This is the controversial new designation for children showing persistent
Reports here provided what may be the last public update on DSM-5, the next edition of American psychiatry's diagnostic guide, before it is formally released louis vuitton sunglasses in May 2013. Many changes have been made since the first draft of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was put out for public comment in early 2010, according to workgroup leaders speaking at several heavily attended symposia at the American Psychiatric Association's (APA) annual meeting. The current version, DSM-IV, was released in 1994. The update effort has been led by DSM-5 task force chairman David Kupfer, MD, of the University of Pittsburgh, and APA research director Darrel Regier, MD, MPH. The actual work of rewriting the manual fell to 13 workgroups, which tackled disorders in 20 categories. The final drafts are to be completed by August, then they must be approved by a scientific review committee and the task force leadership, and finally by the APA's governing bodies. Kupfer said the final version has to be completed by December, when it's set to go to the printer. Its formal release is planned for the APA's annual meeting next May in San Francisco. Here's a brief overview of the changes you can expect. To a great but not complete extent, the DSM-5 workgroups complied with those instructions. Every one of the dozens of disorder categories has been reorganized and/or rewritten to bring them into line with research conducted over the past 20 years. Often, the groups found no basis for classifications and diagnoses contained in DSM-IV. Here are highlights of what is set to be dumped in DSM-5: Axes. DSM-IV's main organizational scheme was to divide disorders, contributing factors, and global functional assessments into 5 axes -- notably with Axis I containing clinical, substance-related, and learning disorders and Axis II comprising personality and certain other disability-based disorders. The DSM-5 leadership determined early on that there was no scientific basis for this distinction, and so disorders in the new edition will be presented as a simple list of 20 chapters for disorder families. NOS diagnoses. Most disorder families in DSM-IV included an NOS diagnosis that served as a catchall for patients who appeared to have some kind of disorder but who didn't fit into the established categories. In practice, however, some of these became extremely discount louis vuitton handbags sale popular. The head of the eating disorders workgroup, for example, cited data indicating that more than half of all patients diagnosed with an eating disorder were coded for "ED-NOS." Also, some disorders that were now well recognized and characterized were included in NOS categories, such as restless legs disorder. In DSM-5, NOS categories are either gone entirely or replaced with NEC for "not elsewhere classified." NEC categories will include a list of "specifiers," each with a specific diagnostic code, that will convey clinical information. For example, Depressive Disorder NEC comes with 5 specifiers such as "short duration" that indicate the patient's clinical condition and why it doesn't meet criteria for one of the main depression syndromes. Bereavement exclusion in major depression. One of the most controversial proposals in DSM-5 does away with the restriction that diagnosis of major depression cannot be given to patients reporting severe grief from the death of a loved one if the death occurred within the preceding two months. As MedPage Today previously reported, the depression workgroup believes that there is no scientific justification to disqualify patients from diagnosis and treatment if they otherwise meet criteria for major depression. But in a bow to critics, they have proposed to include a caveat in the checklist criteria for major depression noting that certain symptoms appear in normal grief but that others may warrant attention -- as did DSM-IV though in a different way. Catatonia as a psychotic diagnosis. The group has reworked the diagnostic criteria for catatonia and removed it as a subtype of schizophrenia. Instead, catatonia is now a specifier in schizophrenia and several other psychiatric diagnoses. The DSM-IV diagnosis of catatonia related to a general medical condition will be retained, and DSM-5 will also create a new "Catatonia NEC" diagnosis for patients showing catatonia of uncertain origin or associated with neurodevelopmental conditions such as autism. Gender identity disorder. Individuals who believe their biological gender doesn't match their gender identification will no longer be labeled with a disorder. Instead, if they seek psychiatric treatment, they can be labeled with "gender dysphoria." The workgroup responsible for dealing with the hot-button issue considered a variety of other approaches, addressed later in this article. Ultimately they settled on a formal diagnosis -- potentially qualifying a patient for insurance-paid treatment if they want it -- but with a less pejorative name than "disorder." Substance abuse. DSM-IV created separate diagnoses for "abuse" and "dependence" in people having problems with mind-altering substances such as marijuana and narcotics. The DSM-5 workgroup in this area agreed that the vast amount of research conducted in recent decades pointed to substance-related problems as occurring on a continuum, such that the abuse-dependence distinction was purely arbitrary. Hence, DSM-5 will instead feature "substance use disorders" as the diagnosis for people with such problems. Also out are physical tolerance and withdrawal symptoms as criteria for a disorder diagnosis. O'Brien noted that these reflect the body's adaptation to chemicals and are not necessary to a diagnosis. In a commentary delivered to APA burberry handbags meeting attendees, Norman Sartorius, MD, of the World Health Organization, remarked on "the irresistible tendency to introduce new names" when revising diagnostic criteria. And indeed, the DSM-5 workgroups were unable to resist it. But Sartorius also noted that new names can be beneficial -- as long as they are accompanied by preparation and education. In addition to new names, some entirely new disorders and methods of diagnosing them are slated to appear in DSM-5. Dimensions. Perhaps the most important conceptual innovation in DSM-5 is its use of dimensional assessments in most disorder categories. These are indicators of severity for certain symptoms. They may be common "cross-cutting" features that appear in conjunction with many disorders, such as suicide risk and anxiety. Or they may be specific to a particular disorder, such as the frequency of flashbacks in PTSD. Biomarkers. For the first time, results of objective testing will be part of the formal diagnostic criteria in psychiatry. Many sleep-wake disorders in DSM-5 will require polysomnography for a diagnosis. Also, narcolepsy is set to become narcolepsy/hypocretin deficiency, with the latter condition diagnosed on the basis of hypocretin measurements in cerebrospinal fluid. Functional impairments. Despite the leadership's wish to eliminate functional impairments and patient distress as necessary requirements for diagnoses, some of the DSM-5 workgroups found that they couldn't get rid of them. For example, an autism diagnosis will still require "symptoms [that] together limit and impair everyday functioning." Similarly, proposed criteria for PTSD include "the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning." Regier acknowledged to MedPage Today that impairments are part and parcel of some disorders, particularly those defined by neuropsychiatric deficits. But for many categories -- especially the personality disorders -- functional impairments were transferred from the checklist criteria into the dimensional assessments. Disruptive Mood Dysregulation Disorder. This is the controversial new designation for children showing persistent foul temper punctuated by bursts of rage. When first proposed, it was widely derided as an attempt to medicalize "toddler tantrums" (even though the criteria clearly stated it was for children older than 5.) But the workgroup stuck to its guns, although it did drop the name "temper dysregulation with dysphoria" that they had initially proposed. Autism Spectrum Disorder. This was another controversial move, insofar as it combined Asperger's syndrome with overt autism, as well as two other DSM-IV categories, into a single disorder. Many in the autism community have been unhappy with the proposal -- one member of the workgroup in this area quit in protest -- but the remaining members were adamant that the change was justified and that many of the criticisms were simply wrong. "Craving." A key innovation in the diagnosis of burberry silk ties substance use disorders is a requirement that the patient report or demonstrate craving for the particular substance. Workgroup chairman Charles O'Brien, MD, of the University of Pennsylvania, said this is the key symptom that separates addiction from mere heavy use.