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Lifes All About ChangeDSM 5, ICD-10 Codes, andASAM Levels Of CareOverviewIntroductionDSM Revision ProcessGeneral Changes to DSM-5New and Revised DisordersICD 10 and the DSM-5ImplicationsBefore the DSM1917- APA had a diagnostic system with 59 mental disorders1934 APA made revisions to classifications1940s Following WWII, military clinicians found little practical use for the APAs diagnostic system1948 6th edition of International Classification of Diseases published1948 APA began development on the DSM 1st Edition1952Queen Elizabeth II succeeded King George VI to the English throne

DSM 1 published with 106 Diagnosis

1968U.S. President Lyndon B. Johnson signs the Civil Rights Act of 1968

Green Bay Packers win Super Bowl II

Hey Jude is #1 on Billboard

DSM 2 published with 182 DiagnosisConformed to the ICD system

1980Ronald Regan is elected President

Bjorn Borg defeated John McEnroe in Wimbledon

Georgia is NCAA Football Champions

Ted Turner launches CNN

Another One Bites The Dust by Queen #1 BillboardDSM III published with 265 DiagnosisRetained conformity to the ICD systemMore emphasis on medical modelMulti-axial system that focused on symptoms rather than causes.

1987Dow Jones closes above 2000 for the first time

First Anti-Smoking campaign airs with Yul Brynner

Living on a Prayer is #1 on the Billboard DSM III R published Increased reliability and validityIncreased diagnosis to 292

1994Nancy Kerrigan is attacked by Tonya Hardings bodyguard

Lorena Bobbitt went to trial

6.6 Earthquake hit LA

Bill Clinton becomes the 42nd President

Forrest Gump is releasedDSM IV published Goal to retain conformity with ICD 9Changes included a detailed system of diagnostic criteriaDiagnoses increased to 3652000The Millennium/Y2K

Air France Flight 4590 Concorde crashes after takeoff killing all 109 passengers

NY Yankees wins 3rd straight World Series ChampionshipDSM IV R published No change in number of diagnoses Increase of 800% from 182 to 365 from 1952 to 2000

DSM-5 REVISION TIMELINEYearActivity1999Pre-Planning2006Task force formed2008-2010Literature review and data AnalysisApril 2010-December 2011Field trials in large, academic medical centersOctober 2010 February 2012Field trials in routine clinical practicesJuly 2012Final draft of DSM 5 for APA reviewDecember 2012Draft finalizedMay 20, 2013Publication dateprinciples to guide dsm-5 revision processHighest priority is clinical utility

Recommendations should be based on research evidence

When possible, continuity with the DSM IV should be maintained

There should be no pre-determined constraints on changes from DSM-IV in areas where the manuals organization and criteria were problematic

Concerns with the revision processEmpirical support Field trialsDimensional assessmentsLow reliabilitiesPossible boundary issues with pharmaceutical companiesKappa Values(Target >= 0.6 for diagnostic reliability )DSM-5DSM-IVDSM-IIIADHD0.610.590.50Alcohol use disorder0.400.80Antisocial PDAttenuated psychosis syndrome