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Can neuroscience be integrated into the DSM-V?

Nature Reviews Neuroscience volume 8, pages 725–732 (2007)Cite this article

Abstract

To date, the diagnosis of mental disorders has been based on clinical observation, specifically: the identification of symptoms that tend to cluster together, the timing of the symptoms' appearance, and their tendency to resolve, recur or become chronic. The Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Disease, the manuals that specify these diagnoses and the criteria for making them, are currently undergoing revision. It is thus timely to ask whether neuroscience has progressed to the point that the next editions of these manuals can usefully incorporate information about brain structure and function.

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Acknowledgements

I gratefully acknowledge the probing discussions of my colleagues, whose ideas on this Opinion have tested and shaped my own thoughts over the past year. I would like to assert that this work represents my personal viewpoint, not an official position of the DSM-V Task Force, of which I am a member, or of the International Advisory Group to the World Health Organization for the Revision of ICD-10, Chapter V (Mental and Behavioral Disorders), of which I am the Chair.

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  1. Steven E. Hyman is Provost at Harvard University, Massachusetts Hall, Cambridge, Massachusetts 02138, USA. seh@harvard.edu,

    Steven E. Hyman

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Steven E. Hyman has consulted for GlaxoSmithKline during the past year and is a member of the Novartis Scientific Advisory Board.

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DATABASES

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attention deficit hyperactivity disorder

autism

bipolar disorder

obsessive–compulsive disorder

Parkinson's disease

schizophrenia

Tourette's disorder

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Glossary

Anhedonia

An inability to experience pleasure.

Candidate gene

A gene implicated as one that confers an increased phenotypic risk, and which is thus deserving of further investigation (for example, in an association study). Candidate genes can be identified based on biological hypotheses, or as a result of their lying within a region of interest identified by a linkage study or a chromosomal break point (a so-called 'positional candidate').

Categorical diagnosis

A disease state that is qualitatively separable from the state of being 'well', for example, tuberculosis or leukaemia.

Diagnostic classification

A listing of diagnoses clustered by relatedness, for example, cancers, metabolic diseases, infectious diseases and unintentional injuries. The ICD was first developed to allow statistical reporting across countries, initially of mortality and later of morbidity.

Diagnostic criteria

The rules for making diagnoses. The DSM-IV and the ICD-10 (Chapter V) provide both classifications and diagnostic criteria.

Dimensional diagnosis

A diagnosis based on states that are defined as above-threshold on one or more quantitative scales or dimensions and that are continuous with the normal state. For example, hypertension is defined in terms of two dimensions: systolic and diastolic blood pressure.

Disorder

A term generally used instead of the term 'disease' for medical conditions in which the causative factors or pathophysiology remain unknown.

Nosology

The classification of diseases.

Reliability

A diagnosis is reliable if the same conclusion is reached by two diagnosticians who examine the patient at approximately the same time (inter-rater reliability), or if a patient receives the same diagnosis if examined more than once within reasonably close time intervals (test-retest reliability).

Single nucleotide polymorphism

(SNP). The most common form of variation in human DNA sequences. It occurs when a single nucleotide (for example, thymine) replaces one of the other three nucleotides (for example, cytosine).

Spectrum disorders

A group of disorders that are thought to be related through the sharing of risk genes or pathophysiological mechanisms.

Syndrome

A cluster of symptoms that can result from different disease processes. For example, cough and fever can result from bacterial, viral or fungal infections, or from autoimmunity, with very different treatments and outcomes.

Valid diagnosis

A diagnosis that picks out a real entity based on aetiology or pathophysiology.

Validity

The extent to which a variable measures what it is intended to measure.

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Hyman, S. Can neuroscience be integrated into the DSM-V?. Nat Rev Neurosci 8, 725–732 (2007). https://doi.org/10.1038/nrn2218

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