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Joined: Feb 2013
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Where in the article does it say "NIMH withdraws support for DSM-5"?
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This is really good news in my opinion. Just looking at the recent dyscalculia thread; there is a real issue with these clustered symptoms diagnostics. If a kid has ten symptoms (of which eight are subjective and situational) and from those you get five different disorders from three different diagnosticians who offer prescriptions to three different drugs and four different OT courses, there is a problem.
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Where in the article does it say "NIMH withdraws support for DSM-5"? KJP was paraphrasing. This statement from that link is not exactly a ringing endorsement of the DSM: But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.” 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. I agree that this move is a good thing. The field is too objective as it stands now. A push toward evidence-based medicine will benefit it enormously.
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Where in the article does it say "NIMH withdraws support for DSM-5"? Aha, that explains it. Often thread subject lines are just the headline of an article linked in the OP, but this time it was from a different article.
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This is really good news in my opinion. Just looking at the recent dyscalculia thread; there is a real issue with these clustered symptoms diagnostics. If a kid has ten symptoms (of which eight are subjective and situational) and from those you get five different disorders from three different diagnosticians who offer prescriptions to three different drugs and four different OT courses, there is a problem. This is a very welcome shift, IMO.
Schrödinger's cat walks into a bar. And doesn't.
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I don't really know much about any of this as all I know is what I've learned on this board. But what does this actually mean in practice? If anything at all? ... asking as a parent of two kids on the spectrum whose diagnoses I don't fully agree with and therefore am in no rush to get them reevaluated just to get another diagnosis slapped on top of the first one. 
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Hopefully it will mean that diagnostic criteria will start heading in an evidence-based direction, rather than the curious patchwork of voodoo symptom-lists and check-boxes that currently exist.
It's not a good sign when a professional shrugs and says "Well, I dunno either-- let's trial this drug and see if it helps!"
Can you imagine an oncologist saying that??
Schrödinger's cat walks into a bar. And doesn't.
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Sorry for the confusion. Pre-coffee posting should be avoided.
I saw it covered by Psychology Today but followed their link to the NIMH and only copied the link to the NIMH here.
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But what does this actually mean in practice? In practice the hope is within ten years time there is a new diagnostic tool that uses actual research and points to functional, physiological, and genetic causes for mental disorders. Making stuff up to illustrate... So ADHD might become: 1) Genetically based reduction in core dopamine production with executive function impact(requires < .09ug...) 2) Prefrontal sensory overload (attention shutdown accompanied by increased xxx waves in yyy system) 3) Hyperglycemia accompanied by active burning of excess glucose Where #2 might lead to ADHD like symptoms, it could also lead to exhibiting ASD like symptoms with pragmatic language issues and the inability to maintain eye contact or being overstimulated in crowds. Under the current DSM approach, the #2 child chould be place on stimulants or placed in 12 months of pragmatic language training. Where what they really need is sensory management training. The medical equivalent to the current DSM would be like: Excess Mucus Disorder Any 4 of these: 1) Runny nose 2) Watering eyes 3) Coughing 4) Sneezy 5) Doc 6) Bashful 7) Expectoration Treatment: Tissue and chicken soup for 7 to 10 days.
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Newtonian-esque mechanistic reductionism works well with a significant portion of the body.
Not so much the mind/psyche.
As my psychiatrist BIL notes, often the problem is "limited education" coupled with "piss-poor coping skills".
Last edited by JonLaw; 05/07/13 12:31 PM.
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It's got to be an improvement to actually call it out, though-- either there IS a problem, and look, here's what it is, and gosh, I guess that means that we'll work our way through THIS set of best-practices here, or...
there isn't really anything but fumbling around in the dark and it's all just idiosyncratic to start with, in which case, why bother with the DSM with all of it's oh-so-official checklists?
I'm not arguing that people in the mental health professions can't-- or shouldn't-- help people who are probably best classified as "other" but it would be a vast improvement to be able to tease them apart from those with problems that can be diagnosed as something in particular using evidence that isn't subjective or opinion-based.
The current state of affairs is like going to the doctor and describing a series of vague aches and pains, and having him/her respond with:
You have arthritis.
a) Let's try more exercise for a month.
b) if that doesn't work, let's try having you rest it for another month.
c) if that doesn't work, we'll do steroid injections and pain management for six months.
d) if that doesn't work, we'll do a hip replacement.
e) if that doesn't work, let's reevaluate in six months.
Clearly that is crazy.
"Aches and pains" can mean so many different things-- some of them self-resolving/transient-- that it's not really diagnostically useful in terms of differential diagnosis. To use it that way anyway is nuts.
Schrödinger's cat walks into a bar. And doesn't.
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Had someone when I was little done evaluation on me and gone through the checklists for Asperger's or high functioning autism, I can guarantee you I would had gotten a diagnosis right there and then! As it turned out in the end, I was just gifted with really bad anxiety. So I just cringe when my kids are now dealing with a lot of the same issues I was back then. I wish there was some magic trick to give a 100% correct diagnosis so we would know if they really are or are not on the spectrum!
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And let's not forget that college students claiming to need Adderall for their ADHD will have a tougher time getting a script when the doc can say, "Well, but your SLC9A (or whatever) values are well within the normal range."
Signed,
The annoyed mother of a kid diagnosed with ADHD by a school pyschologist who had never met him "because he fits so many of the criteria [handing me the DSM]." She wanted to drug him!
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I am a huge fan of taking mental health beyond the checklists so I was really excited to hear about this headline when my husband told me. One reason I did not pursue graduate work in my mental health undergrad degree was because I became disillusioned with the whole set up of the field.
I believe we are doing a huge disservice to patients to continue to practice medicine on the mental health side of things in the same way as we have for over a century. Other than disorders falling in and out of socio-political favor, the practice has changed little. I think it's time mental health joined us in the age of technology and science and left the imprecise checklist based system behind. I have so much enjoyed finding those on the cutting edge of this change to work with my family's needs and I would be thrilled to see an industry-wide shift. I applaud the NIMH for coming out with this statement.
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But what does this actually mean in practice? In practice the hope is within ten years time there is a new diagnostic tool that uses actual research and points to functional, physiological, and genetic causes for mental disorders. Making stuff up to illustrate... So ADHD might become: 1) Genetically based reduction in core dopamine production with executive function impact(requires < .09ug...) 2) Prefrontal sensory overload (attention shutdown accompanied by increased xxx waves in yyy system) 3) Hyperglycemia accompanied by active burning of excess glucose Where #2 might lead to ADHD like symptoms, it could also lead to exhibiting ASD like symptoms with pragmatic language issues and the inability to maintain eye contact or being overstimulated in crowds. Under the current DSM approach, the #2 child chould be place on stimulants or placed in 12 months of pragmatic language training. Where what they really need is sensory management training. THANK YOU! (So it's not just me who thinks this?) sigh.
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Had someone when I was little done evaluation on me and gone through the checklists for Asperger's or high functioning autism, I can guarantee you I would had gotten a diagnosis right there and then! As it turned out in the end, I was just gifted with really bad anxiety. Me too... exactly.
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