The thing that jumped out at me, as a layman, is that in order for the patient to get a diagnosis changed on her medical chart she had to get the original doctor to agree to that change. It's been...
The thing that jumped out at me, as a layman, is that in order for the patient to get a diagnosis changed on her medical chart she had to get the original doctor to agree to that change. It's been decades since that diagnosis was made. How's that doctor supposed to even remember that diagnosis? It makes no sense that it would take anything other than a visit to a new doctor, or maybe two for validation, to get a change made to a diagnosis. Why is it this way?
I think visiting a doctor in this case is not exactly the same as visiting a traditional doctor (e.g. gp) because you are going to be visiting the doctor about the issue multiple times and for...
I think visiting a doctor in this case is not exactly the same as visiting a traditional doctor (e.g. gp) because you are going to be visiting the doctor about the issue multiple times and for potentially longer durations, so doctors are more likely to remember the diagnosis. Another thing is, doctors keep notes which explain why he concluded to a certain diagnosis.
Real disorders not existing in the DSM for decades is nothing new, but it does highlight the fact that the old methodology of revisions every 5-10+ years is simply not adequate in a world where...
Real disorders not existing in the DSM for decades is nothing new, but it does highlight the fact that the old methodology of revisions every 5-10+ years is simply not adequate in a world where the internet exists and global communication is a norm.
I would challenge the body behind the DSM to put out yearly, or even quarterly updates. With many previously illegal drugs finally becoming available for research use in humans, we're finding a lot of new treatments for many mental illnesses from depression to PTSD to alcoholism.
Combine that with the technological age causing higher incidences of certain mental illnesses such as ADHD and the creation of new mental illnesses like gaming addiction, and there's a strong reason to move to a more modern approach.
What's addressed in the article is a bit more complicated than just the correct diagnosis existing. My experiences with psychiatrists have been treated, having many friends who have been treated, and at one point wanting to be one (up to the point of being accepted at more than one medical school) is that psychiatrists, like most doctors, are both fallible and varied in their approach.
The reality is that some doctors want to follow what the literature tells them, and often that literature is outdated. Even among doctors who want the best for their patients, some are unwilling to keep up with modern treatments and even for those who do, only some are creative enough to adapt their treatment to best suit their patients needs.
Combine that with the difficulty there is of assigning a diagnosis to an individual when the diagnoses themselves are often too broad of categories to accurately capture the difference in both symptom and disease inside a single category. Depression, for example, manifests in a variety of ways, has even more causes, and has no universal solution. Compare and contrast this to say, influenza, and even when you're dealing with a mutating viral strain you still have a much better idea of how the symptoms will manifest and how to treat them.
Psychiatry is a unique field and the unfortunate reality is that we still understand so little about the brain that even with additional diagnoses it does not guarantee that these individuals will be getting the correct course of treatment. The quality of psychiatrists (and GPs, since they often treat depression and other 'mild' mental illnesses) and their education is much more important.
The revision schedule has far more to do with the necessary time to generate and replicate evidence than it does with communication speeds. You can't study anything in psych that quickly.
Real disorders not existing in the DSM for decades is nothing new, but it does highlight the fact that the old methodology of revisions every 5-10+ years is simply not adequate in a world where the internet exists and global communication is a norm.
The revision schedule has far more to do with the necessary time to generate and replicate evidence than it does with communication speeds. You can't study anything in psych that quickly.
While I agree that the formal diagnoses don't need to be updated every quarter I think there can be notes to indicate what's going on in the research and potential treatment options. I also think...
While I agree that the formal diagnoses don't need to be updated every quarter I think there can be notes to indicate what's going on in the research and potential treatment options. I also think highlighting trends in mental health is important, such as the increase in ADHD and autism we've seen in recent history. This can help drive discussion as well as research on said subjects and allow a faster turnaround to producing a robust clinical literature reference.
Also it's not just the time necessary to generate and replicate evidence. There are other reasons (such as political ones) that certain diseases do not show up for much longer than is warranted such as with sexual and gender identity disorders.
This also doesn't account for new variations on traditional diseases such as gaming addiction. Proving that another flavor of addiction exists does not require revising the currently existing definition, however, understanding how to treat and allowing people to diagnose so that patients can receive treatment are of utmost importance.
Isn't that precisely what trade journals and peer reviewed study publications do though? p.s. Gaming addiction Internet Gaming Disorder was added as a "Condition for Further Study" in the DSM-5 in...
I think there can be notes to indicate what's going on in the research and potential treatment options
Isn't that precisely what trade journals and peer reviewed study publications do though?
Yes, but can more outlets for highlighting this really be harmful? And we've heard nothing since. It's 2019. In my eyes this is a failure of communication.
Isn't that precisely what trade journals and peer reviewed study publications do though?
Yes, but can more outlets for highlighting this really be harmful?
Gaming addiction was added as a "Condition for Further Study" in the DSM-5 in 2015
And we've heard nothing since. It's 2019. In my eyes this is a failure of communication.
p.s. I largely agree with you that more can/should be done... but I just think focusing your criticism so narrowly on the DSM is not really all that productive. The DSM generally requires rigorous study before inclusion and overall consensus on treatment to be achieved before they add anything to it, and in my experience very few psychiatrists (at least worth their salt) rely solely on it. My own psychiatrist keeps me apprised of most new breakthroughs and studies regarding my own condition (panic disorder) that she comes across in the various trade journals and publications she subscribes to.
The DSM is a not designed to report on that stuff, it's a Diagnostic and Statistical Manual. Whereas trade journals and peer reviewed study publications are... and do.
The DSM is a not designed to report on that stuff, it's a Diagnostic and Statistical Manual. Whereas trade journals and peer reviewed study publications are... and do.
in the long term, no, but in the short term i think trying to prioritize being the most up to date possible on the research as you describe is probably going to lead to a lot of false positives...
Yes, but can more outlets for highlighting this really be harmful?
in the long term, no, but in the short term i think trying to prioritize being the most up to date possible on the research as you describe is probably going to lead to a lot of false positives and dead ends of research that turn out to be somewhat unhelpful or actively harmful. hell, a lot of treatments we currently use for mental illnesses still undergo a lot of scrutiny because it's hard to know how well they work (especially the newer ones)--and a lot of them have had years or decades of research go into them.
Knee-jerk updates to something like this is not the answer. You could have 20 studies published in short succession and not one of them has had the chance to be replicated (and thus effectively...
Knee-jerk updates to something like this is not the answer. You could have 20 studies published in short succession and not one of them has had the chance to be replicated (and thus effectively challenged). The fact you haven't seen Internet Gaming Addiction get more added to it is more likely an indication of the complexity of the answers than some lack of will to answer it quickly.
The thing that jumped out at me, as a layman, is that in order for the patient to get a diagnosis changed on her medical chart she had to get the original doctor to agree to that change. It's been decades since that diagnosis was made. How's that doctor supposed to even remember that diagnosis? It makes no sense that it would take anything other than a visit to a new doctor, or maybe two for validation, to get a change made to a diagnosis. Why is it this way?
I think visiting a doctor in this case is not exactly the same as visiting a traditional doctor (e.g. gp) because you are going to be visiting the doctor about the issue multiple times and for potentially longer durations, so doctors are more likely to remember the diagnosis. Another thing is, doctors keep notes which explain why he concluded to a certain diagnosis.
Real disorders not existing in the DSM for decades is nothing new, but it does highlight the fact that the old methodology of revisions every 5-10+ years is simply not adequate in a world where the internet exists and global communication is a norm.
I would challenge the body behind the DSM to put out yearly, or even quarterly updates. With many previously illegal drugs finally becoming available for research use in humans, we're finding a lot of new treatments for many mental illnesses from depression to PTSD to alcoholism.
Combine that with the technological age causing higher incidences of certain mental illnesses such as ADHD and the creation of new mental illnesses like gaming addiction, and there's a strong reason to move to a more modern approach.
What's addressed in the article is a bit more complicated than just the correct diagnosis existing. My experiences with psychiatrists have been treated, having many friends who have been treated, and at one point wanting to be one (up to the point of being accepted at more than one medical school) is that psychiatrists, like most doctors, are both fallible and varied in their approach.
The reality is that some doctors want to follow what the literature tells them, and often that literature is outdated. Even among doctors who want the best for their patients, some are unwilling to keep up with modern treatments and even for those who do, only some are creative enough to adapt their treatment to best suit their patients needs.
Combine that with the difficulty there is of assigning a diagnosis to an individual when the diagnoses themselves are often too broad of categories to accurately capture the difference in both symptom and disease inside a single category. Depression, for example, manifests in a variety of ways, has even more causes, and has no universal solution. Compare and contrast this to say, influenza, and even when you're dealing with a mutating viral strain you still have a much better idea of how the symptoms will manifest and how to treat them.
Psychiatry is a unique field and the unfortunate reality is that we still understand so little about the brain that even with additional diagnoses it does not guarantee that these individuals will be getting the correct course of treatment. The quality of psychiatrists (and GPs, since they often treat depression and other 'mild' mental illnesses) and their education is much more important.
The revision schedule has far more to do with the necessary time to generate and replicate evidence than it does with communication speeds. You can't study anything in psych that quickly.
While I agree that the formal diagnoses don't need to be updated every quarter I think there can be notes to indicate what's going on in the research and potential treatment options. I also think highlighting trends in mental health is important, such as the increase in ADHD and autism we've seen in recent history. This can help drive discussion as well as research on said subjects and allow a faster turnaround to producing a robust clinical literature reference.
Also it's not just the time necessary to generate and replicate evidence. There are other reasons (such as political ones) that certain diseases do not show up for much longer than is warranted such as with sexual and gender identity disorders.
This also doesn't account for new variations on traditional diseases such as gaming addiction. Proving that another flavor of addiction exists does not require revising the currently existing definition, however, understanding how to treat and allowing people to diagnose so that patients can receive treatment are of utmost importance.
Isn't that precisely what trade journals and peer reviewed study publications do though?
p.s.
Gaming addictionInternet Gaming Disorder was added as a "Condition for Further Study" in the DSM-5 in 2015... which BTW is a classification designed to do pretty much exactly what you're asking for (i.e. drive discussion as well as research on said subjects). See:https://dsm.psychiatryonline.org/doi/10.5555/appi.books.9780890425596.ConditionsforFurtherStudy
Yes, but can more outlets for highlighting this really be harmful?
And we've heard nothing since. It's 2019. In my eyes this is a failure of communication.
You having heard nothing does not mean nothing has been happening.
https://scholar.google.ca/scholar?hl=en&as_sdt=0%2C5&as_ylo=2015&as_yhi=2019&as_vis=1&q=internet+gaming+disorder%7Caddiction&btnG=
p.s. I largely agree with you that more can/should be done... but I just think focusing your criticism so narrowly on the DSM is not really all that productive. The DSM generally requires rigorous study before inclusion and overall consensus on treatment to be achieved before they add anything to it, and in my experience very few psychiatrists (at least worth their salt) rely solely on it. My own psychiatrist keeps me apprised of most new breakthroughs and studies regarding my own condition (panic disorder) that she comes across in the various trade journals and publications she subscribes to.
I'm not saying nothing is happening, I'm saying the DSM isn't reporting on it and I think they should be.
The DSM is a not designed to report on that stuff, it's a Diagnostic and Statistical Manual. Whereas trade journals and peer reviewed study publications are... and do.
in the long term, no, but in the short term i think trying to prioritize being the most up to date possible on the research as you describe is probably going to lead to a lot of false positives and dead ends of research that turn out to be somewhat unhelpful or actively harmful. hell, a lot of treatments we currently use for mental illnesses still undergo a lot of scrutiny because it's hard to know how well they work (especially the newer ones)--and a lot of them have had years or decades of research go into them.
Knee-jerk updates to something like this is not the answer. You could have 20 studies published in short succession and not one of them has had the chance to be replicated (and thus effectively challenged). The fact you haven't seen Internet Gaming Addiction get more added to it is more likely an indication of the complexity of the answers than some lack of will to answer it quickly.
I'm not saying that the updates should be knee-jerk, just that they are too few and too far between.
And I'm saying that more and faster would only be knee-jerk.