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Produced as a partnership between the American Psychiatric Association and the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse, this thought-provoking collection of white papers: Examines nomenclature issues. Reviews genetic, brain imaging, postmortem, and animal model research and includes strategic insights for a new research agenda Outlines recent progress in developmental neuroscience, genetics, psychology, psychopathology, and epidemiology, focusing on the turbulent first two decades of life. Suggests a research agenda for personality disorders that uses a dimensional rather than the current categorical approach to diagnosis. Proposes a research agenda to evaluate the clinical utility and validity of adding relational disorders to DSM-IV. Reevaluates the relationship between mental disorders and disability, proposing that diagnosis and disability be uncoupled. Examines the importance of culture in psychopathology and the main cultural variables at play in the diagnostic process.
Since its initial publication more than 50 years ago, the DSM has systematized the complex intellectual and clinical process of diagnosing mentally ill persons through the use of categories and classification. The manuals have provided a consistent diagnostic language for clinical work, research, and teaching; have established a common international taxonomic standard; and have provided psychiatrists with a means of communicating with patients and the public. With a new iteration of the DSM on the horizon, the APA has initiated a multiphase research review process designed to set the stage for the fifth revision, due to be published in 2013. This book brings together the most promising research presented at the conference "The Future of Psychiatric Diagnosis: Refining the Research Agenda," which was convened by the APA, in collaboration with the World Health Organization and the U.S. National Institutes of Health. Conferees were challenged to go beyond the current categorical definitions set forth in DSM-III and DSM-IV and suggest ways of incorporating more quantitative, dimensional concepts into DSM-V. The resulting work: Addresses the challenge of creating dimensional measures that are compatible with existing categorical definitions and do not unduly disrupt clinical practice Applies a dimensional approach to a broad range of diagnoses, including substance dependence, major depressive episode, psychosis, anxiety disorders, developmental psychopathology, and personality disorders Facilitates the development of broadly agreed upon criteria that researchers worldwide can use in planning and conducting future research exploring the etiology and pathophysiology of mental disorders Identifies and encourages the empirical research necessary to allow informed decision making regarding deficiencies acknowledged in DSM-IV Promotes international collaboration with the objective of eliminating the remaining disparities between DSM-V and the International Classification of Diseases Mental and Behavioural Disorders Section, the next edition of which is due to be released in 2014. The book's painstaking scholarship and thoughtful conclusions should stimulate interest in finding new ways of combining categorical and dimensional approaches in psychiatric nosology. Clinicians and researchers in the United States and the international psychiatric community will discover, in these pages, the beginnings of a new, quantitative methodology that represents the next stage in the evolution of DSM.
Written to help identify major gaps in our knowledge of how gender and age affect psychiatric diagnoses and to stimulate much-needed research to fill these gaps, Age and Gender Considerations in Psychiatric Diagnosis serves as both a valuable short-term source for the DSM-V Task Force and its disorder-specific workgroups, and a long-term guide for future studies that will contribute to revised psychiatric classifications in these three areas. Here, 47 experts present findings in three areas of psychiatric research that historically have been neglected but rightfully have received increasing attention in recent years and thus are worthy of investigation into their clinical features, etiology, and course: 1. Significant gender differences in prevalence, symptom profiles, and risk factors for mental disorders, including neurodevelopmental, neurophysiological, and environmental factors for men and women that cut across diagnostic categories-for example, the critical importance of gender in how psychiatric illness develops and presents; DSM's approach to gender to date; and relevant research findings and gaps in the epidemiology, etiology, and pathophysiology of disorders and the gender-related expression of psychopathology, including the controversial and complex question of whether DSM should have different diagnostic criteria for men and women. 2. Mental disorders in infancy and early childhood, including diagnosis and measurement of psychopathology; PTSD and social and cognitive factors related to the experience of stress; reactive attachment disorder (unique in part because of its specificity to early childhood); mood and anxiety disorders and difficulties in diagnosis; sleep disorders, including two new disorders, Night-Waking Dysomnia and Sleep-Onset Dysomnia; feeding disorders, including the need to address overeating and overfeeding (especially given the alleged U.S. epidemic of obesity); early childhood manifestations of behavior disorders; and early symptoms and diagnosis of autism. 3. Mental disorders in the elderly, such as dementia and depression, once considered normal consequences of aging but now understood to represent mental disorders, including the need to identify specific brain structure abnormalities, biomarkers, and the many contributing biological, psychosocial, and environmental factors of mental illness in late life and to understand their roles in the elderly to better diagnose and monitor disease progression. Written for clinicians and researchers alike, this thought-provoking compendium contributes critical information that helps enhance our understanding of the causes of mental disorders, develop effective preventive and treatment interventions, and inform future editions of DSM and ICD.
Inviting the help of colleagues worldwide, the concise Diagnostic Issues in Substance Use Disorders is part of the new series Advancing the Research Agenda for DSM-V. Its 19 chapters by an international group of experts are designed to stimulate questions that will help guide research related to the development of the next editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Classification of Diseases (ICD-11), with the goal of ensuring that the major substance use diagnoses represent the same condition in both references. They cover 10 major issues in three main sections: Overarching issues relevant for the development of international diagnostic systems -- statistical modeling techniques and whether DSM-V should use categorical and/or dimensional diagnostic approaches; methods review, emphasizing new hybrid techniques for developing and testing diagnostic concepts; the need for separate clinical and research-oriented diagnostic criteria, incorporating both categorical and dimensional attributes; neurobiological changes characterizing substance dependence; the importance of cultural attributes in developing definitions of substance use disorders; and the history of the development of diagnostic systems and how to optimize the "crosswalk" between DSM and ICD. Research questions more specific to the substance use disorders section of DSM -- comorbidity between substance use disorders and other psychiatric conditions, the relatively unique clinical course of substance-induced mental disorders and appropriate treatment approaches; the precision of the criteria and threshold for a diagnosis and how to improve them; the subtypes of substance use disorder, including how they have been derived and the extent to which they relate to neurobiological processes; the seemingly high prevalence of alcohol dependence in young people; suggested research questions to evaluate the application of diagnostic criteria to adolescents; and the specific psychoactive substances cannabis and nicotine. Whether substance use disorders should be included in a broader section termed "addictive disorders" -- impulse-control disorders (especially pathological gambling and the advantages and disadvantages of adding it to the current substance use disorders section), identifying research opportunities regarding their assessment and neurocognitive and physiological bases, discussing the specifics of the research agenda and how it might be implemented, and presenting questions generated by the research agenda developmental process. This informative compendium distills the findings of a wealth of recent research and concludes with recommendations for exploiting research opportunities that promise to inform decisions regarding DSM-V and other classification systems. As such, it will prove invaluable for clinicians and researchers everywhere.
The five-year process of preparing for the revision of the Diagnostic and Statistical Manual (DSM) has been organized around a series of conferences convened by the American Psychiatric Association, in collaboration with the World Health Organization and the U.S. National Institutes of Health, to address the future of psychiatric diagnosis. Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-V is the fruit of one of those conferences and presents the most academically sound, thought-provoking, and timely papers from the proceedings. As the conference and book demonstrate, recent advances in psychiatric diagnosis suggest a new approach to obsessive-compulsive disorder (OCD) classification: Research into the pathogenesis of OCD increasingly supports reclassification out of the anxiety disorders and into a separate group of obsessive-compulsive-related disorders (OCRDs). The relationships among OCRDs may be better defined, delineated, and understood if the current categorical diagnostic approach is supplemented with a dimensional approach which assesses obsessive-compulsive symptom domains. Obsessive-compulsive disorders are believed to be underdiagnosed in patients who complain of broad symptoms of anxiety, and reclassification of OCD as an OCRD would promote more careful examination of distinct obsessive-compulsive symptoms, yield more accurate diagnosis, and result in more effective treatments. Reclassification may facilitate future research directions in examining the biological underpinnings of these disorders. In addition to examining the genetic, neurological, and ethno-cultural bases for OCRDs, the book gives special attention to disorders that cross current diagnostic categories, including: Body dysmorphic disorder (BDD) Tourette's syndrome and trichotillomania Impulse-control disorders The process leading to publication of DSM-V is by its nature an exhaustive and complex one, and the conferences play a critical role in reviewing relevant research, assessing the status of scientific knowledge, and advancing that knowledge base. Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-V represents the cutting-edge thinking that will culminate in new diagnoses, classifications, and standards of practice for this debilitating set of disorders. Clinicians and academicians will be fascinated by this glimpse into the next generation of the DSM-V.
This book acts as a guidepost for the entire DSM process. It reviews recent scientific advances in our understanding of the inter-relationship between generlized anxiety disorder and major depression, summarizes the body of evidence into a few broad conclusions, and reflects on the implications of these findings for future nosologic efforts.
Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for DSM-5 and ICD-11 provides a comprehensive summary of the current state of mental health classification in the United States and internationally, fostering a better understanding of primary research and clinical needs and facilitating the efforts of service planners, researchers and trainees to address current use of psychiatric diagnosis in the public health sector. The volume reflects the proceedings of a research planning conference convened by the APA and World Health Organization (WHO) that focused on public health aspects of the diagnosis and classification of mental disorders. Highly relevant to the ongoing development of DSM-5 and ICD-11, the book includes the background papers prepared and presented by the Conference Expert Groups. The resulting collection: Discusses the current state of mental illness prevention efforts and the role of public health in supporting them -- critical topics, given that development of effective strategies to reduce mental illness around the world depends on the accuracy with which risk and protective factors can be identified, defined, and understood. Features international perspectives on public health implications of psychiatric diagnosis, classification, and service, providing viewpoints that are broad and more globally relevant. Views mental health education, and awareness on a macro level, including its impact on social and economic policy, forensics and the legal system, and education. This approach facilitates the continued development of a research base in community health and promotes the establishment of programs for monitoring, treating, and preventing mental illness. Addresses many fascinating and clinically relevant issues, such as those raised by the concept and the definition of mental disorders and how these impact psychiatric services and practice by individual providers. This collection should prove useful to the advisory groups, task forces, and working groups for the revision of these two classifications, as well as for researchers in the area of diagnosis and classification, and more generally in public health.
The Conceptual Evolution of DSM-5 highlights recent advances in our understanding of cross-cutting factors relevant to psychiatric diagnosis and nosology. These include developmental age-related aspects of psychiatric diagnosis and symptom presentation; underlying neuro-circuitry and genetic similarities that may clarify diagnostic boundaries and inform a more etiologically-based taxonomy of disorder categories; and gender/culture-specific influences in the prevalence of and service use for psychiatric disorders. This text also considers the role of disability in the diagnosis of mental disorders and the potential utility of integrating a dimensional approach to psychiatric diagnosis. A powerful reference tool for anyone practicing or studying psychiatry, social work, psychology, or nursing, The Conceptual Evolution of DSM-5 details the proceedings from the 2009 American Psychopathological Association's Annual Meeting. In its chapters, readers will find a thorough review of the empirical evidence regarding the utility of cross-cutting factors in nosology, as well as specific suggestions for how they may be fully integrated into the forthcoming fifth edition of Diagnostic and Statistical Manual of Mental Disorders.
This handy DSM-5(R) Classification provides a ready reference to the DSM-5 classification of disorders, as well as the DSM-5 listings of ICD-9-CM and ICD-10-CM codes for all DSM-5 diagnoses. To be used in tandem with DSM-5(R) or the Desk Reference to the Diagnostic Criteria From DSM-5(R), the DSM-5(R) Classification makes accessing the proper diagnostic codes quick and convenient. With the advent of ICD-10-CM implementation in the United States on October 1, 2015, this resource provides quick access to the following: - The DSM-5(R) classification of disorders, presented in the same sequence as in DSM-5(R), with both ICD-9-CM and ICD-10-CM codes. All subtypes and specifiers for each DSM-5(R) disorder are included.- An alphabetical listing of all DSM-5 diagnoses with their associated ICD-9-CM and ICD-10-CM codes.- Separate numerical listings according to the ICD-9-CM codes and the ICD-10-CM codes for each DSM-5(R) diagnosis.- For all listings, any codable subtypes and specifiers are included with their corresponding ICD-9-CM or ICD-10-CM codes, if applicable. The easy-to-use format will prove indispensable to a diverse audience--for example, clinicians in a variety of fields, including psychiatry, primary care medicine, and psychology; coders working in medical centers and clinics; insurance companies processing benefit claims; individuals conducting utilization or quality assurance reviews of specific cases; and community mental health organizations at the state or county level.
In the years following publication of the DSM-5(R), the field of psychiatry has seen vigorous debate between the DSM's more traditional, diagnosis-oriented approach and the NIMH's more biological, dimension-based RDoC (research domain criteria) approach. Charney & Nestler's Neurobiology of Mental Illness is an authoritative foundation for translating information from the laboratory to clinical treatment, and its fifth edition extends beyond this reference function to acknowledge and examine the controversies, different camps, and thoughts on the future of psychiatric diagnosis. In this wider context, this book provides information from numerous levels of analysis, including molecular biology and genetics, cellular physiology, neuroanatomy, neuropharmacology, epidemiology, and behavior. Sections and chapters are edited and authored by experts at the top of their fields. No other book distills the basic science and underpinnings of mental disorders-and highlights practical clinical significance-to the scope and breadth of this classic text. In this edition, Section 1, which reviews the methods used to examine the biological basis of mental illness in animal and cell models and in humans, has been expanded to reflect critically important technical advances in complex genetics (including powerful sequencing technologies and related bioinformatics), epigenetics, stem cell biology, optogenetics, neural circuit functioning, cognitive neuroscience, and brain imaging. This range of established and emerging methodologies offer groundbreaking advances in our ability to study the brain as well as unique opportunities for the translation of preclinical and clinical research into badly needed breakthroughs in our therapeutic toolkit. Sections 2 through 7 cover the neurobiology and genetics of major psychiatric disorders: psychoses (including bipolar disorder), mood disorders, anxiety disorders, substance use disorders, dementias, and disorders of childhood onset. Also covered within these sections is a summary of current therapeutic approaches for these illnesses as well as the ways in which research advances are now guiding the search for new treatments. Each of these parts has been augmented in several different areas as a reflection of research progress. The last section, Section 8, reconfigured in this new edition, now focuses on diagnostic schemes for mental illness. This includes an overview of the unique challenges that remain in diagnosing these disorders given our still limited knowledge of disease etiology and pathophysiology. The section then provides reviews of DSM-5(R), which forms the basis of psychiatric diagnosis in the United States for all clinical work, and of RDoC, which provides an alternative perspective on diagnosis in heavy use in the research community. Also included are chapters on future efforts toward precision and computational psychiatry, which promise to someday align diagnosis with underlying biological abnormalities.