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TRANSCRIPT
K. Dayle Jones, Ph.D., LMHC University of Central Florida
Diagnosis with DSM-5 and ICD
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Introduction General Classification Changes for DSM-5 New and Revised Disorders ICD and the DSM DSM-5 and Implications for Diagnostic
Classification - Discussion
Overview
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Introduction: Diagnostic & Statistical Manual of
Mental Disorders
Purposes: Clinical utility Research Common language Educational tool
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General Classification Changes
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DSM-5 Organizational Structure
Section I: DSM-5 Basics
Section II: Essential Elements: Diagnostic Criteria & Codes
Section III: Emerging Measures and Models
Appendix
Sections:
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Section II Table of Contents (1)
1. Neurodevelopmental D/Os
2. Schizophrenia Spectrum & Other Psychotic D/Os
3. Bipolar & Related D/Os
4. Depressive D/Os
5. Anxiety D/Os
6. Obsessive-Compulsive & Related D/Os
7. Trauma- & Stressor-Related D/Os
7. Dissociative D/Os
8. Somatic Symptom & Related D/Os
9. Feeding & Eating D/Os
10. Elimination D/Os
11. Sleep-Wake D/Os
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Section II Table of Contents (2)
13. Sexual Dysfunctions
14. Gender Dysphoria
15. Disruptive, Impulse-Control, & Conduct D/Os
16. Substance-Related & Addictive D/Os
17. Neurocognitive D/Os
18. Personality D/Os
19. Paraphilia D/Os
20. Other Mental D/Os
21. Medication-Induced Movement D/Os & Other Adverse Effects of Medication
22. Other Conditions That May Be a Focus of Clinical Attention
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New nonaxial documentation of diagnosis Combined former Axes I, II and III Eliminated Axis IV. Use “Z codes” (V codes) Eliminated Axis V: GAF.
Propose use of World Health Organization Disability Assessment Schedule (WHODAS) (in Section III).
Removal of Multiaxial System
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Changed diagnostic codes from numeric to alphanumeric. Examples:
New Diagnostic Codes
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ICD-9 ICD-10 OCD 300.3 F42
PTSD 309.81 F43.1
Coding Example in DSM-5
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ICD-9 Code
ICD-10 Code
Current approach: Categorical (binary): presence or absence of disorder
(DSM-IV) Proposed approach: Dimensional (ordinal): disorders are dimensions on
continuous distribution
Working Towards Dimensional Classification Approach
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New and Revised Disorders
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Removed bereavement criterion Added “anxious distress” specifier Added “with mixed features”
Major Depressive Disorder
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Incorporates both Dysthymia and Major Depressive Disorder, Chronic No longer considered “milder” form of depression
Persistent Depressive Disorder (Dysthymia)
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Criterion A for Manic Episode and Hypomanic Episode emphasizes changes in activity and energy, as well as mood Dropped “mixed episode” Added “mixed specifier” Added “with anxious distress” specifier
Bipolar I Disorder
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Temper outbursts involving yelling, rages or physical aggression Overreacting to common stressors Temper outbursts occurring on average 3 or more
times a week for at least 12 months (not symptom-free for more than 3 months at a time) Children age 6 to 18 years
Disruptive Mood Dysregulation Disorder (DMDD)
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Generalized anxiety disorder Panic disorder Agoraphobia Specific phobia Social anxiety disorder (social phobia) Separation anxiety disorder Selective mutism
Anxiety Disorders
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New grouping: Obsessive-Compulsive Disorder Body Dysmorphic Disorder Hoarding disorder Trichotillomania (Hair-Pulling Disorder) Excoriation (Skin-Picking) Disorder
Obsessive-Compulsive & Related Disorders
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Criterion A is more explicit with regard to how an individual experienced “traumatic” events. 4 symptom clusters:
1. Re-experiencing 2. Avoidance 3. Negative cognitions 4. Specify
Note: Separate criteria set for “PTSD for Children 6 Years and Under”
Posttraumatic Stress Disorder
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Eliminated schizophrenia subtypes.
Two criterion A symptoms (one must include 1-3) 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly abnormal psychomotor behavior 5. Negative symptoms
Schizophrenia
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DSM-5 maintained the 10 personality disorder categories and criteria from DSM-IV
Axis II eliminated
A new trait-specific model of personality disorders will be included in Section III to encourage further study.
Personality Disorders
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Combined Abuse and Dependence Requires 2 of 11 symptoms Deleted legal criterion Added “craving” criterion Severity of a Substance Use Disorder:
Mild: 2 to 3 symptoms Moderate: 4-5 symptoms Severe: 6 or more symptoms
Substance Use Disorder
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Moved to “Substance Use and Addictive Disorders” New “behavioral addiction” Added Internet Gaming Disorder to Section 3
Gambling Disorder
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Combines autistic disorder, Asperger’s disorder, childhood disintegrative disorder, & pervasive developmental disorder NOS. Symptoms in two core areas:
1. deficits in social communication & social interaction 2. restricted repetitive behaviors, interests, & activities
New dimensional assessment
Autism Spectrum Disorder
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Name change Severity specifiers:
Determined by adaptive functioning rather than IQ score Assessed using new dimensional assessment Severity Levels: Mild, Moderate, Severe, Profound
Intellectual Disability (Intellectual Developmental Disorder)
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Cognitive decline from previous level of functioning in at least 1 of 6 domains (complex attention, executive function, learning and memory, language, perceptual motor, social cognition) Specify etiology
Difference: Major: interferes with independence Mild: no interference with independence
Major Neurocognitive Disorder Mild Neurocognitive Disorder
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Feeding disorders: pica, rumination disorder and avoidant/restrictive food intake disorder
Eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder
Feeding and Eating Disorders
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Gender Dysphoria Replaces the term “gender identity disorder” Separated from Sexual Disorders
Gender Dysphoria
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Eliminated the term “somatoform” Drops centrality of “unexplained medical symptoms” The disorders: Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder Psychological Factors Affecting Other Medical Conditions Factitious Disorder
Somatic Symptom & Related Disorders
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ICD and the DSM
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Classification system used to track morbidity and mortality of all diseases. Developed by the World Health Organization
International Classification of Diseases (ICD)
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In U.S.: Current version: ICD-9-CM As of October 2014: ICD-10-CM
DSM-IV lists ICD-9-CM codes DSM-5 lists both ICD-9-CM and ICD-10-CM codes
ICD and DSM
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Questions and Discussion
DSM-5 and Implications for Diagnostic Classification
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References American Psychiatric Association (APA). (2010). American Psychiatric Association DSM-5
development. Retrieved from http://www.dsm5.org/Pages/Default.aspx. American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental
disorders, fifth edition (DSM-5). Washington DC: Author. American Psychiatric Association (APA). (2013). Highlights of Changes from DSM-IV-TR to
DSM-5. Retrieved from http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf
First, M. B. (2010). Paradigm shifts and the development of the diagnostic and statistical manual of mental D/Os: Past experiences and future aspirations. The Canadian Journal of Psychiatry, 55, 692-700.
Kraemer, H. C. (2007). DSM categories and dimensions in clinical and research contexts. International Journal of Methods in Psychiatric Research, 16(S1), S8–S15.
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Kupfer, D. J. (2013, March). Psychiatry update: The DSM-5 and more. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CDIQFjAA&url=http%3A%2F%2Fwww.acponline.org%2Fabout_acp%2Fchapters%2Fva%2F13mtg%2Fkupfer_psychiatryupdate.pptx&ei=PRZTUcmyOo3c8wSK4YHQDQ&usg=AFQjCNFCPlZX8LJQfE7uFMKx1mGio1TVig&bvm=bv.44342787,d.eWU
Moran, M. (2013). Continuity and Changes Mark New Text of DSM-5. Psychiatric News, 48(2), 1-6.
Moran, M. (2013). DSM-5 Fine-Tunes Diagnostic Criteria for Psychosis, Bipolar Disorders. Psychiatric News, 48(3), 10-11.
Moran, M. (2013). DSM-5 Provides New Take on Neurodevelopment Disorders. Psychiatric News, 48(2), 6-23.
Moran, M. (2013). DSM-5 updates depressive, anxiety and OCD criteria. Psychiatric News, 48(4), 22-43.
Moran, M. (2013). Somatic chapter drops centrality of unexplained medical symptoms. Psychiatric News, 48(5), 7-7.
Olfson, M., & Marcus, S. C., (2010). National trends in outpatient psychotherapy. American Journal of Psychiatry, 167, 1456-1463.
World Health Organization (2012). WHO Disability schedule assessment 2.0 (WHODAS 2.0). Retrieved from http://www.who.int/entity/classifications/icf/WHODAS2.0_36itemsSELF.pdf
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