Psychiatric diagnosis, drug development, and ethics

doi:10.1136/bmjusa.03090002

BMJ, doi: 10.1136/bmjusa.03090002, (Published 30 September 2003)

Editorial

Psychiatric diagnosis, drug development, and ethics

Accurate assessment and proper prescription

The first 150 words of the full text of this article appear below.

From BMJ USA 2003;September:468

Shorter and Tyrer in their Education and Debate article "Separationof anxiety and depressive disorders: blind alley in psychopharmacologyand classification of disease" (BMJ USA p 511) correctly pointout 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 influenceof the pharmaceutical industry on clinical practice and research,and 3) fundamental tensions in psychiatric classification.

The data regarding the relationship between new drug developmentand the number of Diagnostic and Statistical Manual of Mental Disorders (DSM) categories and assumptions regarding the "slowdown in drug discovery" are questionable at best. Overthe past two decades, pharmaceutical company investment incentral nervous system research has skyrocketed and the PharmaceuticalResearch and Manufacturers . . . [Full text of this article]

Harold Alan Pincus, professor and executive vice chairman

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. pincusha@upmc.edu