NIMH Distances Itself From DSM Categories, Shifts Funding To New Approaches 185
New submitter Big Nemo '60 writes with news that the National Institute of Mental Health is seeking to modernize the diagnosis of mental illness through the use of neuroscience, genetics, etc. From the article: "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."
More importantly, they are going to be shifting funding to research projects that seek to define new categories of mental illness using modern medical science, ignoring the current DSM categorizations: "The strength of each of the editions of DSM has been 'reliability' .. 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. ... 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. ... 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.' ... 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."
Re:About time! (Score:4, Informative)
I had internal infections misdiagnosed as depression for over 4 years before physical symptoms appeared. This is a good thing to avoid these kind of errors in the future. How the hell can a doctor prescribe SSRI without measuring the actual levels first?
Levels of what?
In my experience, it's reasonably common for psychological complaints to get some bloodwork; but mostly for known endocrine issues with fairly blatant psych manifestations. This isn't to say that instances of 'your thyroid is just phoning it in-itis' aren't missed; but that is something that they look for, especially if the SSRI of the month doesn't get results.
Beyond the endocrine markers you can get from a blood draw, though, the invasiveness of sampling goes up fast and the quality of baseline data to compare you against goes down fast.
Re:About time! (Score:5, Informative)
Oh, I'd be the last to deny that the quality of mental health care is deeply uneven(with the limited exception of scheduled substances, where the DEA may end up knocking on your door) if it's FDA approved, any doctor can prescribe it, so there are a lot of drugs being handed out either by dubiously qualified generalists, or by the wrong flavor of specialist. My point was just that, since our knowledge of the brain is so poor(and our methods for sampling an in-vivo brain so... crude) the list of objective chemical markers dwindles alarmingly swiftly once you get past a relatively short list of endocrine issues.
Re:Psychiatry is not medicine (Score:4, Informative)
As opposed to good ol' fashion psychology? Aka the "you want to fuck your mother" syndrome. No thanks. I'll take the happy pills. It worked for Neo.
Psychoanalysts have been mostly confined to the English/contemporary lit departments for quite some time now. Talk therapy is still very much a thing; but old-school analysts are pretty thin on the ground these days.
Re:Psychiatry is not medicine (Score:2, Informative)
Psychiatry may not be medicine per se, but yes, they most certainly are medical doctors and they do prescribe a boatload of medications. As someone who met a DSM classification at 18/19 years old and medicated on many of these drugs for 24 years and off of them for 1 year, I do have some facts and opinions on the subject.
I meet the DSM classification for bipolar disorder II to a tee. And the last 5-10 years of taking medications was a complete misery for me. I got hooked up with a doctor that kept giving me more and more medications to "solve" the problems caused by taking so many medications. I was on benzodiazepines for years and was given stronger and stronger versions of them and was having anterograde amnesia. I described this in great detail to my doctor. People would joke at me at work because I could not remember hardly anything. And the doctor put me on meth to counter the drug induced amnesia. In 2 weeks I was absolutely nuts from taking the meth and took myself off. It was not until the doctor left the country and I saw another one that the new one weened me off of the benzos. I then took myself off of the "anti-psychotics" and then took myself off of lithium. My brain and kidneys and liver could not take these medications any more.
Coming off of these drugs was not easy. Especially the lithium after being on it for 24 years. In fact, I lost my job and was "crazy" for many months. I eventually moved in with my parents and stabilized and started a new job after about 7 months after losing my last job. I still have minor mood swings, but no more or less than I did when I was on the medications. I have greatly altered my diet and quit taking all street drugs, tobacco, and drinking of alcohol and I exercise regularly. I'm pretty confident that drugs and alcohol made me bipolar in the first place because I have only been "manic" when coming off of drugs or had manic symptoms being triggered by psychiatric drugs.
I have my ups and downs, but overall I'm more stable and happy and clear thinking without these medications.
More on topic, I think that the DSM is way overrated. One of the symptoms of bipolar disorder is thinking clearly. I will attest that I am not "normal", but I've also read where in "under developed" countries that bipolar people lose like 6 years of functioning life and in "developed" countries they lose 5 years. To me, that is the same degree of impairment, especially when one considers the stigma of being labeled and medicated as "mentally ill", and the cost and commitment towards being on the special med merry-go-round.
For those of you that do not know, there is no panacea with these drugs. You literally keep rotating them around and your symptoms/side effects change over time and it never stops. These drugs are to be taken for a lifetime, and habituation to them makes it very difficult to come off of them, and they have almost caused me to die more than once.
I've never been given anything besides a DSM test for diagnosis. Never a blood test, a genetic test, or anything 100% valid. And until that happens and I function well, I am not ill anymore. Being off of lithium actually helps me in that I can sense what actually triggers my mood swings and I do not feel like I am on emotional training wheels.
Re:About time! (Score:2, Informative)
A non slightly paranoid person might realize most of the medical research in biology looking for cures is done by university researchers with grants from the NIH with about at $30 Billion/year budget. Who are not folks trying to hook you on anything.
And that most of the research money the Pharma companies spend is on doing clinical trials to see which ones actually work in humans after the university researchers have found potential candidates testing in cell cultures and animal models.
Re:About time! (Score:5, Informative)
And that most of the research money the Pharma companies spend is on doing clinical trials to see which ones actually work in humans after the university researchers have found potential candidates testing in cell cultures and animal models.
Hell no. About 15% of drugs come from academic research, the rest are invented by biotech or pharma companies. For the most part academic labs identify new drug targets. Most of the compounds they develop to test their hypotheses are for the most part useless as actual active pharmaceutical ingredients due to toxicity, bioavailability, and metabolism.
Re:About time! (Score:5, Informative)
As a researcher I can confirm this, but also the parent.
Traditionally the drug companies have relied on methods equivalent to "brute force" programming, test a library of a few thousand possible drugs and see which works. But this is getting harder, it seems they have run out of low hanging fruit, so instead they take some existing understanding and use that to make the drug. By doing this they get the drug and the profit but only by relying on taxpayer funded research. Remember the drug does not need to have been made by government researchers to be reliant on tax funded research for its existence. The researchers find a target the drug companies take it from there, but increasingly it is the first part that is most expensive.
It may in fact be cheaper for society to do all this on the government dime, there is a lot of waste in the drug industry a lot of it from its very nature as private research. Fixing this would involve the government massively increasing research funding and deliberately killing an industry, not likely in the short run.
Re:About time! (Score:5, Informative)
[source needed]
Sorry, a couple of years ago I looked at a year's worth of drug approvals and came up with 15%. The actual data (1998-2007) say 24% came from academia:
http://www.nature.com/nrd/journal/v9/n11/full/nrd3251.html [nature.com]
Firewalled, but there is a great discussion at In The Pipeline that breaks out the numbers:
http://pipeline.corante.com/archives/2010/11/04/where_drugs_come_from_the_numbers.php [corante.com]
Of course more and more university research is funded by Pharma these days, especially the efforts that are most likely to lead to new drugs. Which column would you put that drug in?