DSM-5 Panel Backs Down on some D.S.M. Changes - NYT

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http://www.nytimes.com/2012/05/09/health/dsm-panel-backs-down-on-diagnoses.html

Psychiatry Manual Drafters Back Down on Diagnoses

By BENEDICT CAREY

In a rare step, doctors on a panel revising psychiatry's influential

diagnostic manual have backed away from two controversial proposals that

would have expanded the number of people identified as having psychotic

or depressive disorders.

The doctors dropped two diagnoses that they ultimately concluded were

not supported by the evidence: " attenuated psychosis syndrome, " proposed

to identify people at risk of developing psychosis, and " mixed anxiety

depressive disorder, " a hybrid of the two mood problems.

They also tweaked their proposed definition of depression to allay fears

that the normal sadness people experience after the loss of a loved one,

a job or a marriage would not be mistaken for a mental disorder.

But the panel, appointed by the American Psychiatric Association to

complete the fifth edition of its Diagnostic and Statistical Manual of

Mental Disorders, or D.S.M., did not retreat from another widely

criticized proposal, to streamline the definition of autism. Predictions

by some experts that the new definition will sharply reduce the number

of people given a diagnosis are off base, panel members said, citing

evidence from a newly completed study....

But the panel, appointed by the American Psychiatric Association to

complete the fifth edition of its Diagnostic and Statistical Manual of

Mental Disorders, or D.S.M., did not retreat from another widely

criticized proposal, to streamline the definition of autism. Predictions

by some experts that the new definition will sharply reduce the number

of people given a diagnosis are off base, panel members said, citing

evidence from a newly completed [unpublished] study....

" At long last, DSM 5 is correcting itself and has rejected its worst

proposals, " said Dr. Frances, a former task force chairman and

professor emeritus at Duke University who has been one of the most

prominent critics. " But a great deal more certainly needs to be

accomplished. Most important are the elimination of other dangerous new

diagnoses and the rewriting of all the many unreliable criteria sets. " ...

The proposed definition of autism, which would eliminate related labels

like Asperger's syndrome and " pervasive developmental disorder, " came

under fire in January, when researchers at Yale University presented

evidence that about half of the people who currently have a diagnosis on

the high end of the " autism spectrum " would no long qualify under the

new definition.

At this week's annual meeting, researchers presented data from an

unpublished study of some 300 children, finding that the proposed

definition would exclude very few who currently have a diagnosis of

autism or a related disorder.

But meeting attendees got mixed messages on autism. In a talk on

Tuesday, Dr. E. Swedo, head of the panel proposing the new

definition, said that many people who identify themselves as " aspes, "

for Asperger's syndrome, " don't actually have Asperger's disorder, much

less an autism spectrum disorder. " Dr. Swedo is a researcher at the

National Institute of Mental Health.

The issue is hardly settled. Findings from published studies are

conflicting, but three recent analyses provide support for the Yale

estimate, and more papers in the pipeline are also documenting a

significant reduction in numbers of those who would qualify under the

new criteria. Getting such a diagnosis is critical to obtain

state-financed services for children with special needs.

" I certainly hope the D.S.M. task force is right, that the numbers won't

change much, " said Dr. Fred R. Volkmar, director of the Child Study

Center at the Yale School of Medicine and senior author of the study

presented in January. But if the new definition does not change who gets

a diagnosis, he asked, " Why mess with it at all? " ....