The Last Psychiatrist has a great post this week on one of the proposed changes for the DSM as outlined in a report from Diagnostic Guidelines Task Force of the International Society for Bipolar Disorder. And in case you had any doubts, of course "They not only broadened the definitions of acute mania, bipolar depression, and bipolar II but also proposed definitions of bipolar spectrum and pediatric bipolar disorders." And they believe that the category, schizoaffective disorder, should be removed.
Should there be any surprise at the report? Does the fact that the leader of the task force has the following disclosure statement:
"Disclosure: S. Nassir Ghaemi, MD, MPH, has disclosed that he has received research grants from Janssen Pharmaceutica, Novartis, Abbott Labs, Eisai Inc, and GlaxoSmithKline, and has served on the speaker's bureau for Janssen Pharmaceutica, GlaxoSmithKline and Abbott Labs."
Does knowing that those companies vigorously promote and market their atypical antipsychotic drugs, the very drugs not trumpeted for treatment of bi-polar, offer some hints about forces underlying this report?
The following, from The Last Psychiatrist, really hits the nail on the head, not only for this issue but the whole mess f psychiatric diagnosis:
But the sleight of hand is saying that the schizoaffective is "really" a variation on a mood disorder (read: bipolar.) It is equally plausible that bipolar disorder is a variation of schizoaffective disorder since neither one exist except synthetically. I don't mean the symptomatology doesn't exist, I mean the classification is completely empty. We choose to call this thing schizoaffective, and now we choose not to. We chose to call it depression, now we choose to call it bipolar depression. It's not like you chose to call it a unicorn but later discover it's actually a rhinoceros. A more accurate analogy is that you chose to call this a unicorn, and now choose to call it a ki-ran. Wait-- what's a ki-ran, you say? Exactly.
Or, you find an elephant's leg, and say, this is an elephant. And next you find a horse's leg, so you say, this has much in common with an "elephant," same joint here, so this is an elephant also. Which would be okay, except then we start making treatment decisions based on that logic: ah ha! Antifungal cream is the mainstay of treatment for all elephant illnesses! And meanwhile the elephant dies of throat cancer. Does it make any sense that the best of our science suggests that the manipulation of four neurotransmitters is somehow involved in the treatment of every single psychiatric illness known, from anxiety to xenophobia? "
The entire enterprise of diagnosis seems more and more to me to be a production by the Wizard of Oz. It is thoroughly contaminated by economic interests, unsupported by substantial research which would pass the barest level for science, and it is all determined by committees.
Is this what we really need? Where are the questions about what the rush to medicate more and more people with inadequately tested drugs of limited value even for the problems they were originally designed to help?
This is all nuts!