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teaching:1-history-of-dsm [2020/06/07 11:44]
psychdb [Future of Psychiatry]
teaching:1-history-of-dsm [2020/07/09 16:29] (current)
psychdb
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 ===== Primer ===== ===== Primer =====
-The DSM, or the Diagnostic and Statistical Manual of Mental Disorders has a long and storied history in the history of psychiatry. As the cornerstone of psychiatry and guide for millions of clinicians and healthcare providers, it has been the most significant advance in the diagnosis and treatment of mental disorders. However, in the midst of its success, criticisms of its role have also developed. 
  
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 +The **DSM (Diagnostic and Statistical Manual of Mental Disorders)** has a long and storied history in the history of psychiatry. As the cornerstone of psychiatry and guide for millions of clinicians and healthcare providers, it has been the most significant advance in the diagnosis and treatment of mental disorders. However, in the midst of its success, important criticisms of its role have also arisen.
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 +"[The] DSM[-IV] does none of its jobs perfectly and its awkward fit certainly creates a variety of problems. Some clinicians refuse to learn DSM and stick to their own personal prototypes of disorders. Many epidemiological researchers ignore the requirement for clinical significance before making a psychiatric diagnosis and therefore report ridiculously high rates of mental illness in the general population. Some students take the DSM descriptions too literally and lose the patient as they evaluate the criteria. Lawyers often find loopholes because the language of DSM is frustratingly below legal requirements for precision. And so on. But the unifying and synthesizing whole of DSM-IV is still worth much more than would be the accumulated sum of its individual parts. However imperfect, the DSM's special value is as a common denominator that avoids a Babel and is good enough (if admittedly not best) at each of its jobs."
 +
 +//-- Allen Frances, MD, Chair of the DSM-IV Task Force//
 +</​callout>​
 <callout title="​The Cycle of Classification:​ DSM I through DSM-5" type="​info">​ <callout title="​The Cycle of Classification:​ DSM I through DSM-5" type="​info">​
 [[https://​www.annualreviews.org/​doi/​10.1146/​annurev-clinpsy-032813-153639|Blashfield,​ R. K., Keeley, J. W., Flanagan, E. H., & Miles, S. R. (2014). The cycle of classification:​ DSM-I through DSM-5. Annual review of clinical psychology, 10, 25-51.]] [[https://​www.annualreviews.org/​doi/​10.1146/​annurev-clinpsy-032813-153639|Blashfield,​ R. K., Keeley, J. W., Flanagan, E. H., & Miles, S. R. (2014). The cycle of classification:​ DSM-I through DSM-5. Annual review of clinical psychology, 10, 25-51.]]
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 ==== Interrater Reliability ==== ==== Interrater Reliability ====
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 +The DSM-5 field trials showed the inherent limitations of the DSM's etiologically agnostic approach to diagnosing mental disorders. Some disorders had good interrater reliability (e.g. - [[cl:​2-major-neurocog-disorder|major neurocognitive disorder]] and [[trauma-and-stressors:​ptsd|posttraumatic stress disorder]]),​ while others were very poor. The most prominent example is for [[mood:​1-depression:​home|major depressive disorder]], which has a very poor kappa = 0.28 (questionable agreement). One common reason is because the criteria covers a wide range of illness severity, and is a heterogenous condition.[([[https://​pubmed.ncbi.nlm.nih.gov/​23288382/​|Freedman,​ R., Lewis, D. A., Michels, R., Pine, D. S., Schultz, S. K., Tamminga, C. A., ... & Shrout, P. E. (2013). The initial field trials of DSM-5: new blooms and old thorns.]])]
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 +<callout title="​What is the Kappa Statistic?"​ icon="​true"​ type="​question">​
 +Many medical diagnostics (e.g. - physical exams, imaging, and other diagnostic tests) often depend on some subjective interpretation by the observers. This is especially true in psychiatry where there are no objective diagnostics,​ and the //​clinician//​ is the the diagnostic tool. Thus, the kappa statistic (or kappa coefficient) is the most commonly used statistic to measure the agreement between two or more observers. A kappa of 1 indicates perfect agreement between observers, whereas a kappa of 0 indicates agreement equivalent to chance. As an example, if an illness appears in 10% of a clinic'​s patients and two clinicians agree on its diagnosis 85% of the time, the kappa statistic is 0.46 (this is similar to the weighted composite statistic for schizophrenia in this DSM-5 Field Trial).[([[https://​pubmed.ncbi.nlm.nih.gov/​23288382/​|Freedman,​ R., Lewis, D. A., Michels, R., Pine, D. S., Schultz, S. K., Tamminga, C. A., ... & Shrout, P. E. (2013). The initial field trials of DSM-5: new blooms and old thorns.]])][([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3900052/​|McHugh,​ M. L. (2012). Interrater reliability:​ the kappa statistic. Biochemia medica: Biochemia medica, 22(3), 276-282.]])]
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-  * [[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3900052/​|McHugh,​ M. L. (2012). Interrater reliability:​ the kappa statistic. Biochemia medica: Biochemia medica, 22(3), 276-282.]] 
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 ==== Quotes ==== ==== Quotes ====
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   * [[http://​bjp.rcpsych.org/​content/​186/​5/​364|Craddock,​ N., & Owen, M. J. (2005). The beginning of the end for the Kraepelinian dichotomy.]]   * [[http://​bjp.rcpsych.org/​content/​186/​5/​364|Craddock,​ N., & Owen, M. J. (2005). The beginning of the end for the Kraepelinian dichotomy.]]
   * [[http://​www.psychiatrictimes.com/​blogs/​couch-crisis/​psychiatry-new-brain-mind-and-legend-chemical-imbalance|Pies,​ R. (2011). Psychiatry’s new brain-mind and the legend of the “chemical imbalance.”. Psychiatric Times, 11, 1.]]   * [[http://​www.psychiatrictimes.com/​blogs/​couch-crisis/​psychiatry-new-brain-mind-and-legend-chemical-imbalance|Pies,​ R. (2011). Psychiatry’s new brain-mind and the legend of the “chemical imbalance.”. Psychiatric Times, 11, 1.]]
-===== Research Domain Criteria (RDoC) ​=====+==== Research Domain Criteria (RDoC) ====
 [[https://​www.nimh.nih.gov/​about/​strategic-planning-reports/​highlights/​highlight-what-is-rdoc.shtml|RDoC]] is a research framework proposed by the National Institute for Mental Health (NIMH) for new ways of studying mental disorders. It integrates many levels of information (from genomics to self-report) to better understand basic dimensions of functioning underlying the full range of human behaviour from normal to abnormal. [[https://​www.nimh.nih.gov/​about/​strategic-planning-reports/​highlights/​highlight-what-is-rdoc.shtml|RDoC]] is a research framework proposed by the National Institute for Mental Health (NIMH) for new ways of studying mental disorders. It integrates many levels of information (from genomics to self-report) to better understand basic dimensions of functioning underlying the full range of human behaviour from normal to abnormal.
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 ===== Resources ===== ===== Resources =====
-  * [[https://​peh-med.biomedcentral.com/​track/​pdf/​10.1186/​1747-5341-7-2?​site=peh-med.biomedcentral.com|A brief historicity of the Diagnostic and Statistical +<WRAP group> 
-Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice]] (Kawa and Giordano Philosophy, Ethics, and Humanities in Medicine 2012) +<WRAP half column> 
-  * [[https://​psychcentral.com/​blog/​archives/​2011/​07/​02/​how-the-dsm-developed-what-you-might-not-know/​|How the DSM Developed: What You Might Not Know]] +== Articles ==
-  * [[http://​apsychoserver.psych.arizona.edu/​JJBAReprints/​PSYC621/​Blashfield_etal_2014_ARCP.pdf|The Cycle of Classification:​DSM-I Through DSM-5]] +
-  * https://​blog.oup.com/​2013/​05/​dsm-5-will-be-the-last/​+
   * [[http://​www.spusa.org/​pubs/​health_med/​mental_health/​mh_point_counterpoint.html|Mental Health Point/ Counterpoint]]   * [[http://​www.spusa.org/​pubs/​health_med/​mental_health/​mh_point_counterpoint.html|Mental Health Point/ Counterpoint]]
   * [[http://​www.psyweb.com/​lifestyle/​dsm/​is-the-dsm-5-still-acceptable|Is the DSM-5 Still Acceptable?​]]   * [[http://​www.psyweb.com/​lifestyle/​dsm/​is-the-dsm-5-still-acceptable|Is the DSM-5 Still Acceptable?​]]
 +  * [[https://​psychcentral.com/​blog/​archives/​2011/​07/​02/​how-the-dsm-developed-what-you-might-not-know/​|How the DSM Developed: What You Might Not Know]]
 +  * [[https://​blog.oup.com/​2013/​05/​dsm-5-will-be-the-last/​|DSM-5 will be the last - Edward Shorter]]
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 +== Research ==
 +  * [[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3403926/​|Phillips,​ J., Frances, A., Cerullo, M. A., Chardavoyne,​ J., Decker, H. S., First, M. B., ... & LoBello, S. G. (2012). The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis. Philosophy, Ethics, and Humanities in Medicine, 7(1), 1-16.]]
 +  * [[https://​peh-med.biomedcentral.com/​track/​pdf/​10.1186/​1747-5341-7-2?​site=peh-med.biomedcentral.com|A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice (Kawa and Giordano Philosophy, Ethics, and Humanities in Medicine 2012)]]
 +  * [[http://​apsychoserver.psych.arizona.edu/​JJBAReprints/​PSYC621/​Blashfield_etal_2014_ARCP.pdf|The Cycle of Classification:​DSM-I Through DSM-5]]
 +
 +</​WRAP>​
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 {{tag>​ax-dx}} {{tag>​ax-dx}}