Reports here provided what may be the last public update on DSM-5, the next edition of American psychiatry’s diagnostic guide, before it is formally released in May 2013.

Many changes have been made since the first draft of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was put out for public comment in early 2010, according to workgroup leaders speaking at several heavily attended symposia at the American Psychiatric Association’s (APA) annual meeting.

The current version, DSM-IV, was released in 1994.

The update effort has been led by DSM-5 task force chairman David Kupfer, MD, of the University of Pittsburgh, and APA research director Darrel Regier, MD, MPH.

The actual work of rewriting the manual fell to 13 workgroups, which tackled disorders in 20 categories. The final drafts are to be completed by August, then they must be approved by a scientific review committee and the task force leadership, and finally by the APA’s governing bodies.

Kupfer said the final version has to be completed by December, when it’s set to go to the printer. Its formal release is planned for the APA’s annual meeting next May in San Francisco.

Here’s a brief overview of the changes you can expect.

WHAT’S OUT

Kupfer and Regier gave the workgroups marching orders at the outset. These included:

-  Eliminate “not otherwise specified” (NOS) diagnoses within categories
-  Remove functional impairments as necessary components of the diagnostic criteria
-  Use scientific evidence to justify classifications and criteria

To a great but not complete extent, the DSM-5 workgroups complied with those instructions. Every one of the dozens of disorder categories has been reorganized and/or rewritten to bring them into line with research conducted over the past 20 years. Often, the groups found no basis for classifications and diagnoses contained in DSM-IV. Here are highlights of what is set to be dumped in DSM-5:

Axes. DSM-IV’s main organizational scheme was to divide disorders, contributing factors, and global functional assessments into 5 axes - notably with Axis I containing clinical, substance-related, and learning disorders and Axis II comprising personality and certain other disability-based disorders.

The DSM-5 leadership determined early on that there was no scientific basis for this distinction, and so disorders in the new edition will be presented as a simple list of 20 chapters for disorder families.

NOS diagnoses. Most disorder families in DSM-IV included an NOS diagnosis that served as a catchall for patients who appeared to have some kind of disorder but who didn’t fit into the established categories.

In practice, however, some of these became extremely popular. The head of the eating disorders workgroup, for example, cited data indicating that more than half of all patients diagnosed with an eating disorder were coded for “ED-NOS.” Also, some disorders that were now well recognized and characterized were included in NOS categories, such as restless legs disorder.

In DSM-5, NOS categories are either gone entirely or replaced with NEC for “not elsewhere classified.” NEC categories will include a list of “specifiers,” each with a specific diagnostic code, that will convey clinical information. For example, Depressive Disorder NEC comes with 5 specifiers such as “short duration” that indicate the patient’s clinical condition and why it doesn’t meet criteria for one of the main depression syndromes.

Bereavement exclusion in major depression. One of the most controversial proposals in DSM-5 does away with the restriction that diagnosis of major depression cannot be given to patients reporting severe grief from the death of a loved one if the death occurred within the preceding two months.

As MedPage Today previously reported, the depression workgroup believes that there is no scientific justification to disqualify patients from diagnosis and treatment if they otherwise meet criteria for major depression.

But in a bow to critics, they have proposed to include a caveat in the checklist criteria for major depression noting that certain symptoms appear in normal grief but that others may warrant attention - as did DSM-IV though in a different way.