Saturday, February 11, 2012

The ever-broadening definition of mental illness

What's next? Will religion be declared a mental illness? How about climate skepticism? American psychiatrists would be at home in the old Soviet Union

Childhood shyness could be reclassified as a mental disorder under controversial new guidelines, warn experts. They also fear that depression after bereavement and behaviour now seen as eccentric or unconventional will also become ‘medicalised’. Internet addiction and gambling might also become forms of illness.

The threat comes in the form of proposed changes to a U.S. manual of mental disorders, viewed as a bible by some in the field.

Although the changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders would not directly affect clinical practice here – where doctors tend to use different guidelines – experts say it would eventually influence thinking.

Millions of people, including Britons, could be given a psychiatric diagnosis which could ruin their lives, warn psychiatrists and psychologists here.

The DSM5 changes are also opposed by many experts in the U.S., some of whom claim they reflect efforts by drug companies to sell more products.

Simon Wessely, of the Institute of Psychiatry, King’s College, London, said: ‘We need to be very careful before further broadening the boundaries of illness and disorder.

‘Back in 1840 the census of the United States included just one category for mental disorder. ‘By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision. Do we really need all these labels?

‘Probably not. And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.’

Peter Kinderman, head of the Institute of Psychology, University of Liverpool, said: ‘It will exacerbate problems that result from trying to fit a medical, diagnostic, system to problems that just don’t fit nicely into those boxes.

‘It will pathologise a range of problems which should never be thought of as mental illnesses. Many who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labelled as “mentally ill”. ‘This isn’t valid, isn’t true, isn’t humane.’

Paraphilic Coercive Disorder – becoming aroused by sexual coercion – is one condition proposed for inclusion in DSM5. Professor Kinderman said there was a danger that rapists diagnosed with it would use it as an excuse.

He added that there were ‘huge concerns’ about the changes, which are opposed by the British Psychological Society.

Other experts say the guidelines will straitjacket clinicians into ‘ticking boxes’ that lead to a prescribed diagnosis. Dr Felicity Callard, of King’s College, warned: ‘People’s lives can be altered profoundly – and sometimes ruinously – by being given a psychiatric diagnosis.’

Among the U.S. psychiatrists against the changes is Allen Frances, of Duke University, North Carolina. He warned: ‘DSM5 will radically and recklessly expand the boundaries of psychiatry. Many millions will receive inaccurate diagnosis and inappropriate treatment.’

David Elkins, of Pepperdine University, Los Angeles, said individuals could be ‘labelled with a mental disorder for life and many will be treated with powerful psychiatric drugs’.

Defenders of the American Psychiatric Association guidelines say they will make diagnosis more accurate and scientific.


Skin cancer drug 'clears Alzheimer's protein from the mouse brain'

A promising start

A skin cancer drug could prove to be a precious weapon in the fight against Alzheimer’s. In tests, bexarotene rapidly improved brain health, memory and behaviour of mice genetically engineered to develop the disease.

Researchers described the effect as unprecedented and ‘tremendously exciting’. But others cautioned against raising hopes, pointing out that what works in laboratory mice doesn’t always work in humans.

The researchers, from Cape Western Reserve University in the U.S., used bexarotene to break down amyloid, the toxic protein that clogs the brain of Alzheimer’s patients. Within just six hours of giving the drug to the mice, levels of one type of amyloid fell by a quarter, according to the study detailed in the journal Science.

Levels of another form halved in three days. Memory and behaviour also rapidly improved with treated mice eagerly building nests – an instinct lost by the poorly animals.

Researcher Daniel Wesson said: ‘The results of this study, showing the preservation of behaviour across a wide spectrum, are tremendously exciting and suggest great promise.’

However, Professor Derek Hill, of University College London, warned: ‘Demonstrating that potential drugs for Alzheimer’s are safe and effective takes many years, and requires trials on thousands of patients.’

Dr Anne Corbett, of the Alzheimer’s Society, said: ‘This exciting study could be the beginning of a journey towards a potential new way to treat Alzheimer’s disease.’

She added that focusing on existing drugs rather than trying to invent new ones should speed the development of treatments.

There is currently no cure for Alzheimer’s disease.


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