Last Friday, may 3rd, 2013, National
Institute of Health Mental (NIMH) of the United States announced that decide to
abandon the Diagnostic and statistical Manual of Mental Disorders (DSM), after decades of being used as the means of
diagnosis for excellence not only in the United States but at many other
countries for the treatment of the mental diseases that attack humans from
infancy to old age.
The news comes a few days before that
the Fifth version of this Manual comes to light after some changes that can be
considered minimum, especially in the subject of neurodevelopmental, among
which was the reconsideration of Asperger syndrome as part of the autism
spectrum disorders.
This news is announced with a tone of
sarcasm by different media and social networks to refer to the DSM as the Bible of Psychiatry, which was of course
used as a clinical diagnostic tool for most of the mental health disorders and
which was translated into several languages in order to unify internationally,
regardless of phenotypic aspects.
However, this does not mean that we should burn the DSM and much less that new version shouldn't be received favorably, unlike what many journalistic notes say, separation is not divorce, it is only the gate to allow further diagnostic tools for the treatment of mental illness.
However, this does not mean that we should burn the DSM and much less that new version shouldn't be received favorably, unlike what many journalistic notes say, separation is not divorce, it is only the gate to allow further diagnostic tools for the treatment of mental illness.
On the web site of the American
Psychiatric Association, it was announced very recently that at 22de may of 2013 would appear the
fifth version DMS after two years of intense reviews involving more than 13 000
thousand comments, more than 12,000 e-mails and the work of at least 13 working
groups, thus achieving unified criteria among the scientific community.
Although had been mentioned in various
clinical forums that the Manual had a tradition of reductive of sufferings, it
seemed impossible that this could change, as the length and breadth of the
planet was used as the wand able to choose not only the treatment of patients,
but its future development having medical, educational and legal inference.
One of the main problems is that
continuous attributing illness to each clinical entity based on principles that
do not necessarily occur together in time and space in the symptomatology of
the patient and that it did not allow in many cases, to carry out further
studies of contrast.
The story began in 1952 when the first
version of the Manual was published under various research that emerged after
the second world war who sought to evaluate mental health in surviving soldiers
in the fields of combat the problem and that returned home confused.
Previously, in 1949, the World Health
Organization had published the classification and statistics International of
diseases (ICD) which included a special section for the first time for mental
disorders.
Over the years the DSM had several
reviews, the second published in 1968, the third in 1980, the fourth in 1994
and the fifth waiting be published on May 22, 2013.
The reasons for which the National
Institute of Mental Health of the United States decides to put away the
Diagnostic Manual may be many, from voices that cry out that it is not possible
to classify nosologic entities from a
group of symptoms, such as disorders of autism spectrum disorders or attention
deficit, which did not allow to physicians give clear attention to patients to
the desperate claim of several researchers who watched as nationwide increased
the number of cases of autism and attention Deficit, depression and bipolar
disorders.
The truth is that neurocognitive and
physiological, genetic research have given breakthroughs and not can continue
to be ignored, so that the look will now rest on a project that has already
gone way called Research Domain Criteria (RDoC) seeking to be considered
irregular psychological component to the understanding of mental illness in
cognitive terms, as well as neural and genetic differences.
While the DSM criteria allowed the
overlaps in Diagnostics, for example it was possible to recognise a child with
Down syndrome and autism, usually granted a single diagnosis of the
classification, which would let physicians in a professional helplessness that
sometimes you should work in a despite health and conditions of the patient.
On the other hand, in the case of autistic
spectrum disorders, usually pediatrician only could treat only observable
symptoms, it doesn’t matter were they could begin as perinatal, genetic or
environmental difficulties that may occur as roots of the symptoms leaving the children and their
families under cover of drugs that were not always prescribed whereas clinical
laboratory studies.
In this sense one of the potential
benefits of the removal of the traditional psychiatric model is that it will be
possible, on the one hand analyze further disorders, whereas influential
factors, from genetic, environmental, and clinical and on the other hand, will
force mental health professionals require greater diagnostic tools.
In this context, it may be possible to
see people beyond the label which is granted, in addition to any other forms of
treatment as well as the magic pill cure it all to which traditional Psychiatry
we had used.
Neurocognitive research will finally
have application beyond than only basic research, although to all power, it
will be a great responsibility, as Spider man says, it is also true that
psychological research and neuroscience is under scrutiny because of several
works that have been considered lacking in ethics, so will just be waiting for
the benefit of patients and their families who deserve, no doubt much more respect,
including more and better health care professionals.
Meanwhile, it should not be forgotten
that the context of the United States is very different from the rest of the
countries, however, as I mentioned elsewhere, there to continue the
investigations underway and wait for the response from the international
scientific community.
References
American Psychiatry Association (2013)
DSM-5 Development. Available at: http://www.dsm5.org/Pages/Default.aspx
Drummond K (2013) Federal Institute for
mental health abandons controversial "bible" of psychiatry. Available
at: http://www.theverge.com/2013/5/3/4296626/nimh-abandons-controversial-bible-of-psychiatry
Dzib Goodin (2013) The disorder or
attention: pay attention!. Available at: http://talkingaboutneurocognitionandlearning.blogspot.com/2013/04/the-attention-deficit-disorders-or-pay.html
Dzib Goodin, A (2010) Alteraciones del desarrollo por dificultades
perinatales y la confusión con los trastornos del espectro autista. Revista de
Neuropsicología. 5 (1) 4-9.
Dzib Goodn, (2012) Austism spectrum
disorders: detection of abilities and not dis-abilities. Available at: http://talkingaboutneurocognitionandlearning.blogspot.com/2012/07/autism-spectrum-disorders-detection-of.html
Mind Hacks (2013) National Institute of
Mental Health abandoning the DSM. Available at: http://mindhacks.com/2013/05/03/national-institute-of-mental-health-abandoning-the-dsm/
Reese, H. (2013) The real problem of
psychiatry. The Atlantic. Avaliable at: http://www.theatlantic.com/health/archive/2013/05/the-real-problems-with-psychiatry/275371/
Toor, a. (2013) Controversial update to
"bible" of psychiatry fuels debate over foundations of mental health:
One book raises big questions. Avaliable at: http://www.theverge.com/2013/4/19/4243060/dsm-5-bible-of-psychiatry-mental-health-revisions-spark-boycott
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