What are the benefits of having the DSM
Diagnosis:
1. Reduces clinical complexity
2. Treatment Guides
3. Enables communication
4. *Helps to determine
... [Show More] benefits levels from various programs(
5. Legal relevance
6. Epidemiology
What are the diagnostic issues specific to mental disorders?
1. differentiation between diagnosis.
2. No biological test for mental illnesses (subjective reporting of diagnosis)
3. Changes in the DSM over time. (what is actually a disorder)
4. Difference in Cultural factors -how people act, relate, and presentations.
5. Subjective treatments (moral judgments.
Mental disorder
A syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. (have to involve some type of dysfunction and reflect disability/social, occupation)
^^Just being deviant or conflict with other individual is not diagnosable.
Design of the DSM
1-Polythetic Criteria Set (x number of symptoms to qualify for the diagnosis.)
2. Categories are not mutually exclusive.
3. Design to maximize clinical usefulness.
Polythetic Criteria Set
-for a diagnosis to be made, a person may have some but not all of the possible diagnostic criteria.
Advantages of the DSM system
-Creates a framework to guide research about treatment
-Creates a framework that may be used to guide treatment decisions
-Enables communication among providers
-Increases diagnostic reliability
-Clarifies process of differential diagnosis
Disadvantages of the DSM
Reliability
1. One underlying issue (e.g. severe childhood abuse) can lead to a very large number of diagnoses
2. May lead to labeling people in ways that undermine identity and self-esteem, and lead to seeing a disease rather than a person
3. May lead to expectations about prognosis that become self-fulfilling prophecies (e.g. individuals with schizophrenia in developing countries have substantially better outcomes than those in developed countries)
-uses of antipsychotic (thought that schizophrenia must be a life long treatment. )
DSM-III
merely described the disorders and did not talk about etiologies. This was a changes from DSM 1 & 2.
DSM-5
version of Diagnostic and Statistical Manual of Mental Disorders set to be published in 2013; includes changes to many diagnostic categories (e.g. personality disorders) and more emphasis on severity of symptoms in diagnosis
DSM Transition of 4 to 5
1. The previous 5-axis system of diagnosis was eliminated
Provides information about diagnoses, but does not offer specific guidelines about treatment
2. Moves towards a more dimensional (as opposed to categorical) approach
--E.g. one Autism-Spectrum Disorder as opposed to the five separate categories found in the DSM-IV-TR
3. Organized to follow the lifespan (i.e. diagnoses at the beginning of the book typically manifest early in life)
4. Addition of Disruptive Mood Regulation Disorder (this was invented to fix a mix diagnosis problem.) Resolve to stop the easy diagnosis Bi-polar
no treatments purely diagnostic
Criticism of the DSM-5
1. Normal problems are increasingly seen as pathology.
-removal of MDD
-lowering criteria for GAD
-Removal of Asperger's as 2nd dx
2. Influence from pharmaceutical industry
3. Shift attention to people who could do well without while those who need help don't get it.
Diagnostic with the DSM-5
1. Prototype for the diagnosis, but pt doesn't fit into the criteria.
2. Clinicians vary on whether to adhere strictly to criteria or to diagnose based on similarity to the most relevant prototype
3. Pressure to diagnose "down" avoiding stigmatism
4. Pressure to diagnose "up" -insurance or justify a higher level of care.
Syndrome
cluster of signs and symptoms occurring together that are characteristic of a specific disorder
Many psychiatric disorders this:
Major Depressive Episode symptoms constitute this
Categories of DSM-5
Neurodevelopmental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
Depressive Disorders
Anxiety disorders
Obsessive-Compulsive and Related Disorders
Trauma- and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom and Related Disorders
Feeding and Eating Disorders
Elimination Disorders
More Categories of DSM-5
Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse Control, and Conduct Disorders
Substance-Related and Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilic Disorders
Other Mental Disorders
Medication-Induced Movement Disorders and Other Adverse Effects of Medication
Other Conditions That May Be a Focus of Clinical Attention
Rules for Diagnostic Precedence for DSM-5
The text of each diagnosis contains a section on differential diagnosis that highlights the features that differentiate that diagnosis from other, similar diagnoses (such as symptom duration)
In some cases, the criteria are such that an individual could meet full criteria for more than one diagnosis in a section
In this case, the text will typically state which diagnosis takes precedence
Prevalence
Point prevalence is the percentage of a population that currently has the diagnosis
Lifetime prevalence is the percentage of a population that has met criteria for the diagnosis at any point in life
Incidence is the rate of occurrence of new cases in a population
Course
usual pattern of the disorder across time)
Age of onset
Gradual vs. abrupt onset
Episodic vs. continuous course
Single episode vs. recurrent episodes
Duration
Progression
Familial pattern
Frequency of the disorder among first-degree relatives
Other disorders that are more common in family members of affected individuals
Differential Diagnosis
Each diagnosis has a section describing how to differentiate it from other, similar diagnoses
WHODAS 2.0
Replaces the Axis V Global Assessment of Functioning as the way to communicate level of impairment in functioning
36-item self administered scale of functioning in adults
Six domains
Cognition
Mobility
Self-care
Getting along with people
Life activities (household and school/work)
Participation in society [Show Less]