Two proposed psychiatric diagnoses failed to make the last round of cuts in the laborious process of revising the Diagnostic and Statistical Manual of Mental Disorders — an exhaustive catalog of symptoms used by doctors to diagnose psychiatric illness.

Gone from the latest revision are “attenuated psychosis syndrome,” intended to help identify individuals at risk of full-blown psychosis, and “mixed anxiety depressive disorder”, a blend of anxiety and depression symptoms. Both performed badly on field tests and in public comments gathered by the group in its march toward the May 2013 publication deadline.

Both have been tucked into Section III of the manual — the place reserved for ideas that do not yet have enough evidence to make the cut as a full-blown diagnosis.

What has survived, despite fierce public outcry, is a change in the diagnosis of autism, which eliminates the milder diagnosis of Asperger syndrome in favor of the umbrella diagnosis of autism spectrum disorder.

But that, too, could still be altered before the final manual is published, the group says. The APA opened the final comment period for its fifth diagnostic manual known as DSM-V on May 2, and it will accumulate comments through June 15.

Dr. David Kupfer, who chairs the DSM-5 Task Force, said in a statement that the changes reflect the latest research and input from the public.

Dr. Wayne Goodman, professor and chairman of the department of psychiatry at Mount Sinai Medical Center in New York, said he’s glad the task force is responding to feedback from professionals and the public.

“I think they are trying to listen,” he said.

Goodman agrees with the decisions to drop both of the two disorders in the latest revision.

With the “mixed anxiety and depressive disorder,” he said there was a risk that it would capture a number of people who did not qualify under a diagnosis of depression or anxiety alone.

“It could lead to overdiagnosis,” Goodman said.

He said the “attenuated psychosis syndrome” diagnosis would have been useful for research purposes to help identify those at risk of psychosis, but there was a concern that it might label people who were just a bit different as mentally ill.

“The predictive value is not clear yet,” he said. “I think it’s reasonable not to codify it until we have better definition of its predictive value.”

Goodman, who worked on DSM-4, the last revision of the manual published in 1994, and is working on the Obsessive Compulsive Disorder section of the current revision of DSM-5, said the strength of the process is that it can offer a reliable way for psychiatrists across the country to identify patients with the same sorts of disorders.

The weakness, he said, is that it largely lacks biological evidence — blood tests, imaging tests and the like — that can validate these diagnoses.

“DSM-5 is a refinement of our diagnostic system, but it doesn’t add to our ability to understand the underlying illness,” he said.

Dr. Emil Coccaro, chairman of the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago Medicine, said typically changes in the DSM occur because of new data.

Coccaro, who is contributing to the new section in the DSM-5 on Intermittent Explosive Disorder, said there is no question that many people aren’t convinced that some of the diagnoses need to be changed, or that there need to be new ones added.

“This also happened the last time when they did DSM-4,” he said, but that was nearly 20 years ago.

“You can keep waiting but at certain point you have to fish or cut bait and actually come out with a new edition. that is what is happening now,” he said.

Comments to the manual can be submitted at DSM5.org

It was one step forward and two steps back for safe prescription drugs in 2010.

There was public outcry against Avandia, the heart attack-associated diabetes drug (and the conflicts of interest that kept it on the market) but some say Actos and Byetta, which will take up some of the slack, are no safer.

Meridia, an amphetamine-like diet pill, and Darvon, the pain pill, were withdrawn. but Nuvugil, an extreme and dangerous stimulant was pushed as a “wakefulness” drug for “excessive sleepiness” (including to college kids with their well known narcolepsy and shift study sleep disorder.) and Singulair, Merck’s number one asthma and allergy drug, was said to cause ADHD symptoms in children by Fox news this month. Oops.

Meanwhile, even though antidepressants like Paxil and Cymbalta are linked to mood dysregulation and suicide, FDA approved Cymbalta for arthritis and lower back pain this month anyway.

I thought I was fine by Martha Rosenberg

Still, here are some drugs you may want to save for national take back Prescriptions day.

YAZ and YASMIN

It sounded too good to be true and it was. Birth control pills which also cleared up acne, treated severe PMS (Premenstrual Dysphoric Disorder or PMDD) and avoided the water retention of traditional birth control pills.

But soon after Bayer launched Yaz in 2006 as going “beyond birth control,” 18-year-olds   were coming down with blood clots, gall bladder disease, heart attacks and even strokes. 15-year-old Katie Ketner had her gallbladder removed, Susan Gallenos had a stroke and part of her skull removed and 18-year-old Michelle A. Pfleger collapsed and died of a pulmonary thromboemboli while at college from taking Yaz says her mother Joan Cummins.

While TV ads for Yaz in 2008 was so misleading, FDA ordered Bayer to run correction ads, Yaz sales are still brisk. in fact, financial analysts attribute the third quarter slump in the Yaz “franchise” of 28.1 percent to the appearance of a Yaz generic not the thousands of women who have been harmed.

Why is Yaz sometimes deadly? it includes a drug that was never before marketed in the US — drospirenone — and apparently causes elevated potassium, heart problems, and a change in acid balance of the blood. Who knew? but not only is Bayer still marketing it,   women do not receive “test subject” compensation for using it either.

LYRICA, TOPAMAX and LAMICTAL

Why would Americans take an epilepsy seizure drug for pain? the same reason they’ll take an antipsychotic for the blues and an antidepressant for knee pain: good consumer marketing. in August FDA ordered a warning for aseptic meningitis, brain inflammation, on Lamictal but it is still the darling of military and civilian doctors for unapproved “pain” and “migraine.” Lamictal also has the distinction of looting $51 million from Medicaid last year despite a generic existing, and is the US’s most wasteful drug according to the American Enterprise Institute.

All seizure drugs increase the risk of suicidal thoughts and behaviors according to their mandated labels and an April article in JAMA found seizure drugs linked to 26 completed suicides, 801 attempted suicides, and 41 violent deaths   in just five years! all three drugs can make you lose your memory and hair say posters on the drug rating site askapatient.com —   Topamax is referred to as “Stupamax” in the military —   though evidently not enough to say, “why am I taking this drug again?”

HUMIRA, PROLIA and TNF BLOCKERS

If you think pharma is producing a lot of expensive, dangerous injectables lately, you’re right. Yesterday’s blockbuster pills have been supplanted with vaccines and biologics that are more lucrative and safer…from generic competition, that is. (Of course it didn’t expect the anti-vaxer movement and millions of vaccine refuseniks.) the problem is: not only are biologics like TNF-blockers Humira and Prolia creepy and dangerous —   made from genetically engineered hamster cells and suppress actual immune system —   the diseases they treat are “sold” to healthy people.

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