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Medicine

NIMH Distances Itself From DSM Categories, Shifts Funding To New Approaches 185

Posted by Unknown Lamer
from the diagnose-like-it's-1899 dept.
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."
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NIMH Distances Itself From DSM Categories, Shifts Funding To New Approaches

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  • Hey! (Score:5, Funny)

    by Anonymous Coward on Monday May 06, 2013 @08:24PM (#43649215)

    are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.

    They could all be Climate Scientists!

    • Re:Hey! (Score:5, Insightful)

      by Sique (173459) on Tuesday May 07, 2013 @04:25AM (#43651177) Homepage

      They could all be Climate Scientists!

      No. Then they would need measurements. Lots of them. Millions of them. So much measurement, that some people just sit there, overwhelmed by the sheer number of data points and claim, that no one could ever make any sense of it and thus we should just mind our own business and go away.

    • by TWX (665546)

      They could all be Climate Scientists!

      that could be their secret...

  • by Anonymous Coward on Monday May 06, 2013 @08:25PM (#43649221)

    Clearly they have a plan, and goals that are not compatible with that of humans.

    Our only hope? Super-intelligent space-monkeys.

  • About time! (Score:5, Insightful)

    by gagol (583737) on Monday May 06, 2013 @08:27PM (#43649235)
    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?
    • Re:About time! (Score:5, Insightful)

      by LurkerXXX (667952) on Monday May 06, 2013 @08:37PM (#43649283)

      SSRI's are measured in the blood. Blood levels may or may not reflect the levels in the part of the brain in question for any particular disorder. There's no way to get a 'real' level without a biopsy, which I'm guessing you'd not be real fond of getting.

      It's hard enough for physicians to diagnose ailments in other parts of the body when patients present aytpical symptoms, as often happens. When it happens when the brain is involved, where our understanding much less than it is in every other part of the body, misdiagnosis are bound to be common.

      Should testing at treatments be better? Yes. Which is why it is good that they are questioning the whole DSMC and rethinking how things should be done in catagorizing and diagnosing issues with the brain.

      • Re:About time! (Score:5, Insightful)

        by gagol (583737) on Monday May 06, 2013 @08:44PM (#43649323)
        The less we "try and see what happens" with drugs messing with the brain's chemical balance the better. I am just glad I finally went under the knife, recovered wonderfully and to be back to work. However, I lost a little fortune in time out of work, plus the nightmare that are those drugs when you don't need them.
        • A slightly paranoid person might buy into the theory that Big Pharma doesn't WANT to cure patients. Instead, they want to hook people on life-long "cures" that prove to be very lucrative.

          • Re: (Score:2, Informative)

            by Anonymous Coward

            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)

              by pepty (1976012) on Monday May 06, 2013 @10:39PM (#43649933)

              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.

              • by mad flyer (589291)

                [source needed]

                • Re:About time! (Score:5, Informative)

                  by Anonymous Coward on Monday May 06, 2013 @11:48PM (#43650255)

                  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.

                  • by tibit (1762298)

                    Now they are out of targets where search space scales linearly with findings. They have an exponential decay in findings to fight with, and you can't with with an exponential by brute force.

                    • by pepty (1976012)

                      Now they are out of targets where search space scales linearly with findings. They have an exponential decay in findings to fight with, and you can't with with an exponential by brute force.

                      Do you mean blocking protein-protein interactions as opposed to blocking protein-small molecule interactions? They did buy a few orders of magnitude of brute force by using antibodies as drugs: immune systems and recombinant molecular biology are a lot faster than chemists at coming up with new drug candidates.

                  • by pepty (1976012)

                    The researchers find a target the drug companies take it from there, but increasingly it is the first part that is most expensive.

                    Ok, my turn to demand a source: Which target took $4 billion to identify?

                    Right now the industry side spends $135 billion on R&D for which it gets ~30 new drugs approved per year plus new research on already approved drugs. Most of that is spent on phase II and III clinical trials, which are costing up to $100M each these days. For pretty much all drugs the vast majority of money and man hours are spent on developing and proving the drug (in industry), not on the target.

                    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.

                    A little of that waste in privat

                • Re:About time! (Score:5, Informative)

                  by pepty (1976012) on Tuesday May 07, 2013 @12:05AM (#43650333)

                  [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?

            • by John Allsup (987)
              And that's why there are papers floating around in the literature pointing out that there are often correlations between the 'best drug' in a clinical trial and the sponsoring corporation.  (See Moncrieff's straight talking introduction book.)
            • I think maybe you have a naive or incomplete view.

              You don't think big pharma do tons of their own drug discovery? They just get leads from academia?

              If I ran a pharmaceutical company I wouldn't let you anywhere near executive management or the board. You don't get it. The idea of me-too drug development would totally blindside you.

          • by pepty (1976012)

            A slightly paranoid person might buy into the theory that Big Pharma doesn't WANT to cure patients. Instead, they want to hook people on life-long "cures" that prove to be very lucrative.

            Actual cures would be much more lucrative. If pharmas had a choice, they'd develop a cure rather than a treatment for any serious chronic disease. Unfortunately, for most non-infectious diseases a "cure" would mean making a fundamental and permanent change in how your body operates. Which pretty much means gene therapy, something which we really don't have a handle on yet.

            • by LurkerXXX (667952)

              Shhh, don't bring logic into into it! I have a lot of stock in the tin market.

            • by fluffy99 (870997)

              A slightly paranoid person might buy into the theory that Big Pharma doesn't WANT to cure patients. Instead, they want to hook people on life-long "cures" that prove to be very lucrative.

              Actual cures would be much more lucrative. If pharmas had a choice, they'd develop a cure rather than a treatment for any serious chronic disease. Unfortunately, for most non-infectious diseases a "cure" would mean making a fundamental and permanent change in how your body operates. Which pretty much means gene therapy, something which we really don't have a handle on yet.

              It would be naive to not understand that like most large businesses, the pharmas are driven financial motives which drives their research and product development cycles. Just look at how they magically have a new drug ready to replace the old one right about the time their patent expires and all the generic manufacturers are set to suck up any profit. It doesn't matter if the old drug was effective and had lower side risks, the company will pour money into advertising to convince people they need the lat

              • Re:About time! (Score:4, Insightful)

                by pepty (1976012) on Tuesday May 07, 2013 @12:51AM (#43650553)

                It would be naive to not understand that like most large businesses, the pharmas are driven financial motives which drives their research and product development cycles.

                Absolutely, which is why i said they would prefer to sell a cure.

                Say it will take 8 years and 3 billion dollars in R & D to get your next product to market. It will be either a cure or a treatment for a chronic disease: your pick.

                1. The treatment will compete with all of the other treatments on the market for marketshare. The cure won't have marketshare: it will have the market. There will be no competitors - until another cure is approved, that is.

                2. Price. As far as the accountants at your insurance company are concerned, the cure isn't competing with the price of a dose of the treatment: it is competing with the entire cost of treating your disease until you die (or become someone else's problem). As long as the cure comes out cheaper than a decade of doctors bills, hospitalizations, tests, and lots of different pills, it's a good deal for your insurance company. The treatment, on the other hand, could only hope to command a portion of that revenue stream

                3. Risk/time value of money. Would you rather be paid your next 10 years salary today or once a month over the next 10 years? Someone who buys your cure pays you in full, today. You book all of that revenue while you are still CEO and take home your bonus. Someone who buys your treatment pays you a little at a time until they switch to a competitor's drug. Or until they die. They are an uncertain revenue stream, not a sure thing.

                • by epine (68316)

                  the cure isn't competing with the price of a dose of the treatment: it is competing with the entire cost of treating your disease until you die

                  Wrong, wronger, and wrongest. One imagines a "cure" is only given to people who have an actual medical problem (presumably to develop an actual cure, the mechanism of disease is fully exposed). Uncures are not so narrowly constrained.

                  Statins are consumed (or potentially consumed) by hundreds of millions of people with nothing more than a statistically elevated ris

                  • by pepty (1976012)

                    the cure isn't competing with the price of a dose of the treatment: it is competing with the entire cost of treating your disease until you die

                    Wrong, wronger, and wrongest. One imagines a "cure" is only given to people who have an actual medical problem (presumably to develop an actual cure, the mechanism of disease is fully exposed). Uncures are not so narrowly constrained.

                    Statins are consumed (or potentially consumed) by hundreds of millions of people with nothing more than a statistically elevated risk of possibly developing heart disease according to some rather arbitrary marker.

                    Those markers aren't to determine whether the patient has the disease, they're to determine whether the treatment is (maybe) appropriate for the patient.

                    A cure for atherosclerosis (what statins aim to treat) would be sold not just to everyone currently prescribed a statin for high chloresterol, but pretty much everyone, full stop. Not everyone has atherosclerosis due to high LDL chlolesterol (the indication for statins), but everyone has (or will have) atherosclerosis. Arterial plaque starts in teenagers a

              • by John Allsup (987)
                It's interesting how a drug appears to be 'best thing since sliced bread' in early clinical trials and becomes 'as bad as the first generation drugs' when the patent expires and company X has a new wonder drug on the market.  If you actually look at abstracts using something like the Trip database, you get the feeling that bad trials are getting hidden (like if you went to Amazon and all reviews were 4* or better).
          • by John Allsup (987)
            One trained to investigate serious fraud would recognise this mindset as the 'who benefits' meme that goes around those circles.
      • by tibit (1762298)

        Speak for yourself. I'd be the first in line to have such a biopsy done, were it to be routine in differential diagnosis for, say, depression. These days they have the anesthesia/analgesia down pat, one would have to be truly crazy to reject an objective measure just because there's a biopsy involved. I've had my septum straightened out under very local analgesia just to skip school. And I walked to and from the hospital uphill both ways in a blizzard :)

      • by kermidge (2221646)

        Amen. My first reaction on seeing and reading the submission encompassed "No shit, eh?" to "About fucking time!" and continues. I've had increasing dissatisfaction with the DSM through the last several revisions in particular; my impression is that the too many of the people involved have been infected by political correctness to the detriment of clear thinking (and some will say that the 'squishy sciences' are unclear by definition.... but that's another discussion.)

        I look forward to seeing results from

    • Re:About time! (Score:4, Informative)

      by fuzzyfuzzyfungus (1223518) on Monday May 06, 2013 @08:50PM (#43649361) Journal

      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.

      • by gagol (583737)
        It would be nice to have some tests to determine if the problem is related to some chemical imbalance. I know I a, asking for a lot, but I also find the current medicine to be quite easy to diagnose this or that based on few symptoms. Taking SSRI when you dont need them is a very difficult experience to go through, much worse than anything I can think of. It made me either a complete zombie or very violent depending on the drug they tested. A simple echography would have shown the root cause and avoided the
        • Re:About time! (Score:5, Informative)

          by fuzzyfuzzyfungus (1223518) on Monday May 06, 2013 @09:06PM (#43649467) Journal

          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:About time! (Score:5, Insightful)

            by Runaway1956 (1322357) on Monday May 06, 2013 @09:30PM (#43649609) Homepage Journal

            I'm in over my head already - but, it seemed to me that TFS was saying this very thing: "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."

            They want to stop being witch doctors, and actually research causes and effects. Guessing at problems, then experimenting with various drugs to see what results they give is little more than witch doctoring.

            Yeah, I clicked some of the links, but I get even further over my head with each click. ;^)

        • by pepty (1976012)

          It would be nice to have some tests to determine if the problem is related to some chemical imbalance.

          Give it fifteen years. Your doc will have you snort a dose of a labelling compound up your nose (privileged route past the blood brain barrier) like it was a line of cocaine or inject you with the labelling compound attached to little piece of a rabies protein ( another way to get stuff past the BBB). Then they'll pop you in an MRI machine and generate a 3D map of serotonin concentration in your brain.

    • It's a start, and something I was merely hoping for when I wrote this [briandonohue.org]:

      When it comes to mental health, our science is at an infantile or at best adolescent level of development. Next month, it brings us a new bible of pathology — the DSM-V, which will tell us again how many ways we can be sick, yet with no guide as to what mental health actually is or how it might be strengthened. That, it appears, must become a common effort — crowdsourced, if you will. One of the founding documents of our natio

    • by icebike (68054)

      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?

      Yes it is about time.
      Even those in the profession realized the DSM was a growing embarrassment, stubbornly clung to to avoid admitting the emperor was stark naked.

    • Re : I had internal infections misdiagnosed as depression for over 4 years before physical symptoms appeared.[emphasis mine]
      .
      May I respectfully ask how you could expect anyone to diagnose something which had no physical symptoms manifesting for four years? It's not like doctors have magic. They have to base their diagnosis and diagnostic procedures based upon the history and physical: the history and information given by the patient and the physical exam performed to assess the patient's physical well be
      • by gagol (583737)
        Since my white cells were higher than normal and I acutely lack energy, I think it could have been more thoroughly investigated. It would have ended being cheaper and more effective. I got started on SSRI by a general MD, and then went to a highly regarded specialist in the field. It did not helped that schizophrenia background exist in my family and my relatives went out of their way to steer the doctors in that direction. I still believe the doctors butched this one out of laziness. Since I live in a coun
        • I'm sorry to hear about that. Thank you for sharing the details. I'm sorry that the doctors jumped the gun based on a family history without considering the other possible physical and organic causes. That's the whole point of psychiatrists being M.D.'s: they're supposed to think like medical doctors so that they can rule out things like tumors in the brain or infections that could cause symptoms. I'm also glad you're healthy again. Best wishes for the future.
    • by Ihlosi (895663)
      How the hell can a doctor prescribe SSRI without measuring the actual levels first?

      Most patients would object to a brain biopsy.

      And even doing one would give very little insight into the actual dynamic processes inside the synaptic clefts. It's not a simple issue of "there's too little serotonin in your system", but rather a "there's too little serotonin within the synaptic cleft for the sensitivity and number of receptors to reliably cause an action potential in the receiving cell when required" ...

  • these weaknesses (Score:4, Interesting)

    by WGFCrafty (1062506) on Monday May 06, 2013 @08:57PM (#43649405)

    Were already well known. Considering we don't know too much about the organic causes of most mental disorders I'm curious about what they mean. Is schizophrenia mediated by glutamate or dopamine? We know dopamine antagonists help some people but not too much more.

    • Were already well known. Considering we don't know too much about the organic causes of most mental disorders I'm curious about what they mean.

      Good point. If they're launching this as a research initiative, we should expect a decade or more before it starts traditional methods.

    • by Rich0 (548339)

      Is schizophrenia mediated by glutamate or dopamine? We know dopamine antagonists help some people but not too much more.

      I think the whole idea is that in the future you won't be diagnosed with schizophrenia. Instead you'll be diagnosed with having too much/little dopamine production, causing symptoms of schizophrenia. The treatment for too much/little dopamine will unsurprisingly be a drug that affects dopamine production.

      Coming up with a treatment for schizophrenia is like coming up with a treatment for nausea. Some people with nausea respond really well to coronary stents, and others don't respond at all to this with a

  • by Anonymous Coward on Monday May 06, 2013 @09:10PM (#43649491)

    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. ...

    In the early 1990s, I was prescribed drugs because "there's too much dopamine up there". They didn't measure jack. They just came up with this out of the blue based on how I was behaving.

    The absolute lack of measurement was readily apparent to me, even in my state which after decades was most likely undiagnosed autistic spectrum disorder and post traumatic stress from all the crap that happens when spectrum kids get bullied in school.

    Dopamine up there? How the hell couuld they know without a measurement.

    The other problem with DSM is that it's too normative. Homosexuality is a "disorder", but then when you start treating homosexuals nicely they suddenly become less traumatized, more come out, and you realize that most of them aren't as sick as you thought, and that a lot of the sick ones are like that because you marginalized them in the first place.

    First things first though. Come up with something to measure at least before you even pass judgement on it being normal, and then MAYBE you can try to come up with how much deviation from the mean is healthy. Posted AC for obvious reasons...

    • by Omestes (471991)

      "there's too much dopamine up there"... "was most likely undiagnosed autistic spectrum disorder and post traumatic stress from all the crap that happens when spectrum kids get bullied in school."...

      So your problem with unscientific psychobabble is that it was the wrong type of unscientific psychobabble?

      • by seebs (15766)

        What he said wasn't exactly super formal clinical language, but it certainly fits a pretty well-observed pattern. People do not deal well with autistics.

        • by Omestes (471991)

          Which is neither here nor there... Autism is just as scientific as a non-measured dopamine imbalance, when it comes down to it. Less so, even, since no one can really point to a brain or test and say "yep, there's your autism problem right there".

          This obviously doesn't mean autism doesn't exist, or rather the cloud of behaviors that we currently label "autism" doesn't exist. Autism is very much a diagnostic "shrug" right now, nothing more than a loose collection of behaviors and severities. At one end y

    • The other problem with DSM is that it's too normative. Homosexuality is a "disorder", but then when you start treating homosexuals nicely they suddenly become less traumatized, more come out, and you realize that most of them aren't as sick as you thought, and that a lot of the sick ones are like that because you marginalized them in the first place.

      The concept of a mental illness is fundamentally normative. Even if you think homosexuality is perfectly OK, you need to admit that it was removed for purely political reasons. Objectively it is clearly abnormal: perhaps 1%, perhaps 3%, whatever... but TINY.

      If you insist on adding the requirement that there be harm, and you want to dismiss the suicide issue as a trauma result, the situation is still pretty clear from numerous viewpoints. In the USA, AIDS is still primarily a homosexual disease. I can even a

      • by Znork (31774)

        Yeah, and broken bones are most commonly a symptom of sports so obviously sports should be classified as a cluster of diseases.

        And of course, if failure to produce offspring was actually some form of harm, the catholic priesthood should probably be diagnosed. Atheism, at least in the form of secular humanism, in general does not concern itself with where folks stick their parts or argue any moral obligation to reproduce.

        • by r00t (33219)

          Yeah, and broken bones are most commonly a symptom of sports so obviously sports should be classified as a cluster of diseases.

          There is an optimum level of physical activity. If you get seriously far from this, then yes you do have a mental problem. (land luge, skiing Mount Everest, diving with gases more exotic than helium...) We might not bother forcing you to get treatment; this would deprive us of seeing you earn your Darwin Award on youtube.

          And of course, if failure to produce offspring was actually some form of harm, the catholic priesthood should probably be diagnosed.

          Yes, except for the fact that the beliefs which lead to priesthood are actually the norm. The norm is exempt from being an illness, even if it is wacko.

          Atheism, at least in the form of secular humanism, in general does not concern itself with where folks stick their parts or argue any moral obligation to reproduce.

          I never said "moral". This is more of

      • by Sique (173459)
        The problem with your argument is that humans don't live alone, or as separate families without contact to the neighbours. It has been proven that larger groups of humans are more stable, and their children have a better survival rate if there is someone here to take either care of the children at times when the biological parents can't, or work on tasks people with children can't perform very well at. It is so important that there are childless people in a group of humans, that about every type of society
  • by russotto (537200) on Monday May 06, 2013 @09:17PM (#43649543) Journal

    And I mean it sincerely. Sure, the DSM just categorizes sets of symptoms. But the problem with basing diagnoses on actual conditions is we have little idea what those actual conditions are, and not for lack of research.

  • troll article? (Score:5, Insightful)

    by Black Parrot (19622) on Monday May 06, 2013 @09:28PM (#43649591)

    The New Scientist article -- whoops, guest editorial [newscientist.com] -- is titled "Psychiatry divided as mental health 'bible' denounced", but 'denounced' is a ridiculous overstatement. NIH/NIMH are simply announcing a new cross-category funding program that will step back and question the field's traditional assumptions.

    Either the guest editorialist didn't RTFA, or else is just using the occasion to inject their personal views into public sight.

    Or else just trolling.

    • by omni123 (1622083)

      Either the guest editorialist didn't RTFA, or else is just using the occasion to inject their personal views into public sight.

      Or else just trolling.

      I don't think that is exactly fair--the title and the summary seem perfectly accurate to me (especially given that it's basically a copy and paste from the actual article). The NIMH is indeed distancing itself because if you had read the RTFA, they will not be funding research that targets DSM categories alone any more, which has the potential for a _huge_ impact on thousands of researchers working right now.

  • by gnoshi (314933) on Monday May 06, 2013 @09:42PM (#43649685)

    I'm really glad this has come about, not because the DSM itself is a useless book but because the attitudes towards it lead to some gross errors of judgement.

    The DSM can be useful: if one clinician wants to communicate to another at a fairly high level the symptoms a patient is experiencing, then a DSM-defined disorder can be a reasonably efficient way of doing this. Also, the DSM does group together some symptoms which tend to occur as clusters under labels which can provide cues for looking for related symptoms which might otherwise be missed.

    However...
    People make the mistake of thinking that because something is listed in the DSM it is somehow a 'real disease'. The Epstein–Barr virus is a real disease: it is caused by a specific virus. Type I Diabetes is a real disease: it is caused by the loss of insulin-producing cells in the pancreas (although there is the more distal cause of the cell loss). Depression is not a real disease, in this sense - at least, not at the moment. It is a cluster of symptoms which when the occur together are referred to as Depression. Nothing more. (That isn't to say a 'disease' will not actually be identified at some point, but I suspect that will be for a specific subtype of depression, not depression as it is currently classified).

    On the radio yesterday, I heard an 'aspie' - who under DSM 5 will no longer be an 'aspie' since Aspergers will no longer exist in its current form - talking about how it was great when he was diagnosed because they finally knew what was wrong with him. The problem is this: they didn't and still don't know what's wrong - just that his symptoms fit a commonly observed pattern, and that there are particular interventions to try to address the associated deficits. Having a listing in the DSM doesn't make things any more or less 'real', but some/many people imagine that it does. Just because there isn't a diagnostic criteria for a very shy child (although I imagine one could be found if looking hard enough), that doesn't mean that there aren't programmes to help the child be more comfortable with social interaction.
    This becomes most manifestly a problem when conducting genetic, neurobiological, or even treatment research into the causes for 'a disorder'. Because these disorders are symptom clusters, and often have substantial variation in presentation, they are at times artificially grouped for research. This can hinder research into specific subgroups who show more common characteristics. Similarly, if there is a presentation which includes two DSM disorders (e.g. depression and anxiety, which is a very common comorbidity) then these people will tend to be systematically excluded from research because they are defined as 'having comorbidity'. Are both 'disorders' caused by the same underlying cause? Who knows, but being separate DSM disorders means that this group tends to be very underrepresented in research.

    On top of this, there is the involvement of vested interests in the development of disorders, there is the interpretation of things as 'wrong' because they are a DSM disorder, etc.

    In summary, the DSM can be useful for clinicians to communicate a summary to each other, when accompanied by further detail. It can provide gross groupings for treatment research, but lacks finesse of distinction which could help tailored treatments to individual characteristics rather than the broader presentation. People suddenly seem to think something is 'real' because it appears in the DSM, and so push to have ever more 'disorders' included. This all makes DSM as much of a hindrance as a help to good research and mental health practices.

    • by Livius (318358)

      Asperger's is an excellent example of this, where knowing something about the disorder, what symptoms go together, and what strategies are effective at managing it, is extremely useful. The 'diagnosis' is of enormous practical value.

      But it's not a disease in the sense of a specific diagnosis, nor are they even confident that it is a single disorder, and, at least at present, it certainly doesn't point towards a cure or anything beyond management of symptoms.

      So it's useful, but definitely not 'diagnosis' in

    • Re: (Score:2, Funny)

      by Anonymous Coward

      On the radio yesterday, I heard an 'aspie' - who under DSM 5 will no longer be an 'aspie' since Aspergers will no longer exist in its current form - talking about how it was great when he was diagnosed because they finally knew what was wrong with him.

      SO, he'll be cured when this new version comes out.

      Hurray!

      There's hope!

      Now, if they'll only remove the personality disorder(s) I suffer from.

      And "Alcoholism".

      No, it's called being a M-A-N; you pussies!

      • by seebs (15766)

        Actually, he won't be "cured". He'll have autism spectrum disorder, rather than asperger syndrome, most likely. I can't see a way someone could have an AS diagnosis under DSM-IV and not be considered ASD under DSM-V.

        • Actually, he'll be classified as "High Functioning Autism Spectrum Disorder." This is where many Aspies (myself included) are up in arms about the new DSM. While we recognize that Asperger's Syndrome is part of the Autism Spectrum, calling it "high functioning" makes it sound like you don't need any help. Just like when you say a child is "gifted" and people assume that means he or she will get straight A's with no effort whatsoever. My son (a Aspie) needs a lot of help with social situations. He doesn

    • by Kjella (173770)

      That's all well and nice, but the practical reality is that it goes:
      Symptoms -> Diagnosis -> Treatment

      Except for very basic symptom treatments like painkillers if you're in pain you usually need a diagnosis before you get started on treatments, even if it's not entirely correct or the treatment might not work. If my general physician sees I'm under the weather and should stay in bed for a couple of days he still needs to put some kind of general condition on the sick notice like a non-specific virus i

    • by Pfhorrest (545131)

      A further problem with the "if it's listed in the DSM it's a real disease" attitude is the conflation of conditions with disorders. Just because someone has a particular, identifiable pattern of thought and behavior, which may be useful to name and document, does not mean that that person has something wrong with them that they need fixed. I'm thinking in particular here of conditions frequently found in members of the neurodiversity movement, who may very well have some identifiable distinct difference fro

      • by Aardpig (622459)

        The neurodiversity movement is a load of wank. It's like claiming your car is otherly-powered when the engine falls out.

        • by seebs (15766)

          Uh, no.

          Look, imagine that we discovered that about 2% of our population were heavily vulnerable to simple trickery, like they were much more enthusiastic about a 10% chance of survival than a 90% chance of mortality, even though they're the same thing. And they were easily manipulated by actors who knew how to show a particular emotion on command. And they had some cool things, like they were unusually good at reading emotions from facial expressions, but overall they had crippling problems that made it har

    • RE: gnoshi sez: The problem is this: they didn't and still don't know what's wrong - just that his symptoms fit a commonly observed pattern, and that there are particular interventions to try to address the associated deficits. [emphasis mine]
      .

      But that's exactly what happened with Parkinson's Disease [wikipedia.org], and still is happening with Parkinson's Disease. Dr. Parkinson observed a common pattern in a group of patients. These patterns of symptoms and behaviors constituted a syndrome which began to be called "Pa

    • by John Allsup (987)
      Unfortunately the 'it's number X in the DSM' shortcut thinking means that if clinician A makes a mistake, clinician B is likely to believe clinician A's opinion without critical analysis and just assume that the original diagnosis is correct.  Roll on a few more meetings with clinicians and the 'the previous n clinicians could'nt be wrong' mentality means that a diagnosis is likely to stick whether correct or not.
  • Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms ... 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.

    Heart attacks are physical events; the muscles in the heart stop contracting, risking death. The patient's experience of it is relatively unimportant, except as an indicator of the physical event. It's the heart attack that needs treatment.

    But for mental problems, the patient's perceptual experience often (usually? always?) is the condition that needs treatment. If the patient experiences depression, that is the problem. The physical conditions may be helpful as indicators of the perceptional condition, but

    • by pepty (1976012)
      In the rest of medicine when a group of symptoms tend to travel together without any observable root cause/latent variable they call it a syndrome.
    • The problem with your critique is that the DSM classifications are themselves clusters of symtoms. So what is being proposed is to shift from "cluster symtoms, then try to find things associated with these clusters" to "cluster symtoms, along with genetic, imaging, physiologic, and cognitive data".
  • by meehawl (73285) <meehawl,spam&gmail,com> on Monday May 06, 2013 @10:25PM (#43649861) Homepage Journal

    Nerds opining on psychiatric diagnosis...

    This should go about as well as psychiatrists opining on monads...

  • But does this mean that having a female mind and a male reproductive system no longer means that I'm a serial killer who's constructing a woman suit? Does this mean when they scan my brain and find that it's psysiologically more female than male (these things aren't exact) that it just means that I'm a woman, not that I have a mental illness? What would we ever do if not for the DSM V? Thank you DSM V for acknowledging that being a woman is a mental illness! This post brought to you by b33r.
  • by rossdee (243626) on Monday May 06, 2013 @10:59PM (#43650025)

    Do these guys have the patent on Nickel Metal Hydride batteries?

    And there was a movie called the Secret of NIMH

  • by Coppit (2441) on Tuesday May 07, 2013 @08:57AM (#43652253) Homepage

    I hear the problem with the research is that the rats gain intelligence and escape the laboratory at NIMH. It's a secret, so you may not have heard about it.

An Ada exception is when a routine gets in trouble and says 'Beam me up, Scotty'.

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