Question

Classifying Mood Disorders

This week, you studied the history of mood-disorder classification and diagnosis, including the biological, cognitive-behavioral, and sociocultural perspectives. As you learned, the mood disorders' diagnosis process has changed over time and has become complicated due to the identification of multiple disorders along a spectrum. Analyze how the classification and diagnosis process of mood disorders has changed over time and the ways in which mood disorders are being classified. While exploring these concepts, share your answers to the following questions:

How have our processes for classifying and diagnosing mood disorders changed over time?

Do you think the current classification of mood disorders in categories is appropriate, or should mood disorders be classified from a dimensional perspective? What would you include and exclude if you had to develop a system for classification of mood disorders? Support your answer with a rationale.

Answer 1

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) marks the first significant revision of the publication since the DSM-IV in 1994. Changes to the DSM were largely informed by advancements in neuroscience, clinical and public health need, and identified problems with the classification system and criteria put forth in the DSM-IV. Much of the decision-making was also driven by a desire to ensure better alignment with the International Classification of Diseases and its upcoming 11th edition (ICD-11). In this paper, we describe select revisions in the DSM-5, with an emphasis on changes projected to have the greatest clinical impact and those that demonstrate efforts to enhance international compatibility, including integration of cultural context with diagnostic criteria and changes that facilitate DSM-ICD harmonization. It is anticipated that this collaborative spirit between the American Psychiatric Association (APA) and the World Health Organization (WHO) will continue as the DSM-5 is updated further, bringing the field of psychiatry even closer to a singular, cohesive nosology.

Final determination of DSM-5's impact must await judgment until after the manual has been in use for some time. Epidemiological studies will aid in detecting changes in prevalence and comorbidities from the DSM-IV, including implementation of cross-national surveys of disorders with high public health relevance worldwide, such as schizophrenia, major depressive disorder, and substance use disorders. The more immediate next steps for the DSM-5 include the development of materials that may assist in its use in primary care settings, adaptation of assessment instruments to DSM-5, and documenting the evidence base for revision decisions in the DSM-5 electronic archives. There will also be further testing and development of the dimensional assessments in the manual, including that of a pediatric version of the internationally used WHO Disability Assessment Schedule 2.0.

By continuing collaboration with the WHO in future editions of the DSM, we can assure a more comparable international statistical classification of mental disorders and move closer to a truly unified nosology and approach to diagnosis. Such a collaborative effort should assist the 200,000 psychiatrists worldwide to better care for individuals with these life-altering and potentially destructive conditions, and advance a more synergistic and cumulative international research agenda to find the causes and cures for these disorders.The revision of diagnostic requirements for mood disorders in the forthcoming International Classification of Diseases-11 (ICD-11) classification was governed by the same principles that applied to the rest of the draft. Precedence was given to clinical utility and universal applicability of the classification. Other guiding principles included ensuring scientific validity of the revision and harmonizing it with the Diagnostic and Statistical Manual of Mental Disorders-5. These fundamentals led to considerable reorganization, restructuring, and expansion of the contents of the revision including the section on mood disorders. The mood disorders section now follows a much simpler format than the ICD-10 and is expected to be easier to use. Its simplicity, notwithstanding descriptions of individual diagnostic categories in the revision are more elaborate and precise and in consonance with the current state of knowledge regarding the different mood disorders included in the section. The draft guidelines are undergoing comprehensive field testing on a very large scale across many countries including a majority from the developing world. Results up to now have been encouraging in terms of user acceptability, clinical utility, and global and cross-cultural relevance. However, one has to await the results of further testing and actual use of the final version of the ICD-11 by all stakeholders to determine if the revision indeed meets the high standards it has set for itself. I am personally quite ok with the current approach of classification of mood disorders.