Using the DSM-5 and ICD-10: The Changing Diagnosis of Mental Disorders — A Lecture: Introduction (12:53)
Professor Emeritus Margaret Bloom trained therapists on the DSM since version 3-R. Learning objectives include: becoming familiar with the DSM-5 manual, understanding and using diagnostic criteria, new mental disorders, and implementation on the ICD-10. The first portion will lay the groundwork for working with both diagnostic tools concurrently.
Mental Illness Diagnosis (19:08)
Health professionals use the Diagnostic and Statistical Manual (DSM)-5 and the International Classification of Diseases (ICD)-10 simultaneously. The DSM-5 no longer uses the multi-axial approach. The ICD developed an alphanumeric coding classification internationally; DSM numbers always represented ICD numbers.
DSM-5 and ICD-10 Correlations (13:50)
The DSM-5 incorporates the codes of the ICD-10 into its manual in parenthesis and adds diagnostic criteria and specifiers. All mental and behavioral codes will begin with an F; ICD codes incorporate symptom level, specifier subtypes, key symptoms, and the course of the illness. All therapists need to record the severity of the diagnosis.
Organization and Structure of DSM-5 (13:43)
Every practitioner should have the desk reference and the assessment tables. The American Psychiatric Association switched to the #5 so they could provide electronic corrections and additional assessment measures. Changes include: modifying the definition of a mental disorder, changes in diagnostic classification, and implementing a development life order.
New Manual Organization (10:12)
The manual includes DSM-5 classification, how to use the manual, a chapter for every classification, cultural formations, and appendices. Bloom recommends using the start of the DSM-5 classification when a clinician is ready to make a diagnosis and provides an example of how to use it. The DSM-5 is organized by what stage of life the classification occurs and whether it is internalized or externalized.
Other Conditions that May Be a Focus of Clinical Attention (15:34)
V codes will become Z codes in the ICD-10. The DSM-5 added more codes to family, social, economic, and criminal issues because it eliminated the multi-axial system. Highlights from chapter one include removing the Not Otherwise Specified (NOS) diagnosis, diagnosis deferred, and unspecified mental disorder; use the term provisional when it is incomplete.
Eliminating Multi-Axial Approach (10:39)
Bloom explains how the health care industry subverted the axis and how clinicians list the disorders. Include mental conditions and medications that may impact a disorder. The DSM-5 provides the World Health Organization's Disability Assessment Schedule 2.0.
Organization of the DSM-5 (13:07)
Bloom provides an example of a depressed client's diagnosis list. There are 21 classifications of mental disorders. A new section includes the latest research on suicide risk for each disorder, co-morbidity, and differential diagnosis.
Neurodevelopmental Disorders: Intellectual Disability (17:06)
The rest of the lecture will highlight changes to diagnostic criteria, new disorders, and deleted disorders in the DSM-5. Disorders include: intellectual disability, autism spectrum, communication disorders, learning disorders, Attention Deficit Hyperactivity Disorder, and motor disorders. IQ tests are no longer used to type and create a diagnosis.
Neurodevelopmental Disorders: Communication Disorders (11:40)
Social Pragmatic Communication Disorder overlaps with Autism Spectrum Disorder. In the DSM-5 Autism, Rett Syndrome, Childhood Disintegrative Disorder, and Asperger's were combined into the Autism Spectrum Disorder. A diagnosis requires communication issues and repetitive behaviors.
Neurodevelopmental Disorders: Autism Spectrum Disorder (09:39)
Autism manifests before the age of two and requires communication issues and repetitive behaviors. When writing out a diagnosis, specify the severity level for each domain and whether there is intellectual or language impairment. Labeling patients with a specific diagnosis is necessary for insurance reimbursement.
Neurodevelopmental Disorders: Attention Deficit Hyperactivity Disorder (04:56)
The DSM-5 modified the ADHD criteria to describe how it would manifest in adults and adolescents. Different ICD codes exist for each type: predominantly inattentive, predominantly hyperactive, or combined. In Specific Learning Disorder, add specifiers for the type of impairment.
Schizophrenia Spectrum (11:05)
Schizotypal Personality Disorder and Delusion Disorder are the mild diagnosis on the spectrum; Schizophrenia and Schizoaffective Disorder are the most severe. Bloom describes changes to the classification and how Attenuated Psychosis Syndrome can be diagnosed in different categories.
Schizophrenia and Schizoaffective Disorder (11:59)
Clients must exhibit delusions, hallucinations, or disorganized speech to be diagnosed. Sub-types proved unreliable markers in the Schizophrenia spectrum; the DSM-5 recommends clinicians analyze the level of severity of the disorder from 0-4. The DSM-5 attempted to clarify differences between Schizophrenia and Schizoaffective Disorder.
Bipolar Disorder (13:19)
Bloom incorporates the diathesis stress model whenever she teaches psychopathology. Bipolar disorder has as much in common with Schizophrenia as depression. The DSM-5 asks clinicians to rate the severity of the disorder as well as the specifier by mild, moderate, or severe. Changes that affect bipolar and depressive disorders include incorporating specifiers like mixed presentation or anxious distress.
Major Depressive Disorder (14:59)
Four major changes include Disruptive Mood Dysregulation Disorder, Persistent Depressive Disorder, Premenstrual Dysphoric Disorder, and the removal of bereavement exclusion for Major Depressive Disorder. The criterion set includes coding procedures that are based on the combination of specifiers. Look at the family history and biology to determine diagnosis; depression in children often manifests as irritability.
Persistent Depressive Disorder and Anxiety Disorders (14:19)
PDD is a chronic condition similar to dysthymia and has the same specifiers as the other depressive disorders. A Premenstrual Dysphoric Disorder diagnosis requires the client to log their symptoms for at least two months; use provisional to submit it to insurances. Mental disorders where the dominant syndrome is anxiety include: anxiety disorders, obsessive compulsive and related disorders, and trauma and stressor-related disorders.
Obsessive Compulsive and Related Disorders (11:53)
Bloom speaks with participants about diagnosis and insurance reimbursement. Disorders in this section include OCD, Body Dysmorphic Disorder, hoarding, excoriation, and trichotillomania. Those afflicted usually manifest symptoms in adolescence.
Body Dysmorphic Disorder (12:00)
The mean age of onset is 13 and is either a minor or perceived defect. Cultural symptoms include repetitive thoughts, mirror checking, and isolation. Because children see the naked male body more frequently in advertisements, the gender distribution for those afflicted is equal.
Hoarding and Trichotillomania (16:38)
Those afflicted with hoarding feel the need to save items regardless of value and refuse to throw them away. Those afflicted with trichotillomania pull out their hair and are aware of the repetitive behavior. Bloom describes how excoriation differs from cutting.
Trauma and Stressor-related Behaviors (14:15)
Trauma and stressor disorders is a new category; a diagnosis requires a major stressor. The chronic stress of neglect, experiencing a traumatic event, and an abnormal response to a stressor cause the classification. Disorders include PTSD, Acute Stress, Adjustment, Disinhibited Social Engagement Disorder, and Reactive Attachment Disorder. Bloom discusses the disorders that manifest in childhood.
Those afflicted need to be exposed to death, serious injury, or sexual abuse. Close family members or friends of the person who experienced trauma can have the disorders. The DSM-5 implemented two criteria sets: one for young children and one for those seven and older. Bloom describes the necessary symptoms that must manifest for the diagnosis.
Acute Stress Disorder (10:04)
Individuals need to experience the same symptoms as PTSD for less than a month to be diagnosed, but it is a different pattern. Web resources include decision trees for choosing between PTSD and Acute Stress Disorder. The International Society for Stress Studies provides many assessment tools for diagnosing trauma disorders.
Adjustment Disorder (07:21)
Adjustment disorder is the same as in DSM-IV and when to diagnose it. Coding instructions include a numerical value with the specifier. Bereavement is considered an adjustment disorder.
Feeding and Eating Disorders (14:16)
This chapter now includes Pica Rumination Disorder and Binge Eating Disorder. The DSM-5 requires a low BMI to diagnose Anorexia Nervosa. Over-exercising, purging, controlled eating, and diet pills are not used in Binge Eating Disorder.
Substance Related and Addictive Behaviors (21:27)
DSM-5 changed all categories to a substance use disorder instead of a substance abuse and substance dependence section. Clinicians need to use specifiers and severity ratings to describe the client's presentation. New diagnoses include cannabis, caffeine, and gambling; use the criteria set for the class of drug.
Diagnosing Substance Use (08:09)
Gather legal and illegal substances a client takes during the in-take interview. The National Institute of Alcohol Abuse and Addiction provides a survey individuals can take. Clinicians need to use specifiers and severity ratings to describe the client's presentation in the ICD-9 or ICD-10.
Disruptive Impulse Control and Conduct Disorders (07:03)
The DSM-5 added Oppositional Defiant Disorder and Conduct Disorder to the Impulse Control classification. Anti-social Personality Disorder is the adult version of Conduct Disorder. Children who exhibit these disorders come into conflict with societal norms and authority figures; they are more common in males than females.
Neurocognitive Disorders (11:01)
Neurocognitive disorders are acquired as individual's age instead of developing as a result of brain disease and must be diagnosed by a physician. DSM-5 adapted the Neurocognitive Disorders to Delirium, Major Neurocognitive, and Mild Neurocognitive Disorders along with the accompanying etiology. The ability to use complex attention, executive functions, learning and memory, language, social conduct, and perceptual motor skills everyday dictates the degree of impairment.
Other Diagnostic Changes (08:08)
Somatoform syndromes now incorporate factitious disorders. Gender dysphoria is no longer listed as a disorder, but allows individuals to transition and seek therapy; there have been no changes made to the DSM-5 in Personality Disorders. Bloom describes the steps to change a previous diagnosis to fit DSM-5 criteria.
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