DSM-5 Clinical Case Formulation

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Questions and Answers

What is the primary purpose of the DSM-5 according to the manual?

To assist trained clinicians in the diagnosis of mental disorders. (correct)

To serve as a handbook for medication management.

To provide detailed treatment recommendations for all disorders.

To be used for self-diagnosis of mental disorders.

What must a clinical case formulation involve?

A careful clinical history and a summary of social, psychological, and biological factors. (correct)

A list of medications.

A checklist of symptoms.

A list of previous diagnoses.

Why is it insufficient to simply check off the symptoms in the diagnostic criteria to make a mental disorder diagnosis?

Because it leads to automatic treatment decisions.

Because it might involve too many symptoms.

Because a thorough evaluation and clinical judgment are necessary to ensure reliable assessment. (correct)

Because it requires approval from health insurance providers.

Which of the following is NOT essential for diagnosing a psychopathological condition?

Negative self-perception Signup and view all the answers

What additional tools may aid the evaluation of diagnostic criteria?

Dimensional symptom severity assessment tools Signup and view all the answers

What is the ultimate goal of a clinical case formulation?

To develop a comprehensive treatment plan informed by the individual's cultural and social context. Signup and view all the answers

What is beyond the scope of the DSM-5 manual?

Making recommendations for evidence-based treatment options Signup and view all the answers

What does a diagnosis of mental disorders ultimately require?

Clinical judgment and training Signup and view all the answers

When might the 'other specified' or 'unspecified' category be considered for a diagnosis?

When symptoms cause significant distress but do not meet full criteria for any disorder Signup and view all the answers

Which instruction in the criteria set indicates the use of subtypes?

'Specify whether' Signup and view all the answers

What is the purpose of specifiers within a diagnosis?

To provide a more detailed and specific description of the disorder Signup and view all the answers

Can more than one specifier be applied to a given diagnosis?

Yes, specifiers can be combined as needed Signup and view all the answers

What type of diagnostic descriptions can assist in supporting diagnosis besides criteria?

Introductory sections of each diagnostic chapter Signup and view all the answers

When can subtypes be applied according to the criteria set?

When all criteria for a disorder are met and the subtype is specified Signup and view all the answers

Specifiers providing information about the lifetime course of a disorder are applicable when?

Regardless of current status Signup and view all the answers

What kind of subtypes does anorexia nervosa have according to the criteria?

Restricting type or binge-eating/purging type Signup and view all the answers

What is the primary reason for including 'other specified' or 'unspecified' disorder options in the DSM-5?

To provide diagnostic options for presentations that do not fit exactly into specific categories Signup and view all the answers

In which setting might 'unspecified' disorder be used as a placeholder?

Emergency department Signup and view all the answers

What does the 'other specified' disorder category allow the clinician to do?

Communicate the specific reason a presentation does not meet criteria for any specific category Signup and view all the answers

When might the 'unspecified' disorder category be appropriate to use?

When the most prominent symptoms do not fit a specific category Signup and view all the answers

What does the inclusion of 'other specified' and 'unspecified' categories in DSM-5 recognize?

The limitation of categorical diagnoses in fully describing the range of mental disorders Signup and view all the answers

Which of the following is NOT typically a setting where 'other specified' or 'unspecified' disorders are used?

Fitness centers Signup and view all the answers

What is recorded when diagnosing an individual with persistent hallucinations without any other psychotic symptoms?

other specified schizophrenia spectrum and other psychotic disorder, with persistent auditory hallucinations Signup and view all the answers

What would a clinician record if they choose not to specify the reason for not meeting the criteria for a specific disorder?

unspecified schizophrenia spectrum and other psychotic disorder Signup and view all the answers

What allows maximum flexibility for diagnosis according to DSM-5?

differentiation between other specified and unspecified disorders Signup and view all the answers

What should be used when there is enough clinical information to specify the nature of the presentation?

other specified diagnosis Signup and view all the answers

According to DSM-5, in what scenario can the 'unspecified' diagnosis be given?

In an emergency room setting with limited information Signup and view all the answers

What is a long-standing DSM convention related to 'Conditions for Further Study'?

Conditions can be specified using the 'other specified' designation Signup and view all the answers

What does the inclusion of conditions for further study in the DSM-5 NOT imply?

They are valid diagnostic categories Signup and view all the answers

Who is the DSM-5 designed for?

Individuals with clinical training and experience Signup and view all the answers

Which aspect makes it difficult to separate normal and pathological symptom expressions in mental disorders?

Absence of clear biological markers Signup and view all the answers

What generic diagnostic criterion is used to establish disorder thresholds?

Disturbance causes clinically significant distress Signup and view all the answers

Why is assessing the criterion of clinically significant distress or impairment especially challenging?

It involves subjective clinical judgment Signup and view all the answers

Whose input is often necessary to assess the individual's performance?

Third parties including family members Signup and view all the answers

Which of the following was adopted as the official coding system in the United States since October 1, 2015?

ICD-10-CM Signup and view all the answers

What is the primary role of the clinical significance criterion?

To establish disorder thresholds Signup and view all the answers

Why might a person's symptom presentation not always indicate a mental disorder?

Mild forms of symptoms can be experienced by those for whom a diagnosis of mental disorder would be inappropriate Signup and view all the answers

What does the text say about the role of the clinical significance criterion in terms of treatment needs?

It may help determine an individual's need for treatment Signup and view all the answers

What coding system is used for disorders in DSM-5-TR in the United States?

ICD-10-CM Signup and view all the answers

What is a key function of diagnostic codes in medical settings?

To facilitate data collection and retrieval for statistical information Signup and view all the answers

What does the 'Reason for Visit' represent in an outpatient setting?

The condition that is chiefly responsible for the ambulatory medical services received Signup and view all the answers

What does the principal diagnosis represent in an inpatient setting?

The condition established as chiefly responsible for the admission Signup and view all the answers

Under what system has the use of ICD-10-CM codes been mandated for reimbursement purposes?

Medicare Signup and view all the answers

Where can one find the appropriate code for certain diagnoses like neurocognitive disorders or substance/medication-induced disorders?

Within the criteria set for the disorder with a coding note Signup and view all the answers

What follows the name of some disorders in DSM-5?

Alternative terms enclosed in parentheses Signup and view all the answers

Why might it be difficult to determine which diagnosis is the principal diagnosis or the reason for visit?

It is often arbitrary Signup and view all the answers

What change was made in DSM-5 regarding substance-induced mental disorders?

The term was changed to include medications Signup and view all the answers

Which of the following is NOT considered a substance capable of causing a substance/medication-induced mental disorder?

Sugar Signup and view all the answers

Why were the terms 'organic' and 'nonorganic' eliminated from DSM-IV?

They implied a false dichotomy in the causes of mental disorders Signup and view all the answers

Which edition of the DSM was the first to change the term to 'substance/medication-induced mental disorders'?

DSM-5 Signup and view all the answers

What was the reasoning for introducing the term 'substance/medication-induced' in DSM-5?

To include psychiatric symptoms caused by medications Signup and view all the answers

What aspect of DSM-IV terminology update targeted the classification of 'organic' mental disorders?

They subdivided 'organic' disorders based on physiological effects Signup and view all the answers

Which of the following would be classified under 'substance/medication-induced mental disorder' in DSM-5?

Psychiatric symptoms due to steroid use Signup and view all the answers

How were mental disorders previously divided in editions of DSM up to DSM-III-R?

Into 'organic' and 'nonorganic' categories Signup and view all the answers

Which terminology has been used in DSM-5 to replace 'primary' mental disorder?

Independent Signup and view all the answers

In DSM-5, which term is used instead of 'physical disorder'?

General medical condition Signup and view all the answers

Where are mental disorders classified in the International Classification of Diseases (ICD)?

Chapter 5 Signup and view all the answers

What was a significant reason for replacing the term 'primary' with 'independent' in DSM-5?

To reduce confusion in diagnosing comorbid disorders Signup and view all the answers

According to the DSM-5, mental disorders can be precipitated by:

General medical conditions Signup and view all the answers

What classification factor is NOT mentioned for categorizing conditions in the ICD?

Severity Signup and view all the answers

What type of information does the DSM-5-TR text provide immediately following the diagnostic criteria for each disorder?

Contextual information Signup and view all the answers

Under which heading would instructions for selecting and recording the appropriate ICD-10-CM diagnostic code be found in the DSM-5-TR?

Recording Procedures Signup and view all the answers

Which heading in the DSM-5-TR describes clinical features that are not represented in the criteria but occur significantly more often in individuals with the disorder?

Associated Features Signup and view all the answers

In the DSM-5-TR, which heading systematically includes information about the disorder's prevalence, development, and course?

Development and Course Signup and view all the answers

Which type of information is provided under the 'Subtypes and/or Specifiers' heading in the DSM-5-TR?

Characteristics that differentiate subtypes and specifiers Signup and view all the answers

Which heading covers issues related to the interpretation of symptoms and their cultural context in the DSM-5-TR?

Culture-Related Diagnostic Issues Signup and view all the answers

How does the DSM-5-TR suggest representing information when limited data is available for a section?

Omit the section Signup and view all the answers

Which heading would you find information about the potential association between a disorder and suicidal thoughts or behavior in the DSM-5-TR?

Association With Suicidal Thoughts or Behavior Signup and view all the answers

What type of data is typically used to describe the rates of a disorder in a community?

12-month prevalence Signup and view all the answers

What does the 'Development and Course' section primarily describe?

The typical lifetime patterns of presentation and development for a disorder Signup and view all the answers

Which factors are discussed in the 'Risk and Prognostic Factors' section?

Temperamental, environmental, genetic, and physiological factors Signup and view all the answers

What specific factor related to dementia is listed under genetic and physiological factors?

APOE4 Signup and view all the answers

How are prevalence rates sometimes categorized besides a 12-month prevalence?

Point prevalence Signup and view all the answers

In what section would the sex ratio prevalence (men vs. women) typically be found?

Prevalence Signup and view all the answers

What can be described in the 'Development and Course' section regarding presentation patterns?

Duration of symptoms and progression of severity Signup and view all the answers

Which of the following falls under temperamental factors in 'Risk and Prognostic Factors'?

Personality features Signup and view all the answers

What information is included under Culture-Related Diagnostic Issues?

Norms that may affect the perceived level of pathology Signup and view all the answers

Which category discusses the predominance of symptoms by sex or gender?

Sex- and Gender-Related Diagnostic Issues Signup and view all the answers

What do Diagnostic Markers address?

Objective measures with established diagnostic value Signup and view all the answers

What is included under Association With Suicidal Thoughts or Behavior?

Risk factors for suicide associated with the disorder Signup and view all the answers

What do Functional Consequences impact?

Daily activities like education and work Signup and view all the answers

Which section describes the process of differentiating a disorder from others with similar characteristics?

Differential Diagnosis Signup and view all the answers

What does Comorbidity include descriptions of?

Mental disorders and other medical conditions Signup and view all the answers

Where are prevalence rates by gender located?

In the Prevalence section Signup and view all the answers

Which condition is NOT included in the chapter 'Medication-Induced Disorders and Other Adverse Effects of Medication'?

Suicidal behavior Signup and view all the answers

What is the significance of including medication-induced disorders in Section II?

Differential diagnosis with mental disorders Signup and view all the answers

Why might a condition from the chapter 'Other Conditions That May Be a Focus of Clinical Attention' be coded without an accompanying mental disorder diagnosis?

To explain the need for a test, procedure, or treatment Signup and view all the answers

Which of the following is an example of a relational problem included in the 'Other Conditions That May Be a Focus of Clinical Attention' chapter?

Relationship Distress With Spouse or Intimate Partner Signup and view all the answers

Which chapter covers conditions involving psychosocial or environmental problems?

Other Conditions That May Be a Focus of Clinical Attention Signup and view all the answers

What is the purpose of coding a condition or problem from the 'Other Conditions That May Be a Focus of Clinical Attention' chapter?

To influence overall clinical management Signup and view all the answers

Which of these conditions is specifically listed under the medication-induced disorders in Section II?

Neuroleptic malignant syndrome Signup and view all the answers

Which ICD-10-CM code category is usually used for conditions affecting diagnosis but not considered mental disorders?

Z codes Signup and view all the answers

Which of the following is an example of a psychosocial, personal, and environmental circumstance?

Being a victim of terrorism Signup and view all the answers

What type of problem is 'uncomplicated bereavement' classified as?

Phase of life problem Signup and view all the answers

Which category includes problems related to medical and other health care access?

Problems related to health care Signup and view all the answers

Which of the following is NOT considered a problem related to the social environment?

Unwanted pregnancy Signup and view all the answers

What is an example of a condition or problem that may be a focus of clinical attention?

Wandering associated with a mental disorder Signup and view all the answers

Study Notes

Purpose of DSM-5

The primary purpose of DSM-5 is to assist trained clinicians in diagnosing mental disorders and informing treatment plans.

Approach to Clinical Case Formulation

A thorough clinical history and concise summary of social, psychological, and biological factors contributing to a mental disorder are essential for case formulation.
Simply checking off symptoms in diagnostic criteria is insufficient for a diagnosis.
A thorough evaluation of diagnostic criteria, aided by dimensional symptom severity assessment tools, is necessary for a reliable assessment.
Clinical judgment is required to determine the relative severity and salience of signs and symptoms and their contribution to a diagnosis.
Diagnosis requires clinical training to recognize the combination of predisposing, precipitating, perpetuating, and protective factors resulting in a psychopathological condition.

Goals of Clinical Case Formulation

The ultimate goal of a clinical case formulation is to develop a comprehensive treatment plan informed by the individual's cultural and social context.
The treatment plan should be based on available contextual and diagnostic information.

Limitations of DSM-5

Recommendations for selecting and using evidence-based treatment options are beyond the scope of the DSM-5 manual.

Diagnostic Criteria and Guidelines

Diagnostic criteria serve as guidelines for making diagnoses, and their use should be informed by clinical judgment
Text descriptions, including introductory sections, support diagnosis by providing more detailed information on criteria and differential diagnoses

Application of Disorder Subtypes and Specifiers

Clinicians should consider applying disorder subtypes and/or specifiers after assessing diagnostic criteria
Most specifiers are only applicable to the current presentation and may change over time
Examples of specifiers include good to fair insight, predominantly inattentive presentation, and in a controlled environment
Specifiers can only be given if full criteria for the disorder are currently met

Subtypes and Specifiers

Subtypes define mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis
Subtypes are indicated by the instruction "Specify whether" in the criteria set
Examples of subtypes include restricting type or binge-eating/purging type in anorexia nervosa
Specifiers are not mutually exclusive or jointly exhaustive, and more than one specifier may be applied to a given diagnosis
Specifiers are indicated by the instruction "Specify" or "Specify if" in the criteria set
Examples of specifiers include "Specify if: performance only" in social anxiety disorder
Subtypes and specifiers provide an opportunity to define a more homogeneous subgrouping of individuals

Other Specified and Unspecified Categories

When symptoms do not meet full criteria for any disorder, but cause clinically significant distress or impairment, consider the "other specified" or "unspecified" category corresponding to the predominant symptoms

Limitations of Diagnostic Criteria

The current set of categorical diagnoses does not fully capture the range of mental disorders experienced by individuals.
The diagnostic criteria sets are not exhaustive, and some presentations may not fit exactly into the diagnostic boundaries of disorders.

Other Specified and Unspecified Disorders

DSM-5 provides two diagnostic options for presentations that do not meet the diagnostic criteria for any specific disorder: other specified disorder and unspecified disorder.
The other specified category allows clinicians to communicate the specific reason why the presentation does not meet the criteria for any specific category within a chapter.

Clinical Applications

In certain settings, such as emergency departments, it may only be possible to identify the most prominent symptom expressions associated with a particular chapter (e.g., delusions, hallucinations, mania, depression, anxiety, substance intoxication, neurocognitive symptoms).
In such cases, assigning the corresponding "unspecified" disorder as a placeholder may be necessary until a more complete differential diagnosis is possible.

Diagnostic Class

In diagnostic classification, the category name is followed by the specific reason for the diagnosis, e.g., "other specified schizophrenia spectrum and other psychotic disorder, with persistent auditory hallucinations".
If the clinician chooses not to specify the reason, the diagnosis is "unspecified schizophrenia spectrum and other psychotic disorder".
The distinction between "other specified" and "unspecified" disorders depends on the clinician's decision to provide or not provide reasons for not meeting full criteria.

Use of Clinical Judgment

DSM-5 is a classification of mental disorders for use in clinical, educational, and research settings.
The diagnostic categories, criteria, and textual descriptions require application by individuals with appropriate clinical training and experience in diagnosis.
DSM-5 should not be applied mechanically by individuals without clinical training and experience.

Clinical Significance Criterion

Lack of clear biological markers or clinically useful measurements of severity for many mental disorders makes it difficult to distinguish normal from pathological symptom expressions.
In mild forms, symptoms may not be inherently pathological, making it challenging to diagnose mental disorders.
A generic diagnostic criterion is used to establish disorder thresholds: "the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."
This criterion is particularly helpful in determining an individual's need for treatment.
Assessing distress or impairment is a difficult clinical judgment, often requiring information from the individual, family members, and other third parties.

Coding and Recording Procedures

As of October 1, 2015, the official coding system in use in the United States is the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).
ICD-10-CM is a modified version of the World Health Organization's ICD-10 for clinical use.

Centers for Disease Control and Prevention's National Center for Health Statistics

Provides the only permissible diagnostic codes for mental disorders for clinical use in the United States.

Diagnoses

Most DSM-5 disorders have an alphanumeric ICD-10-CM code that appears preceding the name of the disorder.
The name of the disorder (or coded subtype or specifier) is in the DSM-5-TR Classification and in the accompanying criteria set for each disorder.
For some diagnoses, the appropriate code depends on further specification and is listed within the criteria set for the disorder with a coding note.
The name of the disorder is further clarified in the text section "Recording Procedures."
Some disorders have alternative terms enclosed in parentheses.

Use of Diagnostic Codes

Diagnostic codes are fundamental to medical record keeping.
Diagnostic coding facilitates data collection and retrieval, and compilation of statistical information.
Codes are required to report diagnostic data to interested third parties, including governmental agencies, private insurers, and the World Health Organization.
The use of ICD-10-CM codes for disorders in DSM-5-TR has been mandated by the Health Care Financing Administration for purposes of reimbursement under the Medicare system.

Principal Diagnosis/Reason for Visit

DSM-5 allows multiple diagnoses to be assigned for those presentations that meet criteria for more than one disorder.
The principal diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the individual in an inpatient setting.
In an outpatient setting, the reason for visit is the condition that is chiefly responsible for the ambulatory medical services received during the visit.
The principal diagnosis or the reason for visit is also the main focus of attention or treatment.

Substance/Medication-Induced Mental Disorder

Refers to symptomatic presentations caused by the physiological effects of an exogenous substance on the central nervous system
Includes symptoms that develop during withdrawal from an exogenous substance capable of causing physiological dependence
Exogenous substances include:
- Typical intoxicants (e.g., alcohol, inhalants, hallucinogens, cocaine)
- Psychotropic medications (e.g., stimulants; sedatives, hypnotics, anxiolytics)
- Other medications (e.g., steroids)
- Environmental toxins (e.g., organophosphate insecticides)
DSM-5 term changed to "substance/medication-induced" to emphasize medications can cause psychiatric symptoms

Independent Mental Disorders

Historically, mental disorders were divided into "organic" (caused by physical factors) and "nonorganic" (purely of the mind)
DSM-III-R used these terms, but they were misleading as they implied nonorganic disorders have no biological basis
DSM-IV updated terminology by:
- Eliminating "organic" and "nonorganic" terms
- Dividing former "organic" disorders into:
  - Substance-induced disorders (direct physiological effects of a substance)
  - Disorders due to the direct physiological effects of a medical condition on the central nervous system

Primary vs. Independent Mental Disorder

The term "primary" mental disorder has been replaced by "independent" mental disorder in DSM-5 to clarify that mental disorders are not necessarily independent of other factors like psychosocial or environmental stressors.
The term "primary" was prone to confusion in diagnosing comorbid disorders.

Mental Disorders vs. General Medical Conditions

DSM-5 changed the classification of "mental disorders" vs. "general medical conditions" based on their location within the International Classification of Diseases (ICD).
The ICD classifies medical conditions into 17 chapters based on etiology, anatomical location, body systems, and context.
Mental disorders are typically found in Chapter 5 of the ICD, while general medical conditions occupy the other 16 chapters.
The term "general medical condition" was replaced by "another medical condition" in DSM-5 to:
- Emphasize that mental disorders are medical conditions.
- Recognize that mental disorders can be precipitated by other medical conditions.
- Highlight the interconnection between mental and medical conditions, despite being distinct.

DSM-5-TR Text Structure

The DSM-5-TR text provides contextual information to aid in diagnostic decision-making
The text is organized into sections that systematically describe the disorder
The sections include: • Recording Procedures • Subtypes and/or Specifiers • Diagnostic Features • Associated Features • Prevalence • Development and Course • Risk and Prognostic Factors • Culture-Related Diagnostic Issues • Sex- and Gender-Related Diagnostic Issues • Diagnostic Markers • Association With Suicidal Thoughts or Behavior • Functional Consequences • Differential Diagnosis • Comorbidity

Recording Procedures

Provides guidelines for reporting the name of the disorder and selecting the appropriate ICD-10-CM diagnostic code
Includes instructions for applying subtypes and/or specifiers

Subtypes and/or Specifiers

Provides brief descriptions of applicable subtypes and/or specifiers

Diagnostic Features

Illustrates the use of the criteria and includes key points on their interpretation
Includes examples of potential errors in interpretation, such as attributing medication side effects to negative symptoms

Associated Features

Includes clinical features that are not represented in the criteria but occur more often in individuals with the disorder than those without
Examples include somatic symptoms in individuals with generalized anxiety disorder

Prevalence

Describes the rates of a disorder in a community
Typically reported as 12-month prevalence, but sometimes point prevalence is noted
Prevalence rates are provided by age group and ethnicity
Sex ratio (prevalence in men vs. women) is also described
Geographic variance in prevalence rates is described when international data is available
For certain disorders, prevalence in relevant clinical samples is noted

Development and Course

Describes the typical lifetime patterns of presentation and development for a disorder
Notes the typical age at onset and whether the presentation may have prodromal or insidious features
Describes the differences between a single episode and a recurrent episodic course
Addresses duration of symptoms, progression of severity, and associated functional impact
Describes the general trend of the disorder over time (e.g., stable, worsening, improving)
Notes features related to developmental stage (e.g., infancy, childhood, adolescence, adulthood, late life)

Risk and Prognostic Factors

Discusses factors that influence the development of a disorder
Temperamental factors include personality features
Environmental factors include head trauma, emotional trauma, exposure to toxic substances, and substance use
Genetic and physiological factors include genetic risks (e.g., APOE4 for dementia) and other known familial genetic risks
Addresses familial patterns and epigenetic factors
Course modifiers include factors that may lead to a negative outcome or have ameliorative or protective effects

Important to consider variations in symptom expression across different cultures
Understanding attributions for disorder causes or precipitants is crucial in culturally informed diagnosis
Factors associated with differential prevalence across demographic groups can affect diagnosis
Cultural norms can influence the level of perceived pathology
Risk of misdiagnosis is high if cultural factors are not considered

Diagnosis correlates with sex or gender
Symptoms may predominate in one sex or gender
Diagnosis may vary by sex or gender
Other sex- and gender-related diagnostic implications should be considered

Diagnostic Markers

Objective measures with established diagnostic value
Physical examination findings, laboratory findings, and imaging findings can be diagnostic markers
Examples: signs of malnutrition, low CSF hypocretin-1 levels, regionally hypometabolic FDG PET imaging

Association With Suicidal Thoughts or Behavior

Disorder-specific prevalence of suicidal thoughts or behavior
Risk factors for suicide associated with the disorder

Functional Consequences

Notable functional consequences of a disorder on daily life
Impact on education, work, and independent living
Consequences vary according to age and across the life span

Differential Diagnosis

Differentiating a disorder from other disorders with similar presenting characteristics

Comorbidity

Co-occurring mental disorders and other medical conditions
Conditions classified outside of the Mental and Behavioural Disorders chapter

Other Conditions and Disorders in Section II

Section II of DSM-5 includes two chapters on conditions that are not mental disorders but may be encountered by mental health clinicians.
These conditions may be listed as a reason for a clinical visit in addition to, or in place of, the mental disorders in Section II.

Medication-Induced Disorders and Other Adverse Effects of Medication

This chapter includes conditions such as medication-induced parkinsonism, neuroleptic malignant syndrome, and tardive dyskinesia.
These conditions are important in the management of mental disorders or other medical conditions, and in differential diagnosis with mental disorders.

Other Conditions That May Be a Focus of Clinical Attention

This chapter includes conditions and psychosocial or environmental problems that are not mental disorders but affect the diagnosis, course, prognosis, or treatment of an individual's mental disorder.
Conditions in this chapter are presented with their corresponding ICD-10-CM codes (usually Z codes).
A condition or problem in this chapter may be coded with or without an accompanying mental disorder diagnosis if:
- It is a reason for the current visit;
- It helps to explain the need for a test, procedure, or treatment;
- It plays a role in the initiation or exacerbation of a mental disorder;
- It constitutes a problem that should be considered in the overall management plan.
Examples of conditions in this chapter include suicidal behavior, nonsuicidal self-injury, abuse and neglect, and relational problems (e.g., Relationship Distress With Spouse or Intimate Partner).

Problems

Various types of problems exist, including:
Educational problems
Occupational problems
Housing problems
Economic problems
Social environment problems
Interaction with the legal system can also be a problem
Psychosocial, personal, and environmental circumstances can contribute to problems, such as:
Unwanted pregnancy
Being a victim of crime or terrorism
Access to medical and other health care can be a problem
Circumstances of personal history can contribute to problems, including:
Personal History of Psychological Trauma
Other health service encounters can include:
Counseling
Medical advice (e.g., sex counseling)
Certain conditions or problems may be a focus of clinical attention, such as:
Wandering associated with a mental disorder
Uncomplicated bereavement
Phase of life problem

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This quiz covers the approach to clinical case formulation using the DSM-5, including diagnosis of mental disorders and treatment planning.