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Latest Edition of Psychiatry’s ‘Bible’ Launched Amid Controversy
Authors say it defines disorders more concisely; critics say it will lead to over-diagnosis and unnecessary treatments
WebMD News from HealthDay
By Dennis Thompson
HealthDay Reporter
FRIDAY, May 17 (HealthDay News) — As the American Psychiatric Association unveils the latest edition of what is considered the “bible” of modern psychiatry this weekend, the uproar over its many changes continues.
“This is unprecedented, the amount of commentary and debate and criticism,” said Dr. Jeffrey Lieberman, president-elect of the American Psychiatric Association (APA). “It’s been an interesting phenomenon, but the evidence is what it is. You have to evaluate it and then make your own determination of how compelling it is, and what would be best clinical practice.”
The APA believes that changes made in this fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will allow for more precise diagnoses of mental illnesses in patients, because this edition better characterizes and categorizes disorders.
But it has drawn fire from critics who are concerned that the revised version will lead to the diagnosis of mental illness in people who are simply being challenged by life.
More than 1,500 experts from 39 countries representing a wide variety of medical fields contributed to the new DSM-5, which was more than a decade in the making. Drafts of the manual were made available online as part of three open-comment periods that drew more than 13,000 responses.
One of the most notable naysayers has been Dr. Allen Frances, chairman of the task force that created the DSM-4, the previous version of the guide that has been in use since 1994.
In a commentary released the day of the DSM-5′s release, Frances wrote that this latest revision introduces “several high-prevalence diagnoses at the fuzzy boundary with normality,” and predicted that the changes “will probably lead to substantial false-positive rates and unnecessary treatment.”
“In DSM-5, normal grief becomes a major depressive disorder, temper tantrums become disruptive mood dysregulation disorder, worrying about medical illness becomes somatic symptom disorder, gluttony becomes binge eating disorder and almost everyone will soon qualify for attention-deficit disorder,” Frances said in an interview.
The main points of contention regarding the DSM-5 include:
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The combination of a number of autism-related disorders into a single category called autism spectrum disorder. Although some clinicians believe that placing autism on a continuum from mild to severe will allow for more accurate diagnoses, others are concerned that high-functioning people with autism will find themselves unable to receive services or treatment. This is particularly true of people with Asperger’s Syndrome, a diagnosis that has been eliminated from the DSM-5, critics of the new version contend.
“We’re concerned that people who have Asperger’s — who have high-functioning autism — are going to be dismissed as just being different when the majority of adults with Asperger’s will need people to assist them in parts of their lives,” said Karen Rodman, president and founder of Families of Adults Affected With Asperger’s Syndrome.
“We are very concerned that medicine is going to drop the ball again, and the children who need services won’t get them,” Rodman said. “Fortunately, clinicians and physicians and the public around the world are still going to refer to Asperger’s as Asperger’s. It’s like saying people don’t have a right arm anymore.
“Many people with Asperger’s are [also] concerned there will be a stigma — that everyone will be considered autistic — and when people think of that they think of a child sitting in a corner and spinning,” Rodman added.
- Changes made to the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD). Critics are concerned that changes made to better diagnose ADHD will instead lead to over-diagnosis. In the previous version of the DSM, a person needed to show the onset of symptoms before age 7 to be diagnosed with ADHD. The new version now says 12 is the latest age at which ADHD symptoms can manifest themselves. The DSM-5 also reduces the number of criteria needed to arrive at a diagnoses of adult ADHD from six to five.
- A new diagnostic category for children who are hostile or acting out. The DSM-5 includes a new category called disruptive mood dysregulation disorder, which would apply to children who have extreme irritability but fall short of the standards for bipolar disorder or depression. The category was created to deal with the upswing in bipolar diagnoses among children, but there is concern that some clinicians will label a simple childhood temper tantrum as a treatable mental illness.
- Breaking out obsessive-compulsive disorders into their own category. Obsessions such as hoarding, hair-pulling and skin-picking had been considered anxiety disorders, but in the DSM-5 they will have their own category. Critics are concerned that this change has more to do with reality television’s recent focus on hoarders than with the need for a new category of mental illness.
Liam Neeson Latest Voice Star for ‘Nut Job’
Oscar-nominated and three-time Golden Globe-winning actor Liam Neeson is joining the list of stars lending their voices to The Nut Job, a new animated comedy feature from ToonBox Entertainment (Canada) and Redrover Co., Ltd. (Korea). The voice cast already includes Katherine Heigl, Will Arnett, Brendan Fraser, Stephen Lang, Sarah Gadon and comedian Jeff Dunham. The film is currently in production with plans for a 2013 release.
Directed by former Disney animator Peter Lepeniotis from a script by fellow Disney alum Lorne Cameron, the film is based on Lepionitis 2005 short Surly Squirrel and is an action-packed comedy set in the fictional 1950s town of Oakton which follows the travails of Surly, a mischievous squirrel, and his rat friend Buddy. The two plan a nut store heist of outrageous proportions and unwittingly find themselves embroiled in a much more complicated adventure that brings them face-to-face with unsavory characters like the villainous Raccoon to be played by Neeson.
This is the first feature ToonBox is producing with Redrover, in association with Gulfstream Pictures (U.S. sales). Thom Chapman and Graham Moloy produce. Daniel Woo, Hong Kim, Mike Karz and Tom Yoon exec produce, in association with Gulfstream, headed by Karz and Bill Bindley. Neeson recently starred in Taken 2 and will also be providing a voice for the upcoming animated film LEGO: The Piece of Resistance.
The Nut Job
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Python bounty hunters are latest tool in Florida eradication effort
TALLAHASSEE, Florida |
TALLAHASSEE, Florida (Reuters) – Florida wildlife officials are looking for a few good snake slayers as they enlist the public to combat a proliferation of pythons that have invaded the Florida Everglades.
Combating a surge of pets turned predators, state officials have placed a bounty on the Burmese python in an attempt to eradicate the species from the environmentally sensitive marshy region known as the River of Grass.
The latest attempt will enlist the help of professional python hunters and weekend enthusiasts, who will compete beginning January 12 for the cash in what has been dubbed the “2013 Python Challenge.”
The goal of the month-long event is to reduce the number of non-native reptiles that are gobbling up indigenous wildlife at an increasing rate. Winners will receive up to $ 1,500 for the longest snake, while $ 1,000 will be awarded to the serpent killer who brings in the largest haul.
“Part of the goal of the Python Challenge is to educate the public to understand why non-native species like Burmese pythons should never be released into the wild and encourage people to report sightings of exotic species,” said Kristen Sommers, head of exotic species programs for the Florida Fish and Wildlife Conservation Commission.
Burmese pythons became established in 2000 in the state, which has one of the world’s worst invasive reptile and amphibian problems. The problem is believed to have been caused by pet owners who released their snakes into the wild after they grew too large and became too difficult to manage at home.
Federal wildlife officials in January banned the importation of certain species of python, but snakes already released into the wild are wrecking havoc as they have no natural predators.
A Burmese python found in August set a record as the largest such snake ever captured in the state at 17-feet, 7-inches and carrying a record load of 87 eggs, according to researchers at the University of Florida.
The federal ban affects four species – the Burmese python, the yellow anaconda and the northern and southern African pythons.
The challenge is being supported by several environmental groups.
“They are wiping out entire populations of wildlife in portions of the Everglades,” said Eric Draper, executive director of Audubon Florida. “Having a hunting season is a start, but wildlife officials need to be doing a lot more.”
Among other efforts are catch and release programs that track pythons via radio collar and GPS to find out where they breed. “It’s only a matter of time before they move from the Everglades into areas farther north,” Draper said.
The hunt is unlikely to stem the reptile invasion, but may help scientists learn more about python migration, said Kristina Serbesoff-King, a director of the Nature Conservancy in Florida.
“From a science point, it’s data gathering, it’s more information,” she said. “But in terms of addressing the expanding population of Burmese pythons, it’s not going to solve that problem.”
(Additional reporting by Kevin Gray; Editing by David Adams and Todd Eastham)
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Latest West Nile Tally: 5,245 Cases, 236 Deaths
WEDNESDAY Nov. 28, 2012 — The West Nile virus outbreak has now reached 5,245 cases, including 236 deaths, U.S. health officials reported Wednesday.
As of Tuesday, 48 states plus the District of Columbia had reported West Nile infections in people, birds or mosquitoes. Of the cases involving people, 51 percent were classified as neuroinvasive disease (such as meningitis or encephalitis) and 49 percent were classified as non-neuroinvasive disease.
The bulk of reported cases are from 11 states — California, Illinois, Louisiana, Michigan, Mississippi, Nebraska, New York, Ohio, Oklahoma, South Dakota and Texas. The highest number of reported cases in any one state is in Texas (1,714 cases, 76 deaths), according to the U.S. Centers for Disease Control and Prevention.
The best way to avoid the mosquito-borne virus is to wear insect repellent and support local programs to eradicate mosquitoes. There is no treatment for West Nile virus and no vaccine to prevent it, according to the CDC.
Typically, 80 percent of people infected with the virus develop no or few symptoms, while 20 percent develop mild symptoms such as headache, joint pain, fever, skin rash and swollen lymph glands, according to the CDC.
Although most people with mild cases of West Nile virus will recover on their own, the CDC recommends that anyone who develops symptoms see their doctor right away.
People older than 50 and those with certain medical conditions, such as cancer, diabetes, hypertension, kidney disease and organ transplants, are at greater risk for serious illness.
The best way to protect yourself from West Nile virus is to avoid getting bitten by mosquitoes, which can pick up the disease from infected birds.
The CDC recommends the following steps to protect yourself:
- Use insect repellents when outside.
- Wear long sleeves and pants from dawn to dusk.
- Don’t leave standing water outside in open containers, such as flowerpots, buckets and kiddie pools.
- Install or repair windows and door screens.
- Use air conditioning when possible.
More information
For more on West Nile virus, visit the U.S. Centers for Disease Control and Prevention.
Posted: November 2012
More Cancers May Be Missed Under Latest Mammogram Guidelines
TUESDAY Nov. 27, 2012 — The contentious U.S. guidelines that recommend fewer mammograms for most women could lead to lower screening rates and a dip in breast cancer detection, two new studies suggest.
In 2009, the U.S. Preventive Services Task Force — an independent medical panel with federal support — ignited a controversy when it recommended against routine mammography screening for most women in their 40s and advised less frequent screening for older women.
Instead, the task force said, women in their 40s can discuss mammography screening with their doctors, but should not automatically have it done. For women aged 50 to 74, the panel suggested a mammogram every two years. And for those age 75 and up, the group said there’s too little evidence to recommend for or against screening.
That’s out of step with advice from other groups, such as the American Cancer Society and the American College of Obstetricians and Gynecologists. They urge women to get yearly mammograms starting at age 40.
The two new studies, to be presented Tuesday at the annual meeting of the Radiological Society of North America in Chicago, tried to look at the potential impact of the task force guidelines.
In one, researchers compared mammography screening rates among women on Medicare before and after the 2009 recommendations. They found that the rate inched up by about 1 percent between 2005 and 2009, with almost one-third of women having a mammogram in 2009.
But in 2010, the screening rate dropped to just under 31 percent — a decline of 4.3 percent over one year.
The findings do not prove that the task force guidelines were the cause, but lead researcher Dr. David Levin said he thinks the pattern is clear.
“Up until 2009, the mammography rate was going up slowly. In 2010, there was an abrupt drop. It seems pretty obvious that [the guidelines] were the cause,” said Levin, chairman emeritus of radiology at Thomas Jefferson University Hospital in Philadelphia.
All of the women in the study were on Medicare, which covers Americans aged 65 and up. Levin said the mammography rate could have declined in 2010 because some women were waiting an extra year between mammograms.
“Or some women older than 74 may have dropped out of screening altogether,” he added.
And what would be wrong with that, if that’s the task force guideline? Levin said he thinks women should stick with the traditional advice of the American Cancer Society and other groups. “I think it’s a shame that there’s now a recommendation discouraging some women from getting screened,” he said.
Dr. Elizabeth Arleo, one of the researchers on the second study, agreed.
Her team looked at more than 43,000 screening mammograms done at New York-Presbyterian/Weill Cornell Medical Center between 2007 and 2010. Overall, there were 4.7 cancers caught for every 1,000 mammograms; the rate among women in their 40s was lower — at 2.7 per 1,000.
But women in their 40s accounted for almost 20 percent of all breast cancers.
“It seems unacceptable to potentially miss 20 percent of the breast cancers we are identifying,” said Arleo, an assistant professor of radiology at the medical center.
Her study did not, however, look at a woman’s risk of dying from breast cancer. It’s not clear whether patients in their 40s would have had a greater death risk had their tumors been detected later — either after a woman found a lump, or through a mammogram done at age 50.
But Arleo noted that even the task force said that for women in their 40s, mammograms are linked to a 15 percent reduction in the risk of dying from breast cancer.
The problem, the panel said, is that for women younger than 50, the benefits of mammograms may not outweigh the risks. Those include “false-positive” results that lead to needless invasive tests and anxiety (which are more common in women younger than 50), and overtreatment of early breast tumors that would never have progressed.
In Arleo’s study, just over half of women in their 40s diagnosed with breast cancer — 21 of 39 — had tumors that had invaded the breast tissue. The rest had ductal carcinoma in situ (DCIS), which refers to abnormal cells in the milk ducts that may or may not progress to invasive cancer.
Right now, doctors have no way of predicting which cases of DCIS will progress. So women usually receive treatment — which may mean surgery to remove some breast tissue or the whole breast. And that’s raised concerns about overtreatment.
Because the two new studies were presented at a meeting, the findings should be considered preliminary until they have been published in a peer-reviewed medical journal.
They were also conducted by radiologists — the specialists who do all those mammograms. But an expert who is not a radiologist and not connected to the research agreed that the findings support advice for women to begin mammograms at age 40.
“I think this reinforces concerns a lot of us have had since the [USPSTF] guidelines came out,” said Dr. Therese Bevers, a professor of clinical cancer prevention at the University of Texas M.D. Anderson Cancer Center in Houston.
“There are harms from screening, and I think that’s something everyone in this field recognizes,” Bevers said.
But she thinks the benefits outweigh the downsides, and she also noted that the task force suggests that screening decisions be individualized for women in their 40s, taking into account their risk factors.
However, researchers are still trying to figure out what the risk factors are. Strong family history is one; but in Arleo’s study, Bevers noted, only three of the 39 breast cancer patients in their 40s had a mother or sister diagnosed with early breast cancer.
“Until we have a better understanding of how to target screening to certain women in their 40s, I think we should screen everyone,” Bevers said.
According to the U.S. National Cancer Institute, the average 40-year-old woman has a one in 69 chance of developing breast cancer in the next 10 years. A 60-year-old woman has a one in 29 chance.
More information
Learn more about breast cancer and mammograms from the U.S. National Cancer Institute.
Posted: November 2012
