Download Taking a look at the DSM V

Taking a Look at the
DSM V
KIMMIE JORDAN, MS, CPRP, LADAC
PSRANM 21 ST ANNUAL
CONFERENCE
“THE ART OF RECOVERY ”
Overall Changes
• Organizational changes
–Division into Three Sections
• Chapter Order
–Order of disorders are based on relatedness to each
other
–Alignment with Internal Classification of Diseases
(ICD-11)
• Removal of 5 Axis System
• Changes to Specific Disorders
Organization of the DSM V
• Three Sections:
–Section I
• DSM V Basics
– Introduction
– Instructions for Use
–Section II
• Diagnostic Criteria and Codes
–Section III
• Emerging Measures and Models
– Assessment Measures
– Cultural Formulation
– Conditions for Future Study
Removal of Axis V System
• Axis I, II, and III information combined
unilaterally
–Concerns: Codes will need to be listed with diagnosis
written as some disorders have the same numerical
code.
• Axis IV information with be noted separately
using V or Z codes from ICD
• Axis V ??????
–World Health Organization Disability Assessment
Schedule (WHODAS 2.0) Best current alternative,
but APA is not recommending until there is more
research to validate use
Removal of Axis V System
• Implications for PSR and other programs based on
Global Assessment of Functioning (GAF) scores
– ?????????
–Possible use of the World Health Organization Disability
Assessment Schedule (WHODAS 2.0) to determine level of
functioning
• 36 item Self-administered or Clinician administered assessment tool
• Also comes in short 12 item forms
• Assesses ability to perform activities in 6 areas: Understanding and
communicating, getting around, self –care, getting along with people,
life activities, and participation in society
• Can be used with any medial disorder and can track changes over time
• http://www.who.int/classifications/icf/whodasii/en/index.html
Changes to Specific Disorders in PSR
• Schizophrenia Spectrum and Other Psychotic
Disorders
–Includes Schizophrenia, other psychotic disorders, and
schizotypal (personality) disorder
–Defined by abnormalities in 5 domains:
Delusions
Hallucinations
Disorganized thinking (or speech)
Grossly disorganized or abnormal movements (including
catatonia
• Negative symptoms
•
•
•
•
Changes to Specific Disorders in PSR
• Schizophrenia Spectrum and Other Psychotic
Disorders
–Schizophrenia 295.90
• DSM IV Subtypes Paranoid, Disorganized, catatonic,
undifferentiated and residual are eliminated
• Severity rating: Mild, Moderate, and Severe are added
using Psychosis Symptom Severity Assessment.
Changes to Specific Disorders in PSR
• Bipolar and Related Disorders
–Additional focus on changes in activity and energy
Changes to Specific Disorders in PSR
• Depressive Disorders
–New Disorders
• Disruptive mood dysregulation disorders
– Added to address over diagnosis in children
• Premenstrual dysphoric disorders
• Dysthymia is now persistent depressive disorder
–Bereavement Exclusion removed
• Duration is 1-2 years
• Can be trigger for major depression
Changes to Specific Disorders in PSR
• Anxiety Disorders
–Obsessive-Compulsive Disorders, Posttraumatic
Stress disorder and Acute stress disorder moved to
new chapters
–Agoraphobia, Specific Phobia, Social Anxiety disorder
(Social Phobia) replaces the individual recognizing
that anxiety is excessive with the anxiety being out
of proportion to the actual threat
–Panic Attack disorder changes types of attacks to
unexpected and expected and can be a specified to all
Disorders
Changes to Specific Disorders in PSR
• Anxiety Disorders
–Panic Disorder and agoraphobia are now two
separate diagnosis
–Social Phobia is now Social Anxiety disorder (Social
Phobia) and specifier of generalized is replaced with
performance only
–Separation Anxiety Disorder is now classified as an
anxiety disorder.
Changes to Specific Disorders in PSR
• Obsessive Compulsive and Related Disorders
– New Disorders
• Hoarding Disorder
• Excoriation (skin-picking) disorder
• Substance-/Medication-induced obsessive-compulsive
disorder, obsessive-compulsive and related disorder due to
another medical condition.
–Trichotillomania (hair-pulling disorder)
–Specifier with poor insight changed to good, fair, or
poor insight and absent insight/delusional OCD
beliefs
Changes to Specific Disorders in PSR
• Trauma and Stress Related Disorders
–Acute Stress disorder explicit if event was
experienced, witnessed, or expensed indirectly
–Posttraumatic Stress Disorder
• More explicit as to how event was experienced
• 3 symptom clusters (Reexperiencing, avoidance/Numbing,
and arousal) –now 4 symptom clusters (Intrusion
symptoms, Avoidance symptoms, Negative alterations in
cognitions and mood, alteration in arousal and reactivity
Changes to Specific Disorders in PSR
• Substance-Related and Addictive Disorder
–Removal of abuse and addiction
–Removal of recurrent legal problems
–Addition of craving or strong urge to use
–2-3 Criteria for Mild, 4-5 for moderate, 6 or more severe
–Removal of polysubstance Dependence
–New Specifiers: In a controlled environment, on
maintenance therapy
–Addition of Gambling Disorder
Online Assessment Measures
• Assessment measures to assist in clinical diagnosis, identify other areas to look at,
and guide treatment.
– Level 1 Cross-Cutting Symptom Measures
– Level 2 Cross-Cutting Symptom Measures
• http://www.psychiatry.org/practice/dsm/dsm5/online-assessmentmeasures#Level2
• Depression, Anger, Mania, Anxiety, Somatic Symptom, Sleep Disturbance,
Repetitive Thoughts and Behaviors, and Substance Use
– Disorder-Specific Severity Measures
• http://www.psychiatry.org/practice/dsm/dsm5/online-assessmentmeasures#Disorder
• Depression, Separation Anxiety Disorder, Specific Phobia, Social Anxiety
Disorder (Social Phobia), Panic Disorder, Agoraphobia, Generalized Anxiety
Disorder, Posttraumatic Stress Symptoms, Acute Stress Symptoms, and
Dissociative Symptoms
Mental Health
Rehabilitation
Services
Kimmie Jordan
MS, CPRP, LADAC
1215 New York Ave,
Alamogordo, NM 88310
575-649-8518
WWW.MentalHealthRehabServices.com