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.
Contents Toward DSM-V: basic nomenclature issues. Proposed basic and clinical neuroscience research agenda to guide the development of a pathophysiologically-based classification. Report from developmental issues and diagnosis work group. A research agenda for addressing crucial gaps in the DSM: personality disorders and relational disorders. Mental disorders and disability: time to reevaluate the relationship? Beyond the funhouse mirrors: research agenda on culture and psychiatric diagnosis
Reviews “This book will stimulate research by bringing into play information about updated empirical databases, providing insight into the process of integrating research findings from a classification system that is etiologically based rather than descriptive, and stimulating discussion at all levels, from residents in training seminars to working groups of research investigators around the world.”—Adrianna Neagoe, M.D., Psychiatric Services “This is an important guide for anyone involved in psychiatric research as well as the general psychiatrist who wants to understand the history of the DSM system and wanted to learn about the proposed future classification systems. The book is easy to read and done in great detail.”—Raj Tummala, M.D., Doody's Health Science Book Reviews, December 2002 “I congratulate the authors of the sis chapters of this book as well as its editors. Without question, this volume represents a far-reaching effort and a good start for the work ahead. One hopes that all of the goals in hand for a successful and well-accepted DSM-V will be met not only in the United States but across the world as well.”—Pedro Ruiz, M.D., The American Journal of Psychiatry, September 2004
About the Authors Michael B. First, M.D., is a Research Psychiatrist at the New York State Psychiatric Institute and Associate Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons in New York, New York. David J. Kupfer, M.D., is Thomas Detre Professor and Chair of the Department of Psychiatry at Western Psychiatric Institute and Clinic at the University of Pittsburgh in Pittsburgh, Pennsylvania. Darrel Regier, M.D., M.P.H., is Executive Director of the American Psychiatric Institute for Research and Education and Director of the Division of Research at the American Psychiatric Association in Washington, D.C.
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