Biomedical subjects

Michael B First

Publications and source records attributed to Michael B First.

21 records · Page 2Linked to original sources

PubMedDate not supplied

The DSM series and experience with DSM-IV.

DSM-IV is the standard language for psychiatric diagnosis in the United States. An unanticipated consequence of DSM-III is international interest in this American document; for example, DSM-III was translated into 13 languages. This was due to its adopting a descriptive classification that eschewed etiologic theory and contained operational definitions, following Stengel's recommendations in his WHO report in 1959. These principles were eventually implemented in ICD-10, with the result of being two somewhat different classification systems. Although WHO-APA collaborations have minimized differences, a significant number remains, with only a few reflecting true ideological differences. The challenge for the future will be to integrate the two systems to produce, as much as possible, a unified system for international diagnostic communication.

Humans↗

PubMedDate not supplied

The APA classification of mental disorders: future perspectives.

After 8-10 years of experience with the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) and the tenth edition of the International Classification of Diseases (ICD-10), it is an ideal time to begin looking at the clinical and research consequences of these diagnostic systems. The American Psychiatric Association, in conjunction with the National Institutes of Health, has initiated a research development process intended to accelerate an evaluation of existing criteria while developing and testing hypotheses that would improve the validity of our diagnostic concepts. Over the past year, a multidisciplinary, international panel has developed a series of six white papers which define research opportunities in the following broad areas: Nomenclature, Disability and Impairment, Personality Disorders, Relational Disorders, Developmental Psychopathology, Neuroscience, and Cross-Cultural aspects of Psychopathology. Recommendations for future national and international research in each of these areas will be discussed.

Forecasting↗

PubMedDate not supplied

Mutually exclusive versus co-occurring diagnostic categories: the challenge of diagnostic comorbidity.

Diagnostic comorbidity is the rule rather than the exception in both DSM-IV and ICD-10. Three types of comorbidity include true comorbidity (clinically distinct entities), artifactual comorbidity (a byproduct of the DSM/ICD strategy to split categorical diagnoses) and spurious comorbidity. DSM has established 'mutually exclusive' relationships between disorders to reduce such spurious comorbidity. Four types of mutually exclusive relationships are identified: (1) between disorders that are on different levels of the Kraepelinian-defined hierarchy (e.g., schizophrenia and major depressive disorder); (2) between categories with identical features that are split according to age or duration (schizophrenia and schizophreniform disorder); (3) between categories in which the defining features of one disorder are contained in the definition of more broadly-defined disorder (Asperger's disorder and autistic disorder), and (4) between categories in which the defining features of one disorder are an associated feature of another disorder (e.g., dysthymic disorder and schizophrenia). Although less comorbidity may be desirable to reduce diagnostic complexity, in the absence of knowledge about underlying pathophysiology, the trend in successive editions of the DSM has been to reduce diagnostic hierarchies and increase comorbidity (e.g., elimination of exclusion between panic disorder and major depression in DSM-III-R because of evidence of independence). It is important to understand that comorbidity in psychiatry does not imply the presence of multiple diseases or dysfunctions but rather reflects our current inability to apply Occam's razor (i.e., a single diagnosis to account for all symptoms).

Comorbidity↗