Psychiatr News February 17, 2006
Volume 41, Number 4, page 37
© 2006 American Psychiatric Association
Information on Host City and Meeting Highlights
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Sessions Offer Window Into DSM-V Development Process
Jennifer Shupinka and
Paul Sirovatka
Jennifer Shupinka is the DSM program manager in APA's Division
of Research, and Paul Sirovatka is director of policy analysis in the Division
of Research.
The state-of-the-science in several diagnostic areas looking toward
DSM-V will be illuminated at APA's 2006 annual meeting.
With anticipated publication of DSM-V now only five years away,
APA's 2006 annual meeting will feature numerous sessions that will highlight
scientific, clinical, and methodological issues being explored to improve
diagnosis, according to Darrel Regier, M.D., M.P.H, director of APA's Division
of Research and executive director of the American Psychiatric Institute for
Research and Education (APIRE).
"Since the publication of DSM-IV in 1994, there has been
extraordinary progress in research in so many areas—brain circuitry,
genetics, family studies, and new data analysis techniques—that could
potentially help us to make unprecedented leaps in the way we diagnose our
patients," Regier noted.
APIRE has an NIH-funded, five-year research planning conference grant
designed to engage work groups representing the global research community in
recommending what research needs to be conducted to incorporate these
scientific leaps into a diagnostic reality. Titled "The Future of
Psychiatric Diagnosis: Refining the Research Agenda," the project
comprises 12 research work groups, 10 focused on specific diagnostic topics
and two on methodologic issues. At the annual meeting, four of these work
groups will review their recommendations and describe research now under way
to implement them.
At noon on Monday, May 22, Regier will chair the forum "Research
Planning for the DSM-V," which will provide an overview of the
progress to date on this dynamic project.
"The research planning work groups, which consist of expert
scientists and clinicians throughout the world from various disciplines, were
challenged to focus their collective knowledge on three questions: What are
the strengths and weaknesses of the current DSM criteria? What
research findings currently exist that might justify changes in criteria? And
what research needs to be done that could be tested within the next couple of
years to make the classification more valid and useful?," explained
William Narrow, M.D., M.P.H., associate director for diagnosis and
classification in the Division of Research and a co-principal investigator
with Regier for the conference grant.
Beyond stimulating the field to conduct needed research, the
recommendations generated through the conferences will serve as resources for
future DSM-V work groups and, at the discretion of the WHO
leadership, for the pending ICD-11 revision.
In addition to the forum, four symposia will review in greater detail
evidence arising from conferences on personality disorders, substance use
disorders, stress-induced and fear circuitry disorders, and dementia. All of
these symposia will take place on Tuesday, May 23, at 2 p.m.
A principal focus of the work group on personality disorders has been to
examine the scientific rationale and prospects for integrating alternative
dimensional models into currently used categorical approaches to the diagnosis
of personality disorders. The symposium will be chaired by John Livesley,
Ph.D., and co-chaired by Thomas Widiger, Ph.D., who also co-chaired the
research planning conference on personality disorders.
"Substance Use Disorders: Planning a Research Agenda for
DSM-V" will highlight research opportunities that could
facilitate evidence for changes in substance use disorder definitions and
criteria: Should dependence criteria be tailored to specific substances? How
might a research focus on withdrawal help validate orthogonal concepts of
dependence and abuse? Presentations will review these and other research
priorities generated from this research planning group's efforts. Marc
Schuckit, M.D., and Bridget Grant, Ph.D., will co-chair the symposium.
Dennis Charney, M.D., dean for research at Mt. Sinai School of Medicine,
will lead the symposium "Stress-Induced and Fear Circuitry
Disorders." The research planning work group on this topic questioned
whether future research on selected current anxiety disorder classifications
could be improved or changed by building from brain-based phenotypes. The
presentation will review highlights of state-of the-science findings,
including neural mechanisms of fear and anxiety, the role of cognitions,
neural circuitry, and neurochemistry/neuroendocrinology.
The symposium "Diagnostic Criteria in Alzheimer's Disease and
Dementia," chaired by NIH's Trey Sunderland, M.D., will highlight the
work group's recommendations for exploiting recent scientific breakthroughs in
a fast-moving field. Presentations will address how diagnostic criteria might
be updated to reflect data emerging from novel applications of neuroimaging
technologies, how improved assessment of executive function and attention can
contribute to a better understanding of the pathology of the dementias, and
how prospects for clinically applicable biomarkers in prognosis and diagnosis
of Alzheimer's disease and dementia.
The research planning conference series, which APIRE administers with the
cosponsorship of WHO and NIH, is nearly halfway complete, with five of the 12
conferences already conducted. Future conferences will focus on psychotic
disorders, the spectrum of obsessive-compulsive behavior, somatic
presentations of mental disorders, externalizing disorders of childhood,
depression and generalized anxiety disorders, and the clinical, forensic,
economic, and other implications of a revised classification from a public
health perspective. Another conference will assess the overall practicality
and utility of incorporating dimensional approaches into the DSM.
Each conference is being co-chaired by a senior U.S. investigator and an
international colleague, and psychiatrists and others from around the world
are being invited to participate.
"The extent of international interest in the DSM-V
research-planning conferences is very encouraging," Regier said.
"Because the manual is used throughout the world, we are making a
strenuous effort to ensure that DSM-V empirically considers the
different ways in which individuals experience mental disorders across
cultures, socioeconomic status, and across the globe.
"Members should be aware that a Web site is available at
<www.dsm5.org>
that provides information about the future conferences and detailed summaries
of those that have already taken place. We will use the site to report new
developments as they occur over the next several years and to offer
researchers and the general public opportunities to offer feedback and
suggestions regarding DSM development."
He noted that Michael First, M.D., who is a consultant to APIRE and has
played a major role in prior revisions of the DSM, led the creation
of the Web site. 
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