Wednesday, 10 February 2010

First Thoughts on DSM-V

Well, like everyone else it seems, I just had to go and see which way the wind was blowing, and what a faff and compromise it appears to be.

Here's my uncouth summary, with esp relevance to manic-depression through to schizophrenia.

Clinicians want categories retained for simplicity's sake, although state they find dimensional scoring more useful. Therefore we now have CATEGORIES! AND!!!! DIMENSIONS!!!!

Everything with a hint of psychosis appears to have been shifted onto the schizophrenia side of things (hinting at a psychotic-affective axis in the works (or maybe two axes) in the distant future - say DSM-VI). And the dimensional table (see below, for schizophrenia now includes mania and depression. I am imagining the reason for this is to improve the data for statistical analysis at this point, assuming that manicdep and schizophrenia are two outposts of the same continuum.

If it hasn't been openly admitted that Kraepelin has died, people are ostentatiously starting to sniff the air, while wrinkling their noses and their brows.

Downsides - on paper, it looks easier to get labelled with schizophrenia than before. I'll be keeping even more quiet about 'florid' symptoms to the shrinks than I already am. Also, clinicians hardly pay attention to the detail of symptoms in the current system as it is. I can't see them looking beyond the end of their god-given-biros to inspect the 'patients' more closely. Also, there is still the ridiculous set up where you can't have manic depression if it's more easily accounted for by schizophrenia, and VICE VERSA! And they are merging schizo-affective with schizophrenia, by the sound of it.

In summa: they are merging the main traits of illness, ostensibly for improved research purposes, and under the umbrella of schizophrenia. However, they are still keeping most of the separate categories separate for now.

Oh yes, mixed state has become now, mania with mixed features, or depression with mixed features. Which makes sense.

Enough for now, take care all. Just remember it's all a steaming pile of bollocks! Dx

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Severity ratings for different dimensions (2 is enough to be diagnosed): (scroll down, and down, and down and down and down and you'll find it. Don't ask me why c&p the code didn't work. I blame the DSM.

Link: here.






Seriously, scroll down, or click here.






Keep going, or click here.






Are we there yet?!! or click here.






Wanna go pee-pee!!! or click here.






Can you see the sea yet, kids? (cue interminable a sailor went to etc), or click here.






We're lost, aren't we? (cue generalised temper-tantrums all round, stoppings of the car, roaring and suddenly... the scent of ozone on the air...) or click here.







































































Hallucinations


Delusions


Disorganization


Abnormal Psychomotor Behavior


Restricted Emotional Expression


Avolition


Impaired Cognition


Depression


Mania


0


Not Present


Not Present


Not Present


Not Present


Not Present


Not Present


Not Present


Not Present


Not Present


1


Equivocal (severity or duration not sufficient to be considered psychosis)


Equivocal (severity or duration not sufficient to be considered psychosis)


Equivocal (severity or duration not sufficient to be considered disorganization)


Equivocal (severity or duration not sufficient to be considered abnormal psychomotor behavior)


Equivocal decrease in facial expressivity, prosody, or gestures


Equivocal decrease in self-initiated behavior


Equivocal (cognitive function not clearly outside the range expected for age or SES, i.e., within 1 SD of mean)


Equivocal (some depressed mood, but insufficient symptoms, duration or severity to meet diagnostic criteria)


Equivocal (some inflated or irritable mood, but insufficient symptoms, duration, or severity to meet diagnostic criteria)


2


Present, but mild (little pressure to act upon voices, not very bothered by voices)



Present, but mild (delusions are not bizarre, or little pressure to act upon delusional beliefs, not very bothered by beliefs)


Present, but mild (some difficulty following speech and/or occasional bizarre behavior)


Present, but mild (occasional abnormal motor behavior)


Present, but mild decrease in facial expressivity, prosody, or gestures


Present, but mild in self-initiated behavior


Present, but mild (some reduction in cognitive function below expected for age and SES, b/w 1 and 2 SD from mean)


Present, but mild (meets criteria for Major Depression, with minimum number of symptoms, duration, and severity)


Present, but mild (meets criteria for Mania with minimum number of symptoms, duration, and severity)


3


Present and moderate (some pressure to respond to voices, or is somewhat bothered by voices)


Present and moderate (some pressure to act upon beliefs, or is somewhat bothered by beliefs)



Present and moderate (speech often difficult to follow and/or frequent bizarre behavior)


Present and moderate (frequent abnormal motor behavior)


Present and moderate decrease in facial expressivity, prosody, or gestures


Present and moderate in self-initiated behavior


Present and moderate (clear reduction in cognitive function below expected for age and SES, b/w 2 and 3 SD from mean)


Present and moderate (meets criteria for Major Depression with somewhat more than the minimum number of symptoms, duration, and/or severity


Present and moderate (meets criteria for Mania with somewhat more than the minimum number of symptoms duration, and/or severity)


4


Present and severe (severe pressure to respond to voices, or is very bothered by voices)



Present and severe (severe pressure to act upon beliefs, or is very bothered by beliefs)


Present and severe (speech almost impossible to follow and/or behavior almost always bizarre)


Present and severe (abnormal motor behavior almost constant)


Present and severe decrease in facial expressivity, prosody, or gestures


Present and severe in self-initiated behavior


Present and severe (severe reduction in cognitive function below expected for age and SES, > 3SD from mean)


Present and severe (meets criteria for Major Depression with many more than the minimum number of symptoms and/or severity)


Present and severe (meets criteria for Mania with many more than the minimum umber of symptoms and/or severity)

8 comments:

Pandora said...

I found myself nodding through this post. I haven't read an awful lot of it, but a cursory look through the areas pertinent to me brought a mixture of subtle encouragement and abject disgust. I think in terms of serious psychopathology, they want to reflect the 'real world' diagnoses; on the other hand, it seems worryingly like they want to pathologise everything.

I'm not normally an advocate of burning books, but...

eccedentesiat said...

A quote I have on my wall:

"Each one of us is something of a shizophrenic personality, tragically divided against ourselves"...

Maybe that's the new reasoning.

It's just like Kraft taking over the Cadburys and other foody things. It's all Kraft now. It's either Kraft or nothing. Mad or sane.

I ramble at midnight, apologies. You get my drift right? I'm not making total nonsense am I? x

eccedentesiat said...

schizophrenic* I shouldn't type with my eyes closed

David said...

* ha ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha a ha ha ha ha ha

ha

David said...

Thanks both.

I can see the sense in what they are proposing - but they are puffed-up proud men who cannot bear to admit they are wrong, so they are doing it via the back alley, and perhaps disguising it with the contentious new paradigm: all psychosis=schizophrenic-spectrum, instead of something that would be more useful to people with schizophrenia, which would be placing them with the manic-depressives on a single psychotic spectrum. - Which is, what they have per se, under the covers, in the dark, murked by fog, actually put the foundations in for. They are just going sloooooooooooooooooow.

Strange, how people can mean well* (in terms of sneaking the better science in) but still make a fucking hames out of the whole thing.

Dx

p.s. I saw Differently searching for Normal Personality Disorder earlier... I wondered if diagnosticians only ever see NPD (both sorts, of course) when they look in their mirrors while shaving.

p.p.s. Ecce: I enjoyed the misspellings! More late night misspellings please! :-) (signed, a surreal man)

Differently Sane said...

I've also noted that they've now accepted the possibility of hypomania and depressive features. They're finally admitting that us "mere mortals" that have the audacity not to become completely manic, can still be blighted by the "mixed yuckiness".

Still upset they've deleted Criteria D from AN though. I can no longer sing me "you're wrong, you're wrong" song when people give me the accusatory stare...

Still amuses me though, after all it was there insistence that 'D' was one of the first signs of things going wrong - guess real life kicked 'em in the nuts on that one.

Anyway forewarned is forearmed as they say, now I'm going to go and ensure I have one symptom from every 'box' (symptom cluster/disorder/thingey), and not enough from any of them for me to actually be labelled... ;-)

Take care,
Differently

PS I have normal disorder. I must do. I feel perfectly normal. Therefore there must be something wrong with me, right?

David said...

Hi Diff - just left a rambling, facts and figures sort of reply on your last. Doubt it helps, but I tried...

Interesting what you say about hypos and depression and mixed states - in my area they stick to ICD - so here one can technically be bpii in psychosis and mixed state - but they always bloody qualify things with the damned DSM for their own peace of mind if one asks questions (or indeed, pays a compliment to their much more flexible system)... They have put me in my place, and I don't want to be put any further in my place, thank you very much, no sirreee Mr Sigh Crier Tryst.

Hope you're ok, would be good to catch up, take care Dx

Mossy Mom said...

More people with sz=more people who can be drugged. It's all about selling drugz. DSM and the USA are owned by drug companies.