Psychiatric guide drops 2 disputed diagnoses

Two proposed psychiatric diagnoses failed to make the last round of cuts in the laborious process of revising the Diagnostic and Statistical Manual of Mental Disorders - an exhaustive catalog of symptoms used by doctors worldwide to diagnose psychiatric illness. Gone from the latest revision, the first since 1994, are "attenuated psychosis syndrome," intended to help identify individuals at risk of full-blown psychosis, and "mixed anxiety depressive disorder," a blend of anxiety and depression symptoms. Both performed badly on field tests and in public comments gathered by the American Psychiatric Association in its march toward a May 2013 publication deadline. They have been tucked into Section III of the manual - the place reserved for ideas that do not yet have enough evidence to make the cut as a full-blown diagnosis. What has survived, despite fierce public outcry, is a change in the diagnosis of autism, which eliminates the milder diagnosis of Asperger syndrome in favor of the umbrella diagnosis of autism spectrum disorder. Dr. David Kupfer, who chairs the DSM-5 Task Force, said in a statement that the changes reflected the latest research and input from the public. Dr. Wayne Goodman, professor and chairman of the department of psychiatry at Mount Sinai Medical Center in New York, said he was glad the task force was responding to feedback from professionals and the public. "I think they are trying to listen," he said. Goodman agrees with the decisions to drop both of the two disorders in the latest revision. With the "mixed anxiety and depressive disorder," he said there was a risk that it would capture a number of people who did not qualify under a diagnosis of depression or anxiety alone."It could lead to overdiagnosis," Goodman said. He said the "attenuated psychosis syndrome" diagnosis would have been useful for research purposes to help identify those at risk of psychosis, but there was a concern it might label people who were just a bit different as mentally ill. "The predictive value is not clear yet," he said. "I think it's reasonable not to codify it until we have better definition of its predictive value." Goodman, who worked on DSM-4, the last revision of the manual published in 1994, and is working on the Obsessive Compulsive Disorder section of the current revision of DSM-5, said the strength of the manual was that it can offer a reliable way for psychiatrists across the country to identify patients with the same sorts of disorders.The weakness, he said, was that it largely lacked biological evidence - blood tests, imaging tests and the like - that can validate those diagnoses. "DSM-5 is a refinement of our diagnostic system, but it doesn't add to our ability to understand the underlying illness," he said. Goodman said he had no personal opinion on the debate over autism but that both sides had significant concerns. He said some were worried that eliminating Asperger syndrome would mean patients did not get needed services, while others said the change would not affect their ability to identify people with those issues. Dr. Emil Cockcrow, chairman of the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago Medicine, said changes in the DSM typically occurred because of new data.Cockcrow, who is contributing to the new section in the DSM-5 on Intermittent Explosive Disorder, said there was no question that many people were not convinced some of the diagnoses needed to be changed or that there needed to be new ones added. "This also happened the last time when they did DSM-4," he said, but that was nearly 20 years ago. "You can keep waiting, but at a certain point you have to fish or cut bait and actually come out with a new edition. That is what is happening now," he said.