The Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, governs the tricky science of psychiatric diagnosis. But this gold standard of diagnosis is anything but infallible: as knowledge of mental disorders grows, successive editions have had to change their definitions. The fifth version, due to be published next year, is already drawing criticism—and the most recent attack comes from within the DSM-5’s ranks.
Roel Verheul and John Livesley, a psychologist and psychiatrist who were members of the DSM-5 work group for for personality disorders, found that the group ignored their warnings about its methods and recommendations. In protest, they resigned, explaining why in an email to Psychology Today. Their disapproval stems from two primary problems with the proposed classification system: its confusing complexity, and its refusal to incorporate scientific evidence.
A recent column by Dr. Pauline Chen at the New York Times explores a surprising oversight in modern healthcare: Doctors don’t really have a clue how to predict how long a patient will live. In the absence of a widely accepted, systematic method of prognosis, they’re kind of making it up—an informed guess, with the benefit of education and experience, but a guess nonetheless.
Prognosis was once a diligently studied, widely practiced part of a physician’s job, Chen writes. But as treatments improved, and keeping patients alive longer became ever more possible, the unpleasant but necessary skill of predicting when patients might die fell by the wayside. A recent study, she reports, revealed just how much:
What’s the News: If two South Korean researchers have their way, the days of needing specialized equipment to test whether someone has strep, the flu, or other common illnesses may soon be numbered. The pair want to check for disease markers in a tiny drop of a bodily fluid by pressing it against a touchscreen, so your diagnosis could come straight from your smart phone. While there’s no app for that yet, the scientists recently finished a proof-of-concept study showing that a touchscreen could differentiate between various concentrations of bacterial DNA—a first step towards diagnosing your disease by spitting on your iPad.
What’s the News: A number of recent studies have suggested that brain scans could be used to diagnose autism. Virginia Hughes investigated these claims in a report for the Simons Foundation Autism Research Initiative. While some researchers feel these tests could soon be ready for the clinic, she found, others feel that relying on the scans for diagnosis is at least premature, and perhaps entirely misguided. Some important points in her report:
How the Would-Be Autism Tests Work:
What’s the News: Alzheimer’s is getting an update: for the first time in 27 years, the national criteria for diagnosing the disease have been revised. The new criteria are intended only for use by researchers studying the disease, but they are important because they acknowledge growing evidence for an early stage of Alzheimer’s that could be detectable with biological tests before cognitive impairment sets in. Read More
A double-whammy method of screening for ovarian cancer, which is sometimes called the silent killer, seems to catch many cases in the early stages when the disease is more curable, researchers say. A massive study tested the impact of two types of screening: One is a blood test which measures the levels of a protein called CA125, which is often higher in women with ovarian cancer. The other is an ultrasound scan that looks for abnormalities in the ovaries [The Guardian]. When used in conjunction, the two tests showed great promise in catching cancer cases early on.
Ovarian cancer is one of the most lethal types of cancer. About 21,000 U.S. women are diagnosed each year and more than 15,000 die. The high death rate is due to the fact that the disease is often detected at a late stage of development, when chances for a cure are much lower [Los Angeles Times].
However, many of the women in the study had false positive results, especially those who received only an ultrasound test, leading some to unnecessarily have their ovaries removed. Lead researcher Ian Jacobs cautioned that “women thinking of having [an ultrasound screening] must understand and realize that there’s a possibility it will do more harm than good. We have reason to think it will save lives,” he added, “and then the question is, will it save enough lives to balance out the harm it does?”[The New York Times].
A simple urine test is being developed that would revolutionize the treatment of prostate cancer by differentiating between the benign and aggressive forms of the disease.
While prostate cancer is one of the most commonly diagnosed cancers in men, the real challenge for treatment tends to lie in measuring the progress of the disease. A person can live a long time with benign prostate cancer, but the aggressive kind of tumor grows much more quickly and requires urgent treatment. The current method for distinguishing between the two can involve several rounds of testing, including an invasive and painful biopsy.
The urine test, which will not be ready for at least another three to five years, would be an easy and inexpensive way to determine which type of cancer is present, researchers report in Nature [subscription required]. Research for the test began when doctors found that men with an aggressive form of prostate cancer carry elevated levels of a particular molecule in their urine [The Guardian].