Current issues/controversies in psychiatry?

[iqureshi7]

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What are some of the central issues/controversies in psychiatry these days?


Thanks for your help!

 

[TheWowEffect]

What are some of the central issues/controversies in psychiatry these days?


Thanks for your help!

Mental health parity is one such very important issue.

 

[toby jones]

Whether psychiatry will survive advances in neurology.

Whether the biopsychosocial model is just so much crappy PC bull**** or whether there might actually be some sense to the notion that no one level (e.g., neurological e.g., pharmaceutical) is fundamental.

 

[solumanculver]

Whether psychiatry will survive advances in neurology.

Whether the biopsychosocial model is just so much crappy PC bull**** or whether there might actually be some sense to the notion that no one level (e.g., neurological e.g., pharmaceutical) is fundamental.

I'm casting my vote for crappy bull****

 

[whopper]

Medication of children for disorders such as ADHD. The disorder is real but the problems are that children often don't have a strong say in their treatment, may be abusing the meds or may be using the disorder as a crutch when they really don't have it.

Imprisonment of psychiatric ill people.

Misdiagnosis & subjectivity of the field.

 

[solumanculver]

Misdiagnosis & subjectivity of the field.

Does anybody know if the DSM-V is going to have data about imaging in it? In general is the DSM-V going to decrease misdiagnosis and subjectivity, or is it just going to rehash what's already in the DSM-IV? Also, how do we know that our diagnostic categories are good enough that we can talk about misdiagnosis? It seems like you're just supposed to match the patient's constellation of symptoms with a similar constellation in the DSM... how often does a misdiagnosis actually change the treatment? Probably when there is confusion between psychotic Bi-polar and schizophrenia? Or are they both treated mostly the same?

 

[whopper]

Don't know the answer to your question though the DSM-V isn't going to come out for quite a few years. I'm sure it will include some of the latest cutting edge data.

I'm not hearing much about the DSM-V other than a few tidbits in the medical journals.

http://www.dsm5.org/

I attending an excellent grand rounds @ Columbia a few months back where the lecturer mentioned that PTSD was only manifested if the person had a specific set of genes. Very interesting-and could lead to some good clinical applications. During the grand rounds, the lecturer even commented to the attendings working on DSM-V and said something to the effect of "something to consider before you come out with the next DSM".

There's a good psychiatric movie on the Sundance Channel once in awhile called Whole
http://www.imdb.com/title/tt0429245/

The movie has Michael First, M.D., one of the docs heading the new DSM-V. It includes a disorder where people are obsessed with becoming an amputee which supposedly has hundreds of people around the world with this disorder. First was interviewed in the movie because he doesn't know to include this in the upcoming DSM. This disorder only came to his attention because of internet groups on the subject started drawing people in. Up until that point, all the people who had it thought they were the only ones to have it. Once an internet forum on it starting gaining enough members, certain commonalities between the people were noticed...

e.g.
they usually wanted their left lower leg amputated
they usually knew exactly where they wanted the amputation and what part of the limb to keep
they felt as if the limb they wanted amputated didn't belong to them

Something the movie didn't explore was the neurological work up that was done. Unfortunate, but remember this movie is for the masses, not for doctors. I kept thinking maybe these people had some type of neurological insult to them and if this insult could be isolated. I kept thinking that perhaps this disorder was neurologic, not psychiatric. However given that First is quite brilliant, I'm sure he's already investigated that area.

Just remembered there's another thread asking for controversial topics already "Hot Topics in Psychiatry"

 

[Therapist4Chnge]

The Voluntary Amputee topic has been around for a bit, and it is quite fascinating. It is as if the person took a (gender) identity conflict ("I was born with the wrong parts"), and combined it with some body dysmorphic thinking (a belief that an otherwise 'normal' part of their body is malformed) and then wanting to 'fix' it. I haven't read much on it, though I originally came across it while doing research in some niche areas of Body Dysmorphic Disorder.

-t

 

[pillion]

A really great book to read regarding these questions is 'The Perspectives of Psychiatry'

http://www.press.jhu.edu/books/title_pages/2779.html