DSM V

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DSM-5 troubles

DSM 5

Both Shrink Rap and Mind Hacks report on a debate about how transparent the process for developing the upcoming DSM-V should be. This debate is published in the LA Times. Those in charge of the revision want secrecy, nobody knows why. It is suggested in the comments it could have something to do with the insurance companies?

Besides transparency of the making of the new revision of this psychiatric diagnostic bible other problems were mentioned on this blog as well as others:

  • Psychiatrists updating the DSM did not disclose ties with pharmaceutical drug companies
  • Will Internet addiction be a new diagnosis in the DSM V? Medicalize problems again. In an editorial in the American Journal of Psychiatry Internet Addiction is proposed as a new diagnosis in DSM V. Now the American Journal of Psychiatry used to be a serious peer reviewed journal although some of us doubt this feature for a while now.
  • More than half the 28 new members of writers of the next edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) have ties to the drug industry.
  • The Last Psychiatrist also has an opinion about Internet addiction in the DSM V.
  • Suicidal behavior as Sixth Axis in DSM VIt is suggested in an editorial of the American Journal of Psychiatry that suicidal behavior be considered a separate diagnostic category documented on a sixth axis. Ridiculous. Suicidal behavior (death and attempts) is a symptom of various psychiatric conditions. We will need a seventh axis for addiction, another item often overlooked. It is a kind of safe guard against lack of interest, lack of empathy for psychiatric patients.

There is still a long way to go. The DSM-V is due out in May 2012, and all mental illness and proposals for the classifications of new mental illness are currently under review by the DSM-V committee.

 

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Suicidal Behavior as Sixth Axis in DSM V?

suicidal behavior

It is suggested in an editorial of the American Journal of Psychiatry that suicidal behavior be considered a separate diagnostic category documented on a sixth axis. Ridiculous. Suicidal behavior (death and attempts) is a symptom of various psychiatric conditions.

Their main concern is that during assessment, clinicians evaluate the principal diagnosis responsible for the chief complaint and use overview questions to identify comorbid conditions. They further reason that suicidality in high-risk groups can easily go unidentified.

What they overlook to my opinion is that this addition of another axis will not end. We will need a seventh axis for addiction, another item often overlooked. It is a kind of safe guard against lack of interest, lack of empathy for psychiatric patients. The lack of being able to feel the trouble these patients can have, even resulting in suicidal behavior. We should train our residents in empathy, in getting them to understand the consequences of the symptoms these patients suffer including suicidal behavior.

For that matter another editorial in the same issue hits the nail on the head:

The course asks residents to consider the fact that our sociocultural context is just as critical as basic neurobiology in shaping how we understand and intervene in our patients’ illnesses.

The authors of this editorial describe a course that focuses on the heterogeneity of mental illness
experience, and they describe outcomes in a comprehensive narrative. Texts on illness experience remind residents that they see an extremely brief slice of an individual’s life in the clinic.

In short: the person and his or her world behind the “patient”, that is what important, not another axis in DSM V.

The course consists of lectures, readings, and homework, the course engages residents in discussions about the psychiatric task. Social science is taught not as a set of abstract theories but as a set of tools to use as residents consider the responsibilities, complexities, and uncertainties of clinical work.

ResearchBlogging.org
M. A. Oquendo, E. Baca-Garcia, J. J. Mann, J. Giner (2008). Issues for DSM-V: Suicidal Behavior as a Separate Diagnosis on a Separate Axis American Journal of Psychiatry, 165 (11), 1383-1384 DOI: 10.1176/appi.ajp.2008.08020281
E. Bromley, J. T. Braslow (2008). Teaching Critical Thinking in Psychiatric Training: A Role for the Social Sciences American Journal of Psychiatry, 165 (11), 1396-1401 DOI: 10.1176/appi.ajp.2008.08050690

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DSM V and Author Conflicts

DSM V

More than half the 28 new members of writers of the next edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) have ties to the drug industry, according to the Center for Science in the Public Interest’s Integrity in Science Watch.

A lot of my Dutch and Belgian colleagues are in the United States these days. They are visiting the APA Annual Meeting in Washinton DC.

I thought they should know this, hope they kept on reading this blog.

The conflicts of interests were posted online by the APA last week (look here). They ranged from small to extensive.

You can read some more about this on Pharmalot

But then we already knew this didn’t we?