DSM-5, ICD-11 and 'pathologization of normal conditions'

The media campaign on the DSM-5: recurring comments and lessons for the future of diagnosis in psychiatric practice

Recurring arguments in the media campaign preceding and following the publication of the DSM-5 have been that the manual, referred to as 'the bible of psychiatry', mislabels many people who are basically normal, and that the diagnostic categories it contains are invalid, not being based on laboratory tests. We present data on the use of the DSM worldwide, and discuss the need to assess systematically the pros and cons of operational and prototype approaches to psychiatric diagnosis. We consider different views about what qualifies as mental disorder and how the boundary between pathology and normality should be fixed. We review the role of laboratory tests as applied in medicine, emphasising that most of them are probabilistic, not pathognomonic, markers of disease. We finally summarise the promise and limitations of the Research Domain Criteria project, aiming to 'transform psychiatric diagnosis' by replacing descriptive psychopathology with behavioural and neurobiological measures.

Has the Diagnostic and statistical manual of mental illnesses (fifth edition) jumped the shark and is it now time for Australia to reconsider reliance on it?

OBJECTIVE

The purpose of this article is to consider whether, in light of the significant controversy surrounding the Diagnostic and statistical manual of mental illnesses (fifth edition) (DSM-5), it may be time for Australia to reconsider the influence of, and its past reliance on, the DSM. Also considered is whether it is now time, with the imminent publication of the The international statistical classification of diseases and related health problems (eleventh edition) (ICD-11), to move to the ICD-11 as the primary instrument for diagnosis and research in Australia.

CONCLUSION

That DSM-5 begins its life in an unprecedented plethora of criticism, not only from lay people but also from mental health professionals, which should sound a note of caution for continued reliance on it in Australia.

Longitudinal trends in the dispensing of psychotropic medications in Australia from 2009-2012: focus on children, adolescents and prescriber specialty

OBJECTIVE

Longitudinal trends in the dispensing of antidepressant, antipsychotic and ADHD medications from 2009-2012 were examined according to age and gender of patient and prescriber speciality. Of particular interest were changing trends in the prescription of psychotropic medications to children, adolescents and young adults.

METHOD

Dispensing data for government-subsidised antidepressant, antipsychotic and ADHD medications were obtained from the database maintained by the Department of Human Services. Results were expressed in terms of number of prescriptions dispensed.

RESULTS

Over the four- year study period, the dispensing of antidepressants, antipsychotics and ADHD medications showed overall increases of 16.1%, 22.7% and 26.1% respectively. The most rapid percentage increases in antidepressant and antipsychotic dispensing occurred in children aged 10-14 (35.5% and 49.1% respectively), while ADHD medication dispensing rose most rapidly in those aged 20-24 (70.9%). Dispensing to males was more common during childhood for all investigated classes while two-thirds of adult antidepressant prescribing was to female patients. The most commonly prescribed antidepressants varied by age and were as follows: fluoxetine (3-19 year olds), desvenlafaxine (20-24 years) and venlafaxine (>25 years). Risperidone was the most common antipsychotic dispensed to children under 15, quetiapine to adolescents and young adults (15-24 years), and olanzapine to adults. Methylphenidate was the most common ADHD medication in those aged under 25, and dexamphetamine the most common in adults. Most antidepressants and antipsychotics were prescribed by GPs (89.9% and 70.6% respectively), while the majority of ADHD medications were prescribed by paediatricians (59.1%).

CONCLUSIONS

Dispensing of psychotropic medications increased markedly from 2009 to 2012, with notable age-specific trends. General adherence to treatment guidelines is apparent, yet concerns exist regarding rapid increases in serotonin noradrenaline reuptake inhibitor (SNRI) antidepressant prescribing, the likely overmedication of persons with mild psychological distress, and the increasing use of powerful psychotropic medications in younger populations despite uncertain risk-benefit profiles.