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10 May 2012

Proposed changes dropped from psychiatric guide

Two proposed psychiatric diagnoses failed to make the last round of cuts in the laborious process of revising the Diagnostic and Statistical Manual of Mental Disorders.

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Two proposed psychiatric diagnoses failed to make the last round of cuts in the laborious process of revising the Diagnostic and Statistical Manual of Mental Disorders.

Gone from the latest revision is "attenuated psychosis syndrome," intended to help identify individuals at risk of full-blown psychosis, and "mixed anxiety depressive disorder", a blend of anxiety and depression symptoms. Both performed badly on field tests and in public comments gathered by the group in its march toward the May 2013 publication deadline.

Both have been tucked into Section III of the manual – the place reserved for ideas that do not yet have enough evidence to make the cut as a full-blown diagnosis.

What has survived, despite fierce public outcry, is a change in the diagnosis of autism, which eliminates the milder diagnosis of Asperger syndrome in favour of the umbrella diagnosis of autism spectrum disorder.

Input from the public

But that, too, could still be altered before the final manual is published, the group says. The APA opened the final comment period for its fifth diagnostic manual known as DSM-V on May 2, and it will accumulate comments through June 15.

Dr David Kupfer, who chairs the DSM-5 Task Force, said in a statement that the changes reflect the latest research and input from the public.

Dr Wayne Goodman, professor and chairman of the department of psychiatry at Mount Sinai Medical Centre in New York, said he's glad the task force is responding to feedback from professionals and the public.

"I think they are trying to listen," he said.

Dr Goodman agrees with the decisions to drop both of the two disorders in the latest revision.

Could be over-diagnosis

With the "mixed anxiety and depressive disorder," he said there was a risk that it would capture a number of people who did not qualify under a diagnosis of depression or anxiety alone.

"It could lead to over-diagnosis," Dr Goodman said.

He said the "attenuated psychosis syndrome" diagnosis would have been useful for research purposes to help identify those at risk of psychosis, but there was a concern that it might label people who were just a bit different as mentally ill.

"The predictive value is not clear yet," he said. "I think it's reasonable not to codify it until we have better definition of its predictive value."

Biological evidence lacking

Dr Goodman, who worked on DSM-4, the last revision of the manual published in 1994, and is working on the Obsessive Compulsive Disorder section of the current revision of DSM-5, said the strength of the process is that it can offer a reliable way for psychiatrists across the country to identify patients with the same sorts of disorders.

The weakness, he said, is that it largely lacks biological evidence – blood tests, imaging tests and the like – that can validate these diagnoses.

"DSM-5 is a refinement of our diagnostic system, but it doesn't add to our ability to understand the underlying illness," he said.

Dr Emil Coccaro, chairman of the Department of Psychiatry and Behavioural Neuroscience at the University of Chicago Medical Centre, said typically changes in the DSM occur because of new data.

Change some diagnoses

Dr Coccaro, who is contributing to the new section in the DSM-5 on Intermittent Explosive Disorder, said there is no question that many people aren't convinced that some of the diagnoses need to be changed, or that there need to be new ones added.

"This also happened the last time when they did DSM-4," he said, but that was nearly 20 years ago.

"You can keep waiting but at certain point you have to fish or cut bait and actually come out with a new edition. That is what is happening now," he said.

(Julie Steenhuysen, Reuters Health, May 2012) 

Read more:

Mental health disorders concern

Mental health in SA

 
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