a research agenda for dsm-v

A Research Agenda for DSM-V Published by the American Psychiatric Association Washington, D.C. A Research Agenda for DSM-V Edited by David J. Kupfer, M.D. Michael B. First, M.D. Darrel A. Regier, M.D., M.P.H. Note: The authors have worked to ensure that all information in this book is accu- rate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate as of the time of publication and consistent with stan- dards set by the U.S. Food and Drug Administration and the general medical com- munity. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a spe- cific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. The findings, opinions, and conclusions of this report do not necessarily represent the views of the officers, trustees, or all members of the American Psychiatric Asso- ciation. The views expressed are those of the authors of the individual chapters. Typeset in Adobe's Janson Text and Frutiger Copyright ã 2002 American Psychiatric Association ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 06 05 04 03 02 5 4 3 2 1 First Edition American Psychiatric Association 1400 K Street, N.W., Washington, DC 20005 www.psych.org Library of Congress Cataloging-in-Publication Data A research agenda for DSM-V / edited by David J. Kupfer, Michael B. First, Darrel A. Regier.— 1st ed. p. ; cm. Includes bibliographical references and index. ISBN 0-89042-292-3 (alk. paper) 1. Diagnostic and statistical manual of mental disorders. 2. Mental illness— Diagnosis. 3. Mental illness—Classification. I. Kupfer, David J., 1941- II. First, Michael B., 1956- III. Regier, Darrel A. IV. Dagnostic and statistical manual of mental disor- ders. [DNLM: 1. Mental Disorders—diagnosis. 2. Research. WM 141 R432 2002] RC455.2.C4 R463 2002 616.89¢075—dc21 2002021556 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Contributors . . . . . . . . . . . . . . . . . . . . . . . . . .vii Acknowledgments . . . . . . . . . . . . . . . . . . . . xiii Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . xv David J. Kupfer, M.D., Michael B. First, M.D., Darrel E. Regier, M.D., M.P.H. 1 Basic Nomenclature Issues for DSM-V . . . . . . 1 Bruce J. Rounsaville, M.D., Renato D. Alarcón, M.D., M.P.H., Gavin Andrews, M.D., James S. Jackson, Ph.D., Robert E. Kendell, M.D., Kenneth Kendler, M.D. 2 Neuroscience Research Agenda to Guide Development of a Pathophysiologically Based Classification System . . . . . . . . . . . . . . . . . . . 31 Dennis S. Charney, M.D., David H. Barlow, Ph.D., Kelly Botteron, M.D., Jonathan D. Cohen, M.D., David Goldman, M.D., Raquel E. Gur, M.D., Ph.D., Keh-Ming Lin, M.D., M.P.H., Juan F. López, M.D., James H. Meador-Woodruff, M.D., Steven O. Moldin, Ph.D., Eric J. Nestler, M.D., Ph.D., Stanley J. Watson, M.D., Ph.D., Steven J. Zalcman, M.D. 3 Advances in Developmental Science and DSM-V . . . . . . . . . . . . . . . . . . . . . 85 Daniel S. Pine, M.D., Margarita Alegria, Ph.D., Edwin H. Cook Jr., M.D., E. Jane Costello, Ph.D., Ronald E. Dahl, M.D., Doreen Koretz, Ph.D., Kathleen R. Merikangas, Ph.D., Allan L. Reiss, M.D., Benedetto Vitiello, M.D. 4 Personality Disorders and Relational Disorders: A Research Agenda for Addressing Crucial Gaps in DSM . . . . . . . . . 123 Michael B. First, M.D., Carl C. Bell, M.D., Bruce Cuthbert, Ph.D., John H Krystal, M.D., Robert Malison, M.D., David R. Offord, M.D., David Reiss, M.D., M. Tracie Shea, Ph.D., Tom Widiger, Ph.D., Katherine L. Wisner, M.D., M.S. 5 Mental Disorders and Disability: Time to Reevaluate the Relationship? . . . .201 Anthony F. Lehman, M.D., M.S.P.H., George S. Alexopoulos, M.D., Howard Goldman, M.D., Ph.D., Dilip Jeste, M.D., Bedirhan Üstün, M.D. 6 Beyond the Funhouse Mirrors: Research Agenda on Culture and Psychiatric Diagnosis . . . . . . . . . . . . . . . . . . 219 Renato D. Alarcón, M.D., M.P.H., Margarita Alegria, Ph.D., Carl C. Bell, M.D., Cheryl Boyce, Ph.D., Laurence J. Kirmayer, M.D., Keh-Ming Lin, M.D., M.P.H., Steven Lopez, Ph.D., Bedirhan Üstün, M.D., Katherine L. Wisner, M.D., M.S. Appendix 6–1 Preliminary List of Suggested Areas and Topics of Research in Culture and Psychiatric Diagnosis . . . . . . . . 283 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 vii Contributors Renato D. Alarcón, M.D., M.P.H. Professor and Vice-Chairman, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine; Chief, Mental Health Service Line, Atlanta Department of Veterans Affairs Medical Center, At- lanta, Georgia Margarita Alegria, Ph.D. Professor of Health Services Administration; Director of the Center for Evaluation and Sociomedical Research, University of Puerto Rico, San Juan, Puerto Rico George S. Alexopoulos, M.D. Professor, Department of Psychiatry, The New York Hospital, Cornell Medical Center, Westchester Division, White Plains, New York Gavin Andrews, M.D. Professor, School of Psychiatry, University of New South Wales at St. Vin- cent’s Hospital, Anxiety Disorders Unit, Darlinghurst, New South Wales, Australia David H. Barlow, Ph.D. Professor, Center for Adaptive Systems, Department of Psychology, Bos- ton University, Boston, Massachusetts Carl C. Bell, M.D. President/CEO, Community Mental Health Council/Foundation, Inc.; Professor of Psychiatry, Department of Psychiatry, School of Medicine, and Professor of Public Health, School of Public Health, University of Il- linois at Chicago, Chicago, Illinois Kelly Botteron, M.D. Assistant Professor, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri Cheryl Boyce, Ph.D. Chief, Sociocultural Processes and Health Disparities Program, Develop- mental Psychopathology and Prevention Research Program, National In- stitute of Mental Health, Bethesda, Maryland viii A RESEARCH AGENDA FOR DSM-V Dennis S. Charney, M.D. Chief, Mood and Anxiety Disorders Research Program, National Institute of Mental Health, Bethesda, Maryland Jonathan D. Cohen, M.D. Professor, Department of Psychology; Director, Center for Study of Brain, Mind and Behavior, Princeton University, Princeton, New Jersey; Profes- sor, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Penn- sylvania Edwin H. Cook Jr., M.D. Professor of Psychiatry and Pediatrics, Department of Child and Adoles- cent Psychiatry, University of Chicago, Chicago, Illinois E. Jane Costello, Ph.D. Professor, Department of Psychiatry and Behavioral Sciences, Duke Uni- versity Medical Center, Durham, North Carolina Bruce Cuthbert, Ph.D. Chief, Adult Psychopathology and Prevention Research Branch, Division of Mental Disorders, Behavioral Research and AIDS, National Institute of Mental Health, Bethesda, Maryland Ronald E. Dahl, M.D. Associate Professor of Psychiatry and Pediatrics, Western Psychiatric In- stitute and Clinic, Pittsburgh, Pennsylvania Michael B. First, M.D. Research Psychiatrist, New York State Psychiatric Institute; Associate Pro- fessor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York David Goldman, M.D. Chief, Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland Howard Goldman, M.D., Ph.D. Professor, Department of Psychiatry, University of Maryland, Baltimore, Maryland Raquel E. Gur, M.D., Ph.D. Professor, Director of Neuropsychiatry, Departments of Psychiatry, Neu- rology, and Radiology, University of Pennsylvania, Philadelphia, Pennsyl- vania Contributors ix James S. Jackson, Ph.D. Daniel Katz Distinguished University Professor of Psychology, College of Literature, Science, and the Arts; Professor of Health Behavior and Health Education, School of Public Health; and Director and Research Scientist, Research Center for Group Dynamics, Institute for Social Research, Uni- versity of Michigan, Ann Arbor, Michigan Dilip Jeste, M.D. Professor, University of California San Diego, Department of Veterans’ Affairs San Diego Healthcare System, San Diego, California Robert E. Kendell, M.D. Professor, University Department of Psychiatry, Royal Edinburgh Hospi- tal, Edinburgh, Scotland Kenneth Kendler, M.D. Professor, Department of Psychiatry and Human Genetics, Medical Col- lege of Virginia, Virginia Commonwealth University and Virginia Insti- tute for Psychiatric and Behavioral Genetics, Richmond, Virginia Laurence J. Kirmayer, M.D. Professor, Department of Psychiatry, and Director, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada Doreen Koretz, Ph.D. Associate Director for Prevention, Division of Mental Disorders, Behav- ioral Research and AIDS, National Institute of Mental Health, Bethesda, Maryland John H. Krystal, M.D. Albert E. Kent Professor and Deputy Chairman for Research, Department of Psychiatry, Yale University School of Medicine, New Haven, and Psy- chiatry Service, Veterans’ Administration Connecticut Health System, West Haven, Connecticut David J. Kupfer, M.D. Thomas Detre Professor and Chair, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania x A RESEARCH AGENDA FOR DSM-V Anthony F. Lehman, M.D., M.S.P.H. Professor and Chair, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland Keh-Ming Lin, M.D., M.P.H. Professor, Department of Psychiatry, School of Medicine, University of California at Los Angeles; Director, Research Center on the Psychobiol- ogy of Ethnicity, Harbor–University of California Los Angeles Medical Center, Torrance, California Juan F. López, M.D. Assistant Professor, Department of Psychiatry, University of Michigan; Assistant Research Scientist, Mental Health Research Institute, Ann Arbor, Michigan Steven Lopez, Ph.D. Professor of Psychology and Psychiatry, Department of Psychology, Uni- versity of California, Los Angeles, Los Angeles, California Robert Malison, M.D. Associate Professor of Psychiatry and Associate Director, Clinical Neuro- science Research Unit, Connecticut Mental Health Center, Yale Univer- sity School of Medicine, New Haven, Connecticut James H. Meador-Woodruff, M.D. Associate Professor, Department of Psychiatry, University of Michigan; Senior Associate Research Scientist, Mental Health Research Institute, Ann Arbor, Michigan Kathleen R. Merikangas, Ph.D. Chief, Section on Developmental Genetic Epidemiology, Mood and Anx- iety Disorders Program, National Institute of Mental Health, Bethesda, Maryland Steven O. Moldin, Ph.D. Chief, Genetics Research Branch, Division of Neuroscience and Basic Be- havioral Science, National Institute of Mental Health, Bethesda, Maryland Eric J. Nestler, M.D., Ph.D. Professor and Chairman, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas David R. Offord, M.D. Coordinator of Research Programs, Center for Studies of Children at Risk, McMaster University, Hamilton, Ontario, Canada [...]... Statistical Manual of Mental Disorders, 2nd Edition Washington, DC, American Psychiatric Association, 1968 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition Washington, DC, American Psychiatric Association, 1980 Introduction xxiii American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised Washington, DC, American... norm for the species in such a way as to place them at a biological disadvantage” (p 877) He never elaborated on what he meant by biological disadvantage, but Kendell (197 5a) and Boorse (1975) both argued that it must at least encompass reduced fertility and life expectancy Although many mental disorders are associated with a reduced life expectancy and some, like schizophrenia, are associated with a. .. research A critical goal of psychiatric research is to develop a rigorous database examining the etiology, course, and treatment of the major psychiatric disorders In the move toward evidence-based medicine, meta-analyses are more and more the standard form of data summary Homogeneity of diagnostic classification would be an important criterion for any meta-analysis Fourth, changes in diagnostic criteria... treatment) As we approach DSM-V, what might be said on the basis of more than 20 years of experience with such validating systems for psychiatric illness? First, they are not specific Many things that are not valid psychiatric diagnoses (such as large noses) run in families Second, there is no strong a 8 A RESEARCH AGENDA FOR DSM-V priori rationale to suspect that the application of different diagnostic validators... scientific biomedical terms or are sociopolitical terms that necessarily involve a value judgment Usually, although not invariably, physicians have maintained that they are biomedical terms, whereas most philosophers and social scientists have argued that they are sociopolitical terms The issue has attracted a good deal of attention in the past decade, mainly in response to a closely argued analysis of the... Daniel S Pine, M.D Chief, Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, Maryland Darrel A Regier, M.D., M.P.H Executive Director, American Psychiatric Institute for Research and Education, and Director, Division of Research, American Psychiatric Association, Washington, DC Allan L Reiss, M.D Professor and Associate Chair, Department of Psychiatry and... Psychiatric Diagnosis and Assessment), at NIMH in summer 1999 They felt that it was important for APA and NIMH to work together and focus on an agenda that would expand the scientific basis for psychiatric classification In September 1999, the initial DSM-V Research Planning Conference was held under the joint sponsorship of APA and NIMH From the outset, it was established that this was not meant to... the church (treating it as a sin), or social work (treating it as a social problem) The attraction of this approach is that it is essentially pragmatic or utilitarian Whether the antisocial behavior of habitual delinquents, for example, is best regarded as criminal behavior or as a manifestation of antisocial personality disorder would be determined by the relative success of the criminal justice system... the DSM-V revision process per se but rather to set research priorities that might affect future classifications Participants in this initial stage were selected primarily for their expertise in diverse areas such as family and twin studies, molecular genetics, basic and clinical neuroscience, cognitive and behavioral xx A RESEARCH AGENDA FOR DSM-V science, development, life span issues, and disability... legal professionals and health care administrators as representing lapidary, received wisdom about the nature of mental disorders This high-impact but uncritical use fails to recognize the variability in the level of empirical support for the reliability and validity of different diagnoses If the text or cri- 1 2 A RESEARCH AGENDA FOR DSM-V teria included a more explicit rating of empirical support for . A Research Agenda for DSM-V Published by the American Psychiatric Association Washington, D.C. A Research Agenda for DSM-V Edited by David J. Kupfer, M.D. Michael B. First, M.D. Darrel. Prevention Research Program, National In- stitute of Mental Health, Bethesda, Maryland viii A RESEARCH AGENDA FOR DSM-V Dennis S. Charney, M.D. Chief, Mood and Anxiety Disorders Research Program, National. these chapters: 1) to stimulate research that would enrich the empirical database before the start of the DSM-V re- vision process and 2) to devise a research and analytic agenda that would fa- cilitate