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SOMATIC PRESENTATIONS: OVERVIEW |
Executive Director, American Psychiatric Institute for Research and Education; American Psychiatric Association; Arlington, Virginia
Dr. Regier oversees all federal and industry-sponsored research and research training grants for APIRE but receives no external salary funding or honoraria from government or industry. Sources of grants overseen by Dr. Regier include the National Institute of Mental Health and the American Psychiatric Foundation, which receives pharmaceutical industry funding.
This issue of Psychosomatic Medicine presents a selection of papers reporting the proceedings of a conference focused on somatic presentations of mental disorders. The conference was one in a series titled "The Future of Psychiatric Diagnosis: Refining the Research Agenda." It was convened by the American Psychiatric Association (APA) in collaboration with the World Health Organization (WHO) and the US National Institutes of Health (NIH), with funding provided by the NIH Grant U13 MH67855, and hosted by the Department of Psychiatry, Peking University, in Beijing, China, in September 2006.
RESEARCH PLANNING FOR THE DSM/ICD
The APA/WHO/NIH conference series represents a key element in a multiphase research review process designed to set the stage for the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). In its entirety, the project entails ten workgroups, each focused on a specific diagnostic topic or category, and two additional workgroups dedicated to methodological considerations in nosology and classification.
Within the APA, the American Psychiatric Institute for Research and Education (APIRE), under the direction of the author (D.A.R.) holds lead responsibility for organizing and administering the diagnosis research planning conferences. Members of the Executive Steering Committee for the series include representatives of the WHO's Division of Mental Health and Prevention of Substance Abuse and of three NIH institutes that are jointly funding the project: the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
APA published the fourth edition of the DSM in 1994 (1), and a text revision in 2000 (2). Although DSM-V is not scheduled to appear until 2012, planning for the fifth revision began in 1999 with collaboration between APA and the NIMH designed to stimulate research that would address identified opportunities in psychiatric nosology. A first product of this joint venture was preparation of six white papers that proposed broad-brush recommendations for research in key areas. Topics included developmental issues, gaps in the current classification, disability and impairment, neuroscience, nomenclature, and cross-cultural issues. Each team that developed a paper included at least one liaison member from NIMH, with the intent—largely realized—that these members would integrate many of the workgroups' recommendations into NIMH research support programs. These white papers were published in A Research Agenda for DSM-V (3). This volume more recently has been followed by a second compilation of white papers (4) that outline diagnosis-related research needs in the areas of gender, infants and children, and geriatric populations.
As a second phase of planning, the APA leadership envisioned a series of international research planning conferences that would address specific diagnostic topics in greater depth, with conference proceedings serving as resource documents for groups involved in the official DSM-V revision process. We, in collaboration with colleagues at WHO, developed a proposal for the cooperative research planning conference grant that NIMH awarded to APIRE in 2003, with substantial additional funding support from NIDA and NIAAA. The conferences funded under the grant are the basis for a monograph series, and represent a second major phase in the scientific review and planning for DSM-V.
The conferences that comprise the core activity of this phase of preparation have multiple objectives. One objective is to promote international collaboration among members of the scientific community with the aim of eliminating the remaining disparities between the DSM-V and the International Classification of Diseases (ICD) (5) Mental and Behavioral Disorders section (6). The WHO launched the revision of ICD-10 that will lead to publication of the 11th edition in approximately 2014. A second goal is to stimulate the empirical research necessary to allow informed decision-making regarding deficiencies identified in DSM-IV. A third objective is to facilitate the development of broadly agreed on criteria that researchers worldwide may use in planning and conducting future research exploring the etiology and pathophysiology of mental disorders. Challenging as it is, this last objective reflects widespread agreement in the field that the well-established reliability and clinical usefulness of prior DSM classifications must be matched in the future by a renewed focus on the validity of diagnoses.
APA attaches high priority to ensuring that information and research recommendations generated by each of the workgroups are readily available to investigators who are concurrently updating other national and international classifications of mental and behavioral disorders. Moreover, given the vision of an ultimately unified international system for classifying mental disorders, members of the Executive Steering Committee have made strenuous efforts to realize the participation of investigators from all parts of the world in the project. Toward this end, each conference in the series has two co-chairs, drawn respectively from the US and a country other than the US. Approximately half of the experts invited to each working conference are from outside the US; and half of the conferences are being convened outside the US.
TOWARD DSM-V AND ICD-11
The papers presented in this issue make clear that the diverse collection of conditions that can be clustered under the rubric "somatic presentations of mental disorders" remains a vital and important topic for psychiatry and all of medicine. Of particular import to this topic—and, hence, a primary justification for enlisting the assistance of our Chinese colleagues to convene this conference in Beijing—is the role and influence of cultural factors on the experience of mental disorders. The chance to interact with scientists from around the world in a setting far removed from the APA's homebase in the Washington, DC area was intellectually invigorating. The dissatisfaction with the somatoform disorder section of the DSM-IV and ICD-10 and the need for better research on the bidirectional interaction between somatic syndromes with mood and anxiety syndromes was clearly articulated. We anticipate that the Beijing conference and the research that it stimulates will have far-reaching influence on the empirical research that seeks to integrate central nervous system and other organ system syndromes over the next several years. Likewise, this series of papers will provide a greater scientific rationale for paying more attention to culturally mediated expressions of disorder in future versions of the DSM and ICD.
We appreciate the enthusiastic interest of Joel Dimsdale, MD (co-chair of the Beijing conference), and David Sheps, MD (Editor-in-Chief of Psychosomatic Medicine), in ensuring the availability of these papers to a global readership. Special acknowledgment is due also to Arthur Kleinman, MD, Vikram Patel, MD, and Yu Xin, MD, for their invaluable assistance in planning the conference and helping to identify a superb roster of participants. Reprints of these articles along with additional papers from the conference will be available in a monograph to be published in late 2008 by the American Psychiatric Press, Inc. That volume will serve as a resource document for the DSM-V Task Force and disorder-specific Work Groups. In addition, a summary report of the conference is available online at www.dsm5.org.
The American Psychiatric Association greatly appreciates, as well, the contributions of all participants in the somatic manifestations research planning workgroup and the interest of our broader audience in this topic.
Dr. Regier oversees all federal and industry-sponsored research and research training grants for APIRE but receives no external salary funding or honoraria from government or industry. Sources of grants overseen by Dr. Regier include the National Institute of Mental Health and the American Psychiatric Foundation, which receives pharmaceutical industry funding.
NOTES
This article is being co-published by Psychosomatic Medicine and the American Psychiatric Association.
DOI:10.1097/PSY.0b013e31815afbe4
REFERENCES
This article has been cited by other articles:
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  J. E. Dimsdale, V. Patel, Y. Xin, and A. Kleinman Somatic Presentations A Challenge for DSM-V Psychosom Med, November 1, 2007; 69(9): 829 - 829. [Full Text] [PDF]
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