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Monday 29 April 2013

Little people, lots of pills: Experts debate medicating kids - Courtesy of the CNN Network

Little people, lots of pills: Experts debate medicating kids
By Madison Park, CNN

May 24, 2011


Editor's note: Americans have been led to believe -- by their doctors, by advertisers and by the pharmaceutical industry -- that there is a pill to cure just about anything that ails them. This week, the networks of CNN go deep into the politics and the pills.
(CNN) -- Gavin Gorski, 11, opens his hands as his father dispenses the pills.
An orange tablet, a green pill, white oval shapes and oblong ones -- nine drugs total -- fall into his palm. The fifth-grader scoops them into his mouth. Later in the day, he takes eight more pills.
Gavin takes 119 pills every week.
The clozapine helps him with the hallucinations and voices he hears. The lithium stabilizes Gavin's mood. Without them, he stays up for nights and has no impulse control.
"We couldn't exist without him being medicated," said Rob Gorski, Gavin's father. "We struggled with it at first. Nobody wants to medicate their kids, but it comes to a quality of life issue. When he is un-medicated, his quality of life is really low."
Gavin started taking several drugs at age 5.
Increasingly more U.S. kids are taking behavioral drugs, according to several studies.
The majority of cases are not as severe as Gavin's. The most common reasons for use of antipsychotics by children are intellectual disability, attention deficit/hyperactivity disorder and disruptive behavior disorder.
But children's conditions could be misdiagnosed and drugs prescribed for minor symptoms, experts say. Putting kids on multiple drugs could put them at risk for drug interactions and side effects, they say.
There also is potential for abuse, with parents intentionally medicating their children to make their behavior more manageable.
Drugging kids for parents' relief called abusive
"If the child is horrendously disruptive -- self-injury and hurting themselves -- yes, use medication in young children," said Dr. Mani Pavuluri, director of the Pediatric Brain Research and Intervention Center at the University of Illinois at Chicago. "But it's always cautious to wait until they're a bit older than 5."
Pharmaceuticals should be the last resort after therapies and behavioral interventions, Pavuluri said.
From 1999 to 2001, 0.78 per 1,000 children ages 2 through 5 used antipsychotic drugs. That rate increased to 1.59 by 2007, according to a study published in the Journal of the American Academy of Child and Adolescent Psychiatry.
In a Columbia University study, the rates of antidepressant use increased among people age 6 and older from 5.84% in 1996 to 10.12% in 2005.
Six years ago, Gorski and his wife mulled whether to put their eldest son on several prescription drugs. The Gorskis felt uneasy about putting their then-young son on so many drugs.
Gavin has Asperger's syndrome and schizoaffective disorder, which is similar to schizophrenia.
Without taking 17 pills each day, Gavin boasts that he can jump out the window and fly. He can't differentiate between reality and hallucinations. He loses all fear and runs in front of cars. Sometimes, he becomes violent to his family members.
The drugs help him so much, his father said.
"There is stigma attached to it," Gorski said about putting his son on several drugs. "People think you can manage it with diet and that you're making your child worse, that they're poisoned. If you take meds for the right reasons, it serves a purpose. It gives them a better life."
Other parents have expressed shock at the number of pills Gavin needs to consume.
"We don't medicate him because it makes life easier. We medicate him because it's best for him," said Gorski, a father of three special-needs children in Canton, Ohio.
Medication for mental illnesses is the cornerstone of treatment, especially when patients are aggressive and manic, said Pavuluri, an American Academy of Child and Adolescent Psychiatry spokeswoman.
She recalled a dramatic case of a 6-year-old patient who was using Google to search the word suicide and trying to eat the carbon off a pencil to harm herself.
In such cases, medication may be necessary, but doctors should try to rely less on pills for milder psychological disorders and examine the child's life as a whole, Pavuluri said.
"It's very important to see that behavior is related to how kids are being parented," Pavuluri said.
One diagnosis that is rapidly growing is attention deficit hyperactivity disorder. Nearly one in 10 U.S. children has a diagnosis of ADHD, according to a 2010 report from the Centers for Disease Control and Prevention.
Not all ADHD cases require medication, medical experts said. There are nonpharmaceutical routes such as making sure the child's home life is more organized. Parents can limit screen time and teach planning skills to overcome some distractions, several medical experts said.
ADHD: Who makes the diagnosis?
There could be bigger issues affecting children's behavior and attention, like a death in the family, an abusive relationship and other life experiences, experts said.
The problem could be a result of poor parenting, said Dr. Elizabeth Roberts, a child and adolescent psychiatrist.
"We are medicating children sometimes for ferociously awful behavior based on poor parenting," she said.
The behavior is construed as ADHD, and more severe cases are diagnosed as bipolar disorder, she said.
While stressing there are legitimate cases that call for medicating children, Roberts, who practices in Murrietta, California, warned against throwing pills at a problem.
Sometimes, parents fake a condition for the child in hopes of getting drugs for themselves, she said.
Some parents request prescription drugs because their kids misbehave in school, get low grades or got a lower SAT score than they had hoped for, Roberts said.
ADHD drugs such as Adderall and Ritalin have become popular on college campuses for students who don't have the condition but want to boost their academic performance through better focusing.
A 2010 CDC survey found that one in five U.S. high school students said they had taken a prescription drug such as OxyContin, Percocet, Vicodin, Adderall, Ritalin or Xanax without a physician's prescription.

"Who holds the key to the medicine?" Roberts said, about who controls access to the prescription drugs. "Not the drug companies, the parents, the teachers -- the doctors. They should stop this in the tracks."

Sunday 28 April 2013

DSM-5: What Changes May Mean to Autism with the Removal of Aspberger's Syndrome + Video link Courtesy of www.autism.com

Updates to the APA in DSM-V – What do the changes mean to families living with Autism?


Video: The American Psychiatric Association board of trustees met Dec. 1, 2012 to approve changes to diagnostic criteria for autism that eliminate the diagnosis of Asperger Syndrome and change the criteria for diagnosis - learn why accurate diagnosis matters and what these changes may mean for your family in this presentation from the Fall 2012 ARI Conference by Pamela Compart, M.D.

If you have a child with autism you have likely heard of the DSM-IV.  The DSM-IV stands for the Diagnostic and Statistical Manual-Fourth Edition (DSM-IV). It is published by the American Psychiatric Association and it’s the primary manual used by clinicians to provide a formal diagnosis of autism and related disorders. The manual outlines the specific criteria that must be met to receive a diagnosis, as well as the corresponding label and numerical code that is sometimes used by insurance companies to identify the diagnosis. The main purpose is to provide standard guidelines for clinicians to use for the diagnosis of different psychological disorders and conditions.
The DSM-IV currently identifies a set of Pervasive Developmental Disorders that are considered “autism spectrum disorders” (ASDs). These include Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The DSM-IV has been under revision for several years and a new edition, the DSM-V, will be released in 2013. Significant changes to the criteria and categories of ASDs are planned for the new edition. As a parent it is important that you be well informed, so we will review the proposed changes and their possible implications.
One of the most significant changes is that the separate diagnostic labels of Autistic Disorder, Asperger’s Disorder, and PDD-NOS will be replaced by one umbrella term “Autism Spectrum Disorder.” Further distinctions will be made according to severity levels.  The severity levels are based on the amount of support needed, due to challenges with social communication and restricted interests and repetitive behaviors. For example, a person might be diagnosed with Autism Spectrum Disorder, Level 1, Level 2, or Level 3.  The DSM-V revision website says the reasons for using the umbrella term of “Autism Spectrum Disorder” are 1) the old way isn’t precise enough—different clinicians diagnose the same person with different disorders, and some change their diagnosis of the same symptoms differently from year to year, and 2) autism is defined by a common set of behaviors and it should be characterized by a single name according to severity.
The removal of the formal diagnoses of Asperger’s Disorder and PDD-NOS is a major change. People who currently hold these diagnoses will likely receive a different diagnosis when re-evaluated.  This has the potential to be confusing for parents of children with these diagnoses as well as children and adults who identify strongly with their diagnosis.
Revisions to the specific criteria needed for a diagnosis of Autism Spectrum Disorder have also been made. The new criteria are more thorough and strict compared to the old criteria.  For example, more symptoms are needed to meet criteria within the area of fixated interests and repetitive behaviors. Other changes to the criteria include a reorganization.  Currently, the domains for Autistic Disorder include impairments in Communication, Social Interaction, and Restricted Interests and Repetitive Behaviors.  In the new edition, the Communication and Social Interaction domains will be combined into one, titled “Social/Communication Deficits.” Additionally, the requirement of a delay in language development is no longer necessary for a diagnosis.

These proposed changes are based on research, analysis, and expert opinion. The revisions have been made with the hope that the diagnosis of autism spectrum disorders will be more specific, reliable, and valid.  Despite these positive hopes, legitimate concerns have been raised regarding how these changes might impact people on the spectrum.  One of the biggest concerns is that some who are higher functioning will no longer meet the more strict diagnostic criteria and will therefore have difficulties accessing relevant services.  Questions have been raised about what will happen to people currently diagnosed with Asperger’s Disorder or PDD-NOS.  Furthermore, there is uncertainty regarding how state and educational services and insurance companies will adopt these changes.
It is clear these changes will have an impact on families and people currently diagnosed with an autism spectrum disorder. It remains to be seen how diagnosticians and clinicians will use the new criteria in evaluating children and the impact it will have on the availability of services. Therefore, it is important to remain informed and up to date.  To follow and learn more about the proposed changes, see the DSM-V revision website.

Article reprinted courtesy of the Johnson Center for Child Health & Development

DSM-5 - Open Letter to the The American Psychiatric Association re DSM-5 + Pettion REaches 14,000+ PLEASE SIGN

Open Letter to the DSM-5

To the DSM-5 Task Force and the American Psychiatric Association:
As you are aware, the DSM is a central component of the research, education, and practice of most licensed psychologists in the United States. Psychologists are not only consumers and utilizers of the manual, but we are also producers of seminal research on DSM-defined disorder categories and their empirical correlates. Practicing psychologists in both private and public service utilize the DSM to conceptualize, communicate, and support their clinical work.
For these reasons, we believe that the development and revision of DSM diagnoses should include the contribution of psychologists, not only as select individuals on a committee, but as a professional community. We have therefore decided to offer the below response to DSM-5 development. This document was composed in recognition of, and with sensitivity to, the longstanding and congenial relationship between American psychologists and our psychiatrist colleagues.

Though we admire various efforts of the DSM-5 Task Force, especially efforts to update the manual according to new empirical research, we have substantial reservations about a number of the proposed changes that are presented on www.dsm5.org.  As we will detail below, we are concerned about the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory. In light of the growing empirical evidence that neurobiology does not fully account for the emergence of mental distress, as well as new longitudinal studies revealing long-term hazards of standard neurobiological (psychotropic) treatment, we believe that these changes pose substantial risks to patients/clients, practitioners, and the mental health professions in general.
Given the changes currently taking place in the profession and science of psychiatry, as well as the developing empirical landscape from which psychiatric knowledge is drawn, we believe that it is important to make our opinions known at this particular historical moment. As stated at the conclusion of this letter, we believe that it is time for psychiatry and psychology collaboratively to explore the possibility of developing an alternative approach to the conceptualization of emotional distress. We believe that the risks posed by DSM-5, as outlined below, only highlight the need for a descriptive and empirical approach that is unencumbered by previous deductive and theoretical models.

In more detail, our response to DSM-5 is as follows:
Advances Made by the DSM-5 Task Force
We applaud certain efforts of the DSM-5 Task Force, most notably efforts to resolve the widening gap between the current manual and the growing body of scientific knowledge on psychological distress. In particular, we appreciate the efforts of the Task Force to address limitations to the validity of the current categorical system, including the high rates of comorbidity and Not Otherwise Specified (NOS) diagnoses, as well as the taxonomic failure to establish ‘zones of rarity’ between purported disorder entities (Kendell & Jablensky, 2003). We agree with the APA/DSM-5 Task Force statement that, from a systemic perspective,
"The DSM-III categorical diagnoses with operational criteria were a major advance for our field, but they are now holding us back because the system has not kept up with current thinking. Clinicians complain that the current DSM-IV system poorly reflects the clinical realities of their patients. Researchers are skeptical that the existing DSM categories represent a valid basis for scientific investigations, and accumulating evidence supports this skepticism." (Schatzberg, Scully, Kupfer, & Regier, 2009)
As researchers and clinicians, we appreciate the attempt to address these problems. However, we have serious reservations about the proposed means for doing so. Again, we are concerned about the potential consequences of the new manual for patients and consumers; for psychiatrists, psychologists, and other practitioners; and for forensics, health insurance practice, and public policy. Our specific reservations are as follows:

Lowering of Diagnostic Thresholds
The proposal to lower diagnostic thresholds is scientifically premature and holds numerous risks. Diagnostic sensitivity is particularly important given the established limitations and side-effects of popular antipsychotic medications. Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of transitive, even normative distress. As suggested by the Chair of DSM-IV Task Force Allen Frances (2010), among others, the lowering of diagnostic thresholds poses the epidemiological risk of triggering false-positive epidemics.
We are particularly concerned about:
·         “Attenuated Psychosis Syndrome,”[1] which describes experiences common in the general population, and which was developed from a “risk” concept with strikingly low predictive validity for conversion to full psychosis.
·         The proposed removal of Major Depressive Disorder’s[2] bereavement exclusion, which currently prevents the pathologization of grief, a normal life process.
·         The reduction in the number of criteria necessary for the diagnosis of Attention Deficit Disorder,[3] a diagnosis that is already subject to epidemiological inflation.
·         The reduction in symptomatic duration and the number of necessary criteria for the diagnosis of Generalized Anxiety Disorder.[4]
Though we also have faith in the perspicacity of clinicians, we believe that expertise in clinical decision-making is not ubiquitous amongst practitioners and, more importantly, cannot prevent epidemiological trends that arise from societal and institutional processes. We believe that the protection of society, including the prevention of false epidemics, should be prioritized above nomenclatural exploration.

Vulnerable Populations
We are also gravely concerned about the introduction of disorder categories that risk misuse in particularly vulnerable populations. For example, Mild Neurocognitive Disorder[5] might be diagnosed in elderly with expected cognitive decline, especially in memory functions. Additionally, children and adolescents will be particularly susceptible to receiving a diagnosis of Disruptive Mood Dysregulation Disorder[6] or Attenuated Psychosis Syndrome. Neither of these newly proposed disorders have a solid basis in the clinical research literature, and both may result in treatment with neuroleptics, which, as growing evidence suggests, have particularly dangerous side-effects (see below)—as well as a history of inappropriate prescriptions to vulnerable populations, such as children and the elderly

Sociocultural Variation
The DSM-5 has proposed to change the Definition of a Mental Disorder such that DSM-IV’s Feature E: “Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual,”[7] will instead read “[A mental disorder is a behavioral or psychological syndrome or pattern] [t]hat is not primarily a result of social deviance or conflicts with society.”[8] The latter version fails to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders. Instead, the new proposal focuses on whether mental disorder is a “result” of deviance/social conflicts. Taken literally, DSM-5’s version suggests that mental disorder may be the result of these factors so long as they are not “primarily” the cause. In other words, this change will require the clinician to draw on subjective etiological theory to make a judgment about the cause of presenting problems. It will further require the clinician to make a hierarchical decision about the primacy of these causal factors, which will then (partially) determine whether mental disorder is said to be present. Given lack of consensus as to the “primary” causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.

Revisions to Existing Disorder Groupings
Several new proposals with little empirical basis also warrant hesitation:
·         As mentioned above, Attenuated Psychosis Syndrome[9] and Disruptive Mood Dysregulation Disorder (DMDD)[10] have questionable diagnostic validity, and the research on these purported disorders is relatively recent and sparse.
·         The proposed overhaul of the Personality Disorders[11] is perplexing. It appears to be a complex and idiosyncratic combined categorical-dimensional system that is only loosely based on extant scientific research. It is particularly concerning that a member of the Personality Disorders Workgroup has publicly described the proposals as “a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts” (Livesley, 2010), and that, similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, “Probably the most problematic is the revision of personality disorders, where they’ve made major changes; and the changes are not all supported by any empirical basis.”[12]
·         The Conditions Proposed by Outside Sources[13] that are under consideration for DSM-5 contain several unsubstantiated and questionable disorder categories. For example, “Apathy Syndrome,” “Internet Addiction Disorder,” and “Parental Alienation Syndrome” have virtually no basis in the empirical literature.

New Emphasis on Medico-Physiological Theory
Advances in neuroscience, genetics, and psychophysiology have greatly enhanced our understanding of psychological distress. The neurobiological revolution has been incredibly useful in conceptualizing the conditions with which we work. Yet, even after “the decade of the brain,” not one biological marker (“biomarker”) can reliably substantiate a DSM diagnostic category. In addition, empirical studies of etiology are often inconclusive, at best pointing to a diathesis-stress model with multiple (and multifactorial) determinants and correlates. Despite this fact, proposed changes to certain DSM-5 disorder categories and to the general definition of mental disorder subtly accentuate biological theory. In the absence of compelling evidence, we are concerned that these reconceptualizations of mental disorder as primarily medical phenomena may have scientific, socioeconomic, and forensic consequences. New emphasis on biological theory can be found in the following DSM-5 proposals:
·         The first of DSM-5’s proposed revisions to the Definition of a Mental Disorder transforms DSM-IV’s versatile Criterion D: “A manifestation of a behavioral, psychological, or biological dysfunction in the individual”[14] into a newly collapsed Criterion B: [A behavioral or psychological syndrome] “That reflects an underlying psychobiological dysfunction.”[15] The new definition states that all mental disorders represent underlying biological dysfunction. We believe that there is insufficient empirical evidence for this claim.
·         The change in Criterion H under “Other Considerations” for the Definition of a Mental Disorder adds a comparison between medical disorders and mental disorders with no discussion of the differences between the two. Specifically, the qualifying phrase “No definition adequately specifies precise boundaries for the concept of ‘mental disorder’”[16] was changed to “No definition perfectly specifies precise boundaries for the concept of either ’medical disorder’ or ‘mental/psychiatric disorder’.”[17][18] This effectively transforms a statement meant to clarify the conceptual limitations of mental disorder into a statement equating medical and mental phenomena.
·         We are puzzled by the proposals to “De-emphasize medically unexplained symptoms” in Somatic Symptom Disorders (SSDs) and to reclassify Factitious Disorder as an SSD. The SSD Workgroup explains: “…because of the implicit mind-body dualism and the unreliability of assessments of ‘medically unexplained symptoms,’ these symptoms are no longer emphasized as core features of many of these disorders.”[19] We do not agree that hypothesizing a medical explanation for these symptoms will resolve the philosophical problem of Cartesian dualism inherent in the concept of “mental illness.” Further, merging the medico-physical with the psychological eradicates the conceptual and historical basis for somatoform phenomena, which are by definition somatic symptoms that are not traceable to known medical conditions. Though such a redefinition may appear to lend these symptoms a solid medico-physiological foundation, we believe that the lack of empirical evidence for this foundation may lead to practitioner confusion, as might the stated comparison between these disorders and research on cancer, cardiovascular, and respiratory diseases.[20]
·         The proposed reclassification of Attention Deficit/Hyperactivity Disorder (ADHD) from Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence to the new grouping “Neurodevelopmental Disorders” seems to suggests that that ADHD has a definitive neurological basis. This change, in combination with the proposal to lower the diagnostic threshold for this category as described above, poses high risk of exacerbating the extant over-medicalization and over-diagnosis of this disorder category.
·         A recent publication by the Task Force, The Conceptual Evolution of DSM-5 (Regier, Narrow, Kuhl, & Kupfer, 2011), states that the primary goal of DSM-5 is “to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience.”[21] We believe that the primary goal of DSM-5 should be to keep pace with advances in all types of empirical knowledge (e.g., psychological, social, cultural, etc.).
Taken together, these proposed changes seem to depart from DSM’s 30-year “atheoretical” stance in favor of a pathophysiological model. This move appears to overlook growing disenchantment with strict neurobiological theories of mental disorder (e.g., “chemical imbalance” theories such as the dopamine theory of schizophrenia and the serotonin theory of depression), as well as the general failure of the neo-Kraepelinian[22] model for validating psychiatric illness. Or in the words of the Task Force:
“…epidemiological, neurobiological, cross-cultural, and basic behavioral research conducted since DSM-IV has suggested that demonstrating construct validity for many of these strict diagnostic categories  (as envisioned most notably by Robins and Guze) will remain an elusive goal” (Kendler, Kupfer, Narrow, Phillips, & Fawcett, 2009, p. 1).
We thus believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to pathognomonic physiological signs or even multiple biomarkers. Further, growing evidence suggests that though psychotropic medications do not necessarily correct putative chemical imbalances, they do pose substantial iatrogenic hazards. For example, the increasingly popular neuroleptic (antipsychotic) medications, though helpful for many people in the short term, pose the long-term risks of obesity, diabetes, movement disorders, cognitive decline, worsening of psychotic symptoms, reduction in brain volume, and shortened lifespan (Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Whitaker, 2002, 2010). Indeed, though neurobiology may not fully explain the etiology of DSM-defined disorders, mounting longitudinal evidence suggests that the brain is dramatically altered over the course of psychiatric treatment.

In sum, we have serious reservations about the proposed content of the future DSM-5, as we believe that the new proposals pose the risk of exacerbating longstanding problems with the current system. Many of our reservations, including some of the problems described above, have already been articulated in the formal response to DSM-5 issued by the British Psychological Society (BPS, 2011) and in the email communication of the American Counseling Association (ACA) to Allen Frances (Frances, 2011b).
In light of the above-listed reservations concerning DSM-5’s proposed changes, we hereby voice agreement with BPS that:
•       “…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”
•         “The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgments, with little confirmatory physical 'signs' or evidence of biological causation.  The criteria are not value-free, but rather reflect current normative social expectations.”
•          “… [taxonomic] systems such as this are based on identifying problems as located within individuals. This misses the relational context of problems and the undeniable social causation of many such problems.”
•  There is a need for “a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience” and the fact that strongly evidenced causal factors include “psychosocial factors such as poverty, unemployment and trauma.”
• An ideal empirical system for classification would not be based on past theory but rather would “ begin from the bottom up – starting with specific experiences, problems or ‘symptoms’ or ‘complaints’.”
The present DSM-5 development period may provide a unique opportunity to address these dilemmas, especially given the Task Force’s willingness to reconceptualize the general architecture of psychiatric taxonomy. However, we believe that the proposals presented on www.dsm5.org are more likely to exacerbate rather than mitigate these longstanding problems. We share BPS’s hopes for a more inductive, descriptive approach in the future, and we join BPS in offering participation and guidance in the revision process.

American Psychiatric Association (2011). DSM-5 Development. Retrieved from http://www.dsm5.org/Pages/Default.aspx
British Psychological Society. (2011) Response to the American Psychiatric Association: DSM-5 development. Retrieved from http://apps.bps.org.uk/_publicationfiles/consultationresponses/DSM-5%202011%20-%20BPS%20response.pdf
Compton, M. T. (2008). Advances in the early detection and prevention of schizophrenia. Medscape Psychiatry & Mental Health. Retrieved from http://www.medscape.org/viewarticle/575910
Frances, A. (2010). The first draft of DSM-V. BMJ. Retrieved from http://www.bmj.com/content/340/bmj.c1168.full
Frances, A. (2011a). DSM-5 approves new fad diagnosis for child psychiatry: Antipsychotic use likely to rise. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/display/article/10168/1912195
Frances, A. (2011b). Who needs DSM-5? A strong warning comes from professional counselors [Web log message]. Psychology Today. Retrieved from http://www.psychologytoday.com/blog/dsm5-in-distress/201106/who-needs-dsm-5
Hanssen, M., Bak, M., Bijl, R., Vollebergh, W., & van Os, J. (2005). The incidence and outcome
of subclinical psychotic experiences in the general population. British Journal of Clinical
Psychology, 44, 181-191.
Ho, B-C., Andreasen, N. C., Ziebell, S., Pierson, R., & Magnotta, V. (2011). Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry, 68, 128-137.
Johns, L. C., & van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21, 1125-1141.
Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. The American Journal of Psychiatry, 160, 4-11.
Kendler, K., Kupfer, D., Narrow, W., Phillips, K., & Fawcett, J. (2009, October 21). Guidelines for making changes to DSM-V. Retrieved August 30, 2011, from http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf
Livesley, W. J. (2010). Confusion and incoherence in the classification of Personality Disorder: Commentary on the preliminary proposals for DSM-5. Psychological Injury and Law, 3, 304-313.
Moran, M. (2009). DSM-V developers weigh adding psychosis risk. Psychiatric News Online.
Retrieved from http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=112801
Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2011). The conceptual evolution of DSM-5. Arlington, VA: American Psychiatric Publishing.
Schatzberg, A. F., Scully, J. H., Kupfer, D. J., & Regier, D. A. (2009). Setting the record
straight: A response to Frances commentary on DSM-V. Psychiatric Times, 26. Retrieved from http://www.psychiatrictimes.com/dsm/content/article/10168/1425806
Whitaker, R. (2002). Mad in America. Cambridge, MA: Basic Books. Also see http://www.madinamerica.com/madinamerica.com/Schizophrenia.html
Whitaker, R. (2010). Anatomy of an epidemic. New York, NY: Random House.