tag:blogger.com,1999:blog-7772182113499451603.post2894113779133631467..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Dr.Ghaemi on Dr. SpitzerGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-7772182113499451603.post-64684405898536342672016-04-04T12:17:47.640-05:002016-04-04T12:17:47.640-05:00http://www.nimh.nih.gov/news/science-news/2013/dsm...http://www.nimh.nih.gov/news/science-news/2013/dsm-5-and-rdoc-shared-interests.shtmlGeorge Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-87264925139132841112016-04-04T10:57:34.284-05:002016-04-04T10:57:34.284-05:00I would imagine he has said a lot of things. Here...I would imagine he has said a lot of things. Here for example in a joint statement he endorses it as the "best information available" and acknowledges that researchers currently need more than that.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-63012048914515198982016-04-04T09:45:40.227-05:002016-04-04T09:45:40.227-05:00How is it possible that Lieberman could say someth...How is it possible that Lieberman could say something like that?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-38248026112867502662016-04-03T10:01:28.942-05:002016-04-03T10:01:28.942-05:00That was my point about reliability. He and the ...That was my point about reliability. He and the KOLs (not you) tended to use reliability to make their point but homosexuality when it was a disorder had a high kappa. The issue of course was construct validity. <br /><br />I certainly agree that major depression with melancholia is a valid psychological construct. I have loads of problems with mood disorder and adjustment disorder which not only have validity issues, but reliability issues.<br /><br />In other words, he could have stopped at 15 or so, but now we have 265 "precisely defined mental disorders" according to the Lawrence Kolb professor of psychiatry at Columbia and former APA president or at least his ghostwriter. Which every practicing psychiatrist in the community deep down knows is a load of bull.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-61623018930417933342016-04-02T13:25:47.929-05:002016-04-02T13:25:47.929-05:00A couple of opposing points:
Depression was one o...A couple of opposing points:<br /><br />Depression was one of the major disorders proposed by Feighner. The basis for that proposal is outlined in this reference: http://www.ncbi.nlm.nih.gov/pubmed/20008944 - It includes the table: "TABLE 1. Historical Origins of the Symptomatic Criteria for Major Depression: Criteria Proposed 1950–1980" - with the research papers on which it is based. Feighner's 1972 paper is in column 3.<br /><br />That historical a article BTW, points out that the real tension at the time had nothing to do with money - it was clearly a battle between the Washington University group and their emphasis on diagnosis and psychoanalysts who wanted nothing to do with diagnosis. The origins or a depression diagnosis go back to 1950. <br /><br />I don't recall any discussion of construct vaildity and homsexuality. The MPR piece linked to my post on the subject suggests that he made the decision based on the number of functional and successful psychiatrists he encountered at the GayPA meeting at the time. I would appreciate any academic reference discussing the reasons because I clearly missed it.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-53382557618990930372016-04-02T12:53:29.404-05:002016-04-02T12:53:29.404-05:00I'm with Ghaemi on this one. He could have s...I'm with Ghaemi on this one. He could have said, "Except for the major disorders described by Feighner, psychiatry for the most part treats symptoms, not diseases or any easily definable categorial disorders". That would have been intellectually honest and conform to the actual experience of being a psychiatrist. <br /><br />Instead he went for the money and prestige of trying to shoehorn it all into a disease model in DSM. And even people like Jeffrey Lieberman now believe that “the book precisely defines every known mental illness”. You're talking a sensible nuanced approach but the KOLs are doubling down on overstatement.<br /><br />It's great that Spitzer tossed out homosexuality as a mental disorder. However, in an uncloseted homosexual, the diagnosis has a perfect reliability kappa. He excluded on the basis of lack of construct validity, a concept he failed to apply to such things as adjustment disorder.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-64467535041643469592016-03-30T22:05:04.123-05:002016-03-30T22:05:04.123-05:00"Ghaemi is one of the folks who disagrees wit..."Ghaemi is one of the folks who disagrees with the duration criteria for many mood disorders."<br /><br />Unfortunate - the single most important criteria in the DSM is the duration necessary for a manic episode.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-6111479205839940732016-03-30T20:02:50.330-05:002016-03-30T20:02:50.330-05:00Ghaemi is one of the folks who disagrees with the ...Ghaemi is one of the folks who disagrees with the duration criteria for many mood disorders. Granted they are somewhat arbitrary, but they are put in there for a reason. The DSM Committees have rightly refused to monkey with them. <br /><br />BTW, Hamilton, the author of the HAM-D, had himself stated that his instrument is invalid for distinguishing anxiety and depression. <br /><br />Another big reason for lack of reliability in diagnosis is crappy psychiatric interviewing technique by some of the involved clinicians.David M. Allen M.D.https://www.blogger.com/profile/06280912088483192599noreply@blogger.com