The following is taken from a blog posting by Dr. Thomas Insel, Director of NIMH. It was posted just prior to the release of DSM 5. It is a clear statement of the intention of NIMH to move away from research based on DSM classifications.

Directors Blog: Transforming Diagnosis

April 29, 2013, http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

In a few weeks, the American Psychiatric Association will release its new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This volume will tweak several current diagnostic categories, from autism spectrum disorders to mood disorders. While many of these changes have been contentious, the final product involves mostly modest alterations of the previous edition, based on new insights emerging from research since 1990 when DSM-IV was published. Sometimes this research recommended new categories (e.g., mood dysregulation disorder) or that previous categories could be dropped (e.g., Asperger’s syndrome).[i]

The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.

Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. Through a series of workshops over the past 18 months, we have tried to define several major categories for a new nosology (see below). This approach began with several assumptions:

  • A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
  • Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
  • Each level of analysis needs to be understood across a dimension of function,
  • Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.

It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data. In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”[ii] The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.

That is why NIMH will be re-orienting its research away from DSM categories. 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. The best reason to develop RDoC is to seek better outcomes.

RDoC, for now, is a research framework, not a clinical tool. This is a decade-long project that is just beginning. Many NIMH researchers, already stressed by budget cuts and tough competition for research funding, will not welcome this change. Some will see RDoC as an academic exercise divorced from clinical practice. But patients and families should welcome this change as a first step towards “precision medicine,” the movement that has transformed cancer diagnosis and treatment. RDoC is nothing less than a plan to transform clinical practice by bringing a new generation of research to inform how we diagnose and treat mental disorders. As two eminent psychiatric geneticists recently concluded, “At the end of the 19th century, it was logical to use a simple diagnostic approach that offered reasonable prognostic validity. At the beginning of the 21st century, we must set our sights higher.”[iii]

 



[i] Mental health: On the spectrum. Adam D. Nature. 2013 Apr 25;496(7446):416-8. doi: 10.1038/496416a. No abstract available. PMID: 23619674

[ii] Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Kapur S, Phillips AG, Insel TR. Mol Psychiatry. 2012 Dec;17(12):1174-9. doi: 10.1038/mp.2012.105. Epub 2012 Aug 7.PMID:22869033

[iii] The Kraepelinian dichotomy – going, going… but still not gone. Craddock N, Owen MJ. Br J Psychiatry. 2010 Feb;196(2):92-5. doi: 10.1192/bjp.bp.109.073429. PMID: 20118450

371 Comments
  1. Pingback: Skydiving NYC
  2. Pingback: pickleball paddles
  3. Pingback: water slides
  4. Pingback: hotels
  5. Pingback: interserver coupon
  6. Pingback: Click Here
  7. Pingback: click here
  8. Pingback: read more
  9. Pingback: new website
  10. Pingback: useful reference
  11. Pingback: my company
  12. Pingback: a fantastic read
  13. Pingback: original site
  14. Pingback: look at this site
  15. Pingback: Continued
  16. Pingback: Discover More
  17. Pingback: click resources
  18. Pingback: content
  19. Pingback: see post
  20. Pingback: look here
  21. Pingback: read more
  22. Pingback: best info
  23. Pingback: new website
  24. Pingback: news
  25. Pingback: how to
  26. Pingback: about
  27. Pingback: useful reference
  28. Pingback: imp source
  29. Pingback: my response
  30. Pingback: their explanation
  31. Pingback: her latest blog
  32. Pingback: More Bonuses
  33. Pingback: check that
  34. Pingback: Learn More
  35. Pingback: Get the facts
  36. Pingback: official statement
  37. Pingback: important source
  38. Pingback: click here
  39. Pingback: read more
  40. Pingback: click here
  41. Pingback: click here
  42. Pingback: click here
  43. Pingback: read more
  44. Pingback: read more
  45. Pingback: website
  46. Pingback: click here
  47. Pingback: read more
  48. Pingback: more news
  49. Pingback: her latest blog
  50. Pingback: Clicking Here
  51. Pingback: More hints
  52. Pingback: best value
  53. Pingback: new source
  54. Pingback: best news
  55. Pingback: learn now
  56. Pingback: givehermakeup.com
  57. Pingback: click here
  58. Pingback: read more
  59. Pingback: important
  60. Pingback: find
  61. Pingback: figure out
  62. Pingback: continue reading
  63. Pingback: what to do
  64. Pingback: where to look
  65. Pingback: insight
  66. Pingback: quality article
  67. Pingback: quality article
  68. Pingback: Sperrys for girls
  69. Pingback: useful reference
  70. Pingback: Homepage
  71. Pingback: a fantastic read
  72. Pingback: find this
  73. Pingback: browse this site
  74. Pingback: my response
  75. Pingback: More hints
  76. Pingback: Get the facts
  77. Pingback: official statement
  78. Pingback: try this web-site
  79. Pingback: explanation
  80. Pingback: mitogen dex
  81. Pingback: read more
  82. Pingback: check my blog
  83. Pingback: click site
  84. Pingback: my review here
  85. Pingback: useful reference
  86. Pingback: Get More Info
  87. Pingback: see here
  88. Pingback: great post to read
  89. Pingback: my company
  90. Pingback: imp source
  91. Pingback: click to read more
  92. Pingback: find more info
  93. Pingback: see it here
  94. Pingback: Homepage
  95. Pingback: find this
  96. Pingback: Bonuses
  97. Pingback: read this article
  98. Pingback: click here now
  99. Pingback: browse this site
  100. Pingback: check here
  101. Pingback: original site
  102. Pingback: my response
  103. Pingback: this page
  104. Pingback: news
  105. Pingback: click here
  106. Pingback: click here
  107. Pingback: click here
  108. Pingback: click here
  109. Pingback: read more
  110. Pingback: read more
  111. Pingback: read more
  112. Pingback: read more
  113. Pingback: what is new
  114. Pingback: what is new
  115. Pingback: what is new
  116. Pingback: more info
  117. Pingback: click here
  118. Pingback: read article
  119. Pingback: website
  120. Pingback: source
  121. Pingback: important
  122. Pingback: news
  123. Pingback: url
  124. Pingback: click here
  125. Pingback: what is niagen
  126. Pingback: read more
  127. Pingback: click here
  128. Pingback: find now
  129. Pingback: important
  130. Pingback: new article
  131. Pingback: best information
  132. Pingback: exceptional
  133. Pingback: see this here
  134. Pingback: Visit Website
  135. Pingback: keep reading
  136. Pingback: home page
  137. Pingback: more about this
  138. Pingback: check my site
  139. Pingback: More Bonuses
  140. Pingback: click resources
  141. Pingback: Get the facts
  142. Pingback: official statement
  143. Pingback: click reference
  144. Pingback: you can look here
  145. Pingback: her explanation
  146. Pingback: why not try here
  147. Pingback: informative post
  148. Pingback: click here
  149. Pingback: read more
  150. Pingback: info
  151. Pingback: website
  152. Pingback: news
  153. Pingback: link
  154. Pingback: best source
  155. Pingback: ebook
  156. Pingback: post
  157. Pingback: next
  158. Pingback: click reference
  159. Pingback: visit site
  160. Pingback: look here
  161. Pingback: click to read
  162. Pingback: look at here now
  163. Pingback: important link
  164. Pingback: Niagen
  165. Pingback: click here
  166. Pingback: click here
  167. Pingback: read more
  168. Pingback: website
  169. Pingback: webpage
  170. Pingback: visit them
  171. Pingback: new source
  172. Pingback: news
  173. Pingback: best info
  174. Pingback: information
  175. Pingback: read more
  176. Pingback: information
  177. Pingback: website
  178. Pingback: webpage
  179. Pingback: news
  180. Pingback: best source
  181. Pingback: best source
  182. Pingback: click here
  183. Pingback: Source
  184. Pingback: have a peek here
  185. Pingback: Check This Out
  186. Pingback: this contact form
  187. Pingback: weblink
  188. Pingback: check over here
  189. Pingback: this content
  190. Pingback: click here
  191. Pingback: Source
  192. Pingback: Check This Out
  193. Pingback: this contact form
  194. Pingback: navigate here
  195. Pingback: check over here
  196. Pingback: this content
  197. Pingback: check my blog
  198. Pingback: more info here
  199. Pingback: look at this site
  200. Pingback: visit
  201. Pingback: see this
  202. Pingback: directory
  203. Pingback: see this here
  204. Pingback: feres
  205. Pingback: feres inşaat
  206. Pingback: feres gayrimenkul
  207. Pingback: feres
  208. Pingback: feres
  209. Pingback: additional hints
  210. Pingback: a fantastic read
  211. Pingback: find more info
  212. Pingback: great post to read
  213. Pingback: my company
  214. Pingback: my review here
  215. Pingback: click site
  216. Pingback: check my blog
  217. Pingback: this content
  218. Pingback: click here
  219. Pingback: midogen
  220. Pingback: midogen
  221. Pingback: midogen
  222. Pingback: click here
  223. Pingback: niagen reviews
  224. Pingback: click here
  225. Pingback: niagen review
  226. Pingback: niagen
  227. Pingback: More Bonuses
  228. Pingback: check my source
  229. Pingback: navigate here
  230. Pingback: Source
  231. Pingback: additional reading
  232. Pingback: great post to read
  233. Pingback: advice
  234. Pingback: more information
  235. Pingback: go now
  236. Pingback: Related Site
  237. Pingback: useful link
  238. Pingback: useful link
  239. Pingback: pop over here
  240. Pingback: Full Article
  241. Pingback: read more
  242. Pingback: click here
  243. Pingback: pop over here
  244. Pingback: Full Article
  245. Pingback: click here
  246. Pingback: pop over here
  247. Pingback: Full Article
  248. Pingback: click here
  249. Pingback: pop over here
  250. Pingback: Full Article
  251. Pingback: click here
  252. Pingback: pop over here
  253. Pingback: Full Article
  254. Pingback: Full Article
  255. Pingback: read more
  256. Pingback: click here
  257. Pingback: news
  258. Pingback: click site
  259. Pingback: news
  260. Pingback: this content
  261. Pingback: click here
  262. Pingback: check over here
  263. Pingback: check my blog
  264. Pingback: imp source
  265. Pingback: this page
  266. Pingback: Get More Info
  267. Pingback: Homepage
  268. Pingback: great post to read
  269. Pingback: useful reference
  270. Pingback: my review here
  271. Pingback: a fantastic read
  272. Pingback: official site
  273. Pingback: directory
  274. Pingback: his explanation
  275. Pingback: dig this
  276. Pingback: read this article
  277. Pingback: Bonuses
  278. Pingback: look at this site
  279. Pingback: More hints
  280. Pingback: additional hints
  281. Pingback: More Bonuses
  282. Pingback: Continued
  283. Pingback: check over here
  284. Pingback: this content
  285. Pingback: weblink
  286. Pingback: navigate here
  287. Pingback: navigate here
  288. Pingback: this contact form
  289. Pingback: have a peek here
  290. Pingback: Source
  291. Pingback: check my blog
  292. Pingback: great post to read
  293. Pingback: see here
  294. Pingback: see here
  295. Pingback: useful reference
  296. Pingback: Get More Info
  297. Pingback: my review here
  298. Pingback: news
  299. Pingback: my company

Comments are closed.