MORE ON THE DSM-5
Psychosis Revisited
Schizophrenia is characterized by a tenuous grasp of reality, difficulty thinking and speaking clearly, and unusual emotional responses. In today’s diagnostic manual, the DSM-IV, this complex disorder is split up into the following “types”:
- Paranoid: delusions and auditory hallucinations but normal speech and emotional responses.
- Disorganized: erratic speech and behavior and muted emotions.
- Catatonic: unusual postures and movements or paralysis.
- Residual: very few typical symptoms but some odd beliefs or unusual sensory experiences.
- Undifferentiated: none of the other types.
Yet another form of the illness is shared psychotic disorder: when someone develops the same delusions as a friend or family member with schizophrenia.
Soon you can forget all these variants. As with certain personality disorders, there is little evidence for the existence of these discrete categories. Catatonia, for instance—an intermittent “freezing” of the limbs—also accompanies bipolar disorder, post-traumatic stress disorder and depression. Therefore, psychiatrists say it makes little sense to call it a form of schizophrenia. Catatonia also does not respond well to the antipsychotic medications used to treat schizophrenia.
Even as it sheds these subtypes, the DSM-5 embraces novel forms of psychosis. The most contentious is attenuated psychosis syndrome, a cluster of warning signs that some researchers think precede the frequent delusions and hallucinations that characterize the full-blown disorder. Its purpose is to catch young people at risk and prevent this insidious progression. Critics contend, however, that two thirds of the children who qualify for the at-risk criteria never develop real psychosis and may unnecessarily receive powerful drugs [see “At Risk for Psychosis?” by Carrie Arnold; Scientific American Mind, September/October 2011]. After all, about 11 percent of us sometimes hear voices or engage in moments of intense magical thinking with little or no distress.
Another controversial addition is disruptive mood dysregulation disorder, a diagnosis for kids that carries less stigma than its predecessor, childhood bipolar disorder. Since about 2000, diagnoses of pediatric bipolar disorder have jumped at least fourfold in the U.S. Many psychiatrists, however, argued that their peers were mislabeling a condition that was not bipolar disorder at all and treating children with strong drugs before knowing what really ailed them.
Very few people younger than 20 develop true bipolar disorder, in which moods swing between depression and mania. The vast majority of the kids who received the label did not, in fact, oscillate in this way. Instead they were in a bad mood all the time and frequently exploded in anger and physical violence, even in response to a minor offense. Because of these differences, disruptive mood dysregulation disorder describes a child (younger than 10) who is constantly irritable and has extreme temper tantrums about three times a week.
The APA says this pediatric entry will “provide a ‘home’ for these severely impaired youth,” but some critics worry doctors will dole out the diagnosis like lollipops to droves of tantrum-prone toddlers. The treatment is the same, despite the new name: a mixture of mood stabilizers, antipsychotics, antidepressants and stimulants. —F.J.
Personality Problems
To a psychologist, a personality consists of persistent patterns of thought, emotion and behavior. Someone with a personality disorder has rigid and dysfunctional patterns that disrupt his or her ability to maintain healthy relationships. The current encyclopedia of mental illness, the DSM-IV, describes 10 such conditions. These include paranoid personality disorder—the inability to trust others and an irrational belief that people are out to get you—and narcissistic personality disorder, an exaggerated sense of self-importance, a need for constant admiration and excessive envy of others.
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22 Comments
Add Comment"Although many psychiatrists do not sit down with the DSM and take its scripture literally..."
Reply | Report Abuse | Link to thisThis is an important caveat. And it illustrates why more attention needs to be drawn not to what's in the book, but how the book is used.
As a practicing psychiatrist, I agree with you that many clinicians "rely on personal expertise to make a diagnosis." What we are forced to write in the chart, however, is dictated by the DSM. From that point on, the diagnosis-- NOT the patient-- becomes the focus of treatment. It serves as a gateway not only to a wide range of social services-- which could be beneficial-- but also to a potential lifetime of medication trials and other ill-advised treatments.
Most psychiatrists view the DSM and the diagnostic process as a necessary evil: "necessary" for reimbursement and to be able to help the people who seek our assistance, but "evil" because in many systems the assistance we provide is dictated by the diagnosis, not by the unique needs of the individual.
"Residual: very few typical symptoms but some odd beliefs or unusual sensory experiences."
Reply | Report Abuse | Link to thisThat describes most of the people I know.
The DSM is nothing more than a piece of trash. These so called conditions were made up from a committee of "scientists" the majority of whom have financial connections to drug companies. These companies are drooling over the fact that new markets will be open to them to sell more worthless and harmful drugs. There is absolutely NO scientific basis for the conditions included in the DSM. This is nothing more than a sham to make insurance companies pay for more drug therapy at an astronomical increase in cost.
Reply | Report Abuse | Link to thisQuote: In the past the APA has received harsh criticism
Reply | Report Abuse | Link to thisAnswer: "I have lived a full, interesting and creative life supported by my family and many friends and irritated and spurred on by the hostile criticisms of a group of psychiatrists representing APA and NIMH."
Those words were spoken by Dr. Abram Hoffer , 'father of Orthomolecular Psychiatry'.
http://orthomolecular.org/history/hoffer/index.shtml
"Catatonic schizophrenic"
"Left in a coma and was dying"
"The next day he sat up and drank it and thirty days later he was well. He was discharged and remained well"
The American Psychiatric Association advocates AGAINST the use of the treatment above.
The American Psychiatric Association MUST be harnessed and their powers removed.
So, ironjustice, all you have is a story from the website of orthomolecular.org itself?
Reply | Report Abuse | Link to thisEven if it's true, it occasionally happens that people wake up from a coma for no discernible reason. One case is not statistically significant.
"Schizophrenia is characterized by a tenuous grasp of reality, difficulty thinking and speaking clearly, and unusual emotional responses."
Reply | Report Abuse | Link to thisCan we use this diagnosis for political parties? Pretty please with sugar on top?
But seriously. Opening the process is probably a good thing. But does it go far enough? AFAIK, the DSM was originally a collection of random wisdom from a bunch of doctors. It was unexpectedly a best seller. Arguably, it's long past time to put some science into it. One hears phrases like "evidence based medicine". How would that work with the DSM? Maybe pilot projects. One publishes a DSM for Wayne County, and another for Macomb County. Figure out the pluses and minuses of each through use, and apply the results to the next pilot projects. Results are only expanded to larger populations when the desired outcomes are maximized. No politics. No vested interests. This isn't easy, but it appears that there is a mandate.
If religion had to undergo as massive and dramatic an overhaul as this, devotees of "science" would roundly denounce it. In fact, "psychiatry", "psychology", "psychoanalysis" all have traits that utterly disqualify them much less than as "scientific", but even as useful. Consider that all "psychoanalytic theories" are definitively different, if not wholly incompatible. Freud's emphasis on sex, Fromm saying a desire for conformity and programming defines man, Skinner saying everything is already programmed, Jung invoking already defined stereotypes. And all supposedly describing the same human mand! And yet no devotees of "science" attack "psychology" as a fraud! They respect the money, not ethics! Just as in the case of the single most accusatory quality of "psychoanalysis". Claiming to be a modeling of all human minds, "psychoanalytic theories" all derive solely from case histories! All "psychoanalytic theory" is based on individuals with proven mental instabilities, yet, they try to generalize from these to healthy minds! No "psychoanalytic theory" recognized by "science" derived from interviewing sane people!
Reply | Report Abuse | Link to thisDave , there is no room to place much of his 600 published works. The fact you seem not to know anything OTHER than that which I have placed , one article , means ? You don't have the gear to be commenting.
Reply | Report Abuse | Link to thisWhat evidence do you have of this alleged interference from drug companies? That's a strong accusation to make blindly.
Reply | Report Abuse | Link to thisI've often thought it's very ironic that "science-based" critics of alternative medicine ignore therapists and psychologists, who *really* have little or no research support for much of what they do. Psychiatrists might practice somewhat more science-based medicine, but still deserve criticism from a science-based point of view.
Reply | Report Abuse | Link to thisQuote: what evidence
Reply | Report Abuse | Link to thisAnswer: Depakote.
600? So? L. Ron Hubbard published far more.
Reply | Report Abuse | Link to thisQuite the generalization, that is.
Reply | Report Abuse | Link to thisQuote: L. Ron Hubbard published far more
Reply | Report Abuse | Link to thisAnswer: Typed that name into Medline. No hits.
A good companion to the DSM is the "Psychodynamic Diagnostic Manual". This book informs us about the patient rather than the diagnosis. It is linked to the DSM classification of disorders and so provides us with an informative complement to the DSM.
Reply | Report Abuse | Link to thisThe DSM5 comment process as diagnostic tool - fifty million comments, mostly critical, from half a million individuals. Average 100 comments per individual. I'd guess most sane individuals probably commented 1, 2 or 10 issues. I hope they gave no weight to the comments of those who submitted hundreds or thousands.
Reply | Report Abuse | Link to thisIt's "Psychology's," not "Psychiatry's." Psychiatrists mainly dispense meds. In fact, psychiatrists are required to have no psychological training. Psychologists use the DSM a whole order of magnitude more than psychiatrists. I'd expect SciAm to get that right.
Reply | Report Abuse | Link to this-Dr.Bunny
As someone who has worked in this field for 40 years and been psychoanalyzed, trained first as a Rogerian, then a psychoanalytic, then Eriksonian and lastly CBT therapist; worked in an acute inpatient setting, a multidisciplinary outpatient setting, for a managed care insurance company, doing admissions for an facility and currently working in an outpatient practice group I can say that the DSM is an important tool. It does not capture the unique individual in the room but it provides a framework for organizing ones thinking about that person.
Reply | Report Abuse | Link to this"Suspiciously, between 40 and 60 percent of all psychiatric patients are diagnosed with a personality disorder, hinting that symptoms of at least some of these “disorders” resemble typical behavior too closely."
Reply | Report Abuse | Link to thisI think that often a doctor will add on a personality disorder because the diagnosed clinical disorder does not contain all the patient's relevant symptoms.
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I'm glad concepts like severity and behavior spectrums are starting to be introduced.
There is a catch 22 especially with anti psychotic medications. After you have been on them for months and seek to withdraw from the medication the withdrawal side effects are exactly the behaviors that supposedly were diagnosed in the first place and then some. Anti psychotic drugs cause an even greater chemical imbalance in the brain than actually existed at the time of the diagnosis and treatment. Withdrawal from anti psychotic drugs makes you even crazier than when you first started out with the medication.
Reply | Report Abuse | Link to this"What evidence do you have of this alleged interference from drug companies?" Is that Musclefox of fox tv.? All aspects of US society are controlled by Corporations. The FDA and Dept of Ag. are run by Monsanto, Condoleezza Rice went from Exon to Secretary of State for Bush/Chaney's OIL WAR Industry, The Dept. of Energy historically by Coal ,Oil and Nuclear Industries Retirees ,The Senate Watch dog on Internet Porn gets busted with young boy in public restroom, What Govt. agency is not run by 'the fox guarding the Hen house'. Corporations Make the rules Americans have to live by. The People have no voice, not in the White House,Congress, or the Corporate Media, Against them.The Pharmaceutical Companies keep America the Most Doped Up people in the World. What evidence do you need ? If you will not believe FACTS ! But You won't hear that on Fox news.Occupy Truth ! Freud was a Fraud which Drug Companies Perpetuate through Funding of 'University Studies' .
Reply | Report Abuse | Link to thisSeveral stupid police officers in Western Australia just recently abducted some innocent guy off the street in Perth, and handed him over to psychiatric staff from Graylands Hospital, who then promptly injected him with a powerful drug to sedate him, ignoring his protests all the while. This innocent guy had an immediate adverse reaction to the drug and had to be hospitalised at a major hospital. It turns out that this poor fellow was mistaken for a psychiatric patient who'd absconded from Graylands where he'd been in psychiatric care for approximately eight months, yet the extremely "lax"[read as: stupid] psychiatric staff were unable to positively identify the patient being sought and thought that this guy will do since he's being given them by the police. He was securely handcuffed after possibly being roughed-up by the police to boot. This just shows how inadequately putatively trained psychiatric staff keep their patients under observation and typifies how they're also unable to assess the mental condition of any person adequately, just like the myriad psychiatrists involved with the fiasco that occured during the "Rosenhan Pseudopatient Experiment" in the United States of America. The Graylands patient who was still being sought presented himself back at the secure ward several days later, entirely of his own volition.
Reply | Report Abuse | Link to thisUntil such time that we are provided with something far superior than just the fallible human brain with which to assess any person's mental condition, present-day psychiatric assessments are about as futile as the endeavour of an inept businessman who doesn't advertise. This inept businessman, because he doesn't advertise his business, is just like the guy who winks at a pretty girl in the dark. He knows what he's thinking...but nobody else does! Maybe he could do better working as a psychiatrist?