DSM 5

Question 1

What is the DSM-5?

Answer 1

-The Diagnostic & Statistical Manual of Classification of Mental Disorders found its
inception in 1844 by the American Psychological Association (APA) in 1844 as
statistical classification of institutionalized patients at the time which was used as a component of the full U.S. census.

-It however did not inherit the incumbent title until 1956 when the first
DSM was published as a classification of mental disorders, eventually
evolving through four major editions into a robust diagnostic
classification system widely used to diagnose mental health conditions

Question 2

What are the challenges of using DSM-5 to make a diagnosis?

Answer 2

Patient-Related:
* Reliability of history (diagnosis is sometimes hard to confirm with investigations, depends entirely on the Hx).
* Contradiction of reported (what the patient/family reports is what guides the diagnosis) VS. observed signs & symptoms.
* Culture, Spirituality & identity.
* Paucity of clearly understood mental illness biomarkers

Approach Related Factors:
* Dimensional(includes a spectrum of symptoms that create ordinal categories like mild, moderate, and severe for a disease) VS. Categorical Approaches(either in/out).
* Validity(the test is able to pick up true cases in a research) VS. Clinical Utility ( will test to find cases, & using interventions on the cases improve their outcomes?)
* Diagnostic hierarchy in co-morbid illness(Excluding other disorders & substances before making a mental illness disorder).
* ICD(Focuses on clinical utility). or DSM(useful in research, emphasis on diagnostic validity) .

Question 3

The clinical signs and symptoms create a minefield of biases in diagnosing mental health disorders. Mention a few things influencing the signs and symptoms.

Answer 3

*Patient’s internal values and constructs
* Age
* Intellectual range
* Cooperativeness
* Recall
* Clinician’s acumen, ongoing professional development, expertise,
experience level and their own internal values, constructs and motivation.
* Rapport
* Therapeutic Alliance
* Resources
* Collateral

Question 4

What is the significance of biomarkers in diagnosing mental health diseases?

Answer 4

• Limited data available
• Can make correlations between epigenetic changes,
  genes and propensity to develop mental illness
• Psycho-socio-spiritual overlay to biological orchestra.
• The brain is not a logic gate, and is prone to internal
  inconsistencies, both conscious and unconscious. * Therefore biomarkers and epigenetics are only one
  facet of diagnosing and understanding these disorders.
• Environmental influences?

Question 5

Describe the diagnostic hierarch in Psychiatry.

Answer 5

From the top of the pyramid to the bottom(You must first rule out these causes before you can think of a mental disorder) :
1. Organic causes
2. Substances/alcohol.
3. Functionally impairing psychoses.
4. Mood.
5. Anxiety & Neuroses.
6. Personality & Behaviour.

Question 6

Describe the organizational structure of the DSM-5.

Answer 6

• Broad Symptom Categories through the lifespan.
• 20 disorder chapters.
• Section on disorders for further study included

Question 7

What chapters are there in the DSM-5?

Answer 7

• Neurodevelopmental Disorders
• Schizophrenia Spectrum and Other Psychotic Disorders
• Bipolar and Related Disorders
• Depressive Disorders
• Anxiety Disorders
• Elimination Disorders
• Other Mental Disorders and Additional Codes
• Obsessive-Compulsive and Related Disorders
• Trauma- and Stressor-Related Disorders
• Dissociative Disorders
• Somatic Symptom and Related Disorders
• Feeding and Eating Disorders
• Sleep-Wake Disorders
• Sexual Dysfunctions
• Gender Dysphoria
• Disruptive, Impulse-Control, and Conduct Disorders
• Substance-Related and Addictive Disorders
• Neurocognitive Disorders * Personality Disorders
• Paraphilic Disorder
• Medication-Induced Movement Disorders and Other Adverse
  Effects of Medication
• Other Conditions That May Be a Focus of Clinical Attention

Question 8

Describe the diagnostic structure of the DSM-5.

Answer 8

In the past, used to range diagnosis into axis:
I, II, III, IV, V.

(Axis I: Mental Health and Substance Use Disorders.
Axis II: Personality Disorders and Mental Retardation (now Intellectual Development Disorder)
Axis III: General Medical Conditions.
Axis IV: Psychosocial and Environmental Problems.
Axis V: Global Assessment of Functioning (GAF)

DSM 5 Changes
A.A. Non-axial documentation of diagnosis: Now, we write the principal diagnosis and other potential causes.
Axis: I, II,III are combined to encourage a dimensional approach to diagnosis. List diagnosis in order of diagnostic
hierarchies, beginning with the Principal Diagnosis

B: Record important psychosocial & contextual factors(Formerly Axis IV).
-IV: “Z-Codes” (Psychosocial & Environmental Factors)

C: Disability.
V: WHO Disability Assessment Scale (WHODAS)

Terms to clarify:
Z-codes: are used by clinicians to note stressful situations that might have a negative impact on mental health.

Question 9

What other changes were implemented in the DSM-5 from the DSM-4.

Answer 9

• Removal of potentially categorizing terms to limit effect of social
  constructs and biases
• Introduction of the Cultural Formulation Interview
• Understanding of the delicate interplay between culture and certain
  clinical presentations.
• Cross-cutting review committees and an Ethnoracial Equity & Inclusion
  Work Group involved in compilation of the Manual