Michael B First

Michael B First
Columbia University | CU · Department of Psychiatry

Doctor of Medicine

About

252
Publications
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76,482
Citations

Publications

Publications (252)
Article
Full-text available
Aim: This study aimed to identify whether clinicians' gender, clinical experience, and personal attitudes influenced their perception of criminality of specific sexual behaviours, their judgments about criminal liability if mentally disordered, and the need for treatment as part of criminal settings for those having ICD-11 paraphilic disorders. Me...
Article
The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research...
Article
Full-text available
Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more e...
Article
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and...
Article
Objective: This article narrates a history of several important changes to the substance-related disorders chapter in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), based on interviews with people involved in the pre-planning and the development of the revisions. These changes include collapsing substance abuse a...
Article
Structural racism has received renewed focus over the past year, fueled by the convergence of major political and social events. Psychiatry as a field has been forced to confront a legacy of systemic inequities. Here, we use examples from our clinical and supervisory work to highlight the urgent need to integrate techniques addressing racial identi...
Article
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Public trust in the credibility of medicine and physicians has been severely tested amid the COVID-19 pandemic and growing sociopolitical fissures in the United States. Physicians are being asked to be ambassadors to the public of scientific information. Psychiatrists have an opportunity to help the public understand and accept a "new normal" durin...
Article
Background The diagnosis of paraphilic disorder is a complicated clinical judgment based on the integration of information from multiple dimensions to arrive at a categorical (present/absent) conclusion. The recent update of the guidelines for paraphilic disorders in ICD-11 presents an opportunity to investigate how mental health professionals use...
Article
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It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the tw...
Article
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is ge...
Article
Full-text available
The novel coronavirus pandemic and the resulting expanded use of telemedicine have temporarily transformed community-based care for individuals with serious mental illness (SMI), challenging traditional treatment paradigms. We review the rapid regulatory and practice shifts that facilitated broad use of telemedicine, the literature on the use of te...
Article
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The Internet has fundamentally altered mental health clinicians' "public selves," challenging previous models of self-disclosure and maintenance of boundaries within treatment. The conception of a public self altered by the digital age presents both opportunities and pitfalls in clinical practice. Information about clinicians available online may b...
Article
This article narrates a consensus history of the proposal to include diagnostic criteria for a psychosis risk syndrome in the DSM-5, in part, to document what happened, but also to potentially help focus future efforts at clinically useful early detection. The purpose of diagnosing a risk state would be to slow and ideally prevent the development o...
Article
Objective: Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alte...
Article
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The number of people with opioid use disorder and the number of overdose deaths in the United States have increased dramatically over the past 20 years. U.S. Congress passed the SUPPORT for Patients and Communities Act, which was signed into law in 2018, authorizing almost $8 billion to address the crisis. As experts in the treatment of central ner...
Article
Aim - The ICD‐11 classification of personality disorders (PDs) has adopted a dimensional approach which includes three levels of severity (mild, moderate and severe) with the option of specifying five trait qualifiers (negative affectivity, detachment, dissociality, disinhibition and anankastia) and one borderline pattern qualifier. This study exam...
Article
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Despite widespread use, how clinicians use the DSM in psychiatric practice is not well understood. Recognizing public and professional attitudes toward the DSM are integral to future DSM development, to assess a commonly held assumption such as that the DSM is used primarily for coding, and to assess its clinical utility. A convenience sample of Ps...
Article
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Following approval of the ICD‐11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD‐10 to the ICD‐11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions an...
Article
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The upcoming 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO) offers a unique opportunity to improve the representation of painful disorders. For this purpose, the International Association for the Study of Pain (IASP) has convened an interdisciplinary...
Article
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Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy dec...
Article
Full-text available
Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy dec...
Article
Full-text available
The upcoming 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO) offers a unique opportunity to improve the representation of painful disorders. For this purpose, the International Association for the Study of Pain (IASP) has convened an interdisciplinary...
Article
Classifications of psychotic disorders are moving towards utilizing dimensional symptom domains as the preferred mechanism for describing psychotic symptomatology. The ICD-11 has proposed six symptom domains (Positive symptoms, Negative symptoms, Depressive symptoms, Manic symptoms, Psychomotor symptoms, and Cognitive symptoms) that would be rated...
Article
Full-text available
Background: The ICD-11 classification of Personality Disorders focuses on core personality dysfunction, while allowing the practitioner to classify three levels of severity (Mild Personality Disorder, Moderate Personality Disorder, and Severe Personality Disorder) and the option of specifying one or more prominent trait domain qualifiers (Negative...
Article
Full-text available
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is ge...
Article
Full-text available
In this paper we report the clinical utility of the diagnostic guidelines for ICD‐11 mental, behavioural and neurodevelopmental disorders as assessed by 339 clinicians in 1,806 patients in 28 mental health settings in 13 countries. Clinician raters applied the guidelines for schizophrenia and other primary psychotic disorders, mood disorders (depre...
Article
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Third edition of the International Classification of Headache Disorders
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Clinical practice is assumed to be informed and supported by evidence-based clinical research. Nonetheless, clinical practice often deviates from the research evidence base, sometimes leading and sometimes lagging. Two examples from integrated care in mental health care (care for serious mental illness and collaborative mental health care in primar...
Article
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We report on a global survey of diagnosing mental health professionals, primarily psychiatrists, conducted as a part of the development of the ICD-11 mental and behavioural disorders classification. The survey assessed these professionals' use of various components of the ICD-10 and the DSM, their attitudes concerning the utility of these systems,...
Article
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Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-...
Article
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During the last decade, there has been heated debate regarding whether compulsive sexual behaviour should be classified as a mental/behavioural disorder. Compulsive sexual behaviour disorder has been proposed for inclusion as an impulse control disorder in the ICD-11. It is characterized by a persistent pattern of failure to control intense, repeti...
Article
Psychiatry is on the cusp of major changes. It is time to look at where the specialty has been, where it is now, and to try to imagine its future. What will psychiatrists do, and how will this be delivered and financed? How will psychiatry’s relationship with society change? How must mental health laws adapt? Can psychiatry go digital? And how will...
Article
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The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged wi...
Article
Beginning with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III), depressive episodes following the loss of a loved one were considered to represent normal grief if they did not include certain severe symptoms or if they lasted less than 2 months. This was called the bereavement exclusion rule. A debate about whether to e...
Article
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Suicide prevention efforts are increasing to enhance capabilities and better understand risk factors and etiologies. Postvention, or how clinicians manage the postsuicide aftermath, strengthens suicide prevention, destigmatizes the tragedy, operationalizes the confusing aftermath, and promotes caregiver recovery. However, studies regarding its effi...
Data
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En la próxima undécima revisión de la Clasifcación Internacional de las Enfermedades y Problemas de Salud Relacionados (ICD-11) de la Organización Mundial de la Salud, se han propuesto cambios sustanciales a la clasificación de los trastornos mentales y conductuales relacionados con la sexualidad y la identidad de género de la ICD-10. Estos concier...
Article
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In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings...
Article
Anxiety disorders are highly prevalent worldwide and engender substantial economic costs and disability. The World Health Organization is currently developing the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), which represents the first opportunity to improve the validity, clinical utility, a...
Article
Assessment of the variations of clinical course to aid in diagnosis, assessment of patients’ functioning and to guide treatment planning has gained momentum in recent years. A specific scale is introduced to plot the temporal course to assist empirically-minded psychotherapists and researchers who treat the DSM-5 Disorders and who want to monitor t...
Article
Field trials of diagnostic classification systems can be divided into two types: developmental field trials, which are designed to collect performance data from users during the revision process, and summative field trials, which aim to assess what users can expect in terms of the classification's psychometric properties after the classification ha...
Article
The World Health Organization (WHO) Department of Mental Health and Substance Abuse has developed a systematic program of field studies to evaluate and improve the clinical utility of the proposed diagnostic guidelines for mental and behavioral disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Pro...
Article
Criteria A2, experience of helplessness, fear, or horror at the time of the traumatic event, was removed from the posttraumatic stress disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We argue that there is empirical support for retention of A2, a criterion that has clinical value and may improve diagn...
Book
Proces diagnostyczny wymaga umiejętności uzyskania informacji od pacjenta, rozpoznania objawów i ustalenia ich wzorca, określenia możliwych przyczyn oraz ostatecznego ustalenia odpowiedniej diagnozy. Doświadczeni specjaliści z zakresu zdrowia psychicznego wiedzą, że rozpoznanie różnicowe jest sztuką, ale też złożoną umiejętnością naukową, dlatego c...
Article
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The present study developed and validated a configurable, adaptive, web-based version of the Structured Clinical Interview for DSM, the NetSCID. The validation included 24 clinicians who administered the SCID and 230 participants who completed the paper SCID and/or the NetSCID. Data-entry errors, branching errors, and clinician satisfaction were qu...
Chapter
Diagnoses of schizophrenia were assigned a degree of certainty and were considered primary or secondary, based on the chronological presentation of concomitant illnesses. Since the inception of the concept of schizophrenia, the heterogeneity of its symptom presentation has been indicated in terms of clinical subtypes. This chapter examines the main...
Article
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The World Health Organization is in the process of preparing the eleventh revision of the International Classification of Diseases (ICD-11), scheduled for presentation to the World Health Assembly for approval in 2017. The International Advisory Group for the Revision of the ICD-10 Mental and Behavioural Disorders made improvement in clinical utili...
Chapter
The Structured Clinical Interview for DSM-5 (SCID-5) is the most widely used structured diagnostic instrument for assessing DSM-5 disorders. The SCID-PD (formerly SCID-II) is used for the evaluation of the DSM-5 personality disorders. The SCID-5 is organized into diagnostic modules, and it assesses mood disorders, psychotic disorders, substance use...
Article
To propose options for gradually transitioning to a thoroughgoing dimensional model of personality disorder. The American Psychiatric Association was less willing to implement a dimensional approach to the diagnosis of personality disorder than the leadership of the DSM-5 anticipated. The next opportunity to implement such an approach will be in th...
Article
Full-text available
The clinical use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is explicitly stated as a goal for both the DSM Fourth Edition and DSM Fifth Edition (DSM-5) revisions. Many uses assume a relatively faithful application of the DSM diagnostic definitions. However, studies demonstrate significant discrepancies between clinical psyc...
Article
Despite initial aspirations for a paradigm shift, DSM-5 ended up evolutionary, rather than revolutionary. The requirement that revisions be grounded in empirical evidence, crucial for the credibility of the DSM as a scientifically based document, is inherently in conflict with the push to develop innovative DSM-5 proposals given their limited empir...
Article
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We conducted blinded psychiatric assessments of 26 Amish subjects (52±11 years) from four families with prevalent bipolar spectrum disorder, identified 10 potentially pathogenic alleles by exome sequencing, tested association of these alleles with clinical diagnoses in the larger Amish Study of Major Affective Disorder (ASMAD) cohort, and studied m...
Article
Given that paraphilic disorders are diagnosed largely in forensic settings, virtually every significant change in the criteria has forensic implications. Several controversial changes were considered during the DSM-5 revision process, but most were ultimately not included in the published text. However, any changes that make it easier to assign a p...
Article
A clinical reappraisal study was carried out in conjunction with the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) All-Army Study (AAS) to evaluate concordance of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses based on the Composite International Diagnostic Interview Screening...
Article
According to the introduction to the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, each disorder must satisfy the definition of mental disorder, which requires the presence of both harm and dysfunction. Constructing criteria sets to require harm is relatively straightforward. However, establishing the presence of dysfu...
Article
The In Review articles in this issue on normality and disorder by Dr Rachel Cooper and Dr Derek Bolton explore the importance of a value component of harm in the concept of mental disorder. They focus on the Diagnostic and Statistical Manual of Mental Disorder's clinical significance criterion, requiring that symptoms cause significant distress or...
Article
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Objective: The attitudes of psychiatrists toward individuals with highly stigmatized conditions such as substance use disorders and serious mental illness may influence treatment effectiveness. These attitudes may be influenced by factors including previous specialty training and current practice patterns. This study examined the attitudes of addic...
Article
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The diagnostic concepts of post-traumatic stress disorder (PTSD) and other disorders specifically associated with stress have been intensively discussed among neuro- and social scientists, clinicians, epidemiologists, public health planners and humanitarian aid workers around the world. PTSD and adjustment disorder are among the most widely used di...
Article
Based on the recommendations of the sub-workgroup on trauma and dissociative disorders, the American Psychiatric Association (APA) removed the "bereavement exclusion" from the criteria for major depression in DSM-5. In addition, proposed DSM-5 research criteria for persistent complex bereavement disorder (PCBD) were included in the new manual in a...
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In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis -- the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances' responses to the commentaries, and my own view of the multiple discussions. In th...
Article
Objective: To conduct a blinded study to examine the diagnostic efficiency of the Department of Defense (DoD) Post-Deployment Health Reassessment (PDHRA) screens for major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and alcohol abuse. Method: Participants were 148 post-deployed soldiers who were completing the PDHRA protocol...