AHIMA: Ten Reasons to Not Delay ICD-10 (ICD-10-CM)

AHIMA: Ten Reasons to Not Delay ICD-10 (ICD-10-CM)

Post #147 Shortlink: http://wp.me/pKrrB-1Xw

This material relates to the forthcoming US specific “clinical modification” of the WHO ICD-10, known as “ICD-10-CM.” It does not relate to other country specific clinical modifications of ICD-10.

On January 16, 2009, Department of Health and Human Services (HHS) published a Final Rule in the Federal Register mandating adoption of ICD-10-CM and ICD-10-PCS to replace ICD-9-CM in HIPAA transactions, with a compliance date of October 1, 2013.

Until implementation, codes in ICD-10-CM are not valid for any purpose or use. ICD-10-CM has been subject to partial code freeze since October 1, 2011.

The 2012 release of ICD-10-CM is now available from the CDC site and replaces the December 2011 release:

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

 

HHS announces delay for compliance

On February 16, HHS Secretary Kathleen Sebelius issued a press release announcing that HHS will initiate a process to postpone the date by which certain health care entities are required to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes.

HHS Secretary Kathleen Sebelius said, “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead.  We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

HHS has yet to announce a new compliance date but it is speculated that the delay would be for at least one year, rather than for a few months.

Related content:

Post #142 | February 16, 2012

HHS Secretary Sebelius announces intent to delay ICD-10-CM compliance date

For background see: 

Could the U.S skip ICD-10 and leapfrog directly to ICD-11?

February 16, 2012 | Tom Sullivan, Government Health IT

HIMSS statement, February 17, 2012

HIMSS Calls for Maintaining October 1, 2013 ICD-10 Implementation Deadline for Most Healthcare Entities

Information Week report

ICD-10 Delay Worries Health IT Leaders

The train’s already left the station for organizations that have been prepping for an October 2013 ICD-10 deadline, say health IT organizations and CIOs.

Nicole Lewis | InformationWeek |February 22, 2012

Practice Fusion

HHS Asks for a Delay to the Start of ICD-10

Robert Rowley, MD | February 21, 2012

AHIMA issues statement and press release

Yesterday, American Health Information Management Association (AHIMA) issued a statement and press release in response to HHS Sebelius’ February 16 announcement to delay the ICD-10-CM compliance date.

AHIMA represents more than 64,000 Health Information Management professionals in the United States and around the world. www.ahima.org

American Health Information Management Association statement and press release

http://journal.ahima.org/2012/02/22/ten-reasons-to-not-delay-icd-10/

     AHIMA statement IDC-10 Delay 02.17.12

Ten Reasons to Not Delay ICD-10

Feb 22, 2012 01:12 pm | posted by Kevin Heubusch | ICD-10

This week AHIMA announced it will reach out to leaders at the Department of Health and Human Services and urge there be no delay in the implementation of ICD-10-CM and ICD-10-PCS.

“We recommend that HHS reach out to the full healthcare community and gather more information about the great strides many have achieved— in good faith—since the ICD-10 deadline was set in January 2009,” said AHIMA CEO Lynne Thomas Gordon, quoted in a statement.

Further, AHIMA encouraged the healthcare community to continue its implementation planning and not let up its efforts.

In a statement released today, AHIMA offered 10 reasons not to delay ICD-10 implementation.

Ten Reasons We Need ICD-10 Now

1. It Enhances Quality Measures. Without ICD-10 data, serious gaps will remain in the healthcare community’s ability to extract important patient health information needed for physicians and others to measure quality care.
2. Research Capabilities Will Improve Patient Care. Data could be used in a more meaningful way to enable better understanding of complications, better design of clinically robust algorithms, and better tracking of the outcomes of care. Greater detail offers the ability to discover previously-unrecognized relationships or uncover phenomenon such as incipient epidemics early.
3. Significant Progress Has Already Been Made. For several years, hospitals and healthcare systems, health plans, vendors and academic institutions have been preparing in good faith to put systems in place to transition to ICD-10. A delay would cause an unnecessary setback.
4. Education Programs Are Underway. To ready the next generation of HIM professionals, academic institutions have set their curriculum for two-year, four-year, and graduate programs to include ICD-10.
5. Other Healthcare Initiatives Need ICD-10. ICD-10 is the foundation needed to support other national healthcare initiatives such as meaningful use, value-based purchasing, payment reform, quality reporting and accountable care organizations. Electronic health record systems being adopted today are ICD-10 compatible. Without ICD-10, the value of these other efforts is greatly diminished.
6. It Reduces Fraud. With ICD-10, the detail of health procedures will be easier to track, reducing opportunities for unscrupulous practitioners to cheat the system.
7. It Promotes Cost Effectiveness. More accurate information will reduce waste, lead to more accurate reimbursement and help ensure that healthcare dollars are used efficiently.

If ICD-10 Is Delayed:

1. Resources Will Be Lost. For the last three years, the healthcare community has invested millions of dollars analyzing their systems, aligning resources and training staff for the ICD-10 transition.
2. Costs Will Increase. A delay will cause increased implementation costs, as many healthcare providers and health plans will need to maintain two systems (ICD-9 and ICD-10). Delaying ICD-10 increases the cost of keeping personnel trained and prepared for the transition. Other systems, business processes, and operational elements also will need upgrading. More resources will be needed to repeat some implementation activities if ICD-10 is delayed.
3. Jobs Will Be Lost.To prepare for the transition, many hospitals and healthcare providers have hired additional staff whose jobs will be affected if ICD-10 is delayed.

And Finally…

We Can’t Wait for ICD-11. The foundations of ICD-11 rest on ICD-10 and the foundation must be laid before a solid structure can be built. ICD-11 will require the development and integration of a new clinical modification system. Even under ideal circumstances, ICD-11 is still several years away from being ready for implementation in the United States.*

In a report by Tom Sullivan (Health Care Finance News, February 16, 2012), Christopher Chute, MD, who chairs the ICD-11 Revision Steering Group, warned of a possible further delay for completion of ICD-11 from 2015 to 2016.

Implementation of ICD-11 has already been shifted from 2012 to 2014, then last year, to 2015+. These are projections for pilot, then global implementation for ICD-11.

The DHHS Office of the Secretary Final Rule document, February 2009, stated:

“We estimated that the earliest projected date to begin rulemaking for implementation of a U.S. clinical modification of ICD–11 would be the year 2020.”

Canada uses a clinical modification of ICD-10 called ICD-10-CA. WHO-FIC meeting materials suggest that Canada might not move onto ICD-11 (or a modification of ICD-11) until 2018+.  Australia, which uses a clinical modification of ICD-10 called ICD-10-AM, is discussing potentially earlier adoption of ICD-11.

Round-up: Recent commentaries by Allen Frances, MD, on a DSM-5 in distress

Round-up: Recent commentaries by Allen Frances, MD, on a DSM-5 in distress

Post #146 Shortlink: http://wp.me/pKrrB-1X2

Allen Frances’ Blog at Huffington Post

DSM 5 Freezes Out Its Stakeholders

Allen Frances, MD | February 21, 2012

Scary news. The Chair of the DSM 5 Task Force, Dr. David Kupfer, has indicated that 90 percent of the decisions on DSM 5 have already been made.

Why so scary? DSM 5 is the new revision of the psychiatric diagnosis manual, meant to become official in May 2013. It proposes a radical redefinition of the boundary between mental disorder and normality, greatly expanding the former at the expense of the latter. Understandably, this ambitious medicalization of the human condition has generated unprecedented opposition, both from the public and from mental heath professionals. To top it off, the DSM 5 proposals are poorly written, unreliable, and likely to cause the misdiagnosis and the excessive treatment of millions of people.

Under normal circumstances the DSM 5 team would have taken the many criticisms to heart, gone back to the drawing board, and improved the quality and acceptability of their product. After all, the customer is very often right. But this DSM process has been strangely secretive, unable to self-correct, and stubbornly closed to suggestions coming from outside. As a result, current DSM 5 proposals show very little improvement over poorly done first drafts posted in February 2010.

Is there any hope of a last-minute save? I have gathered opinions from three well-informed DSM 5 watchers. They were asked to assess the current state of DSM 5 and offer suggestions about future prospects. The first comment comes from Suzy Chapman, a public advocate, whose website provides the most comprehensive documentary source on the development of DSM 5 and ICD-11. Ms Chapman writes:

DSM 5 consistently misses every one of its deadlines and then fails to update its website with a new schedule. The Timeline was finally revised a couple of weeks ago, but we are still no nearer to a firm date for the final period of invited public comment. We’ve known since November that DSM 5 is stuffed as far as its planned January-February comment period and that Dr Kupfer now reckons “no later than May” – but all the website says is “Spring.” That’s no use to those of us who need to alert patient groups and their professional advisers…

Psychology Today

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D.

ICD-10-CM Delay Removes Excuse For Rushing DSM 5 Into Premature Publication: Time needed to avoid harmful document

Allen Frances, MD | February 22, 2012

Until yesterday, there were only two reasons to stick with the projected date of DSM 5 publication (May 2013): 1) the need to coordinate DSM 5 with ICD-10-CM coding, which was scheduled to start Oct 2013; and, 2) the need to protect APA publishing profits in order to meet budget projections.

The first reason just dropped out. Health and Human Services (HHS) Secretary Kathleen G. Sebelius has announced that the start date for ICD-10-CM has been postponed. It is not yet clear for how long, but most likely a year (see http://www.dhhs.gov/news/press/2012pres/02/20120216a.html ).

also on Psychiatric Times

Registration required for access

ICD-10-CM Delay Removes Excuse For Rushing DSM-5 Into Premature Publication

and Education Update

Psychology Today

DSM5 in Distress

DSM 5 to the Barricades on Grief

Defending The Indefensible

Allen Frances, MD | February 18, 2012

The storm of opposition to DSM 5 is now focused on its silly and unnecessary proposal to medicalize grief. DSM 5 would encourage the diagnosis of ‘Major Depressive Disorder’ almost immediately after the loss of a loved one—having just 2 weeks of sadness and loss of interest along with reduced appetite, sleep, and energy would earn the MDD label (and all too often an unnecessary and potentially harmful pill treatment). This makes no sense. To paraphrase Voltaire, normal grief is not ‘Major’, is not ‘Depressive,’ and is not ‘Disorder.’ Grief is the normal and necessary human reaction to love and loss, not some phony disease.

All this seems perfectly clear to just about everyone in the world except the small group of people working on DSM 5. The press is now filled with scores of shocked articles stimulated by two damning editorial pieces in the Lancet and a recent prominent article in the New York Times.

The role of public defender of DSM 5 has fallen on John Oldham MD, president of the American Psychiatric Association…

Psychology Today

DSM5 in Distress

Allen Frances, MD | February 17, 2012

Lancet Rejects Grief As a Mental Disorder: Will DSM 5 Finally Drop This Terrible Idea

The Lancet is probably the most prestigious medical journal in the world. When it speaks, people listen. The New York Times is probably the most prestigious newspaper in the world. Again, when it speaks, people usually listen. The Lancet and The New York Times have both spoken on the DSM-5 foolishness of turning grief into a mental disorder. Will DSM-5 finally listen?

Here are some selected quotes from today’s wonderful Lancet editorial
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60248-7/fulltext

Previous DSM editions have highlighted the need to consider, and usually exclude, bereavement before diagnosis of a major depressive disorder. In the draft version of DSM-5 , however, there is no such exclusion for bereavement, which means that feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than 2 weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction.”

“Medicalising grief, so that treatment is legitimized routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed…”

Psychology Today

DSM5 in Distress

DSM 5 Minor Neurocognitive Disorder: Let’s Wait For Accurate Biological Tests

Allen Frances, MD | February 16, 2012

Within the next 3-5 years, we will likely have biological tests to accurately diagnose the prodrome of Alzheimer’s disease (AD). Much remains to be done in standardizing these tests, determining their appropriate set points and patterns of results, and negotiating the difficult transition from research to general clinical practice. And, given the lack of effective treatment, there are legitimate concerns about the advisability of testing for the individual patient and the enormous societal expense with little tangible benefit. Despite these necessary caveats, there is no doubt that biological testing for prodromal AD will be an important milestone in the clinical application of neuroscience.

How does this impact on the DSM 5 proposal to include a Minor Neurocognitive Disorder as a presumed prodrome to AD…

Psychology Today

DSM5 in Distress

PTSD, DSM 5, and Forensic Misuse: DSM 5 would lead to overdiagnosis in legal cases.

Allen Frances, MD | February 09, 2012

In preparing DSM IV, we worked hard to avoid causing confusion in forensic settings. Realizing that lawyers read documents in their own special way, we had a panel of forensic psychiatrists go over every word to reduce the risks that DSM IV could be misused in the courts. They did an excellent job, but all of us missed one seemingly small mistake– the substitution of an ‘or’ for an ‘and’ in the paraphilia section that lead to serious misunderstandings and the questionably constitutional preventive psychiatric detention of sexual offenders.

DSM 5 is about to make a very different, less crucial, but still consequential forensic mistake. The proposed A criterion for PTSD includes the following wording…

Psychology Today

DSM5 in Distress

Documentation That DSM 5 Publication Must Be Delayed because DSM 5 is so far behind schedule

Allen Frances, MD | February 07, 2012

I wrote last week that DSM 5 is so far behind schedule it can’t possibly produce a usable document in time for its planned publication date in May 2013. My blog stimulated two interesting responses that illustrate the stark contrast between DSM 5 fantasy and DSM 5 reality. Together they document just how far behind its schedule DSM 5 has fallen and illustrate why publication must be delayed if things are to be set right.

The first email came from Suzy Chapman of http://dxrevisionwatch.wordpress.com …

also on Psychiatric Times

Registration required for access

Documentation That DSM-5 Publication Must Be Delayed

Additional coverage of DSM-5 controversies

Sidney Morning Herald

About-turn on treatment of the young

Amy Corderoy | February 20, 2012

CONCERNS about the overmedication of young people and rigid models of diagnosis have led the architect of early intervention in Australian psychiatry, Patrick McGorry, to abandon the idea pre-psychosis should be listed as a new psychiatric disorder.

The former Australian of the Year had previously accepted the inclusion of pre-psychosis – a concept he and colleagues developed – in the international diagnostic manual of mental disorders, or DSM, which is being updated this year.

Professor McGorry has been part of a team researching pre- and early-psychosis, and his work in the latter helped secure a massive $222.4 million Commonwealth funding injection for Early Psychosis Prevention and Intervention Centres across Australia…

Sidney Morning Herald

Suffer the children under new rules

Kathryn Wicks | Opinion | February 20, 2012

Canberra Times

A new chapter for psychiatrists’ bible

Amy Corderoy | February 19, 2012

Madness is being redesigned. The Diagnostic and Statistical Manual of Mental Disorders (DSM) will be updated this year, meaning what counts as a psychiatric disorder will change.

Frances, one of the architects of the current manual, DSM-IV, published in 1994, knows the results of his changes to the definitions of mental illness.

“We were definitely modest, conservative and non-ambitious in our approach to DSM-IV,” he says. “Yet we had three epidemics on our watch…”

“Bodily Distress Disorders” to replace “Somatoform Disorders” for ICD-11?

“Bodily Distress Disorders” to replace “Somatoform Disorders” for ICD-11?

Post #145 Shortlink: http://wp.me/pKrrB-1Vx

The information in this report relates only to proposals for the forthcoming ICD-11; it does not relate to ICD-10 or the forthcoming US specific “clinical modification” of ICD-10, ICD-10-CM.

Part One

This report contains an important update on proposals for ICD-11 Chapter 5: Mental and behavioural disorders.

In a February 16 report by Tom Sullivan for Health Care Finance News, Christopher Chute, MD, who chairs the ICD Revision Steering Group, warns of a possible delay for completion of ICD-11 from 2015 to 2016. Nevertheless, the ICD-11 Beta drafting platform remains scheduled to launch in May, this year.

The Beta drafting platform will take the form of a publicly viewable browser similar to the Alpha drafting platform that has been in the public domain since last May.

You can view the Alpha Drafting Browser here:

Foundation Component view:

http://apps.who.int/classifications/icd11/browse/f/en

Morbidity Linearization view:

http://apps.who.int/classifications/icd11/browse/l-m/en

The Morbidity Linearization is the view that includes (what may be temporarily assigned) sorting codes. These codes are likely to change as chapter organization progresses. Click on the small grey arrows next to the chapters and categories to display parent > child > grandchildren hierarchies. Click on individual terms to display descriptive content in the right hand frame of the Alpha Browser.

Textual content for ICD-11 is in the process of being written and population of content for some chapters is more advanced than others. Content for some of these “ICD-11 Content Model parameters” may display: ID legacy code from ICD-10 (where applicable); Definition; Inclusions; Exclusions; Body Site; Causal Mechanism; Signs and Symptoms.

(For ICD-11, entities will be defined through up to 13 “Content Model parameters” across all chapters – considerably more descriptive content than in ICD-10 and a significant workload for the Topic Advisory Group members and managers who are generating the content for ICD-11.)

The Alpha Browser User Guide is here:

http://apps.who.int/classifications/icd11/browse/Help/en

This page of the User Guide sets out differences between Foundation view and Morbidity Linearization view.

The various ICD Revision Topic Advisory Groups (TAGs) are carrying out their work on a separate, more complex, multi-author drafting platform. Editing histories and “Category and Discussion Notes” are recorded so the progress of proposals and reorganization of ICD entities can be tracked, as the draft evolves.

When the Beta drafting platform launches, interested stakeholders will be invited to register for increased access and interaction with the drafting process by submitting comments and suggestions on draft content and proposals.

It is also possible to register for increased access to the Alpha drafting platform and for downloading PDFs of drafts for the “Print Versions for the ICD-11 Alpha Morbidity Linearization” for all 25 chapters of ICD-11. These are obtainable, once registered and logged in, from the Linearization > Print Versions tab.

Caveats

I’m going to reiterate the ICD-11 Alpha Browser Caveats because it’s important to understand that the ICD-11 Alpha draft is a work in progress – not a static document – and is subject to change.

The draft is updated on a (usually) daily basis; when you view the Alpha Browser, you are viewing a “snapshot” of how the publicly viewable draft stood at the end of the previous day; not all chapters are as advanced as others for reorganization or population of content; the draft is incomplete and may contain errors and omissions.

The codes and “sorting labels” assigned to ICD parent classes, child and grandchildren terms are subject to change as reorganization of the chapters progresses. The Alpha draft has not yet been approved by the Topic Advisory Groups, Revision Steering Group or WHO and proposals for, and content in the draft may not progress to the Beta drafting stage – so be mindful of the fact that the draft is in a state of flux.

We may have a clearer idea of what is being proposed once the Beta drafting platform is released, but as it currently stands, the Alpha lacks clarity; not all textual content will have been generated and uploaded for terms imported from ICD-10 and there may be no definitions or other textual content displaying for proposed new terms.

Two chapters that are a focus of this site are Chapter 5: Mental and behavioural disorders and Chapter 6: Disorders of the nervous system (the Neurology chapter). (ICD-11 is dropping the use of Roman numerals.)

I won’t be reporting on specific categories in Chapter 6 in this post but will do a follow up post for Chapter 6 in a few days; again, there is a lack of clarity for Chapter 6 and requests for specific clarifications, last year, from the chair of Topic Advisory Group Neurology and the lead WHO Secretariat for TAG Neurology have met with no response.

Continued on Page 2: Somatoform Disorders in ICD-10; Somatoform Disorders to Bodily Distress Disorders for ICD-11?

Pages: 1 2

Round-up: media coverage following Lancet’s criticism of DSM-5 proposals for grief

Round-up: media coverage following Lancet’s criticism of DSM-5 proposals for grief

Post #144 Shortlink: http://wp.me/pKrrB-1V2

Previous Post #143:

Criticism of DSM-5 proposals for grief in this week’s Lancet: Editorial and Essay

Bloggers

Christopher Lane, Ph.D.:  Good Grief: The APA Plans to Give the Bereaved Two Weeks to Conclude Their Mourning, Britain’s “Lancet” calls the proposal “dangerously simplistic and flawed.”

Allen Frances, MD: Lancet Rejects Grief As a Mental Disorder, Will DSM 5 Finally Drop This Terrible Idea

———————–

Media

———————–

Libby Purves, columnist and author, lost a son in his late teens to suicide.

The Times

Why must grief be a sign of mental illness?

Libby Purves | February 20, 2012

Treating the bereaved for depression after two weeks typifies our urge to medicalise everyday experience…

Content behind sub or paywall

———————–

Medscape

From Medscape Medical News > Psychiatry

Lancet Weighs in on DSM-5 Bereavement Exclusion

Megan Brooks | February 16, 2012

February 16, 2012 — An editorial that appears in this week’s Lancet expresses concerns about the proposed elimination of the bereavement exclusion to major depression in the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association (APA)…

Read on

———————–

Daily Mail

Lancet urges doctors to treat grief with empathy, not pills

Lauren Paxman | February 17, 2012

‘Grief is not a mental illness that should be treated with pills’: Doctors hit back at creeping medicalisation of life events

Treatment of grief with antidepressants is ‘dangerously simplistic’, experts say

Backlash follows the American Psychiatric Association’s reclassification of grief as a mental illness. In an unsigned editorial in the influential medical journal The Lancet, experts argue that grief does not require psychiatrists and that ‘legitimising’ the treatment of grief with antidepressants ‘is not only dangerously simplistic, but also flawed.’ 

Read on

———————–

ABC News Radio

February 17, 2012

Grief: Normal, Not A Mental Illness

(NEW YORK) — Grief following the death of a loved one isn’t a mental illness that requires psychiatrists and antidepressants, according to editors of The Lancet, who oppose “medicalizing” an often-healing response to overwhelming loss.

Routinely legitimizing the treatment of grief with antidepressants “is not only dangerously simplistic, but also flawed,” says the unsigned lead editorial appearing in Friday’s edition of the influential international medical journal. “Grief is not an illness; it is more usefully thought of as part of being human and a normal response to the death of a loved one.”

Read On

———————–

The Australian

Individual difference suffers in the neverending explosion of mental illness

Frank Furedi | February 18, 2012

YOU may be suffering from a mental illness that you never realised existed. The American Psychiatric Association has just published a draft version of the updated edition of its Diagnostic and Statistical Manual. According to this diagnostic bible, called DSM-5, shyness in children and confusion over gender is likely to be labelled as a mental disorder.

Read on for subscribers

———————–

TIME

Depression

Good Grief! Psychiatry’s Struggle to Define Mental Illness Goes Awry

A proposed new definition of depression would include normal bereavement. Why that’s a bad idea.

Maia Szalavitz | @maiasz | February 17, 2012

The editors of the forthcoming fifth edition of the Diagnostic and Statistical Manual — psychiatry’s diagnostic handbook — are having a hard time. They’ve been attacked by autism advocacy groups for proposing to eliminate the Asperger’s diagnosis. They’ve been slammed for adding a diagnosis, or “prediagnosis,” for people determined to be “at high risk” of developing schizophrenia. And, now, they’re being pummeled for introducing a provision to diagnose grief as depression…

Read on

———————–

Telegraph

Grief is not an illness, warns The Lancet

Stephen Adams Medical Correspondent | February 17, 2012

Bereaved relatives overcome by grief should not be given pills and treated as if they are clinically depressed, a leading medical journal warns today (Fri).

“Grief is not an illness”, say the journal’s editors in an impassioned editorial, which argues that “medicalising” such a normal human emotion is “not only dangerously simplistic, but also flawed”.

Doctors tempted to prescribe pills “would do better to offer time, compassion, remembrance and empathy”, they write.

The editors are worried by moves which appear to categorise extreme emotions as problems that need fixing.

Their fears have been prompted by the publication of a new draft version of the psychiatrists’ ‘bible’, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, known as DSM-5…

Read on

———————–

Inside Ireland

The Lancet: Grief is not an illness

Sarah Greer | February 17, 2012

A leading medical journal has today warned that bereaved relatives should not be given pills and treated as if they are clinically depressed.

“Grief is not an illness,” the journal’s editors say. They argue that ‘medicalising’ such a normal human emotion is ‘not only dangerously simplistic, but also flawed’, and say doctors who are tempted to prescribe pills ‘would do better to offer time, compassion, remembrance and empathy’.

The editors are worried by moves which appear to categorise extreme emotions as problems that need fixing…

Read on

———————–

Criticism of DSM-5 proposals for grief in this week’s Lancet: Editorial and Essay

Criticism of DSM-5 proposals for grief in this week’s Lancet: Editorial and Essay

Post #143 Shortlink: http://wp.me/pKrrB-1Um

Update:

Christopher Lane Ph.D. has blogged at Side Effects at Psychology Today

Side Effects
From quirky to serious, trends in psychology and psychiatry.
by Christopher Lane, Ph.D.

Good Grief: The APA Plans to Give the Bereaved Two Weeks to Conclude Their Mourning

Britain’s “Lancet” calls the proposal “dangerously simplistic and flawed.”

Published on February 17, 2012 by Christopher Lane, Ph.D. in Side Effects

Allan Frances, MD, former chair of DSM-IV Task Force has blogged in DSM5 in Distress at Psychology Today

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D.

Lancet Rejects Grief As a Mental Disorder

Will DSM 5 Finally Drop This Terrible Idea

Published on February 17, 2012 by Allen J. Frances, M.D. in DSM5 in Distress

 

This week in the Lancet

The lead Editorial in this week’s Lancet expresses concerns about specific proposals for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

The misclassification of grief as a mental illness

An Editorial expresses concerns about the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While previous editions of DSM have highlighted the need to consider, and usually exclude, bereavement before diagnosis of a major depressive disorder, the current draft of this fifth edition fails to do that. In this week’s The Art of Medicine Arthur Kleinma reflects on his own personal experiences of grief and continues the discussion on the classification of grief as a mental illness. Finally, a Comment asks if attenuated psychosis syndrome should be included in DSM-5.

Lancet Editorial: Grief is not an illness and should not be routinely treated with antidepressants (Full text)

The Lancet, Volume 379, Issue 9816, Page 589, 18 February 2012 doi:10.1016/S0140-6736(12)60248-7 
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60248-7/fulltext

Also includes reference to ICD-11:

“WHO’s International Classification of Diseases, currently under revision as ICD-11, is debating a proposal to include “prolonged grief disorder”, but it will be another 18 months before that definition will be clear.” Editorial, The Lancet, Page 589, 18 February 2012

Essay: Culture, bereavement, and psychiatry (Full text)

The Lancet, Volume 379, Issue 9816, Pages 608 – 609, 18 February 2012 doi:10.1016/S0140-6736(12)60258-X
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60258-X/fulltext

Comment: Should attenuated psychosis syndrome be included in DSM-5? (Subscription or payment required)

The Lancet, Volume 379, Issue 9816, Pages 591 – 592, 18 February 2012 doi:10.1016/S0140-6736(11)61507-9
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61507-9/fulltext

Previous Lancet article on DSM-5

The first flight of DSM-5 | Niall Boyce

The Lancet, Volume 377, Issue 9780, Pages 1816 – 1817, 28 May 2011 doi:10.1016/S0140-6736(11)60743-5

HHS Secretary Sebelius announces intent to delay ICD-10-CM compliance date

HHS Secretary Sebelius announces intent to delay ICD-10-CM compliance date

Post #142 Shortlink: http://wp.me/pKrrB-1Ux

Coverage today of the announcement by Health and Human Services (HHS) Secretary Kathleen G. Sebelius of intent to delay ICD-10-CM compliance date.

Will American Psychiatric Association Board of Trustees take this opportunity to delay its DSM-5 timeline, take a breathing space, and reconsider its controversial proposals for DSM-5, or submit them to independent scientific scrutiny?

Link to report at end of post also quotes Chris Chute, Chair, ICD-11 Revision Steering Group, on possible delay for completion of ICD-11 from 2015 to 2016 – no surprise that ICD Revision may be considering another shift of timeline given the technical ambitiousness of the revision project, the lack of resources and slipping targets for the Alpha and Beta drafts.

Tom Sullivan reports:

Should the U.S. delay the ICD-10 compliance deadline just one year, until 2014, then the WHO will have a beta of ICD-11 ready. And if Sisko’s gut is correct, and the new ICD-10 deadline flows into 2015, well, then a final version of ICD-11 will be fast-approaching.

When it arrives, currently slated for 2015 (but Chute said it could be 2016), the underlying structure of ICD-11 will be profoundly different than any anterior ICD.

“ICD-11 will be significantly more sophisticated, both from a computer science perspective and from a medical content and description perspective,” Chute explains. “Each rubric in ICD-11 will have a fairly rich information space and metadata around it. It will have an English language definition, it will have logical linkages with attributes to SNOMED, it will have applicable genomic information and underpinnings linked to HUGO, human genome standard representations.”

ICD-10, as a point of contrast, provides a title, a string, a number, inclusion terms and an index. No definitions. No linkages because it was created before the Internet, let alone the semantic web. No rich information space.”

 

HHS Secretary Kathleen Sebelius announces intent to delay ICD-10 compliance date

February 16, 2012 | Carl Natale, Editor, ICD10Watch

Health and Human Services (HHS) Secretary Kathleen G. Sebelius confirmed Wednesday that they will change the ICD-10 timeline.

A HHS press release stated they “will initiate the rulemaking process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).”

On Tuesday, Marilyn Tavenner, the acting administrator of the Centers for Medicare and Medicaid Services (CMS), said the agency will examine the ICD-10-CM/PCS timeline. Tavenner made the statement at a conference of the American Medical Association (AMA) National Advocacy Conference. The AMA has declared vigorous opposition to the medical coding system citing the cost, complexity and lack of perceived benefit to patients… Read on

 

CMS Public Affairs Press Release:

http://www.dhhs.gov/news/press/2012pres/02/20120216a.html

News Release
Contact: CMS Public Affairs
(202) 690-6145

FOR IMMEDIATE RELEASE
February 16, 2012

HHS announces intent to delay ICD-10 compliance date

As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.

“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.

Report:

http://www.healthcarefinancenews.com/news/could-us-skip-icd-10-and-leapfrog-directly-icd-11

Could the U.S skip ICD-10 and leapfrog directly to ICD-11?

February 16, 2012 | Tom Sullivan, Government Health IT

Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

Post #141 Shortlink: http://wp.me/pKrrB-1TL

On February 9, psychiatrist, Prof Nick Craddock, and psychologist, Prof Peter Kinderman, discussed the implications of proposals for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) at a Science Media Centre press briefing for invited journalists.

There has been significant UK and international media interest in mental health professionals’ concerns for a range of controversial proposals for DSM-5. Press coverage is being collated in this Dx Revision Watch post:

Media coverage of UK concerns over DSM-5 (Science Media Centre press briefing)

Commentaries from Allen Frances, MD, today, on Huffington Post:

Can the Press Save DSM 5 from Itself? 

“…The intense press scrutiny of DSM 5 is really just beginning. I know of at least 10 additional reporters who are preparing their work now for publication in the near future. And many of the journalists whose articles appeared during these last few weeks intend to stay on this story for the duration — at least until DSM 5 is published, and probably beyond. They understand that DSM 5 is a document of great individual and societal consequence — and that its impact and risks need a thorough public airing…”

and Christopher Lane, Ph.D. on Side Effects at Psychology Today

DSM-5 Controversy Is Now Firmly Transatlantic

Why the APA’s lower diagnostic thresholds are causing widespread concern.

“Proposed draft revisions to the DSM, which the American Psychiatric Association recently made available on its website, are stirring major controversy on both sides of the Atlantic…”  Read on

 

Science Media Centre has very kindly given permission to publish, in full, the comments provided by research and clinical professionals for use by the press:

DSM5: New psychiatry bible broadens definitions of mental illness to include normal quirks of personality

10.02.2012

Round-up comments

Tim Carey, Associate Professor at the Centre for Remote Health and Central Australian Mental Health Service, said:

“The DSM does not assist in understanding psychological distress nor in treating it effectively. It does not “carve nature at its joints” as it were. It is a collection of symptom patterns that have no underlying form or structure. It is akin to an anthology of the constellations in the night sky. While it does not assist in understanding or treating psychological distress, it has generated phenomenal revenues for the APA, expanded the market for pharmaceutical companies, assisted in promulgating and maintaining a disease and illness model of psychological suffering, and constrained the focus of research activity. Are these the activities a humane and scientific society should seek to promote?

“The authors of the DSM themselves acknowledge the inadequacy of the DSM diagnostic system.

“On page xxxi of the latest edition of the DSM it states: ‘there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder. There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways’.

“So, according to the DSM authors, the boundaries demarcating ‘schizophrenia’ (for example) don’t separate ‘schizophrenia’ from ‘depression’ (or social phobia or intermittent explosive disorder or post-traumatic stress disorder or …) or (perhaps most importantly) the boundaries don’t separate ‘schizophrenia’ from ‘no schizophrenia’.

“One would have to ask: if the function of creating particular categories is not to separate these categories from each other or from their absence, what exactly are they for?”

David Pilgrim, Professor of Mental Health Policy, University of Central Lancashire, said:

“It’s hard to avoid the conclusion that DSM-5 will help the interests of the drug companies and the wrong-headed belief of some mental health professionals (mainly most psychiatrists, but sadly all too often others as well). Some patients and many relatives also gain some advantages from diagnosis some of the time because it reduces the reality of the complexity of their experiences and their responsibilities within those existential struggles.

“Madness and misery exist but they come in many shapes and sizes and so they need to be appreciated in their very particular biographical and social contexts. At the individual level this should mean replacing diagnoses with tailored formulations, and for research purposes we should be either looking at single symptoms or shared predicaments of those with mental health problems and their significant others. I worry that we risk treating the experience and conduct of people as if they are botanical specimens waiting to be identified and categorised in rigid boxes – in my opinion that would itself be a form of collective madness for all those complicit in the continuing pseudo-scientific exercise.”

Dr Felicity Callard, Senior Research Fellow, Service User Research Enterprise, Institute of Psychiatry, King’s College London, said:

“The ongoing chaos surrounding the development of DSM-5 has intensified rather than lessened fears that this project is ill-conceived and founded on a weak evidence base. People’s lives can be altered profoundly – and, we should bear in mind, sometimes ruinously – by being given a psychiatric diagnosis. In my opinion, that the architects of DSM-5 are pressing on with such a flawed framework undermines their claim that they wish to produce a DSM that is ‘useful to all health professionals, researchers and patients’.”

Dr Paul Keedwell, Honorary Consultant Psychiatrist and Clinical Lecturer in the Neurobiology of Mood Disorders, Cardiff University, said:

“New findings arising from genetics and brain imaging studies hint at biological mechanisms, and challenge the way we classify disorders: syndromes (like bipolar and unipolar depression) might merge, while others (like “the schizophrenias”) might diverge. However a few more decades will pass before we radically change our existing classifications.

“Where the proposed DSMV is particularly controversial is in its addition of more disorders, like “Apathy Syndrome” and “Disruptive Mood Dysregulation Disorder”, which suggest a worrying trend toward medicalising normal variation in behaviour.

“Every new diagnosis implies a new treatment, suiting vested interests in the health industry. Nothing should enter the final version of DSMV without sound research evidence of the need for professionals to intervene.

“Also, every mental health professional should remember that classification systems are a guide to diagnosis only: they do not necessarily map on to the complex needs of an individual in real practice, and they are definitely not a guide to treatment.”

Allen Frances, Emeritus Professor at Duke University and Chair of the DSM-4 Steering Committee, said:

“DSM 5 will radically and recklessly expand the boundaries of psychiatry by introducing many new diagnoses and lowering the thresholds for existing ones. As an unintended consequence, many millions of people will receive inaccurate diagnosis and inappropriate treatment. Costs include: the side effects and complications of unnecessary medication; the perverse misallocation of scarce mental health resources toward those who don’t really need them (and may actually be harmed) and away from those who do most desperately require help; stigma; a medicalization of normality, individual difference, and criminality; and a reduced sense of personal responsibility. The publication of DSM 5 should be delayed until it can be subjected to a rigorous and independent review, using the methods of evidence based medicine, and meant to ensure that it is both safe and scientifically sound. New diagnoses can be as dangerous as new drugs and require a much more careful and inclusive vetting than has been provided by the American Psychiatric Association. Future revisions of psychiatric diagnosis can no longer be left to the sole responsibility of just one professional organization.”

David Elkins, Professor Emeritus of Psychology, Pepperdine University, Los Angeles, and Chair of the Division 32 Task Force for DSM-5 Reform, said:

“My committee and I remain very concerned the DSM-5, as currently proposed, could result in the widespread misdiagnosis of hundreds of thousands of individuals whose behaviour is within the continuum of normal variation. If this occurs, it means these individuals will be labelled with a mental disorder for life and many will be treated with powerful psychiatric drugs that can have dangerous side effects.

“We are also alarmed that the DSM-5 Task Force seems unresponsive to the concerns of thousands of mental health professionals and dozens of mental health associations from around the world.

“My committee recently asked the DSM-5 Task Force to submit the controversial proposals for review by an outside, independent group of scientists and scholars. Our request was denied.

“My committee launched the Open Letter/Petition Website which has now gathered more than 11, 000 individual signatures and endorsements from more than 40 from mental health associations including 13 other Divisions of the American Psychological Association.”

Dr Kevin Morgan, Senior Lecturer, Department of Psychology, University of Westminster, said:

“The proposed revisions to the diagnosis of schizophrenia i.e. the elimination of subtypes and the use instead of symptom dimensions, is an example of how DSM5 may prove to be more clinically beneficial than the current version of the manual. I wait with great interest to see the final agreed set of changes.”

Til Wykes, Professor of Clinical Psychology and Rehabilitation, Institute of Psychiatry, Kings College London, said:

“The proposals in DSM 5 are likely to shrink the pool of normality to a puddle with more and more people being given a diagnosis of mental illness. This may be driven by a health care system that reimburses only if the individual being treated has a recognised diagnosis – one in the DS manual. Luckily in the UK we have the NHS which treats people on the basis of need, not if they fit a diagnostic system.

“It isn’t just a health care system that is subverted by the spreading of diagnostic labels into normality, research will also be changed. Most research studies that reach the widest readership get published in US journals which will expect these diagnostic labels to have been used.

“We shouldn’t use labels unless we are clear they have some benefit. Saying someone is at risk of a mental illness (in some categories of DSM5) puts a lot of pressure on the individual and their family. When we do not have a good enough prediction mechanism, this is too high a burden.”

Dr David Harper, Reader in Clinical Psychology, University of East London, said:

“The American Psychiatric Association’s revisions of the DSM have become as regular as updates for Microsoft Windows and about as much use. It has facilitated an increasing medicalisation of life (the number of disorders the DSM covers has increased exponentially from its first edition in 1952 to 357 in 2000) and is hugely costly (the text revision of DSM IV made $44m in revenue between 2000 and 2006). The problem is not simply the revisions proposed in DSM 5 but the idea that psychological distress matches its diagnostic categories – people’s experiences of distress cluster in an entirely different manner. This is why most people end up with more than one diagnosis, why the ‘not otherwise specified’ category is massively over-used and why ratings of agreement between psychiatrists continue to be poor. The DSM represents a massive failure of imagination: most clinicians and researchers know the system is flawed but try to convince themselves, despite the evidence, that it aids communication, research and treatment. It does not. The frustrating thing is that there are other viable alternatives – for example, a focus on homogenous experiences of distress would aid research, the use of case formulation would aid treatment. Unfortunately, the pharmaceutical industry can see little profit in either alternative and, instead, continue to swing their considerable weight behind the DSM.”

Richard Bentall, Chair of Clinical Psychology at the University of Bangor, said:

“I share the widespread concerns about the proposed revisions to the DSM diagnostic system. Like earlier editions, this version of the manual is not based on coherent research into the causes or nature of mental illness. For example, it treats ‘schizophrenia’ and ‘bipolar disorder’ as separate conditions despite evidence that this is, at best, an over-simplification. It also looks set to widen some of the diagnostic criteria, for example by removing the grief exclusion from major depression, and by expanding the range of psychotic disorders to include an ‘attenuated psychosis syndrome’ (my own research on this, in press, shows that only about 10% of people meeting the attenuated or prodromal psychosis criteria are likely to go on to develop a full-blown psychotic illness). As there is no obvious scientific added value compared to DSM-IV, and as there are some obvious risks associated with this expansion of diagnostic boundaries, one is bound to ask why there is a need for this revision, or who will benefit from it. It seems likely that the main beneficiaries will be mental health practitioners seeking to justify expanding practices, and pharmaceutical companies looking for new markets for their products.”

Dr Lucy Johnstone, Consultant Clinical Psychologist, Cwm Taf Health Board, Mid Glamorgan, South Wales, said:

“The DSM debate is all about how we understand mental distress. DSM and the proposed revisions are based on the assumption that mental distress is best understood as an illness, mainly caused by genetic or biochemical factors. It is important to realise that, with the exception of a few conditions such as dementia, there is no firm evidence to support this. On the contrary, the strongest evidence is about psychological and social factors such as trauma, loss, poverty and discrimination. In other words, even the more extreme forms of distress are ultimately a response to life problems. We need a paradigm shift in the way we understand mental health problems. DSM cannot be reformed – it is based on fundamentally wrong principles and should be abandoned.”

Dr Warren Mansell, Reader in Psychology & Clinical Psychologist, University of Manchester, said:

“Contemporary research across genetics, neuroscience, psychology and culture all point to the fact that the majority of psychiatric disorders share the same underlying processes and are treated by very similar interventions. Therefore in further emphasising different categories of mental health problems, DSM5 is heading in completely the opposite direction from the most pioneering research across the field of mental health.”

Simon Wessely, Professor of Epidemiological and Liaison Psychiatry at the Institute of Psychiatry, King’s College London:

“We need to be very careful before further broadening the boundaries of illness and disorder. Back in 1840 the Census of the United States included just one category for mental disorder. By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision. Do we really need all these labels? Probably not. And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.”

Professor Sue Bailey, President of the Royal College of Psychiatrists, said:

“We recognise the importance of accurate and prompt diagnosis in psychiatry. The classification system used in NHS hospitals and referred to by UK psychiatrists is the World Health Organisation’s International Classification of Disease (ICD). Therefore, the publication of DSM-V will not directly affect diagnosis of mental illness in our health service.”

The British Psychological Society has released a statement on the DSM-5 which can be found here: BPS Statement on DSM-5

* The fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be published in May 2013 by the American Psychiatric Association.

Practice Central on ICD-10-CM transition; APA Monitor and WHO Reed on ICD-11

Two articles on forthcoming classification systems: the first on ICD-10-CM from Practice Central; the second on ICD-11 from the February 2012 edition of the American Psychological Association’s “Monitor on Psychology”

Post #140 Shortlink: http://wp.me/pKrrB-1Tt

Update: Medicare could delay burdensome rules on doctors | Julian Pecquet, for The Hill, February 14, 2012

“The acting head of the Medicare agency said Tuesday that she is considering giving the nation’s doctors more time to switch to a new insurance coding system that critics say would cost millions of dollars for little gain to patients.

“Marilyn Tavenner, the acting administrator of the Centers for Medicare and Medicaid Services, told a conference of the American Medical Association (AMA) that her agency could delay adoption of the so-called ICD-10 system. Current law calls for physicians to adopt the new codes next year…

“…Speaking to reporters after her prepared remarks, Tavenner said her office would formally announce its intention to craft new regulations “within the next few days.”

ICD-10 Deadline Review Update | Andrea Kraynak, for HealthLeaders Media, February 15, 2012

“Big news regarding the ICD-10-CM/PCS implementation timeline came Tuesday morning during the American Medical Association (AMA) National Advocacy Conference in Washington, DC.”

“Per CMS acting administrator Marilyn Tavenner, CMS plans to revisit the current implementation deadline of October 1, 2013. Tavenner said CMS wants to reexamine the pace of implementing ICD-10 and reduce physicians’ administrative burden, according to an AMA tweet…”

Practice Central: Resources for Practicing Psychologists

Practice Central, a service of the APA Practice Organization (APAPO), supports practicing psychologists in all settings and at all stages of their career. APAPO is a companion organization to the American Psychological Association. Our mission is to advance and protect your ability to practice psychology.

http://www.apapracticecentral.org/update/2012/02-09/transition.aspx

Practice Update | February 2012

Transition to the ICD-10-CM: What does it mean for psychologists?

Psychologists should be aware of and prepare for the mandatory shift to ICD-10-CM diagnosis codes in October 2013

By Practice Research and Policy staff

February 9, 2012—Beginning October 1, 2013 all entities, including health care providers, covered by the Health Insurance Portability and Accountability Act (HIPAA) must convert to using the ICD-10-CM diagnosis code sets. The mandate represents a fundamental shift for many psychologists and other mental health professionals who are far more attuned to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).

Most psychologists were trained using some version of DSM. For other health care providers, the World Health Organization’s International Classification of Diseases and Related Health Problems (ICD) – which contains a chapter on mental disorders – is the classification standard.

Over the years, efforts to harmonize these two classifications have resulted in systems with similar (often identical) codes and diagnostic names. In fact, even if psychologists record DSM diagnostic codes for billing purposes, payers recognize the codes as ICD-9-CM – the official version of ICD currently used in the United States. Since 2003, the ICD-9-CM diagnostic codes have been mandated for third-party billing and reporting by HIPAA for all…

Read full article here

 

Dr Geoffrey M. Reed, PhD, Senior Project Officer, WHO Department of Mental Health and Substance Abuse, is seconded to WHO through IUPsyS (International Union for Psychological Science). Dr Reed co-ordinates the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders.

Meetings of the International Advisory Group are chaired by Steven Hyman, MD, Harvard University, Cambridge, MA, a former Director of the National Institute of Mental Health (NIMH) and DSM-5 Task Force Member.

The Department of Mental Health and Substance Abuse will also be managing the technical part of the revision of Diseases of the Nervous System (currently Chapter VI), as it is doing for Chapter V.

February 2012 edition of the American Psychological Association’s “Monitor on Psychology”:

http://www.apa.org/monitor/2012/02/disorder-classification.aspx

Feature

Improving disorder classification, worldwide

With the help of psychologists, the next version of the International Classification of Diseases will have a more behavioral perspective.

By Rebecca A. Clay

February 2012, Vol 43, No. 2

Print version: page 40

What’s the world’s most widely used classification system for mental disorders? If you guessed the Diagnostic and Statistical Manual of Mental Disorders (DSM), you would be wrong.

According to a study of nearly 5,000 psychiatrists in 44 countries sponsored by the World Health Organization (WHO) and the World Psychiatric Association, more than 70 percent of the world’s psychiatrists use WHO’s International Classification of Diseases (ICD) most in day-to-day practice while just 23 percent turn to the DSM. The same pattern is found among psychologists globally, according to preliminary results from a similar survey of international psychologists conducted by WHO and the International Union of Psychological Science.

“The ICD is the global standard for health information,” says psychologist Geoffrey M. Reed, PhD, senior project officer in WHO’s Department of Mental Health and Substance Abuse. “It’s developed as a tool for the public good; it’s not the property of a particular profession or particular professional organization.”

Now WHO is revising the ICD, with the ICD-11 due to be approved in 2015. With unprecedented input from psychologists, the revised version’s section on mental and behavioral disorders is expected to be more psychologist-friendly than ever—something that’s especially welcome given concerns being raised about the DSM’s own ongoing revision process. (See “Protesting proposed changes to the DSM” .) And coming changes in the United States will mean that psychologists will soon need to get as familiar with the ICD as their colleagues around the world…

Read full article here

For more information about the ICD revision, visit the World Health Organization.

Rebecca A. Clay is a writer in Washington, D.C

ICD-11 Beta drafting platform for release in May 2012

ICD-11 Beta drafting platform for release in May 2012

Post #139 Shortlink: http://wp.me/pKrrB-1SE

ICD-11 Beta drafting platform

ICD Revision on Facebook has announced that a ‎4th Face to Face meeting of the ICD Revision Topic Advisory Group for Internal Medicine (TAG IM) was held recently, in Tokyo.

No agenda, meeting materials or documents have been posted on the ICD-11 Revision Google site but a PowerPoint presentation prepared by WHO’s, Dr Bedirhan Üstün, is viewable here on the “Slideshare” platform.

Dr Bedirhan Üstün is Coordinator, Classifications, Terminology and Standards, Department of Health Statistics and Information, WHO, Geneva.

You won’t need a PowerPoint .pptx format viewer to view this presentation on the Slideshare site, but you will need a .pptx viewer if you want to download and view the file. (A free .pptx viewer can be downloaded for free from the Microsoft site.)

In order to download the file, you will first need to register with Slideshare or use a Facebook membership as Sign in. If you do agree to download through a Facebook membership, please read and digest the T & C before you agree to Slideshare accessing your Facebook profile data.

View the presentation here:

http://www.slideshare.net/ustunb/tokyo-2012-ustun-show

Tokyo 2012 ustun (show) by Bedirhan Ustun on Feb 10, 2012

for which it states:

“WHO is revising the ICD to be completed by 2015. It is going to enter into a Beta phase by 2012 May during which all stakeholders could see and comment on the ICD as well as propose changes, test in practice.”

Slide #7 states:

• 2011  : Alpha version (ICD 11 alpha draft)

– + 1 YR  : Commentaries and consultations

• 2012  : Beta version & Field Trials Version

– + 2 YR Field Trials

• 2014   : Final version for public viewing

– 2015  : WHA Approval

• 2015+  implementation

Slides #11 and #12, set out the thirteen parameters of the ICD-11 “Content Model”.

 

The “Content Model”

ICD Revision says that the most important difference between ICD-10 and ICD-11 will be the Content Model.

Content in ICD-11 will be populated in accordance with the ICD-11 Content Model Reference Guide. There is the potential for considerably more content to be included for diseases, disorders and syndromes in ICD-11 than appears in ICD-10, across all chapters:

“Population of the Content Model and the subsequent review process will serve as the foundation for the creation of the ICD-11. The Content Model identifies the basic characteristics needed to define any ICD category through use of multiple parameters (e.g. Body Systems, Body Parts, Signs and Symptoms, Diagnostic Findings, Causal Agents, Mechanisms, Temporal Patterns, Severity, Functional Impact, Treatment interventions, Diagnostic Rules).”

This is the most recent available version of the Content Model Reference Guide January 2011

This iCAT Glossary page gives an overview of the 13 Content Model parameters.

See also Post #62: ICD-11 Content Model Reference Guide: version for December 2010

 

New Beta drafting browser

In May 2011, a publicly viewable ICD-11 Alpha Browser platform was launched.

In July 2011, this platform was opened up to professionals and other interested stakeholders who can register via the site for fuller access and for reading and submitting comments. See the ICD-11 Alpha Browser User Guide for information on how the Browser functions and how to register for increased access. (This is the Alpha/Beta “hybrid” referred to in the WHO-FIC Council conference call report, February 16, 2011: Page 6: PDF for Report)

ICD-11 Revision and Topic Advisory Groups are continuing to use a separate platform for drafting purposes.

Stakeholder participation at the Beta stage

In preparation for the Beta drafting stage, another publicly viewable platform is being developed. According to ICD Revision presentations, this platform will invite and support a higher level of professional and public interaction with the drafting process, with various levels of input and editing authority for interested stakeholders who register for participation. According to editing status, registered stakeholders would be permitted to:

Make comments
Make proposals to change ICD categories
Participate in field trials
Assist in translating

See presentation slides in Dx Revision Watch Posts #70 and #71:

ICD Revision Process Alpha Evaluation Meeting 11 – 14 April 2011: The Way Forward?

ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations

 

Slides #15 and #16 of Dr Üstün’s presentation show the methods via which interested stakeholders will be able to register for interaction with the platform.

I will update when more information becomes available on the launch of the Beta platform.

Media coverage of UK concerns over DSM-5

Media coverage of UK concerns over DSM-5 (Science Media Centre press briefing)

Post #138  Shortlink: http://wp.me/pKrrB-1R8

Update: See also

Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

Criticism of DSM-5 proposals for grief in this week’s Lancet: Editorial and Essay

Round-up: media coverage following Lancet’s criticism of DSM-5 proposals for grief

---

On February 9, UK Science Media Centre held a press briefing for invited journalists amid mounting concern from mental health professionals for controversial proposals for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).

DSM-5 is slated for publication in May 2013.

A third draft of proposed changes to DSM-IV categories and criteria is expected to be posted on the DSM-5 Development site, this May, for a two month long stakeholder review and feedback period.

This final review might be viewed as little more than a public relations exercise given the late stage in the drafting process – according to Task Force chair, David Kupfer, MD, “the revisions are about 90 percent complete.”

Those involved in the press briefing included:

Prof Nick Craddock, MRC Centre for Neuropsychiatric Genetics & Genomics, Cardiff University School of Medicine

Peter Kinderman, Professor of clinical psychology at the University of Liverpool; honorary appointment as consultant clinical psychologist with Merseycare NHS Trust and a former Chair of the British Psychological Society’s Division of Clinical Psychology

Both have research and clinical interests in schizophrenia, bipolar disorder and psychosis.

Psychologists and psychiatrists providing comment on their concerns for potential changes to DSM-IV, included Prof Nick Craddock, Prof Peter Kinderman, Allen Frances, MD, who had chaired the task force that had oversight of the drafting of DSM-IV, Prof Simon Wessely, Prof Richard Bentall, Dr Lucy Johnstone and Prof Til Wykes.

A Reuters News Alert by Kate Kelland, Health and Science Correspondent, issued on February 9, generated considerable interest and has been picked up by dozens of international news sites including Chicago Tribune, Orlando Sentinel, Windsor Star, Psychminded.co.uk, MSNBC, Montreal Gazette, Baltimore Sun and Vancouver Sun.

Professor Peter Kinderman and Dr David Kupfer who chairs the DSM-5 Task Force, debated concerns on Friday’s BBC Radio 4 “Today” programme (link for audio below).

Medical writer, Christopher Lane, author of How Normal Behaviour Became a Sickness, blogged, yesterday, at Side Effects at Psychology Today.

Side Effects
From quirky to serious, trends in psychology and psychiatry.
by Christopher Lane, Ph.D.

DSM-5 Controversy Is Now Firmly Transatlantic

Why the APA’s lower diagnostic thresholds are causing widespread concern.

Proposed draft revisions to the DSM, which the American Psychiatric Association recently made available on its website, are stirring major controversy on both sides of the Atlantic… Read on

John M Grohol, PsyD, editor at PsychCentral, is in a bit of a snit, here.

Comments provided by research and clinical professionals for the Science Media Centre DSM-5 press briefing here: http://wp.me/pKrrB-1TL

For around 100 links for news and media sites that have run DSM-5 stories in the past three weeks or so, open Word file here: Concerns for DSM-5 – Media coverage

Selected UK and international media coverage posted below, as it comes in, most recent at the top:

---

Insideireland.ie

Shyness: A mental illness?

Sarah Greer | February 13, 2012

British Psychological Society

Is shyness a mental illness?

February 13, 2012

Shyness in a child, and depression following the death of a loved one, could be classed as mental illness under new guidelines. The move could result in millions of people being placed at risk of having a psychiatric disorder, experts have warned.

Guardian

Comment is free

Do we need a diagnostic manual for mental illness?

Profs Richard Bentall and Nick Craddock discuss the controversial revisions to the US Diagnostic and Statistical Manual

Guardian, Comment is free | February 10, 2012

Friday round up…’hypersexual disorder’ is added to the psychiatric bible…

PULSE GP magazine  | February 10, 2012

Financial Times  (Registration may be required)

US mental guidelines attacked

Andrew Jack | February 10, 2012

ABC News

American Psychiatric Association Under Fire for New Disorders

Katie Moisse | February 10, 2012

Shyness, grief and eccentricity could suddenly become mental health disorders if the newest edition of the Diagnostic and Statistical Manual of Mental Disorders goes through as planned. But it won’t if more than 11,000 petitioners, most of whom are mental health professionals, have their way.

The DSM, the 900-page “bible” of psychiatric symptoms published by the American Psychiatric Association, has been around since 1952. But the fifth and latest edition, scheduled for publication in May 2013, has come under attack for “medicalizing” behaviors that some people would consider normal. The 11,000 petitioners are challenging proposed changes they say would label millions more Americans as mentally ill…

Read on

BBC News website and BBC Radio 4 Today programme

http://news.bbc.co.uk/today/hi/today/newsid_9694000/9694926.stm

0831
A new draft of the “psychiatric bible” – DSM5 – has provoked anger for its definitions of behaviours indicative of mental illness. Already, more than 11,000 have signed a petition calling for it to be rewritten and re-thought. David Kupfer who chairs the DSM 5 committee for the American Psychiatric Association, which put the book together, and Peter Kinderman, professor and honorary consultant clinical psychologist with Mersey Care NHS Trust, debate its pros and cons.

Quirk or mental illness?

[Audio interviews with DSM-5 Task Force Chair, David Kupfer, and Prof Peter Kinderman]

The new psychiatric bible, DSM 5, which is the world’s most widely used psychiatric reference book, has been released in draft form. Already, more than 11,000 people have signed a petition calling for it to be rewritten and re-thought. Some claim the new edition broadens the range of behaviours considered indicative of mental illnesses to a point where normal quirks of personality will lead to erroneous diagnoses.

David Kupfer who chairs the DSM 5 committee for the American Psychiatric Association, which put the book together, and Peter Kinderman, professor and honorary Consultant Clinical Psychologist with Mersey Care NHS Trust, debate the pros and cons of the book.

Behind a subscription or pay for access

BMJ News

News
Critics attack DSM-5 for overmedicalising normal human behaviour
BMJ 2012; 344 doi: 10.1136/bmj.e1020 (Published 10 February 2012)
Cite this as: BMJ 2012;344:e1020

News Bullet.in

Grieving, shyness to be called mental illness

Courtesy: Fox News | February 10,  2012

MILLIONS of healthy people – including shy or defiant children, grieving relatives and people with fetishes – may be wrongly labeled mentally ill by a new international diagnostic manual according to a report which appeared in Fox News.

The new classification is expected to figure in the influential Diagnostic and Statistical Manual of Mental Disorders (DSM). According to Fox News, psychologists, psychiatrists and mental health experts said its new categories and “tick-box” diagnosis systems were at best “silly” and at worst “worrying and dangerous…”

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Daily Mail

Shyness in a child and depression after bereavement could be classed as mental illness in controversial new reforms

Jenny Hope | February 9, 2012

Childhood shyness could be reclassified as a mental disorder under controversial new guidelines, warn experts.

They also fear that depression after bereavement and behaviour now seen as eccentric or unconventional will also become ‘medicalised’…

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Telegraph

also Independent.ie

Shyness could be defined as a mental illness

By Donna Bowater | February 10, 2012

SHYNESS, bereavement and eccentric behaviour could be classed as a mental illness under new guidelines, leaving millions of people at risk of being diagnosed as having a psychiatric disorder, experts fear.

Under changes planned to the diagnosis handbook used by doctors in the US, common behavioural traits are likely to be listed as a mental illness, it was reported…

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Independent

Lonely? Shy? Sad? Well now you’re ‘mentally ill’, too

Expanded psychiatric ‘bible’ will see more people needlessly medicated, experts warn

Jeremy Laurance | February, 10 2012

Mild eccentrics, oddball romantics and the lonely, shy and sad could find themselves diagnosed with a mental disorder if proposals to add new conditions to the world’s most widely used psychiatric bible go ahead, experts have warned.

A major revision of the the 1994 Diagnostic and Statistical Manual of Mental Disorders, whose fifth edition is due for publication next year, threatens to extend psychiatric diagnoses to millions of people currently regarded as normal, they say. Among the diagnostic labels are “oppositional defiance disorder” for challenging adolescents, “gambling disorder” for those compelled to have a flutter, and “hypersexual disorder” for those who think about sex at least once every 20 minutes. People crippled by shyness or suffering from loneliness could be diagnosed with “dysthymia”, defined as “feeling depressed for most of the day”.

More worrying, according to some experts, are attempts to redefine crimes as illnesses, such as “paraphilic coercive disorder”, applied to men engaged in sexual relationships involving the use of force. They are more commonly known as rapists…

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Psych Central Blogs

Could Sadness And Shyness Be Mental Illnesses?

Richard Zwolinski, LMHC, CASAC | February 10, 2012

C.R. writes: No. The title of this blog post isn’t a joke. It is based on a series of alarming articles I just read about the new edition of the perennially controversial DSM.

 

In a Reuters piece, Peter Kinderman, a British clinical psychologist and head of the Institute of Psychology at Liverpool University was quoted as saying:

 

“The proposed revision to DSM … will exacerbate the problems that result from trying to fit a medical, diagnostic system to problems that just don’t fit nicely into those boxes,” said Peter Kinderman at a briefing about widespread concerns over the book in London.

 

He said the new edition – known as DSM-5 – “will pathologise a wide range of problems which should never be thought of as mental illnesses”.

 

“Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill,” he said. “It’s not humane, it’s not scientific, and it won’t help decide what help a person needs…”

 

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Wales Online

Fears that grieving relatives could be labelled mentally ill

Madeleine Brindley Health Editor | February 10, 2012

CHANGES to the American “bible” of mental health disorders could see grieving relatives labelled mentally ill, experts have claimed.

In a backlash to the proposed reforms to the fourth version of the Diagnostic and Statistical Manual of Mental Disorders – known as DSM-5 – thousands of experts have spoken out against the changes…

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Guardian

Psychologists fear US manual will widen mental illness diagnosis
Mental disorders listed in publication that should not exists, warn UK experts

Sarah Boseley Health editor | February 9, 2012

Hundreds of thousands of people will be labelled mentally ill because of behaviour most people would consider normal, if a new edition of what has been termed the psychiatrists’ diagnostic bible goes ahead, experts are warning…

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Reuters | February 9, 2012

Shyness an illness in “dangerous” health book-experts

• Grieving relatives could be classed as ill

• Revisions mean broader diagnoses of mental disorders

• Petition signed by 11,000 health workers calls for halt

By Kate Kelland, Health and Science Correspondent

LONDON, Feb 9 (Reuters) – Millions of healthy people – including shy or defiant children, grieving relatives and people with fetishes – may be wrongly labelled mentally ill by a new international diagnostic manual, specialists said on Thursday.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and mental health experts said its new categories and “tick-box” diagnosis systems were at best “silly” and at worst “worrying and dangerous”.

Some diagnoses – for conditions like “oppositional defiant disorder” and “apathy syndrome” – risk devaluing the seriousness of mental illness and medicalising behaviours most people would consider normal or just mildly eccentric, the experts said.

At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers – under labels like “paraphilic coercive disorder” – and may allow offenders to escape prison by providing what could be seen as an excuse for their behaviour, they added.

The DSM is published by the American Psychiatric Association (APA) and has descriptions, symptoms and other criteria for diagnosing mental disorders. It is used internationally and is seen as the diagnostic “bible” for mental health medicine.

More than 11,000 health professionals have already signed a petition (at http://dsm5-reform.com ) calling for the development of the fifth edition of the manual to be halted and re-thought.

“The proposed revision to DSM … will exacerbate the problems that result from trying to fit a medical, diagnostic system to problems that just don’t fit nicely into those boxes,” said Peter Kinderman, a clinical psychologist and head of Liverpool University’s Institute of Psychology at a briefing about widespread concerns over the book in London.

He said the new edition – known as DSM-5 – “will pathologise a wide range of problems which should never be thought of as mental illnesses”.

“Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labelled as mentally ill,” he said. “It’s not humane, it’s not scientific, and it won’t help decide what help a person needs.”

RADICAL, RECKLESS, AND INHUMANE

Simon Wessely of the Institute of Psychiatry, King’s College London said a look back at history should make health experts ask themselves: “Do we need all these labels?”

He said the 1840 Census of the United States included just one category for mental disorder, but by 1917 the APA was already recognising 59. That rose to 128 in 1959, to 227 in 1980, and again to around 350 disorders in the fastest revisions of DSM in 1994 and 2000.

Allen Frances, Emeritus professor at Duke University and chair of the committee that oversaw the previous DSM revision, said the proposed DSM-5 would “radically and recklessly expand the boundaries of psychiatry” and result in the “medicalisation of normality, individual difference, and criminality”.

As an unintended consequence, he said an emailed comment, many millions of people will get inappropriate diagnoses and treatments, and already scarce funds would be wasted on giving drugs to people who don’t need them and may be harmed by them.

Nick Craddock of Cardiff University’s department of psychological medicine and neurology, who also spoke at the London briefing, cited depression as a key example of where DSM’s broad categories were going wrong.

Whereas in previous editions, a person who had recently lost a loved one and was suffering low moods would be seen as experiencing a normal human reaction to bereavement, the new DSM criteria would ignore the death, look only at the symptoms, and class the person as having a depressive illness.

Other examples of diagnoses cited by experts as problematic included “gambling disorder”, “internet addiction  disorder” and “oppositional defiant disorder” – a condition in which a child “actively refuses to comply with majority’s requests” and “performs deliberate actions to annoy others”.

“That basically means children who say ‘no’ to their parents more than a certain number of times,” Kinderman said. “On that criteria, many of us would have to say our children are mentally ill.” (Reporting by Kate Kelland; Editing by Andrew Heavens)