Kate's Illness Sometimes Linked to Twins

Hyperemesis gravidarum, the reason newly pregnant Kate Middleton is in the hospital, is a rare but acute morning sickness that results in weight loss and accounts for about 2 percent of all morning sickness, doctors say.

The condition is sometimes associated with women having twins, experts said.

Women diagnosed with hyperemesis gravidarum have lost 5 percent of their pre-pregnancy weight, or 10 pounds, said Dr. Ashley Roman, a professor and OB/GYN at New York University Langone Medical Center.

It poses little danger to the tiny heir, doctors said.

"It's traditionally thought that nausea and vomiting is a sign of a healthy pregnancy," Roman said

Dr. Nancy Cossler, an OB/GYN at University Hospitals in Ohio said the condition does not cause loss of pregnancy or birth defects, but it can be a torture to endure.

"The biggest problem with this is how it interferes with your life," Cossler said. "Constantly feeling sick and puking is difficult."

Click here to read about other women with hyperemesis gravidarum.

Hyperemesis gravidarum is thought to be caused by higher levels of the pregnancy hormone, hCG, or human chorionic gonadotropin, Cossler said. Extra hCG can often be brought on by carrying more than one fetus, she said.

Chris Jackson/AFP/Getty Images

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In other words, it could be a sign that Middleton is carrying twins. Although there's very little data on twins and hyperemesis gravidarum, one study showed that women carrying twins had a 7.5 percent higher risk of experiencing the acute morning sickness, Roman said.

The extreme morning sickness is usually diagnosed about nine weeks into the pregnancy, and in most cases resolves itself by 16 or 20 weeks, Roman said. In rare cases, it can last the whole pregnancy.

"As the pregnancy is in its very early stages, Her Royal Highness is expected to stay in hospital for several days and will require a period of rest thereafter," a statement from St. James Palace said. Prince William is at the hospital with Middleton, according to the Britain's Press Association.

Click here for photos of Kate through the years.

Roman said doctors prescribe vitamins and ginger capsules at first. If that doesn't stop the vomiting, they will prescribe antihistamines and stronger anti-nausea medications.

Women with hyperemesis gravidarum are also treated with fluids, said Dr. Jessica Young, an OB/GYN at Vanderbilt University. But if left untreated, a pregnant woman who is severely dehydrated for a long period of time could die, "just like any person," Young said.

In extreme cases in which the woman is losing weight and unable to eat, doctors will treat her with intravenous nutrition, Young said.

Hospital stays can vary, and women will often have to be admitted more than once before the condition passes, doctors said.

Hyperemesis gravidarum is somewhat mysterious because some expectant mothers have acute morning sickness during only one of their pregnancies, but have no morning sickness for subsequent pregnancies.

There is a chance that higher levels of hCG, which likely caused Middleton's nausea, could be a sign of a molar pregnancy instead of twins, Cossler said. This would mean Middleton is carrying only a benign growth in her uterus instead of a fetus, or she is carrying a fetus with abnormal DNA and a benign growth. Neither is considered a viable pregnancy.

However, Cossler said molar pregnancies become apparent early on, and doctors would already know whether Middleton had one.

"They would not have released this information," Cossler said of the birth announcement. "I'm certain that they have already eliminated both of those [types of molar pregnancies]."

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North Korea urged to drop rocket launch plan

MOSCOW/BEIJING (Reuters) - Russia and China urged North Korea on Monday not to go ahead with a plan for its second rocket launch of 2012, with Moscow saying the launch would violate restrictions imposed by the U.N. Security Council.

North Korea's state news agency on Saturday announced the decision to launch another space satellite and reportedly told neighbors it would take a similar path to that planned for a failed rocket launch in April.

"We urgently appeal to the government (of North Korea) to reconsider the decision to launch a rocket," the Russian Foreign Ministry said in a statement.

Echoing its criticism of the April launch, Russia said North Korea had been warned not to ignore a U.N. Security Council resolution which "unambiguously prohibits (it) from launching rockets using ballistic technology".

China was not so direct in its criticism of North Korea, but urged "all sides" not to take any action that "worsens the problem".

"China believes that maintaining peace and stability on the Korean peninsula and in Northeast Asia accords with the interests of all sides and is the joint responsibility of all sides," Foreign Ministry spokesman Hong Lei told reporters.

"In the present circumstances, we hope all sides can be calm and restrained and not take any moves to worsen the problem. China will remain in touch and coordinate with all sides."

In Washington, U.S. State Department spokeswoman Victoria Nuland condemned the launch plan on Sunday as a provocative threat to the Asia-Pacific region.

ELECTION IN SOUTH

North Korea says its rockets are used to put satellites into orbit for peaceful purposes. Russia said in its statement North Korea would be allowed only to exercise its right to peaceful activity in space if the U.N.-imposed restrictions were lifted.

The warnings come just weeks before South Korea's December 19 presidential election in which how to handle North Korea is a major campaign issue. The isolated North has for years tried to influence major events in the South by issuing propaganda or launching armed attacks.

North and South Korea have been technically at war since their 1950-53 conflict ended in a truce, not a peace treaty, and regional powers have for years been trying to rein in the North's nuclear program.

Countries trying to stop North Korea's arms program believe it is using rocket launches to perfect technology to build a missile arsenal capable of delivering a nuclear warhead to the United States.

North Korea is under U.N. sanctions that ban trading in missile or nuclear technology that have driven its already dire economy deeper in trouble by cutting off what was once a lucrative source of hard cash.

Russia has often balanced criticism of Soviet-era client state North Korea's nuclear activities and missile launches with calls on other powers to refrain from belligerent actions against it, which Russia says can be counterproductive.

Russia is a permanent member of the U.N. Security Council and is upset by any defiance of council resolutions. Past launches by Pyongyang have caused concern among Russians living near the country's border with North Korea.

(Additional reporting by Ben Blanchard in Beijing; Writing by Steve Gutterman and Nick Macfie; Editing by Robert Birsel)

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Asian markets mixed China data offset by US worries

HONG KONG: Asian markets were mixed on Monday, after data showing Chinese manufacturing activity had picked up pace in November were tempered by concerns over US talks to avert the fiscal cliff.

Tokyo closed 0.13 per cent, or 12.17 points, higher at 9,458.18, Seoul ended up 0.37 per cent, or 7.12 points, to 1,940.02 and Sydney gained 0.57 per cent, or 25.5 points, to 4,531.5.

However, Hong Kong tumbled 1.19 per cent, or 262.54 points, to 21,767.85, while Shanghai closed down 1.03 per cent, or 20.35 points, at 1,959.77.

Beijing said Saturday that factory activity grew for the second month in a row in November, the latest figures showing the world's number two economy is emerging from its recent slowdown.

The country's official purchasing managers' index (PMI) reached 50.6, up from 50.2 in October and 49.8 in September and the highest since hitting 53.3 in April. Anything above 50 indicates expansion.

In a separate survey, HSBC said its PMI hit a 13-month high of 50.5 in November from 49.5 in October. The bank's PMI had been in negative territory for 12 months.

Chinese manufacturing has been hit by weaker demand in Europe and the United States, with economic growth hitting a more than three-year low of 7.4 per cent in the July-September quarter.

A more upbeat outlook for China filtered through to currency markets, where the euro continued its recent rise.

The single currency gained to US$1.3035 and 107.29 yen in late afternoon trade, from US$1.2982 and 107.07 yen in New York late Friday.

The US dollar eased to 82.30 yen from 82.48 yen in US trade.

The yen has weakened over the past few weeks as investors expect a win in December 16 polls for Shinzo Abe, the opposition leader who has pledged to carry out more aggressive monetary easing measures to jumpstart Japan's limp economy.

However, there are worries over the lack of progress US lawmakers are making in agreeing a deal to avoid the fiscal cliff of tax hikes and spending cuts due to come into effect on January 1 and which could tip the economy into recession.

Republican House Speaker John Boehner told the Fox News Sunday TV show that talks were going "nowhere".

He said he was "flabbergasted" when Treasury Secretary Timothy Geithner, President Barack Obama's point man for the talks, presented the White House's proposal, which included huge tax increases for the rich.

"I looked (at) him and said, 'You can't be serious,'" Boehner recounted, saying three of the seven weeks available had "been wasted with this nonsense".

"Right now, I would say -- we're nowhere, period. We're nowhere" towards reaching a compromise.

Oil prices were higher. New York's main contract, light sweet crude for delivery in January, gained 10 cents to US$89.01 a barrel and Brent North Sea crude for January delivery added 19 cents to US$111.42.

Gold was at US$1,718.77 at 0810 GMT compared with US$1,728.37 late Friday.

Taipei rose 0.26 per cent, or 19.74 points, to 7,599.91. Hon Hai Precision gained 1.61 per cent to TW$94.7 while Taiwan Semiconductor Manufacturing Co was 0.81 per cent down at TW$97.9.

Manila rose 0.57 per cent, or 32.25 points, to 5,672.70.

Wellington was flat, falling 1.00 point to 4,049.09. Broadband provider Chorus slumped 14.4 per cent to NZ$2.91 after regulators flagged a cut to wholesale pricing, while Telecom was up 0.43 per cent at NZ$2.32.

- AFP/jc

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FDI in retail to safeguard international market mafias' interest: BJP

ANI Dec 1, 2012, 03.28PM IST

NEW DELHI: India's main opposition Bharatiya Janata Party (BJP) today said retail reform is a step taken by the Congress led-federal government to safeguard the interests of the international market mafias at the cost of national interest.

BJP vice president Mukhtar Abbas Naqvi said on Saturday that voting inside the parliament would decide as to who is in favour of national interest and who is working for international interests.

"The government feels that their responsibility is to safeguard the interest of international market mafias instead of national interest and for saving the interest of international market mafias, the government is ready to compromise with national interests. Now, the parliament will decide as to who is in support of international market mafias and who are supporting national interests," said Naqvi.

The government's decision to allow foreign supermarket chains such as Wal-Mart had triggered protest not only from opposition parties but also from some of its allies.

BJP had sought debate on the issue of allowing Foreign Direct Investment (FDI) in the retail sector, under the rule that entails voting after discussions.

Meanwhile, Minister in the Prime Minister Office (PMO), V Narayanaswamy said the government would answer all the queries raised by the opposition parties in the parliament and will explain the benefits of allowing FDI in retail sector.

The lower house of parliament has set December 04 and 05 as the date to vote and debate on FDI. The dates for the upper house are yet to be decided.

Narayanaswamy said the government is confident of becoming victorious in the debate.

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Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

Read More..

Boehner on Fiscal Cliff Talks: 'You Can't Be Serious'

President Obama and his White House team appear to have drawn a line in the sand in talks with House Republicans on the "fiscal cliff."

Tax rates on the wealthy are going up, the only question is how much?

"Those rates are going to have to go up," Treasury Secretary Tim Geithner flatly stated on ABC's "This Week." "There's no responsible way we can govern this country at a time of enormous threat, and risk, and challenge ... with those low rates in place for future generations."

But the president's plan, which Geithner delivered last week, has left the two sides far apart.

In recounting his response today on "Fox News Sunday," House Speaker John Boehner said: "I was flabbergasted. I looked at him and said, 'You can't be serious.'

"The president's idea of negotiation is: Roll over and do what I ask," Boehner added.

The president has never asked for so much additional tax revenue. He wants another $1.6 trillion over the next 10 years, including returning the tax rate on income above $250,000 a year to 39.6 percent.

TOBY JORRIN/AFP/Getty Images

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Boehner is offering half that, $800 billion.

In exchange, the president suggests $600 billion in cuts to Medicare and other programs. House Republicans say that is not enough, but they have not publicly listed what they would cut.

Geithner said the ball is now in the Republicans' court, and the White House is seemingly content to sit and wait for Republicans to come around.

"They have to come to us and tell us what they think they need. What we can't do is to keep guessing," he said.

The president is also calling for more stimulus spending totaling $200 billion for unemployment benefits, training, and infrastructure projects.

"All of this stimulus spending would literally be more than the spending cuts that he was willing to put on the table," Boehner said.

Boehner also voiced some derision over the president's proposal to strip Congress of power over the country's debt level, and whether it should be raised.

"Congress is not going to give up this power," he said. "It's the only way to leverage the political process to produce more change than what it would if left alone."

The so-called fiscal cliff, a mixture of automatic tax increases and spending cuts, is triggered on Jan. 1 if Congress and the White House do not come up with a deficit-cutting deal first.

The tax increases would cost the average family between $2,000 and $2,400 a year, which, coupled with the $500 billion in spending cuts, will most likely put the country back into recession, economists say.

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Mursi calls December 15 referendum, Islamists rally

CAIRO (Reuters) - Egypt's President Mohamed Mursi called a December 15 referendum on a new constitution, hoping to end protests over a decree expanding his powers, as at least 200,000 of his Islamist supporters rallied in Cairo on Saturday.

Approval of the constitution drafted by an assembly stacked with Mursi's Islamist allies will override the November 22 decree that temporarily shielded Mursi from judicial oversight and triggered statements of concern from Western governments.

The decree plunged Egypt into its worst crisis since Mursi won office in a June election and sparked countrywide protests and violence in which two people have been killed and hundreds injured. This hit an economy just showing signs of recovery.

"I renew my call for opening a serious national dialogue over the concerns of the nation, with all honesty and impartiality," said Mursi after receiving the final draft from the constituent assembly. "We must move beyond the period of confrontation and differences, and get on to productive work."

The constitution is meant to be the cornerstone of democracy after three decades of army-backed autocracy under President Hosni Mubarak. Yet drafting it has been divisive, exposing splits between newly empowered Islamists and their opponents.

Protesters in an open-ended sit-in in Cairo's Tahrir Square, which was also the focus of demonstrations against Mubarak, accuse Mursi's Muslim Brotherhood of trying to impose a flawed constitution.

Leading opposition figure Mohamed ElBaradei said on Twitter that "struggle will continue" despite the referendum and that the draft constitution "undermines basic freedoms."

Liberal figures including former Arab League chief Amr Moussa pulled out of the constituent assembly last month, as did representatives of Egypt's Christian minority.

The draft constitution contains Islamist-flavored language which opponents say could be used to whittle away human rights and stifle criticism. It forbids blasphemy and "insults to any person", does not explicitly uphold women's rights and demands respect for "religion, traditions and family values".

The text also limits presidents to two four-year terms, requires parliamentary approval for their choice of prime minister, and introduces some civilian oversight of the military - although not enough for critics.

Mursi described it as a constitution that fulfilled the goals of the January 25, 2011 revolution that brought an end to Mubarak's rule. "Let everyone - those who agree and those who disagree - go to the referendum to have their say," he said.

JUDGES TO SUPERVISE VOTE

To hold the referendum, Mursi will depend on a judiciary which has been on partial strike over the November 22 decree, and which he and the Brotherhood suspect of links to the Mubarak regime. Judges oversee elections in Egypt.

Vice President Mahmoud Mekky said he trusted the judiciary would supervise the vote, state news agency MENA reported.

Mursi is betting the Islamists' core supporters and ordinary Egyptians fed up with instability will pass the constitution.

While Mursi only secured the presidency by a slim margin, the Islamists have won all elections since Mubarak was toppled.

The opposition must decide whether to urge a boycott or a "No" vote in the referendum. If they secure a "No", the president could retain the powers he has unilaterally assumed.

The referendum call met with cheers from the pro-Mursi rally at Cairo University. Streets were clogged with those sympathetic to the Muslim Brotherhood and more hardline Salafi parties.

The rally was a show of strength by Islamists who feel under attack from leftist, liberal and socialist parties. By early evening, the crowd peaked at at least 200,000, said Reuters witnesses, basing estimates on previous Cairo rallies. Authorities declined to give an estimate for the crowd's size.

"The people want the implementation of God's law," chanted flag-waving demonstrators, many bussed in from the countryside.

Tens of thousands of Egyptians protested against Mursi on Friday, chanting: "The people want to bring down the regime," echoing a trademark slogan of the revolts against Arab leaders.

Rival demonstrators threw stones after dark in the northern city of Alexandria and a town in the Nile Delta. Similar clashes erupted again briefly in Alexandria on Saturday, state TV said.

Mohamed Noshi, 23, a pharmacist from Mansoura, said he had joined the rally in Cairo to support Mursi and his decree. "Those in Tahrir don't represent everyone. Most people support Mursi and aren't against the decree," he said.

Egypt cannot hold a new parliamentary election until a new constitution is passed. The country has been without an elected legislature since the Supreme Constitutional Court ordered the dissolution of the Islamist-dominated lower house in June.

The court is due to meet on Sunday to discuss the legality of parliament's upper house.

"We want stability. Every time, the constitutional court tears down institutions we elect," said Yasser Taha, a 30-year-old demonstrator at the Islamist rally in Cairo.

(Additional reporting by Marwa Awad, Yasmine Saleh and Tamim Elyan; Writing by Alistair Lyon and Tom Perry; Editing by Myra MacDonald and Jason Webb)

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N Korea notifies Japan of rocket path: report

SEOUL: North Korea has notified neighbours including Japan of the trajectory of the rocket it plans to launch this month, a report said on Sunday, after international condemnation of the move by the nuclear-armed state.

The communist North announced on Saturday it would launch a rocket sometime between December 10 and 22 -- its second long-range rocket launch this year after a much-hyped but botched attempt in April.

Washington and Seoul urged Pyongyang to scrap the launch while Tokyo reportedly postponed talks due next week with North Korea and ordered its military to prepare to shoot down the rocket if it goes over Japan.

"The North has notified aviation authorities in nations including Japan that could come under potential danger ... of the timing and expected path (of the rocket)," Yonhap news agency quoted an unnamed senior Seoul official as saying.

China and the Philippines were also likely to have been notified, it added.

The North said on Saturday the rocket would blast off "southward" from its Sohae Space Centre in the country's northwest.

"A safe flight path has been chosen so that parts of the carrier rocket that might fall during the launch process would not affect neighbouring countries," it said.

It added Pyongyang would "fully comply" with relevant international rules for the launch, which some analysts said was aimed at stirring patriotism and support for the country's young, inexperienced ruler Kim Jong-Un.

Pyongyang also repeated its claim made during its April launch that the rocket was aimed at promoting "the use of space for peaceful purposes" by placing a polar-orbiting earth observation satellite into orbit.

But the US and its allies view the launch as a disguised test for an inter-continental ballistic missile banned under UN resolutions triggered by Pyongyang's two nuclear tests in 2006 and 2009.

- AFP/xq

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FDI in retail to safeguard international market mafias' interest: BJP

NEW DELHI: India's main opposition Bharatiya Janata Party (BJP) today said retail reform is a step taken by the Congress led-federal government to safeguard the interests of the international market mafias at the cost of national interest.

BJP vice president Mukhtar Abbas Naqvi said on Saturday that voting inside the parliament would decide as to who is in favour of national interest and who is working for international interests.

"The government feels that their responsibility is to safeguard the interest of international market mafias instead of national interest and for saving the interest of international market mafias, the government is ready to compromise with national interests. Now, the parliament will decide as to who is in support of international market mafias and who are supporting national interests," said Naqvi.

The government's decision to allow foreign supermarket chains such as Wal-Mart had triggered protest not only from opposition parties but also from some of its allies.

BJP had sought debate on the issue of allowing Foreign Direct Investment (FDI) in the retail sector, under the rule that entails voting after discussions.

Meanwhile, Minister in the Prime Minister Office (PMO), V Narayanaswamy said the government would answer all the queries raised by the opposition parties in the parliament and will explain the benefits of allowing FDI in retail sector.

The lower house of parliament has set December 04 and 05 as the date to vote and debate on FDI. The dates for the upper house are yet to be decided.

Narayanaswamy said the government is confident of becoming victorious in the debate.

Read More..

Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

Read More..