Plan B Forum

IN RADICAL changes to the way mental health conditions are diagnosed, what was once considered an unruly child's temper tantrum could soon be labelled ''disruptive mood dysregulation disorder''.

If a widow's grief lasts longer than a fortnight then she might be diagnosed with ''major depressive disorder''. When the mother in a bitter custody battle tries to turn a child against the father, it might create ''parental alienation disorder''.

These are among new conditions proposed for the fifth edition of the psychiatrist's bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is due to be finalised next year.

The proposed changes have caused an international outcry. The Association for Psychological Science, the American Counselling Association, the British Psychological Society and leading psychiatrists are calling for the draft of the new edition to be subject to independent scientific review.

They fear it is so inclusive it risks mislabelling millions of healthy people as mentally ill, potentially leading to increased stigma and medication.

Doctors in Australia are also concerned, some arguing the revised manual - which has been produced by the American Psychiatric Association since 1952 and is used globally by psychiatrists and psychologists to diagnose mental disorders - is turning unhappiness into a disease.

''It's such a narrow and limited view of human experience to want to reduce every bit of suffering to medical diagnosis,'' University of Adelaide psychiatry professor Jon Jureidini said.

''Whenever you promote a new mental illness or a new medical way of understanding people's suffering, the impact of that is almost always going to be increased prescribing.''

The controversy over the new manual reflects division within the mental health community over a global rise in the use of drugs such as antidepressants, stimulants and antipsychotics.

The inclusion of conditions such as attention deficit hyperactivity disorder and autism in previous editions of the manual is believed to have contributed to increased prescribing.

The changes in the new manual would mean children only have to display six of 13 possible symptoms for a diagnosis of ADHD, compared with six out of nine in the previous manual.

New ADHD symptoms that have been added to the manual include acting without thinking, being often impatient, being uncomfortable doing things slowly and systematically, and finding it difficult to resist temptation.

Under the new edition's criteria, the diagnosis threshold for some existing disorders is also being lowered so that grief over the death of a loved one can qualify as a major depressive illness.

However, the authors have defended the move, saying the previous criteria potentially prevent people who need treatment from receiving help.

''A broad range of evidence … shows that there are little to no systematic differences between individuals who develop a major depression in response to bereavement and in response to other severe stressors, such as being physically assaulted and raped,'' Kenneth Kendler, a member of the DSM-5 mood disorders group, said in a statement.

Read more: http://www.smh.com.au/national/health/d ... z1fWllfUzu

New ADHD symptoms that have been added to the manual include acting without thinking, being often impatient, being uncomfortable doing things slowly and systematically, and finding it difficult to resist temptation

A. Five (or more) of the following criteria have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a medical condition.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gain

4. Insomnia or hypersomnia nearly every day

5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

6. Fatigue or loss of energy nearly every day

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (Language regarding “impairment” may change for consistency with DSM-IV conventions)

C. The episode is not due to the direct physiological effects of a substance or antidepressant intervention (e.g., a drug of abuse, a medication, or other treatment). Note: A full hypomanic or manic episode emerging during antidepressant treatment (medication, ECT, etc) and persisting beyond the physiological effect of that treatment is sufficient evidence for a hypomanic or manic episode diagnosis. However, caution is indicated so that one or two symptoms (particuarly increased irritability, edginess or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic or manic episode.

• Symptom (1) plus at least four of symptoms (3)-(9);
  
  Symptom (2) plus at least four of symptoms (3)-(9); or
  
  Symptom (1) plus symptom (2) plus at least three of symptoms (3)-(9).

"what are you going to do about it?"

loCAtek wrote:The issue is: And then what?

Dope up her feelings, but the void left by her deceased spouse is still there.

What did he fulfill, that she can't cope without?

So, she copes with meds ...and then what?

The Hen wrote:It also involves taking positive steps for yourself.

That part can be the hardest for most depressives to handle.

bigskygal wrote:Meds are merely the first step out of the darkness; the CBT or grief counseling is what will take the individual back to life entirely.

The Hen wrote:True that the first step is needed. However, if drugs don't work, then a different approach should be considered to get them over that first step.

Doing nothing is usually not a productive solution.

Drugs, CBT, counselling, exercise, whatever it takes.