<p>[NIMH</a> · Transforming Diagnosis](<a href=“http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml]NIMH”>http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml) I posted this elsewhere but thought it might be worth mentioning here as well. I agree with NIMH’s opinion.</p>
<p>Thanks Jym.</p>
<p>Heres the proposed alternative [NIMH</a> · NIMH Research Domain Criteria (RDoC)](<a href=“http://www.nimh.nih.gov/research-funding/rdoc/nimh-research-domain-criteria-rdoc.shtml]NIMH”>http://www.nimh.nih.gov/research-funding/rdoc/nimh-research-domain-criteria-rdoc.shtml)</p>
<p>Thanks Jym, hadn’t seen this before - looks as though it will have a profound impact in the future.</p>
<p>I don’t see where it says NIHM rejects the DSM. The document says we can and should do better, but this is what we have given the lack of objective laboratory data to measure mental health. </p>
<p>It’s going to be a very long time before those data are gathered and analyzed, especially given current historically low levels of NIH funding that probably never will be restored to what they were.</p>
<p>I don’t see a ‘rejection’ either – just an admission that we need a whole LOT more study and real data, and that NIMH will lead the charge to collect it.</p>
<p>To describe the DSM as lacking in validity is not much of an endorsement IMO</p>
<p>They are going to tie NIH funding to their new system. That’s a pretty profound rejection.</p>
<p>perhaps its semantics, but to me a rejection would be a strong recommendation to Medicare/Medicaid that they not pay for diagnoses under DSM. In other words, NIMH finds DSM to be invalid.</p>
<p>Instead, they are just saying lets’ go get more research into this, that and this other thing, which will improve (and perhaps replace?) DSM.</p>
<p>When psych patients are doing better in places like Nigeria and India, you know there’s a problem:</p>
<p>[Are</a> Psychiatric Medications Making Us Sicker? - The Chronicle Review - The Chronicle of Higher Education](<a href=“Are Psychiatric Medications Making Us Sicker?”>Are Psychiatric Medications Making Us Sicker?)</p>
<p>Good link, mini.</p>
<p>Not sure what that has to do with the diagnostic conundrum.</p>
<p>How much of the diagnostic work follows the availability of pharmaceuticals, rather than the other way around? (ADHD, for example, was barely if ever diagnosed until drugs were created in search of a condition to treat.)</p>
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<p>This is interesting and definitely warrants further study to determine whether medications might be beneficial in the short term but harmful in the long term. However, I do see a connection between the claim that people who take psychotropic medications fare worse over the long term as compared to people who do not take these medications and the DSM, which is that one of the primary reasons that the DSM exists is to enable research about mental illness. Research tells us nothing unless the people in the experiemntal and control groups are the same. And there are no objective tests for mental illnesses (so far as I know) so the DSM is important because if everyone in the study meets the DSM criteria, then at least we know they are the same with respect to those criteria.</p>
<p>Not if the criteria are simply lists of symptoms. There are multiple medical conditions with similar symptomology. Use the wrong meds based simply on symptomology and you may, and will, eventually, kill some of your patients.</p>
<p>The true story of why the DSM was created to begin with is an interesting tale, but it would hijack the thread.</p>
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<p>The DSM criteria are lists of symptoms. As I understand it (my area is health care policy, not medicine), there is no way to diagnose mental illnesses on the basis of etiology rather than symptomology. Because we lack knowledge of the etiology of most (all?) mental illnesses.</p>
<p>But of course practitioners know this. If someone shows up in the ER experiencing symptoms of psychosis, there are several things that could be causing those symptoms. If the patient has signs of being a drug user, then the ER doc might suspect amphetamine psychosis, rather than schizophrenia.</p>
<p>This is fantastic. Truly fantastic.</p>
<p>It’s such a great idea that I wish I had come up with it. >.></p>
<p>“But of course practitioners know this. If someone shows up in the ER experiencing symptoms of psychosis, there are several things that could be causing those symptoms.”</p>
<p>Sadly, many, or even most don’t, or don’t act like they do. I spent much of my career working on health policy around mental health and substance abuse. We found repeatedly that, when treating supposed dually diagnosed patients for their substance abuse problems, the mental health diagnosis would disappear. The mental health professionals would insist that it was “in remission”; the substance abuse people would say that it wasn’t there to begin with.</p>
<p>If treated for mental health difficulties first, chances are the patients would never get well. Through case review - we found that 11% of people committed to one of the state mental hospital did not have, and never had had a mental health disorder. We found one patient there for nine years who never had a mental disorder. Of course, it was (and is) then argued that the mental health drugs had forced the disorder into remission. But the drugs were often given without a clear diagnosis to begin with, just a list of symptoms. Then, as the article above points out, over time, the patients did worse than those provided no drugs, or simply talk therapy.</p>
<p>We also did a study of patients who (from what we could tell) were truly dual disordered, and severely so. Some when to inpatient mental health facilities where they also received substance abuse treatment. Some went to substance abuse facilities where they also received mental health treatment. You can guess which group of patients, by a large margin did better than the other. The main difference, from what we could tell, was that in the substance abuse facility, people actually talked to the patients.</p>
<p>Not to get further sidetracked, but the insurance industry plays a large role in the diagnostic and treatment conundrum. For example, a patient might have a dual diagnosis of a head injury and a substance abuse problem. Health insurance, even with the supposed improvements in parity between coverage for MH vs medical dx, will commonly have better coverage for the medical than the MH diagnosis. And often (at least in the past when I did inpatient work) each side of the insurance house, when treating a dual diagnosed pt, will try to throw the reimbursement responsibility to the other side of the house, and then no one pays the bill.</p>
<p>[NIMH</a> Delivers A Kill Shot To DSM-5](<a href=“http://www.science20.com/science_20/blog/nimh_delivers_kill_shot_dsm5-111138]NIMH”>NIMH Delivers A Kill Shot To DSM-5 | Science 2.0) another interesting article on NIMH’s stance</p>
<p>and another <a href=“http://www.govhealthit.com/news/nimh-moving-beyond-dsm[/url]”>http://www.govhealthit.com/news/nimh-moving-beyond-dsm</a></p>