Introduction: DSM-5: Overview and New Assessment Tools to Improve Clinical Practice— A Lecture (11:19)
Beth Eckerd, a clinical psychologist, works as a university professor and in private practice; her main focus is the grieving process. Participants introduce themselves and explain why they are attending this seminar. Today's lecture will include two short breaks as well as lunch.
Overview of Today's Program (10:23)
The DSM-5 does not include a five-axis diagnosis, does not allow for a NOS diagnosis, and incorporates useful assessment tools to screen and track client progress. Eckerd explains what was lacking in the DSM-4 and why the switch was so controversial. Mental health diagnoses cannot decipher an underlying cause because there are so many mitigating factors.
Who Decides (10:35)
The DSM's board contains mainly psychiatrists. Common criticisms include the large psychiatric influence, potential pharmaceutical influence, insufficient field-testing, and loss of public services. Each category of disorders contained a six to eight person team who reviewed recent literature and incorporated it into the DSM-5.
Mood Disorders (17:16)
Changes that affect bipolar and depressive disorders include incorporating new specifiers like mixed presentation or anxious distress. Rate the severity of the disorder as well as the specifier by mild, moderate, and severe; describing the change of activity is required for diagnosing bipolar disorders. Fill in the category of the disorder instead of using NOS.
Depressive Disorders (10:55)
Four major changes include Disruptive Mood Dysregulation Disorder, Persistent Depressive Disorder, Premenstrual Dysphoric Disorder, and the bereavement exclusion for Major Depressive Disorder has been removed. Mood stabilizers and anti-psychotic medications are used to treat bipolar disorder. Estimated prevalence is between two and five percent.
Premenstrual Dysphoric Disorder (PMDD) (12:41)
Individuals present five symptoms like marked irritability, depressed mood, and physical symptoms. Therapists can make the diagnosis provisionally, but clients need to track and rate their symptoms. The board based their creating new disorders upon the following criteria: different enough from other disorders, validity, and clinically useful.
Persistent Depressive Disorder (14:16)
The new diagnosis merges Dysthymic Disorder and Major Depressive Disorder- Chronic into a single syndrome; the criteria remain the same as in DSM-4. Rate the severity of the disorder and incorporate new specifiers into the diagnosis that describes how the depression manifested itself for the past two years. Clinicians used to not diagnose major depressive disorder if clients were in the first two months of bereavement; people often mimic depression symptoms when they are grieving.
Rest of Depressive Disorders (12:36)
Use specified and unspecified disorders replace NOS for quick diagnosis when you only have a few minutes to meet a client in an emergency capacity. Eckerd briefly explains the differences between recurrent brief depression, short-duration depressive episode, specified depressive disorder, and depressive episode with insufficient symptoms. Changes in anxiety disorders include anxious distress specifiers, clinician decision about levels of fear, increasing cultural awareness, symptoms must have occurred for at least six months, and removal of the social phobia disorder.
Case Study: Sam (13:40)
Eckerd presents a case study of Sam, a young man who experiences panic attacks after the death of his mother and worries he may be schizophrenic. Participants address cultural differences.
Case Study: Sam: Potential Diagnoses (14:23)
Participants address denial and separation anxiety issues with a panic attack specifier. Possible diagnoses include unspecified depressive disorder, major depressive disorder, and depressive episode with insufficient symptoms with panic attacks and anxious distress as a specifier.
Obsessive Compulsive and Related Disorders (14:33)
New disorders in this section include hoarding, excoriation, and trichotillomania. OCD and related disorders follow anxiety because both have similar symptoms. New specifiers include a degree of insight, tics, and muscle dysmorphia.
Trauma and Stressors Disorder: PTSD (20:17)
Trauma and stressors disorders is a new category; to be diagnosed in this chapter clients need to experience a stressor. Disorders include PTSD, Acute Stress, Adjustment, Disinhibited Social Engagement Disorder, and Reactive Attachment Disorder. Eckerd explains the changes to PTSD and symptomology in the DSM-5.
Trauma and Stressors Disorder: Acute Stress Disorder (10:04)
Individuals need to experience the same symptoms as PTSD for less than a month to be diagnosed. Learn about preschool subtype and the dissociative subtype. Eckerd explains how Adjustment disorder is the same as in DSM-4 and when to diagnose it.
Trauma and Stressors Disorder: Children (12:29)
Flashbacks and disruptive memories can manifest out while playing. Reactive Attachment Disorder differs from Social Engagement Disorder because the child does not want to connect to adults. In Persistent Complex Bereavement Disorder, clients experience different symptoms because they are grieving.
Dissociative Changes and Somatoform Disorders (11:33)
Many clients who exhibit dissociative disorders experienced a trauma, but it is not required. Eckerd describes the changes between Dissociative Identity, Dissociative Fugue, Dissociative Amnesia, and Depersonalization Disorders. New disorders in the Somatoform Chapter include Somatic Symptom Disorder, Conversion Disorder, and Factitious Disorder.
Somatoform Disorders (10:18)
Somatic Symptom Disorders incorporates many previous diagnoses into a single disorder; critics argue that the threshold for the diagnosis is too low. Eckerd describes recent changes to Illness Anxiety Disorder.
Feeding and Eating Disorders (13:29)
Changes in this chapter include incorporating Pica Rumination Disorder and creating Binge Eating Disorder. Changes include the removal of the requirement for amenorrhea in an Anorexia Nervosa Diagnosis and removing pejorative language in the chapter. DSM-5 breaks up the sexual dysfunction chapter from gender identity issues.
The DSM-5 no longer labels gender dysphoria and paraphilia as disorders, because it is stigmatizing. There is also a paraphilic disorder, which occurs when it impairs an individual's function or the client feels anxiety about their fetish. One therapist uses Male Hyperactive Sexual Desire Disorder as a diagnosis for sexual addiction.
Other Diagnoses (10:09)
In the DSM-5 diagnoses like paranoid schizophrenia and catatonic schizophrenia, subtypes have been eliminated. Use a specifier like delusional disorder with bizarre content in cases where people imagine and believe things that cannot exist in the real world. Eckerd explains changes to the Neurodevelopmental Disorder chapter, emphasizing the Autism Spectrum Disorder.
Autism Spectrum Disorder: Specifiers (10:11)
Therapists are asked to describe the level of language impairment, intellectual disability, and if it is due to a specific medical condition in their diagnosis. Critics argued about a number of individuals who would lose their services under the DSM-5 model. Eckerd answers questions from the participants about the new criterion, insurance, and public aid.
Neurodevelopmental Disorders: ADHD (09:41)
Symptoms needed to manifest themselves prior to age twelve to obtain an Attention Deficit Hyperactivity Disorder diagnosis in the DSM-5. The latest version removed specific learning disorders from the category and created a general Learning Disorder diagnosis. Eckerd explains the potential problems using IQ tests as a tool in Intellectual disabilities.
Neurocognitive Disorders (09:17)
DSM-5 adapted the neurocognitive disorders to Delirium, Major Neurocognitive, and Mild Neurocognitive Disorders along with the accompanying etiology. Critics argue that mild neurocognitive disorders threshold is too low. Eckerd describes changes to Oppositional Defiant Disorder, Conduct Disorder, Intermittent Explosive Disorder, and Anti-social Personality Disorder.
Substance Abuse and Related Disorders (15:02)
DSM-5 changed all categories to a substance use disorder instead of a substance abuse and substance dependence section and incorporates a severity rating. Clinicians need to use specifiers and severity ratings to describe the client's presentation. New diagnoses include cannabis, caffeine, and gambling.
Personality Disorders (13:53)
There have been no changes made to the DSM-5 in this category. Eckerd explains fundamental changes to the manual including just listing all diagnoses, psychosocial factors, severity level, and level of impairment. The DSM is organized by what stage of life the categories predominantly occur.
Standardized Assessments (13:13)
DSM provides free assessments for symptomology, impairment, and cultural background. Eckerd describes how to use the expanded list of V codes. Medicare will begin penalizing doctors who do not assess thoroughly.
Symptom Assessment (18:13)
The client regularly performing written assessments can find it therapeutic; participants discuss the benefits and drawbacks to incorporating different assessments into their practice. Therapists need to be qualified in order to administer specific tests. Eckerd explains when to use each form and interpreting it.
Conclusion: DSM-5: Overview and New Assessment Tools to Improve Clinical Practice — A Lecture (19:13)
The World Health Organization's Schedule is an assessment tool that describes a client's impairment. The average number of psychotherapy sessions a client attends is between four and five. Eckerd discusses common misconceptions about the ICD-10 and how to find the correct codes.
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