Leaders of the American Psychiatric Association (APA) heading up the development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) say the manual is important not only to psychiatry but all medical specialties.

David Kupfer, MD, and Darrel Regier, MD, MPH, chair and vice chair, respectively, of the DSM-5 task force, say one of the primary goals of developing the new manual is to make it more useful in all clinical practice, including primary care.

“Although psychiatrists and other mental health care professionals have a high level of interest in this forthcoming edition, other health care professionals should also be interested in the development of DSM-5. For instance in primary care settings, approximately 30% to 50% of patients have prominent mental health symptoms or identifiable mental health disorders, which have significant adverse consequences if left untreated,” they write in an editorial in a special theme issue on mental health published May 19 in the Journal of the American Medical Association.

“Even in surgical specialties, many presurgical and postsurgical developments are associated with significant mental health issues,” they add.

Scheduled for publication in May 2013, the first draft of the new edition, which represents a decade of work by the APA in reviewing and revising the DSM, has now been through the first round of public review and outside commentary.

From here members of the task force’s 13 work groups, which represent different categories of psychiatric diagnoses, will continue to refine the manual based on public feedback and ultimately various rounds of field trials in clinical and academic settings.

One of the goals of the JAMA commentary, say the authors, is to highlight for physicians several major goals of the DSM-5 process, including facilitating further integration of psychiatry into mainstream medical practice, looking at the challenges of diagnosing mental disorders in general medical settings, and “emphasizing the importance of attending to patients with mental disorders regardless of the clinician’s medical specialty.”

According to the authors, as the DSM-5 moves into the next stages of revision and development, there are several key issues that need to be addressed:

* Determining how clinical assessments of mental disorders can be improved to reflect the realities of the patients seen by clinicians on a daily basis;
* Determining how to better address the interface between psychiatry and general medicine, including co-occurring psychiatric and general medical symptoms;
* Determining whether clinicians can move away from relying on signs and symptoms to classify mental disorders and whether new research developments in underlying pathophysiology and treatment response can better inform diagnostic categories;
* Determining whether DSM-5 can be made more flexible to incorporate future advances in neuroscience and behavioral science in a timely way; and
* Determining whether DSM-5 can be aligned with the international community, including primary care physicians worldwide.

Before being appointed as chair of the DSM-5 Task Force, Dr. Kupfer reports having served on advisory boards for Eli Lilly & Co, Forest Pharmaceuticals Inc, Pfizer Inc, Solvay/Wyeth Pharmaceuticals, and Johnson & Johnson and consulting for Servier and Lundbeck. Dr. Regier, executive director of the American Psychiatric Institute for Research and Education, oversees all federal and industry-sponsored research and research training grants in the American Psychiatric Institute for Research and Education but reports receipt of no external salary, funding, or honoraria from any government or industry sources.

JAMA. 2010;303:1974-1975.