A16 16..16

This edition of the Journal starts with the big questions in psychiatry: what is a diagnosis? And how does one justify treatment against the will of the individual? The next version of the World Health Organization’s bible, the ICD–11, is being prepared at the same time as the American Psychiatric Association’s fifth edition of the DSM. The push for harmonising these two different systems is discussed by First (pp. 382–390) in a special article. It is illuminating that only one diagnostic category is identical (of the 176 in these systems); but it is more promising that many more criteria are relatively closely aligned (78%) although one-fifth show more significant conceptual differences. It is unusual to refer readers to the appendices of an article – but this is one case where this is likely to pay dividends. An accompanying editorial by Jablensky (pp. 379–381) addresses the different purposes served by these publications, and argues that their ultimate value lies in their utility and validity, not only for clinicians but also for researchers and service users. Both articles emphasise the need for further research to fill the gaps where there are true conceptual divides in diagnostic practice. A reappraisal of the preparations for DSM–V by Frances (pp. 391–392), formerly Chair of the DSM–IV Task Force, highlights perceived problems with both the development process and its target. This makes for an illuminating discussion of the clinical utility of dimensional approaches, and of biological markers, in psychiatric diagnosis. Ethical principles propose that an individual has the right to refuse treatment; this right is suspended where the individual lacks capacity, and is thus unable to make an informed decision. Psychiatric treatment often takes place in the latter scenario; Owen and colleagues (pp. 403–407) assessed patients’ views on treatment decisions taken by psychiatrists, once they had regained capacity for their own decision-making. Interestingly, 83% of patients gave retrospective approval for their treatment, and the proportions did not differ between those detained under the Mental Health Act and patients admitted informally; however, patients who had not regained capacity demonstrated lower levels of approval.