

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

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

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

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

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

 

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

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

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

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

Allen Frances, MD | January 31, 2012

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

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

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

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

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

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

Full commentary here on DSM5 in Distress

 

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

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

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

William Narrow | January 30, 2012

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

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

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

Read the rest of Dr Narrow’s responses here

 

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

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

From the President

Your Board’s Agenda Focuses on the Future

John M. Oldham, M.D.

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

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

Item: 11.A
Board of Trustees
December 2011

DSM-5 TASK FORCE AND WORK GROUP UPDATE

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

———–

This report contains:

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

Under Plans for 2012 it reports:

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

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

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

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

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

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

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

 

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

Op-Ed Contributor

Not Diseases, but Categories of Suffering

Gary Greenberg | January 29, 2012

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

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

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

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

 

Benjamin Nugent, Op-Ed piece, NYT:

New York Times

Op-Ed Contributor

I Had Asperger Syndrome. Briefly.

Benjamin Nugent | January 31, 2012

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

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

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

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

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

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

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

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

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

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

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

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

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

Full revised Timeline here

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