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DSM5 - Ticket back to Reevesville

Discussion in 'Action Alerts and Advocacy' started by Khalyal, Feb 12, 2010.

  1. oerganix

    oerganix Senior Member

    No, they don't. They are desperate to keep a foot in the door for just about every illness on earth.

    One of the criteria for a new descriptive term: "4. can be used readily in patients who also have pathologically established disease"

    Like barbers of old who also bled people and applied leeches, they don't want to give up business prospects. And the insurance companies are in alignment with them because those mental illnesses just need 6 weeks of GET/CBT and presto! chango! back to work!
  2. leelaplay

    leelaplay member

    Field Testing to Begin in July for DSM-5

    By John Gever, Senior Editor, MedPage Today
    Published: May 25, 2010

    NEW ORLEANS -- More than 10 years after the American Psychiatric Association (APA) began developing the fifth edition of its Diagnostic and Statistical Manual of Mental Diseases (DSM), the process is now moving smartly toward its planned 2013 conclusion, leaders of the effort said here.

    After receiving more than 8,600 comments on a first draft of the DSM-5 after it was posted on the Internet in February, field trials of revised definitions and some entirely new diagnoses are set to begin in July, said David Kupfer, MD, of the University of Pittsburgh, chairman of the DSM-5 task force.

    Often called the "bible" of the psychiatric profession, the DSM was last fully updated in 1994. More than a dozen symposia and presentations at the APA's annual meeting here focused on the progress to date.

    The upcoming field trials of the proposed DSM-5 revisions will take place both in large academic centers and in small, routine-practice settings, according to Darrel Regier, MD, MPH, the APA's director of research. All of the field trials will be testing the feasibility, clinical utility, and sensitivity to change in the revisions.

    Some of the trials will involve as many as 300 patients and will also look at the reliability of the proposed diagnostic protocols -- that is, whether retesting of patients using the same criteria will produce the same diagnostic results.

    The larger trials will focus on disorders in which the proposed new diagnostic criteria have the greatest potential to change clinical practice, Regier said.

    Among them:

    * Collapsing four separate autism-related disorders in the current edition of the DSM into just one, Autism Spectrum Disorder
    * New eating disorder categories, including binge eating as separate from bulimia
    * So-called temper dysregulation disorder with dysphoria, expected to dramatically reduce the number of children diagnosed with bipolar disorder
    * New scales for assessing suicide risk in adults and adolescents

    Although the trials will mainly involve psychiatrists and allied professionals such as clinical psychologists, primary care physicians will also be included in at least some of the large trials, Kupfer said.

    Also to be tested are so-called dimensional assessments, an innovation in DSM-5.

    Up to this point, the DSM has focused on providing labels for groups of patients, but had no formal way of noting disorder severity or tracking changes over time. The 13 DSM-5 work groups have been charged with developing quantitative measures as part of the symptom assessment process for each disorder category.

    The idea, said Jay Burke, MD, MPH, of Harvard University, is to "provide additional information to clinicians" beyond the simple categorization of symptoms.

    Dimensional assessments may cover not only severity of symptoms, but also other factors not necessary to diagnosis but important in prognosis, treatment planning, and measuring outcomes.

    These could be ideal for evaluating functional impairments, which are being deemphasized in DSM-5 as diagnostic criteria per se.

    These were included in the last edition of the DSM. The intent was to justify medicopsychiatric treatment of conditions that, without a finding of objectively negative impacts, might be considered merely extreme expressions of normal behaviors and emotions.

    This was "useful in theory, but not reliable in practice," said Jane Paulsen, PhD, of the University of Iowa. "It was too complicated and subject to differing interpretations."

    Another difficulty has been that a requirement of impairment as part of diagnosis precludes treating patients before they become impaired.

    The field trials are to be completed in time for results to be available by next April, Kupfer said. The results will likely trigger additional revisions, some of which will need testing in a second round of field trials in 2011.

    Final language is to be drafted in 2012, to be approved by the APA's governing bodies late that year. The official DSM-5 is to be unveiled at the group's annual meeting in 2013.

    The current meeting here "is very important for the DSM process," Kupfer said at a press conference.

    He said the direct, face-to-face feedback with meeting attendees here was an important complement to the online comments, suggestions, and criticisms of the proposed revisions.

    Most people at the meeting are practicing clinicians, Kupfer noted, calling them "the ultimate consumers" of the final DSM-5 product, whose input is essential to creation of the revised diagnostic manual.

    At least one potential revision emerged at a symposium here that included a report on new criteria for attention deficit-hyperactivity disorder (ADHD).

    The proposed changes, described by work group co-chair Xavier Castellanos, MD, of New York University, included an attention-deficit symptom of difficulty with "lengthy readings."

    During the question-and-answer period, Thomas E. Brown, PhD, of Yale University and also in private practice, commented that many children have no trouble reading books they choose for themselves, mentioning the Harry Potter series as an example.

    What they have trouble with is long readings assigned to them in school, Brown said. He suggested revising the language to stipulate difficulty with "lengthy assigned readings."

    "I like it. We'll take it to the work group," Castellanos responded.

    But, highlighting the contentiousness of the DSM-5 revisions, another questioner followed Brown to the microphone to say his experience was exactly the opposite -- that his ADHD patients often focused better with assignments and deadlines than when left on their own.
  3. Dx Revision Watch

    Dx Revision Watch Owner of Dx Revision Watch

    APA: Comments Lead to Changes in DSM-5 Draft

    APA: Comments Lead to Changes in DSM-5 Draft
    By John Gever, Senior Editor, MedPage Today
    Published: May 26, 2010

    NEW ORLEANS -- Proving that the request for public comments on proposed revisions to the psychiatry profession's main diagnostic manual was not just window-dressing, a number of changes have already been incorporated, officials of the American Psychiatric Association indicated here.

    Coinciding with the group's annual meeting here, recent revisions to new diagnostic criteria and descriptions in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Diseases (DSM-5), made in response to comments and criticisms, have been highlighted on the effort's website,

    Among them were changes in several areas within the Sexual and Gender Identity Disorders category, as well as modifications to criteria for adjustment disorders and the main types of eating disorders.

    The APA had posted the draft on the Internet in February and asked for comment from all interested parties, from APA members to other professional societies and the general public.

    "We thought we might get 2,000 comments, and we would have been happy with that," said David Kupfer, MD, of the University of Pittsburgh, chairman of the APA's DSM-5 taskforce.

    Instead, more than 8,600 comments were received by mid-April, he said.

    The largest number, 1,337, were about neurodevelopmental disorders. Kupfer said that wasn't surprising, as the proposed revision makes significant changes to autism-related disorders. Whereas the current version of the DSM has four separate classifications for autism and related conditions, the draft collapsed these down to a single Autism Spectrum Disorder with various "specifiers" to identify subtypes such as Asperger's syndrome.

    Also attracting many comments were the anxiety disorders (1,217) and those involving sex and gender identity (811).

    The smallest number were in the category of sleep disorders, Kupfer's own specialty, with just 57. "But those 57 comments were quite useful," he said.

    On the basis of comments, the following changes were made, according to the DSM-5 website:

    For anorexia nervosa, numerical examples of "body weight less than 85% of that expected" were replaced simply with "markedly" low weight to describe patients' physical appearance.

    Mechanisms of compensatory behavior for diagnosing bulimia nervosa were expanded to include medication, excessive exercise, and fasting.

    Wording of one criterion for adjustment disorders was expanded to include "other important areas of functioning."

    Also, the Sexual and Gender Identity Disorders Work Group made revisions to language involving several disorders within the category:

    For all Paraphilia Disorders, two specifiers were added: "in remission" and "in controlled environment."

    Within Pedohebophilic Disorder -- a new classification that takes in sexual preference for pubescent children as well as the prepubescent -- wording of one criterion was revised to read "use of pornography depicting prepubescent or pubescent children..." and another was modified to refer to it.

    Hypersexual Disorder was modified to specify that patients must be at least 18 years old.

    Transvestic Disorder now includes the specifier With Autoandrophilia (Sexually Aroused by Thought or
    Image of Self as Male) and was also changed to allow for the possibility of diagnosing females with this disorder.

    The work group explained that the latter change was to make the criteria consistent with other paraphilias, for example, which do not formally exclude females from potential diagnosis even though they appear extremely rare in females.

    As with other areas where the draft has not been altered, the revisions will be subjected to "field trials" starting in July to test their clinical feasibility and utility.

    The final version of the DSM-5 is scheduled to be formally released in May 2013.
  4. Dx Revision Watch

    Dx Revision Watch Owner of Dx Revision Watch


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