Saturday, May 4, 2013

NIMH rejects DSM-V criteria for its research

I just edited the following line in my manuscript, "The DSM-IV and V exemplify a symptom/diagnosis/medication-based view, which blatantly disregards the neurobiological, somatic, environmental and genetic causes of afflictive mind states. Its hyper-focus on categorization does little to help patients (and clinicians!) recognize why distressful mind states manifest and how to ameliorate them." And then logged onto Facebook to see the amazing development that the National Institute for Mental Health (NIMH) has announced it will move away from preferencing research that uses DSM categories.

Two-weeks before the official release of the DSM-V, the manual every clinician must use to delineate diagnostic criteria for insurance reimbursement (few of us use it for anything else!), NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”. He continues,  "Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system."

Insel's alternative is a Research Domain Criteria (RDoC) project, which focuses on the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences. I could not be more pleased and proud of the governmental organization that funds so much of America's premier mental health research.

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