Toronto's Centre for Addiction and Mental Health (CAMH) has been selected as one of seven adult field trial sites in North America and the only site in Canada to test proposed diagnostic criteria for the American Psychiatric Association's (APA) fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Used by health professionals around the world, DSM is the manual that provides descriptions, symptoms and other criteria for diagnosing mental disorders. CAMH is participating in field trials to help assess the practical use of proposed DSM-5 criteria in real-world clinical settings.
"We are honored to be selected as one of the field trial sites," said Dr. Michael Bagby, Director of Clinical Research at CAMH. "Our role in the development of DSM-5 is a reflection of CAMH's standing in medical research, particularly in the field of psychiatry and mental disorders." APA has reported that the selection process was very competitive; only 11 organizations were chosen from the 65 that submitted proposals to be considered for a field trial site, and CAMH was the only Canadian site chosen.
The field trials held at CAMH will be led by Drs. Bruce Pollock, Michael Bagby and Kwame McKenzie. Disorders being studied at CAMH include schizophrenia, schizoaffective disorder, attenuated psychotic symptoms syndrome, and personality disorders. Clinicians participating in the field trial will evaluate new and existing patients at different stages of treatment using the proposed DSM-5 diagnostic criteria and measures.
The field trial design will address several important aspects of the proposed diagnostic criteria, including:
- Feasibility: are the proposed criteria easy for clinicians to understand and to use?
- Clinical Utility: do the proposed criteria do a good job in describing patients' psychiatric problems and help clinicians make decisions about treatment plans?
- Reliability: are the same conclusions reached consistently when the criteria are used by different clinicians?
- Validity: how accurately do the diagnostic criteria reflect the mental disorders they are designed to describe?
In addition, the field trials will test new tools that help clinicians evaluate the severity of symptoms, and whether patients are improving over time; as well as "cross-cutting dimensional assessments" that measure symptoms that occur across a wide range of diagnoses, such as sleep problems.
"The clinicians and researchers at CAMH demonstrate the highest level of expertise in mental health research and clinical care," said David Kupfer, M.D., chair of the DSM-5 Task Force. "This field trial research is a part of a critical phase in development of DSM-5 and will give us the information we need to better understand how the proposed revisions affect clinicians' practices and, most importantly, patient care."
The field trials follow a public comment period in which more than 8,000 written comments on the draft diagnostic criteria were submitted to the DSM-5 web site by clinicians, researchers and family and patient advocates. Submitted comments were reviewed by DSM-5 Work Groups and resulted in further refinement of the criteria. The field trial results will help further refine the criteria and provide invaluable information for DSM-5, to be released in May 2013.
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