Video Notes: DSM-5-TR, ICD-11, Culture, and Diagnostic Frameworks (Vocabulary Flashcards)

DSM-5 criteria influenced ICD-11 development, leading to greater harmonization than previous versions.
ICD-11 was endorsed globally in ext{May } 2019 and became effective ext{January } 1, 2022, but the U.S. continues to use ICD-10-CM.

A mental disorder is a syndrome with clinically significant disturbance in cognition, emotion, or behavior, reflecting dysfunction in psychological, biological, or developmental processes.
It's usually associated with significant distress or disability.
Exclusions: normal responses to stressors (e.g., grief), socially deviant behavior (unless due to individual dysfunction).
Diagnosis should have clinical utility (prognosis, treatment plans) but is not always equivalent to a need for treatment.

Categorical Design Issues: High comorbidity, symptom heterogeneity, frequent use of 'other specified/unspecified' diagnoses.
Dimensional Approaches: Classify based on quantification of attributes, better for continuous phenomena, can increase reliability and convey more clinical information (subthreshold features).
Limitations: Less clinical utility historically, no consensus on optimal dimensions.
DSM-5 remains primarily categorical but incorporates dimensional elements.

Section III includes the DSM-5 Level 1 Cross-Cutting Symptom Measure.
Purpose: Assess major areas of psychiatric functioning (mood, psychosis, cognition, personality, sleep) to uncover latent disorders, atypical presentations, and coexistent pathologies.
Recommended as a first step in psychiatric evaluations.

DSM-5 moved to nonaxial documentation.
Clinical disorders (Axis I), personality disorders (Axis II), and general medical conditions (Axis III) are now listed together.
Psychosocial and contextual factors (Axis IV) are now Z codes.
Global Assessment of Functioning (GAF - Axis V) was replaced by the WHO Disability Assessment Schedule (WHODAS).

Cultural contexts shape the experience, expression, and severity thresholds of symptoms.
Clinicians should consider how an individual's experiences and presentations differ from sociocultural norms and how social structures affect exposure to adversity and resources.

Boundaries between normality and pathology vary across cultures.
Cultural factors influence vulnerability, fears, stigma, support, coping, help-seeking, diagnosis acceptance, and treatment adherence.
Cultural differences between clinicians and patients can affect diagnostic accuracy and treatment outcomes.

Three constructs replace 'culture-bound syndromes':
1) Cultural idiom of distress: A localized way to express distress (e.g., "I feel so depressed").
2) Cultural explanation or perceived cause: Culturally coherent etiology for symptoms (e.g., spirits, stress).
3) Cultural syndrome: Cluster of co-occurring distinctive symptoms found in specific cultural groups.

Race is a social construct, not biological; racialization is the social process linking racial identities with discrimination.
Racism (personal, interpersonal, systemic, social structural) contributes to pervasive inequities in health outcomes and access to care, and can lead to misdiagnosis (e.g., schizophrenia in African Americans with mood disorders).
Clinicians must actively recognize and address racism, bias, and stereotyping.

DSM-5-TR review involved cultural and ethnoracial equity committees to address cultural influences and avoid stereotypes.
Language changes: uses terms like 'racialized' and 'ethnoracial'; avoids 'Caucasian', 'minority', and 'non-White' unless specific for study labels.
Emphasizes heterogeneity within societies (e.g., 'cultural contexts' instead of 'culture').

Sex: Attributes related to reproductive organs and chromosomal composition (e.g., XX/XY).
Gender: Reproductive biology plus self-representation (psychological, behavioral, social aspects of gender identity).
Sex/gender influences illness risk (e.g., premenstrual dysphoric disorder), prevalence, symptom expression, help-seeking, and aspects of the reproductive life cycle (e.g., pregnancy, menopause).