Bmj Usa: Editorial

Psychiatric diagnosis, drug development, and ethics

BMJ 2003; 327 doi: https://doi.org/10.1136/bmjusa.03090002 (Published 19 November 2003) Cite this as: BMJ 2003;327:E249
  1. Harold Alan Pincus, professor and executive vice chairman (pincusha@msx.upmc.edu)
  1. Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, senior scientist and director, RAND—University of Pittsburgh Health Institute, Pittsburgh, PA.

    Accurate assessment and proper prescription

    From BMJ USA 2003;September:468

    Shorter and Tyrer in their Education and Debate article “Separation of anxiety and depressive disorders: blind alley in psychopharmacology and classification of disease” (BMJ USA p 511) correctly point out that psychiatric diagnosis is stuck in a rut. Unfortunately, their analysis is flawed and their prescription is too narrow. They conflate three separate (though somewhat related) issues, each with its own pathophysiology, diagnosis and treatment: 1) drug development incentives and disincentives, 2) the influence of the pharmaceutical industry on clinical practice and research, and 3) fundamental tensions in psychiatric classification.

    The data regarding the relationship between new drug development and the number of Diagnostic and Statistical Manual of Mental Disorders (DSM) categories and assumptions regarding the “slowdown in drug discovery” are …

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