Bup Feeds

Effects of spinally administered bifunctional NOP/MOP ligands in mouse models of neuropathic and inflammatory pain.

J Pharmacol Exp Ther. 2013 May 7;

Authors: Sukhtankar DD, Zaveri NT, Husbands SM, Ko MC

Abstract
Nociceptin/Orphanin FQ peptide receptor (NOP) agonists produce antinociceptive effects in animal models following spinal administration and potentiate mu-opioid receptor (MOP)-mediated antinociception. The aim of this study was to determine the antinociceptive effects of spinally administered bifunctional NOP/MOP ligands and the antinociceptive functions of spinal NOP and MOP receptors in mice. Antinociceptive effects of bifunctional NOP/MOP ligands BU08028 and SR16435 were pharmacologically compared with the putative bifunctional ligand buprenorphine, selective NOP agonist SCH221510 and selective MOP agonist morphine in neuropathic and inflammatory pain models. Additionally, the degree of tolerance development to the antiallodynic effects of SR16435 and buprenorphine were determined following repeated intrathecal administration. Our data indicated that BU08028 and SR16435 were more potent than morphine and SCH221510 in attenuating nerve injury-induced tactile allodynia and inflammation-induced thermal hyperalgesia. Co-administration of receptor-selective antagonists further revealed that both NOP and MOP in the spinal cord mediated the antiallodynic effects of BU08028 and SR16435, but intrathecal buprenorphine-induced antiallodynic effects were primarily mediated by MOP. Repeated intrathecal administration of SR16435 resulted in reduced and slower development of tolerance to its antiallodynic effects compared to buprenorphine. In conclusion, both NOP and MOP receptors in the spinal cord independently drive antinociception in mice. Spinally administered bifunctional NOP/MOP ligands not only can effectively attenuate neuropathic and inflammatory pain, but also have higher antinociceptive potency with reduced tolerance development to analgesia. Such ligands therefore display a promising profile as spinal analgesics.

PMID: 23652222 [PubMed - as supplied by publisher]

Thanks to you, we are gaining momentum to put a stop to Urban Outfitters selling products made to look like prescription pill bottles!

U.S. Congressman Hal Rogers (KY) has sent a letter directly to Richard A. Hayne, CEO and Chairman of Urban Outfitters, encouraging him to “remove these items from the shelves immediately so as not to contribute to this epidemic.”

Along with Rogers, Kentucky Attorney General Jack Conway, who co-chairs the Substance Abuse Committee of the National Association of Attorneys General, has joined the effort.

In just the past few days, various media outlets have brought this to the public’s attention, including ABC News, Associated Press, The Huffington Post, News 4 WOAI, UPI and more!

We’re not done, because we still haven’t received a response from Urban Outfitters.

Please take the time to tweet your plea. Here are some sample tweets: 

Join me in stopping @UrbanOutfitters from selling products that promote teen Rx drug abuse. http://ow.ly/kQbJm #endmedicineabuse

Help stop @UrbanOutfitters from selling products that promote teen Rx abuse. http://ow.ly/kQbJm #endmedicineabuse

If you can’t tweet, we encourage you to invite your family, friends and colleagues to sign and share the Facebook Causes Petition today.

Older teens and young adults with mental health issues who participate in community-based treatment programs report lower levels of substance use disorders, a new government report finds.

The Substance Abuse and Mental Health Services Administration (SAMHSA) says young adults ages 18 to 25 who take part in community-based treatment programs supported by the agency achieve positive outcomes in behavioral and emotional health, employment, school enrollment, daily life skills and reduced homelessness.

SAMHSA notes 20 percent of young adults in the United States had a mental health condition last year, according to Medical News Today. More than 1.3 million had a disorder that interfered with their ability to function in daily life.

Among participants in SAMHSA’s adolescent substance abuse treatment programs, over an eight-month period, there was an 80 percent increase in the number of young adults who were living in the community, a 34 percent decrease in the number who reported experiencing mental health concerns, such as depression and anxiety, and a 10 percent increase in the number who were enrolled in school or working.

The report found among young adults who took part in SAMHSA-sponsored programs, 28 percent showed notable improvement in behavioral and emotional health within six months, and 38 percent showed considerable improvement within a year.

In SAMHSA’s Pregnant and Postpartum Women program, 86 percent of young adults reported no substance use after six months of treatment, compared with 40 percent of those entering the program, and 29 percent reported being employed or in school, compared with 13 percent of those entering the program.

“These data show that treatment is effective. Young people who experience mental or substance use disorders can recover and lead healthy, productive lives with improvements in employment opportunities, housing, education and emotional well-being,” SAMHSA Administrator Pamela S. Hyde said in a news release.

The American College of Chest Physicians this week recommended that older, heavy smokers receive annual low-dose CT scans to detect lung cancer, according to Reuters.

The recommendation is aimed at current smokers ages 55 to 74 with more than 30 “pack-years” of smoking, or former heavy smokers who quit within the last 15 years. A pack-year is defined as smoking 20 cigarettes daily for one year. An estimated 7 million Americans fall into these categories, chest physician David Midthun of the Mayo Clinic told Reuters.

In 2011, a study of 53,000 current or former heavy smokers concluded that CT scans reduce deaths from lung cancer in this group by 20 percent, compared with no screening or with X-rays. CT scans can find smaller, earlier lesions that are more likely to be cured by surgery than those found with X-rays.

Other medical groups have issued differing recommendations on CT scanning for smokers. In 2012, the National Comprehensive Cancer Network advised that people 50 and older who had at least 20 pack-years of smoking, plus one additional risk factor, such as having chronic obstructive pulmonary disease, also be screened.

Dr. Frank Detterbeck, Chief of Thoracic Surgery at Yale University School of Medicine, cautioned that entrepreneurs may offer free CT screening, which can produce findings that lead to more costly tests and procedures, but ultimately do not detect cancer. “You find a lot of things and most of them are nothing,” he said. These tests will cause worry, more tests and invasive biopsies, which are often conducted using a long needle inserted through the chest wall.

Legislators in Colorado on Wednesday passed the first laws regulating the state’s recreational marijuana market, which will take effect in January 2014. Governor John Hickenlooper is expected to sign them by early June, The Wall Street Journal reports.

Washington state, which also approved the recreational use of marijuana for adults 21 and older, is still drafting regulations.

Many questions remain, including how local governments will implement the laws, and how the federal government will respond, since marijuana remains illegal under federal law.

Under the new regulations, marijuana buyers would pay a 10 percent state sales tax and a 15 percent excise tax, plus local sales tax. The revenues raised would be used to build public schools and to enforce the marijuana law. Voters must approve the tax rate in November.

Some marijuana entrepreneurs say that high tax rates could benefit illegal marijuana producers, because buyers would turn to the black market. A task force that included health officials and representatives of the state’s marijuana industry had recommended Colorado set taxes high enough to pay for administering the new law, but not high enough to drive customers to the black market.

The new regulations preserve the current model used for medical marijuana, which requires retailers to grow 70 percent of what they sell, until October 2014. The model is designed to avoid diversion to the black market. After that date, marijuana companies will be able to become either producers or sellers.

Colorado legislators also passed a bill this week that sets limits on levels of THC, the active ingredient in marijuana, for drivers. The new law mandates that drivers found with a THC level of five nanograms or more per milliliter of blood will be considered to be under the influence.

[Emergent drugs (II): the Pharming phenomenon.]

An Sist Sanit Navar. 2013 enero-abril;36(1):99-114

Authors: Burillo-Putze G, Aldea-Perona A, Rodríguez-Jiménez C, García-Sáiz M, Climent B, Dueñas A, Munné P, Nogué S, Hoffman R

Abstract
The use of medicines, with or without medical prescription, for recreational ends by the young population has received little attention from doctors. In the USA, one in five adolescents has used medicines for recreational purposes, and consultations in Emergency Departments for medicine abuse have exceeded those for illegal drugs. Although few data are available in Spain, such consumption is situated between 3.1 and 8.6% according to surveys. The medicines most used are dextromethorphan and methylphenidate. The former, on sale without prescription, presents a varied symptomatology, dosage and dependent metabolic action, ranging from euphoria to hallucinations. Methylphenidate, taken orally, nasally or intravenously, is used as a stimulant in substitution for cocaine and is one of the medicines most diverted onto the illicit market at the world level. In principle, other substances like modafinil and propofol present a limited incidence of non-medical use, but they have a probable abuse potential that should be borne in mind, above all in the health context. Finally, opiates like fentanyl, oxycodone and buprenorphine, with new pharmaceutical presentations, have recently become generalized in the therapeutic arsenal of many medical specialities; they are giving rise to phenomena of abuse, dependence and diversion towards the illicit market. Demands for detoxification treatment, their mixture with illegal substances, and cases of death should alert us to the abuse of these medicines.

PMID: 23648497 [PubMed - as supplied by publisher]

Buprenorphine.

J Pain Symptom Manage. 2013 May;45(5):939-49

Authors: Foster B, Twycross R, Mihalyo M, Wilcock A

Abstract
Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

PMID: 23648060 [PubMed - in process]

Acute Pain Control Challenges with Buprenorphine/Naloxone Therapy in a Patient with Compartment Syndrome Secondary to McArdle's Disease: A Case Report and Review.

Pain Med. 2013 May 3;

Authors: McCormick Z, Chu SK, Chang-Chien GC, Joseph P

Abstract
OBJECTIVE: We report the first case of non-iatrogentic exertional rhabdomyolysis leading to acute compartment syndrome in a patient with McArdle's disease. We describe considerations of concurrent buprenorphine/naloxone therapy during episodes of severe acute pain. DESIGN: Case report. CASE PRESENTATION: A 50-year-old male with a history of McArdle's disease, taking buprenorphine/naloxone for chronic pain and opioid dependence, presented to the Emergency Department with severe bilateral anterior thigh pain. Over the following 8 hours, he was given a total of 12 mg of intravenous hydromorphone with minimal pain relief. The decision was made to initiate patient-controlled analgesia (PCA) with hydromorphone started at 0.5 mg as needed with a 15-minute lockout. Subsequently, the patient's anterior thighs were found to be extremely tense. His creatine kinase level rose to 198,688 units/L and compartment pressures were greater than 90 mm Hg bilaterally. The patient was taken for emergent bilateral fasciotomies. The hydromorphone PCA was increased to 0.8 mg as needed with a 15-minute lockout and a basal rate of 0.5 mg/h. The patient's reported pain plateaued at 3/10 intensity 2 days after surgery, and he was transitioned to oxycodone and hydrocodone/acetaminophen. He followed up with his pain management physician 2 months later who restarted suboxone and a buphrenorphine transdermal patch. DISCUSSION: Buprenorphine/naloxone is being prescribed off-label with increasing frequency for pain management in patients with or without a history of opioid abuse. Severe acute pain is more difficult to control with opioid analgesics in patients taking buprenorphine/naloxone, requiring higher than usual doses. If buprenorphine/naloxone is discontinued to better treat acute pain with other opioids, monitoring for overdose must take place for at least 72 hours.

PMID: 23647815 [PubMed - as supplied by publisher]

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We recently learned that pint glasses, flasks and shot glasses made to look like prescription pill bottles are available for sale in Urban Outfitters (UO) retail locations and on urbanoutfitters.com.

At a time when Rx overdoses are killing our high school and college-age kids, these products make light of prescription drug abuse.

We sent a letter to Richard A. Hayne, CEO and Chairman of Urban Outfitters, asking him to stop selling these irresponsible products. Unfortunately, we still haven’t heard back from any representative from UO, so please help us keep the pressure on to remove these products from their stores and website immediately.

Please sign and share this Facebook Cause petition today!

The Chairman of the House Appropriations Committee, Hal Rogers, on Monday called on Urban Outfitters to stop selling products designed to look like prescription pill bottles, the Associated Press reports.

In a letter to company President and CEO Richard Hayne, Rogers wrote, “For a company with sales of $2.79 billion in 2012 to trivialize the pain and suffering of those struggling with addiction is tasteless at best, but irresponsible at worst.” He said he is concerned sales of the flasks, shot glasses and pint glasses could lead to an increase in overdose deaths from prescription drugs.

“While I understand that your company’s business model is predicated on the sale of controversial products, I believe marketing products to young people with an explicit allusion to the misuse of prescription medicines is simply a bridge too far,” wrote Rogers, co-founder of the Congressional Caucus on Prescription Drug Abuse.

Urban Outfitters did not respond to a phone call and email seeking comment, the AP noted.

Last week, The Partnership at Drugfree.org urged people to write or email Hayne, or sign a Facebook petition calling on Urban Outfitters to remove the products from its stores and website. “Combined with alcohol, the misuse and abuse of prescription medications can be especially dangerous, making the Urban Outfitter Rx pint and shot glasses and flasks even more disturbing,” the organization noted. “Tongue-in-cheek products that normalize and promote prescription drug abuse only serve to reinforce the misperception about the dangers associated with abusing medicine and put more teens at risk.”

Synthetic marijuana use during pregnancy can lead to symptoms similar to those caused by dangerous conditions known as preeclampsia and eclampsia, California doctors report. Preeclampsia is marked by high blood pressure and a high level of protein in the urine. It can lead to eclampsia, which can cause a pregnant woman to develop seizures or coma, and in rare cases is fatal.

At the American College of Obstetricians and Gynecologists annual meeting, the doctors this week described the case of a woman who said she was about 35 weeks pregnant, who suffered a seizure and appeared agitated. She had high blood pressure and protein in her urine, so the doctors treated her for eclampsia, HealthDay reports. They performed an emergency cesarean section because the baby was in distress.

The woman screened negative for drugs, but an anonymous caller reported the woman regularly smoked Spice Gold, a type of synthetic marijuana. Spice Gold cannot be detected with a standard urine test.

The baby tested negative for drugs. The woman required psychiatric care for psychotic behavior the day after delivery. “This was not a pregnancy problem but a drug problem,” Dr. Cindy Lee said in a news release. “Eclampsia is cured with delivery of the baby, but she did not get better after delivery.”

The doctors noted obstetricians and gynecologists should be aware of emerging drugs, and consider the possibility patients may be taking them when making a diagnosis.

Patient safety experts are urging hospitals to require physicians to have random drug and alcohol tests. The tests should also be conducted if a patient dies suddenly or is injured unexpectedly during surgery, they write in the Journal of the American Medical Association.

In a commentary published in the journal, the experts say that if a doctor is found to be impaired, the hospital could suspend or revoke their medical license, according to The Baltimore Sun. The incident in some cases could be reported to the state licensing board, wrote Dr. Julius Cuong Pham, an emergency medicine physician at The Johns Hopkins Hospital in Baltimore, Dr. Peter J. Pronovost, Director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality, and Dr. Gregory E. Skipper of the drug and alcohol treatment center Promises, in Santa Monica, California.

They recommend impaired physicians undergo treatment and routine monitoring, as a condition for continued licensure and hospital privileges.

“Patients might be better protected from preventable harm. Physicians and employers may experience reduced absenteeism, unintentional adverse events, injuries, and turnover, and early identification of a debilitating problem,” the doctors added. They note that physicians are as susceptible to alcohol, narcotic and sedative addiction as the general public.

“Patients and their family members have a right to be protected from impaired physicians,” they conclude. “In other high-risk industries, this right is supported by regulations and surveillance. Shouldn’t medicine be the same? A robust system to identify impaired physicians may enhance the professionalism that peer review seeks to protect.”

Nine “recovery courts” will be created in Tennessee to combat substance abuse and mental health issues, state officials announced this week. They will combine services currently found in drug courts, mental health courts and veterans courts.

The Tennessee Department of Mental Health and Substance abuse Services said the new courts will serve juvenile and adult addicted nonviolent offenders, whose participation will be voluntary, according to the Associated Press.

“We are facing a major prescription drug problem in our state,” Department Commissioner Douglas Varney said in a news release. “We need to focus all of our resources in the most efficient, effective and collaborative way to maximize our impact on this issue and drug abuse overall. And because so many people who are dealing with a substance abuse issue also have a mental health issue … these recovery courts will be able to help them get all the help that they need at one time and in one location.”

The new courts will incorporate intensive judicial supervision, treatment services, sanctions and incentives, the article notes. State officials said that while these courts often exist separately in other states, Tennessee will integrate them “in an effort to combine similar issues of mental health, substance abuse, and veterans affairs in one location and to best utilize the available funds.”

Severe DRESS syndrome managed with therapeutic plasma exchange.

Pediatrics. 2013 Mar;131(3):e945-9

Authors: Alexander T, Iglesia E, Park Y, Duncan D, Peden D, Sheikh S, Ferris M

Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but increasingly described phenomenon of immune activation and organ dysfunction in association with a wide variety of medications. This reaction shows a broad spectrum of clinical presentation and severity, ranging from mild to lethal. Treatment strategies of immune suppression appear be helpful in some cases, but treatment failures occur frequently with reported mortality rates of 5% to 10%. We present a pediatric case of DRESS syndrome associated with either lamotrigine or bupropion, leading to multiorgan involvement and life-threatening complications of respiratory failure and cardiac arrest. After failing to improve with removal of these medications and administration of systemic corticosteroids, our patient showed dramatic, sustained clinical response to therapeutic plasma exchange. To our knowledge, this is the first reported case of therapeutic plasma exchange used for life-threatening DRESS syndrome in a pediatric patient. This case suggests needed research for this therapeutic option in life-threatening DRESS syndrome resistant to high-dose steroids.

PMID: 23420918 [PubMed - indexed for MEDLINE]

This year’s Partnership Attitude Tracking Study (PATS) results, which confirmed that one in four teens has misused or abused a prescription (Rx) drug at least once in their lifetime, received extensive media attention, with numerous national and local media outlets reporting on the findings. Please take a look at just a few highlights below:

Read the story from the Associated Press

Read the HealthDay story, and view a resulting television piece

Read the story from United Press International (UPI)

Listen to Steve Pasierb’s Associated Press Network Radio interview and NPR radio interview

Read the story on WebMD, About.com, The Washington Post and Reuters

The Neurological Center for Pain’s Chronic Pain Rehabilitation Program (CPRP) at the Cleveland Clinic has created a Chemical Education Track designed specifically for patients with chronic non-cancer pain who also have a therapeutic opioid addiction. Initial results are promising. Patients who complete the program report low opioid resumption rates 12 months after they complete the program. They also report sustained improvements in pain severity, mood and pain-related functional impairment.

The Chemical Education Track began in 2009 and was designed to help the growing number of patients with both chronic pain and addiction, explains Sara Davin, Psy.D, MPH, of the Cleveland Clinic’s Neurological Center for Pain (NCP). While it is not a chemical dependency treatment program, patients are educated about addiction and how it has affected their lives and their pain, said Dr. Davin, who spoke about the program with the NCP’s Director, Edward Covington, MD, at the recent American Academy of Pain Medicine meeting.

The CPRP’s intensive day-treatment program lasts three to four weeks, from 7:30 a.m. to 5 p.m. All patients treated in the program, including those in the chemical education track, are offered a variety of services, including medication management, physical and occupational therapy, psychodynamic group therapy, individual psychotherapy, biofeedback training and group and individual cognitive behavioral therapy, including relaxation training. The program also emphasizes weekly participation in family education and family therapy.

“Often people with chronic non-cancer pain have gone through a lot of treatments— and for our patients, pain takes hold of their lives to the point that it is disabling,” Dr. Davin says. “They often are not working, they may have depression and anxiety related to their pain, or maybe it was there before, and got worse as time went on. We don’t offer a cure, but we offer coping strategies and tools to help folks get their lives back.”

All patients in the program, whether or not they have a therapeutic opioid addiction, are tapered off opioids and other habituating medications. “Other, adjunctive medications are used that carry less risk of addiction and have been shown to be more effective in treating chronic non-malignant pain,” she notes.

Each patient coming into the pain treatment program undergoes an extensive evaluation that includes questions about substance use. “If someone is struggling with an active recreational addiction, we ask them to get chemical dependency treatment before they come into the program,” Dr. Davin explains.

Throughout the program, patients are monitored and assessed for possible misuse of opioids and other prescribed medications, through urine toxicology, information from family and through continued meetings with the program staff.

The chemical education track includes daily classes that cover topics such as the myths of addiction, the signs and symptoms of addiction in people with chronic pain who are using prescription medication, and the pros and cons of using opioid medications to treat chronic pain. “We encourage self-help program involvement when appropriate, and we talk about relapse prevention,” Dr. Davin states. “If a patient leaves our program and develops an acute pain incident that requires treatment with opioids, we talk about how they can do that safely without developing a full-blown relapse.”

Drs. Huffman and Sweis of the Neurological Center for Pain have been tracking the outcomes of patients with co-occurring chronic pain and therapeutic opioid addiction who have been treated for pain in the CPRP. Preliminary results indicate these patients do just as well as those without an addiction. Patients with substance use disorders, who were dropping out of the program at higher rates than other patients, are now staying in the program at the same rate, notes Kelly L. Huffman, PhD., M.S. “We found both groups, whether they are in the chemical education track or not, improved on measures of pain, mood and function,” explains Giries W. Sweis, Psy.D., MHS.

Drs. Sweis and Huffman followed 120 patients for a year after they left the program. Only 22.5 percent reported resuming opioid use after one year. Patients who were addicted to opioids were no more likely to resume use than patients without an addiction. They note this is very significant, as abstinence-based chemical dependency programs treating those with non-medical opioid addictions have found relapse rates as high as 91 percent. Only patients who were depressed, whether or not they had a history of substance abuse, were more likely to have resumed opioid use a year after the program. They also noted while co-occuring therapeutic opioid addiction did not increase the odds of resumption, levels of depression at the time of program completion did.

“Overall, our data suggests that our multi-disciplinary CPRP benefits those seeking relief from these intractable conditions. It is especially encouraging to see such a strong and long-lasting improvement in these patients, and based on these findings patients’ mood is more on my radar,” says Dr. Sweis.

Scientists have blocked heroin addiction relapse in rats using a vaccine, according to U.S. News & World Report. They hope the vaccine will be ready for human testing later this year.

The vaccine allows the immune system to neutralize the effects of heroin and its byproducts, before the drug can reach the brain and cause a “high,” scientists from The Scripps Research Institute in California found. They say the vaccine might prevent a person addicted to heroin from overdosing on the drug.

Rats in the study were allowed unlimited access to heroin for several weeks, and then studied for four weeks while they received no heroin. Half of the rats were then given the vaccine, and all of the animals were reintroduced to heroin. “The rats who were not vaccinated relapsed quickly, the vaccinated rats stopped taking it,” said researcher George F. Koob. “In effect, what the vaccine does is prevent heroin from reaching the brain.”

The findings appear in the Proceedings of the National Academy of Sciences.

Last year, a researcher at the Walter Reed Army Institute of Research was awarded a grant from the National Institute on Drug Abuse to develop a vaccine that would treat heroin addiction and protect against HIV.

Former President Bill Clinton this week pledged his foundation will work with the New York Police Department (NYPD) and other partners to address prescription drug abuse, with a focus on college students.

The Clinton Foundation hopes within five years to cut in half the number of young adults ages 18 to 26 who misuse prescription drugs for the first time, the New York Daily News reports. The foundation will recruit colleges to join a Prescription Safe Campus Initiative to implement best practices designed to reduce prescription drug abuse. “This is insane to have the brightest of our young people dropping out under conditions of which their addiction has not been treated or their abuse is out of ignorance,” Clinton said on Monday.

The program will include prevention education programming, student-led awareness campaigns, and increased substance abuse and mental health services on campuses that participate, according to a foundation news release.

NYPD Commissioner Ray Kelly announced the department will work with colleges and universities in New York City to increase awareness about prescription drug abuse during freshman orientation.

The soon-to-be-released update of the manual used to diagnose mental illness lacks scientific validity, says the director of the National Institute of Mental Health (NIMH). The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not reflect the complexity of many disorders, according to Dr. Thomas R. Insel.

The updated version of the DSM, known as DSM-5, is scheduled to be released later this month. Dr. Insel told The New York Times the manual’s way of categorizing mental illnesses should not be used to guide research.

“As long as the research community takes the DSM to be a bible, we’ll never make progress,” Dr. Insel said. “People think that everything has to match DSM criteria, but you know what? Biology never read that book.”

He said the field of psychiatry needs a new paradigm for understanding mental illness. He noted there is a vast amount that scientists still do not know regarding the causes of these disorders.

In a recent NIMH blog post, Dr. Insel wrote DSM diagnoses are based on a consensus about clusters of clinical symptoms, instead of an objective laboratory measure. “In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”

NIMH has launched the Research Domain Criteria project, which aims to incorporate genetics, imaging, cognitive science and other information to lay the foundation for a new classification system for mental health. He announced NIMH will be re-orienting its research away from DSM categories.

Other critics of DSM-5 have said it will expand the list of what constitutes mental illness and will lead to a needless increase in diagnoses.