With three years still left until publication, the fights over the new version of the psychiatric diagnostic manual, the DSM-V, are hotting up and The New York Times has a concise article that covers most of the main point of contention.

- “What you have in the end,” Mr. Shorter said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”

- Psychiatrists involved in preparing the new manual contend that it is too early to say for sure which cards will be added and which dropped.

Although I doubt the DSM committee are using that exact metaphor, it certainly illustrates the point that the process requires a certain degree of value-judgement.

It’s interesting, however, that the public debate is currently focused on whether certain diagnoses should be included or not, rather than whether diagnosis itself is useful for psychiatry.

We’ve had psychometrics for a good 100 years that allow us to measure dimensions of human experience and performance with a much greater degree of accuracy than Read the rest of this entry »

The Alzheimer’s Foundation of America just released a thoughtful report advocating for widespread cognitive screenings after the age of 65 (55 given the right conditions).

According to the press release,

- “The report shatters unsubstantiated criticism and instead emphasizes the safety and cost-effectiveness of these tools and calls on Congress to develop a national dementia screening policy.”

- “Lifting the barriers to early detection is long overdue,” Hall said. “Conversations about brain health are not taking place. We must educate and empower consumers to talk openly about memory concerns, particularly with primary care providers, so they get the attention and quality of life they deserve.”

- “Demand for screenings is evidenced by the success of AFA’s recent sixth annual National Memory Screening Day held on November 18, during which an estimated 50,000 people were given free confidential memory screenings at nearly 2,200 community sites nationwide. During last year’s event, approximately 16 percent of individuals who had a face-to-face screening scored positive and were referred to their primary care providers for follow-up. An AFA survey of participants revealed that fewer than one in four with self-reported memory complaints had previously discussed them with their physicians despite recent visits.”

Excellent report available: here

Please note that the Alzheimer’s Association recently argued in the opposite direction (no screenings) – which probably triggered this response.

We see emerging trends that suggest the position in favor of cognitive assessments may in fact gather momentum over the next few years: widespread computerized cognitive screenings in the US Army, insurance companies like OptumHealth adding such tools to its clinical decision-making systems, polls such as the American Society of Aging’s a couple of years ago indicating a very strong demand for an “annual mental check-up”, the availability of useful assessment tools and research-based preventive advice.

The starting point is to understand what those assessments are NOT: they are not diagnostic tools. When used properly, they can be used as a baseline to track performance in a variety of cognitive domains over time, so that both the individual AND the physician are not blinded by a one-time assessment, comparing an individual with his or her peers (instead of his or her past performance) when serious symptoms have frequently already been going on for a while.

Our contributor  Dr. Joshua Silverman, from Albert Einstein College of Medicine, recently generated a nice debate on the topic by asking our readers their reaction to these 3 questions: Read the rest of this entry »