Michael B. First

David J. Kupfer

Darrel A. Regier

In the ongoing quest to improve our psychiatric diagnostic system, we are now searching for new approaches to understanding the etiological and pathophysiological mechanisms that can improve the validity of our diagnoses and the consequent power of our preventive and treatment interventions -- venturing beyond the current DSM paradigm and DSM-IV framework. This thought-provoking volume -- produced as a partnership between the American Psychiatric Association, the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse -- represents a far-reaching attempt to stimulate research and discussion in the field in preparation for the eventual start of the DSM-V process, still several years hence. The book Explores a variety of basic nomenclature issues, including the desirability of rating the quality and quantity of information available to support the different disorders in the DSM in order to indicate the disparity of empirical support across the diagnostic system. Offers a neuroscience research agenda to guide development of a pathophysiologically based classification for DSM-V, which reviews genetic, brain imaging, postmortem, and animal model research and includes strategic insights for a new research agenda. Presents highlights of recent progress in developmental neuroscience, genetics, psychology, psychopathology, and epidemiology, using a bioecological perspective to focus on the first two decades of life, when rapid changes in behavior, emotion and cognition occur. Discusses how to address two important gaps in the current DSM-IV: (1) the categorical method of diagnosing personality disorders and their relationship with Axis I disorders, and (2) the limited provision for the diagnosis of relational disorders -- suggesting a research agenda for personality disorders that considers replacing the current categorical approach with a dimensional classification of personality. Reevaluates the relationship between mental disorders and disability, asserting that research into disability and impairment would benefit from the diagnosis of mental disorders be uncoupled from a requirement for impairment or disability to foster a more vigorous research agenda on the etiologies, courses, and treatment of mental disorders as well as disabilities and to avert unintended consequences of delayed diagnosis and treatment. Examines the importance of culture in psychopathology and the main cultural variables at play in the diagnostic process, stating that training present and future professionals in the need to include cultural factors in the diagnostic process is a logical step in any attempt to develop comprehensive research programs in psychology, psychiatry, and related disciplines. This fascinating work, with contributions from an international group of research investigators, reaches into the core of psychiatry, providing invaluable background and insights for all psychology and psychiatry professionals -- food for thought and further research that will be relevant for years to come.

A Research Agenda For DSM V

Norman Sartorius

Shekhar Saxena

Benedetto Saraceno

Patricia Esparza

Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for DSM-5 and ICD-11 provides a comprehensive summary of the current state of mental health classification in the United States and internationally, fostering a better understanding of primary research and clinical needs and facilitating the efforts of service planners, researchers and trainees to address current use of psychiatric diagnosis in the public health sector. The volume reflects the proceedings of a research planning conference convened by the APA and World Health Organization (WHO) that focused on public health aspects of the diagnosis and classification of mental disorders. Highly relevant to the ongoing development of DSM-5 and ICD-11, the book includes the background papers prepared and presented by the Conference Expert Groups. The resulting collection: Discusses the current state of mental illness prevention efforts and the role of public health in supporting them -- critical topics, given that development of effective strategies to reduce mental illness around the world depends on the accuracy with which risk and protective factors can be identified, defined, and understood. Features international perspectives on public health implications of psychiatric diagnosis, classification, and service, providing viewpoints that are broad and more globally relevant. Views mental health education, and awareness on a macro level, including its impact on social and economic policy, forensics and the legal system, and education. This approach facilitates the continued development of a research base in community health and promotes the establishment of programs for monitoring, treating, and preventing mental illness. Addresses many fascinating and clinically relevant issues, such as those raised by the concept and the definition of mental disorders and how these impact psychiatric services and practice by individual providers. This collection should prove useful to the advisory groups, task forces, and working groups for the revision of these two classifications, as well as for researchers in the area of diagnosis and classification, and more generally in public health.

Refining the Research Agenda for DSM-5 and ICD-11

Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders

Paul J. Sirovatka

Jim van Os

Carol A. Tamminga

Deconstructing Psychosis: Refining the Research Agenda for DSM-V provides an all-important summary of the latest research about the diagnosis and pathophysiology of psychosis. This volume gives the reader an inside look at how psychotic phenomena are represented in the current diagnostic system and how DSM-V might better address the needs of patients with such disorders. The book presents a selection of papers reporting the proceedings of a conference titled "Deconstructing Psychosis" convened by the American Psychiatric Association (APA) in collaboration with the World Health Organization (WHO) and the U.S. National Institutes of Health (NIH). The conference was designed to be a key element in the multiphase research review process for the fifth revision of DSM. This book is one in a series of ten that reflects some of the most current and critical examinations of psychiatric disorders and psychotic syndromes. APA published the fourth edition of DSM in 1994 and a text revision in 2000. DSM-V is scheduled for publication in 2013. Deconstructing Psychosis: Refining the Research Agenda for DSM-V examines the current evidence regarding the diagnosis and pathophysiology of common psychotic syndromes including: Schizophrenia Bipolar disorder Major depressive psychosis Substance-induced psychosis It also addresses broad issues relating to diagnosis such as the ways in which psychosis cuts across multiple diagnostic categories. Beyond merely summarizing the current state of the science, the authors of these papers critique the current research and clinical evidence, and raise questions about gaps in our knowledge. The book provides recommendations for the most promising areas of research in psychosis, which may lead to more refined treatments based on a better understanding of what biological and environmental factors contribute to its development and symptoms. In the learned editors' selection of papers for inclusion in this volume, they have exhibited their conviction that DSM-V is a "living document" that will reflect the pace of progress in multiple areas, ranging from molecular genetics and brain imaging to social, behavioral, and anthropological science. As a book on the narrowly defined topic of linking the classification of psychotic syndromes with their underlying pathophysiology and potential etiology, there is no other writing of comparable content available today.

Refining the Research Agenda for DSM-V

Deconstructing Psychosis

The Conceptual Evolution of DSM-5 highlights recent advances in our understanding of cross-cutting factors relevant to psychiatric diagnosis and nosology. These include developmental age-related aspects of psychiatric diagnosis and symptom presentation; underlying neuro-circuitry and genetic similarities that may clarify diagnostic boundaries and inform a more etiologically-based taxonomy of disorder categories; and gender/culture-specific influences in the prevalence of and service use for psychiatric disorders. This text also considers the role of disability in the diagnosis of mental disorders and the potential utility of integrating a dimensional approach to psychiatric diagnosis. A powerful reference tool for anyone practicing or studying psychiatry, social work, psychology, or nursing, The Conceptual Evolution of DSM-5 details the proceedings from the 2009 American Psychopathological Association's Annual Meeting. In its chapters, readers will find a thorough review of the empirical evidence regarding the utility of cross-cutting factors in nosology, as well as specific suggestions for how they may be fully integrated into the forthcoming fifth edition of Diagnostic and Statistical Manual of Mental Disorders.

The Conceptual Evolution of DSM-5

Dennis S. Charney

Gavin Andrews

As disorders in which stress or fear play major roles present an increasing need for psychiatric care around the world, this volume summarizes current research to determine whether a specific group of stress-induced and fear-based disorders form a distinct syndrome independent from other anxiety disorders such as obsessive-compulsive disorder or generalized anxiety. Intended to suggest DSM-V revisions regarding the classification of these disorders, Stress-Induced and Fear Circuitry Disorders reflects findings that may lead to more refined treatments for these specific anxiety disorders based on a better understanding of the biological and environmental factors that contribute to their development and symptoms. Thirty contributors, all international authorities on this group of mental illnesses, clarify how these disorders develop and what factors contribute to symptomatology. Focusing on posttraumatic stress disorder, panic disorder and agoraphobia, social phobias, and specific phobia, the authors explore the possibility of linking the classification and etiology of these conditions by showing that they may be closely related in terms of brain pathophysiology. In addition to assessing the stability of disorders across patient lifespans and determining whether they form a cohesive and distinct group, the authors examine shared etiologies and biopsychosocial correlates, as well as aspects unique to each disorder. Among the book's specific insights: How minority populations, particularly African Americans, are differentially affected by these disorders. The neuronal mechanisms of normal fear and anxiety, including how changes in the genetics of the serotonin system can increase the risk of anxiety. The role of cognition in symptom presentation and treatment, revealing cognitive biases that favor the processing of threat-related information. The contribution of stress and psychosocial factors, such as peer victimization and childhood sexual abuse. The use of neuroimaging to analyze neural structure and function for each of the four disorder groups. How neurochemistry and neuroendocrine markers may aid in classification of anxiety disorders. The contribution of substance abuse to the pathophysiology of these disorders. Given the importance of changes to DSM for professional education and public health, this book offers important new ways of thinking about stress-induced and fear-based disorders. It not only allows researchers to more accurately assess their diagnostic classifications, but also can help clinicians more effectively communicate with patients regarding the nature of their illness and the importance of adhering to treatment regimens.

Darrel A. Regier

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