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href="/topics/tech-psychiatry">Technology & Psychiatry</a></li><li class=" text-left m-1 p-2 ml-8 hover:opacity-80 hover:underline hover:text-primary"><a class=" " href="/topics/transcranial-magnetic-stimulation">Transcranial Magnetic Stimulation</a></li></ul></div></div></div><div class="sm:flex w-full hidden text-sm border-menu-border"><p class="my-auto flex font-bold text-primary w-auto ">SPOTLIGHT <span class="font-normal">-</span></p><div id="" class="headers w-[90%] h-5 overflow-hidden flex flex-row flex-wrap undefined my-4 ml-0 z-[9999]"><div class=""><a class="block cursor-pointer text-primary hover:underline px-2 pb-3 hover:text-black border-l border-current pl-auto first:border-none first:pl-0 " href="/topics/major-depressive-disorder"> Major Depressive Disorder </a><div class="mt-4 max-w-[125px]"></div></div><div class=""><a class="block cursor-pointer text-primary hover:underline px-2 pb-3 hover:text-black border-l border-current pl-auto first:border-none first:pl-0 " href="/topics/schizophrenia"> | Schizophrenia/Psychosis </a><div class="mt-4 max-w-[125px]"></div></div><div class=""><a class="block cursor-pointer text-primary hover:underline px-2 pb-3 hover:text-black border-l border-current pl-auto first:border-none first:pl-0 " href="/topics/mental-health-awareness"> | Mental Health Awareness Month </a><div class="mt-4 max-w-[125px]"></div></div></div></div></div></nav><div id="sripriya-chari-phd" class="container mx-auto flex m-1 min-h-[57vh] px-4"><div class="flex-auto w-[calc(100%-300px)] pr-0 md:pr-6 mt-16 sm:mt-0"><div class="pb-24 my-2"><h1 class="text-3xl">Sripriya Chari, PhD</h1><div class="w-full mb-2 border border-secondary"></div><div class=" flex-1 py-2 text-sm"><a class="text-primary" href="/">home</a><a class="text-primary" href="/authors"> / <span class="">authors</span></a><span class="text-gray-400"> / <span class=" text-gray-400">sripriya-chari-phd</span></span></div><div class="flex justify-end gap-2"></div><div class="flex flex-col sm:flex-row"><div id="description-summary" class="py-2 text-sm text-gray-500 sm:w-[calc(100%-100px)]"><div class="blockText_blockContent__TbCXh"><p class="pb-2"><strong>Dr Chari </strong><em>is the assistant psychosocial director and didactic lead of the INSPIRE Clinic and a clinical associate professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine in California.</em></p></div></div></div><h3 class="text-xl">Articles</h3><div class="flex flex-wrap w-full"><div class="w-full h-full"><hr class="mt-1 w-full " style="border-top-width:1px;border-top-color:#F3F4F6"/><div class="w-full h-full"><div class="w-full md:w-auto md:flex md:flex-col md:items-center lg:items-start lg:flex-row mb-4 mt-3 "><div class="flex flex-1 md:col-span-2 " style="background-color:transparent;border-color:#F3F4F6;border-width:0;border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem"><a class=" md:flex-none w-full md:w-48 mt-2" href="/view/opening-pandoras-box-the-importance-of-assessing-and-treating-trauma-in-individuals-experiencing-psychosis"><div class=""><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;padding-top:56.043956043956044%"></span><img alt="trauma" title="trauma" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="responsive" class="shrink-0" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%"/><noscript><img alt="trauma" title="trauma" sizes="100vw" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F3baa097f1742d64c9afda10b2c6f7deda469f1dc-7280x4080.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=640&q=75 640w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F3baa097f1742d64c9afda10b2c6f7deda469f1dc-7280x4080.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=750&q=75 750w, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F3baa097f1742d64c9afda10b2c6f7deda469f1dc-7280x4080.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=828&q=75 828w, 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src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F3baa097f1742d64c9afda10b2c6f7deda469f1dc-7280x4080.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="responsive" style="border-top-left-radius:0rem;border-top-right-radius:0rem;border-bottom-left-radius:0rem;border-bottom-right-radius:0rem;position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%" class="shrink-0" loading="lazy"/></noscript></span></div></a><div class="flex-auto w-[200%] md:w-auto ml-2 flex-1"><p class="font-bold text-[1rem] pl-4 text-undefined" style="font-size:1rem"><a href="/view/opening-pandoras-box-the-importance-of-assessing-and-treating-trauma-in-individuals-experiencing-psychosis">Opening Pandora’s Box: The Importance of Assessing and Treating Trauma in Individuals Experiencing Psychosis</a></p><div class=" pl-4"><a class="text-sm text-sky-800" href="/authors/sripriya-chari-phd">Sripriya Chari, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/grace-eun-lee-phd">Grace Eun Lee, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/nichole-d-olson-phd">Nichole D. Olson, PhD</a><span class="mr-1 ml-[1px]">;</span><a class="text-sm text-sky-800" href="/authors/kate-v-hardy-psyd">Kate V. Hardy, PsyD</a></div><a href="/view/opening-pandoras-box-the-importance-of-assessing-and-treating-trauma-in-individuals-experiencing-psychosis"><span class="text-sm text-gray-500 pl-4">November 12th 2024</span><div class="mt-2 ml-4"></div><div class="flex flex-row gap-2"></div><p class=" mt-4 text-gray-800 pl-4">Traumatic life events are common among individuals who experience psychosis. 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","_key":"NR5D3Z4v"},{"_key":"x7LnS8Eu","_type":"span","marks":[],"text":"None of the above"}],"_type":"block","style":"normal","_key":"p7b4UpV4","markDefs":[]},{"markDefs":[],"children":[{"_key":"beumj4VF","_type":"span","marks":["strong"],"text":"Discussion: "}],"_type":"block","style":"normal","_key":"IZSPP3bO"},{"_key":"Lm804AuE","markDefs":[],"children":[{"marks":[],"text":"Evidence suggest that paraphilic interests do change. These include the fact that the incidence of sex crimes decreases as people age, and the likelihood that a known high-risk sex offender will ever reoffend decreases the longer the offender does not commit a crime-as well as the self-report of men and women with paraphilic disorders.","_key":"3NjCS18G","_type":"span"},{"marks":["superscript"],"text":"1","_key":"nffosxeP","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"_key":"5897378bc56e","_type":"span","marks":[],"text":"Some approaches seek to change the manner in which sex offenders against children are assessed and treated, even in the face of popular media. One such program is the "},{"text":"Sexual Behaviours Clinic","_key":"31a5df9d75d8","_type":"span","marks":["a2548a21a649"]},{"_type":"span","marks":[],"text":" (SBC) at The Royal Ottawa Mental Health Centre. 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Paul Fedoroff, MD, on which this quiz was based. In his article, Dr Fedoroff explains some of the realities about sex offenders and why psychiatrists should be more optimistic about their patients’ prognoses.","_key":"Yv65Eez1"}]},{"children":[{"marks":["strong"],"text":"References","_key":"vg76JgjW","_type":"span"}],"_type":"block","style":"normal","_key":"8rP2QLws","markDefs":[]},{"children":[{"marks":["strong"],"text":"1.","_key":"25995d19569e","_type":"span"},{"_type":"span","marks":[],"text":" Fedoroff JP. Managing versus successfully treating paraphilic disorders: the paradigm is changing. In: Levine CB, Althof SE, eds. ","_key":"569iSe1V"},{"text":"Handbook of Clinical Sexuality for Mental Health Professionals.","_key":"j7LiPTuU","_type":"span","marks":["em"]},{"_key":"n8zcHd8n","_type":"span","marks":[],"text":" New York: Taylor and Francis; 2016:345-361."}],"_type":"block","style":"normal","_key":"0d2d6f28dd9b","markDefs":[]},{"style":"normal","_key":"kCwXx25l","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"2.","_key":"mtQVvrka"},{"_type":"span","marks":[],"text":" Fedoroff JP. Pedophilia: interventions that work. ","_key":"z8uQ9S0C"},{"_type":"span","marks":["em"],"text":"Psychiatric Times","_key":"iFk7qhPp"},{"_type":"span","marks":[],"text":". 2016;32(7): 39-41.","_key":"EGFCE7V8"}],"_type":"block"},{"style":"normal","_key":"3eec69bdced9","markDefs":[],"children":[{"_type":"span","marks":["em","superscript"],"text":"This quiz was originally posted on August 16, 2016 and has since been updated.","_key":"c3fa2d5afbe5"}],"_type":"block"}],"_type":"poll","_key":"77e931770b78b51212b760325380df84","choices":[{"choiceAnswer":false,"choiceText":"A. Pedophilia is incurable","_type":"pollText","choiceCount":3109,"_key":"d2e85d7f21ea2a7e00f49710230d3b38"},{"choiceAnswer":false,"choiceText":"B. Pedophilia is an orientation","_type":"pollText","choiceCount":2856,"_key":"82ea0a6aaef13813b96f73ff8cd349ec"},{"choiceAnswer":false,"choiceText":"C. 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Pat yourself on the back and grab a coffee. Otherwise, you might want to read on.","_key":"be551bf52576","_type":"span"}],"_type":"block","style":"normal","_key":"5baad7dcaec3"}],"_type":"poll","_key":"e2ad675ced44","choices":[{"_key":"c5266f219d31","choiceText":"A. DSM-5 permits the clinician to make a mental disorder diagnosis simply by checking off the symptoms listed in a disorder’s diagnostic criteria.","_type":"pollText","choiceCount":108},{"choiceCount":118,"_key":"c8e6c9e8cc01","choiceText":"B. To make a DSM-5 mental disorder diagnosis, the clinician need not assess the social, psychological and biological factors that may have contributed to the patient’s condition.","_type":"pollText"},{"choiceText":"C. DSM-5 is an embodiment and expression of the “biomedical” model in psychiatry.","_type":"pollText","choiceCount":108,"_key":"ecf97a66f012"},{"choiceText":"D. DSM-5 posits that mental disorders are discrete entities sharply distinguished both from “normality” and from each other.","_type":"pollText","choiceCount":72,"_key":"a594d0015b49"},{"choiceText":"E. All of the above","_type":"pollText","choiceCount":309,"_key":"08218d39fb2a"},{"choiceText":"F. None of the above","_type":"pollText","choiceCount":506,"_key":"87973bfd8a46"}],"upload_doc":null,"medias":null,"uploadAudio":null,"question":"Which of the following statements regarding DSM-5 is/are true?"},{"uploadAudio":null,"markDefs":[],"children":[{"marks":["strong"],"text":"","_key":"aff18e7eac1f0","_type":"span"}],"_type":"block","style":"normal","_key":"c3a285027c9f","upload_doc":null,"medias":null},{"_key":"a548c72bc7cb","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"text":"Symptom Check Lists Won’t Cut It","_key":"ede87fbcba6c","_type":"span","marks":["strong"]}],"_type":"block","style":"normal"},{"_key":"a6383326d262","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"_key":"14d18f83fb1e","blank":true,"_type":"link","href":"https://theconversation.com/forget-talking-just-fill-a-script-how-modern-psychiatry-lost-its-mind-9569"}],"children":[{"marks":[],"text":"Critics of psychiatric diagnosis often caricaturize the DSM process as the “Chinese Menu” approach. Thus, a professor of history and philosophy—in an article titled, “Forget talking, just fill a script: how modern psychiatry lost its mind”—","_key":"ad3923e532df0","_type":"span"},{"_type":"span","marks":["14d18f83fb1e"],"text":"wrote","_key":"f0928d2e9911"},{"_type":"span","marks":[],"text":"","_key":"a8fcf47fef95"},{"marks":[],"text":":","_key":"94bc6be6ea4d","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In clinical practice, DSM-III led to a “Chinese menu” approach to psychiatric diagnosis: a specific mental illness can be diagnosed if a sufficient number of boxes can be ticked. This is only of limited value in clinical practice.","_key":"5aca93396c100"},{"_type":"span","marks":["superscript"],"text":"3","_key":"94b44aaa353d"}],"_type":"block","style":"blockquote","_key":"0a28fab4df2f","upload_doc":null,"medias":null,"uploadAudio":null},{"children":[{"text":"Indeed, merely checking off boxes of symptoms (and signs) ","_key":"dd87609bcfdd0","_type":"span","marks":[]},{"_key":"dd87609bcfdd1","_type":"span","marks":["em"],"text":"is"},{"_type":"span","marks":[],"text":" of very limited clinical value—","_key":"dd87609bcfdd2"},{"_type":"span","marks":["em"],"text":"but that is not at all what DSM-5 calls for.","_key":"dd87609bcfdd3"},{"_type":"span","marks":[],"text":" As my colleague, Dr Mark Ruffalo, and I ","_key":"dd87609bcfdd4"},{"_type":"span","marks":["7c5dce4cd2ce"],"text":"pointed out","_key":"1343d1c8c660"},{"_key":"29a9eeaa7daa","_type":"span","marks":[],"text":""},{"_type":"span","marks":[],"text":", the DSM-5 makes it crystal clear: Simply checking off symptoms ","_key":"95714023b2f1"},{"_key":"dd87609bcfdd5","_type":"span","marks":["em"],"text":"cannot and does not constitute a psychiatric diagnosis—"},{"_type":"span","marks":[],"text":"which requires a comprehensive ","_key":"dd87609bcfdd6"},{"_type":"span","marks":["em"],"text":"case formulation.","_key":"dd87609bcfdd7"},{"_key":"7b7908229203","_type":"span","marks":["em","superscript"],"text":"4"},{"_type":"span","marks":["superscript"],"text":" ","_key":"dd87609bcfdd8"},{"_type":"span","marks":[],"text":"As the ","_key":"4981780c6043"},{"_type":"span","marks":["em"],"text":"Manual ","_key":"dd87609bcfdd9"},{"_type":"span","marks":[],"text":"itself ","_key":"dd87609bcfdd10"},{"_type":"span","marks":["a40e0494c206"],"text":"notes","_key":"17931b7ccdaa"},{"_type":"span","marks":[],"text":"","_key":"52c6816f8f0f"},{"_type":"span","marks":[],"text":":","_key":"ae521907939c"}],"_type":"block","style":"normal","_key":"bab7d1828d16","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://www.psychologytoday.com/us/blog/freud-fluoxetine/202006/psychiatric-diagnosis-20-the-myth-the-symptom-checklist","_key":"7c5dce4cd2ce"},{"blank":true,"_type":"link","href":"https://dsm.psychiatryonline.org/","_key":"a40e0494c206"}]},{"upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"text":"The case formulation for any given patient must involve a careful clinical history and concise summary of the social, psychological and biological factors that may have contributed to developing a given mental disorder. ","_key":"85ab544a4f4a0","_type":"span","marks":[]},{"_key":"85ab544a4f4a1","_type":"span","marks":["em"],"text":"Hence, it is not sufficient to simply check off the symptoms of the diagnostic criteria to make a mental disorder diagnosis "},{"_type":"span","marks":[],"text":"(emphasis added).","_key":"85ab544a4f4a2"},{"_type":"span","marks":["superscript"],"text":"5(p19)","_key":"33c92ab96b83"}],"_type":"block","style":"blockquote","_key":"097fbc5bf59d"},{"upload_doc":null,"content":[{"markDefs":[],"children":[{"marks":["em","strong"],"text":"\"You cannot snag a DSM diagnosis merely by collecting a group of signs and symptoms.\"","_key":"b8e0da0891d1","_type":"span"}],"_type":"block","style":"normal","_key":"5eeefcbe8854"}],"medias":null,"uploadAudio":null,"_type":"sidebar","_key":"bb15b1acef8e"},{"upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"href":"http://www.lacounseling.org/images/lca/Conference/DSM-5%20LCA%20Case%20Formulation%20Rev.pdf","_key":"277f401e0e25","blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"As Dr Gary G. Gintner has ","_key":"d92361110e490"},{"_key":"614ec03d46cf","_type":"span","marks":["277f401e0e25"],"text":"explained"},{"_type":"span","marks":[],"text":"","_key":"ad0054afc94c"},{"_type":"span","marks":[],"text":", the case formulation “. . . is a core clinical skill that links assessment information and treatment planning. It is a hypothesis about the mechanisms that cause and maintain the problem. It answers the question, ‘Why is this person, having this type of problem, now?’”","_key":"593064299bc4"},{"_type":"span","marks":["superscript"],"text":"6","_key":"ad00fead3832"}],"_type":"block","style":"normal","_key":"568dfef4eabc"},{"upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://en.wikipedia.org/wiki/DSM-5","_key":"6730571c1bd0"}],"children":[{"_type":"span","marks":[],"text":"In principle, the case formulation—and by extension, the final DSM diagnosis—requires medical knowledge, or at least access to medical consultation, in order to assess the “biological factors” that may have contributed to the patient’s problem. Finally, we should note that, in addition to meeting sign/symptom criteria for a mental disorder, virtually all the major ","_key":"90c06147a54a0"},{"_type":"span","marks":["6730571c1bd0"],"text":"DSM-5 categories","_key":"76e7903202a7"},{"_type":"span","marks":[],"text":"","_key":"d887b4f66c33"},{"marks":[],"text":" require evidence of “clinically significant distress or impairment in social, occupational or other important areas of functioning.” You cannot snag a DSM diagnosis merely by collecting a group of signs and symptoms. There must also be adverse consequences in the person’s life.","_key":"aa7780433f3d","_type":"span"}],"_type":"block","style":"normal","_key":"c33a1708e853"},{"_key":"7569c721b605","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"The DSM-5 Is “Biomedical”? Not So Much","_key":"13577f2f584d0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"aee8b68d7d35","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"It is clear from the aforementioned description of the case formulation that the DSM-5 explicitly uses a “biopsychosocial” approach to diagnosis. In addition, DSM-5 has extensive coverage of cultural issues, as they impinge on differential diagnosis. Excellent examples of the “case conceptualization” using a bio-psychosocial-cultural approach may be found in the text by Sperry and Sperry.","_key":"4cbb04c594a80"},{"_type":"span","marks":["superscript"],"text":"7","_key":"c4eb4d2cae95"}]},{"upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://journals.sagepub.com/doi/abs/10.1177/0959353512467974","_key":"2cad2965cdb7"}],"children":[{"marks":[],"text":"Nonetheless, some commentators—mainly critics of psychiatric nosology—have asserted that DSM-5 represents the “biomedical” model. For example, 1 paper ","_key":"31f81735a0bf0","_type":"span"},{"_type":"span","marks":["2cad2965cdb7"],"text":"argues","_key":"ad2720f585c5"},{"_type":"span","marks":[],"text":"","_key":"c28d62decd5d"},{"_type":"span","marks":[],"text":" that,","_key":"c07307108016"}],"_type":"block","style":"normal","_key":"a89b1bf1dc19"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The ","_key":"4d7d5c8398940"},{"_key":"4d7d5c8398941","_type":"span","marks":["em"],"text":"Diagnostic and Statistical Manual of Mental Disorders"},{"_type":"span","marks":[],"text":" . . . offers a biomedical framing of people’s experiences of distress and impairment, and despite decades of criticism, it remains the dominant approach.","_key":"4d7d5c8398942"},{"_type":"span","marks":["superscript"],"text":"8","_key":"7ad7cb0112b3"}],"_type":"block","style":"blockquote","_key":"40c18087430d","upload_doc":null,"medias":null,"uploadAudio":null},{"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://journals.sagepub.com/doi/abs/10.1177/0959353512467974","_key":"bcea9ca8aa06"}],"children":[{"_type":"span","marks":[],"text":"These authors go on to argue that, “. . . a biomedical construction of ‘mental illness’ all too frequently fails to protect individuals from delegitimation and stigma.” That is a provocative claim worth examining but is beyond the scope of this essay. What is striking about the paper by these 2 psychologists is that the term “biomedical” is never fully defined. The authors do ","_key":"462ecf099e420"},{"_key":"6bc99380248b","_type":"span","marks":["bcea9ca8aa06"],"text":"note"},{"_type":"span","marks":[],"text":"","_key":"0f6884a260d0"},{"_type":"span","marks":[],"text":" the biomedical model is oriented “around the problems of the body . . . such as genetics or neurochemistry.”","_key":"21a8318dcccb"},{"text":"8","_key":"c89e7cb62697","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal","_key":"deba9e3ad206","upload_doc":null,"medias":null},{"style":"normal","_key":"39b09f4a19b7","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/early-warnings-neuropsychiatric-manifestations-huntington-disease","_key":"0de6f0e3140c"}],"children":[{"text":"If we take that rough formulation as a guide, it can be readily seen that—with a few exceptions—there is very little in DSM-5 that invokes “genetics” or “neurochemistry.” True, DSM-5’s discussion of ","_key":"dce356c6a1660","_type":"span","marks":[]},{"_type":"span","marks":["0de6f0e3140c"],"text":"Huntington disease","_key":"998e080ba613"},{"marks":[],"text":"","_key":"b0108c3ca6e7","_type":"span"},{"_type":"span","marks":[],"text":" does reference abnormalities on chromosome 4; and other neurocognitive disorders, such as Lewy body disease, are linked to genetic abnormalities. But such references to specific genetic abnormalities are by far the exception, particularly for the more classically “psychiatric” disorders, such as schizophrenia and bipolar disorders. (We do find, under the rubric of “Risk and Prognostic Factors,” the statement that “Schizophrenia and bipolar disorder likely share a genetic origin . . .”","_key":"c3733e7056ec"},{"_type":"span","marks":["superscript"],"text":"5","_key":"4801e82e8f19"},{"_type":"span","marks":[],"text":" but that is about as far as the ","_key":"2c93b622354d"},{"_key":"dce356c6a1661","_type":"span","marks":["em"],"text":"Manual"},{"_key":"dce356c6a1662","_type":"span","marks":[],"text":" goes)."}],"_type":"block"},{"alignment":"right","asset":{"path":"images/0vv8moc6/psychtimes/34def3064505b4e400fdc8147dc7123c929c23f4-992x776.jpg","extension":"jpg","sha1hash":"34def3064505b4e400fdc8147dc7123c929c23f4","uploadId":"CIt12qnuyVAvA9XFe4KbVclvZW1t51Uh","size":151048,"url":"https://cdn.sanity.io/images/0vv8moc6/psychtimes/34def3064505b4e400fdc8147dc7123c929c23f4-992x776.jpg","_type":"sanity.imageAsset","mimeType":"image/jpeg","assetId":"34def3064505b4e400fdc8147dc7123c929c23f4","_updatedAt":"2021-03-23T15:01:55Z","_createdAt":"2021-03-23T15:01:55Z","metadata":{"palette":{"vibrant":{"title":"#fff","population":0.01,"background":"#3c7c8c","_type":"sanity.imagePaletteSwatch","foreground":"#fff"},"dominant":{"population":6.37,"background":"#2f4349","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff"},"_type":"sanity.imagePalette","darkMuted":{"population":6.37,"background":"#2f4349","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff"},"muted":{"population":1.9,"background":"#69828a","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff"},"lightVibrant":{"background":"#b4cadc","_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff","population":0.2},"darkVibrant":{"foreground":"#fff","title":"#fff","population":0.48,"background":"#3c8484","_type":"sanity.imagePaletteSwatch"},"lightMuted":{"background":"#9dbec4","_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff","population":0.65}},"hasAlpha":false,"lqip":"data:image/jpeg;base64,/9j/2wBDAAYEBQYFBAYGBQYHBwYIChAKCgkJChQODwwQFxQYGBcUFhYaHSUfGhsjHBYWICwgIyYnKSopGR8tMC0oMCUoKSj/2wBDAQcHBwoIChMKChMoGhYaKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCj/wAARCAAQABQDASIAAhEBAxEB/8QAFwAAAwEAAAAAAAAAAAAAAAAAAAQGBf/EAB4QAAICAgMBAQAAAAAAAAAAAAECAwQAERITUUEF/8QAFQEBAQAAAAAAAAAAAAAAAAAAAwT/xAAaEQACAwEBAAAAAAAAAAAAAAAAAQMREgJR/9oADAMBAAIRAxEAPwByKwVGjKoG/Mp6UVN4I5JSnYR9TeSS8yQwTYy0/MhtGpE8UKEcfMaRuiWJLRpVadJoQeiN9/eAwxuqLAhAdVU+AYYFsozz4f/Z","dimensions":{"_type":"sanity.imageDimensions","width":992,"aspectRatio":1.2783505154639174,"height":776},"isOpaque":true,"_type":"sanity.imageMetadata"},"originalFilename":"PSY032021_PiesDSM_Table1.jpg","_rev":"5q8DjueuIO7vq4ld9RpoHA","_id":"image-34def3064505b4e400fdc8147dc7123c929c23f4-992x776-jpg"},"blank":true,"link":"https://cdn.sanity.io/images/0vv8moc6/psychtimes/34def3064505b4e400fdc8147dc7123c929c23f4-992x776.jpg?auto=format","uploadAudio":null,"_key":"a3e1379b9f75","medias":null,"imgcaption":[{"_key":"6feec78dec53","markDefs":[],"children":[{"marks":["strong"],"text":"Table 1. What DSM-5 Is and What It Is Not","_key":"65990a6ffa25","_type":"span"}],"_type":"block","style":"normal"}],"widthP":35,"_type":"figure","upload_doc":null},{"markDefs":[],"children":[{"text":"What About “Neurochemistry”?","_key":"9977b2841c2e0","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"a16c790a0e87","upload_doc":null,"medias":null,"uploadAudio":null},{"_type":"block","style":"normal","_key":"ba2aa9da3917","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://dsm.psychiatryonline.org/","_key":"a0aeb0d0ce16"}],"children":[{"_type":"span","marks":[],"text":"As far as I know, discussion of “neurochemistry” as a ","_key":"4558c0fb942f0"},{"text":"causal or etiological factor","_key":"4558c0fb942f1","_type":"span","marks":["em"]},{"text":" in any of the common psychiatric disorders is entirely lacking in DSM-5. (So much for “chemical imbalances”). With only a few exceptions, DSM-5 avoids commitments regarding etiology. Indeed, the ","_key":"4558c0fb942f2","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"Manual ","_key":"4558c0fb942f3"},{"_type":"span","marks":[],"text":"explicitly ","_key":"4558c0fb942f4"},{"text":"notes","_key":"4854258bf606","_type":"span","marks":["a0aeb0d0ce16"]},{"_type":"span","marks":[],"text":"","_key":"42e91efbcfe0"},{"_type":"span","marks":[],"text":", “a diagnosis does not carry any necessary implications regarding the etiology or causes of the individual’s mental disorder. . .”","_key":"dd9ac997a7f8"},{"_type":"span","marks":["superscript"],"text":"5(p25)","_key":"08a9a0df8f98"},{"text":" One can see this as a serious deficiency in the DSM-5—but one cannot claim the ","_key":"b4306e79b14a","_type":"span","marks":[]},{"text":"Manual ","_key":"4558c0fb942f5","_type":"span","marks":["em"]},{"marks":[],"text":"endorses anything resembling neurochemical etiologies or “chemical imbalances” for the major mental disorders.","_key":"4558c0fb942f6","_type":"span"}]},{"upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"href":"https://journals.sagepub.com/doi/abs/10.1177/0959353512467974","_key":"4a6c213a1875","blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"In sum, there is no credible basis for ","_key":"dec98c7ab62f0"},{"_type":"span","marks":["4a6c213a1875"],"text":"arguing","_key":"f761fd457434"},{"marks":[],"text":"","_key":"075f6897ed7b","_type":"span"},{"_type":"span","marks":[],"text":" that the DSM-5 “offers a biomedical framing of people’s experiences of distress and impairment.”","_key":"dd0a65d63a6e"},{"_type":"span","marks":["superscript"],"text":"8","_key":"1a8d78fa18fb"},{"text":" Deacon, in a detailed review and critique, argues that “The biomedical model posits that mental disorders are brain diseases and emphasizes pharmacological treatment to target presumed biological abnormalities.”","_key":"fb4909ed388e","_type":"span","marks":[]},{"marks":["superscript"],"text":"9","_key":"6f09945f91c8","_type":"span"},{"marks":[],"text":" I do not contest that description, but nothing in Deacon’s analysis shows that DSM-5 is essentially “biomedical” in the sense he explicates.","_key":"e23a3f8136b2","_type":"span"}],"_type":"block","style":"normal","_key":"63200e276463"},{"_key":"61ff117070c1","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"_key":"e6f630d9933d0","_type":"span","marks":["strong"],"text":"Fuzzy Boundaries, Overlapping Symptoms, and Dimensions of Pathology"}],"_type":"block","style":"normal"},{"_key":"4f560435e5e8","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"_key":"e04600f374050","_type":"span","marks":[],"text":"Another common claim is that DSM-5 is a strictly “categorical” framework that conceptualizes mental illness as a collection of discrete, diagnostically separable entities. As one paper puts it, “. . . the DSM-5 is a categorical system. Thus, individual disorders are regarded as discrete units—“you either have it, or you don't.”"},{"_type":"span","marks":["superscript"],"text":"10","_key":"70938dab549b"},{"_type":"span","marks":[],"text":" A related claim is that DSM-5 posits a clear and distinct separation between mental abnormality and “normal” mental or psychological states. ","_key":"0edae070055e"}],"_type":"block","style":"normal"},{"_key":"4d793f1845fb","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://cdn.sanity.io/images/0vv8moc6/psychtimes/34def3064505b4e400fdc8147dc7123c929c23f4-992x776.jpg?auto=format","_key":"24338a1fb671"}],"children":[{"_key":"5c60fad957dd0","_type":"span","marks":[],"text":"In truth, neither claim is supported in the DSM-5 ("},{"text":"Table 1","_key":"5c60fad957dd1","_type":"span","marks":["strong","24338a1fb671"]},{"_type":"span","marks":[],"text":"","_key":"279eb87df95b"},{"marks":[],"text":"). On the contrary, the Introduction to the ","_key":"5c60fad957dd2","_type":"span"},{"_type":"span","marks":["em"],"text":"Manual ","_key":"56b2b05c3e89"},{"_type":"span","marks":[],"text":"clearly states,","_key":"691b4ad75a36"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The results of numerous studies of comorbidity and disease transmission . . . make strong arguments for what many astute clinicians have long observed: the boundaries between many disorder “categories” are more fluid over the life course than DSM-IV recognized, and many symptoms assigned to a single disorder may occur, at varying levels of severity, in many other disorders. These findings mean that DSM . . . should accommodate ways to introduce dimensional approaches to mental disorders, including dimensions that cut across categories . . . Although some mental disorders may have well-defined boundaries around symptom clusters, scientific evidence now places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors, and possibly shared neural substates . . . ","_key":"78107f484f400"},{"_type":"span","marks":["em"],"text":"In short, we have come to recognize that the boundaries between disorders are more porous than originally believed.","_key":"2d61b5d3ba19"},{"marks":[],"text":"” (Italics added)","_key":"19facd202b8c","_type":"span"},{"_type":"span","marks":["superscript"],"text":"5(pp5-6)","_key":"3fb484507689"},{"_type":"span","marks":[],"text":"","_key":"365491a27bc70"}],"_type":"block","style":"blockquote","_key":"57dc0cc46007","upload_doc":null,"medias":null,"uploadAudio":null},{"children":[{"_type":"span","marks":[],"text":"Furthermore, the DSM-5 does not argue for a hard and fast boundary between “normal” and “abnormal” states and conditions. On the contrary, it states:","_key":"f299962ef90a0"}],"_type":"block","style":"normal","_key":"8d71057879ae","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[]},{"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The boundaries between normality and pathology vary across cultures for specific types of behaviors…Hence, the level at which an experience becomes problematic or pathological will differ. The judgment that a given behavior is abnormal and requires clinical attention depends on cultural norms that are internalized by the individual and applied by others around them, including family members and clinicians.","_key":"875cbfd1866e0"},{"marks":["superscript"],"text":"5","_key":"431cbcbebb25","_type":"span"}],"_type":"block","style":"blockquote","_key":"dba9a96d6508","upload_doc":null},{"alignment":"right","asset":{"_updatedAt":"2021-03-23T15:02:37Z","_type":"sanity.imageAsset","assetId":"609ade8b5182635e0794137012407eede1478403","_rev":"Nlhasuott3tGitd8Z9JOKa","_id":"image-609ade8b5182635e0794137012407eede1478403-979x861-jpg","size":175848,"originalFilename":"PSY032021_PiesDSM_Table2.JPG","metadata":{"dimensions":{"_type":"sanity.imageDimensions","width":979,"aspectRatio":1.1370499419279907,"height":861},"isOpaque":true,"_type":"sanity.imageMetadata","palette":{"lightVibrant":{"background":"#a9ccdc","_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff","population":0.01},"darkVibrant":{"background":"#264c5e","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff","population":0},"lightMuted":{"_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff","population":0.55,"background":"#9ac2c7"},"vibrant":{"foreground":"#fff","title":"#fff","population":0,"background":"#4993b5","_type":"sanity.imagePaletteSwatch"},"dominant":{"background":"#84a4ac","_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff","population":16.48},"_type":"sanity.imagePalette","darkMuted":{"population":11.03,"background":"#23363d","_type":"sanity.imagePaletteSwatch","foreground":"#fff","title":"#fff"},"muted":{"background":"#84a4ac","_type":"sanity.imagePaletteSwatch","foreground":"#000","title":"#fff","population":16.48}},"hasAlpha":false,"lqip":"data:image/jpeg;base64,/9j/2wBDAAYEBQYFBAYGBQYHBwYIChAKCgkJChQODwwQFxQYGBcUFhYaHSUfGhsjHBYWICwgIyYnKSopGR8tMC0oMCUoKSj/2wBDAQcHBwoIChMKChMoGhYaKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCj/wAARCAASABQDASIAAhEBAxEB/8QAGAABAAMBAAAAAAAAAAAAAAAAAAIDBAX/xAAfEAACAgICAwEAAAAAAAAAAAABAgADESEEMRJBUYH/xAAYAQEAAwEAAAAAAAAAAAAAAAACAQMEBf/EABgRAQADAQAAAAAAAAAAAAAAAAABERJR/9oADAMBAAIRAxEAPwDUbGyeh+SatnZdQfmJT771JKqFcl8H5iaXPqG2nh0Wp52KrsfcS7jFVqABOIiscxxxzJcbd2DsREKx0qwPHoRESRf/2Q=="},"sha1hash":"609ade8b5182635e0794137012407eede1478403","path":"images/0vv8moc6/psychtimes/609ade8b5182635e0794137012407eede1478403-979x861.jpg","_createdAt":"2021-03-23T15:02:37Z","mimeType":"image/jpeg","uploadId":"3BUOlmv4LxHBG3DSl0mQivgAFAiLngNc","url":"https://cdn.sanity.io/images/0vv8moc6/psychtimes/609ade8b5182635e0794137012407eede1478403-979x861.jpg","extension":"jpg"},"medias":null,"uploadAudio":null,"upload_doc":null,"imgcaption":[{"children":[{"_type":"span","marks":["strong"],"text":"Table 2. 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To be sure, many different approaches to psychiatric diagnosis have been ","_key":"5a6089611570","_type":"span"},{"_type":"span","marks":["f99e57bd700a"],"text":"proposed and debated","_key":"e59dbb7f245b"},{"text":"","_key":"4ead56afdde0","_type":"span","marks":[]},{"_key":"f49e75a15fe0","_type":"span","marks":[],"text":"—each with its pros and cons."},{"_type":"span","marks":["superscript"],"text":"14","_key":"942f805d585e"},{"_type":"span","marks":[],"text":" ","_key":"0dfaf38aca8e"}],"_type":"block","style":"normal"},{"upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://peh-med.biomedcentral.com/articles/10.1186/1747-5341-7-9","_key":"f7f35df24f73"},{"blank":true,"_type":"link","href":"https://cdn.sanity.io/images/0vv8moc6/psychtimes/609ade8b5182635e0794137012407eede1478403-979x861.jpg?auto=format","_key":"0f1c047ee704"}],"children":[{"_type":"span","marks":[],"text":"Personally, I favor a prototype-based diagnostic approach for every-day clinical work; and a parallel set of “research diagnostic criteria” for investigative purposes (","_key":"8e8f2ea67577"},{"_type":"span","marks":["strong","0f1c047ee704"],"text":"Table 2","_key":"fe1ed015da421"},{"_type":"span","marks":[],"text":"","_key":"c5cb85b9d6c1"},{"_type":"span","marks":[],"text":"). “Prototype” diagnosis refers to the use of idealized models or archetypes of disease, rather than either “categorical” or “dimensional” methods of classification. ","_key":"fe1ed015da422"},{"_type":"span","marks":["f7f35df24f73"],"text":"Phillips and colleagues","_key":"fe1ed015da423"},{"marks":["superscript"],"text":"14","_key":"fe1ed015da424","_type":"span"},{"_type":"span","marks":[],"text":" discuss and debate various diagnostic models in a wide-ranging colloquium.","_key":"5edeba76678b"}],"_type":"block","style":"normal","_key":"4c6d89dae9a4"},{"_type":"block","style":"normal","_key":"e9bf0e5cde7c","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"_key":"ecc53e65abd80","_type":"span","marks":[],"text":"It seems very clear that diagnosis is, and will always remain, a necessary part of clinical care, both in general medicine and psychiatry. When a patient presents with the complaint, “I hear threatening voices in my head,” we simply must"},{"_type":"span","marks":["em"],"text":" diagnose","_key":"ecc53e65abd81"},{"_type":"span","marks":[],"text":"—a word whose etymology means, “knowing the difference between.” For example, we must know the difference between “threatening voices” stemming from combat-related trauma, on the one hand, versus schizophrenia or anti-NMDA receptor encephalitis","_key":"ecc53e65abd82"},{"_type":"span","marks":["superscript"],"text":"15","_key":"06256ee9df73"},{"_key":"85a9f0b3a9f8","_type":"span","marks":[],"text":" on the other. Otherwise, our treatment is likely to be misguided."}]},{"markDefs":[{"blank":true,"_type":"link","href":"https://www.medscape.com/viewarticle/942694#vp_1","_key":"f5e26e0eaf4d"},{"_type":"link","href":"https://www.psychiatry.org/","_key":"bd7fde28952e"}],"children":[{"_type":"span","marks":[],"text":"No, whatever the lay press claims, DSM-5 is not “The Bible of psychiatry.’ It is not a sacred, eternal, and inviolable text, or even a very sophisticated diagnostic tool. 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But before we use the DSM-5’s text to line our bird cages—as a renowned British psychiatrist I once met described the utility of the DSM-III—we should at least understand what DSM-5 does, and does not, represent.","_key":"85ae6926e9850"}],"_type":"block","style":"normal","_key":"7e515a3586b6","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Dr Pies","_key":"1494743e6aec0"},{"_type":"span","marks":["em"],"text":" is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and editor in chief emeritus of ","_key":"1494743e6aec1"},{"_type":"span","marks":[],"text":"Psychiatric Times","_key":"1494743e6aec2"},{"text":"TM","_key":"1494743e6aec3","_type":"span","marks":["em","superscript"]},{"_type":"span","marks":["em"],"text":" (2007-2010).","_key":"81cc63a101b8"}],"_type":"block","style":"normal","_key":"353d669181c3","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[]},{"_type":"block","style":"normal","_key":"a1580b85ff0e","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"mailto:PTEditor@mmhgroup.com","_key":"b931db2d80b6"}],"children":[{"marks":["strong","em"],"text":"Let us hear from you!","_key":"f34aa6cd02f60","_type":"span"},{"_type":"span","marks":["em"],"text":" Share comments with your colleagues by emailing ","_key":"f34aa6cd02f61"},{"_type":"span","marks":["b931db2d80b6","em"],"text":"PTEditor@mmhgroup.com","_key":"f34aa6cd02f62"},{"_type":"span","marks":["em"],"text":". Comments may be shared online pending review and editing for style.","_key":"f34aa6cd02f63"}]},{"_type":"block","style":"normal","_key":"69c23961020e","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"marks":["strong"],"text":"References","_key":"d552fbd715ca0","_type":"span"}]},{"upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://www.youtube.com/watch?v=WA_NnXyDDLk","_key":"7565756addbb"}],"children":[{"_key":"1cefe98664810","_type":"span","marks":[],"text":"1. jmm1000. Dr Pepper \"So Misunderstood\" feat Carol Kane - 1973-1974. YouTube. June 30, 2017. Accessed March 17, 2021. "},{"_type":"span","marks":["7565756addbb"],"text":"https://www.youtube.com/watch?v=WA_NnXyDDLk","_key":"1cefe98664811"}],"_type":"block","style":"normal","_key":"da809d3e1dd1"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"2. Regier DA, Narrow WE, Clarke DE, et al. DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. ","_key":"5248ab0cc9fd0"},{"_type":"span","marks":["em"],"text":"Am J Psychiatry.","_key":"5248ab0cc9fd1"},{"_key":"5248ab0cc9fd2","_type":"span","marks":[],"text":" 2013;170(1):59-70."}],"_type":"block","style":"normal","_key":"66a1eb4e0fad","upload_doc":null,"medias":null,"uploadAudio":null},{"children":[{"text":"3. Pols H: Forget talking, just fill a script: how modern psychiatry lost its mind. ","_key":"f168f272ee680","_type":"span","marks":[]},{"text":"The Conversation.","_key":"f168f272ee681","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" October 21, 2012. Accessed March 17, 2021. ","_key":"f168f272ee682"},{"_key":"f168f272ee683","_type":"span","marks":["e024b1ca6628"],"text":"https://theconversation.com/forget-talking-just-fill-a-script-how-modern-psychiatry-lost-its-mind-9569"}],"_type":"block","style":"normal","_key":"f64f9b483afc","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://theconversation.com/forget-talking-just-fill-a-script-how-modern-psychiatry-lost-its-mind-9569","_key":"e024b1ca6628"}]},{"upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"https://www.psychologytoday.com/us/blog/freud-fluoxetine/202006/psychiatric-diagnosis-20-the-myth-the-symptom-checklist","_key":"ffbca7489e39"}],"children":[{"_key":"6af5f02f71600","_type":"span","marks":[],"text":"4. Ruffalo ML. Pies RW. Psychiatric Diagnosis 2.0: The Myth of the Symptom Checklist. "},{"text":"Psychology Today.","_key":"6af5f02f71601","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" June 14, 2020. Accessed March 17, 2021. ","_key":"6af5f02f71602"},{"text":"https://www.psychologytoday.com/us/blog/freud-fluoxetine/202006/psychiatric-diagnosis-20-the-myth-the-symptom-checklist","_key":"6af5f02f71603","_type":"span","marks":["ffbca7489e39"]}],"_type":"block","style":"normal","_key":"60f9cdbdf6f1"},{"_key":"b7168d238e0f","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"_type":"link","href":"https://dsm.psychiatryonline.org/","_key":"6e46aa9a8f30","blank":true}],"children":[{"text":"5. American Psychiatric Association. ","_key":"edb7e3c6b25d0","_type":"span","marks":[]},{"text":"Diagnostic and Statistical Manual of Mental Disorders","_key":"edb7e3c6b25d1","_type":"span","marks":["6e46aa9a8f30"]},{"_type":"span","marks":["6e46aa9a8f30"],"text":", 5th edition","_key":"edb7e3c6b25d2"},{"marks":[],"text":"","_key":"33c968533ba6","_type":"span"},{"_type":"span","marks":[],"text":". Washington, DC; American Psychiatric Publishing, Inc: 2013.","_key":"b63148cecbe3"}],"_type":"block","style":"normal"},{"_key":"d81d024c14c9","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"blank":true,"_type":"link","href":"http://www.lacounseling.org/images/lca/Conference/DSM-5%20LCA%20Case%20Formulation%20Rev.pdf","_key":"da172dc45f25"}],"children":[{"text":"6. Gintner GG. Using DSM-5 in Case Formulation. Louisiana Counseling Association presentation. Accessed March 17, 2021. ","_key":"aeda64b6d95b0","_type":"span","marks":[]},{"text":"http://www.lacounseling.org/images/lca/Conference/DSM-5%20LCA%20Case%20Formulation%20Rev.pdf","_key":"1c11883fed39","_type":"span","marks":["da172dc45f25"]},{"_type":"span","marks":[],"text":"","_key":"30af0136314e"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"7. Sperry L, Sperry J. ","_key":"245dd5cda7280"},{"_type":"span","marks":["em"],"text":"Case Conceptualization","_key":"245dd5cda7281"},{"_type":"span","marks":[],"text":". ","_key":"245dd5cda7282"},{"_type":"span","marks":["em"],"text":"Mastering this Competency with Ease and Confidence.","_key":"245dd5cda7283"},{"_type":"span","marks":[],"text":" Routledge, 2012.","_key":"245dd5cda7284"}],"_type":"block","style":"normal","_key":"a3cbd570c424","upload_doc":null,"medias":null,"uploadAudio":null},{"_key":"d44d804fd832","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"href":"https://www.researchgate.net/scientific-contributions/Suzanne-McKenzie-Mohr-2024012959","_key":"2f4f2d398c39","_type":"link"},{"blank":true,"_type":"link","href":"https://journals.sagepub.com/doi/abs/10.1177/0959353512467974","_key":"02088501317c"}],"children":[{"marks":[],"text":"8. Lafrance MN, McKenzie-Mohr S. ","_key":"f9a0650bbb9c0","_type":"span"},{"_type":"span","marks":["02088501317c"],"text":"The DSM and its lure of legitimacy","_key":"f9a0650bbb9c3"},{"marks":[],"text":". ","_key":"f9a0650bbb9c4","_type":"span"},{"_type":"span","marks":["em"],"text":"Fem Psychol","_key":"f9a0650bbb9c5"},{"_key":"f9a0650bbb9c6","_type":"span","marks":[],"text":". 2013;23(1):119-140."}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"9. Deacon BJ. The biomedical model of mental disorder: a critical analysis of its validity, utility, and effects on psychotherapy research. ","_key":"2a12c50fe55c0"},{"_type":"span","marks":["em"],"text":"Clin Psychol Rev.","_key":"2a12c50fe55c1"},{"_type":"span","marks":[],"text":" 2013;33(7):846-861.","_key":"2a12c50fe55c2"}],"_type":"block","style":"normal","_key":"8d7ffcf8a0e6","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[]},{"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"text":"10. van Heugten-van der Kloet D, van Heugten T. The classification of psychiatric disorders according to DSM-5 deserves an internationally standardized psychological test battery on symptom level. ","_key":"c9c91979e1cb0","_type":"span","marks":[]},{"text":"Front Psychol","_key":"c9c91979e1cb1","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". 2015;6:1108.","_key":"c9c91979e1cb2"}],"_type":"block","style":"normal","_key":"1728e396d8eb","upload_doc":null},{"_key":"1be29da81334","upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[{"_type":"link","href":"https://www.cambridge.org/core/journals/psychological-medicine/article/abs/what-kinds-of-things-are-psychiatric-disorders/0E09E96725B4831DB5D5EBADF88C8361","_key":"10ee50be8680","blank":true}],"children":[{"_type":"span","marks":[],"text":"11. Kendler KS, Zachar P, Craver C. ","_key":"8eafdb35a2d20"},{"_type":"span","marks":["10ee50be8680"],"text":"What kinds of things are psychiatric disorders?","_key":"e5e5a45e93bf"},{"_type":"span","marks":[],"text":"","_key":"1801a89f6b63"},{"marks":[],"text":" ","_key":"457dd36dac37","_type":"span"},{"text":"Psychol Med.","_key":"8eafdb35a2d21","_type":"span","marks":["em"]},{"text":" 2011;41(6):1143-1150.","_key":"8eafdb35a2d22","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"upload_doc":null,"medias":null,"uploadAudio":null,"markDefs":[],"children":[{"text":"12. Gabor, GT. ‘Carving nature at its joint’: The Platonic method of division in Plato, Aristotle, and their Neoplatonic commentators. ","_key":"1fca78705c270","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"ETD Collection for Fordham University","_key":"1fca78705c271"},{"marks":[],"text":". AAI3466699. 2011. Accessed March 17, 2021. https://research.library.fordham.edu/dissertations/AAI3466699","_key":"1fca78705c272","_type":"span"}],"_type":"block","style":"normal","_key":"b13f09bfe11d"},{"uploadAudio":null,"markDefs":[{"_type":"link","href":"https://winstonchurchill.org/resources/quotes/the-worst-form-of-government/","_key":"ba888ebed4b5"}],"children":[{"_type":"span","marks":[],"text":"13. Churchill W. The Worst Form of Government. International Churchill Society. November 11, 1947. Accessed March 17, 2021. ","_key":"418e6b0d90660"},{"marks":["ba888ebed4b5"],"text":"https://winstonchurchill.org/resources/quotes/the-worst-form-of-government/","_key":"418e6b0d90661","_type":"span"}],"_type":"block","style":"normal","_key":"efc0819a51a9","upload_doc":null,"medias":null},{"markDefs":[],"children":[{"marks":[],"text":"14. Phillips J, Frances A, Cerullo MA, et al. 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Augmentation with memantine","_type":"pollText","choiceCount":217,"_key":"8a2c19ca6e330d9a4690d0349c7136d2"},{"choiceText":"B. Switching from lorazepam to oral diazepam","_type":"pollText","choiceCount":283,"_key":"02a7c30f2df4d7f1473262d7d4303469","choiceAnswer":false},{"choiceText":"C. Addition of haloperidol","_type":"pollText","choiceCount":256,"_key":"1daa7c73da2b3527e19ea82c7f1b1c47","choiceAnswer":false},{"_key":"f7e5ffa779ff1c6c862ebcf46e4191fe","choiceAnswer":false,"choiceText":"D. Transfer to psychiatry for ECT","_type":"pollText","choiceCount":485},{"_type":"pollText","choiceCount":117,"_key":"8598355e044ed3d47b752e58d815070a","choiceAnswer":false,"choiceText":"E. Addition of sertraline"}],"upload_doc":null,"medias":null,"uploadAudio":null,"question":"The next step in treatment might include:","response":[{"style":"normal","_key":"SYaLXDmt","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Answer A.","_key":"x0BAS3A2"},{"marks":[],"text":" Augmentation with memantine","_key":"JKAscLtK","_type":"span"}],"_type":"block"},{"children":[{"marks":["strong"],"text":"Discussion:","_key":"GkXDthih","_type":"span"}],"_type":"block","style":"normal","_key":"ncYjGEj6","markDefs":[]},{"_key":"VHXDupg9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"A variety of medical conditions can produce stupor, which is a decreased awareness and interaction with the external environment. Stupor can occur with preserved alertness, more often seen in catatonia, or with lethargy, more often seen in delirium. Differences between etiologies (psychiatric vs medical) do not appear to alter the general treatment approach for catatonia. Removal of suspected offending agents, treatment of the underlying medical condition, or management of drug withdrawal are essential.","_key":"vydeGmLJ"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Potential adverse effects of high-dose intravenous lorazepam include anion gap acidosis from its solvent, propylene glycol. This risk increases with higher doses and in renal impairment, but toxicity has been reported with as little as 2 mg per hour. The osmolar gap (a marker for glycol toxicity) should be monitored every other day if the lorazepam infusion reaches 1 mg/kg daily.","_key":"ZNxIee2Z"}],"_type":"block","style":"normal","_key":"49YROZ2j"},{"_type":"block","style":"normal","_key":"IGpiyw8N","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Augmentation with memantine or amantadine may be helpful. Their hypothesized mechanism is N-methyl-d-aspartic acid (NMDA) receptor antagonism, which may be linked to GABA hypofunction. Memantine can be started at 5 to 10 mg daily and titrated based on medical status with monitoring of the QT interval. Improvement from memantine seems slower than with lorazepam, but both can be co-administered. Amantadine is started at 100 to 200 mg daily and titrated, but it should be used with caution if renal impairment or seizure risk is present. Mania, suicidal ideation, and withdrawal-emergent NMS have also been reported with administration of amantadine.","_key":"t7ubw40M"}]},{"markDefs":[{"blank":true,"_type":"link","href":"update-medical-catatonia-highlight-delirium","_key":"href_1582646605606298972"}],"children":[{"_key":"BnqPKWDn","_type":"span","marks":[],"text":"For more on this topic, see "},{"marks":["href_1582646605606298972"],"text":"Update on Medical Catatonia: Highlight on Delirium","_key":"BDocXbSS","_type":"span"},{"_type":"span","marks":[],"text":", by Jo Ellen Wilson, MD, MPH, Lex Denysenko, MD, and Andrew Francis, PhD, MD, on which this quiz is based.","_key":"oArdP8pf"}],"_type":"block","style":"normal","_key":"m3RvbaCN"}]}],"_updatedAt":"2024-11-26T19:36:59Z","gptTakeaways":"• The patient's symptoms and partial response to lorazepam suggest catatonia, despite normal vital signs and brain imaging.\n• Higher lorazepam doses increase sedation, necessitating alternative management strategies to address catatonia effectively.\n• Consideration of treatments like ECT or medications such as amantadine or memantine may be appropriate.\n• Multidisciplinary team collaboration and close monitoring are crucial for achieving optimal patient outcomes.","published":"2017-05-12T19:30:30Z","_rev":"75rfQRjSti1FAZGj7wqPGw","_createdAt":"2020-02-25T16:04:30Z","internalTag":["Somatoform Disorder","Delirium","Quizzes"],"nodeId":"387353","factCheckAuthors":null,"seoTag":["Somatoform Disorder","Delirium","Quizzes"],"summary":"A patient with lupus presents with rash, arthralgias, and altered mental status. Various symptoms, including stupor and mutism, improve with treatment but higher doses of the drug cause more sedation. How would you proceed?","authorMapping":[{"_ref":"pst_author_316918","_type":"reference","_key":"f50580370197f87d821a1b4e5c2147b8"}],"authors":[{"displayName":"Andrew Francis, PhD, MD","url":"andrew-francis-phd-md"}],"updatedOn":null,"contentCategory":{"_ref":"9e4880fc-85b8-4ffb-a066-79af8dfaa4e1","_type":"reference"},"title":"Mini Quiz: Medical Catatonia","gptSummary":"The patient, a 37-year-old female with lupus, presents with neuropsychiatric symptoms including stupor, mutism, posturing, and echopraxia, while vital signs, creatine kinase, and brain MRI remain normal. Partial symptom improvement with lorazepam suggests a possible catatonia diagnosis. However, higher doses lead to increased sedation, indicating a need for alternative management strategies. Consideration of other treatments such as electroconvulsive therapy (ECT) or alternative medications like amantadine or memantine may be warranted. 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psychosexual disorders","_type":"pollText","choiceCount":510,"_key":"c89a56afb004bd1995f402274dca94e4"},{"choiceAnswer":false,"choiceText":"B. psychopathic personality disorders","_type":"pollText","choiceCount":151,"_key":"7b8fad3b726c26c5cd5524faf6460f2b"},{"_type":"pollText","choiceCount":206,"_key":"9ba9d007f25c003e0fb0e988eec7e536","choiceAnswer":false,"choiceText":"C. personality disorders and certain other nonpsychotic mental disorders"},{"choiceAnswer":false,"choiceText":"D. sexual dysfunctions","_type":"pollText","choiceCount":304,"_key":"f975195923723b05448b7ef78b9d2209"}],"upload_doc":null,"medias":null,"uploadAudio":null,"question":"The DSM originally characterized sexual deviations as:","response":[{"_type":"block","style":"normal","_key":"9IUo5DG7","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Answer B.","_key":"89IZ7T8B"},{"marks":[],"text":" Psychopathic personality 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