This is the second installment of a new series in which clinically relevant research is briefly discussed and, perhaps more important, a few tips on how to read and interpret research studies are presented. Your feedback, suggestions, and questions are eagerly solicited at rajnish.mago@jefferson.edu.
Surprisingly, the American Psychiatric Association (APA) has never established formal guidelines that address what qualifications are required for one to use DSM.
Oregon’s Governor Kulongoski has vetoed a bill that would have allowed psychologists to practice clinical medicine without adequate training-otherwise known by the euphemism of “prescribing.” The Governor’s rationale was precisely the one opponents of the bill, such as I, had advocated.
Readers who know me well will not be surprised by my citing the Tao Te Ching-but some may be taken aback by my quoting football legend, Kurt Warner, who announced his retirement recently.1 Mr Warner had some wise things to say about leaving a job under your own steam, while you are still in good health-and preferably, before you are shown the door. As I prepare to step down from the editor in chief position at Psychiatric Times in June, I believe I can honestly claim that these conditions apply to my departure. The “hail and farewell!” is intended to encompass both my leave-taking from the helm and my greetings to the incoming editor in chief-my friend and colleague, James Knoll, MD.
The overall effectiveness of electroconvulsive therapy (ECT) is well known, but its speed of action is much less talked about. Here I review what is known about the time course of action of ECT in depression.
Included in this list of disorders is an addition that has sparked debate on this site: temper dysregulation with dysphoria (alternative labels are being considered).
Select members of the Anxiety, Obsessive-Compulsive, Posttraumatic, and Dissociative Disorders Work Group, among others, are addressing the proposed revision of the definition of a mental disorder. Do you agree with their rationale?
Should the Task Force add more conditions to DSM5? If so, what are they? Some of the recommendations for addition include:
What are the overall structural and classification issues in the proposed DSM5 that need to be addressed? Should the Axes be combined, such as the approach used in the International Classification of Diseases? How can we better assess for disability and distress? Do you agree with the proposed dimensional assessments?
Houston, we have a problem. There is a critical shortage of psychiatrists.
Please see the letter I sent to the APA Trustees on April 8, 2010. It contains an urgent plea that the Trustees move immediately to correct the increasingly wayward course of DSM5. The DSM5 Task Force is about to begin a field trial that is a complete mistake for these reasons:
The problems in the preparation of DSM5 have arisen from its unhappy combination of excessive ambition and poor execution. A prime example is the totally unrealistic ambition to provide diagnostic rating scales for each section of DSM5. The goal is to help standardize interviewing in order to increase diagnostic reliability. Surely, it would be nice to have clinicians gather the most pertinent information in a consistent and systematic way.
Time is running out on DSM5 and the mistakes keep piling up. The latest puzzling misstep is the design for the DSM5 field trials. The APA will conduct a remarkably complex and expensive reliability study to determine whether 2 raters can agree on a diagnosis. It will devote enormous resources to answer a question that once mattered greatly but is now of quite limited interest. Meanwhile, DSM5 will perversely avoid the one question that does really count: ie, what will be its likely impact on the rates of psychiatric diagnosis? At least $2.5 million and 1 year later (or possibly 2, if things get delayed as I expect they will), DSM5 will still be flying completely blind on the safety of its proposals.
DSM5 first went wrong because of excessive ambition; then stayed wrong because of its disorganized methods and its lack of caution. Its excessive and elusive ambition was to aim at a “paradigm shift.” Work groups were instructed to think creatively, that everything was on the table. Accordingly, and not surprisingly, they came up with numerous pet suggestions that had in common a wide expansion of the diagnostic system-stretching the ever elastic concept of mental disorder. Their combined suggestions would redefine tens of millions of people who previously were considered normal and hundreds of thousands who were previously considered criminal or delinquent.
The recently posted criteria sets for DSM5 are a mess. The writing is unclear, inconsistent, and imprecise. Unless they are edited and drastically improved, any field testing based on them will be a waste of time, effort, and money- and DSM5 may not be usable.
Nine months ago, Dr. Robert Spitzer and I wrote to alert you that DSM5 had gone badly off track. We warned that its process was unsupervised, poorly planned, secretive, disorganized, and was falling far behind schedule. You took the appropriate steps of appointing an Oversight Committee and delaying for 1 year the target dates for field trials and for the publication of DSM5.
Ronald Pies, MD, is Editor-in-Chief Emeritus of Psychiatric Times, and a professor in the psychiatry departments of SUNY Upstate Medical University and Tufts University School of Medicine. He is the author of The Judaic Foundations of Cognitive Behavioral Therapy; a collection of short stories, Ziprin’s Ghost; and a poetry chapbook, The Heart Broken Open. His most recent book is The Three-Petalled Rose: How the Synthesis of Judaism, Buddhism, and Stoicism Can Create a Healthy, Fulfilled and Flourishing Life (iUniverse: 2013).
Daniel J. Carlat, MD, is associate clinical professor of psychiatry at Tufts University School of Medicine in Boston and Editor-in-Chief of The Carlat Psychiatry Report-a monthly newsletter on psychopharmacology that is widely read by psychiatrists and nurses in the United States. His blog, The Carlat Psychiatry Blog, is consistently ranked as one of the 10 most influential health blogs by Wikio and has received an award for outstanding mental health journalism by the Psych Central Web site.
Allen Frances, MD, was the chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.
James L. Knoll IV, MD, is Editor-in-Chief of Psychiatric Times. He is an associate professor of psychiatry at the SUNY Upstate Medical Center in Syracuse, where he is director of forensic psychiatry, and director of the forensic psychiatry fellowship at Central New York Psychiatric Center. Dr Knoll provides forensic consults for the criminal justice system and the private sector. He has authored numerous articles and book chapters and is coeditor of the Correctional Mental Health Report. He contributes frequently to Psychiatric Times and is series editor of the column Psychiatry & The Law. He writes a forensic psychiatry blog, The Edge Effect.
Michael Blumenfield, MD, is The Sidney E. Frank Distinguished Professor Emeritus of Psychiatry and Behavioral Sciences at New York Medical College. He is a Past Speaker of the Assembly of the American Psychiatric Association. Dr Blumenfield lives and practices in Woodland Hills, Calif, where he also writes the weekly blog, PsychiatryTalk.com.
H. Steven Moffic, MD, after an award-filled career focusing on the underserved, retired from clinical work and his Tenured Professorship at the Medical College of Wisconsin on June 30, 2012. However, he will continue to write, present, and serve on boards devoted to this-and related-ethical concerns. Dr Moffic’s book The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare (Jossey-Bass, 1997) was the first on the subject. He has edited ethics columns for 3 psychiatric newsletters.
Doctors at Duke University Medical Center have documented a connection between fluctuations in the stock market and heart attack frequency.
Today, May 5, I'll be turning 64. Normally, that would not seem to be a birthday of particular distinction. Why is it for me?
By teaching those with PTSD to manage the stress and pain associated with the disorder's recurring horrors and disturbances, Edna Foa , MD has earned a spot on Time Magazine’s top 100 list of the most influential people in the world.