jtotheizzoe:

The essential reference tome of the world’s psychiatrists is getting its first major update in 30 years. Due for publication in May 2013, Ferris Jabr has a great and detailed summary of the challenges, changes and history of the Diagnostic and Statistical Manual of Mental Disorders. Some highlights of the new edition:

• They’ve eliminated several diagnoses (including the controversial “childhood bipolar disorder”)
• They’ve combined several groups of related disorders (including officially grouping Asperger’s and CDD into “Autism Spectrum Disorders”) and increased the number of symptoms one must display to be diagnosed.
• They’ve added several new diagnoses, including binge eating disorder, gambling addiction, and both hypersexual and absexual disorder.
• They got rid of the Roman numerals.

Doctors and publishers have been more transparent in revising this version than in the past (posting drafts online for comment), but concerns remain. Although psychiatrists want to ensure that diagnoses are only given to those who meet certain criteria, will increased stringency prevent some high-functioning people from receiving needed treatment? How strong is the biology behind many of the criteria and distinct diagnoses? Will insurance companies and doctors continue to struggle with “gray-area” patients?

The debates surrounding the manual’s revisions are not merely back-office chatter. Although many psychiatrists do not sit down with the DSM and take its scripture literally—relying instead on personal expertise to make a diagnosis—the DSM largely determines the type of diagnoses clinicians make. Insurance companies often demand an official DSM diagnosis before they pay for medication and therapy. Many state educational and social services—such as after-school programs for kids with autism—also require a DSM diagnosis. Consequently, psychiatrists cannot dole out diagnoses of their own invention. They are bound to the disorders defined by the DSM.

SciAm will be publishing a week-long blog series about the new DSM-5. Highly recommended.

neurolove:

What is the DSM (Diagnostic and Statistical Manual of Mental Disorders)?

I mention it sometimes, but I haven’t talked about it before.  Most frequently, you will hear the DSM referred to by its current edition (DSM-IV, usu said colloquially as ‘dee es em eye vee’ instead of four for the roman numeral).  The DSM was first created in 1954 by the American Psychiatric Association (APA), and the most recent big revision for the DSM-IV was back in 1994 (though there was a text revision, ‘TR,’ in 2000).  I know several people who have been consulting for several disorders for the DSM-V (actually called DSM-five) which they are working on putting together now.

The DSM classifies psychiatric disorders.  This may seem pretty simple, but how do you really diagnose schizophrenia or drug dependence?  The DSM tells you how.  For instance, it might have a list of possible criteria and suggest that a person must meet so many of them to be diagnosed with that disorder.  It’s not perfect by any means, but it is certainly a very good guide and helps to standardize definitions of mental disorders across clinicians and researchers.

Hopefully, with more and more editions, the DSM will continue to improve.  For instance, the DSM-IV does not include hoarding as a disorder (rather, it is listed as a symptom of OCD), but I know some researchers who are fighting to get it listed as a separate disorder since it can appear in individuals who do not fit the other criteria for OCD and has separate neurological presentation (meaning it seems to involve different brain areas) and might merely have high comorbidity (meaning they occur together) with OCD.  This is still up for debate however, so I imagine we’ll have to wait until they release the DSM-V to see what the result is!

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• Abulia or aboulia: In neurology, refers to a lack of will or initiative. Thus, the patient is unable to act or make decisions independently
• Akataphasia (Kraepelin 1896): disorder of thought expression in speech and results due to dissolution of logical order of trains of thought.
  
• Alogia: refers to poverty of speech generally seen in chronic psychotic disorders such as schizophrenia and sometimes in in advanced dementia.
• Anhedonia refers to a state of mind in which the subject finds no pleasure in anything. This is characteristic in severe depressive states and schizoid personality disorder. 
  
• Anwesenheit : refers to the feeling of presence of something or some person. It can be seen in normal grief reaction, schizophrenia and some emotionally arousing situations.
  
• Cataplexy: an attack of muscular flaccidity especially in response to extreme emotional stimuli. It has to be differentiated from  syncope where consciousness is lost and heart rate goes slow.
  
• Confabulation: the confusion of imagination with memory, and/or the confusion of true memories with false memories.
• Cotard’s syndrome: nihilistic delusional syndrome in which, for example, the patient believes that he denies his own existence or existence of his body parts and belongings etc. and has a firm conviction about that. This can be seen usually in schizophrenia and severe depressive states especially in context of a bipolar disorder.
  
• Extracampine hallucinations: hallucinations beyond the possible sensory field, e.g., ‘seeing’ somebody standing behind you is a visual extracampine hallucination experience.
  
• In écho de la pensée, meaning “thought echo” in French, thoughts seem to be spoken aloud just after being produced. The patient hears the ‘echo’ of his thoughts in the form of a voice after he has made the thought.
  
• Dementia pugilistica, also called “chronic traumatic encephalopathy”, “pugilistic Parkinson’s syndrome”, “boxer’s syndrome”, and “punch-drunk syndrome”, is a neurological disorder which affects career boxers and others who receive multiple dazing blows to the head. The condition develops over a period of years, with the average time of onset being about 16 years after the start of a career in boxing.
• Folie a deux is a delusional disorder shared by two or more people who are closely related emotionally. One has real psychosis while the symptoms of psychosis are induced in the other or others due to close attachment to the one with psychosis. Separation usually results in symptomatic improvement in the one who is not psychotic.
  
• In Fregoli syndrome, the person has a delusional belief that different people are in fact a single person who changes appearance or is in disguise. The delusional person often believes that he or she is being persecuted by the person he or she believes to be in disguise.
  
• Gegenhalten is a catatonic phenomenon in which the subject opposes all passive movements with the same degree of force as applied by the examiner. It is slightly different from negativism, in which the subject does exactly the opposite to what is asked in addition to showing resistance.
  
• Idée fixe is an alternate term for an overvalued idea. In this condition, a belief that might seem reasonable both to the patient and to other people comes to dominate completely the patient’s thinking and life.
  
• In Kluver-Bucy syndrome, a patient will display placidity, hyperorality, hypersexuality, and hyperphagia. This condition results from bilateral destruction of the amygdaloid bodies of the limbic system. 
  
• In logoclonia, the patient often repeats the last syllable of a word. Symptom of Parkinson’s Disease.
  
• Moria is the condition characterized by euphoric behavior, such as frivolity and the inability to act seriously. In addition there is a lack of foresight and a general indifference.
  
• Pallilalia is characterized by the repetition of a word or phrase i.e. the subject continues to repeat a word or phrase after once having said. It is a persistent phenomenon.
  
• Palinacousis refers to a phenomenon in which the subject continues to listen to a word, a syllable or any sound, even after the withdrawal of stimulus.
  
• Reduplicative paramnesia is a delusional misidentification syndrome in which the patient’s surroundings are believed to exist in more than one physical location.
  
• The Stockholm syndrome is a psychological is a psychological response sometimes seen in a hostage, in which the hostage exhibits loyalty to the hostage-taker, in spite of the danger (or at least risk) in which the hostage has been placed. Stockholm syndrome is also sometimes discussed in reference to other situations with similar tensions.
  
• Torpor in psychopathology is usually taken to mean profound inactivity not caused by reduction in consciousness.
  
• In vorbeigehen or vorbeireden, a patient will answer a question in such a way that one can tell the patient understood the question, although the answer itself may be very obviously wrong. For example “how many legs does a dog have?” - “six”. This condition occurs in Ganser syndrome  and has been observed in prisoners awaiting trial. Vorbeigehen (giving approximate answers) was the original term used by Ganser but Vorbeireden (talking past the point) is the term generally in use (Goldin 1955). This behaviour is also seen in people trying to feign psychiatric disorders (hence association with prisoners)
  
• Wahneinfall is alternate term for autochthonous delusions. This is one of the types of primary delusions in which a firm belief comes into the patient’s mind ‘out of the blue’ or as an intuition, hence called delusional intutition.  Other types of primary delusions include delusional mood (or atmosphere), delusional (apophanous perception) and delusional memories.

• Psychopathology is a term which refers to either the study of mental illness or mental distress or to the manifestation of behaviours and experiences which may be indicative of mental illness or psychological impairment.

   

The schizophrenic brain