PHRM845 Exam 4-Lecture 51 Flashcards
Overview of the DSM-5 and Rating Scales
DSM-5: number of people that could be diagnosed with a mental health disorder
1 in 5
Is 5 in DSM-5 a number or roman numeral?
NUMBER
When was the publication of DSM-5?
May 2013
When was the publication of the DSM-5, TR added? What changes did it make?
-March 2022; added further SDOH and cultural factors in diagnosis. (Mental illness from lived things, no longer self-caused as previously believed)
-Not trying to silo someone into a diagnosis, but now looking at lived experiences
Challenging, but positive transition for mental health providers with DSM-5
-DSM-IV had been used for 20 years, so it was difficult to transition
-DSM-5 dropped the multi-axial assessment because it negatively separated psychiatric and mental health disorders
-DSM-5 was reorganized to reflect disorders across a continuum based on developmental and lifespan considerations.
Are mental health disorders identifiable?
No because there is no objective information
Mental health disorders begin with
-Neurodevelopmental disorders which encompass disorders previously considered to be childhood diagnosis
What are the neurodevelopmental disorders?
-Intellectual disabilities and delays; communication disorders
-Autism spectrum disorders (deletes the diagnosis of Asperger’s disorder)
-Attention-deficit/hyperactivity disorder
Schizophrenia spectrum, depression, bipolar disorder: Did any specific psychotic disorders get deleted?
NO; only deleted schizophrenia subtypes
What is special about bipolar and related disorders and depressive disorders?
Bipolar and related disorders and depressive disorders have separate chapters–with bipolar found between schizophrenia spectrum and depressive disorders–reflecting the overlapping nature of bipolar disorder
**Overlap of symptoms
In previous DSM editions, the anxiety disorders existed in one BIG chapter. In DSM-5, they are separated into…
-Anxiety disorders: includes GAD, social anxiety disorder, and panic disorder (arise out of fight or flight mechanism)
New separate chapters in DSM-5 for …
OCD, trauma- and stressor-related disorders
To decrease stigma, substance related disorders are no longer seen as
Abuse and dependence (puts blame on the person)
**Now seen as substance use disorders
For substance-related disorders, there is a set criteria for all substance that only vary with symptom presentation based on type of substance used including…
-Alcohol
-Caffeine
-Cannabis
-Hallucinogens
-Inhalants
-Opioids
-Sedatives/hypnotics/
anxiolytics
-Stimulants
-Tobacco
-Other
-Includes gambling disorder–other behavioral excesses have been studied, but not included yet (internet, shopping, etc)
What causes substance-disorders?
The inhibition is gone
Neurocognitive disorders were previously referred to as ___
Dementia
Neurocognitive disorders are categorized into…
Major and mild neurocognitive disorders
-Specifics include types (Alzheimer’s, etc)
Rating scales are difficult because you wonder…
-Who is doing the rating
-What is rated
Rating scale for depression: Patient Health Questionnaire (PHQ-9)
-9 questions to screen for depression and suicidal thinking
-Patient-rated
Rating scale for depression: Beck Depression Inventory (BDI)
-Primarily for research
-Very validated over time for change in meds
-21-item; patient-rated
Mood disorders questionnaire (MDQ)
Designed to be a patient-rated screening tool for bipolar I (mania and depression)
**Often presents as unipolar depression; may make diagnosis worse if it is not treated for the right thing
**Not designed to diagnose bipolar II
Any manic disorder is ____, not ____
bipolar; depression
What is used to diagnose depression?
No objective sign in depression, so we must use rating scales
Hamilton Depression rating scale (HAM-D, HDRS)
-Clinician-rated
-Validated in clinical trials; gold-standard for evaluating change over time
Montgomery-Asberg Depression Rating Scale (MADRS)
-Validated in clinical trials
-Gold standard
-May be more relevant based upon comparison to BDI
Bipolar disorder and Generalized Anxiety: Young Mania Rating Scale (YMRS)
-11 item
-Clinician rated by patient report of symptoms over the past 48 hours
-Used to evaluate symptoms at baseline and over time
Hamilton Anxiety Rating Scale (HAM-A)
-Clinician-rated
Schizophrenia rating scale: Positive and Negative Syndrome Scale (PANSS)
-Gold-standard scale: 20% reduction in symptoms indicates antipsychotic efficacy
-Clinician-rated
Schizophrenia Rating Scale: Brief Psychiatric Rating Scale (BPRS)
-Gold standard scale in clinical trials
-Clinician-rated
Antipsychotics are good at treating ___; ____ don’t do well with tx
-Positive issues
-Social interactions
Movement side effects of antipsychotics: SAS
Simpson-Angus scale
-Evaluates drug-induced parkinsonian symptoms
-Clinician-rated
Movement side effects of antipsychotics: BARS
Barnes Akathisia Scale
-Clinician-rated
-Objective observation of akathisia (Motor restlessness)
What causes Tardive Dyskinesia/Overall Movement side effect?
The unblocking of dopamine receptors
Abnormal Involuntary Movement Scale (AIMS)
Assesses tardive dyskinesia
-Clinician-rated
Extrapyramidal symptoms rating scale (ESRS)
Assesses parkinsonian symptoms, akathisia, dystonia, and tardive dyskinesia in one rating scale.
-Clinician-rated
-Very time-consuming, so not always effective for clinic use
Clinical Global Impressions (CGI)
-Assesses overall psychiatric functioning
-CGI-S=Severity
-CGI-I=Improvement
-Used to assess change over time: can assess efficacy of other rating scales
Global Assessment of Functioning (GAF)
-Assesses overall psychiatric functioning
-Clinician-rated
-0-100 (100 is perfect function)
-Variable results based on clinician evaluation and experience (“cop out” when used in clinical trials)
