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NIMH to Steer Away from New Manual

The agency will no longer use the newly revised guide to mental disorders to categorize its funding priorities.

By | May 9, 2013

FLICKR, LIZ HENRYThomas Insel, the Director of the National Institute of Mental Health (NIMH), wrote a blog post last week (April 29) stating that the agency will be transitioning away from using the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM, in allocating its research funding. Rather, the agency will be working on developing new categories for research based on neural circuits and biomarkers.

 “While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each,” Insel wrote. The DSM gives mental health professionals a language to talk about mental illness, but it is not based on “any objective laboratory measure,” he added. This month, a new edition of the manual, called the DSM-5, will be released amid ongoing controversy about some of the changes from its previous version.

To better classify mental disease, the NIMH has started the Research Domain Criteria (RDoC) project, which Insel said will “transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.”

However, biological biomarkers for mental disease are few, so Insel said that RDoC is more of a framework for future knowledge to fit into than a completed classification system.

In order to better fill in the gaps, he said that NIMH grant applicants will be asked to think of research projects that cut across diagnoses. For instance, a study looking for biomarkers of “depression” might focus on people with specific individual symptoms, such as anhedonia, regardless of their diagnosis, or a clinical trial might examine a wider range of patients with mood disorders rather than necessarily focusing on one.

“Efforts like [this] are vital to the continued progress of our collective understanding of mental disorders,” DSM-5 task force chair David Kupfner said in a statement last week (May 3). “But they cannot serve us in the here and now, and they cannot supplant DSM-5.”

Indeed, the NIMH is not “ditching” the DSM completely, Insel told Time. DSM diagnostic criteria will continue to be important in the clinic, just not as guides for research.

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Avatar of: James V. Kohl

James V. Kohl

Posts: 110

May 9, 2013

This change in the categorization of funding priorities was predicted in the content of the "FDA Critical Path Initiative."

Adapted from Kohl (2012)

Given the importance of understanding how food odors and nutrition epigenetically influence individual survival in other mammals, it is not surprising that a reiteration of the ‘FDA Critical Path Initiative’ (Marts & Resnick, 2007) stresses the need to approach the development of human sexual behavior, which is required for our species survival and beneficial to human well-being, by using the same pathway that links food odors and pheromones to the behavior of honeybees and humans.

Including the interactions among the gene, cell, tissue, organ, organ-system pathway (Wizemann & Pardue, 2001) allows sexual differentiation of the brain and behavior to be detailed in the manner that was suggested by Diamond, Binstock, and Kohl (1996) and more recently by McCarthy and Arnold (2011). These details are in obvious accord with what has been neuroscientifically known for several decades about organization and activation of the brain and behavior (Naftolin, 1981). Neuroscientists can now incorporate the role of epigenetic influences of food odors and pheromones, as well as in utero effects of endocrine disruptors on GnRH (Wolstenholme, Rissman, & Connelly, 2011) and on mate choice (Jasarevic et al., 2011). For example, endocrine disruptors and pheromones may act on species-specific and sex-specific GnRH feedback pathways to alter the estrous cycle and alter pubertal onset via changes in gene expression that result in significant physiological and behavioral changes throughout life (Cao, Mickens, McCaffrey, Leyrer, & Patisaul, 2011).

The FDA critical path initiative seems to have also been incorporated into the Public Policy Statement: Definition of Addiction (ASAM, 2011), which represents a paradigm shift that may move the current practice of clinical psychology forward. It dictates the adoption and integration of neuroscientific principles that are required in order to understand differences between genetically predisposed brain disease, naturally occurring variations of behavioral development, and choice. These neuroscientific principles include focus on how sensory input influences behavior. The statement specifically mentions food and sex along with drugs and alcohol; each seems to chemically condition changes in hormones and in behavioral responses. Although no link between cause and effect is mentioned by ASAM, these principles could incorporate the GnRH neurophysiological mechanism and levels of LH, which link food odors and pheromones to chemically conditioned behaviors.

Medical practitioners from ASAM and neuroscientists are more likely than psychologists to be aware that effective FDA-approved therapeutic intervention frequently involves pharmaceuticals that alter feedback on the GnRH neuronal system (Grumbach & Styne, 1992), which is the central neuronal system that is essential to species survival in all vertebrates (Kotitschke, Sadie-Van Gijsen, Avenant, Fernandes, & Hapgood, 2009) via its integral involvement in the acquisition of food and in sexual reproduction. ASAM seems to think that clinical psychologists should become more aware of currently accepted neuroscientific facts, which may be important to their understanding of eating disorders and of human sexuality among other things that are not currently understood about the development of behavior.

What I think is happening at NIMH follows from the progress represented in the works cited above. It is somewhat regretable that medical practitioners (e.g., psychiatrists) seem to be faulted in the same context as psychologists, but the change at NIMH will probably help to differentiate the professions.

 

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