bipolar disorders: changes from dsm iv tr to dsm disorders: changes from dsm‐iv‐tr to dsm‐5...

Download Bipolar disorders: Changes from DSM IV TR to DSM   disorders: Changes from DSM‐IV‐TR to DSM‐5 ... Criteria D DSM‐IV DSM‐5 E. ... diagnosis of Bipolar I Disorder

Post on 01-Apr-2018

218 views

Category:

Documents

2 download

Embed Size (px)

TRANSCRIPT

  • Bipolardisorders:ChangesfromDSMIVTRtoDSM5

    M.AminEsmaeili,MD,MPHIranianResearchCenterforHIV/AIDS(IRCHA)

    Iranian National Center for Addiction Studies (INCAS)IranianNationalCenterforAddictionStudies(INCAS)MooddisorderscommitteeofIranianPsychiatricAssociation

    TehranUniversityofMedicalSciences

  • OverviewOverview

    History of classification for psychiatric disordersHistoryofclassificationforpsychiatricdisorders TheprocessofDSM5developmentR i f DSM 5 ReviewofDSM5

  • Why do we need to classify disorders?Whydoweneedtoclassifydisorders?

    Toincreasethereliabilityofdiagnoses Tofacilitatecommunicationbetweencliniciansand researchersandresearchers

    Tocorrectlyidentifycases(sensitivity)N t t i t k l id tif h lth i di id l Nottomistakenlyidentifyhealthyindividualsaspatients(specificity)

  • PreWorldWarII

    Bythe1880census,seven categoriesoft l ill di ti i h d imentalillnessesweredistinguished:mania,

    melancholia,monomania,paresis,dementia,dipsomania and epilepsydipsomania,andepilepsy.

    I 1921 th C itt St ti ti f th In1921,theCommitteeonStatisticsoftheAmericanPsychiatricAssociation.

  • PostWorldWarII

    WHOpublishedICD6includedasectionformentaldisorders;

    AvariantoftheICD6thatwaspublishedin1952 asDSMI;

    TheuseofthetermreactionthroughoutDSMIreflectedtheinfluenceofAdolfMeyer's

    h bi l i l ipsychobiologicalview; DSMIIwassimilartoDSMIbuteliminatedtheterm reaction termreaction.

  • DSMIIDescriptionofManicDepressiveDisorderDisorder

    Thesedisordersaremarkedbyseveremoodswingsandatendencytoremissionandrecurrence.Patientsmaybegiventhisdiagnosisintheabsenceofaprevioushistoryofaffectivepsychosisifthereisnoobviousprecipitatingevent.Thisdisorderisdividedintothreemajorsubtypes:manictype,depressedtype,andcirculartype.

  • Manicdepressiveillness,manictype(manicdepressive psychosis manic type):depressivepsychosis,manictype):

    Thi di d i t l i l f i Thisdisorderconsistsexclusivelyofmanicepisodes.Theseepisodesarecharacterizedby

    i l ti i it bilit t lk tiexcessiveelation,irritability,talkativeness,flightofideas,andacceleratedspeechand

    t ti it B i f i d f d imotoractivity. Briefperiodsofdepressionsometimesoccur,buttheyarenevertrued i i ddepressiveepisodes.

  • Manicdepressiveillness,circulartype(manicp , yp (depressivepsychosis,circulartype):

    Thisdisorderisdistinguishedbyatleastonett k f d i i d d iattackofadepressiveepisodeandamanicepisode.

  • DevelopmentofDSMIII ThirdEdition (DSMIII)wascoordinatedwiththedevelopmentofICD9.WorkbeganonDSMIIIin1974, withpublicationin1980.

    ImportantmethodologicalinnovationsinDSMIII: Anexplicitdiagnosticcriteria Amultiaxial system, Adescriptiveapproachthatattemptedtobeneutralwithrespecttotheoriesofetiology.

  • DSMIIIRandDSMIV TherevisionsandcorrectionsofDSMIIIandpublicationofDSMIIIRin1987.p

    In1994,thelastmajorrevisionofDSM,DSMIV,waspublished.p

    DevelopersofDSMIVandICD10workedcloselytocoordinatetheirefforts,resultinginy gincreasedcongruencebetweenthetwosystemsandfewermeaninglessdifferencesin

    dwording.

  • DSM5I 1999 d l f DSM 5 b In1999,developmentofDSM5began

    Publicationofthefiftheditionof DiagnosticandStatistical Manual of Mental Disorders (DSM 5) willStatisticalManualofMentalDisorders (DSM5)willbeinMay2013

    The 166th APA Annual Meeting in San Francisco The166thAPAAnnualMeetinginSanFrancisco,May1822,2013,willmarktheofficialreleaseofDSM5.

    FinalPublicCommentclosedasofJune15,2012 Morethan700distinguishedmentalhealthandgmedicalexpertswereworkingon

  • Steering committeeSteeringcommittee

    National Institutes of Health funding institutesNationalInstitutesofHealthfundinginstitutes NationalInstituteofMentalHealth

    l f b NationalInstituteofDrugAbuse NationalInstituteofAlcoholAbuse AmericanPsychiatricAssociation World Health OrganizationWorldHealthOrganization

  • FourprinciplesforrevisingDSM5 First,thehighestpriorityisclinicalutility All recommendations should be guided by research Allrecommendationsshouldbeguidedbyresearchevidence

    DSM5 should maintain continuity with previousDSM 5shouldmaintaincontinuitywithpreviouseditions.

    No a priori restraints should be placed on the level ofNoapriorirestraintsshouldbeplacedonthelevelofchangepermittedbetweenDSMIVandDSM5.

  • InrevisingDSM5,theyarelookingfor: whatelementsofthecurrentedition(DSMIV)areworkingwell,whatelementsdonot) g ,meettheneedsofcliniciansandhowbesttocorrectthoseconcerns.

    Theyarefocusingonreducingdiagnosescurrently called Not Otherwise Specifiedcurrentlycalled NotOtherwiseSpecified inDSMIV

    Aiming to better specify treatment Aimingtobetterspecify treatmenttargetsforclinicians

  • theseriesofresearchplanningconferences(endedinFebruary2008)

    DSM5WorkGroups PresentationsonDSM5andRelatedTopics FinalizedthedraftdiagnosticcriteriaDSM 5 Fi ld T i l (b i 2010 ) DSM5FieldTrials(beganin2010)

    Toassessthefeasibility,clinicalutility,reliability,and(wherepossible)thevalidityofthedraftcriteria(twoversions)

    Revisedtothedraftcriteria Postedthedraftonlineforpubliccomment

  • BipolarIDisorder A.Presence(orhistory)ofoneormoreManicEpisodes. B.TheManicEpisode(s)arenotbetteraccountedforbySchizoaffectiveDisorderandarenot

    superimposedonSchizophrenica,Schozphreniform Disorder,DelusionalDisorder,orPsychoticDisorderNEC.

    C The symptoms cause clinically significant distress or impairment in social occupational or otherC.Thesymptomscauseclinicallysignificantdistressorimpairmentinsocial,occupational,orotherimportantareasoffunctioning.

    Specifyif: CurrentorMostRecent EpisodeManic CurrentorMostRecent EpisodeHypomanic CurrentorMostRecent EpisodeDepressed With MixedFeatures With Psychotic Features With MixedFeatures WithPsychoticFeatures WithCatatonicFeatures WithAtypicalFeatures(fordepression) WithMelacholic Features(fordepression)( p ) WithRapidCycling WithSuicideRiskSeverity WithAnxiety,mildtosevere WithSeasonalPattern WithPostpartumOnset

  • BipolarIIDisorder A Presence (or histor ) of one or more Major Depressi e Episodes A.Presence(orhistory)ofoneormoreMajorDepressiveEpisodes B.Presence (orhistory)ofatleastoneHypomanicEpisode C.TherehasneverbeenaManicEpisode D.Themoodsymptoms in CriteriaAandBarenotbetteraccountedforbySchizoaffectiveDisorderandy p y

    arenotsuperimposedonSchizophrenia,Schizophreniform Disorder,DelusionalDisorder,orPsychoticDisorderNotElsewhereClassified.

    E.Thesymptomscauseclinicallysignificantdistressorimpairmentinsocial,occupational,orotherimportant areas of functioningimportantareasoffunctioning.

    Specify if: CurrentorMostRecent EpisodeHypomanic CurrentorMost Recent EpisodeDepressed WithMixedFeatures With Psychotic Features(fordepression) WithCatatonicFeatures(fordepression)

    Wi h A i l (f d i ) WithAtypicalFeatures(fordepression) With MelancholicFeatures(fordepression) WithRapidCycling With Anxiety mild to severeWithAnxiety,mildtosevere WithSuicideRiskSeverity WithSeasonalPattern WithPostpartumOnset

  • Manic EpisodeManicEpisode

  • Manicepisode:CriteriaA

    DSMIV DSM5

    A.Adistinctperiodof A. Adistinctperiodofabnormallyandpersistentlyelevated,expansive,orirritable mood, lasting at least

    abnormallyandpersistentlyelevated,expansive,orirritable mood andirritablemood,lastingatleast

    1week(oranydurationifhospitalizationisnecessary).

    irritablemoodandabnormallyandpersistentlyincreasedactivityorenergy,lasting at least 1 eek andlastingatleast1weekandpresentmostoftheday,nearlyeveryday(oranydurationifhospitalizationisnecessary).

  • Manicepisode:CriteriaB

    DSMIV DSM5

    B.Duringtheperiodofmooddisturbance,three(ormore)of the following symptoms

    B. Duringtheperiodofmooddisturbanceandincreased energy or activity,ofthefollowingsymptoms

    havepersisted(fourifthemoodisonlyirritable) and ha e been

    increasedenergyoractivity,three(ormore)ofthefollowingsymptoms(fourifthe mood is onl irritable) areirritable)andhavebeen

    presenttoasignificantdegree:

    themoodisonlyirritable)arepresenttoasignificantdegree,andrepresentanoticeablechangefromusualbehavior:

  • DSMIV DSM5

    1.inflatedselfesteemorgrandiosity2 decreased need for sleep (e g feels

    1.Inflatedselfesteemorgrandiosity2 Decreased need for sleep (e g feels rested2.decreasedneedforsleep(e.g.,feels

    restedafteronly3hoursofsleep)3.moretalkativethanusualorpressuretokeeptalking

    2. Decreasedneedforsleep(e.g.,feelsrestedafteronly3hoursofsleep)3. Moretalkativethanusualorpressuretokeeptalking

    4.flightofideasorsubjectiveexperiencethatthoughtsareracing5.distractibility(i.e.,attentiontooeasilyd t i t t i l t

    4. Flightofideasorsubjectiveexperiencethatthoughtsareracing5. Distractibility(i.e.,attentiontooeasilyd t i t t i l t t ldrawntounimportantorirrelevant

    externalstimuli)6.increaseingoaldirectedactivity(eithersocially, at work or school, or sexually) or

    drawntounimportantorirrelevantexternalstimuli),asreportedorobserved6. Increaseingoaldirectedactivity(eithersocially, at work or school, or sexually) orsocially,atworkorschool,orsexually)or

    psychomotoragitation7.excessiveinvolvementinpleasurableactivitiesthathaveahighpotentialfor

    socially,atworkorschool,orsexually)orpsychomotoragitation(i.e.,purposelessnongoaldirectedactivity)7. Excessiveinvolvementinactivitiesthat

    painfulconsequences(e.g.,engaginginunrestrained buyingsprees,sexualindiscretions,orfoolishbusinessinvestments)

    haveahighpotentialforpainfulconsequences(e.g.,engaginginunrestrainedbuyingsprees,sexualindiscretions,orfoolishbusiness investments)investments) businessinvestments)

  • Manicepisode:CriteriaCDSMIV DSM5C.Thesymptomsdonotmeeti i f i d i d

    C. Themooddisturbanceisffi i lcriteriaforaMixe