The Elephant in the Room Series Two: Status of the CISSD Project unscrambled

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The Elephant in the Room Series Two: Status of the CISSD Project unscrambled

10 June 2009

This posting is intended to unscramble the status and authority of the CISSD Project.

1] The official APA DSM-V Work Group tasked with developing proposals towards the revision of the current DSM-IV section for “Somatoform Disorders” (code categories 300.xx) is the

The DSM-V “Somatic Distress Disorders” Work Group

This is one of 13 DSM-V Work Groups announced by the APA in May 2008. The APA is also using a considerable number of external advisors to the DSM-V Task Force and to individual Work Groups, whose names are not being released.

You might also see this committee referred to by the APA as the Somatic Symptom Disorders (SSD) Work Group or the Somatic Symptoms Workgroup (SSW).

Its members (with bios and Conflict of Interest Disclosures) are listed here on the APA’s website:

http://www.psych.org/MainMenu/Research/DSMIV/DSMV/WorkGroups/SomaticDistress.aspx

The most recent update on the progress of this Work Group is this one:

http://tinyurl.com/DSMSDDWGApril09

The April 2009 Report of the DSM-V Somatic Distress Disorders Work Group

A more expansive report on the progress of this Work Group is here:

http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext

The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report Journal of Psychosomatic Research
Editorial: June 2009: Joel Dimsdale and Francis Creed on behalf of the DSM Workgroup on Somatic Symptom Disorders Journal of Psychosom Research, Volume 66, Issue 6, Pages 473-476 (June 2009)
 
A PDF of this Editorial is also available.

See relevant section under: “Psychological factor affecting general medical condition”

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2] More information on the APA’s DSM-V revision process can be found here:

http://www.psych.org/MainMenu/Research/DSMIV/DSMV.aspx

The American Psychiatric Association (APA) DSM revision process has been underway since 1999. The target date for the final, approved version of DSM-V is May 2012.

Field trials of some of the new diagnostic criteria are expected to begin in October 2009.

The APA participates with the WHO in a DSM-ICD Harmonization Coordination Group.

The task of this group is “to facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria” with the objective that “the WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.”

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3] The WHO is revising the classification of its chapter on Mental and Behavioural Disorders (currently Chapter V) as part of the overall revision of ICD-10, a process that has been underway since April 2007.

Revision of the International Classification of Diseases (ICD):

http://www.who.int/classifications/icd/ICDRevision/en/index.html

The most recent timeline was published in March 2008:

“The Alpha draft version of ICD-11 should be completed in 2010, followed by 1 year for commentary and consultation.
The Beta draft version should be completed in 2011, followed by field trials, analysis of field trial data, and revision during the subsequent 2 years. The final version for public viewing should be completed in 2013, with approval by the World Health Assembly in 2014.”

So the timelines for DSM-V and ICD-11 are not running entirely in parallel.

The classifications for ICD-10 Somatoform Disorders are currently under Chapter V: Mental and Behavioural Disorders (F45-F48 codes) here:

http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gF40.htm+F454

The classifications for ICD-10 Diseases of the nervous system (G00-G99); Other disorders of the nervous system (G90-99) are here:

http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933

For the purpose of revision of WHO ICD-10 Chapter V: Mental and Behavioural Disorders, a number of committees have been established:

International Advisory Group (AG) for the Revision of ICD-10 Mental and Behavioural Disorders

Sub committees:

Global Scientific Partnership Coordination Group
Stakeholder Input and Partnership Coordination Group
Global Health Practice Network (GHPN)
DSM-ICD Harmonization Coordination Group

For the International Advisory Group (AG) for the Revision of ICD-10 Mental and Behavioural Disorders Terms of Reference and members see:

http://www.who.int/classifications/icd/TagMH/en/index.html

The most recent meeting of the Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders was held in Geneva on 1-2 December 2008. The WHO has yet to publish a summary of this meeting. [Ed: Update: Summary Report has since been published on 18 September 2009, see: http://wp.me/p5foE-21S ]

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4] The CISSD Project ran from 2003 to 2007, that is, before the DSM Work Groups were announced.

The full name of the CISSD Project is:

The Conceptual Issues in Somatoform and Similar Disorders Project

The Project was initiated by Dr Richard Sykes, PhD, chaired by Professor Kurt Kroenke (US Chair) and Professor Michael Sharpe (UK Chair). It comprised an organising committee and a workgroup of 28 members with a large number of additional advisors to the Project. It held three workshops in 2005-2006.

Action for M.E. were the principal administrators for the CISSD Project and received one retrospective payment of £1750 in administration fees.

The Principal Collaborator was Rachel Jenkins, Director of the WHO Collaborating Centre, Institute of Psychiatry, London, to which Dr Sykes is affiliated.

From 2003, Dr Sykes was an “Honorary Member” of the WHO Collaborating Centre. He is now attached to the WHO Collaborating Centre as a “Visiting Research Associate” and is currently engaged on the London Medically Unexplained Physical Symptoms and Syndromes Project (MUPSS) for which he receives funding of £27,000 per year.

The CISSD Project received three years funding from the Hugh and Ruby Sykes Charitable Trust and was completed in October 2007.

The paper: Kroenke K: Somatoform disorders and recent diagnostic controversies. Psychiatr Clin North Am 2007 Dec;30(4):593-619. http://www.ncbi.nlm.nih.gov/pubmed/17938036

contains the caveat:

“Although the CISSD is an ad hoc group that includes many international experts on somatoform disorders, it was neither appointed nor sanctioned by the APA or WHO, the organizations authorized to approve revisions of DSM and ICD, respectively. As such, the CISSD recommendations should be considered advisory rather than official. Also, there were some suggestions for which the CISSD achieved near consensus but other issues where opinions diverged considerably.”

Recommendations and proposals resulting out of the work of the CISSD Project have fed into the DSM-V revision process. Proposals have also been submitted to the WHO ICD Update and Revision Platform to the Topic Advisory Group Mental Health (TAGMH) section by Dr Sykes, specifically in respect of F45-F48 codes. No proposals appear to have been submitted by Dr Sykes to any other Topic Advisory Group (TAG) via the ICD Update and Revision Platform.

There are three documents relevant to the work of this unofficial CISSD Project:

a) In July 2007, the CISSD Project leads published the following review paper:

Review: Kroenke K, Sharpe M, Sykes R: Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations. Psychosomatics 2007 Jul-Aug;48(4):277-85.

FREE Text: http://psy.psychiatryonline.org/cgi/content/full/48/4/277

A PDF is also available.

This paper was presented to the APA in 2007 and also presented to the WHO.

In April 2006, eight papers resulting out of the proceedings of the first CISSD Project Workshop (London, 20 May 2005) were published in the Journal of Psychosomatic Research. The Editor of the Journal of Psychosomatic Research is Francis Creed, a CISSD Project Work Group member and now a member of the APA’s DSM-V Somatic Distress Disorders Work Group.

 

b) In December 2007, Dr Richard Sykes presented his “Final Report” to the Project’s principal administrators, Action for M.E.

The CISSD Project and CFS/ME   Report on the CISSD Project for Action for M.E.

Richard Sykes (Report to be read in conjunction with the Co-ordinator’s Final Report) December 2007

Neither of these two documents has been published by Action for M.E.

Unofficial texts of the December 2007 “Final Report” and the “Co-ordinator’s Final Report” to Action for M.E. were placed in the public domain on 8 June.

The text of these documents can be accessed at:

https://meagenda.wordpress.com/2009/06/08/the-redacted-bits-sykes-cissd-report-for-the-mea/ 

and also from http://www.meactionuk.org.uk

When the original versions of the reports held by Action for M.E. and the Institute of Psychiatry have been made available these will be added to ME agenda site.

* Note that within the text of the “Final Report”, ICD code G33.3 appears where one would expect this to have been G93.3 and G33.4 where one would expect G93.4.

 

c) On 3 June 2009, the ME Association published a “Summary Report” of the CISSD Project in association with Dr Richard Sykes.

THE CISSD PROJECT 2003-2007  (Conceptual Issues in Somatoform and Similar Disorders)
SUMMARY REPORT

This document can be read on the ME Association’s website here:

http://www.meassociation.org.uk/content/view/878/161/ 

and on ME agenda site, with brief commentary, here:

https://meagenda.wordpress.com/2009/06/03/cissd-project-report-from-dr-richard-sykes/

Although the material published by the ME Association “Summary Report” on 3 June, on behalf of Dr Richard Sykes, draws on his December 2007 “Final Report” to Action for M.E. it cannot be considered a substitute.

Important content, which includes an entire appendix devoted to discussion of current and potential future ICD codings and classifications has been omitted from the material published on the ME Association’s website (see Appendix B in the “Final Report”).

The text of the redacted Appendix B and full CISSD Project Final Reports to Action for M.E. can be read here:

https://meagenda.wordpress.com/2009/06/08/the-redacted-bits-sykes-cissd-report-for-the-mea/ 

Although the CISSD Project workgroup comprised many very influential and internationally published researchers and clinicians from the field of psychiatry and psychosomatics, five of whom are now directly involved with the DSM revision process as members of the Task Force and “Somatic Symptom Disorders” Work Group, I hope this compilation will serve to clarify:

  • that the work of the CISSD group was not sanctioned or authorised by the APA or the WHO;
  • that recommendations and proposals published in the name of the CISSD Project should be considered proposals only and do not have the authority of the APA or the WHO;
  • that although there were suggestions for which the CISSD workgroup achieved near consensus, there were other issues where opinions diverged considerably.

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DSM-V and ICD-11 Directory page:  https://meagenda.wordpress.com/dsm-v-directory/

Psychiatric Times maintains a page of resources for the current edition of DSM, DSM-IV, with updates, articles and commentary around the development of DSM-V.

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