* Diagnoses fail to make cut in revised manual
* Field tests showed they were not reliable
* Group accepting comments on proposed changes
By Julie Steenhuysen
CHICAGO, May 9 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
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.
That, too, could still be altered before the final manual is
published, the group says. The APA opened the final comment
period for its fifth diagnostic manual known as DSM-V on May 2,
and it will accumulate comments through June 15.
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.
'TRYING TO LISTEN'
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
"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
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
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
"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.
Comments to the manual can be submitted at www.DSM5.org
(Reporting By Julie Steenhuysen; Editing by Peter Cooney)