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liveonearth) wrote2013-11-05 07:12 pm
liveonearth) wrote2013-11-05 07:12 pm
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DSM 5 (not V) Notes
These notes from the Oct 15, 2013 Grand Rounds at OHSU in the Psychiatry department. Watching it online, it's about "what you need to know about the new DSM".
SOURCE
http://www.ohsu.edu/edcomm/flash/flash_player.php?params=4`/sch/som/psyc/pgr101513.flv`vod&width=640&height=480&title=Psychiatry%20Grand%20Rounds%20Oct.%2015th%2C%202013
A diagnosis is not everything; it is clinical shorthand
Group of pts that seem to present in similar way
Doesn't predict the future
Schizophrenics: some get better, in spite of idea that it is progressive
Also need to know: genetics, FOA, presentation, culture, substances
DSM 5 not V because they intend to come out with 5.1 and on up, like software
HISTORY
DSM = diagnostic and statistical manual
Originally made for pts that are in asylums, a dictionary of disorders (before WWII)
1917 first precursor manual was released
1952 DSM1 out
DSM 3 is more medically oriented
DSM 4 longer effort, involving more people
DSM 5 trying to understand how to best make dxs, publishing this year
SECTIONS
1 Basics
2 Diagnostic Criteria and Codes
3 Emerging Measures and Models (Dimensional Assessments are new)
Appendix
GONE: multiaxial diagnosis, NOS diagnoses (now it's Unspecified or Other Specified)
NEURODEVELOPMENTAL DISORDERS
(new chapter)
Mental Retardation is gone, now known as Intellectual Disability Disorder
Severity used to be determined by IQ, now by a functional assessment, how much help do they need
Communication Disorders renamed
Child Onset Fluency Disorder = stuttering
Social or Pragmatic Communication Disorder = lack of appropriate contextual and modulated language and nonverbal communications
Specific Learning Disorder is merged from many
ADHD must have sx by age 12 (instead of 7, more people will be included)
AUTISM SPECTRUM DISORDER
major changes
aspergers, PDD NOS, others all consolidated
two domains: social communication and interaction, repetitive behavior
sx by the age of 3 no more, just has to be early development
Severity = requiring support, substantial support, very substantial support
SCHIZOPHRENIA AND OTHER PSYCHOSIS
old: sx = bizarre, running commentary, hearing voices, somatic delusions (historic descriptions)
new: more specific for positive sx: delusions, hallucinations and disorganized speech
subtypes eliminated (paranoid, disorganized, catatonic, undifferentiated)
"You are either in or you're out", you have the dx or you don't
DEPRESSIVE DISORDERS
NEW: PERSISTENT DEPRESSIVE DISORDER
incl dysthymia to major depression that lasts a long time
bereavement exlusion for depression, lasts less than 2 mo after death of loved one
can have some manic sx in depression without giving bipolar dx
panic disorder and agoraphobia are separated now
panic attacks can be attached to any dx
OCD and PTSD are no longer in anxiety chapter
social anxiety disorder can be dxd without pt insight
acute stress disorders
trauma and stress related
less emphasis on dissociative sx
adjustment disorders reconceptualized as a stress response disorder
PTSD
more explicit about traumatic events
seeing someone killed, nearly being killed, subjective reaction does not have to be shock or horror
4 sx clusters, added: persistent negative in cognition and mood, inability to remember events, negative emotional state (fear, horror)
can combine PTSD and depression disorders
DISSOCIATIVE DISORDERS
Depersonalization and derealization disorder
disociative fugue now specifier of amnesia
dissociative identity disorder can include gaps in remembering ADLs
ADDICTIVE DISORDERS
now includes gambling, behavioral
substance abuse and dependence are no longer separated
uses substance plus description of severity
cravings added, legal problems removed
severity criteria used to describe
NO MORE POLYSUBSTANCE DEPENDENT
you have to specify which ones they want
"in a controlled environment"
"on maintenance therapy"
SOMATIC SYMPTOM DISORDER
Undifferentiated
may have a single somatic symptom
levels of severity
may become a catch all in the new system depending on reimbursement
Illness anxiety disorder = was hypochondriasis
NEW DX: Psych factors affecting other medical conditions
ex: food addiction-->diabetes
include relative to adherence to tx regimen: pt can't do what they are told (noncompliant)
(how medically dangerous is this nonadherence)
OCD
has its own chapter now
incl hoarding, excoriation, trichotillamania, body dysmorphic disorder, med-induced OCD
insight criteria refined: more levels, good fair poor, absent, delusional
body dysmorphic disorder: incl muscle dysphoria, repetitive behavior criteria
DISRUPTIVE IMPULSE CONTROL AND CONDUCT DISORDERS
ODD, intermittent explosive, conduct, pyromania, kleptomania
antisocial personality disorder
ODD has 3 types: angry/irrit, angry/defiant, vindictive
Intermit explosive: used to require physical outburst, now can be just verbal abuse
NEUROCOGNITIVE
lumped dementias and amnestic disorders
delirium in here too
major and mild types
severity specifier, functional assessment relative to difficulties with ADLs (mild, mod, sev)
PERSONALITY DISORDERS
discussed changing criteria, big debate
end result: some change
New: alternative model in section III, great relevance for the future but not part of formal dx at this time
Pathologic personality traits: negative affect, detachment, antagonism, disinhibition, psychotic
Rate on each of these
REIMBURSEMENT
V codes = stressors
insurance used to only cover axis 1 dxs
hoping more will be covered
SOURCE
http://www.ohsu.edu/edcomm/flash/flash_player.php?params=4`/sch/som/psyc/pgr101513.flv`vod&width=640&height=480&title=Psychiatry%20Grand%20Rounds%20Oct.%2015th%2C%202013
A diagnosis is not everything; it is clinical shorthand
Group of pts that seem to present in similar way
Doesn't predict the future
Schizophrenics: some get better, in spite of idea that it is progressive
Also need to know: genetics, FOA, presentation, culture, substances
DSM 5 not V because they intend to come out with 5.1 and on up, like software
HISTORY
DSM = diagnostic and statistical manual
Originally made for pts that are in asylums, a dictionary of disorders (before WWII)
1917 first precursor manual was released
1952 DSM1 out
DSM 3 is more medically oriented
DSM 4 longer effort, involving more people
DSM 5 trying to understand how to best make dxs, publishing this year
SECTIONS
1 Basics
2 Diagnostic Criteria and Codes
3 Emerging Measures and Models (Dimensional Assessments are new)
Appendix
GONE: multiaxial diagnosis, NOS diagnoses (now it's Unspecified or Other Specified)
NEURODEVELOPMENTAL DISORDERS
(new chapter)
Mental Retardation is gone, now known as Intellectual Disability Disorder
Severity used to be determined by IQ, now by a functional assessment, how much help do they need
Communication Disorders renamed
Child Onset Fluency Disorder = stuttering
Social or Pragmatic Communication Disorder = lack of appropriate contextual and modulated language and nonverbal communications
Specific Learning Disorder is merged from many
ADHD must have sx by age 12 (instead of 7, more people will be included)
AUTISM SPECTRUM DISORDER
major changes
aspergers, PDD NOS, others all consolidated
two domains: social communication and interaction, repetitive behavior
sx by the age of 3 no more, just has to be early development
Severity = requiring support, substantial support, very substantial support
SCHIZOPHRENIA AND OTHER PSYCHOSIS
old: sx = bizarre, running commentary, hearing voices, somatic delusions (historic descriptions)
new: more specific for positive sx: delusions, hallucinations and disorganized speech
subtypes eliminated (paranoid, disorganized, catatonic, undifferentiated)
"You are either in or you're out", you have the dx or you don't
DEPRESSIVE DISORDERS
NEW: PERSISTENT DEPRESSIVE DISORDER
incl dysthymia to major depression that lasts a long time
bereavement exlusion for depression, lasts less than 2 mo after death of loved one
can have some manic sx in depression without giving bipolar dx
panic disorder and agoraphobia are separated now
panic attacks can be attached to any dx
OCD and PTSD are no longer in anxiety chapter
social anxiety disorder can be dxd without pt insight
acute stress disorders
trauma and stress related
less emphasis on dissociative sx
adjustment disorders reconceptualized as a stress response disorder
PTSD
more explicit about traumatic events
seeing someone killed, nearly being killed, subjective reaction does not have to be shock or horror
4 sx clusters, added: persistent negative in cognition and mood, inability to remember events, negative emotional state (fear, horror)
can combine PTSD and depression disorders
DISSOCIATIVE DISORDERS
Depersonalization and derealization disorder
disociative fugue now specifier of amnesia
dissociative identity disorder can include gaps in remembering ADLs
ADDICTIVE DISORDERS
now includes gambling, behavioral
substance abuse and dependence are no longer separated
uses substance plus description of severity
cravings added, legal problems removed
severity criteria used to describe
NO MORE POLYSUBSTANCE DEPENDENT
you have to specify which ones they want
"in a controlled environment"
"on maintenance therapy"
SOMATIC SYMPTOM DISORDER
Undifferentiated
may have a single somatic symptom
levels of severity
may become a catch all in the new system depending on reimbursement
Illness anxiety disorder = was hypochondriasis
NEW DX: Psych factors affecting other medical conditions
ex: food addiction-->diabetes
include relative to adherence to tx regimen: pt can't do what they are told (noncompliant)
(how medically dangerous is this nonadherence)
OCD
has its own chapter now
incl hoarding, excoriation, trichotillamania, body dysmorphic disorder, med-induced OCD
insight criteria refined: more levels, good fair poor, absent, delusional
body dysmorphic disorder: incl muscle dysphoria, repetitive behavior criteria
DISRUPTIVE IMPULSE CONTROL AND CONDUCT DISORDERS
ODD, intermittent explosive, conduct, pyromania, kleptomania
antisocial personality disorder
ODD has 3 types: angry/irrit, angry/defiant, vindictive
Intermit explosive: used to require physical outburst, now can be just verbal abuse
NEUROCOGNITIVE
lumped dementias and amnestic disorders
delirium in here too
major and mild types
severity specifier, functional assessment relative to difficulties with ADLs (mild, mod, sev)
PERSONALITY DISORDERS
discussed changing criteria, big debate
end result: some change
New: alternative model in section III, great relevance for the future but not part of formal dx at this time
Pathologic personality traits: negative affect, detachment, antagonism, disinhibition, psychotic
Rate on each of these
REIMBURSEMENT
V codes = stressors
insurance used to only cover axis 1 dxs
hoping more will be covered