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Posts Tagged ‘schizophrenia’

The diagnostic bible of the American Psychiatric Association is getting a makeover. A rough draft of version 5 (which is still being debated by the powers that be) is posted at http://www.DSM5.org. And this debate is going to be a dilly.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the manual that doctors, insurers, and scientists use in deciding what is officially considered a mental disorder and how to tell if someone has it. Every now and then they decide to re-evaluate this based on the latest research findings. In a new twist, they were seeking feedback via the Internet from both psychiatrists and the general public about whether the changes will be helpful before finalizing them. That ended in April. Now they have a committee (called the DSM-5 work group on their website) reviewing the comments; and between public input, APA member input, and private research, they will have the new version ready for publication by May of 2013.

Why so long? Take a look at their website, especially the timeline. Then check out the list of diagnostic categories on the home page. These are only the general categories. Specific disorders in each category can be seen by clicking on the name of the general category. All things considered, that final list is going to be huge – when they decide what will be on it and why.

Here’s one issue that they have to decide before 2013. Is Gender Identity Disorder a physical problem, a mental problem, or just another way for humans to behave? The LGBT community is already on the edge of their seats waiting for the APA to have an official opinion, and one way or another, that decision will make headlines for weeks.

My personal source of amusement comes from the fact that, at the moment, PMS is lumped in with bipolar disorder in the Mood Disorders category. I have both, I can tell the difference between the two, and I think that putting them in the same diagnostic category is hilarious. PMS is a physical problem with emotional side effects, and doesn’t belong in the DSM at all (although I think several men around the world would loudly disagree with me).

In other categories, the APA is officially considering hoarding, skin-picking, tics, and olfactory reference syndrome (delusional beliefs about one’s own body odor) as formally classified Anxiety Disorders. Binge eating is also being considered for placement with anorexia and bulimia in the Eating Disorders category. There’s an idea. I could get insurance to pay for a doctor to help me stop pigging out.

Seriously, if you are concerned about the diagnostic process when it comes to mental disorders, keep checking back for updates to their website. I hope that they’re carefully considering the comments of the people who have to personally deal with these issues every day, and not just letting the insurance companies tell the APA how to interpret the research.

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I can’t decide which I like best – the database itself or the information-sharing. The National Institute of Mental Health (NIMH) is gathering information on what a normal kid’s brain looks like so they can share the information with people who are researching developmental disorders like autism.

NIMH described the latest release of data on their website today. They studied over 500 kids, from infants to young adults, using MRI brain scans, physical exams, psychological exams, and measurements of hormonal activity. The point was to catch each kid at different points in their life, get all of this information for that age, and wait a couple of years before doing it again to see what changed. The younger ones got tested more frequently because development occurs faster in the younger years.

The project, called The NIH Magnetic Resonance Imaging (MRI) Study of Normal Brain Development, is looking at things like brain size, memory function, motor skills, language development, and general social skills.

Their focus in this study is only on kids with no health problems. This way, they can pass on the information to people who are trying to figure out why some kids don’t develop normally, who can then compare the “normal” scans and physiological data to that of those kids and study what’s different. Hopefully, we’ll all learn something soon about why the brain can sometimes go haywire in childhood, and whether there is anything we can do to keep it from happening.

If you’re wondering how they got the kids to lie still for the MRI, I read somewhere else that the younger ones are usually scanned while they are sleeping. Trust me – telling most two-year olds to lie down and be still while they’re awake is like asking most puppies to calm down when you come home. That research environment must have been a real trip.

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Question: What’s the funniest thing in the wonderful world of healthcare right now?

Answer: Those five-minute pill commercials where it takes longer to get through the FDA disclosures than it does to talk about the benefits of the pill. If someone could make a late-night infomercial with a bunch of those strung together, I might be able to ditch my sleeping pills. (Ah – but then, they probably don’t want that.)

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Did you know that there may be a genetic link between bipolar disorder and schizophrenia?

Yep. Take a look at this. Apparently there were three different genetic variation research studies going on recently. (“Genetic variation” is a nice way of saying your heredity has screwed you in some way.) All of them point to one particular chromosome that had problems in both schizophrenic and bipolar patients – #6.

We all have 23 pairs of chromosomes, and that’s where our genes are. The last pair is the most famous, because it determines whether a person is male or female. Chromosome pair #6 (only named that because it’s the 6th largest chromosome) is already known for genes that regulate immunity, among other things. So, not only do we have a common link between bipolar disorder and schizophrenia, autoimmune conditions are probably a part of the mix as well. (“Autoimmune” is a nice way of saying that your own body is screwing you in some way.)

The director of the National Institute of Mental Health (NIMH) is now wondering if they should redefine the diagnostic categories of mental illnesses. Good for him – the answer is YES. We would be one step closer toward the possibility of an accurate diagnosis and relevant treatment for all of us. Keep learning, people.

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Here’s another encouraging bit of news:  mental health is getting more funding in the form of grant money from the American Recovery and Reinvestment Act (ARRA).  The main requirement is that those funds be used for research projects that have the potential to make a difference in scientific advancement in under two years.

The National Institutes of Health (NIH), which bills itself as The Nation’s Medical Research Agency, really does sponsor a great deal of medical research, so feeding over $8 billion to the NIH was probably the best way to provide research funding to the most projects at once.  Autism research was one of the main target areas, along with opportunities for science educators and existing short-term research projects which were running out of funds.

Some of that money is going to the National Institute of Mental Health (NIMH).  On their web pages, I found a couple of interesting grant opportunities that I’d like to keep an eye on.

One priority area is developing new ways of evaluating the brain without actually cutting into it.  From what I understand, just about every other organ in the body can be biopsied and analyzed without significant damage to a person’s health.  I’ll bet there aren’t very many people who are willing to give up a chunk of their brain for the advancement of science, so this new technology (whatever it is) will be great.

They would also like to get a report card on the current system of “community re-entry programs” for prisoners in need of mental health services.  I have a hunch that they’ll find that it needs major help.  I know a guy who knows a guy who regularly steals something when he’s having a hard time coping just so he can go back to jail.  He thinks that the struggle to survive is easier there.  Most jails are now being seen as modern variations of the “funny farms”, so new information here could have an impact on quite a few areas.

The grant money will also target the nature of schizophrenia and other major mental disorders, the genetics of mental illness, how to improve services for racially and ethnically diverse populations, intervention strategies for youth and young adults, and how to develop low-risk drugs that might be better solutions for some of us, among other things.

The big news will have be the results of the “Grand Opportunities” grants.  The NIMH is going to give out money to anyone who comes up with research studies which will find out more about brain development (or which part of our brain went haywire at what point to impact our symptoms), which genes specifically affect the risk of mental illness, and – my personal favorite – “Neurodevelopmental Genomics:  Trajectories of Complex Phenotypes”.

In plain English, this means we could end up with a better understanding of how genetics, physical growth, environment, and behaviour all work together over time to make us who we are.  We could end up with a more accurate system of categorizing mental and emotional disorders, which in turn might make it easier to accurately diagnose and treat them.

Click here for the full story on what the National Institute of Mental Health is doing with their piece of the pie.  I’m really looking forward to the “How Are We Doing?” page on the federal government’s ARRA website to see how this all plays out.

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