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From DSM-IV toward DSM-V: The process of development

Objectives. To understand the pre-DSM-V and current DSM-V development process.To understand how culture, broadly defined, has been excluded/included in the process and content to date.To stimulate discussion about how SSPC and attendees can impact on development of DSM-V.. Agenda. Cast of Charact

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From DSM-IV toward DSM-V: The process of development

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    1. From DSM-IV toward DSM-V: The process of development Francis G. Lu, MD Professor of Clinical Psychiatry, UCSF

    2. Objectives To understand the pre-DSM-V and current DSM-V development process. To understand how culture, broadly defined, has been excluded/included in the process and content to date. To stimulate discussion about how SSPC and attendees can impact on development of DSM-V.

    3. Agenda Cast of Characters 1 Timeline Process Comments Products Cast of Characters 2 Task Force Gender and Cross-Cultural Issues Study Group 13 Workgroups Possible Action Steps

    4. Cast of Characters 1 APA-American Psychiatric Association-The Board of Trustees (BOT) appointed the DSM-V Task Force (TF) and Workgroups (WGs), who will create the DSM-V. The Board will review and approve the DSM-V. APIRE-American Psychiatric Institute for Research and Education-An affiliate organization of APA that initiated the Research Agenda and 13 Research Planning Conferences process that preceeded the appointment of the Task Force. Darrel Regier, MD, Executive Director APPI-American Psychiatric Press, Inc.-An affiliate organization of APA that has published several volumes in the Research Agenda for DSM-V series and will publish DSM-V.

    5. Cast of Characters 1 NIH-(NIMH, NIDA, NIAAA)-co-sponsors of the 13 Research Planning Conferences World Health Organization (WHO)-co-sponsor of the 13 Research Planning Conferences APA Council on Minority Mental Health and Health Disparities (Council)-One of 10 councils of the APA that provides guidance to the APA governance structure. Francis Lu chaired from 2002 to 2007. Council initiated Action Items that needed approval by the Joint Reference Committee and then by the BOT to take effect.

    6. DSM-V Timeline 1999-2008 Development of Research Agenda for DSM-V monographs 2002 Publication of “A Research Agenda for DSM-V” (monograph with six chapters, one on culture)   2004-now www.DSMV.org or www.DSM5.org describes the pre-DSM-V process and current process (now links to APA site) 2004-8 Publication of additional DSM-V monographs

    7. DSM-V Timeline 2004-2007 13 Research Planning Conferences: -invitational -about 20 people, 50% international -held throughout the world -focused mostly on specific diagnostic categories -summaries at www.dsm5.org and publications now and in near future

    8. DSM-V Timeline 4/2006 Appointment of David Kupfer (Pittsburgh) and Darrel Regier as TF Co-chairs 8/2007 Announcement of the DSM-V Task Force 5/2008 Announcement of Workgroup members 2008 Appointment of Advisors for the WGs 2009 Draft criteria for field trials 5/2012 Publication of DSM-V

    9. Process Comments 1999 Initial list of 5 chapters left out culture. Lobbying APIRE/APA got it in. 2002 Chapter on culture stimulated additional monographs on other specific aspects of culture. 6/2003 Council initiated Action Item to: Include culture in the Planning Conferences Ensure transparent development process

    10. Process Comments 2004 APIRE solicited from Council names of experts on culture for the Planning Conferences, etc. 9/2006 Council initiated Action Item to: Ensure appointment of at least one cultural expert on the TF and each WGs These cultural experts would meet as a cultural workgroup to coordinate efforts.

    11. Process Comments 12/2006 BOT voted Action Item down, but supported importance of culture. This led to: 9/2007 A Study Group of 7 TF members on Gender and Cross-Cultural Issues formed. (1 of 4 SGs to cross-cut WGs) Some experts in culture, broadly defined, appointed to TF and WGs.

    12. Process Comments 10/2006 BOT appointed BOT TF on the DSM-V appointment process (Donna Norris, Sec-Treasurer, Chair) Key criteria: $10k income/$50k stock limit related to pharma Vetting process delayed the appointment of the TF and WGs for one year. Generated some backlash and contributed to Dr. Norris’ loss of the 2008 APA President-Elect race to Alan Schatzberg, a psychopharmacologist and chair at Stanford.

    13. Research Agenda for DSM-V workgroups and publications -Workgroup on Culture (2000-2002). Renato Alarcon, chair. The manuscript was published as one of 6 chapters in A Research Agenda for DSM-V (APPI, 2002) -Workgroup on the Elderly (2003-2006). Dilip Jeste, chair. Published in Age and Gender Considerations in Psychiatric Diagnosis (APPI, 2007)

    14. Research Agenda for DSM-V workgroups and publications -Workgroup on Children and Adolescence (2003-2006). Irene Chatoor, chair. Published in Age and Gender Considerations in Psychiatric Diagnosis (APPI, 2007) -Workgroup on Gender (2003-2006). Katherine Philips, chair. Published in Age and Gender Considerations in Psychiatric Diagnosis (APPI, 2007)

    15. Research Agenda for DSM-V workgroups and publications -Workgroup on Religion and Spirituality (2005-2008). John Peteet and Francis Lu, co-chairs. In press at APPI. -Non-APIRE Workgroup on GLB Issues/Committee on GLB Issues (2004-2008). Barry Common, chair. Manuscript in process of completion for possible APIRE review and submission for publication.

    16. Research Agenda for DSM-V Additional publications Relational Processes and DSM-V, 2006 Dementia, 2007 Substance Use Disorders, 2007 Dimensional Models of Personality Disorders, 2007 Dimensional Approaches in Diagnositic Classification, 2008

    17. DSM-V Task Force 28 TF members, 20 with experience in some way with NIH; chairs of 13 WGs 4 non-MDs, none international (not Canada) 4 Study Groups that cross-cut WGs Gender and Cross-Cultural Study Group Kimberly Yonkers (Yale), Rapporteur Javier Escobar (UNJMD) Roger Peele (BOT and Assembly) William Wommack (BOT) Philip Wang (NIMH) James P. McNulty (NAMI Pres. Emeritus) Maritza Rubio-Stipec (Statistics and Methods)

    18. 13 Workgroups Members: 130 International (not counting Canada): 23 Non-MDs: 48 Cultural Experts (?): 22 Cultural Experts, narrowly defined: 10

    19. Experts in Culture on the Workgroups (?) ADHD/Disruptive Behavior Disorders F. Xavier Castellanos* (NYU), Glorisa Canino (Univ of PR), Luis Rohde (Fed. Univ of Rio Grande do Sul, Brazil) Anxiety, O-C Spectrum, Posttraumatic, and Dissociative Disorders Katharine Phillips* (Brown), Roberto Lewis-Fernandez (Columbia) Disorders in Childhood and Adolescence Ellen Leibenluft (NIMH)

    20. Experts in Culture on the Workgroups (?) Eating Disorders Anne Becker (Harvard) Mood Disorders James Jackson (Univ of Mich), Michael Philips (Beijing, China) Neurocognitive Disorders Dilip Jeste* (UC San Diego), Dan Blazer (Duke), Warachal Faison (Med Univ of SC), Perminder Sachdev (Univ of NSW)

    21. Experts in Culture on the Workgroups (?) Neurodevelopmental Disorders Harry Wright (Univ of SC) Personality and Personality Disorders Renato Alarcon (Mayo), Carl Bell (Univ of Ill, Chicago) Psychotic Disorders Juan Bustillo (Univ of NM), Ming Tsuang (UC San Diego)

    22. Experts in Culture on the Workgroups (?) Sexual and Gender Identity Disorders Jack Drescher (NY Medical College) Sleep-Wake Disorders Somatic Disorders Sing Lee (Chinese Univ of HK) Substance-Related Disorders Walter Ling (UCLA), Spero Manson (Univ of Colorado)

    23. Internationals on the Workgroups Australia-Gavin Andrews, Perminder Sachdev Brazil-Luis Rohde China-Michael Phillips Denmark-Poul Thorsen France-Marc Auriacombe Germany-Diether Riemann, Hans Wittchen

    24. Internationals on the Workgroups Italy-Mario Maj Netherlands-Susan Bögels, Peggy Cohen-Kettenis, Hans W. Hock, Jim van Os, Wim van den Brink, Roel Verheul Sweden-Niklas Långström South Africa-Dan Stein UK-Francis Creed, David Goldberg, Francesca Happé, Michael Owen, Michael Sharpe, Eric Taylor

    25. Non-MDs Task Force: Helena Kraemer (Biostatistics),James McNulty (NAMI), Maritza Rubio-Stipec (Statistics/Methods Director), Ken Zucker (Chair, Sexual and Gender Identity Disorders) ADHD: Glorisa Canino, Paul Frick, Terrie Moffitt, Joel Nigg, Rosemary Tannock

    26. Non-MDs Anxiety: Susan Bögels, Michelle Craske, Hans W. Wittchen Childhood: E. Jane Costello, Rachel Klein Eating: Marsha Marcus, Ruth Striegel-Moore, G. Terence Wilson, Barbara Wolfe, Stephen Wonderlich Mood: Ellen Frank, James Jackson Neurocognitive: Jane Paulsen

    27. Non-MDs Neurodevelopmental: Francesca Happé, Catherine Lord, Sally Rogers, Amy Wetherby Personality: Donna Bender, Lee Clark, Robert Krueger, Leslie Morey, Roel Verheul Psychotic: Deanna Barch Sexual and Gender Identity: Ken Zucker, Irving Binik, Ray Blanchard, Peggy Cohen-Kettenis, Cynthia Graham, Heino Meyer-Bahlburg

    28. Non-MDs Sleep: Charles Morin, Ruth O’Hara, Allan Pack, Kathy Parker, Diether Riemann Somatic: Nancy Frasure-Smith, Francis Keefe Substance-Related: Kathleen Bucholz, Alan Budney, Bridget Grant, Deborah Hasin, Spero Manson, A. Thomas McLellan, Nancy Petry

    29. Possible Action Steps Communicate with the Gender and Cross-Cultural Study Group Suggest Advisors with cultural expertise Outreach to WG cultural experts Highlight pre-DSM-V work already done SSPC to work with WPA-TPS, WACP

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