Post by Amtram on May 11, 2014 19:43:11 GMT -5
Obviously, those of us who aren't involved in the relevant research aren't going to have a full understanding of the implications (or even access to or understanding of the full text) of the RDoC. When I first read them, I wasn't quite sure what it meant, because the way it was presented it seemed to imply that the DSM was going to get tossed out and those of us who depend on having a diagnosis in order to get treatment would be left out in the cold. Fortunately, as I later learned, these new criteria were designed to better understand the symptoms in order to eventually improve diagnosis and treatment - and that they applied to research directions. I had read a lot of good things about them, and still think that they're probably a better direction than the ones a lot of research have taken. Of course they're not perfect, but thanks to Dorothy Bishop, I understand a little better what the potential shortcomings might be. In Changing the landscape of psychiatric research: What will the RDoC initiative by NIMH achieve? she writes,
Go read her post for the specifics. I wasn't aware that this would result in funding being taken away from some legitimate diagnosis-based research as well as diverting it away from what I might consider diagnosis-obsessed research.
In 2013, Tom Insel, Director of the US funding agency, National Institute of Mental Health (NIMH), created a stir with a blogpost in which he criticised the DSM5 and laid out the vision of a new Research Domain Criteria (RDoC) project. This aimed "to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system."
He drew parallels with physical medicine, where diagnosis is not made purely on the basis of symptoms, but also uses measures of underlying physiological function that help distinguish between conditions and indicate the most appropriate treatment. This, he argued, should be the goal of psychiatry, to go beyond presenting symptoms to underlying causes, reconceptualising disorders in terms of neural systems.
This has, of course, been a goal for many researchers for several years, but Insel expressed frustration at the lack of progress, noting that at present: "We cannot design a system based on biomarkers or cognitive performance because we lack the data". That being the case, he argued, a priority for NIMH should be to create a framework for collecting relevant data. This would entail casting aside conventional psychiatric diagnoses, working with dimensions rather than categories, and establishing links between genetic, neural and behavioural levels of description.
This represents a massive shift in research funding strategy, and some are uneasy about it. Nobody, as far as I am aware, is keen to defend the status quo, as represented by DSM. As Insel remarked in his blogpost: "Patients with mental disorders deserve better". The issue is whether RDoC is going to make things any better. I see five big problems.
He drew parallels with physical medicine, where diagnosis is not made purely on the basis of symptoms, but also uses measures of underlying physiological function that help distinguish between conditions and indicate the most appropriate treatment. This, he argued, should be the goal of psychiatry, to go beyond presenting symptoms to underlying causes, reconceptualising disorders in terms of neural systems.
This has, of course, been a goal for many researchers for several years, but Insel expressed frustration at the lack of progress, noting that at present: "We cannot design a system based on biomarkers or cognitive performance because we lack the data". That being the case, he argued, a priority for NIMH should be to create a framework for collecting relevant data. This would entail casting aside conventional psychiatric diagnoses, working with dimensions rather than categories, and establishing links between genetic, neural and behavioural levels of description.
This represents a massive shift in research funding strategy, and some are uneasy about it. Nobody, as far as I am aware, is keen to defend the status quo, as represented by DSM. As Insel remarked in his blogpost: "Patients with mental disorders deserve better". The issue is whether RDoC is going to make things any better. I see five big problems.