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The Voice of the American Psychiatric Association and the Psychiatric Community
APA President-elect Jeffrey Lieberman, M.D., and National Institute of Mental Health (NIMH) Director Thomas Insel, M.D.,issued a joint statement today about DSM-5 and NIMH's Research Domain Criteria (RDoC) project. In thestatement,theyacknowledged that along with the International Classification of Diseases, DSM "represents the best information currently available for clinical diagnosis of mental disorders" and that the two publications "remain the contemporary consensus standard to how mental disorders are diagnosed and treated."
"Yet, what may be realistically feasible today for practitioners is no longer sufficient for researchers," they said."Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories. It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior," which is the focus of the RDoC initiative.
"All medical disciplines advance through research progress in characterizing diseases and disorders. DSM-5 and RDoC represent complementary, not competing, frameworks for this goal," they said. "DSM-5, which will be released May 18, reflects the scientific progress seen since the manual’s last edition was published in 1994.RDoC is a new, comprehensive effort to redefine the research agenda for mental illness. As research findings begin to emerge from the RDoC effort, these findings may be incorporated into future DSM revisions and clinical practice guidelines. But this is a long-term undertaking. It will take years to fulfill the promise that this research effort represents for transforming the diagnosis and treatment of mental disorders." Lieberman and Insel concluded the statement by saying APA and NIMH "are committed to improving the outcomes for people with some of the most disabling disorders in all of medicine."
Patients and parents concerned about mental illness have every right to be confused. The head of the federal agency that finances mental health research has just declared that the most important diagnostic manual for psychiatric diseases lacks scientific validity and needs to be bolstered by a new classification system based on biology, not just psychiatric opinion. The hitch is that such a biology-based system will not be available for a decade or more...
...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.”2 The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. 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.
That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system. The best reason to develop RDoC is to seek better outcomes.more...
Proponents of Connecticut establishing a law that would allow the involuntary treatment of people with mental illness in the community have recently used two misleading ideas to support their case.
They acknowledge that voluntary treatment is preferable, but point out it doesn't work for everyone. Among the reasons they give for the failure of voluntary treatment is that some people with mental illness have a condition that makes them unaware they are ill, or they don't like the side effects of medication. Both assertions are highly questionable and neither does justice to the seriousness of the issue. more...
The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open. more...
Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention. more...
The Obama administration is planning a national campaign to encourage the discussion of mental health issues in light of recent mass shootings.
Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan will lead the effort, which will begin within weeks, Sebelius said Tuesday.
Discussing a psychiatrist’s objections to mandated treatment.
To the Editor:
Recent tragic events have linked mental illness and violence. Some people — I, for one — consider this link dangerously stigmatizing. People with mental illness are far more likely to be victims of violence than perpetrators. Moreover, psychiatrists have limited capacity to reliably predict violence. Nonetheless....
Any psychiatrist who has practiced during the last decade has probably written more than a few prescriptions for an atypical antipsychotic. But do these drugs provide any clear advantages over their predecessors? This is a question that is best answered by science, not by anecdote or by popular impression. Unfortunately, good science on this topic is hard to find. Pharmaceutical companies have exerted a tremendous influence not only over academic departments and the scientific literature, but also practitioners’ expectations. In this article we will concentrate on science, bypassing the well-publicized issues regarding infamous key opinion leaders (KOLs) and the numerous well-documented examples of fraud and deceit in the literature (which make it especially difficult to dissect out where the good science actually is)....
THIRTY years ago, I was given a diagnosis of schizophrenia. My prognosis was “grave”: I would never live independently, hold a job, find a loving partner, get married. My home would be a board-and-care facility, my days spent watching TV in a day room with other people debilitated by mental illness. I would work at menial jobs when my symptoms were quiet. Following my last psychiatric hospitalization at the age of 28, I was encouraged by a doctor to work as a cashier making change. If I could handle that, I was told, we would reassess my ability to hold a more demanding position, perhaps even something full-time...
The Senate Health, Education, Labor & Pensions Committee heard two panels on Thursday on the state of America's mental health system. The first panel consisted of Substance Abuse and Mental Health Services Administration head, Pamela Hyde, and Dr. Thomas Insel, director of the National Institute of Mental Health.
The second panel, beginning at minute 1:44:00, was former commissioner of New York's State Office of Mental Health Mike Hogan, PhD, Robert Vero, EdD, CEO of Centerstone of Tennessee, George DelGrosso, MA, executive director of the Colorado Behavioral Health Council, and Larry Fricks of the National Council for Behavioral Health.
Committee members who were present include Chairman Tom Harkin, Ranking Republican Lamar Alexander, Senator Patty Murray, Senator Michael Enzi, Senator Tammy Baldwin, Senator Lisa Murkowski, Senator Al Franken, Senator Barbabra Mikulski, Senator Bernard Sanders, Senator Elizabeth Warren.
With the state’s mental health system in disarray, Vermont is experimenting with a radical form of therapy to treat patients with the most severe psychoses.
State officials have been exploring various options for replacing in-patient psychiatric beds since Tropical Storm Irene wiped out the state hospital in August 2011...more
*Upcoming Events are not necessarily sponsored or endorsed by the Foundation, but are listed for the benefit of those interested in scientific inquiry and recovery-oriented treatment in the field of mental health.