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Questions and Answers
What is the primary purpose of the DSM-5 Level 1 Cross-Cutting Symptom Measure?
What is the primary purpose of the DSM-5 Level 1 Cross-Cutting Symptom Measure?
How many psychiatric domains are assessed in the adult version of the DSM-5 Level 1 Cross-Cutting Symptom Measure?
How many psychiatric domains are assessed in the adult version of the DSM-5 Level 1 Cross-Cutting Symptom Measure?
Who may complete the Level 1 Cross-Cutting Symptom Measure if the individual is unable to do so?
Who may complete the Level 1 Cross-Cutting Symptom Measure if the individual is unable to do so?
Which of the following is NOT one of the psychiatric domains included in the Level 1 measure?
Which of the following is NOT one of the psychiatric domains included in the Level 1 measure?
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What type of rating does the DSM-5 Level 1 Cross-Cutting Symptom Measure use?
What type of rating does the DSM-5 Level 1 Cross-Cutting Symptom Measure use?
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How long is the time frame for assessing symptoms in the Level 1 measure?
How long is the time frame for assessing symptoms in the Level 1 measure?
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What was a primary finding regarding the implementation of the measure in clinical settings?
What was a primary finding regarding the implementation of the measure in clinical settings?
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Which population was specifically mentioned as part of the studies evaluating the adult self-rated version of the measure?
Which population was specifically mentioned as part of the studies evaluating the adult self-rated version of the measure?
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How many questions are included in the parent/guardian-rated version of the measure for children?
How many questions are included in the parent/guardian-rated version of the measure for children?
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What is one psychiatric domain assessed by the parent/guardian-rated version of the measure?
What is one psychiatric domain assessed by the parent/guardian-rated version of the measure?
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What aspect of communication did individuals find the measure facilitated during clinical encounters?
What aspect of communication did individuals find the measure facilitated during clinical encounters?
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In terms of psychometric evaluation, which property was confirmed in studies involving the adult self-rated version?
In terms of psychometric evaluation, which property was confirmed in studies involving the adult self-rated version?
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Which psychiatric symptoms are included in the measure's assessment?
Which psychiatric symptoms are included in the measure's assessment?
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What is the main time frame used for assessing symptoms in children?
What is the main time frame used for assessing symptoms in children?
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What additional version of the measure may be considered for children aged 11-17?
What additional version of the measure may be considered for children aged 11-17?
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In what context was the measure found to be clinically useful?
In what context was the measure found to be clinically useful?
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Where can the child-rated version of the measure be found online?
Where can the child-rated version of the measure be found online?
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How is a rating of 'mild' defined on the adult self-rated version of the measure?
How is a rating of 'mild' defined on the adult self-rated version of the measure?
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In what situation should a clinician particularly review the score on an item within a domain?
In what situation should a clinician particularly review the score on an item within a domain?
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Which of the following items indicates a severity of symptoms based on the recommended scale?
Which of the following items indicates a severity of symptoms based on the recommended scale?
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Which type of symptom assessment is suggested to be reviewed when a score of mild or greater is noted in certain domains?
Which type of symptom assessment is suggested to be reviewed when a score of mild or greater is noted in certain domains?
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Which specific symptoms should not be included when a clinician reviews scores of mild or greater in the domains?
Which specific symptoms should not be included when a clinician reviews scores of mild or greater in the domains?
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What score indicates the need for further inquiry in the substance use domain?
What score indicates the need for further inquiry in the substance use domain?
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How are items pertaining to suicide attempts and substance abuse rated?
How are items pertaining to suicide attempts and substance abuse rated?
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Which statement is true regarding the threshold score for inattention?
Which statement is true regarding the threshold score for inattention?
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What is the scoring scale for most items on the mental health measure?
What is the scoring scale for most items on the mental health measure?
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Which item scores on the 'Don't Know' scale require further inquiry?
Which item scores on the 'Don't Know' scale require further inquiry?
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What does the Level 2 cross-cutting symptom assessment provide?
What does the Level 2 cross-cutting symptom assessment provide?
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Which domains are assessed in the Level 2 cross-cutting symptom assessment?
Which domains are assessed in the Level 2 cross-cutting symptom assessment?
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What should clinicians focus on when scores are mild or greater in specific domains?
What should clinicians focus on when scores are mild or greater in specific domains?
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What is the purpose of indicating the highest score in the 'Highest Domain Score' column?
What is the purpose of indicating the highest score in the 'Highest Domain Score' column?
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Which characteristic differentiates the child-rated version from the parent/guardian-rated version?
Which characteristic differentiates the child-rated version from the parent/guardian-rated version?
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What additional action may be required when a substance use item indicates a high score?
What additional action may be required when a substance use item indicates a high score?
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What does Table 2 provide guidance on?
What does Table 2 provide guidance on?
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In which age group are substance use items particularly relevant according to the guidelines?
In which age group are substance use items particularly relevant according to the guidelines?
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What is the primary function of the Level 2 Cross-Cutting Symptom Measures?
What is the primary function of the Level 2 Cross-Cutting Symptom Measures?
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How should Level 1 and Level 2 measures be used to track changes in symptom presentation over time?
How should Level 1 and Level 2 measures be used to track changes in symptom presentation over time?
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What should high scores on a Level 1 domain indicate to a clinician?
What should high scores on a Level 1 domain indicate to a clinician?
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For which group is it preferred for the Level 2 measures to be completed by the same informant at follow-ups?
For which group is it preferred for the Level 2 measures to be completed by the same informant at follow-ups?
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What is indicated by a clinician's review of the 'Highest Domain Score' column?
What is indicated by a clinician's review of the 'Highest Domain Score' column?
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What characteristic differentiates the child-rated version from the parent/guardian-rated version?
What characteristic differentiates the child-rated version from the parent/guardian-rated version?
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What is the main purpose of the Clinician-Rated Dimensions of Psychosis Symptom Severity measure?
What is the main purpose of the Clinician-Rated Dimensions of Psychosis Symptom Severity measure?
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Which symptom domains are included in the Clinician-Rated Dimensions of Psychosis Symptom Severity measure?
Which symptom domains are included in the Clinician-Rated Dimensions of Psychosis Symptom Severity measure?
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How many items are included in the Clinician-Rated Dimensions of Psychosis Symptom Severity?
How many items are included in the Clinician-Rated Dimensions of Psychosis Symptom Severity?
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What aspect of psychotic disorders does the severity of mood symptoms indicate?
What aspect of psychotic disorders does the severity of mood symptoms indicate?
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During what timeframe should symptom severity be rated by the clinician?
During what timeframe should symptom severity be rated by the clinician?
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What kind of cognitive issues are frequently observed in individuals with psychotic disorders?
What kind of cognitive issues are frequently observed in individuals with psychotic disorders?
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What does a score of 3 indicate on the rating scale?
What does a score of 3 indicate on the rating scale?
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When should the measure be completed to track changes in symptom severity?
When should the measure be completed to track changes in symptom severity?
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What might consistently high scores in a symptom domain indicate?
What might consistently high scores in a symptom domain indicate?
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Which statement is true regarding the clinician's role in scoring?
Which statement is true regarding the clinician's role in scoring?
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What is the lowest score on the 5-point scale?
What is the lowest score on the 5-point scale?
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What does the clinician indicate for each item in the 'Score' column?
What does the clinician indicate for each item in the 'Score' column?
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Study Notes
DSM-5 Level 1 Cross-Cutting Symptom Measure
- A self- or informant-rated measure assessing domains important across psychiatric diagnoses
- Helps clinicians identify additional areas of inquiry impacting treatment and prognosis
- Tracks changes in symptom presentation over time
Domains Assessed
- 13 psychiatric domains, including:
- Depression
- Anger
- Mania
- Anxiety
- Somatic Symptoms
- Suicidal Ideation
- Psychosis
- Sleep Problems
- Memory
- Repetitive Thoughts and Behaviors
- Dissociation
- Personality Functioning
- Substance Use
Measure Composition
- 23 questions in the adult version
- Each domain consists of 1-3 questions
- Items inquire about the level of bother or frequency of symptoms during the past 2 weeks
Administration
- Can be completed by the individual or a knowledgeable adult informant if the individual has impaired capacity (e.g., major neurocognitive disorder)
Measure's Reliability and Usefulness
- The measure was found to be clinically useful and reliable in the DSM-5 Field Trials conducted in adult clinical samples across the United States and Canada.
- Individuals' symptom ratings were shared with the clinician before meeting, facilitating communication during the clinical encounter.
- Clinicians in both major academic-medical research institutions and routine clinical practice settings found the measure clinically useful and feasible for integration into everyday clinical care and specialty clinical settings.
- Multiple studies have evaluated the psychometric properties of the adult self-rated version of the cross-cutting symptom measure in various populations.
- A large study of non-treatment-seeking college students across the United States demonstrated acceptable internal consistency and internal validity.
Parent/Guardian-Rated Version
- The parent/guardian-rated version of the measure is designed for children ages 6-17 and consists of 25 questions.
- The questions assess 12 psychiatric domains, including:
- Depression
- Anger
- Irritability
- Mania
- Anxiety
- Somatic symptoms
- Inattention
- Suicidal ideation/attempt
Psychiatric Symptom Measure
- Assessments include psychosis, sleep disturbance, repetitive thoughts and behaviors, and substance use.
- Ratings are based on the frequency or severity of symptoms over the past 2 weeks.
- The measure has been found to be clinically useful and reliable in pediatric clinical samples across the United States.
Administration
- Parent/guardian ratings are required for children of all ages.
- For children ages 11-17, clinicians may consider obtaining self-ratings from the child using the child-rated version of the measure.
- The child-rated version of the measure is available online at www.psychiatry.org/dsm5.
Scoring of Self-Rated Measures
- Each item is rated on a 5-point scale: 0 (none or not at all), 1 (slight or rare, less than a day or two), 2 (mild or several days), 3 (moderate or more than half the days), and 4 (severe or nearly every day)
- Clinicians should review scores on each item within a multi-item domain to identify the most problematic symptom
- A rating of mild (2) or greater on any item within a domain (except substance use, suicidal ideation, and psychosis) indicates the need for further assessment
Scoring Guidelines for Child Mental Health
Overview
- The guidelines describe how to use scores from a parent/guardian-rated mental health measure to determine if a more detailed assessment is necessary.
- The measure includes 25 items rated on a 5-point scale, with the exception of three items that are rated on a "Yes, No, or Don't Know" scale.
Scoring and Interpretation
- Most items are rated on a 5-point scale, ranging from 0 (none or not at all) to 4 (severe or nearly every day).
- Scores on the substance use, suicidal ideation, and psychosis domains are used to determine the need for further inquiry.
- A rating of 1 (slight or rare) or greater on any item within these domains may indicate a need for further assessment.
- For inattention and psychosis, scores are interpreted differently, with a rating of 1 (slight or rare) or greater used as an indicator for further inquiry.
- Suicide Attempt and Substance Abuse items are scored on a "Yes, No, or Don't Know" scale, with a rating of "Don't Know" indicating a need for further inquiry.
Threshold Scores
- Threshold scores for further inquiry are outlined in a table, indicating scores of 1+ for substance use, suicidal ideation, psychosis, and inattention, and "Don't Know" for suicide attempt and substance abuse.
Additional Assessment
- Depending on the score, a Level 2 cross-cutting symptom assessment may be needed, providing a more detailed evaluation of possible mental health concerns.
- Level 2 assessment includes domains such as substance use, suicidal ideation, psychosis, inattention, suicide attempt, and substance abuse.
Substance Use Items for Children
- Use of substance use items for children aged 11-17 years may lead to further probing of issues with the child
- This includes using the child-rated Level 2 Cross-Cutting Symptom Measure for the relevant domain
Clinician Guidance
- Clinicians should indicate the highest score on any item within a domain in the "Highest Domain Score" column
- Table 2 provides threshold scores that guide further inquiry for remaining domains
Child-Rated Version Guidelines
- Clinician instructions and guidelines for the child-rated version are similar to those of the parent/guardian-rated version
- Exception: "Don't Know" response categories are not present in the child-rated version
- Refer to www.psychiatry.org/dsm5 for more information
Level 2 Cross-Cutting Symptom Measures
- Threshold scores on Level 1 measures indicate a possible need for detailed clinical inquiry
- Level 2 measures provide in-depth information on potentially significant symptoms to inform diagnosis, treatment planning, and follow-up
- Level 2 measures are available online at www.psychiatry.org/dsm5
- Adult and pediatric versions are available online for most Level 1 symptom domains
Frequency of Use of the Cross-Cutting Symptom Measures
- Level 1 and relevant Level 2 measures can be completed at regular intervals to track change in symptom presentation over time
- Measures should be completed by the same knowledgeable informant for individuals with impaired capacity
- Measures should be completed by the same parent or guardian for children ages 6-17 years
- Consistently high scores on a particular domain may indicate significant and problematic symptoms that warrant further assessment, treatment, and follow-up
- Clinical judgment should guide decision making in using the cross-cutting symptom measures
Psychotic Disorders and Symptom Severity
- Psychotic disorders are heterogeneous, and symptom severity can predict aspects of the illness, such as cognitive and/or neurobiological deficits.
- Dimensional assessments capture meaningful variation in symptom severity, helping with treatment planning, prognostic decision-making, and research on pathophysiological mechanisms.
Clinician-Rated Dimensions of Psychosis Symptom Severity Measure
- The measure provides scales for dimensional assessment of primary symptoms of psychosis, including: • Hallucinations • Delusions • Disorganized speech • Abnormal psychomotor behavior • Negative symptoms
- The measure also includes a scale for dimensional assessment of cognitive impairment, which predicts functional abilities and prognosis.
- Scales for dimensional assessment of depression and mania are provided to identify co-occurring mood pathology.
Assessment and Rating
- The Clinician-Rated Dimensions of Psychosis Symptom Severity is an 8-item measure completed by the clinician during clinical assessment.
- Each item asks the clinician to rate the severity of each symptom as experienced by the individual when it was at its most severe during the past 7 days.
Scoring and Interpretation
- Ratings for each item on the measure are done on a 5-point scale with the following levels:
- 0: none
- 1: equivocal
- 2: present, but mild
- 3: present and moderate
- 4: present and severe
- Each rating level has a symptom-specific definition to guide the clinician's judgment
- Clinicians review all available information and select the level that best describes the symptom severity based on clinical judgment
Frequency of Use
- The measure can be completed at regular intervals to track changes in symptom severity over time
- The frequency of use depends on the individual's symptom stability and treatment status
- Consistently high scores on a particular domain may indicate significant problems that require further assessment, treatment, and follow-up
- Clinical judgment should guide decision making when interpreting results
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Description
A self- or informant-rated measure that assesses domains important across psychiatric diagnoses, helping clinicians identify areas for further inquiry and track symptom changes.
