Issues for DSM-V: The Medical Diagnostic Model

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Back to table of contents Previous article Next article EditorialFull AccessIssues for DSM-V: The Medical Diagnostic ModelMax Fink M.D.Michael A. Taylor M.D.Max Fink M.D.Search for more papers by this authorMichael A. Taylor M.D.Search for more papers by this authorPublished Online:1 Jul 2008https://doi.org/10.1176/appi.ajp.2008.08020245AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Early in the modern psychopharmacologic era, treatment response was considered verification for a diagnosis. A well-developed response to lithium in excited patients was consistent with a diagnosis of manic depression. A response to anticonvulsants supported a diagnosis of a seizure disorder. As syndrome categories broadened in scope and became less specific (e.g., the easily met criteria for major depression), the usefulness of such responses fell and interest waned. In the 1970s, hypercortisolemia was reported among severely depressed patients but not in patients with other mental disorders. Initial observations were made in patients with melancholic depression who were so ill they were referred for electroconvulsive therapy. The abnormality disappeared with remission and reappeared with relapse. The development of a simplified dexamethasone suppression test encouraged studies. However, when the test was applied as diagnostic criterion to populations classified according to DSM-III criteria for major depression, specificity was lost and the test was precipitously discarded. Recent interest in rigorously diagnosed examples of melancholia and psychotic depression based on narrowly defined mood, motor, and vegetative symptoms suggests that hypercortisolemia may be a verifying criterion and the response to specific treatments a validating criterion (1) . Psychiatric classification has swollen into a kaleidoscope of putative disorders. It is not likely that any one rule of taxonomy will define the many entities that may be included in DSM-V. But a medical diagnostic model will define those conditions for which we already have a biological interest in their identification and, more importantly, methods of resolution.Address correspondence and reprint requests to Dr. Fink, PO Box 457, St. James, NY 11780; [email protected] attglobal.net (e-mail). Editorial accepted for publication March 2008 (doi: 10.1176/appi.ajp.2008.08020245).The authors report no competing interests.Editorials discussing other DSM-V issues can be submitted to the Journal at http: //mc.manuscriptcentral.com/appi-ajp. Submissions should not exceed 500 words.Reference1. Taylor MA, Fink M. Melancholia: The Diagnosis, Pathophysiology, and Treatment of Depressive Illness. Cambridge, UK, Cambridge University Press, 2006Google Scholar FiguresReferencesCited byDetailsCited BySchizophrenia Research, Vol. 150, No. 1Diagnostic and statistical manual of mental disorders 5: A quick glanceIndian Journal of Psychiatry, Vol. 55, No. 3 Volume 165Issue 7 July, 2008Pages 799-799THE AMERICAN JOURNAL OF PSYCHIATRY July 2008 Volume 165 Number 7 Metrics PDF download History Published online 1 July 2008 Published in print 1 July 2008