"Old Friends" Battle it out Over DSM-V Psychosis

Yesterday, Psychiatric Times published this response to the Allen Frances critique of DSM-V. It is written by William Carpenter, who is Professor of Psychiatry at the University of Maryland, and the chairman of the DSM-V work group on psychosis.

Carpenter begins his response by saying that Allen Frances is an "old friend," although from the tenor of this article, "old" may be the operative word. I know Dr. Carpenter myself, having interviewed him for the March 2007 issue of The Carlat Psychiatry Report, and having chatted with him here and there at APA meetings. He's a southern gentleman, and I found him very forthcoming and honest about a range of issues, including his refreshing skepticism of the value of some of the newer atypical antipsychotics. He has done some consultation with drug companies but very little over the past few years. He's definitely no hired gun, and he speaks his own mind.

The bottom line is that Dr. Carpenter is extremely credible and anything he says or writes you have take seriously. And if you were to boil down his response to Dr. Frances to a few sentences, it would be:

"In actuality, there will be very few substantive changes in the DSM-V. Most of the diagnostic criteria will be the same. We might add a handful of rating scales. There will be no 'paradigm shift.' We are considering adding a sub-threshold psychosis diagnosis but then again we may not--it's a complex scientific issue and we, like you, are concerned about overdiagnosis and stigma."

Basically, Dr. Carpenter is saying that Dr. Frances has created a sensationalized straw man argument, making all kinds of predictions about DSM-V, few of which will materialize.

Of course, Carpenter is focusing on only one of many diagnostic categories, so the Frances critiques may still apply to the rest of DSM-V. Hopefully, we'll hear from the other Work Group chairs soon.