In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.
BACKGROUND We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys. (1994)(1995)(1996)(1997)(1998)(1999)(2000) of the Health and Retirement Study (HRS)-5,942 women aged 50 to 61 years, and 4 waves (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey-4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998. METHODS This cohort study includes participants from 4 waves RESULTSReceipt of mammography is stable at 70% to 80% among women aged 50 to 64 years, then declines to around 40% among those aged 85 to 90 years. For Pap tests there is a decline from 75% among women aged 50 to 54 years to 25% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt.CONCLUSIONS Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups. INTRODUCTIONH ealth maintenance care for young adults is focused on identification and reduction of long-term health risks, whereas care for elderly patients is generally focused on case finding. Early discovery of treatable, asymptomatic cancers is an important motive for patients and clinicians, but an important question persists: Is it reasonable to screen for common cancers in the elderly?Truls Østbye, MD, MPH, MBA, PhD 1 Gary N. Greenberg, MD 210The exponential age-related increase in incidence of some cancer types argues in favor of increased screening. Furthermore, case fatality rates also increase with age.1 There is also evidence that increasing age is associated with an increasing "sojourn time," which begins when cancer might first be detected by screening and ends when cancer is detected through the appearance of symptoms. Given a certain screening interval, increased sojourn time allows a larger proportion of cancers to be detected in a preclinical stage.Life expectancy obviously decreases with age, however, and the competing risk of dying from other diseases increases rapidly, reducing the number of years that can be saved through screening. There is also a selection problem: the healthiest elderly, with lower risk of disease, are more likely to be screened. For example, in a Dutch breast cancer-screening ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.