Revised psychiatry manual targets autism, substance disorders
Psychiatrists are in the process of revising the guidelines, known as the Diagnostic and Statistical Manual of Mental Disorders. The manual has implications for how psychiatric drugs are developed and prescribed, what treatments get covered under insurance plans, which approach doctors take in treating their patients, and how patients view their own identities.
The committees do not take insurance or drug company opportunities into account when crafting revisions to the DSM, she said. But First noted that the DSM does have these implications.
"Any new disorder added provides an opportunity for a pharmaceutical company to develop a new drug," First said.
The term Asperger's has become too vague and may currently prevent some children from receiving the assistance they need at schools that offer "autism" services and don't necessarily include them.
First also takes issue with "psychosis risk syndrome," a proposed classification of the set of symptoms that sometimes precede schizophrenia.
That means "an unusual and unconventional adolescent who has a very rambling writing and speaking style, whose parents are concerned about the fact that their son is different, could qualify for this disorder," he said. This kind of diagnosis could ruin this person's life, affecting his social life and college plans, and landing him on antipsychotic medications with strong side effects.
The psychiatric association's rationale for considering psychosis risk syndrome is that psychotic illness is most effectively treated early and that intervening early may have long-lasting benefits not achievable with later therapy, the proposal said. But moving forward on putting this on the list of disorders, or in the appendix, depends on field trials.
First and Raison both lauded the association for proposing to get rid of the terms "substance abuse" and "substance dependence" and putting them under one name: addiction and related disorders, with the subheading "substance use disorders."
The new criteria will be available for public comment at DSM5.org until April 20. They will reviewed and refined over the next two years, during which time the American Psychiatric Association will conduct field trials to test some of the proposed revisions in real-world clinical settings.