Deborah Brauser

June 08, 2011

June 8, 2011 (Honolulu, Hawaii) — The upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is on track to be published in May 2013, will be available for the first time in both electronic and print versions, according to David Kupfer, MD, chair of the DSM-5 Task Force.

In an exclusive interview with Medscape Medical News at the American Psychiatric Association (APA) 2011 Annual Meeting, Dr. Kupfer said the new electronic version will be "a living document" that will be much easier to update and may even include links to videos and vignettes.

"It is crucial that we make this clinician friendly, educationally friendly, and even patient friendly," he said.

Dr. David Kupfer

He added the plan is to have both versions ready in time for the 2013 APA Annual Meeting in San Francisco, California. As recently reported by Medscape Medical News, the newest proposed draft of the manual includes an extensive framework restructuring and is currently posted on the DSM-5 Web site.

Before the current restructured version, there were more than 8000 responses to the last publicly released draft of the DSM-5. Areas that generated the greatest response included proposed criteria changes for autism spectrum disorders and Asperger's; the issue of whether pediatric bipolar disorder is being overdiagnosed or underdiagnosed and overtreated or undertreated; and how to deal with mild and major neurocognitive disorder, said Dr. Kupfer.

"Nobody wants to be told they have early Alzheimer's disease, and they don't even want an assessment. But under the aegis of memory clinics, which are springing up all over the place, a good evaluation of early changes might be very important."

He said that "there are really subgroups" of mild neurocognitive disorder. One may consist of people with no progression, whereas another could be made up of those with a serious Alzheimer's problem within 24 months. "And maybe that's the group where you do your neuroimaging because you don't do neuroimaging on everybody.

"By mapping out the appropriate subgroups, you then may be able to map out the appropriate prognosis, which may then help you with treatment. Unless all of this is being done within the DSM framework, it's very hard to deal with it — especially with all the research that is going on."

Dr. Kupfer reported that the development of disorders across the lifespan is also "a major area" that is also being changed in the new manual.

"Rather than just having 1 chapter on childhood disorders, the whole notion of development and the early onset of disorders is important, and you will now find it throughout the entire book. Certainly, the way we are clustering disorders, and even the discussion of specific disorders, is based very much on what we continue to learn about development."

Field Trials Moving Ahead

Also, as reported by Medscape Medical News, standardized field trials are now being conducted to assess the practical use of the proposed DSM-5 diagnostic criteria in real-world clinical settings before the manual is published.

"The field trials are going well, although it obviously takes a while to get things carried out so everything is moving efficiently. We now have 11 sites taking on patients to evaluate and the numbers will continue to increase. We have about 700 patients now, and I won't be happy until we get well over a thousand patients involved. But we're well on our way," said Dr. Kupfer.

In addition, he said that the DSM-5 Work Groups are trying to align a lot of what they do "with what is going on in the development of the International Classification of Diseases or ICD-11. And that involves working collaboratively and harmoniously with the WHO [World Health Organization]."

Finally, Dr. Kupfer noted that the second public commentary period for the DSM-5 draft ends June 15, and there will be a third that will likely start at the end of 2011 or very early in 2012.

"Overall, I'd like for everyone to realize that the process doesn't end with the publication of DSM-5. In many ways, we are hoping it becomes a living document and that we'll have an opportunity to incorporate the latest research and clinical knowledge in an orderly fashion.

"We also hope to establish ongoing review groups to make periodic assessments so that in many ways we are prepared for future science — and can have an even better DSM-5.1 or DSM-5.2. We are determined to make the DSM-5 and its updates the most useful DSM that we've had so far," he concluded.

American Psychiatric Association (APA) 2011 Annual Meeting.


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