Psychiatry is an important discipline within the field of medicine with the diagnosis, treatment and prevention of mental disorders currently being debated. The most controversial topic at the moment is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which was launched in May 2013. Furthermore, mental disorders are associated with physical health problems; for example, depression has been linked to an increased risk of cardiovascular disease, stroke, diabetes and obesity morbidity. Emerging evidence indicates that risk factors for common mental disorders like anxiety include lifestyle behaviors such as diet, physical inactivity and smoking.
“Using DSM categories as railway tracks for research risks limiting the exploration of novel or more promising nosologies or dichotomies.”
Michael Berk, University of Melbourne
To focus on these topics, BMC Medicine has launched Current Controversies in Psychiatry, an article collection that aims to address the key challenges in mental health from diagnosis to co-morbidities, and focuses on precision medicine to understand vulnerability and specific therapies in mental disorders. In an Editorial to launch the collection, Michael Berk from the Univesrity of Melbourne, Australia, discusses the debate on diagnostic categories in mental health based on DSM-5, and argues that this is disproportionate to what the changes will actually mean. Furthermore, in a debate article, Bruce Cuthbert and Thomas Insel from the National Institute of Mental Health, USA, highlight that future psychiatric nosologies will be informed by the Research Domain Criteria (RDoC) that is based on genetics, neuroscience and behavioural science, which will help achieve precision medicine for mental disorders.
New research on diagnostic applications in mental disorders published in BMC Medicine using electroencephalogram (EEG)-derived measures of brain connectivity show neurophysiological differences between Asperger’s syndrome and autism in children, suggesting that Asperger’s should be considered as a separate entity. These controversial findings are in agreement with the DSM-5 which classifies Asperger’s syndrome within the broad autistic spectrum; however these results also demonstrate that patients with Asperger’s syndrome can be physiologically distinguished from those with autism spectrum disorders .
The latest additions to the article collection include an interview with David Kupfer from the University of Pittsburgh, USA, about the challenges, controversies and future directions of DSM-5 and an interview with Eric Taylor who addresses how the changes will affect the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in clinical practice. Both interviews are available to listen to in Biome here.
Personal views on how DSM-5 might affect clinical application in other areas including autism, trauma-related and stressor-related disorders, obsessive-compulsive and related disorders, mood disorders and schizophrenia spectrum disorders, have been discussed in a forum article by several BMC Medicine Editorial Board members and their colleagues.
“Is it an improvement over DSM-IV? Yes, But perhaps not what we all wished for at this stage.”
Charles Nemeroff & Daniel Weinberger
The topic of lifestyle and mental disorders is emerging and the article collection includes an opinion article by Almudena Sanchez-Villegas and Miguel Martínez-Gonzalez who discuss how diet may help prevent depression, and recommend that observational studies and clinical trials need to be carried out to confirm the association. Depression has also been associated with cardiovascular diseases and Peter de Jonge and colleagues argue that although there is a link between coronary heart disease (CHD) and depression, this association is confounded by heterogeneity, such that depression is a non-causal risk factor for CHD. However, Kenneth Freedland and Robert Carney dispute that depression predicts CHD but admit that better methods are required to ascertain whether depression is a causal risk factor for CHD, which could help determine treatment strategies for CVD prevention.
The move towards focusing on a more personalized approach to psychiatric research is also highlighted in a review article by Charles Nemeroff and colleagues, where the genetics, epigenetics, biomarkers, treatment response and environmental factors of mood disorders and schizophrenia are discussed, with particular emphasis on the impact of neuroimaging on personalized medicine in psychiatry.
The Current Controversies in Psychiatry article collection highlights the debates on psychiatric diagnosis, the relationship between diet, physical and mental health and the need for personalized medicine approaches based on biological system-based evaluations. We will continue to add further articles on the important open questions in psychiatry and we anticipate developments in the field that will ultimately improve the diagnosis, management, treatment and care of psychiatric patients.
The complete list of series articles: