DSM-V-TR Lecture Notes PDF

DSM-V-TR Asst.Prof.Dr.Siriporn Poonruksa, RN  Objective: After studying this topic, the students will be able to 1. Explain the evolution of diagnostic criteria in psychiatric work 2. Describe the diagnostic criteria by using multi-axial assessment 3. Explain the DSM-V-TR classifica...

DSM-V-TR Asst.Prof.Dr.Siriporn Poonruksa, RN  Objective: After studying this topic, the students will be able to 1. Explain the evolution of diagnostic criteria in psychiatric work 2. Describe the diagnostic criteria by using multi-axial assessment 3. Explain the DSM-V-TR classification in psychiatric nursing  The evolution of DSM -Diagnostic and Statistical Manual of Mental Disorders (DSM) is initiated by The American Psychiatric Association (APA). -There are many versions as follow. - DSM I 1952 - DSM II 1968 - DSM III 1980 - DSM III-R 1987 - DSM IV 1994 - DSM IV-TR 2000 - DSM V 2013 - DSM V –TR 2022 (April) and still being use now  Why mental health and psychiatric nurses must learn about DSM? https://www.freepik.com/free-ai-image/  MULTIAXIAL ASSESSMENT  A multi-axial system involves an assessment on several axes, each of which refers to a difference domain of information that may help the health care team plan treatment and predict outcome (Michael, et al., 2022). Description of the 5 axes in DSM I to V-TR Axis I : Psychiatric Clinical Disorders Axis II : Personality Disorders or Mental Retardation Axis III : Medical or Physical Conditions Axis IV : Contributing Environmental or Psychosocial Factors Axis V : Global Assessment of Functioning (GAF) Axis I : Psychiatric Clinical Disorders Axis I is for reporting all the various disorders or conditions in the classification, except for the Personality Disorders and Mental Retardation (which are reported on Axis II) Example of clinical disorders in Axis I  Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence (excluding Mental Retardation-Axis II)  Delirium, Dementia, and Amnestic and Other Cognitive Disorders  Substance-Related Disorders  Schizophrenia and Other Psychotic Disorders  Mood Disorders  Anxiety Disorders  Somatoform/ Factitious/ Dissociative Disorders  Sexual and Gender Identity Disorders  Eating Disorders/ Sleep Disorders/ Adjustment Disorders  Other conditions that may be a focus of clinical attention  Axis II : Personality Disorders or Mental Retardation  Axis II is for reporting Personality Disorders, usually diagnosed in adults, and Mental Retardation diagnosed in children and adolescents.  The classes of disorders on Axis II were given their own axis because their usually mild and chronic symptomatology is often overshadowed (to be darkened) by a more florid (excessive) Axis I condition. Example of clinical disorders in Axis II  In childhood: Mental Retardation  In adulthood: Personality disorders Cluster A- Paranoid/ Schizoid/ Schizotypal Cluster B- Antisocial/ Borderline/ Histrionic/ Narcissistic Cluster C- Avoidant/Dependent/Obsessive-Compulsive Axis III : Medical or Physical Conditions  Axis III is for reporting current general medical conditions that are potentially relevant to the understanding or management of the individual’s mental disorder. Example: General Medical Conditions (https://smhp.psych.ucla.edu/conted2/dsm.htm)  Infectious and parasitic diseases  Neoplasms  Endocrine, nutritional, and metabolic diseases and immunity disorders  Diseases of the blood and blood-forming organs  Diseases of the nervous system and sense organs  Diseases of the circulatory system  Diseases of the respiratory system  Diseases of the digestive system  Diseases of the genitourinary system  Complications of pregnancy, childbirth, and the puerperium  Diseases of the skin and subcutaneous tissue  Diseases of the musculoskeletal system and connective tissue  Congenital anomalies  Certain conditions originating in the perinatal period  Symptoms, signs, and ill-defined conditions  Injury and poisoning Example: Lung cancer is a cause of depression.  Axis IV: Contributing Environmental or Psychosocial Factors Example of Axis IV  Problems with primary support group (death, abuse, separation)  Problems related to the social environment (discrimination, living alone)  Educational problems  Occupational problems (unemployed)  Housing problems (homeless, unsafe)  Economic problems  Problems with access to health care services  Problems related to interaction with the legal system/crime  Other psychosocial and environmental problem  Axis V : Global Assessment of Functioning (GAF)  Axis V is for reporting the clinician’s judgment of the individual’s overall level of functioning.  This information is useful in planning treatment and measuring its impact, and in predicting outcome.  Global Assessment of Functioning (GAF) Scale Code 91-100 Happy, healthy, no symptom 81-90 Good functioning 71-80 Slightly impairment; transient symptoms 61-70 Mild symptoms; able to function with some problems in relationship and work 51-60 Moderate symptoms 41-50 Serious symptoms (suicidal ideation but low risk), Serious impairment in one area 31-40 Some impairment in reality testing 21-30 Delusion, hallucination (communication, judgment) 11-20 Some danger of hurting self 0-10 Persistent danger of hurting self or others Remark: the higher score is more mental healthier (Michael, et al., 2022: Morgan and Townsend, 2020).  What are changes in DSM-V-TR?  The main goal of DSM-V-TR is to comprehensively updated the descriptive text that is provided for each DSM based on reviews of the literature (APA, 2023). There are three main changes in DSM-V-TR. 1. Axis I,II,III has been removed since in DSM-V as they caused complicating diagnosis. Therefore, they are grouped to be ONE axis that consists of 20 disorders a according to the coded in ICD-11- CM. 2. Axis IV has been removed. 3. Axis V has taken place with WHO Disability Assessment Schedule (WHODAS) 20 disorders in DSM-V-TRa -Neurodevelopmental disorders -Schizophrenia spectrum and other psychotic disorders -Bipolar and related disorders -Depressive disorders -Anxiety disorders -Obsessive-Compulsive and related disorders -Trauma-and stressor–related disorders -Dissociative disorders -Somatic symptom and related disorders -Feeding and eating disorders -Elimination disorders -Sleep-wake disorders -Sexual dysfunctions -Gender dysphoria -Disruptive, impulse control, and conduct disorders -Substance-related and addictive disorders -Neurocognitive disorders -Personality disorders -Paraphilic disorders -Other mental disorders The change inside each axis of DSM-V-TR can be divided into four categories. 1. Addition of diagnostic entities and symptom codes include Prolong grief disorder, Unspecified mood disorder, Stimulant-induced mild neurocognitive disorder 2. Change in diagnostic criteria or specified definitions include Autistic spectrum disorder, Manic episode, Adjustment disorder, Delirium 3. Updated terminology includes replacing “neuroleptic medication” with “antipsychotic medication”, “intellectual disability” with “intellectual development disorder”, changing “conversion disorder” to “functional neurological syndrome” 4. Comprehensive text updates Experts had reviewed the texts related to DSM concerning racism and discrimination. The significant revisions include prevalence, risk and prognostic factors, culture related to prognostic features, sex and gender related prognostic features, association with suicidal thoughts and behaviors, and comorbidity.  WHO Disability Assessment Schedule (WHODAS)  The World Health Organization Disability Assessment Schedule (WHODAS 2.0) is a practical, generic assessment instrument that can be used to measure health and disability at population level or in clinical practice (WHO), 2010).  It measures level of functioning in six domains of life: 1. Cognition 2. Mobility 3. Self-care 4. Getting along 5. Life activities 6. Participation 1. Cognition – Assesses communication and thinking activities; specific areas assessed include concentrating, remembering, problem solving, learning and communicating. 2. Mobility – Assesses activities such as standing, moving around inside the home, getting out of the home and walking a long distance. 3. Self-care – Assesses hygiene, dressing, eating and staying alone. 4. Getting along – Assesses interactions with other people and difficulties that might be encountered with this life domain due to a health condition; in this context, “other people” includes those known intimately or well (e.g. spouse or partner, family members or close friends) and those not known well (e.g. strangers). 5. Life activities – Assesses difficulty with day-to-day activities (i.e. those that people do on most days, including those associated with domestic responsibilities, leisure, work, and school). 6. Participation – Assesses social dimensions, such as community activities; barriers and hindrances in the world around the respondent; and problems with other issues, such as maintaining personal dignity. (see WHO Disability Assessment Schedule (WHODAS) in PDF) References American Psychiatric Association. Online Assessment Measures. (2nd.). Retrieved December 6, 2023, from https://www.psychiatry. org/File%Library/Psychiatrists/Practice/DSM/APA_DSM5_WHODAS -2-Self-Administered.pdf Michael, B.F., Lamyaa, H. Y., Diana, E.C., Philip, S.W., Nitin, J., and Paul, S.A. (2022). World psychiatry, Vol.21:2, June. Morgan, K.I. and Townsend, M.C. (2020). Essentials of psychiatric mental health nursing (8th). Philadelphia: F.A.Davis. https://smhp.psych.ucla.edu/conted2/dsm.htm