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Current Controversies in Psychiatry

Collection published: 14 May 2013

Last updated: 12 September 2013

Psychiatry is an important medical speciality, and several topics on the diagnosis, treatment and prevention of mental disorders are currently being debated. The area of diagnosis has attracted much dialogue with the recent launch of the DSM-5; the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. Development of a new psychiatric classification system, Research Domain Criteria (RDoC), by the National Institute of Mental Health in 2009, is a decade-long research framework, that aims to incorporate genetics, neuroimaging and cognitive science with a move towards precision medicine for mental disorders.

Mental disorders are associated with physical health problems and there are many initiatives to make mental health a key public health priority. For example, depression is known to increase the risk of cardiovascular disease, stroke, diabetes and obesity morbidity. Emerging evidence is showing that risk factors for common mental disorders like anxiety include lifestyle behaviors such as diet, physical inactivity and smoking. Understanding the relationship between physical and mental health will help drive prevention strategies in mental health by building on established schemes and developing approaches used for noncommunicable somatic diseases.

This article collection on the current controversies in psychiatry seeks to address the key challenges in mental health from diagnosis to co-morbidities. The series also focuses on precision medicine where advances in genetics, epigenetics, biomarkers, treatment response and environmental factors will facilitate understanding of vulnerability and the requirement of specific therapies for mental disorders.

Further submissions of original research, reviews and debates focusing on the controversies and open questions in psychiatry are encouraged. If you would like your work to be considered for this series you can send a pre-submission query to bmcmedicineeditorial@biomedcentral.com.

		Question and Answer DSM-5 and ADHD – an interview with Eric Taylor Eric Taylor BMC Medicine 2013, 11:204 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary In this Q&A audio podcast, we interview child and adolescent psychiatrist Eric Taylor about the revisions to the diagnosis of attention deficit hyperactivity disorder (ADHD) in DSM-5, and explore how these changes will affect clinical practice.
		Question and Answer The DSM-5 - an interview with David Kupfer David Kupfer BMC Medicine 2013, 11:203 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary In this Q&A audio podcast, we interview David Kupfer, chair of the task force for the fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), on the challenges and future directions of psychiatric diagnosis.
		Forum DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions Charles B Nemeroff, Daniel Weinberger, Michael Rutter, Harriet L MacMillan, Richard A Bryant, Simon Wessely, Dan J Stein, Carmine M Pariante, Florian Seemüller, Michael Berk, Gin S Malhi, Martin Preisig, Martin Brüne, Paul Lysaker BMC Medicine 2013, 11:202 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary Our Editorial Board Members and their colleagues discuss their personal views on the newly released fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), specifically with regard to how it may, or may not, affect their specific areas of psychiatric medicine.
		Commentary Diagnostic heterogeneity in psychiatry: towards an empirical solution Klaas J Wardenaar, Peter de Jonge BMC Medicine 2013, 11:201 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary Given the current challenges in psychiatric medicine, Klaas Wardenaar and Peter de Jonge argue that evidence-based diagnostic methods should be developed by using multimode analysis and modelling to assess heterogeneity across persons and symptoms over time, to accurately identify optimal homogeneous subgroups.
		Opinion So depression is an inflammatory disease, but where does the inflammation come from? Michael Berk, Lana J Williams, Felice N Jacka, Adrienne O’Neil, Julie A Pasco, Steven Moylan, Nicholas B Allen, Amanda L Stuart, Amie C Hayley, Michelle L Byrne, Michael Maes BMC Medicine 2013, 11:200 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary Depression is associated with a low-grade inflammatory response; Michael Berk and colleagues discuss the sources of inflammation, oxidative and nitrosative stress in depression and emphasize that these factors can be treated or prevented.
		Research article The relationship of Asperger’s syndrome to autism: a preliminary EEG coherence study Frank H Duffy, Aditi Shankardass, Gloria B McAnulty, Heidelise Als BMC Medicine 2013, 11:175 (31 July 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary EEG-derived measures of brain connectivity show that Asperger's syndrome and autism in children are closely related, but there are neurophysiological differences between the groups, suggesting that Asperger’s should be considered a separate entity.
		Commentary Patient advocacy and DSM-5 Dan J Stein, Katharine A Phillips BMC Medicine 2013, 11:133 (17 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Dan Stein and Katharine Phillips comment on the patient experience that has helped define the psychiatric classification of obsessive-compulsive spectrum disorders (OCD) in DSM-5, and describe the importance of taking patient opinion into account.
		Review Personalized medicine in psychiatry: problems and promises Uzoezi Ozomaro, Claes Wahlestedt, Charles B Nemeroff BMC Medicine 2013, 11:132 (16 May 2013) Abstract \| Full text \| PDF \| PubMed \| Cited on BioMed Central \| Editor’s summary Charles Nemeroff and colleagues review the genetics, epigenetics, biomarkers, treatment response and environmental factors of mood disorders and schizophrenia, and describe the impact of neuroimaging on personalized medicine in psychiatry.
		Debate Depression as a risk factor for adverse outcomes in coronary heart disease Kenneth E Freedland, Robert M Carney BMC Medicine 2013, 11:131 (15 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Kenneth Freedland and Robert Carney argue that depression predicts coronary heart disease (CHD) but better methods are required to ascertain whether depression is a causal risk factor for CHD, which could help determine treatment strategies for CVD prevention.
		Debate Depression as a non-causal variable risk marker in coronary heart disease Anna Meijer, Marij Zuidersma, Peter de Jonge BMC Medicine 2013, 11:130 (15 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary 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 CHD.
		Review Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile Brenda WJH Penninx, Yuri Milaneschi, Femke Lamers, Nicole Vogelzangs BMC Medicine 2013, 11:129 (15 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Consequences of depression include somatic diseases, such as obesity and cardiovascular disease; Brenda Penninx and colleagues review the biological pathways and their dysregulation between depressive symptoms and somatic health, and describe the therapeutic implications.
		Editorial The DSM-5: Hyperbole, Hope or Hypothesis? Michael Berk BMC Medicine 2013, 11:128 (14 May 2013) Abstract \| Full text \| PDF \| PubMed \| Cited on BioMed Central \| Editor’s summary In an editorial to launch our article collection on Current Controversies in Psychiatry, Michael Berk discusses the debate on diagnostic categories in mental health based on the new edition of diagnostic criteria; the DSM-5.
		Debate Informing DSM-5: biological boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia Victoria E Cosgrove, Trisha Suppes BMC Medicine 2013, 11:127 (14 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Victoria Cosgrove and Trisha Suppes agree that boundaries between the diagnosis of bipolar disorder I, schizophrenia and schizoaffective disorder are preserved in the DSM-5 criteria, as there is not yet enough data to justify a continuous model of psychosis.
		Debate Toward the future of psychiatric diagnosis: the seven pillars of RDoC Bruce N Cuthbert, Thomas R Insel BMC Medicine 2013, 11:126 (14 May 2013) Abstract \| Full text \| PDF \| PubMed \| Cited on BioMed Central \| Editor’s summary Bruce Cuthbert and Thomas Insel argue 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.
		Debate Clinical classification in mental health at the cross-roads: which direction next? Ian B Hickie, Jan Scott, Daniel F Hermens, Elizabeth M Scott, Sharon L Naismith, Adam J Guastella, Nick Glozier, Patrick D McGorry BMC Medicine 2013, 11:125 (14 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary There is much debate on DSM-5 diagnosis in mental health, and Ian Hickie and colleagues argue for the development of new approaches that identify pathways underlying the illnesses rather than using broad categories to describe psychiatric disorders.
		Opinion Diet, a new target to prevent depression? Almudena Sanchez-Villegas, Miguel A Martínez-González BMC Medicine 2013, 11:3 (3 January 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Depression is linked to inflammation and high lipid profiles, so recent cohort studies have focused on the effects of diet; Sanchez-Villegas and Martinez-Gonzalez discuss how diet may prevent depression, and recommend that observational studies and clinical trials can confirm the association.
		Opinion Moving towards a population health approach to the primary prevention of common mental disorders Felice N Jacka, Arnstein Mykletun, Michael Berk BMC Medicine 2012, 10:149 (27 November 2012) Abstract \| Full text \| PDF \| PubMed \| Cited on BioMed Central \| Editor’s summary Felice Jacka et al. discuss new evidence from studies on diet quality and common mental disorders, and argue that depression and anxiety be ranked amongst prevalent medical conditions influenced by lifestyle, to help develop prevention strategies.

		Question and Answer DSM-5 and ADHD – an interview with Eric Taylor Eric Taylor BMC Medicine 2013, 11:204 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary In this Q&A audio podcast, we interview child and adolescent psychiatrist Eric Taylor about the revisions to the diagnosis of attention deficit hyperactivity disorder (ADHD) in DSM-5, and explore how these changes will affect clinical practice.
		Question and Answer The DSM-5 - an interview with David Kupfer David Kupfer BMC Medicine 2013, 11:203 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary In this Q&A audio podcast, we interview David Kupfer, chair of the task force for the fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), on the challenges and future directions of psychiatric diagnosis.
		Forum DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions Charles B Nemeroff, Daniel Weinberger, Michael Rutter, Harriet L MacMillan, Richard A Bryant, Simon Wessely, Dan J Stein, Carmine M Pariante, Florian Seemüller, Michael Berk, Gin S Malhi, Martin Preisig, Martin Brüne, Paul Lysaker BMC Medicine 2013, 11:202 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary Our Editorial Board Members and their colleagues discuss their personal views on the newly released fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), specifically with regard to how it may, or may not, affect their specific areas of psychiatric medicine.
		Commentary Diagnostic heterogeneity in psychiatry: towards an empirical solution Klaas J Wardenaar, Peter de Jonge BMC Medicine 2013, 11:201 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary Given the current challenges in psychiatric medicine, Klaas Wardenaar and Peter de Jonge argue that evidence-based diagnostic methods should be developed by using multimode analysis and modelling to assess heterogeneity across persons and symptoms over time, to accurately identify optimal homogeneous subgroups.
		Opinion So depression is an inflammatory disease, but where does the inflammation come from? Michael Berk, Lana J Williams, Felice N Jacka, Adrienne O’Neil, Julie A Pasco, Steven Moylan, Nicholas B Allen, Amanda L Stuart, Amie C Hayley, Michelle L Byrne, Michael Maes BMC Medicine 2013, 11:200 (12 September 2013) Abstract \| Full text \| PDF \| Editor’s summary Depression is associated with a low-grade inflammatory response; Michael Berk and colleagues discuss the sources of inflammation, oxidative and nitrosative stress in depression and emphasize that these factors can be treated or prevented.
		Research article The relationship of Asperger’s syndrome to autism: a preliminary EEG coherence study Frank H Duffy, Aditi Shankardass, Gloria B McAnulty, Heidelise Als BMC Medicine 2013, 11:175 (31 July 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary EEG-derived measures of brain connectivity show that Asperger's syndrome and autism in children are closely related, but there are neurophysiological differences between the groups, suggesting that Asperger’s should be considered a separate entity.
		Commentary Patient advocacy and DSM-5 Dan J Stein, Katharine A Phillips BMC Medicine 2013, 11:133 (17 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Dan Stein and Katharine Phillips comment on the patient experience that has helped define the psychiatric classification of obsessive-compulsive spectrum disorders (OCD) in DSM-5, and describe the importance of taking patient opinion into account.
		Review Personalized medicine in psychiatry: problems and promises Uzoezi Ozomaro, Claes Wahlestedt, Charles B Nemeroff BMC Medicine 2013, 11:132 (16 May 2013) Abstract \| Full text \| PDF \| PubMed \| Cited on BioMed Central \| Editor’s summary Charles Nemeroff and colleagues review the genetics, epigenetics, biomarkers, treatment response and environmental factors of mood disorders and schizophrenia, and describe the impact of neuroimaging on personalized medicine in psychiatry.
		Debate Depression as a risk factor for adverse outcomes in coronary heart disease Kenneth E Freedland, Robert M Carney BMC Medicine 2013, 11:131 (15 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Kenneth Freedland and Robert Carney argue that depression predicts coronary heart disease (CHD) but better methods are required to ascertain whether depression is a causal risk factor for CHD, which could help determine treatment strategies for CVD prevention.
		Debate Depression as a non-causal variable risk marker in coronary heart disease Anna Meijer, Marij Zuidersma, Peter de Jonge BMC Medicine 2013, 11:130 (15 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary 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 CHD.
		Review Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile Brenda WJH Penninx, Yuri Milaneschi, Femke Lamers, Nicole Vogelzangs BMC Medicine 2013, 11:129 (15 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Consequences of depression include somatic diseases, such as obesity and cardiovascular disease; Brenda Penninx and colleagues review the biological pathways and their dysregulation between depressive symptoms and somatic health, and describe the therapeutic implications.
		Editorial The DSM-5: Hyperbole, Hope or Hypothesis? Michael Berk BMC Medicine 2013, 11:128 (14 May 2013) Abstract \| Full text \| PDF \| PubMed \| Cited on BioMed Central \| Editor’s summary In an editorial to launch our article collection on Current Controversies in Psychiatry, Michael Berk discusses the debate on diagnostic categories in mental health based on the new edition of diagnostic criteria; the DSM-5.
		Debate Informing DSM-5: biological boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia Victoria E Cosgrove, Trisha Suppes BMC Medicine 2013, 11:127 (14 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Victoria Cosgrove and Trisha Suppes agree that boundaries between the diagnosis of bipolar disorder I, schizophrenia and schizoaffective disorder are preserved in the DSM-5 criteria, as there is not yet enough data to justify a continuous model of psychosis.
		Debate Toward the future of psychiatric diagnosis: the seven pillars of RDoC Bruce N Cuthbert, Thomas R Insel BMC Medicine 2013, 11:126 (14 May 2013) Abstract \| Full text \| PDF \| PubMed \| Cited on BioMed Central \| Editor’s summary Bruce Cuthbert and Thomas Insel argue 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.
		Debate Clinical classification in mental health at the cross-roads: which direction next? Ian B Hickie, Jan Scott, Daniel F Hermens, Elizabeth M Scott, Sharon L Naismith, Adam J Guastella, Nick Glozier, Patrick D McGorry BMC Medicine 2013, 11:125 (14 May 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary There is much debate on DSM-5 diagnosis in mental health, and Ian Hickie and colleagues argue for the development of new approaches that identify pathways underlying the illnesses rather than using broad categories to describe psychiatric disorders.
		Opinion Diet, a new target to prevent depression? Almudena Sanchez-Villegas, Miguel A Martínez-González BMC Medicine 2013, 11:3 (3 January 2013) Abstract \| Full text \| PDF \| PubMed \| Editor’s summary Depression is linked to inflammation and high lipid profiles, so recent cohort studies have focused on the effects of diet; Sanchez-Villegas and Martinez-Gonzalez discuss how diet may prevent depression, and recommend that observational studies and clinical trials can confirm the association.
		Opinion Moving towards a population health approach to the primary prevention of common mental disorders Felice N Jacka, Arnstein Mykletun, Michael Berk BMC Medicine 2012, 10:149 (27 November 2012) Abstract \| Full text \| PDF \| PubMed \| Cited on BioMed Central \| Editor’s summary Felice Jacka et al. discuss new evidence from studies on diet quality and common mental disorders, and argue that depression and anxiety be ranked amongst prevalent medical conditions influenced by lifestyle, to help develop prevention strategies.