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.

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