View Full Version : NIMH to Orient Research Away from DSM Categories


APSJ
05-07-13, 08:01 PM
This as an excerpt from a recent announcement from the National Institute of Mental Health:

While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. 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. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.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. Through a series of workshops over the past 18 months, we have tried to define several major categories for a new nosology (see below). This approach began with several assumptions:


A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
Each level of analysis needs to be understood across a dimension of function,
Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.

It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data. In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”2 The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.

That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system.http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

Any thoughts on the implications of this for ADHD research?

Amtram
05-07-13, 08:17 PM
Mindhacks (http://mindhacks.com/2013/05/03/national-institute-of-mental-health-abandoning-the-dsm/) has an opinion, Fortune commented on. . .another thread, somewhere here. . .I see several points, but I'm still divided about whether I think this is a good thing or not.

TygerSan
05-07-13, 08:35 PM
Well, that's interesting (and the first I've heard of this).

I think that, overall, this is a good thing. I think this gem of a quote from the OP sums it up best:

Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM categoryBasically, if we *don't* know what causes a syndrome/set of symptoms, then how can we design tests to measure the causal relationships? The DSM groups clusters of symptoms that are easily observable. That doesn't mean, however, that everyone's ADHD symptoms arise from the same set of genes/biomarkers/causes. It just means that by outward appearance they look similar.

Who knows! By re-focusing efforts on data-mining and biomarkers, we may find we need to reclassify certain disorders. There is a autoimmune disorder that affects NMDA receptors in the brain, for example, which cause a myriad of symptoms that overlap with bipolar disorder and schizophrenia, but is caused by an immune reaction, and responds to immunosupression therapy: http://www.cbsnews.com/8301-204_162-57568485/newly-diagnosed-brain-disease-may-be-misdiagnosed-as-psychological-disorder/

I know that the opposite might not be true, and that we might end up barking up the wrong tree looking at literally millions of different combinations of genes/biomarkers *without* some form of framework, but I still think that this is a potentially valuable approach, and may lead to a rethinking of the way we diagnose and treat psychiatric/neurological disorders.

atSWIMtooboreds
05-07-13, 08:38 PM
I think this is great, personally. It's the right way to go.

Fortune
05-07-13, 09:05 PM
I think people who dislike the DSM-5 are a bit quick to jump on this as something that it is not.

ginniebean
05-07-13, 09:59 PM
I think people who dislike the DSM-5 are a bit quick to jump on this as something that it is not.


Judging from the comments on that article I'd have to agree, it's a bit disturbing. This certainly brought out the anti-psychiatry wing nuts.

I'd like to hear a LOT more about this because right now, my spidey senses are tingling.

Kunga Dorji
05-07-13, 11:16 PM
No, it is not antipsychiatry at all- though I am sure that the antipsychiatry crowd will try to exploit it.

However this quote sums it up well:

Dr Thomas Insel (http://en.wikipedia.org/wiki/Thomas_R._Insel), Director of the National Institutes of Mental Health (http://en.wikipedia.org/wiki/Mental_health), joins the growing group of leading psychiatrists who address the neuroscientific inadequacy of the current diagnostic system.
Read more: http://www.corepsych.com/2013/05/nimh-agrees-dsm-5-needs-revision/#ixzz2SfQKzAsB



DSM has only ever been an attempt at getting a scientific study of "psychological problems/mental illness" going- and its introduction specifically recognises that its categories are not diagnoses- but descriptions of common patterns.

This is pretty much what I have been saying all along- and the fact that this understanding of DSM is not common amongst the lay public (or many doctors or less well trained psychiatrists) is exactly the logical flaw that gives the "antipsychiatry crowd" a way in.

ginniebean
05-08-13, 01:45 AM
http://neurocritic.blogspot.ca/2013/05/rdoc-dimensional-approach-for-research.html

Fortune
05-08-13, 01:55 AM
Thank you for that link. That is how I interpreted the story, and it is good to see that it is the case.

Amtram
05-08-13, 11:52 AM
(Sigh of relief) ginnie's link clarifies this as a gradual change, which is much more sensible, and what I would have expected from the NIH. Weren't we mentioning journalistic hyperbole elsewhere???

My concern when reading the initial links that popped up in my newsfeed was that the NIH was going to simply toss out the diagnostic criteria wholesale. The science is definitely going in a direction that will result in much more specified and accurate symptom-based diagnosis and treatment, but we're such a long way away from it becoming reality. . .and the public is already inclined to dismiss most psychiatric diagnoses and hogwash anyway. . .

I still feel some trepidation about these announcements because of the public perception, though. What's coming across is "NIH tosses out bogus DSM!!!" That's not going to do any of us any favors.

ginniebean
05-08-13, 12:35 PM
You're right Amtram, it's not. From the looks of things, the anti-psychiatry is having a grand time and considering this a victory.

Dizfriz
05-08-13, 01:14 PM
I had read of this lately and understood that it was primarily a change in research direction and not a change in current diagnostic protocols nor really a challenge to the DSM. I see nothing here that I would disagree with all that much.

This letter from the director of the NIMH explains it pretty well as I understood it.

http://www.nimh.nih.gov/about/director/index.shtml#p145045

A few excerpts

It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data. In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.” The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.

That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system. The best reason to develop RDoC is to seek better outcomes.

RDoC, for now, is a research framework, not a clinical tool. This is a decade-long project that is just beginning. 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. RDoC is nothing less than a plan to transform clinical practice by bringing a new generation of research to inform how we diagnose and treat mental disorders. As two eminent psychiatric geneticists recently concluded, “At the end of the 19th century, it was logical to use a simple diagnostic approach that offered reasonable prognostic validity. At the beginning of the 21st century, we must set our sights higher.” I really don't see any problem with this is that it in that, while the DSM is the best we have right now, using biological markers would be, by far, preferred as diagnostic tools. Ah he said however right now we cannot do this because we do not have enough information so we will have to use the DSM for the time being.

I suspect it will be a good number of years until we get an adequate set of biologically based diagnostic criteria to retire much of the current method but, as in the case of ADHD, it would be extremely helpful to have a solid way of diagnosing this disorder.

Really, the only way I can see this being used by anti psychiatry advocates is to misrepresent what is being said. This is simply a planned focus on research and nothing else as far as I can see.

Just my impressions,

Dizfriz

finallyfound10
05-09-13, 11:28 AM
I was going to post this and saw that it already was! I didn't see that anyone had posted one of the parts that will help us understand what it "looks" like so here it is:

http://www.nimh.nih.gov/research-funding/rdoc/nimh-research-domain-criteria-rdoc.shtml

I think this whole concept is a great idea and hopefully will make diagnosing, treating and living with ADD, just a bit easier!!!

Kunga Dorji
05-12-13, 10:57 AM
I had read of this lately and understood that it was primarily a change in research direction and not a change in current diagnostic protocols nor really a challenge to the DSM. I see nothing here that I would disagree with all that much.

This letter from the director of the NIMH explains it pretty well as I understood it.

http://www.nimh.nih.gov/about/director/index.shtml#p145045

A few excerpts

I really don't see any problem with this is that it in that, while the DSM is the best we have right now, using biological markers would be, by far, preferred as diagnostic tools. Ah he said however right now we cannot do this because we do not have enough information so we will have to use the DSM for the time being.

I suspect it will be a good number of years until we get an adequate set of biologically based diagnostic criteria to retire much of the current method but, as in the case of ADHD, it would be extremely helpful to have a solid way of diagnosing this disorder.

Really, the only way I can see this being used by anti psychiatry advocates is to misrepresent what is being said. This is simply a planned focus on research and nothing else as far as I can see.

Just my impressions,

Dizfriz


From the quote that you referenced I am sure that much more linkage will be found across categories currently described as quite different conditions- ie there will certainly be a number of biomarker similarities between say fibromyalgia, cfs & chronic depression as there will be between cfs, fibromyalgia, adhd, and bipolar.

Ultimately it is likely that there will be very substantial differences between the categories DSM uses, and more refined models that will arise over the next 50 years.

One early instance of this is Daniel Amen's work- which shows distinct crossovers between subtypes of depression and his subtypes of ADHD- based on SPECT scan.

[SPECT is unlikely to be greatly used as a biomarker given unnecessary radiation, and that QEEG gives sufficiently similar information for most purposes now].

The antipsychiatry crowd will latch onto any excuse at all to avoid thinking beyond their philosophical biases, but we need to be aware of not falling into the trap of disagreeing with any information that they may seek to misuse.

daveddd
05-12-13, 11:18 AM
hopefully this is the end of the page long lists of "comorbids", all separate and distinct of course

im sure there are very few people who have separate disorders

but the lists people have with ADHD are hilarious

daveddd
05-12-13, 11:44 AM
this isnt new thinking, i dont believe

these two examples are the easiest i can find to link

the fragile x pre mutation (without intellectual disabilities) and its strikingly similar behavioral phenotype

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192166/


and the most succinct version of millons biosocial model i can link

http://books.google.com/books?id=Tna-9d_ykPIC&pg=PA63&dq=theodore+millon+biosocial&hl=en&sa=X&ei=DC7AUP2_K86NqQGz1YGABw&ved=0CDYQ6AEwAg#v=onepage&q=theodore%20millon%20biosocial&f=false

ana futura
05-12-13, 02:14 PM
I think in the future this will wind up being one of the best things to ever happen to the field of psychiatry and for the treatment of mental health .

This has been coming for some time, and it's a desperately needed kick in the pants.

Fortune
05-12-13, 07:02 PM
hopefully this is the end of the page long lists of "comorbids", all separate and distinct of course

im sure there are very few people who have separate disorders

but the lists people have with ADHD are hilarious

I think that this is more of a "things should be like this" thing than a "this is how things actually are" thing. That is, I don't see how one could conclude that "everyone is likely to have a single thing" is more likely than "multiple diagnoses are possible for many." Such a conclusion strikes me as being more a matter of expedience than anything.

daveddd
05-12-13, 07:09 PM
not so much everyone is likely to have one thing

as one is likely to have one underlying predisposition or vulnerability

ive stated the DSM is fine for billing and writing out prescriptions

but me personally, i like to go further into it

anagram
05-12-13, 07:14 PM
Statistics FTW! (Because, so far, it has been Statistics FTF.)

Like the text says, it's not that the DSM fails at its intended purposes, but rather that its intended purposes are flawed by design. While there weren't many resources available for objective analysis six decades ago when the first DSM was released, there are a lot of resources available today. It's about time academics start basing their factual references on facts, instead of limiting and distorting the meaning of facts because of largely speculative basic references.

As for the politics involved, I don't know, and I don't know if I care, since it matters naught whether I do. Politics will remain politics. There are no Good Guys, just politics.

Fortune
05-12-13, 07:53 PM
not so much everyone is likely to have one thing

as one is likely to have one underlying predisposition or vulnerability

This is what I find difficult to agree with. I may have phrased it poorly, but that was what I was trying to say.

daveddd
05-12-13, 08:06 PM
ok, so your view is everything is distinct and separate?

the extremely high "comorbid" rates are just coincidental ?

youre entitled to that perspective, you just wont convince me of it

Fortune
05-12-13, 08:21 PM
My view is that everything someone has is not necessarily explainable as a single thing for each person.

I'm not trying to convince you of that perspective. I think said perspective lends itself to expedience over appropriate treatment. The last time someone tried to convince me that I had one thing to explain all my problems, it was a thing I do not actually show any signs of, and struck me as bypassing my actual needs for the sake of simple explanation presented as a neat package.

daveddd
05-12-13, 08:54 PM
My view is that everything someone has is not necessarily explainable as a single thing for each person.

I'm not trying to convince you of that perspective. I think said perspective lends itself to expedience over appropriate treatment. The last time someone tried to convince me that I had one thing to explain all my problems, it was a thing I do not actually show any signs of, and struck me as bypassing my actual needs for the sake of simple explanation presented as a neat package.

ok im between both those views

i believe in an underlying vulnerability

but interactions with social, environment, and so on is anything but a neat package to me

thats the categorical reductionist view, that i dont like about the dsm(other than the reasons ive already stated it is good for)

daveddd
05-12-13, 09:16 PM
if you scroll up to the chart on this link it someone portrays my view
http://books.google.com/books?id=mF2poNOgOGkC&pg=PA5&dq=neurodevelopmental+borderline+personality&hl=en&sa=X&ei=ZXV4UcCoAceRqwH9mIGIAw&ved=0CEMQ6AEwAg#v=onepage&q=neurodevelopmental%20borderline%20personality&f=false

Amtram
05-13-13, 09:52 AM
Neurodevelopmental issues have a variety of triggers, and some of them have no specific triggers at all - the brain just develops differently right from the start.

I could get into a big honkin' lecture about how the genetics can cause the same symptom in multiple disorders, but also cause the grouping of symptoms that end up being classified as one disorder but not another, but I doubt that it would actually explain much.

The thing is that in searching for a genetic cause for various conditions, researchers have found that certain genes, alleles, gene placement or combinations, and so on can be responsible for a behavioral symptom even in people who don't have the condition being studied. All of this is leading to a much more specific understanding of the genetics that build brain structures, and the differences in brain structures that influence symptoms. . .and it works backwards and forwards until a picture can arise of what genetic conditions cause what clusters of abnormal function or connectivity in the brain, and why this cluster and not that one.

It's also showing that symptoms can exist absent of other symptoms, so once we can figure out correlations and causes on a symptom by symptom basis, we'll be able to accurately diagnose and treat each one individually, rather than having to classify people as having an entire disorder or disease in order to treat them - and end up treating even the symptoms they don't have in the process.

It's a good goal. It means being able to have tests that clearly demonstrate the presence or absence of a problem. It means being able to develop treatments that are specific to that problem. It will benefit patients not only as it regards treatment, but also when it comes to understanding and public acceptance of the legitimacy of their symptoms. It's just that being able to do that is still a long way off.

daveddd
05-13-13, 11:32 AM
Ok. Help me understand it a bit better with an example

I only use fx because I don't have to look up the info

They say between 50-100 alleles appear in the patients with just psychological impairments

100-200 alleles in intellectually disabled who also have the psychological impairments


Then in men without either usually develope a tremor/ ataxia

The women premature ovarian failure


So are you saying things trigger these genes. Or the genes trigger the impairments?

daveddd
05-13-13, 12:05 PM
And the amount of alleles and different symptoms?

So what came first. Allele amount Trigger. Or impairment ?

Dizfriz
05-13-13, 12:39 PM
Statistics FTW! (Because, so far, it has been Statistics FTF.)

Like the text says, it's not that the DSM fails at its intended purposes, but rather that its intended purposes are flawed by design. While there weren't many resources available for objective analysis six decades ago when the first DSM was released, there are a lot of resources available today. Really there aren't. Right now none of the DSM disorders have biological/neurological markers that are valid for diagnosis. If you note the article stats: It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data. While we have a lot more than we had when the DSM first came out, we don't yet have enough to replace it. The DSM, as flawed as it may be, is the best we have for now and is far, far better than having nothing. You might look up the Washington times article today on the DSM: http://www.washingtonpost.com/lifestyle/style/the-bible-of-the-mind-turns-the-page/2013/05/12/17d8fc1c-b1b6-11e2-baf7-5bc2a9dc6f44_story.html

It discusses some of the history of the DSM and explores some of the current issues.


It's about time academics start basing their factual references on facts, instead of limiting and distorting the meaning of facts because of largely speculative basic references. This is the thing, we don't yet have the facts needed to change diagnostic methods. The DSM (symptom based)was and remains the current best solution to a difficult problem: how to have reasonably consistent diagnoses among different clinicians. The is the primary problem that the DSM was designed to handle. The question remains, what would one replace the DSM with today? Objective criteria based mental health diagnostic system seems unfortunately, to be a some distance in the future. It is the desired goal but it is not for now.

Not a criticism of your post but you made some interesting points that seemed worthwhile to address.

Dizfriz

ana futura
05-13-13, 01:20 PM
This is an interesting take, from one of DSM-5's most outspoken critics-
http://www.huffingtonpost.com/allen-frances/nimh-vs-dsm-5-no-one-wins_b_3252323.html

The flat out rejection of DSM-5 by National Institute of Mental Health is a sad moment for mental health and an unsafe one for our patients. The APA and NIMH are both letting us down, failing to be safe custodians for the mental health needs of our country.

DSM-5 certainly deserves rejecting. It offers a reckless hodgepodge of new diagnoses that will misidentify normals and subject them to unnecessary treatment and stigma.
The NIMH director may have hammered the nail in the DSM-5 coffin when he so harshly criticized its lack of validity.

But the NIMH statement went very far overboard with its implied promise that it would soon find a better way of sorting, understanding, and treating mental disorders. The media and internet are now alive with celebrations of this NiMH 'kill shot'. There are chortlings that DSM-5 is dead on arrival and will perhaps take psychiatry down along with it.

This is misleading and dangerous stuff that is bad for the patients both institutions are meant to serve.

NIMH has gone wrong now in the very same way that DSM-5 has gone wrong in the past -- making impossible to keep promises. The new NIMH research agenda is necessary and highly desirable -- it makes sense to target simpler symptoms rather than complex DSM syndromes, especially since so far we have come up empty. And the new plan will further, and be furthered, by the big, new Obama investment in brain research. But the likely payoff is being wildly oversold. There is no easy solution to what is in fact an almost impossibly complex research problem.

Personally, I think he's missing the mark. The NIMH's rejection of the DSM is ONLY for research purposes. The NIMH had to had to reject the DSM to liberate brain research from the constraints placed upon it by a symptom-cluster based approach. However I do agree with his assertion of an "oversold payoff", at least at the moment.

I think the real danger to patients comes from a public who doesn't understand why the DSM was rejected. So therefore it's the job of people like Dr. Francis to educate the public as to why. I think the NIMH is doing a great job of explaining their motives. While I usually have a lot of respect for Dr. Francis, I think he's missing the bigger picture here. I do find his criticism of the NIMH offering "impossible promises" interesting and valid, yet brain research is advancing exponentially right now. We are probably a few years away from a saliva swab test for ADHD! I don't think it's as impossible as it seems.

ana futura
05-13-13, 01:41 PM
Another interesting take-
http://www.nytimes.com/2013/05/12/opinion/sunday/why-the-fuss-over-the-dsm-5.html?_r=0

But many critics overlook a surprising fact about the new D.S.M.: how little attention practicing psychiatrists will give to it.

There are dozens of revisions in the D.S.M. — among them, the elimination of a “bereavement exclusion” from major depressive disorder and the creation of binge eating disorder — but they won’t alter clinical practice much, if at all.

This is because psychiatrists tend to treat according to symptoms.

So why the fuss over D.S.M.-5? Because of the unwarranted clout that its diagnoses carry with the rest of society: They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits.
...

The media will trumpet the release of the new D.S.M., but practicing psychiatrists will largely regard it as a nonevent. Unfortunately, the same cannot be said for other institutions — insurance companies, state and government agencies, and even the courts — which will continue to imbue the D.S.M. with a precision and an authority it does not have.

Dizfriz
05-13-13, 02:40 PM
I really think the controversy is much ado about not much.

The NIMH is, in my opinion, not rejecting the DSM but as they state in one of their articles: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

This approach began with several assumptions:

A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,

Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,

Each level of analysis needs to be understood across a dimension of function,

Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment. The NIMH seems to be saying that, as above, it will not be constrained by the DSM. That is a perfectly logical and reasonable approach. They make a strong point that they are not suggesting replacing the DSM 5 with anything but hope to replace the symptom based diagnosis methodology that we currently have with a perhaps better one in the fullness of time. I think that is a very good idea and one that most in the field would encourage.

As Ana Futura reported, the DSM 5 is pretty much a non event with clinicians. It is simply a update of what we had before. Really no big deal.

When the DSM III and IV came out there was a good bit of initial sniping from critics which had relatively little impact. Some of the criticisms were valid though and over time were taken into account thus the text revision on the IV.

What we may be seeing is a bit of turf war between the NIMH and the DSM with various jabs between them but that will likely settle down. I suspect clinicians will read the new DSM, incorporate it into their methodology and go about their business. The researchers will likely do the same.

Some of the contention may have come from some who do not want the DSM approach changed and some who simply do not like the DSM approach (both sides). I think much of the criticism of the DSM I have read after the NIMH reports were released suggesting that DSM as being somehow terminally flawed is simple foolishness. Right now, it is the best we have.

I applaud both the NIMH and the DSM committees. Both a trying to deal with an imperfect situation in an imperfect world. Both are trying to give us the best tools to help.


Just my opinion and thoughts. Take them as that only.

Dizfriz

Dizfriz
05-15-13, 08:17 AM
On the DSM-NIMH issue, there was a joint press release stating:


In the statement, they acknowledged that along with the International Classification of Diseases, DSM "represents the best information currently available for clinical diagnosis of mental disorders" and that the two publications "remain the contemporary consensus standard to how mental disorders are diagnosed and treated." http://alert.psychiatricnews.org/

USA today also had an article on this.

http://www.usatoday.com/story/news/nation/2013/05/14/dsm-5-mental-health-diagnosis/2159345/


I hope this clarifies the controversy a little.

Dizfriz

mildadhd
05-15-13, 11:47 AM
"Yet, what may be realistically feasible today for practitioners is no longer sufficient for researchers," they said. "Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories. It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior," which is the focus of the RDoC initiative.


http://alert.psychiatricnews.org/

Kunga Dorji
05-17-13, 08:46 AM
On the DSM-NIMH issue, there was a joint press release stating:


http://alert.psychiatricnews.org/

USA today also had an article on this.

http://www.usatoday.com/story/news/nation/2013/05/14/dsm-5-mental-health-diagnosis/2159345/


I hope this clarifies the controversy a little.

Dizfriz

Beware of the rush to consensus. That is the path to mediocrity.
This comment is not directed at you, Dizfriz- but the medical profession as a whole is overly prone to group think. Remember what happened to Semmelweiss when he suggested washing hands between delivering babies
(ridicule, locked up in a psych hospital under false pretenses and hounded to his death), or the difficulties that were faced by Barry Marshall in the 1980s when he identified Helicobacter as a causative agent in peptic ulceration.

In fact I would like to write a serious journalistic article on the destructive consequences of conformity in the medical profession. I have most of the material, but the trick is to express it in a fresh way, and to find a market for the finished product.

ADD me
05-18-13, 01:26 PM
.Remember what happened to Semmelweiss when he suggested washing hands between delivering babies (ridicule, locked up in a psych hospital under false pretenses and hounded to his death), or the difficulties that were faced by Barry Marshall in the 1980s when he identified Helicobacter as a causative agent in peptic ulceration.

In fact I would like to write a serious journalistic article on the destructive consequences of conformity in the medical profession. I have most of the material, but the trick is to express it in a fresh way, and to find a market for the finished product.

Even more germaine -- when I was in nursing school in the mid-'60s, on my psych rotation there was a generally amused disdain for a resident who believed that schizophrenia was a biochemical condition. Fast forward a few decades -- schizophrenia is now universally acclaimed to be a biochemical condition connected to dopamine levels in the brain.

Then there was the guy who insisted that peptic ulcers were caused by bacteria. They laughed at him, too -- until he swallowed a culture of the causative organism at a medical conference, in front of the audience, and promptly developed an ulcer. I think he got a Nobel Prize in medicine for that one.

As for the book you want to write -- look at Stephen Toulmin's, The Logic of Scientific Discovery. It develops that precise hypothesis in the area of basic research. He contrasts "normal science" with "revolutionary science" -- the stuff that gets shunted aside until it eventually wins out. Careful though; a lot of stuff shunted aside really is bad science. And as defenders of the scientific method themselves point out, it is precisely the scientific method that makes the good "revolutionary science" win out eventually.

ginniebean
05-18-13, 01:59 PM
Another interesting take-
http://www.nytimes.com/2013/05/12/opinion/sunday/why-the-fuss-over-the-dsm-5.html?_r=0

Y'know, Alan Frances can go suck it. As far as I'm concerned he started this recent spate of media frenzy and rabid skepticism over ADHD with his constant whinge over how the new DSM would make Psychiatrists look and how it might stigmatize normal people.

He gave NO thought to how he stigmatize those of us with adhd, do we somehow deserve it and "normal" people don't. His crusade, with ADHD as one of his poster child's to new kicked around has done a lot of damage and I firmly believe he has set back public and even professional understanding about adhd for potentially years.

Far too often P-Docs have their own set of opinions and orthodoxies/prejudices that keeps them from even reading the research or caring that ADHD causes harm and suffering in people's lives, the professionals still continue to trivializes adhd. This is stubborn refusal to look at facts.


Those of us who care to see ADHD being treated as alegitimate and serious disorder are climbing uphill during an avalanche. Thanks so much Dr, Francis. He can just go suck it with his new backpedling. Oops, forgot about the people who legitimately had ADHD. Sarah sweets special sauce to him!

SB_UK
05-18-13, 04:19 PM
As for the book you want to write -- look at Stephen Toulmin's, The Logic of Scientific Discovery. It develops that precise hypothesis in the area of basic research. He contrasts "normal science" with "revolutionary science" -- the stuff that gets shunted aside until it eventually wins out. Careful though; a lot of stuff shunted aside really is bad science. And as defenders of the scientific method themselves point out, it is precisely the scientific method that makes the good "revolutionary science" win out eventually.

Personal experience - the poor scientist reacts emotionally (obvious in their language) to a challenging idea.
It's imperative that we dissociate the idea of scientific method from scientist - the scientist can as narrow-minded (perhaps more so) than the average person.

Attachment to ideas isn't a quality which the true scientist can support.

SB_UK
05-18-13, 04:22 PM
The obvious opinion to DSM in whichever guise - is that there're two types of science - physics (mechanism) and stamp-collecting (DSM 1..5) ... ... a point made over and over again here
- the stamp-collector classifies - the scientist explains.

It's easy to argue that the profe$$ional stamp collector wouldn't want mankind to push past stamps by shifting to electronic communication.
Just the same logic used against drug companies - where there is no drug company which'd want to cure disease (any of 'em) - for that'd mean dwindling profit$.

Amtram
05-18-13, 05:09 PM
Conspiracy theories are one of the strongest examples of attachment to ideas. Just sayin'.

ana futura
05-18-13, 05:46 PM
Far too often P-Docs have their own set of opinions and orthodoxies/prejudices that keeps them from even reading the research or caring that ADHD causes harm and suffering in people's lives, the professionals still continue to trivializes adhd. This is stubborn refusal to look at facts.


This is the main reason I want to see ADHD treatment and research separated from psychiatry and given to Neurology/ Neuroscience.

I imagine that from a neurologist's perspective, it probably doesn't matter if ADHD is currently overdiagnosed or underdiagnosed, because genetic research is the only thing that will be able to give us a concrete definition of what ADHD actually is, and we're not quite there yet. So ambiguity is to be expected at this stage, and it's better to over-treat than to under-treat. If over-diagnosing is actually happening, it will stop once we have a DNA test. It's not about over vs under diagnosing. They're likely both happening. Yammering on about either is pointless, as we need to be aiming for accuracy. As long as Psychiatry is calling the shots, ADHD will remain a cluster of symptoms, and nothing more.

And hopefully once we can finally do a DNA test for ADHD, all this nonsense discussion over whether or not it actually exists will finally end.

I'm doing my part by boycotting psychiatry :cool:

daveddd
05-18-13, 05:50 PM
but should we keep the behavioral psychology along with the neuroscience ?

ana futura
05-18-13, 05:57 PM
but should we keep the behavioral psychology along with the neuroscience ?

I think yes, definitely. I think that when we do have a DNA test, we will see that there are lots of people with the genetic markers who will not qualify for a diagnosis (according to the DSM), and lots of people without the markers who will qualify.

We may have to come to terms with the fact that some people actually don't have this thing called "ADHD", but still need stimulant medication to be functional members of society. What then?

daveddd
05-18-13, 06:00 PM
Conspiracy theories are one of the strongest examples of attachment to ideas. Just sayin'.

closely followed by negative rumination?

Amtram
05-18-13, 08:18 PM
DNA alone is probably not going to be sufficient for anything but risk assessment. Anything that is not monogenic (caused by a single gene) or expressed in specific, recognizable physical symptoms (such as deformities or internal anomalies or other testable abnormalities) is going to indicate only that a risk factor is present. It will have to be combined with other tests to measure whether the gene is expressed, where, and how.

Symptoms will still be the first sign - they are the first sign for every human condition - but genetic and other tests will be used to confirm a diagnosis, same as they are now. Just as you go to the doctor with a sore throat and he takes an inventory of your symptoms to narrow down what might cause it and then decides what tests to order, and then decides what treatment will be most effective, you'll be able to go to the doctor with behavioral symptoms and get a science-based treatment instead of an evidence-based treatment.