Although the DSM classification represents a categorical approach to the diag- nosis of mental disorders, such approaches have a number of shortcomings.
... [Show More] Which of the following is not a limitation of categorical approaches as de- scribed in DSM-5?
A. Failure to find "zones of rarity" between diagnoses.
B. Need to create intermediate categories.
C. Low rates of comorbidity.
D. Frequent use of "not otherwise specified (NOS)" diagnoses.
E. Lack of treatment specificity for various diagnostic categories.
Low rates of comorbidity.
Explanation: According to DSM-5, the limitations of a categorical diagnostic system include the failure to find zones of rarity between diagnoses (i.e., delineation of mental disorders from one another by natural boundaries), the need for intermediate categories like schizoaffective disorder, high rates of comorbidity, frequent use of NOS diagnoses, relative lack of utility in furthering the identification of unique antecedent validators for most mental disorders, and lack of treatment specificity for the various diagnostic categories.
Which of the following statements about the World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0), is true?
a. It is a clinician-administered scale.
b. It focuses only on disabilities due to psychiatric illness.
c. It assesses a patient's ability to perform activities in six functional areas.
d. It is available in both an adult self-rated version and a parent/guardian-rated version.
e. It primarily measures physical disability.
It assesses a patient's ability to perform activities in six functional areas.
Explanation: The WHODAS 2.0 was developed to assess a patient's ability to perform activities in six areas: understanding and communicating; getting around; self-care; getting along with people; life activities (e.g., household, work/school); and participation in society. The scale corresponds to concepts contained in the WHO International Classification of Functioning, Disability and Health. This assessment can also be used over time to track changes in a patient's disabilities.
The adult self-administered version of WHODAS 2.0 was designed to be used in adults age 18 years and older with any medical disorder. If the adult individual is of impaired capacity and unable to complete the form (e.g., a patient with dementia), a knowledgeable informant may complete the proxy-administered version of the measure (available at www.psychiatry.org/dsm5).
Which of the following statements about the DSM-5 Level 1 Cross-Cutting Symptom Measure is true?
a. It is intended to help clinicians assess a patient's ability to perform activities in six areas of daily life functioning.
b. It asks about the presence and frequency of symptoms in 13 psychiatric domains.
c. It focuses only on symptoms present at the time of the interview.
d. It lacks validity data in clinical settings and is primarily intended as a research tool.
e. Because it is self-rated, it cannot be used with patients who have communication or cognitive disorders.
It asks about the presence and frequency of symptoms in 13 psychiatric domains.
Explanation: The DSM-5 Level 1 Cross-Cutting Symptom Measure is a patient- or informant-rated measure that assesses mental health domains that are important across psychiatric diagnoses. It is intended to help clinicians identify additional areas of inquiry that may have significant impact on the individual's treatment and prognosis. In addition, the measure may be used to track changes in the individual's symptom presentation over time.
The adult version of the self-rated DSM-5 Level 1 Cross-Cutting Symptom Measure consists of 23 questions that assess 13 psychiatric domains, including depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors, dissociation, personality functioning, and substance use. Each item inquires about how much (or how often) the individual has been bothered by the specific symptom during the past 2 weeks. If the individual is of impaired capacity and unable to complete the form (e.g., an individual with dementia), a knowledgeable adult informant may complete this measure. The measure was found to be clinically useful and to have good reliability in the DSM-5 field trials that were conducted in adult clinical samples across the United States and in Canada.
In clinician review of item scores on the DSM-5 Level 1 Cross-Cutting Symptom Measure for an adult patient, a rating of "slight" would call for further inquiry if found for any item in which of the following domains?
A. Depression.
B. Mania.
C. Anger.
D. Psychosis.
E. Personality functioning.
Psychosis.
Explanation: On the adult self-rated version of the DSM-5 Level 1 Cross-Cutting Symptom Measure, each item is rated on a 5-point scale (0=none or not at all; 1=slight or rare, less than a day or two; 2=mild or several days; 3=moderate or more than half the days; and 4=severe or nearly every day). Whereas for most domains, a rating of mild (i.e., 2) or greater for any item within the domain is the threshold to guide further inquiry, for the substance use, suicidal ideation, and psychosis domains, a rating of slight (i.e., 1) or greater is the threshold for pursuing additional inquiry and follow-up to determine if a more detailed assessment is needed (which may include the Level 2 cross-cutting symptom assessment for that domain).
If a parent answers "I don't know" to the question "In the past TWO (2) WEEKS, has your child had an alcoholic beverage (beer, wine, liquor, etc.)?" in the parent/guardian-rated version of the DSM-5 Level 1 Cross-Cutting Symptom Measure, what is the appropriate clinician response?
a. Advise that the child be hospitalized before further workup proceeds.
b. Ask the child questions from the substance use domain of the child-rated Level 2 Cross-Cutting Symptom Measure.
c. Rely on other questions from the substance use domain and do not incorporate this answer into the final score.
d. Ask the parent to ask the child, and schedule a follow-up visit to re-administer the questionnaire.
e. Consider reporting the parent to child protective services.
Ask the child questions from the substance use domain of the child-rated Level 2 Cross-Cutting Symptom Measure.
Explanation: On the parent/guardian-rated version of the DSM-5 Level 1 Cross-Cutting Symptom Measure for children age 6-17, items in 2 of the 12 domains—suicidal ideation/attempts and substance use—are each rated on a "Yes, No, or Don't Know" scale. A parent or guardian's rating of "Don't Know" on the suicidal ideation, suicide attempt, and any of the substance use items, especially for children ages 11-17 years, would warrant additional prob- ing of the issues with the child, including using the child-rated Level 2 Cross- Cutting Symptom Measure for the relevant domain (see Table 2). [Show Less]