Forgetfulness is minor neurocognitive disorder says DSM-V #mentalhealth #WTFnews


Eat or surf a lot? You risk being labelled mentally ill

, TNN | Mar 24, 2013, 

Eat or surf a lot? You risk being labelled mentally ill
The latest psychiatry manual will, for the first time, spell out Adult Attention Deficit Disorder, minor neurocognitive disorder (like forgetfulness), binge eating, internet addiction, etc. Each new condition could trigger a mega sale of pills.
MUMBAI: Come May, psychiatrists will acquire a new manual to diagnose mental illnesses. But instead of anticipation, there seems to be an air of trepidation hanging around the fifth installment of the Diagnostic and Statistical Manual of Mental Disorders — DSM-V, in short — that is published by the American Psychiatric Association and followed across the world.

Several practitioners are voicing reservations about DSM-V’s new labels. Hinting at a pharmaceuticals-driven manual, a senior psychiatrist said: “It’s about molecules … DSM-Vhas identified so many new conditions that people will be handed out prescriptions more rapidly then before.”

The psychiatry manual will, for the first time, spell out Adult Attention Deficit Disorder, minor neurocognitive disorder (like forgetfulness), binge eating, internet addiction, etc. Each new condition could trigger a mega sale of pills, but the DSM-V team has shrilly denied any connection with the big-buck pharma sector.

Manual key to research

Earlier this week, American psychiatrist Allen Frances, who helped devise the fourth edition of the manual (DSM-IV), lashed out against the new installment in the British Medical Journal. “It risks mislabelling a sizeable number of population as mentally ill,” Frances wrote.

He is disturbed about a new introduction called ‘somatic symptom disorder’ that will need only one bodily symptom distressing or disrupting daily life for about six months. “This new category will extend the scope of mental disorder classification by eliminating the requirement that somatic symptoms must be medically unexplained,” he wrote. In a field trial study to check for somatic symptom disorder, the results included 15% of patients with cancer or heart disease and 26% with irritable bowel syndrome or fibromyalgia. “The rate of psychiatric disorder among medically ill patients is unknown, but these rates seem high,” added Frances.

Doctors in India are not too supportive of the somatic symptom disorder. “One symptom cannot be used to diagnose a mental condition,” said Dr Shubhangi Parkar, who heads KEM Hospital’s psychiatry department. “In India, we need to take into account the patient’s body language, our social milieu and families before making a diagnosis,” she said.

Dr Rochelle Suri, a counsellor, said she is not a big fan of DSM-V because it is too generalized. “Just because someone has a few of the symptoms doesn’t mean they have the illness,” she said. Dr Harish Shetty from L H Hiranandani Hospital said: “Treatment modalities should focus on the narratives of life and not on presentation of symptoms alone. A clear diagnosis should be viewed as a trailer and not the movie that needs treatment.”

How important is DSM-V in the Indian context? Parkar said: “DSM-V is important because care has been taken to ensure that cultural context is considered in diagnosis.” In fact, the Indian Psychiatric Society set up a task force to discuss DSM-V and send its recommendations.

Dr B N Gangadhar, professor at Nimhans who was on the IPS task force on DSM-V, said: “DSM is important mainly for doctors who are doing research. With growing amount of research conducted in the country, DSM-V will be an important tool.” But he added diagnosis in India is mainly done on the basis of World Health Organisation’s parallel scale called ICD ( International Classification of Diseases).

Suri said DSM is becoming popular in India’s “westernized” metros because it aids fast diagnosis. “People want a treatment plan as quickly as possible. Hence, DSM would be a good tool in the cities, but in rural settings, where western influence is low, it may not be possible to use it,” she added.

Parkar said each DSM has brought about debate and changes while Shetty viewed it as flexing of muscles. “DSM-V is an aggressive campaign for space and more power for psychiatry in a world where physical illnesses are the emperors,” Shetty said.

New illnesses in psychiatry handbook 

Temper tantrums are now Disruptive Mood Dysregulation Disorder

Grief is Major Depressive Disorder

Forgetfulness is minor neurocognitive disorder

Adults can have Attention Deficit Disorder too

Binge Eating Disorder

Internet Addiction

DSM

DSM stands for Diagnostic and Statistical Manual of Mental Disorders. It’s published by the American Psychiatric Association (APA) and contains descriptions, symptoms, and other criteria for diagnosing mental disorders. This ensures that a diagnosis of schizophrenia is consistent from one clinician to another, across the world. DSM is also important to establish criteria for diagnosis that can be used in research on psychiatric disorders.

DSM has been periodically reviewed and revised since the publication of DSM-I in 1952. Given the burst of information in neurology, genetics and behavioral sciences, experts feel the need to upgrade the scale of diagnosis.

DSM V has been courting controversy for the last four-five years because as critics say, it’s trying to be the game-changer in psychiatry.

In an internet forum, American psychiatrist Dr Allen Frances, who was in the team to draw up DSM-IV, listed the 10 worst changes in DSM-V:

(1) Disruptive Mood Dysregulation Disorder: DSM-5 will turn temper tantrums into a mental disorder. Children and youngsters may be given medication.

(2) Normal grief will become Major Depressive Disorder, thus medicalising emotional reactions to the loss of a loved one. More pills

(3) The old-age characteristic of forgetting could be diagnosed as minor neurocognitive disorder, creating a huge false positive population of people who are not at special risk for dementia

(4) DSM-5 could lead to overdiagnosis of Adult Attention Deficit Disorder and widespread misuse of drugs

(5) Excessive eating 12 times in three months will not be considered gluttony, but a psychiatric illness called Binge Eating Disorder.

(6) DSM-V may exclude Asperger Syndrome, a form of high-functioning autism. Autism diagnosis is likely to fall

(7) First-time substance abusers will be clubbed with long-time addicts

(8) DSM-5 has introduced Behavioral Addictions. Could lead to over-diagnosis of internet and sex addiction

(9) DSM-5 highlights Generalized Anxiety Disorder and the worries of everyday life.

(10) DSM-5 could lead to misdiagnosis of post-traumatic stress disorder

 

Do we Need a Diagnostic Manual for Mental Illness ?


The Guardian

Richard Bentall and Nick Craddock discuss the controversial revisions to the US Diagnostic and Statistical Manual

‘Who will benefit from the proposed revision?’

The way that we think and talk about psychiatric illness has implications for all of us – not only mental health professionals and their patients, but anyone with affected friends and family members, policy-makers struggling to know what services to provide and pharmaceutical companies considering future profits. So it’s unsurprising that a proposed new edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), widely described as the “psychiatrists’ bible”, is causing much furore – but slightly more surprising that much of the dissent comes from within psychiatry.

Since the publication of the third edition in 1980, the DSM has employed a checklist approach to assigning diagnoses. By ticking off the symptoms listed under each disorder, a mental health professional can reach a diagnosis that is likely to be in agreement with the judgment of any other mental health professional. At the time, this seemed to be a huge step forward from earlier approaches, which were highly subjective and led to widespread disagreements about conditions (the diagnosis of schizophrenia, for example, was used much more widely in the US than in Britain). The fourth edition, in 1994, passed without much opposition, but the proposed fifth edition has attracted much criticism – not least from Dr Allen Frances, the American psychiatrist charged with editing its predecessor.

The main focus has been the broadening of psychiatric diagnoses, making an increasing range of behaviours targets of psychiatric concern. (As evidence this is already happened to an alarming degree: last year about one in four US citizens took a psychiatric drug.) For example, it has been proposed that grief should be dropped as an exclusion criterion for the diagnosis of depression, raising the risk that normal grief reactions will be considered evidence of illness. In the case of severe mental illness, the discovery that a large proportion of the population (about 10%) sometimes experience “subclinical” hallucinations and bizarre beliefs has led to the inclusion of an attenuated psychosis syndrome. (Research shows that only about 10% of people who meet these criteria will go on to become severely affected; clearly there is a risk that many will receive toxic drugs unnecessarily.)

Behind these concerns about the expanding scope of psychiatry lies a deeper problem. The proposed revision has been constructed on the basis of clinical consensus – psychiatric folklore institutionalised by committee – rather than scientific research. For example, despite evidence that “schizophrenia” and “bipolar disorder” overlap, they continue to be treated as separate illnesses.

Defenders of the DSM and similar systems argue that some kind of categorical method of diagnosing patients is required to allow communication between clinicians. Critics, such as myself, argue that it’s better to communicate with a detailed and individualised list of a patient’s problems. Either way, an important question is, who will benefit from the proposed revision? As there is no obvious scientific added value compared to the fourth edition of the DSM, and as there are some obvious risks associated with this expansion of diagnostic boundaries, one is bound to ask why there is a need for this revision, or who will benefit from it. It seems likely that the main beneficiaries will be mental health practitioners seeking to justify expanding practices, and pharmaceutical companies looking for new markets for their products.

Nick Craddock: ‘Accurate and prompt diagnosis may be life-saving’

In my view, there are many problems with the DSM approach to diagnosis. There are too many categories, distinctions between diagnoses often seem arbitrary and it is largely driven by expert opinion, rather than solid scientific evidence. Like me, many other psychiatrists in the UK and Europe are similarly sceptical about the fifth edition of the DSM and its expansion of categories and consequent risks of over-diagnosis.

But we need to be clear: if someone is unwell, the first step to delivering effective care is to diagnose what the problem is. Making a diagnosis guides evidence-based clinical decisions. In most situations encountered in mental health, some level of diagnosis is essential to ensure effective help is provided (when needed) and that everyone can have some shared understanding of the situation.

For example, there are many reasons why an adult may develop lethargy, lose weight and become less active and interested in life. This could reflect temporary adjustment to a changing life situation (ie, a normal response to life’s difficulties). The person might have cancer. The person might have heart failure. Alternatively, the person may be experiencing a severe depressive episode and be at immediate risk of suicide. The ways of helping are all very different – and not all medical – and diagnosis is needed to distinguish between the possibilities and implement the right help as early as possible. Accurate and prompt diagnosis may be life-saving.

A diagnosis can provide reassurance that a person’s situation is not unique, mysterious or inexplicable and that there is a body of knowledge and experience that can be brought to bear in providing help. It can reduce stigma by explicitly acknowledging the presence of illness (and, thus, that the feelings or behaviour cannot be dismissed as character weakness or bloody-mindedness).

We should also remember that mental illness and physical illnesses very commonly occur together; this largely explains the fact that people with severe mental illness typically die 20 years earlier than do those without such severe mental illness. Thus, diagnosis of both mental and physical illness is a vital part of the care that those with mental health problems should expect.

The fifth edition of the DSM is an American development. In the UK we use the World Health Organisation‘s International Classification of Diseases (ICD), so the DSM does not directly affect NHS patients. Prompt and accurate diagnosis and recognition of mental illness and related health problems is the cornerstone of high-quality health services. That should be our focus in the UK.

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