venerdì 12 febbraio 2010

Aspettando il DSM-V...

La prima versione del DSM (Diagnostical and Statistical Manual of Mental Disorders - Manuale Diagnostico e Statistico dei Disturbi Mentali) venne redatta nel 1952 dall' American Psychiatric Association - APA. La seconda nel '68, la terza nel 1980 revisionata nell'87, la quarta nel '94 revisionata nel 2000... versione che oggi si usa nella clinica.
Il DSM-V vedrà la luce intorno al maggio 2013 e in piena epoca 2.0, mentre già si parla di web 3.0 e realtà aumentata non più sperimentale ma quotidiana, nasce un sito che ci conduce per mano alla uscita del manuale di psichiatria per eccellenza.
Il sito lo trovate al seguente indirizzo:
http://www.dsm5.org/Pages/Default.aspx

Il sito è ovviamente in lingua inglese ed è ricco di anticipazioni e di informazioni che ci possono far riflettere sul lavoro compiuto dalla Task Force che si occupa della redazione del manuale.
...non vi anticipo nulla... il sito è davvero interessante e merita di essere spulciato a dovere.
...solo un piccolo assaggio:

DSM-5 Overview: The Future Manual

The process for revising Diagnostic and Statistical Manual of Mental Disorders (DSM) began with a brief discussion between Steven Hyman, M.D., (then-director of the National Institute of Mental Health [NIMH]), Steven M. Mirin, M.D. (then-medical director of the American Psychiatric Association [APA]), and David J. Kupfer, M.D., (then-chair of the American Psychiatric Association Committee on Psychiatric Diagnosis and Assessment) at the NIMH in 1999. They believed it was important for the APA and NIMH to work together on an agenda to expand the scientific basis for psychiatric diagnosis and classification.

Under the joint sponsorship of the two organizations, an initial DSM-5 Research Planning Conference was convened in 1999 to set research priorities. Participants included experts in family and twin studies, molecular genetics, basic and clinical neuroscience, cognitive and behavioral science, development throughout the life-span, and disability. To encourage thinking beyond the current DSM-IV framework, many participants closely involved in the development of DSM-IV were not included at this conference. Through this process, participants recognized the need for a series of white papers that could guide future research and promote further discussion, covering over-arching topic areas that cut across many psychiatric disorders. Planning work groups were created, including groups covering developmental issues, gaps in the current system, disability and impairment, neuroscience, nomenclature, and cross-cultural issues.

In early 2000, Darrel A. Regier, M.D., M.P.H., was recruited from the NIMH to serve as the research director for the APA and to coordinate the development of DSM-5. Additional conferences were held later in July and October of 2000 to set the DSM-5 research agenda, propose planning the work groups’ membership, and to hold the first face-to-face meetings. These groups, which included liaisons from the National Institutes of Health (NIH) and the international psychiatric community, developed the series of white papers, published in “A Research Agenda for DSM-5” (2002, APA). A second series of cross-cutting white papers, entitled “Age and Gender Considerations in Psychiatric Diagnosis,” was subsequently commissioned and published by APA in 2007.

Leaders from the APA, the World Health Organization (WHO), and the World Psychiatric Association (WPA) determined that additional information and research planning was needed for specific diagnostic areas. Hence, in 2002, the American Psychiatric Institute for Research and Education (APIRE), with Executive Director Darrel A. Regier, M.D., M.P.H., as the Principal Investigator, applied for a grant from the NIMH to implement a series of research planning conferences that would focus on the scientific evidence for revisions of specific diagnostic areas. A $1.1 million cooperative agreement grant was approved with support provided by NIMH, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcoholism and Alcohol Abuse (NIAAA).

Under the guidance of a steering committee comprised of representatives from APIRE, the three NIH institutes, and the WHO, 13 conferences were held from 2004 to 2008. Expertise represented at these conferences spanned the globe: each conference had co-chairs from both the U.S. and another nation, and approximately half of the 397 participants were from outside the U.S. In each conference, participants wrote papers addressing specific diagnostic questions, based on a review of the literature, and from these papers and the conference proceedings, a research agenda was developed on the topic. The results of seven of these conferences have been published to date in peer-reviewed journals or American Psychiatric Publishing, Inc. (APPI) monographs, with the remainder of the publications anticipated in 2010 and 2011. Findings from all 13 conferences are available to serve as a substantial contribution to the research base for the DSM-5 Task Force and Work Groups and for the WHO as it develops revisions of the International Classification of Diseases.

In 2006, APA President Dr. Steven Sharfstein announced Dr. Kupfer as chair and Dr. Regier as vice-chair of the task force to oversee the development of DSM-5. They, along with other leaders at the APA, nominated additional members to the task force, which includes the chairs of the diagnostic work groups that will review the research and literature base to form the content for DSM-5. These task force nominees were reviewed for potential conflicts of interest, approved by the APA Board of Trustees, and announced in 2007. In turn, the work group chairs, together with the task force chair and vice-chair, recommended to the successive APA Presidents, Drs. Pedro Ruiz and Carolyn Robinowitz, nominees widely viewed as leading experts in their field, who were then formally nominated as members of the work groups. All work group members were also reviewed for potential conflicts of interest, approved by the APA Board, and were announced in 2008.

Since late 2007, each work group has met regularly, in person and on conference calls. They began by reviewing DSM-IV’s strengths and problems, from which research questions and hypotheses were developed, followed by thorough investigations of literature reviews and analyses of existing data. Based on their comprehensive review of scientific advancements, targeted research analyses, and clinical expertise, the work groups have developed draft DSM-5 diagnostic criteria. The release of the final, approved DSM-5 is expected in May 2013.

6 commenti:

Centro Mimir ha detto...

Mah, i DSM piacciono a chi ritiene che in questo modo venga riconosciuta ufficialmente la specificità di una patologia (leggo i commenti su Facebook che riguardano ad esempio la Sindrome di Asperger)
Non mi ha mai convinto però, lo trovo un minestrone peggiore della vecchia nosografia psichiatrica, che non sempre si fonda neppure su criteri e dati scientifici basati sulle acquisizioni delle Neuroscienze, e che secondo me serve ad aumentare la già eccessiva distanza tra lo specialista (psichiatra, psicoterapeuta) e una persona con disagio psico/fisico,laddove soprattutto gli psichiatri dovrebbero riacquistra l'antica consuetudine a dialogare coi loro 'pazienti' lasciando fluttura l'attenzione, anzichè concentrarsi sul selezionare o deselezionare delle caselline...

Daniele ha detto...

Eh devo dire che concordo con Centro Mir e la diagnosi dell'ADHD rappresenta un'altro esempio sui dubbi in merito a l''affidabilità del DSM. Pochi giorni fa abbiamo visto nello sceneggiato di Basaglia come sia l'ascolto una delle cure migliori indipendentemente dalla "patologia".
Certo, l'ascolto richiede pazienza e disponibilità che non sono strumenti industrializzabili in un sistema che privilegia la quantità a discapito della qualità.

LAURA BELLODI ha detto...

certo che se qualcuno avesse qualcosa di meglio..ma meglio davvero..xchè se dall'ascolto arriva solo..altro ascolto, magari a pagamento..
lo chiaman aiuto aspecifico ma lo può dare il prete il mago o la shampista, a scelta, non c'è bisogno nè di psichiatri nè di psicoterapeuti

Anonimo ha detto...

il DSM serve per inventare le diagnosi e quindi per vendere i farmaci.

CyberMaster ha detto...

Ciao Anonimo,
...sicuro sicuro delle tue affermazioni?

Anonimo ha detto...

il DSM qualunque sia la sua evoluzione rimane comunque utile basandosi su di un punto di vista statistico e per questo in continuo cambiamento e revisione per rispecchiare la realtà clinica dei pazienti.
Esistono terapie non solo legate all'ascolto ma soprattutto al fare per cambiare, all'agire concretamente in modo diverso per sentire diversamente. Questa terapia fa parte dell'approccio cognitivo comportamentale che nelle sue sfumatura (causale, post razionalista, classico cognitivista), offre ai pazienti la possibilità di stare meglio concretamente e non di spendere soldi rincorrendo col "terapauta" favolette ipotetiche non verificate. Per il DSM V ben venga, staremo a vedere.