Intro to DSM V

psychiatric, categorizes, clinicians

What is the DSM?

• Produced by the American _____________ Association

• Describes and ____________ all generally accepted forms of mental illness and other problems related to mental and behavioral life

• Utilized by → ____________, students, practitioners, researchers

classification, clusters, language, diagnosis

Why do we have a DSM?

• The DSM creates a reliable ____________ system

• Allows a researcher to study a group of people with similar symptom ___________

• Creates a common _____________ that allows psychiatrists and psychologists to communicate with each other and with professionals in other fields

• Relatively simple and useful reference to guide you in the ____________ of mental illness

insanity, epilepsy, Army, VA

A brief history of the DSM

• 1840 → one diagnosis (__________)

• 1880 → seven diagnoses (+ ____________)

• 1939 → WWII

  • US ______ made a list of psychiatric diagnoses

  • List was adapted by the __ administration and was ultimately included by the WHO in the international classification of diseases (ICD)

• 1952 → Diagnostics Statistics Manual (DSM)

  • APA adapted the ICD-6 classification into the first DSM

  • Little more than a pamplet

empirical, no, reinterpreted

Revision Guidelines for DSM-5

• Recommendations to be grounded in _____________ evidence

• There are __ present limitations on the number of changes that may occur over time with the new DSM-5

• The DSM-5 will continue to exist as a living, evolving document that can be updated and ______________ over time

developmental, deleted, diagnostic, etiological

Focus of DSM-5 Changes

• Emphasis was on ___________ adjustment criteria

• New disorders were considered, and older disorders were to be ___________

• There is a dimensional component to the categories to be further researched and covered in Section III of the DSM-5

• The _____________ groups have been reshuffled

• DSM-5is striving to be more _____________ → however disorders are caused by a complex interaction of multiple factors and various etiological factors can present with the same sx pattern

mental disorder, disability, culturally, deviant, dysfunction

Definition of a Mental Disorder

• A ________ _________ is 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

• Mental disorders are usually associated with significant distress or _____________ in social, occupational, or other important activities

• An acceptable or ___________ approved response to a common stressor or loss, such as death of a loved one, is not a mental disorder

• Socially _________ behavior (eg political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a ____________ in the individual, as described above

prognosis, treatment, outcomes, treatment, severity, salience, distress

Why identify a mental disorder diagnosis?

• Diagnosis of a mental health disorder should have clinical utility:

  • Helps to determine ___________

  • Helps in development of ____________ plans

  • Helps to give an indication of potential treatment ___________

  • A diagnosis of a mental disorder is not equivalent to a need for ____________. Need for treatment is a complex clinical decision that takes into consideration:

    • Symptom ___________

    • Symptom _________ (presence of relevant symptoms eg: presence of suicidal ideation)

    • The client’s _________ (mental pain) associated with the symptom(s)

    • Disability related to the client’s symptoms, risks, and, benefits of available treatment

    • Other factors such as mental symptoms complicating other illnesses

axis, personality, GAF, dimensional

Obvious Changes in DSM-5

• The DSM-5 discontinued the multiaxial diagnosis, no more _____ I, II, III, IV, and V → means that ___________ disorders will now appear as diagnostic categories and there will be no more ___ score or listing of psychosocial stressor or contributing medical conditions

• The multi-axial model will be replaced by ______________ component to diagnostic categories

developmental, gender, cultural, alphanumeric

Obvious Changes in DSM-5

• _____________ adjustments added to criteria

• The goal has been to have the categories more sensitive to ________ and __________ differences

• Diagnostic codes will change from numeric to _______________

  • Ex → OCD will change from 300.3 to F42

• They have done away with the NOS labeling and replaced it with other specified … or unspecified

specified, unspecified, classification, unwilling, 6

What Replaces ‘Not otherwise specified’ (NOS)?

• NOS is replaced by either → other __________ disorder or ____________ disorder type. These are to be used if the dx is uncertain because of 

  • Behaviors which are associated with a ___________ are seen but there is uncertainty regarding the diagnostic category

  • The pt has been ____________ to provide info d/t and unwillingness to be w/ the clinician or angery about being brough in to be seen or there is too brief a period in which the pt has been seen

  • Rules of use of other specific or unspecified

• The designation can last only _ months and after that a specific diagnostic category must be determined for the diagnosis

inpatient, outpatient, harder, equally, principle, attention

Principle Diagnosis

• Principle diagnosis is to be used when more than one diagnosis for an individual is given in most cases as the main focus of attention or treatment

  • __________ setting

    • principle diagnosis is the condition established to be chiefly responsible for the admission of the individual

  • ___________ setting

    • principle diagnosis is the condition established as reason for visit responsible for care to be received

• Often ________ to ID when a substance/med related disorder is accompanied by a non-substance-related dx such as MDD since both may have contributed equally to the need for admission or treatment

• ___________ dx is listed first and the term “principle dx” follows the diagnosis name

• Remaining disorders are listed in order of focus of ____________ and treatment

presumption, information, provisional

Provisional Diagnosis

• Specifier “provisional” can be used when there is a strong ___________ that the full criteria will be met for a disorder, but not enough _____________ is available for a firm diagnosis

• It must be recorded “______________” following the diagnosis given

valid, groups, individuals, examination

Why take a course if I have a DSM-5?

• DSM diagnoses are reliable, but not necessarily ______

• The DSM is focused on _______ of people, not ____________

• No checklist can substitute for judgement and a careful clinical _____________

psychosocial, mental status, testing

Steps to formulate an initial diagnosis

1. Do a thorough ______________ history

2. Do a ________ _________ examination

3. Order appropriate diagnostic __________

4. Develop a diagnosis using DSM-5