The DSM-5 was officially released today. We will be covering it in the weeks to come here on the blog and over at Psych Central Professional in a series of upcoming articles detailing the major changes.

In the meantime, here is an overview of the big changes. We sat in on a conference call that the American Psychiatric Association (APA) had in order to introduce the new version of the diagnostic reference manual used primarily by clinicians in the U.S. to diagnose mental disorders. It is called the Diagnostic and Statistical Manual of Mental Disorders and is now in its fifth major revision (DSM-5).

James Scully, Jr., MD, CEO of the APA, kicked off the call by remarking that the DSM-5 will be a “critical guidebook for clinicians” — a theme echoed by the other speakers on the call.

In the past week, I’ve seen some incredibly sensationalistic articles published about the upcoming DSM-5 and a letter recently released by the National Institute of Mental Health (NIMH). In the letter by Dr. Thomas Insel, director of the NIMH, wrote in part, “That is why NIMH will be re-orienting its research away from DSM categories.”

Some writers read a lot more into that statement than was actually there. Science 2.0 — a website that claims it houses “The world’s best scientists, the Internet’s smartest readers” — had this headline, “NIMH Delivers A Kill Shot To DSM-5.” Psychology Today made the claim, “The NIMH Withdraws Support for DSM-5.” (The DSM-5 is the new edition of the reference manual used to treatment mental disorders in the U.S.)

So is any of this true? In a word, no. This is science “journalism” at its worse.

If you were hoping to get some medications prescribed for attention deficit hyperactivity disorder (ADHD) while in college or at university, you might be in for a rude surprise.

Colleges and university are cutting back on their involvement with ADHD, primarily due to abuse of the psychiatric medications — stimulants like Ritalin — prescribed to treat the disorder. Students — whether they are malingering the symptoms or actually have it — are prescribed a drug to treat ADHD (sometimes from different providers in different states), then sell a few (or all the) pills on the side. Profit!

Now universities are becoming wise to the epidemic nature of the problem, as some studies have suggested up to a third of college students are illicitly taking ADHD stimulants.

This might help curb the abuse problem, but will it also make it harder for people with actual ADHD to receive treatment?

“Insanity is doing the same thing over and over again but expecting different results.”
~ Rita Mae Brown

Ya have to admire psychologists who endlessly lobby state legislatures for the right to extend prescription privileges to their profession (with a little additional training). They won’t take repeated defeat as a sign that perhaps their efforts are… insane?

Illinois is the latest state to hand psychologists seeking prescription privileges a defeat, with NAMI Illinois siding on the side of not supporting the bills in front of the Illinois legislature. After intense lobbying by both sides of this issue, they concluded, “NAMI Illinois opposes SB 2187 and HB 3074 in its current form to expand prescriptions privileges to psychologists.”

When will psychologists learn?

Most people diagnosed with depression today aren’t depressed, according to Edward Shorter, a historian of psychiatry, in his latest book How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown. 

Specifically, about 1 in 5 Americans will receive a diagnosis of major depression in their lifetime. But Shorter believes that the term major depression doesn’t capture the symptoms most of these individuals have. “Nervous illness,” however, does.

“The nervous patients of yesteryear are the depressives of today,” he writes.

And these individuals aren’t particularly sad. Rather, their symptoms fall into these five domains, according to Shorter: nervous exhaustion; mild depression; mild anxiety; somatic symptoms, such as chronic pain or insomnia; and obsessive thinking.

Americans take considerable pride in our Constitutionally guaranteed civil liberties, yet our government and institutions often abridge or ignore those rights when it comes to certain classes of people.

According to a National Council on Disability report, people with psychiatric illnesses are routinely deprived of their civil rights in a way that no other people with disabilities are (2). This is particularly so in the case of people who are involuntarily committed to psychiatric wards.

Under present standards of most states, a person who is judged by a psychiatrist to be in imminent danger to self or others may be involuntarily committed to a locked psychiatric ward and detained there for a period of time (3). Some would argue that involuntary civil commitment is a necessary approach justified by safety and treatment concerns. Others would counter that it is an inhumane and unjustifiable curtailment of civil liberties.

Let’s look at the example of recent suicide survivors in order to examine this debate in more depth.

Sometimes you just need to know the basics. For instance, if you think something is wrong with your mind, your emotional life, and you want to get help for it, where do you even begin?

With today’s knowledge, the steps toward getting a valid mental disorder diagnosis and treatment are fairly simple. Unless otherwise required by your health insurance plan, you should generally start with a mental health professional — either a psychologist or psychiatrist. These are the specialists of mental health, and usually have the greatest knowledge and depth of experience to be able to diagnose you and setup a treatment plan with you that will be most effective.

If you haven’t seen your primary care physician or family doctor in some time, it never hurts to also see them at the same time — to rule out any possible physical causes of your symptoms. This is especially true if you have a health condition or family history of certain health problems (because sometimes physical maladies can mimic mental disorder symptoms).

Psychology has been rooted in self-exploration for individuals seeking help with mental health issues …

Although this will not come as news to anyone who’s been on any one of the most common psychiatric medications prescribed — such as Celexa, Lexapro, Cymbalta, Prozac, Xanax, Paxil, Effexor, etc. — getting off of a psychiatric medication can be hard. Really hard.

Much harder than most physicians and many psychiatrists are willing to admit.

That’s because most physicians — including psychiatrists — have not had first-hand experience in withdrawing from a psychiatric drug. All they know is what the research says, and what they hear from their other patients.

While the research literature is full of studies looking at the withdrawal effects of tobacco, caffeine, stimulants, and illicit drugs, there are comparatively fewer studies that examine the withdrawal effects of psychiatric drugs. Here’s what we know…

When electricity and the brain are mentioned in the same sentence, your mind might immediately jump to disturbing images of people receiving huge shocks while covered in electrodes, strapped to tables.

But electroconvulsive therapy (ECT) treatment has developed considerably since the days depicted in “One Flew Over the Cuckoo’s Nest.”  A current study at JAMA Psychiatry examines a treatment called transcranial Direct Current Stimulation (tDCS).

Could this fairly new form of electrical treatment for depression really be effective — and without the negative side effects of ECT?

In his book, Understanding Depression: What We Know And What You Can Do About It, J. Raymond DePaulo Jr., M.D. asserts that for the 20 percent of his patients who are more difficult to treat, or “treatment-resistant,” he sets an 80 percent improvement, 80 percent of the time goal. And he usually accomplishes that.

Now, if you’re not someone who has struggled with chronic depression, those stats won’t warrant a happy dance.

But if you’re someone like myself, who assesses her mood before her eyes are open in the morning, hoping to God that the crippling anxiety isn’t there, then those numbers will have you singing Hallelujah.

Where do you go if your child’s teacher tells you your child has symptoms of attention deficit hyperactivity disorder (ADHD)? What if you see your child struggling in school?

It can be overwhelming if your child is not doing well academically, behaviorally or socially. However, there are professionals available to guide you through the process of finding a diagnosis and getting treatment.

Your pediatrician or family physician is one type of professional to approach for assistance. At the first visit, your physician most likely will get a complete academic, learning and activity history from you and your child. It would be helpful to bring information such as report cards and past evaluations.

If you have had the same physician for years, he may not take a full past medical history, while a new physician more than likely will take one. He or she will want to look for any neurological problems, hospital admissions, history of trauma, poisonings or prematurity as well as a developmental history (milestones such as walking and first word). The next step should be a complete physical exam, including a full neurological workup.