DSM- 5
Recognised by the assembly of the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) is primarily designed for the use of American Psychiatrists. It is also contirbutes greatly to the revenue of the American Psychiatric Association, as such measures like copyright permission . It is also a useful means of attaining accurate health statistics concerning individuals suffering from a psychiatric disorder.
How is it used to diagnose depression?
In the diagnosis of depression the DSM-5 criteria is focused around the diagnosis of Major Depressive Disorders and diagnosis of mild, moderate, and severe depression can be made relative to this. For a formal diagnosis, the patient must experience 5/9 symptoms on a daily baisis for a minimum duaration of 2 weeks. These depressive symptoms must also be accompanied by anhedonia and to some degree impair the individuals daily functioning in their daily lives.
Symptoms include:
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Irritability or low mood, either experienced by the individual (feeling lonely, lost) or noticeable to others (e.g. crying)
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Anhedonia or lack of interest in most activities, for the majority of the day
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Marked change in weight (5%) or apetite changes
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Sleep disturbances including insomnia or hypersomnia
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Differences in activity: restlessness or retardation
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Fatigue, diminishing energy levels
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Self decaprication or exccessive feeling of guilt
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Poor concentration levels or inability to make simple decisions
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Suicidal ideation or behaviour
To further distinguish between mild, moderate, or severe depression the following criteria may be used.
Criticisms of the revised DSM criteria?
In order to make a formal diagnosis of any severity of depression using this table:
Either criteria A and B must be satisfied
OR
The no: of symptoms from criteria and the severity of impairment /affecting daily activities must be satisfied.
The revised edition of the DSM has faced much criticism and controversy since being released in 2013. In particular, there have been concerns regarding the "expanding definitions" of the diagnostic criteria. The concern stems from the fact that this loosening of criteria may lead to overdiagnosis of depression in patients experiencing perfectly natural feelings of loss and sadness. Recently, Professor Christopher Dowrick and Professor Allen Frances expressed such concerns in the British Medical Journal which will be discussed further, first lets address the main factor that's facing so much criticism.
The latest revision of the DSM has removed the "bereavement exclusion criteria" which was present in the DSM-4. According to the DSM-4, practitioners were discouraged from diagnosing any patient suffering from bereavment within the first 2 months following the event. It was thought that patients were in some way protected from developing major depression during the grieveing period. The removal of the bereavment exclusion criteria is thought to prevent signs of major depression from going unoticed, enabling earlier interventions to be conducted. Dowrick and Frances titled the paper "Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit"By means of the DSM-5, it is now possible to diagnose a patient with Major Depressive Disorder (MDD), as early as 2 weeks post bereavment. The transition from a non-psychiatric disorder (grief) to a psychiatric disorder (MDD) was undertaken to enable ease of access to efficacious treatments. This is particularly evident in the USA, where funding for therapeutic costs is dependant on a formal diagnosis. Dowrick and Frances argued that "homogenisation of depression is a mistake, as they state that it is unlikely that patients will suffer an episode of MDD, a year following uncomplicated episodes of MDD in comparison to those that are unaffected. Another criticism against the DSM-5 is the fact that the diagnosis of depression and prescriptions for antidepressants have risen significantly. Within communities the prevalence of depressive illnesses remain stable. Between 1992-85 and 2002-05, the diagnosis has doubled (amongst Medicare Beneficiaries). It is now believed that since the criteria has been expanded, overdiagnosis will consequently increase. In England, there has been an annual increase of 10% between 1992-2010 in prescribed antidepressants, which is a consequence of long term prescription increased.
What does the evidence say?
By means of a meta-analyses (placebo controlled trials), the evidence indicate that antidepressants show minimal or no effect in the treatment of mild depression
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