Psychiatric Disorders & DSM-5 Changes: Key Concepts and Diagnostic Criteria

Intellectual Development Disorder - IDA

Intellectual: Deficits in reasoning, problem solving, planning, abstract thinking, judgment, academic learning, learning from experience

Developmental: Onset during developmental period

Adaptive: Deficits in communication, social participation, independent living

All 3 must be met;

Specifiers: Mild, Moderate, Severe, Profound

IDD Differential Diagnosis

Differential Diagnosis:

• Major and Minor neurocognitive disorders

• Communication disorder and specific learning disorders

• Autism spectrum disorder

Autism Spectrum Disorder - SEND

Deficits in Social-emotional reciprocity

Deficits in Nonverbal communicative behaviors

Deficits in Developing, maintaining, understanding relationships

ASD - IRIS

Restricted/repetitive behaviors: Inflexible (sameness, rituals)

Repetitive (motor, objects, speech)

Interests (fixated, abnormal intensity)

Sensory (hyper/hyporeactivity)

ASD - How to use

Persistent SEND deficits + at least 2 IRIS Specifiers: level of support, with/without intellectual impairment, with/without language impairment, medical/environmental factors, Catatonia

ASD Differential Diagnosis

Differential Diagnosis:

• ADHD

• ISD

• Language disorders and social (pragmatic) communication disorder

• Selective mutism

• Stereotypic movement disorder

• Rett Syndrome

• Symptoms associated with anxiety disorders

• OCD

• Schizophrenia

• Personality Disorders

ADHD - MOAT (Inattentive)

Mistakes (careless)

Organization (difficulty)

Attention (sustaining)

Tasks (avoids sustained effort)≥6 symptoms for ≥6 months

ADHD - RUNS FAST (Hyperactive/Impulsive)

Restless/fidgets

Unable to stay seated

Noisy (runs/climbs)S

peaks excessively

Fidgets/taps

Answers out of turn

Stays 'on the go'

Trouble waiting≥6 symptoms for ≥6 months

ADHD Differential Diagnosis

Differential Diagnosis: ODD, Intermittent Explosive Disorder, Other neurodevelopmental disorders, Specific learning disorder, IDD, ASD, Reactive attachment disorder, anxiety disorders, PTSD, Depressive disorders, Bipolar disorder, Disruptive mood regulation disorder, Substance use disorders, Personality disorders, Psychotic disorders, Medication-induced symptoms of ADHD, Neurocognitive disorders

ODD - ARGUE

Argumentative with authority figures

Resentful/angry

Grudges/vindictive

Upset easily

Everyday defiance

Duration ≥6 months

Conduct Disorder - TRAP

Threats/aggression toward people or animals

Rule violations (serious)

Aggression toward people/animals

Property destruction

Duration ≥12 months

Intermittent Explosive Disorder - V-BOP

Verbal aggression (2/week × 3 months, no damage)

Behavioral outbursts (3 in 12 months, with damage/injury)

Out of proportion aggression

Premeditation absent

Age ≥6; Not part of adjustment disorder (age 6-18)

Kleptomania - IT NAG

Impulse to steal (cannot resist)

Tension before theft

Not better explained by CD, mania, antisocial

Anger not motive

Gratification at theft

Specific Learning Disorder - RAW SUN

Reading (inaccurate, slow)

Applying math reasoning

Written expression (grammar, punctuation, composition)

Spelling (adds/omits/substitutes)

Understanding meaning (reads accurately but not comprehending)

Numbers (poor sense, facts, calculation)

≥6 months despite intervention

DSM-5 Change - Axes

DSM-IV: Axis I (clinical),

II (personality/ID),

III (medical),

IV (psychosocial),

V (GAF)

DSM-5: Single axis; GAF removed; WHODAS 2.0 + cross-cutting measures

DSM-5 Change - Measures

Introduces dimensional & cross-cutting symptom measures

Severity levels (mild/moderate/severe)

WHODAS 2.0 for functioning

DSM-5 Change - ICD

DSM-5 aligned with ICD-10/11; includes ICD codes for billing & research

DSM-5 Change - Culture

Includes Cultural Formulation Interview (CFI)Cultural syndromes, idioms of distress, explanations

DSM-5 New Disorders

DMDD, Hoarding, PMDD, Binge Eating, ExcoriationASD combines prior categoriesPTSD → Trauma & Stressor-relatedSubstance Use: abuse & dependence combined

Clinical Intake - Skills

Interview skills, helping skills, diagnostic skills

Blend professional writing + narrative + interpretation

Know your audience

Intake Breakdown

15% presenting problem

30% diagnostic pursuit

15% medical/family history

25% personal/social history

10% MSE

5% discussion of dx & treatment

Helping Skills

Attending behaviors (eye contact, posture, tone, tracking)

Clarifications

Paraphrasing

Reflection of feeling

Summarization

Silence