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Great for Psychologists, disappointing for Psychiatrists
on December 19, 2002
Of course, this is the bible of mental disorder diagnoses, at least in the U.S. The diagnoses are pretty inclusive, but there are several problems with this book as it pertains to the practice of Psychiatry. First, the book offers about 900 pages on symptom diagnosis, and about half a paragraph on the types of psychiatric medications that are effective for the particular diagnosis. 95% of diagnoses have absolutely no recommendations for treatment.
This leads to the second problem: differentiation of primary vs. secondary symptoms. The primary symptoms are the cornerstone of diagnosis. The secondary symptoms take way too much space in this book, and are generally not helpful in making a diagnosis, because the vast majority of secondary symptoms overlap in most mental illnesses. The important use for secondary symptoms is for the type of therapy that should be used (psychotherapy or pharmacotherapy). For example, if two patients are depressed, the diagnosis is made from primary symptoms (tiredness, irritability, difficulty concentrating, psychomotor retardation). However, if patient "A" has no significant secondary symptoms like anxiety or insomnia, they can take a high dose of SSRI or Effexor. But if patient "B" has the secondary symptoms of prominent anxiety and insomnia, Remeron or Serzone may be more helpful, and perhaps a benzodiazepine can be added.
The DSM IV does nothing to further the practicality of psychiatry. And that's a shame, because only a few hundred extra pages of pharmacotherapy recommendations would make the book so much more helpful to psychiatrists, who currently waste a lot of time experienting with every drug for the treatment-resistant patients. Some drugs work better for some people based on secondary symptoms, which cannot be ignored in the choice of drug treatment. A good book that does match secondary symptoms to drug treatment is The Failures of American Medicine.