Psychiatry: DSM vs. biological reality

[aphar]

Looks like I am not alone in being unhappy with the DSM approach:

2013: NIMH director says the DSM lacks biological validity in its diagnoses:
Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.

2017: Insel brought to NIMH a commitment to finding neurochemical and other quantifiable markers for psychiatric disorders rather than relying on behavior and self-reported feelings:
I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.

Any volunteers to repeat the Rosenhan experiment? (Note that modern drugs are probably much more powerful than those used 40 years ago, so the experiment is much more dangerous!)

Comments

[aphar]

drugs are different, there are NOT more powerful.
if anything, they are LESS powerful, with fewer side effects
Nice to hear this!

the approaches to hospitalization are different, much more autonomy
could you please be more specific?

i have not idea what do you mean by "conservative"
don't prescribe drugs unless absolutely confident that the diagnosis is correct and the drugs are necessary.

[signamax]

3. why not?

[aphar]

3. why not?
huh?

[signamax]

you made 3 statements

i referred to the 3d one

[aphar]

where did I make 3 statements?
what is the statement (as opposed to "definition") are you referring to?

[signamax]

1. " drugs are different, there are NOT more powerful.
if anything, they are LESS powerful, with fewer side effects
Nice to hear this!

2. the approaches to hospitalization are different, much more autonomy
could you please be more specific?

3. i have not idea what do you mean by "conservative"
don't prescribe drugs unless absolutely confident that the diagnosis is correct and the drugs are necessary.

[aphar]

These are not statements.
The first is a "comment".
The second is a "question".
The third is a "definition" (of a term "conservative").

I don't see how your why not? can be applied to the definition.

[signamax]

"don't prescribe drugs unless absolutely confident that the diagnosis is correct and the drugs are necessary." - is a statement

i have no interest talking about semantics
you understood me well

if you do not want to converse - just say so
придирки к словам мне не интересны
мне интересно только по существу

[aphar]

I really don't understand what you meant by "why not".
really.
seriously.
honestly.

are you saying that it's good to be "conservative"?
bad?
they are not conservative?
they are?

can you write a complete grammatical sentence explaining what you were thinking when you wrote those two words?

[signamax]

i wrote "why not?" on you statement starting with "do not..."
reasons: i. it is a common practice to prescribe medications even before the final diagnosis is made, ii. the reaction to a specific treatment is a part of a diagnostic process; iii. trial treatment is an acceptable strategy


"are you saying that it's good to be "conservative"?"
i am saying that i did not know what do you mean by "conservative"
prescibe less? prescibe more? withhold prescription?

[aphar]

i wrote "why not?" on you statement starting with "do not..."
reasons: i. it is a common practice to prescribe medications even before the final diagnosis is made, ii. the reaction to a specific treatment is a part of a diagnostic process; iii. trial treatment is an acceptable strategy

Finally we are talking. :-)
Yes, I think that, given possible irreversible effects on the patient's mind, the aggressive prescription policy you describe is unwarranted.

See, this is exactly the continuation of our previous conversation: normative is not necessarily the domain exclusive to the experts.

[signamax]

the paradigm has changed

45 years ago - prescription meant an order
now days it is a suggestions

a patient is under no obligation to take the medication
it is up to an expert to make a general judgement based on his/her expertise how diagnose and what to prescribe
it is NOT to an expert to make a judgement (or a decision) for a patient to take or not to take

ps
although I am still amused with your fascination of positive/normative - I personally do not care much

[signamax]

@Yes, I think that, given possible irreversible effects on the patient's mind, the aggressive prescription policy you describe is unwarranted.@

you are entitled to you opinion and you are entitled (as any patient) to your autonomy - to take or not to take the prescribed medication.

your opinion, however, how and what to prescribe has very little value in this field of expertise, similar to the value of a psychiatrist’s opinion in your field of expertise.

[signamax]

Q: what is the statement (as opposed to "definition") are you referring to?

A: "don't prescribe drugs unless absolutely confident that the diagnosis is correct and the drugs are necessary."