Government Institute Announces Distancing from Psychiatric “Bible”

May 4, 2013
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Just mere weeks before the next edition of the “bible” of psychotherapeutics hits doctors’ offices nationwide, the federal government entity tasked with overseeing medical research is announcing a plan to conduct its investigations away from using the principles of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V). This “bible” has for years defined how many psychiatric disorders are evaluated, diagnosed, and treated.

Just mere weeks before the next edition of the “bible” of psychotherapeutics hits doctors’ offices nationwide, the federal government entity tasked with overseeing medical research is announcing a plan to conduct its investigations away from using the principles of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V). This “bible” has for years defined how many psychiatric disorders are evaluated, diagnosed, and treated.

The federal National Institutes of Mental Health cites the “lack of validity”, as opposed to the intergenerational constant of “reliability” seen in the previous editions of the manual in approaching the workup of psychiatric disorders. The NIMH notes that symptom clusters drive diagnosis and treatments within psychiatry, rather than objective measures. The increase in research involving genetics and cognitive science and how it applies to the diagnosis of mental illness appears to be the compelling force in driving the change for the NIMH.

DSMPatients with mental disorders deserve better. 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. Through a series of workshops over the past 18 months, we have tried to define several major categories for a new nosology … 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.”

Sounds like an admonition to me. The institute writer goes on to say that “RDoC serves as a framework for collecting data for a new nosology”, and “it became … clear that we cannot design a system based upon biomarkers or cognitive performance because we lack the data…”

It’ll be interesting to see inroads into how institute directed research moves away from DSM categories – a framework that has existed for decades — to a system built upon the discovery of biological and cognitive data that will not only make diagnosis of mental disorders much more precise but also increasingly responsible for developing appropriate and targeted drug therapy. | LINK

(image: psychiatric “bible” / shutterstock)