DSM-5 Released Today

By Ryan Jaslow & Michelle Castillo

Controversial update to psychiatry manual, DSM-5, arrivesThe controversial revision to psychiatrists’ “bible” of diagnostic criteria has finally arrived. The American Psychiatric Association released its fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or dubbed simply as the “DSM-5.”

The manual’s release was coincided with the APA’s annual meeting that kicked off May 18 in San Francisco.

The first major revision to the manual in almost two decades, the new DSM has been met by controversy since reports of proposed changes started to crop up last March.

Doctors often utilize the DSM to diagnose mental health disorders in patients that meet a specific set of criteria.

Among the major changes that garnered the most controversy was dropping Asperger’s syndrome, child disintegrative disorder and pervasive developmental disorder not otherwise specified (PDD), and included them under the blanket diagnosis of autism spectrum disorder.

Revisions were also made to diagnostic criteria for mental health disorders including schizophrenia, bipolar disorder, dissociative identity disorder and depressive disorders.

For example, in the last version of the manual, the 1994 DSM-IV, there was was an exclusion criterion for a major depressive episode that was applied to people with symptoms of depression lasting less than 2 months following the death of a loved one. The DSM-5 removed this after the APA realized since the last version that grief can last up to two years, and bereavement can be a severe psychological stressor that triggers depression, rather than an exception.

Besides worrying some mental health advocates over concerns changes in their diagnosis would affect their abilities to get treatment for state funding, the manual’s release also pitted the government’s National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA),

NIMH director Thomas Insel wrote in a statement in early May that the NIMH felt the proposed definitions for psychiatric disorders were too broad and ignore smaller disorders that were lumped in with a larger diagnosis.

“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,” he wrote.

The government agency said it would use a different classification system, the Research Domain Criteria (RDoC) project, instead for its studies.

The NIH and APA released a joint statement on May 13, saying that “patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care.” But, the statement also said, “The National Institute of Mental Health (NIMH) has not changed its position on DSM-5.”

A petition was also started by doctors to protest the new DSM.

One vocal critic, Dr. Allen Frances, who co-authored the DSM-IV, told CBS This Morning on Thursday that we are over-treating people in this country who are “basically well” and are “shamefully neglecting” people with mental disorders who are really sick, including one million people in prison with psychiatric disorders. The new manual, he said, is too loose for its diagnoses.

He said the average diagnosis is being given by a primary care doctor in a seven minute visit.

“People who are basically normal are getting all kinds of medicine that they don’t need that makes them worse and it is a terrible drain on the economy,” Frances said.

“I’m very curious to see what happens because as you know there’s kind of this tension between the DSM and some of the new NIMH initiatives,” Dr. James Murrough, an assistant professor of psychiatry and neuroscience at Mount Sinai Hospital in New York City, told CBSNews.com Murrough was not involved in the new DSM, but will be presenting research at the APA meeting this weekend.

He said by now, some psychiatrists had hoped the new DSM would contain more information about scientific tests or scans for psychologists or psychiatrists to help aid their diagnoses. But, he added the new version doesn’t appear to look very different from the last one.

“I think everyone is kind of disappointed that we don’t have that yet,” he said.

More information about the DSM-5 can be found on the APA’s website.

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How Positive Parenting During Early Childhood May Prevent Obesity

By Stone Hearth News

How positive parenting during early childhood may prevent obesityPrograms that support parents during their child’s early years hold promise for obesity prevention, according to a new study in the online February 6 issue of Pediatrics.

Today, one out of five American children is obese. Young children who are overweight are five times more likely than their peers of normal weight to be obese by adolescence. Obese children and adolescents, especially low-income and minority youth, are at increased risk for a range of medical, social and academic problems.

The new study led by Laurie Miller Brotman, PhD, professor of Child and Adolescent Psychiatry and Director of the Center for Early Childhood Health and Development at the NYU Child Study Center investigated whether early family intervention that was effective for parents of children with behavior problems, resulted in lower rates of obesity. This innovative study took advantage of two long-term follow up studies of high-risk children who had participated in evaluations of either ParentCorps or another effective parenting intervention, the “Incredible Years,” during early childhood. The study involved 186 children from low-income, minority families at high risk for obesity who were randomly assigned to family intervention or a control group when the children were approximately four years old. Behavioral family intervention in early childhood included a series of weekly 2-hour parent and child groups over a 6-month period. The interventions did not address nutrition, activity, or weight.

“Children who enter school with behavior problems are at very high risk for academic underachievement and school dropout, antisocial behavior, delinquency, obesity and other health problems. ParentCorps engages parents of high-risk children, reduces harsh and ineffective parenting and prevents early behavior problems from escalating into more serious and intractable problems,” said Dr. Brotman.

For more than a decade, Dr. Brotman and her colleagues have developed and evaluated programs for parents and young children living in urban poverty. ParentCorps, a culturally-informed family program for young children, helps parents to be more responsive and nurturing as well as more effective in their approach to discipline. ParentCorps graduates are more attentive and attuned to their children, spend more time playing and reading with their children and praise positive behaviors such as sharing with peers. After participating in ParentCorps groups, parents replace physical punishment with more effective strategies such as time out. ParentCorps has benefits for ethnically and socioeconomically diverse families, and is especially helpful for parents of children with behavior problems.

In both follow-up studies, children who were assigned to the intervention and children in the control condition were evaluated from three to five years later. The evaluation of children as they approached adolescence included examination of body mass index, sedentary activity and physical activity. In one of the studies, blood pressure and nutritional intake were also measured.

Children who received family intervention during early childhood had significantly lower rates of obesity compared to children in the control group. In the larger study, without intervention, more than half of the children with early behavior problems were obese by second grade. In contrast, among children with behavior problems who received ParentCorps in early childhood, only 24% were obese. Similarly positive effects were found across the two studies on sedentary behavior and physical activity. The one study that examined blood pressure and diet showed lower rates of blood pressure and relatively lower consumption of carbohydrates in adolescents who received early childhood intervention.

ParentCorps and other programs that promote effective parenting and prevent behavior problems at a young age may contribute to a reduction of obesity among low-income, minority youth.

Dr. Brotman’s co-authors include Spring Dawson-McClure, PhD, Keng-Yen Huang, PhD, Rachelle Theise, PsyD, Dimitra Kamboukos, PhD, Jing Wang, MA, Eva Petkova, PhD, of the Department of Child and Adolescent Psychiatry and Gbenga Ogedegbe, MD, of the Department of Medicine, Division of General Internal Medicine, NYU School of Medicine.

This study of health outcomes was supported by the J. Ira and Nicki Harris Family Foundation. The original randomized controlled trials were supported by grants from the National Institute of Mental Health and the Institute for Education Sciences to Dr. Brotman.

Source: http://www.stonehearthnewsletters.com/how-positive-parenting-during-early-childhood-may-prevent-obesity/updates/

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Mental Health Medications – Free Guide

Free resource from the National Institute of Mental Health.

This guide describes the types of medications used to treat mental disorders, side effects of medications, directions for taking medications, and includes any FDA warnings.


Guide to Mental Health Medications

Related CEU Course:
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Depression CEUs for Mental Health Professionals

depression continuing education courses for mental health professionalsDepression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.

True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer.

Usually the most effective treatment for depression is a combination of medication and psychotherapy.

For this reason, mental health professionals need to stay current on clinical advances in the treatment of depression. Professional Development Resources offers the following continuing education courses for that very purpose:

Depressive Disorders – Overview – This 1-hour online course reviews the different types of depressive disorders including major depression, dysthymia, and mania. The etiology, assessment, and treatment of depressive disorders in both children and adults are discussed. National Institute of Mental Health | 2001 | 11 pages | 10 posttest questions | Course #10-15

Depression: What You Must Know – This 2-hour online course provides in depth information about the diagnosis and treatment of depression in a simple, straightforward way. Major Depression is a very common illness that can be life threatening, yet the majority of sufferers of this illness never get proper treatment. This is despite the fact that there are many different and varied treatments currently available. Dr’s Kuna and Nelson-Kuna will share with you published information combined with their joint 36 years of experience to give you their honest opinion on what is likely hype and what has been proven to work. KunaLand Productions, Inc | 2009 | 22 pages | 25 posttest questions | Course #20-25


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Suicide Prevention and Research

NIMH researcher Dr. Jane Pearson talks about warning signs as well as progress in suicide prevention.

NIMH researcher Dr. Jane Pearson talks about warning signs as well as progress in suicide prevention.

Click to watch video


Dr. Jane Pearson: Suicide is a major public health problem in this country. And like other external causes of death — accidents, homicides — suicides are also considered external causes of death. And because of that, we think we have opportunities to prevent it.

Announcer: Dr. Jane Pearson is a leader of the suicide prevention research team at the National Institute of Mental Health in Bethesda. The tragedy of suicide touches large numbers of American families every year. But people across the globe now benefit from advances in suicide prevention research and guidelines that emerged from national and global strategies formed a decade ago. An example of specific action steps that have been developed can be found in medical emergency rooms.

Dr. Jane Pearson: We can do better for people who actually come to the emergency department saying they’re suicidal. We felt like we could find better ways of helping those people how to better screen, access them, treat them. I think some other areas we’ve made significant progress is in understanding what treatments seem to work at least for people who have attempted suicide. We’ve got some interventions, some psycho-social counseling for psychotherapy that look particularly effective. And a number of these use cognitive behavioral approaches that directly address people’s thinking about suicide. It’s really important in suicide prevention that we think of continuity of care when people’s care changes as they leave the hospital going back into the community. We know that’s a very high risk time. So we need to think about what would provide more continuous care — more support for both the individual and maybe their family members to help them stay well and to start getting the treatment that they need.

Announcer: An alliance of people and organizations, including researchers at NIMH, has uncovered critical pieces of information that include those individuals who may be at higher risk for suicide. Included are people with known mental disorders such as schizophrenia or bipolar. People with alcohol or drug problems may have higher risks along with those who suffer from chronic illness. A family history of suicide could serve as a warning as well as people who have been physically abused or neglected….

Dr. Jane Pearson: The highest risk groups are people — are older men, white men in particular who are 85 and older who have a rate of suicide that’s four times the national average. American Indian and Alaskan native males also have very high risks.

Announcer: There are many things we as individuals can do to look for warning signs but perhaps the best advice for loved ones and friends — don’t dismiss or minimize threats of suicide.

Dr. Jane Pearson: If somebody’s talking about suicide you really should take it seriously. There may be parents or even providers who say — oh, somebody just wants to get some attention. Well, they probably need to get some attention for a reason. It’s worth following through. It might be that we don’t know for sure if somebody really intends to or not. And the individual might not be certain either, but we certainly want to give them some help.

Announcer: Dr. Pearson’s work and wide-ranging NIMH-funded research have helped shed new light on suicide treatment and prevention.

Dr. Jane Pearson: We’re trying to pull together what we can learn from surveillance data to find the highest risk groups and really get them the interventions they need. And there are people across NIMH helping with this, across federal agencies. And I think there’s a lot of momentum, and I think we’ve got some good reason to hope that we can actually change these numbers.

Source: National Institute of Mental Health: http://www.nimh.nih.gov/media/video/suicide-prevention-and-research.shtml

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