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Psychiatry divided as mental health 'bible' denounced

Discussion in 'Other Health News and Research' started by natasa778, May 5, 2013.

  1. natasa778

    natasa778 Senior Member

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    http://www.newscientist.com/article/dn23487-psychiatry-divided-as-mental-health-bible-denounced.html

    The world's biggest mental health research institute is abandoning the new version of psychiatry's "bible" – the Diagnostic and Statistical Manual of Mental Disorders, questioning its validity and stating that "patients with mental disorders deserve better". This bombshell comes just weeks before the publication of the fifth revision of the manual, called DSM-5.

    On 29 April, Thomas Insel, director of the US National Institute of Mental Health (NIMH), advocated a major shift away from categorising diseases such as bipolar disorder and schizophrenia according to a person's symptoms. Instead, Insel wants mental disorders to be diagnosed more objectively using genetics, brain scans that show abnormal patterns of activity and cognitive testing.

    This would mean abandoning the manual published by the American Psychiatric Association that has been the mainstay of psychiatric research for 60 years.

    The DSM has been embroiled in controversy for a number of years. Critics have said that it has outlasted its usefulness, has turned complaints that are not truly illnesses into medical conditions, and has been unduly influenced by pharmaceutical companies looking for new markets for their drugs.

    There have also been complaints that widened definitions of several disorder have led to over-diagnosis of conditions such as bipolar disorder and attention deficit hyperactivity disorder.
    Now, Insel has said in a blog post published by the NIMH that he wants a complete shift to diagnoses based on science not symptoms.

    "Unlike our definitions of ischaemic heart disease, lymphoma or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure," Insel says. "In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain, or the quality of fever."

    Insel says that elsewhere in medicine this type of symptom-based diagnosis been abandoned over the past half-century as scientists have learned that symptoms alone seldom indicate the best choice of treatment.

    To accelerate the shift to biologically based diagnosis, Insel favours an approach embodied by a programme launched 18 months ago at the NIMH called the Research Domain Criteria project.
    The approach is based on the idea that mental disorders are biological problems involving brain circuits that dictate specific patterns of cognition, emotion and behaviour. Concentrating on treating these problems, rather than symptoms is hoped to provide a better outlook for patients.

    "We cannot succeed if we use DSM categories as the gold standard," says Insel. "That is why NIMH will be reorienting its research away from DSM categories," says Insel.

    Prominent psychiatrists contacted by New Scientist broadly support Insel's bold initiative. However, they say that given the time it will take to realise Insel's vision, diagnosis and treatment will continue to be based on symptoms.

    Insel is aware that what he is suggesting will take time – probably at least a decade, but sees it as the first step towards delivering the "precision medicine" that he says has transformed cancer diagnosis and treatment.

    "It's potentially game-changing, but needs to be based on underlying science that is reliable," says Simon Wessely of the Institute of Psychiatry at King's College London. "It's for the future, rather than for now, but anything that improves understanding of the etiology and genetics of disease is going to be better [than symptom-based diagnosis]."

    Michael Owen of the University of Cardiff, who was on the psychosis working group for DSM-5, agrees. "Research needs to break out of the straitjacket of current diagnosis categories," he says. But like Wessely, he says it is too early to throw away the existing categories.

    "These are incredibly complicated disorders," says Owen. "To understand the neuroscience in sufficient depth and detail to build a diagnosis process will take a long time, but in the meantime, clinicians still have to do their work."

    David Clark of the University of Oxford says he's delighted that NIMH is funding science-based diagnosis across current disease categories. "However, patient benefit is probably some way off, and will need to be proved," he says.

    The controversy is likely to erupt more publically in the coming month when the American Psychiatric Association holds its annual meeting in San Francisco, where DSM-5 will be officially launched, and in June in London when the Institute of Psychiatry holds a two-day meeting on the DSM.
  2. Bob

    Bob

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    It's an interesting development.

    Here's the blog by the NIMH director, Thomas Insel, that's linked to in the New Scientist article:
    http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

    It's well worth a read. It seems like a revolutionary approach for research, diagnosis and treatment for mental health.

    Excerpts:
    "Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system."

    "Many NIMH researchers, already stressed by budget cuts and tough competition for research funding, will not welcome this change. Some will see RDoC as an academic exercise divorced from clinical practice. But patients and families should welcome this change as a first step towards "precision medicine,” the movement that has transformed cancer diagnosis and treatment."
    biophile likes this.
  3. sianrecovery

    sianrecovery Senior Member

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    Delighted to hear The Weasel has fallen off his ass on the way to Damascus and thinks diagnosis needs to be based on 'underlying science that needs to be reliable'. FFS....
    peggy-sue likes this.
  4. Jarod

    Jarod Senior Member

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    I worry about this folks. Somehow I imagine this may end up being a bio-marker for mental illness if we are not careful.

    Seems like they should focus on the root illness first and foremost, and then list some potential symptom that go with it.

    Which came first, depression or lead poisoning? That is kind of my point. List the primary cause. Bacterial infection with associated fatigue, dizzyness, slow reaction, and reduced social functioning.

    Edit: I don't really "worry about it" I should have said I "wonder about it".
    golden likes this.
  5. Tally

    Tally Senior Member

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    What's wrong with having bio-markers for mental illnesses? Can you please explain?

    I've felt this was the way all along. Mental illness is just like an illness of any other organ, except that brain is so complex that science today doesn't have nearly good enough understanding of it to be setting up bio-markers. But for me it seems like a move in the right direction.

    Diagnosis should be based on presence of bio-markers for mental illness not absence of bio-markers for physical illness.
    peggy-sue and beaker like this.
  6. beaker

    beaker CFS/ME 1986

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    I read about this on Science magazine website. Someone commented or maybe it was in the article. Anyways, somebody somewhere at sometime ( my cfs/me brain fallback position ) commented that this was fueled by the current admins pouring $$$ into neuro science research. In otherwords, they are just following the money.
    That said, I do think it's a good thing. If I can find the link I will come back and add it in.

    ETA: Ok it wasn't Science It was Scientific American, close enough ?
    Here is their blog about it .
  7. Enid

    Enid Senior Member

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    Good news Natasha - I've always felt (4 real Docs in my family) that the position of psychiatry in medicine has become the tail trying to wag the dog.
    RosieBee, natasa778 and merylg like this.
  8. Bob

    Bob

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  9. Jarod

    Jarod Senior Member

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    Hi Tally,

    I believe that most so called "mental illness" is a result of physical illness. The so called "mental illness" is just another symptom of the physical illness in most cases, just like inflamation or dizzyness is.

    If we could find biomarkers for ME, migranes, autism, GWI, cancer, IBS, etc...95% of the mental illness would be more accurately described as another symptom of the underlying neuro-immune disease cluster many of us really suffer from.

    Biomarkers might be a good thing, we just need the honest folks working in academia to identify the root cause; The neuroimmune disease type cluster of diseases I mentioned above.

    I got a flat butt biomarker from sitting on the couch, but it is not from depression. :)

    The mental illness push has always been a way to sell drugs, deny treatment, and control the population from my perspective. I think mental illness is another symptom of a sick body in many cases. Probably not everybody, but the majority.

    The push around mental illness in the media lately is making the situation more difficult for the people who are not living in our shoes to understand.
  10. Bob

    Bob

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    Hi Jarod. The new approach is intended to exactly address those concerns that you have. They are looking to define the actual disease process, rather than just the symptoms. It's a scientific approach rather than a psychiatric approach. I think it will be revolutionary, for psychiatry.
    peggy-sue and Tally like this.
  11. Jarod

    Jarod Senior Member

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    That sounds great Bob. I appreciate it.
    Bob likes this.
  12. wdb

    wdb Admin

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  13. Kina

    Kina Moderation Team Lead

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    The question for me is 'what exactly is mental illness' because it seems what used to be considered normal behaviour has now become pathological. If you think too much about your health, it's pathological. But where is the line drawn. At what point does thinking about your health become pathological. If a person thinks about their health 20 times a day, are they more mentally ill than a person who thinks about their health 19 times a day? Even a child having too many temper tantrums has been turned into a form of mental illness - I have met some angry two year olds in my time but mentally ill -- no. Even using the Internet too much apparently is a form of mental illness.

    How much distress and impaired functioning has to be occurring to be diagnosed with a mental illness. It seems these days a doctor can diagnose a patient with all sorts of mental illness without the patient showing significant distress and impaired functioning.

    The DSM-V should be scrapped. The term 'mental illness' should be scrapped. There is way too much stigma associated with mental illness.

    My daughter has had so many DSM diagnoses (about ten in all -- Autism, PDD-NOS, juvenile Bipolar Disorder, ADHD, Conduct Disorder, Mental Retardation -- etc) applied to her by different doctors and all of them ended up being wrong and she got the diagnoses from the subjective beliefs of each different doctor not from any sort of scientific process. It's pretty horrible having these diagnoses slapped on your child but the worst thing was their attempts at behaviour mod, pharmaceuticals, dire predictions of the future based on these diagnoses. These doctors were really vicious to me when I refused to believe them (I was in denial), when I refused all the anti-psychotics they were offering her (I was in denial and a bad mother to boot). I have a psychiatric report in my possession that says my daughter has an IQ in the lowest percentile of the population, that she will never live independently, that she will unlikely graduate from elementary school, and will likely have to have one-to-one support for the rest of her life. I thought IQ testing was supposed to be accurate -- obviously it's not because my daughter just finished her first year in College designed for students with developmental disabilities etc -- a professor described her to me as having 'average' academic ability compared to all college students. I doubt the average college student is intellictually delayed. Obviously, what the psychiatrist predicted was totally wrong but this kind of thing shouldn't be happening in the first place.

    It's all so very wrong and it's high time that it stopped.
    Ren, jimells, Shell and 3 others like this.
  14. Tally

    Tally Senior Member

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    Hello Jarod,

    yes, a version of that was what I was trying to say. Saying a mental illness is a physical illness or that a mental illness is a result of a physical illness is basically the same thing.
    Jarod likes this.
  15. Bob

    Bob

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    Jarod

    You might find this reassuring:
    "The insistence that “mental disorders” be viewed and studied entirely as “biological disorders” shunts aside the APA’s supposed agnosticism on that front; but it also uncannily echoes Robert Spitzer’s effort (dating here from June 1976) to push through a similar proviso for DSM-III: “A mental (psychiatric) disorder is a medical disorder"."
    http://www.psychologytoday.com/blog/side-effects/201305/the-nimh-withdraws-support-dsm-5
  16. Jarod

    Jarod Senior Member

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    Hiya Bob,

    Sounds like they are trying to legitimize mental illness with fancier tests. By "incorporating genetics, imaging , and cognitive science" as they put it.

    I think mental illnesses are a sub-set of symptoms related to a bigger picture and should be treated as such.
    The bigger picture being neuro-immune disease with an underlying infection.

    It's dishonest to take only a few symptoms of a much larger disease cluster and try to define that as mental illness. All the while, ignoring the inflamation, encephalitis, dizzyness etc that is likely the root cause for some of the depressive, bi-polar, psychosis type symptoms some patients report....

    The mental illness stuff seems like it is only a sub-set symptoms belonging to larger neuro-immune disease in our case. That is the case in my situation. I don;t leave the house or have friends, but that is not due to depression. I like people and have tons of adventures I would like to make reality before I die. That is not depression, but shows up as depression on the tests they give me. It's dishonest, and not science. It is mainly due to dizzyness and mental fatigue etc that makes it impossible to hold down/create any serious relationships when homebound. Not due to any kind of depression or mental illness that the psyhiatrist can never detect with their biased tests.

    To be honest, they need to start with the bigger neuro-immune disorder and account for that first and explain how it can cause the mental illness as just a sub-set of the bigger picture. They also need to account for the inflammation, liver disease, IBS, infections that don't clear etc.



    P.S. I'm just trying to give feedback if it might help somebody keep these these psychiatrists honest along the way. This is not affecting me to the point I'm loosing sleep over it at the moment.
  17. caledonia

    caledonia

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    Actually the underlying cause would be poor methylation. Watch the Methylation Made Easy videos - first link my signature.
    Jarod likes this.
  18. Bob

    Bob

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    Hi Jarod,
    Yes, I agree with you. I think they will make a fundamental mistake if they think that psychiatric conditions start in the brain, or are caused by a malfunctioning brain. The malfunctioning brain has an alternative cause. I agree with you that any psychiatric symptoms are caused not by the brain but by the body as a whole. I hope that a focus on biological investigations will move them towards finding the causes, such as inflammation, genetic changes, epigenetics, endogenous viruses, exogenous viruses, faulty immune systems, etc. etc.
    It is now universally acknowledged that many psychiatric illnesses are biomedical conditions, and I hope the proposed program will widen that to all psychiatric illness.
    Personally, I view things like schizophrenia, autism and depression to all be biomedical conditions that need biomedical research.
    It looks to me as if they are taking a step in the right direction. I hope so anyway.
    Jarod, Nielk and natasa778 like this.
  19. Jarod

    Jarod Senior Member

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    A follow up article in Forbes to the "NIMH" Thomas Insel Article.

    This little tidbit was interesting.

    alex3619 likes this.
  20. alex3619

    alex3619 Senior Member

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    The thing the Forbes article shows is that the NIMH is not rejecting DSM5, but emphasizing their way of doing things. They will still fund research using DSM5 criteria.

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