NIMH abandoning the new DSM-5

  1. Greg Bernhardt

    Staff: Admin

    http://news.sciencemag.org/scienceinsider/2013/05/nimh-wont-follow-psychiatry-bibl.html

    Do you think neuroscience has advanced beyond this "Bible"?
     
  2. jcsd
  3. Evo

    Staff: Mentor

    I always considered the DSM to be primarily a diagnostic tool.

    And apparently it isn't the official diagnostic tool for the US.

    http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders

    See http://en.wikipedia.org/wiki/Intern...ated_Health_Problems#Usage_and_current_topics
     
    Last edited: May 7, 2013
  4. That sure would be nice. The problem is what to do in the meantime...

    How long is this this gonna take?
     
  5. edward

    edward 1,005
    Gold Member

    The NIMH appears to have a well defined goal aimed at research.

    bold mine

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

    I can only assume that the NIMH wants more emphasis put into research in neuroscience and less research on drugs that just treat psychiatric symptoms.

    The diagnostic codes in the DSM are almost endless with many individuals fitting into numerous codes.

    http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders
     
  6. Evo

    Staff: Mentor

    I don't think NIHM will have much bearing on the ICD or even the DSM. What they decide to use for research grants is neither here nor there as far as the diagnosing of patients that is accepted in the medical and insurance fields. I think they should distance themselves.
     
  7. Research normally delves into subjects more deeply than textbooks. And, for that matter, the textbooks themselves are based on the research. I would answer yes. Neuroscience, along with other subjects, are and always have been ahead of the DSM.
     
  8. Nope, I do not get it. Any approach to mental health has to be based on the mental health context and symptoms. The subject is far too complex for the linear approach of science and requires its integration alongside the subjective evidence of human perception.
    A good example of this is that schizophrenia is barely distinguishable in its inheritance and chemistry to creative genius.
     
  9. Psychiatry has a long way to come, but it is still not as a stage where conditions can be categorised based on objective tests rather than the interpretation of symptoms. I applaud the NIMH for taking this step, hopefully it will stimulate more research in this field. We are becoming more aware that mental illnesses do not fall into discrete categories but lie somewhere on a spectrum. There was a good article on the topic in Nature recently (http://www.nature.com/news/mental-health-on-the-spectrum-1.12842).

    The history of the DSM is fascinating. In 1952, it was 130 pages long and listed 106 mental disorders. In 1994, it was 886 pages long and listed 297 disorders. I think a lot of doctors tend to use it as a guide rather than a rigid diagnostic instrument. In Australia we use the ICD-10.
     
  10. We discussed the DSM-V in abnormal psychology this year. The discussion revolved around the 180 degree changes in the DSM-V regarding aberrant behaviors (among other things), and the fact that many therapists see a disconnect in the diagnoses in V verses previous serial versions of the DSM.

    I have no idea whether it is right or wrong, just an observation of mine that it was a lively debate! Ciao.
     
  11. Monique

    Monique 4,699
    Staff Emeritus
    Science Advisor
    Gold Member

    Already in 2010 the NIMH announced that psychotic disorders should be classified differently (Toward New Approaches to Psychotic Disorders: The NIMH Research Domain Criteria Project). In fact, that was also the goal of the DSM-5: to not classify disorders based on distinct classifications (Kraepelin approach), but to use a continuum. This however met with a lot of criticism from clinicians who were skeptical that such an approach could be implemented as a diagnostic tool in the clinic.

    Clearly research is headed in the direction of characterizing the continuum (example: Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis). Neuroscience is definitely advancing beyond the bible, but changing the mindset of doctors who have used it as a diagnostic tool will take a large effort.
     
  12. It would be a complete paradigm change. There's a lot of clinical other than doctors who work in mental health. A change to diagnoses on a continuum would require a long transition period and considerable costs in implementation. Nevertheless, given the evidence for this model, it seems to be the right path to take.
     
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