Will I Be Obselete When Dsm-v Arrives?

[rednucleus]

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I have seen so many psychiatrists trained prior to the biological movement back in the psychodynamic days struggle or atleast not thrive like the psychiatrists who were trained with all of the pharmacology. I even see it sometimes in their diagnoses and thinking process between the DSM-III and DSM-IV. I have trained entirely with the DSM-IV and am getting ready to be entering as a full attending. I start to think will this happen to me? With the DSM-V coming out I hear there are going to be major differences from the DSM-IV. While I'll try to catch up I know that I'll be busy working hard and not doing the learning I have done in residency. Is this a bad time to be getting psychiatry training? 😕

 

[Anasazi23]

Is this a bad time to be getting psychiatry training? 😕

I actually think it's a great time. Understanding the evolution of the description of disorders and the thinking processes behind the categorical assignments can only enhance one's tangible feel for the more current and indeed, future iterations of these disorders.

As those on the board here know, I like to read, and have copies of almost all the original DSMs going back to DSM-I. By understanding the thought processes behind these categorizations, I can see how the societal and biological changes affect our understanding of these diseases.

Make no mistake - the old school psychiatrists were much better master of descriptive psychopathology than we are. This is in part understandable, since there were no medications to be bogged down with back then.

Knowing exactly how organic brain syndrome was used, and how it applies today and remains a better description than many other more modern terms means something. By training in residency today, you get the transition between the DSM versions. You'll learn both, you'll memorize both, and you'll understand its evolution and differences. This will make you a richer psychiatrist.

There are endless CME opportunities, conferences, books, and journals that can and will keep you up to date. You'll only "fall behind" if you let yourself.

 

[michaelrack]

Memorizing the current diagnostic criteria is only a minute part of psychiatry (except when you are taking your board exams).

 

[toby jones]

I'd be surprised if the DSM V was all that different from the DSM IV. I would be extremely surprised if the DSM V was as different from the DSM IV as the DSM III was from the DSM II, for example.

Just different enough to justify the sales methinks ;-)

 

[Faebinder]

1) For old diseases... I doubt DSM V will be that much different.

2) We are physicians... not a mid levels with stagnant knowledge.. you should be ready to always move ahead. It keeps our field solid and strong. You will always be able to claim that you are on the cutting edge. Take pride in what you do and note the new improvement with our tools and in our sciences. (I am not accusing you of anything.. just trying to preach here).

3) This is not about whether "you" will be behind time. Take it from the prespective of "your patients" will be short-handed if you dont improve yourself. Hold back improvement so you stay current? Nah.

On the other hand, I do acknowledge the need to see some sort of a book of brochure that tells you what changed from DSM IV to DSM V. It's important to make this change clear and easily recieved by older generations.

 

[Anasazi23]

On the other hand, I do acknowledge the need to see some sort of a book of brochure that tells you what changed from DSM IV to DSM V. It's important to make this change clear and easily recieved by older generations.

The DSM (full version) describes the changes in detail in the forward. The DSM study guides also outline the changes in detail.

 

[whopper]

If you read the previous DSM's vs the IV-TR, the previous ones are vastly inferior in detail & diagnosing practicality.

I am looking very forward to the DSM V. It should be a much better tool and should bring our field up a few notches.

Imagine being Scotty in the engineering section of the Enterprise and getting a new tech manual for a brand new & improved engine. Wouldn't that be like getting an awesome present on X-mas? Or getting a PS3 Game System when you previously had a PS2.

Any field of medicine will require you to read up on the new advancements.

 

[OldPsychDoc]

...
Imagine being Scotty in the engineering section of the Enterprise and getting a new tech manual for a brand new & improved engine. Wouldn't that be like getting an awesome present on X-mas? ....

I don't think Scotty ever bothered himself with manuals...😀

 

[michaelrack]

Any field of medicine will require you to read up on the new advancements.

I wouldn't call revising a diagnostic manual an "advancement". Real advancements in psychiatry could include things like new medications, new forms/improvements in psychotherapy, learning more about the genetic basis/pathophysiology of psych diseases, etc.
Having a bunch of committees vote on how to modify the DSM is more of a way for the apa to sell books than an "advancement"

 

[TheWowEffect]

I wouldn't call revising a diagnostic manual an "advancement". Real advancements in psychiatry could include things like new medications, new forms/improvements in psychotherapy, learning more about the genetic basis/pathophysiology of psych diseases, etc.
Having a bunch of committees vote on how to modify the DSM is more of a way for the apa to sell books than an "advancement"

You are right but if some of these things are included in DSM-V, it may well turn out to be an advancement.

 

[whopper]

What I was going to say....

it may well turn out to be an advancement.

 

[nitemagi]

I think there's also much to be said for studying outside of the DSM system. I find it endlessly fascinating to talk with much older psychiatrists who started working before DSM-II. They had breakdown's for depression, for example, based more on etiology, which I think is a lot more helpful in thinking about approach than just MDE vs. other, which let's face it a lot of our patients don't fall into. Reading the Oxford Textbook of Psychiatry also reveals how much of the world outside of the U.S. views psychiatry, with its own diagnostic criteria.

Overall I think the DSM is useful to know, but never to be limited by. I think the primary utility is a first line means of categorizing psychopathology when you're early in your training (as I am), but then should be used only as a skeleton afterwards. Maybe DSM-V will be some giant step forward, but the real nature of psychiatry requires a much more diverse knowledge base than is included in any DSM (in my humble intern opinion), and which is a lifelong learning process.

 

[whopper]

but the real nature of psychiatry requires a much more diverse knowledge base than is included in any DSM (in my humble intern opinion), and which is a lifelong learning process.

Strongly Agree.

The DSM presents the archetype pathologies. There are several that are not in the book, new ones that will be discovered, and ones that seem to be in between. It is the beginning of understanding psychiatric diagnosis, not the end. It is also a very useful tool in allowing us to talk about psychiatric pathology & be on the same page.