Substance-induced disorders: moving towards DSM-V and ICD-11

The development of substance abuse disorders (SUD) for DSM-V is put into perspective according to an expert meeting organized by APA and chaired by M.A. Schuckit and J.B. Saunders. Substantial compatibility with ICD-11 of WHO was expected to be achieved. A dependence syndrome, a non-dependence category as well as a subthreshold condition is supposed to be included in the SUD section in DSM-V. Categorical criteria will possibly be supplemented by dimensions conceptualized as quantitative formulations of criteria content. General and substance-specific criteria may be included for dependence. The comorbidity problem requires more research to separate substance-induced from substance-independent mental disorders in patients with SUDs. It was an open discussion, whether the aim to include biological criteria for better defining of SUDs will be achieved in DSM-V.     

On the road to DSM-V and ICD-11

Development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has been ongoing since 1994, though official release will not occur for another 4 years. Potential revisions are being derived from multiple sources, including building on perceived limitations of DSM-IV; broad-based literature reviews; secondary and primary data analyses; and discussions between global members of the mental health community. The current focus on aligning DSM with the International Classification of Diseases-11 (ICD-11) speaks to the importance of creating a unified text that embraces cross-cutting issues of diagnostics, such as developmental, age-related, and cultural phenomena. International discourse is vital to this process and has been fostered by a National Institutes of Health-sponsored conference series on diagnosis-specific topics. From this series, the DSM-V Task Force developed the following set of revision principals to guide the efforts of the DSM-V Work Groups: grounding recommendations in empirical evidence; maintaining continuity with previous editions of DSM; removing a priori limitations on the amount of changes DSM-V may incur; and maintaining DSM’s status as a living document. With work group formation complete, members are currently carrying out the research and revision recommendations proposed during the conference series. Ongoing activities include adding specialized advisors to each work group; completing literature reviews and planning data analyses; and forming study groups to discuss integration of cross-cutting issues (e.g., developmental lifespan factors; formation of diagnostic spectra). The road to DSM-V and ICD-11 has been challenging, but members continue to work diligently in their goal of constructing the most harmonious, scientifically sound, and clinically relevant DSM to date.

     

Classification of sexual dysfunctions: Towards DSM-V and ICD-11

This article reports on the changes in the classification of sexual dysfunctions since DSM-III, and on the results of the efforts to make these disorders compatible in DSM-lV and ICD-10. A comparison is made between the ways in which sexual dysfunctions are conceptualized in DSM-III, DSM-III-R, DSM-lV and ICD-10. Special attention is given to the extent to which: (1) in the diagnostic criteria due weight is given to the physiological and psychological aspects, and to the different phases of the sexual response cycle; and (2) these disorders apply to people of different sexes and sexual orientations, and to problems arising while using different sexual techniques. After publication of DSM-III, the classification of sexual dysfunctions has evolved considerably. Moreover, there are still important differences between DSM-IV and ICD-10. Suggestions for DSM-V and ICD-11 are (among others): (1) introduction of excessive (hyperactive) sexual desire in addition to diminished (hypoactive) sexual desire; (2) differentiation between genital arousal disorder and sexual excitement disorder; and (3) differentiation between orgasmic disorder, anhedonic orgasm, ejaculation disorder, and premature orgasm.     

Deconstructing bipolar disorder: a critical review of its diagnostic validity and a proposal for DSM-V and ICD-11

The development of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and International Classification of Diseases, Eleventh Edition, deserves a significant conceptual step forward. There is a clear need to improve and refine the current diagnostic criteria, but also to introduce dimensions, perhaps not as an alternative but rather as a useful complement to categorical diagnosis. Laboratory, family, and treatment response data should also be systematically included in the diagnostic assessment when available. We have critically reviewed the content, concurrent, discriminant, and predictive validity of bipolar disorder, and to overcome the validity problems of the current classifications of mental disorders, we propose a modular system which may integrate categorical and dimensional issues, laboratory data, associated nonpsychiatric medical conditions, psychological assessment, and social issues in a comprehensive and nevertheless practical approach.     

Development of DSM-V and ICD-11: Tendencies and potential of new classifications in psychiatry at the current state of knowledge

A reason for the necessity to revise ICD‐10 and DSM‐IV is the increase of knowledge in the past 20 years, especially neurobiological knowledge. But is this increase of knowledge, for example in the field of neurogenetics, of such magnitude that a revision of the psychiatric classification is necessary and promises to be fruitful? The current plans for DSM‐V or ICD‐11, respectively, focus on different improvements. In this context also the introduction of a purely syndromatic/dimensional approach without including etiopathogenetic hypotheses, is discussed. A switch to such a dimensional approach, which was discussed among others in the DSM‐V task force Deconstructing Psychosis, would be the most radical development. It could avoid many theoretical pre‐assumptions about causal hypotheses, which are still associated with ICD‐10 and DSM‐IV. This would indeed increase the validity of psychiatric classification, but it would also reduce the information as compared to traditional diagnostic categories with all the current implications concerning etiopathogenesis, therapy and prognosis. Such a dimensional approach would also mean that the syndromes would have to be assessed in a standardized way for each person seeking help from the psychiatric service system or for each person undergoing psychiatric research. This would have to be a multi‐dimensional assessment covering all syndromes existing within different psychiatric disorders. Based on the different aspects that must be considered in this context, a careful revision seems more advisable than a radical change of classification.     

Classification of functional psychoses and its implication for prognosis: comparison between ICD-10 and DSM-IV

BACKGROUND: The aim was to examine the agreement and differences between ICD-10 and DSM-IV in the classification of functional psychoses. Sampling and METHODS: In a sample of 218 first-hospitalised patients, ICD-10 diagnoses were compared with DSM-IV diagnoses. Functional psychoses of both diagnostic systems were classified into the four diagnostic groups schizophrenia, transient/episodic psychoses, delusional disorders and affective disorders. Based on information from a 15-year follow-up, it was examined which course is associated with each diagnostic group. RESULTS: Although in ICD-10 there was a higher frequency of schizophrenia and a lower one of affective disorders, a high agreement between ICD-10 and DSM-IV (kappa value of 0.82) was found. In both diagnostic systems, transient/episodic psychoses and affective disorders were mainly associated with a non-chronic course and schizophrenia was mainly associated with a chronic one. Nevertheless, several patients with transient/episodic psychoses showed a chronic course (ICD-10: 10%, DSM-IV: 15%) and more than one third of patients with schizophrenia a non-chronic one (ICD-10: 40%, DSM-IV: 33%). CONCLUSIONS: In the cross-sectional assessment, there is a high diagnostic agreement between ICD-10 and DSM-IV. With respect to the long-term course, the delimitation of transient/episodic psychoses from schizophrenia was neither completely achieved by ICD-10 nor by DSM-IV.     

A dimensional option for the diagnosis of substance dependence in DSM-V

In this paper we discuss the creation of dimensional equivalents for categorically defined substance use disorders (SUDs) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), which now is being created. We begin with a review of the considerable literature that has accumulated on the dimensional properties of the SUDs. These studies have primarily examined the alcohol use disorders, but work relevant to other substances is reviewed as well. The weight of evidence indicates that SUDs fit well into a unidimensional concept. We next discuss potential advantages, drawbacks, and challenges in developing a dimensional alternative for the SUDs and highlight some issues for an ongoing research agenda to further explore the challenges. Finally we offer a specific proposal for a SUDs dimensional option for DSM-V. The model we propose is based on, and would relate directly back to, the categorical criteria that will be created for the SUDs by the substance use diagnostic workgroup. It is our contention that offering a dimensional equivalent for the DSM-V categories would be of great value, but that the categorical and dimensional definitions should be based on the same symptoms and closely linked. A dimensional scale that does not relate directly to the categorical definition would be counterproductive.