NYT on 1) revisions to the DSM and 2) The Americanization of Mental Illness

Mari · 02-10-2010, 04:26 AM

HI,
The New York Times has two recent articles about mental illness.
The first one is short -- about discussions going on among psychiatrists as they revise the DSM.
The second is longer and about how the West has spread its version of mental illness around the world.

Revising Book on Disorders of the Mind
http://www.nytimes.com/2010/02/10/he...0psych.html?hp

Quote:

In a conference call on Tuesday, Dr. Regier, Dr. Kupfer and several other members of the task force outlined their favored revisions. The task force favored making semantic changes that some psychiatrists have long argued for, trading the term “mental retardation” for “intellectual disability,” for instance, and “substance abuse” for “addiction.”

One of the most controversial proposals was to identify “risk syndromes,” that is, a risk of developing a disorder like schizophrenia or dementia. Studies of teenagers identified as at high risk of developing psychosis, for instance, find that 70 percent or more in fact do not come down with the disorder.

“I completely understand the idea of trying to catch something early,” Dr. First said, “but there’s a huge potential that many unusual, semi-deviant, creative kids could fall under this umbrella and carry this label for the rest of their lives.”

=-=-=-=-=-=-

The Americanization of Mental Illness
http://www.nytimes.com/2010/01/10/ma...l?pagewanted=4

Quote:

In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.

Quote:

"The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.” The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events.

“Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.”

In other words, the belief that was assumed to decrease stigma actually increased it. Was the same true outside the lab in the real world?

The question is important because the Western push for “mental-health literacy” has gained ground.

I'm not sure I understand the second article. 'Will have to go back to it. I have seen articles in the past about how culture influences manifestations and treatment of mental illness. 'Would like to know more.

M.

bizi · 02-10-2010, 09:23 PM

I am not sure I understand what is being said here either.

Isis · 02-11-2010, 02:00 AM

A shot - naming an illness invites a more extreme reaction?
Like - a bleeding mole will be lovingly, gently bandaged up until it is called a melanoma and then it is cancer. So agressive treatment is justified and excused,

Mental illness related to a cause can elicit sympathy - poor A, she went into such a depression when her mother died - as oppossed to - A has clinical depression. People tend to find a named illness justifies aggressive treatment and a 'has to put up with it' attitude, ok sometimes with the underlying sentiment of 'poor thing!' - but still.

Can't say I agree all the way, but its a thought often valid.

Mari · 02-11-2010, 03:57 AM

Hi,
I've seen these studies discussed before. According to the WHO, patients with schizophrenia in India have better outcomes than patients in the West have:

http://psychservices.psychiatryonlin...ull/57/1/143-a
Better Outcomes for Schizophrenia in Non-Western Countries

Quote:

The characterization of schizophrenia as a biological "disease" that needs to be managed mostly by pharmacologic means may also contribute to poor prognosis.

It is also possible that in Western societies, expectation and beliefs about mental illness and the operation of the health care system serve to alienate patients with schizophrenia from normal roles in society and to prolong illness.
In contrast, beliefs and practices in non-Western societies may encourage short-term illness and a quick return to premorbid status. Thus prognosis may also be the result of culturally based self-fulfilling prophecies (4).

It is obvious that although schizophrenia may have a biological basis, good outcomes depend on a pharmaco-psycho-social approach, and the psychosocial aspect may well have the greatest impact on improved outcomes.

I think in the US we do a poor job of the pyscho-social treatments that can help some people.

M.

Mari · 02-11-2010, 04:42 AM

Hi,

Here is the link to a draft copy.
http://www.dsm5.org/Pages/Default.aspx
DSM-5: The Future of Psychiatric Diagnosis

Here is a link to rethinking dx of Mixed Episode
http://www.dsm5.org/ProposedRevision...n.aspx?rid=428

Quote:

A) If predominantly Manic or Hypomanic, full criteria are met for a Manic Episode (see Criteria for Manic Episode) or Hypomanic Episode (see Criteria for Hypomanic Episode), and at least 2-3 of the following symptoms are present nearly every day for at least a one week period. Symptoms must be unusual or uncharacteristic of the person’s usual behavior:

PLACEHOLDER SYMPTOM LIST

- depressed/down,

- decreased interest/pleasure,

- psychomotor retardation

- fatigue,

- worthlessness/guilt,

- death/suicide.

B) If predominantly Depressed, full criteria are met for a Major Depressive Episode (see Criteria for Major Depressive Episode), and at least 2-3 of the following symptoms are present nearly every day for at least a one week period. Symptoms must be unusual or uncharacteristic of the person’s usual behavior.

PLACEHOLDER SYMPTOM LIST

- expansive or irritable (considerable discussion whether irritability belongs on this list)

- grandiose

- increased/pressured speech,

- flight of ideas or racing thoughts without depressive content

- increased or excessive involvement in activities that have high potential for painful consequences.

- Increased goal directed activity

-Increased energy

- Decreased need for sleep [We need language to help clinicians decide difference between decreased need for sleep, and inability to sleep – maybe “feels rested on less than normal amount of sleep”]

C) For those who meet full episode criteria for both Mania and Depression, they should be labeled as having a Manic Episode, with mixed features, due to the marked impairment and clinical severity of full mania.

Here is a link to the article the Washington Post that explains some other disorders in the DSM-5: http://www.washingtonpost.com/wp-dyn...000005_pf.html
Changes proposed in how psychiatrists diagnose

Quote:

Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders - such as dementia or schizophrenia - based on early symptoms, even though there's no way to know who will worsen into full-blown illness. It's a category the psychiatrist group's own leaders say must be used with caution, as scientists don't yet have treatments to lower that risk but also don't want to miss people on the cusp of needing care.

Another change: The draft sets scales to estimate both adults and teens most at risk of suicide, stressing that suicide occurs with numerous mental illnesses, not just depression.

But overall the manual's biggest changes eliminate diagnoses that it contends are essentially subtypes of broader illnesses - and urge doctors to concentrate more on the severity of their patients' symptoms. Thus the draft sets "autism spectrum disorders" as the diagnosis that encompasses a full range of autistic brain conditions - from mild social impairment to more severe autism's lack of eye contact, repetitive behavior and poor communication - instead of differentiating between the terms autism, Asperger's or "pervasive developmental disorder" as doctors do today.

The psychiatric group expects that overarching change could actually lower the numbers of people thought to suffer from mental disorders.

waves · 02-14-2010, 06:12 PM

Quote:

Originally Posted by Mari

Here is the link to a draft copy.
http://www.dsm5.org/Pages/Default.aspx

i really appreciate this thread and in particular this link Mari. if my pdoc has not seen a draft yet i will pass this on to him. again thanks. ~ waves ~

Mari · 02-16-2010, 04:24 AM

HI,
Here is more about child bipolar VS Temper Dysregulation Disorder with Dysphoria.

M.

http://www.child-psych.org/2010/02/c...dysphoria.html

Childhood Bipolar Disorder is not Bipolar?
DSM-V and the new Temper Dysregulation Disorder with Dysphoria
Written by Nestor Lopez-Duran PhD on Wednesday, February 10.2010

Quote:

Let me start by explaining that the creation of TDD does NOT deny the existence of classic bipolar disorder in childhood. That is, although extremely rare, bipolar disorder can occur in children and adolescents, and it looks very much like adult bipolar. Instead, TDD was created to capture a valid syndrome with characteristics and outcomes that are different than those of bipolar disorder.

The available scientific data supports the position that the TDD syndrome is NOT simply the manifestation of bipolar disorder in childhood.
This means that thousands of children that have been diagnosed with childhood bipolar disorder may not have bipolar and instead have a completely different syndrome now called Temper Dysregulation Disorder with Dysphoria.

bizi · 02-16-2010, 08:17 PM

a new disease with the ability to medicate even more children....
urgh!

Mari · 02-16-2010, 10:13 PM

Quote:

Originally Posted by bizi

a new disease with the ability to medicate even more children....
urgh!

Dear Bizi,
I think that the pdocs are steering away from childhood bipolar -- most children grow out of it.

http://abcnews.go.com/Health/MindMoo...9795049&page=3

Quote:

There is currently a recognized syndrome known as oppositional defiant disorder, but some children also display severe aggression and negative moods that go beyond mere stubbornness, according to Shaffer.

Such children are often tagged as having juvenile bipolar disorder, but research has shown that the label is often inappropriate, since they usually do not qualify for a bipolar disorder diagnosis when they reach adulthood, though they remain dysfunctional.

More often, these children are diagnosed as depressed when they become adults.

While we wait for better technology and better imaging techniques, I guess the committee members are trying to narrow down a better dx.

(Big pharma always wins no matter what happens.)

Mari

Isis · 02-17-2010, 12:58 AM

Quote:
There is currently a recognized syndrome known as oppositional defiant disorder, but some children also display severe aggression and negative moods that go beyond mere stubbornness, according to Shaffer.

Such children are often tagged as having juvenile bipolar disorder, but research has shown that the label is often inappropriate, since they usually do not qualify for a bipolar disorder diagnosis when they reach adulthood, though they remain dysfunctional.

More often, these children are diagnosed as depressed when they become adults.

That describes my daughter. Except that, out of the house she would win any Miss. Congeality contest. She is on Paxil CR for OCD and Abilify to make her be just that bit nicer.

I do hope Depression doesn't follow as the study says it does.

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