dsm-5 no roman numerals changes/updates - 5.1, 5.2 … print and electronic versions severity scales...
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DSM-5•No Roman numerals•Changes/Updates - 5.1, 5.2 …•Print and electronic versions•Severity scales - more specific•Suicide risk will be discussed with many
diagnoses•Cultural context emphasized-
• section 3 - chapter on cultural formulation; structured interview •Implementation date unclear- ICD 10
• DSM-5 websites:• www.dsm5.org and www.psychiatry.org/dsm5
NOS Eliminated
• Other specified disorder• Other unspecified disorder• Provisional diagnoses – time limited
Multiaxial System Eliminated• Axis I-V eliminated• GAF eliminatedPsychosocial and environmental problems
eliminatedContributing medical conditions eliminated• V Codes still available• Decision trees in an appendix eliminated• Lots of specifiers are available• Online assessment measures at www.psychiatry.org/dsm5)
Diagnostic Groupings1. Neurodevelopmental Disorders2. Schizophrenia Spectrum and Other
Psychotic Disorders3. Bipolar and Related Disorders4. Depressive Disorders5. Anxiety Disorders6. Obsessive-Compulsive and Related
Disorders7. Trauma and Stressor-Related
Disorders8. Disruptive, Impulse Control, and
Conduct Disorders9. Personality Disorders
Neurodevelopmental Disorders
Category includes:Intellectual Disability Communication DisordersAutism Spectrum DisorderADHDSpecific Learning DisorderMotor Disorders
Intellectual DisabilityIQ not the sole diagnostic criteria IQ typically below 70Severity is based upon adaptive functioning and
IQ scoreReplaces Mental retardation - DSM-IVBorderline Intellectual Functioning is a V codeAssess functional ability in 3 domains:
◦ Conceptual-language, reading, writing, math, reasoning,knowledge, memory
◦ Social-empathy, social judgment, interpersonalcommunication skills, friendships
◦ Practical-personal care, job responsibilities, moneymanagement, recreation, organizing school and workactivities
Communication Disorders
Language Disorder ◦ Difficulties in acquisition and use of language
Speech Sound Disorder (was Phonological Disorder)
Childhood-Onset Fluency Disorder (was Stuttering)
Social (Pragmatic) Communication Disorder (new) ◦ Persistent difficulties in the social use of
verbal and nonverbal communicationAutism
Autism Spectrum Disorders (ASD)
Asperger’s, Childhood Disintegrative Disorder, Rett’s Disorder, and Pervasive Developmental Disorder (PDD) NOS will be eliminated
Autism Spectrum Disorders
Three domains in DSM-IV - Two in DSM-5:DSM-IV:1. Qualitative impairment in social interaction2. Qualitative impairments in communication3. Restricted repetitive and stereotyped, patterns of behavior, interests, and activities (RRB’s)DSM-5:1. Social and communication deficits2. Restricted repetitive behaviors, interests, and activities (RRB’s)
ADHD
Age of onset of symptoms will be raised from age 7 to age 12
Must have several symptoms two or more settings
Can now have a comorbid diagnosis with autism
Fewer symptoms needed for adults (5 instead of 6 for both inattention and hyperactivity/impulsivity)
Greater emphasis on identifying adults (but onset must still be before age 12)
Symptom lists basically unchanged
Schizophrenia Spectrum andOther Psychotic Disorders
Schizotypal Personality Disorder (also listed under personality disorders)
Delusional DisorderBrief Psychotic DisorderSchizophreniform DisorderSchizophreniaSchizoaffective Disorder
Schizophrenia Spectrum andOther Psychotic Disorders
The 5 subtypes of schizophrenia have been dropped. ◦Paranoid◦Disorganized◦Catatonic◦Undifferentiated◦Residual
Bipolar and Related Disorders
Bipolar I Disorder◦ Presence or history of one or more
manic episodes, may also have episodes of depression or hypomania
Bipolar II Disorder◦Presence or history of one or more
major depressive episodes◦ Presence or history of at least one
hypomanic episode◦There has never been a manic
episode◦Cyclothymic Disorder
Depressive Disorders
• Category includes:• Disruptive Mood
Dysregulation Disorder (new)• Major Depressive Disorder• Persistent Depressive
Disorder (was Dysthymia)• Premenstrual Dysphoric
Disorder (new)
Depressive Disorders• Core criteria are little changed from DSM-IV
• Prevalence:• 12-month=7%• 18-29 year olds 3x risk of people over 60• Females 1.5-3x greater risk than males
• Anxious Distress specifier (negatively impacts prognosis)
• Keyed up/tense• Unusually restless• Decreased concentration• Fear of something awful happening• Fear of losing control
Persistent Depressive Disorder(Dysthymia)Symptoms are a consolidation of
chronic major depression and dysthymia
Early or late onset (age 21 is dividing line)
Prevalence 1%
SuicidePrimary cause of psychiatric malpractice
suits but discussed rarely in DSM-IVU.S. Preventive Services Task Force has
determined that risk scales are not predictive of who will commit suicide
Active suicidal ideation (SI) is no more predictive than passive SI
When assessing risk look at:• Long-term factors• Recent factors (past 3 months)• Current factors (past week)
Disruptive Mood DysregulationDisorderNew diagnosisSimilar to Bipolar Disorder with
extreme temper and rage, also similar to Oppositional Defiant Disorder, but more severe
Prevalence 2-5%
Disruptive Mood DysregulationDisorderSevere recurrent temper outbursts• Verbal or behavioral• Inconsistent with developmental level
Mood between outbursts is persistently irritable or angry
Present in at least 2 settings, severe in at least one
Don’t diagnose before age 6 or after age18Frequency of at least 3 times weeklyDuration 12 months, no more than 3
months symptom-free
Premenstrual Dysphoric DisorderSymptoms usually begin during
the week before the menstrual cycle starts and terminate with the onset of menses
About 1.8-5.8% prevalenceMust happen in at least two
cycles
Anxiety DisordersPTSD and OCD no longer in this categoryCategory includes:• Separation Anxiety Disorder (can diagnose
with adult onset)• Selective Mutism• Specific Phobia• Social Anxiety Disorder (Social Phobia)• Panic Disorder• Panic Attack (now just a specifier)• Agoraphobia (now a stand-alone diagnosis,
doesn’t need to be linked with Panic Disorder)• Generalized Anxiety Disorder
Trauma and Stressor-Related DisordersCategory includes:• Reactive Attachment Disorder• Disinhibited Social Engagement
Disorder• PTSD• Acute Stress Disorder• Adjustment Disorders
Reactive Attachment DisordersDisorders develop out of insufficient care,
comfort, and affection or neglect and deprivation,
Reactive Attachment Disorder• The child rarely seeks comfort when
distressed and shows emotional distress when others attempt to provide comfort• Minimal social and emotional responsiveness• Limited positive affect• Unexplained irritability, sadness, or fearfulness• This is rare, affecting about 10% of severely
neglected children
Disinhibited Social EngagementDisorderDisinhibited Social Engagement
Disorder• The child is overly familiar with
strangers and does not hesitate to leave familiar caregivers• The child has loose boundaries with
people, little reticence with strangers• Doesn’t check back with caregiver
after venturing away• This is rare, about 20% of severely
neglected children
PTSDDSM-IV3 symptom clusters
– Re-experiencing– Avoidance and numbing– Arousal
DSM-54 symptom clusters
– Re-experiencing and intrusive symptoms– Avoidance– Arousal and reactivity– Negative alterations in cognitions and
mood
Trauma and Stressor-RelatedAdjustment Disorders• Begins within 3 months, lasts no longer than
6 months after the stressor has ceased• Most symptoms are similar to DSM-IV• Prevalence in outpatient mental health is 5-
20%
Acute Stress Disorder• With Acute Stress Disorder early
intervention can help prevent PTSD• Only half of people with ASD develop PTSD.
It’s not predictive.
Disruptive, Impulse-Control, andConduct DisordersTrichotillomania and Gambling movedCategory includes:• Oppositional Defiant Disorder• Intermittent Explosive Disorder (must be
at least 18)• Conduct Disorder• Pyromania• Kleptomania• Antisocial Personality Disorder (dually
listed here and in personality disorders section)
Limited Prosocial Emotions SpecifierSpecifier for use with Conduct
Disorder• Lack of remorse or guilt• Unconcerned about performance• Shallow or deficient affect• Callous, lack of empathy• Less sensitive to punishment cues• Thrill-seeking, less inhibited• More proactive and reactive aggression• Traits can diminish when quality of
parenting improves