Week 4 Flashcards
What is in DSM?
What does it contain?
- Criteria, descriptions, symptoms, and other signs for diagnosing mental disorders.
What is in DSM?
What is the purpose?
- Ensure that a diagnosis is both accurate and reliable
- as best we can, given our current knowledge
What is in DSM
- What is not offered?
- reccomendatin on the preferred course of treatment
- atheoretical
History of DSM
How has the DSM evolved over the years?
- 1952: DSM I – 106 disorders
- 1968: DSM II – 182 disorders
- 1980: DSM III – 265 disorders
- 1987: DSM III-R Revised – 292 disorders
- 1994: DSM IV- 297 disorders
- 2000: DSM IV-TR – 365 disorders
- May, 2013 – DSM 5- 367
Why is DSM being revised?
To reflect what?
- new information in neurobiology, genetics, and behavioral sciences
- clearer understanding of how the brain works
Why is DSM being revised?
What will it help?
- researchers study how disorders relate to each other
Why is DSM being revised?
To guide what?
- clinicians in making more accurate and consistent diagnoses
Why is DSM being revised?
Being more responsive to…?
- research findings
Four Principles Guided This Revision
- Clinical utility
- Research based…”validators”- what validates your claim that this is a criterion for disorder.
- Continuity with prior editions
- No “a priori” restraints on the change
What is good mental health?
- ability to recover quickly from stressors of life
- ability to judge reality accurately
- ability to see long range effects of choices
- ability to love an sustain personal relationships
- ability to work cheerfully and productively
- ability to gratify hunger, thirst, sex urges in. Such a way as to not hurt others or oneself
- ability to exercise one’s conscience effectively
DSM-5 Diagnostic Classification
- Symptoms that satisfy DSM-5 diagnostic criteria for diagnosis(eThe first diagnosis written down is the primary diagnosis
- Technically, a diagnosis requires completion of all five Axes. (DSM-IV policy)
- Symptoms that satisfy DSM-IV diagnostic criteria listed for primary and secondary or dual diagnoses
DSM 5 Diagnostic Classification
Axis I
- records every mental disorder except for mental retardation and personality disorder
DSM 5 Diagnostic Classification
Axis II
- records mental retardation and personality disorders
DSM-5 Diagnostic Classification
Axis III
- Records ICD-9 CM
- (International Classification of Diseases 9, Clinically Modified)
- general medical conditions – according to patient
DSM-5 Diagnostic Classification
Axis IV
- records psychosocial and environmental problems
DSM-5 Diagnostic Classification
Axis V
- records current and past year Global Assessment of Functioning (GAF) – [GAF Scale is located on page 34 of the DSM IV TR]
DSM 5 Diagnostic Classification:
The History
- Are these data that supports the diagnosis reliable?
- Are there other data that have been over-looked?
- Are there enough data to make a diagnosis?
- Are there other plausible diagnoses that may be over-looked?
- Has the diagnosis been unduly influenced by data (age, sex, appearance, etc.)?
- Try to disprove your diagnosis:
DSM-5 Diagnostic Classification: The History
Try to disprove your diagnosis:
- “Young adult client, dysphoric, tired, socially withdrawn, has little drive to work… recently lost his job due to poor work performance…”
- Hypothesis 1: Adjustment Disorder (job loss)
- Hypothesis 2: Prodromal stage of schizophrenia (socially withdrawn, job problems, young adult)
- Hypothesis 3: Severe anemia (tired, no drive)
Rule these out. If you do not have enough information, must find more.
DSM-IV TR
DSM
- Diagnostic and Statistical Manual of Mental Disorders
DSM-IV TR
Manual of Mental Disorders
- implies there is a differentiation between an organic disorder and a mental disorder
- – no such thing exists – a mental disorder has an organic component and vice versa
DSM-IV TR
Mental disorder
- a clinically significant behavioral or psychological syndrome or pattern that occurs and is associated with present distress
- (a painful symptom) or a disability (an impairment of one or more important areas of functioning- psychological, social or occupational).
- There is no mental disorder that is not also physiological.
- It is not a mental disorder if it is not clinically significant
DSM-IV TR
DSM IV myths:
- It dehumanizes people – it looks at five areas of functioning in a person –
- a broad range of disorders described, not people [“alcoholism” not “alcoholic”]
- Does not help with treatment - it gives guidance – points out what needs to be remedied
- Too complicated to be useful – No it’s not.
DSM IV TR
Limitations
- you either have the disorder or you don’t
- There are real world challenges with categorical symptoms
- DSM IV is a categorical system
- Categorical systems have construct validity problems because they don’t/can’t capture the clinical complexity of a patient’s experience
Limitations to DSM IV
DSM IV is a categorical system
- Categorical systems do not always fit with the range of symptoms of a specific client
- Client with schizophrenia can have several other symptoms not included in the criteria set
- Depression, anxiety, insomnia, suicidal ideation
- There was no way to directly assess the level or severity of these other symptoms (dimensions)
- So, Dimensional Assessments were added in DSM 5
What does DSM 5 do for categorized diagnoses?
- Doesn’t replace it, but adds a dimensional option
Creating DSM 5
The workgroups were tasked to
- Clarify boundaries between specific mental illness and normal functioning in specific cases
- Clarify the boundaries between mental disorders
- Consider “cross-cutting” symptoms (Dimensions)
- Symptoms that are common across different diagnoses
- Anxiety/depression, etc.
- Provide research justification for all recommendations (validators)
DSM 5
Process Timeline
- 1999-2007: white paper monographs published
- 2007: 13 workgroups appointed to study 20 categories of disorders
- April 2010 – December 2011
- first drafts submitted for public review and revised
- Field trials occurred and were followed by revisions
- These revisions were put on the Internet for feedback
- December 2012
- Final draft presented to APA and approved
- May 22, 2013
- DSM 5 launched
The 3 Sections of the DSM 5
Section 1
- Introduction on use (Please read intro)
The 3 Sections of the DSM 5
Section 2
- the 20 Chapters of categorical disorders
The 3 Sections of the DSM 5
Section 3
- conditions that require further research, assessment instruments (greater emphasis on measurement on DSM-5) (proposal personality disorders, these have been left unchanged form DSM-IV
DSM 5 Chapter Sequence
- DSM 5 chapters are broad categories
- Each category describes related disorders in developmental lifespan sequence (childhood, adolescence, adulthood and later life)
- The rationale is to advance the understanding of the relationship between diagnoses.
Overarching Perspective
- Most of DSM 5 will be familiar
- Important organizational and criteria set differences exist
- Comorbidity within and across diagnoses addressed
- Criteria sets parallel the ICD 11 (proposed)
Purpose of Diagnosis
- Facilitate treatment
- Uniform clinical language
- Features of a diagnosis
Purpose of Diagnosis
Features of a diagnosis
Must show some impairment of function
Must be a clear deviation from usual roles, i.e. most people do not have it.
Must cause distress to the person with it
All 3 items must be clinically significant: speaks to the level of disruption it creates in a person’s life, the level of distress it causes to the person.
Making a diagnosis
- Avoid the rush to certainty: postpone judgment and think of any information you could have missed
- It’s a process not an event
- It’s an art as well as a science
- It’s a “search for the locus of pain”
Diagnostic Criteria Sets
Signs
- are an objective finding observed by the therapist
Diagnostic Criteria Sets
Symptoms
- are subjective experiences described by the client
Diagnostic Criteria Sets
Syndromes
- a group of signs and symptoms that occur together and present the picture of a recognizable condition.
- (Diagnoses in the DSM are syndromes- a combination of signs and symptoms).
Medical History Form
Remerber*** DO NOT DO WHAT?
- For liablility reasons, do not miss anything so you can make recommendations and referrals.
- DO NOT FORGET THAT PATIENTS’ CASE HISTORY IS A LEGAL DOCUMENT
The Counselor Should Be Able To
- Document a DSM-5 Diagnosis
- Demonstrate that the condition is treatable; no one will pay for something that is not treatable
- Outline a treatment plan
- Provide a rationale for the intervention
- Describe the progress toward goals
- Provide a timeline (in reality, managed care defines the timeline)
- Outline discharge criteria
Attitude
- systematic way of feeling, thinking, and reacting
Etiology
- cause or origin of disorder (Many disorders have multiple etiologies meaning many causes; although 2 clients may have the same disorder, they may have different causes)
Pathogenesis
- course of development of the disorder (how it develops)
Incidence
- the number of new cases that occur in a given period
Prevalence
- the number of existing cases in any time period
- (ex: The incidence of flu in December was 46% of the total flu cases for the season.)
Point Prevalence
- how prevalent it is on a given day or a particular point in time (how epidemiology data is collected)
Psychopathology
- impairment of psychological, social or occupational functioning that is clinically significant and causes distress to the individual.
Diagnosis: Two major approaches
psychosocial
- Suggests diagnosis is based on some inferred cause, some underlying event that explains why.
- Disturbance, in that approach, paranoid part of personality cause that response.
- DSM I & II based on – psychodynamic theory influences
Diagnosis: Two major approaches
descriptive
- Objective signs, symptoms and natural history
- comes from British approach
- basis for DSM III & IV
Diagnosis
Psychopathology is defined by 3 distinct features:
- Clinically significant impairment
- Psychological, social, or occupational functioning
- Clinically significant deviance from the norm
- Clinically significant distress
Diagnosis with the DSM-IV: ● For a person to meet criteria for a disorder we look for 3 things
signs
- objective findings observed by clinician (client was crying)
Diagnosis with the DSM-IV: ● For a person to meet criteria for a disorder we look for 3 things
symptoms
- subjective experiences of client
- (“I have no energy.”)
- Counselor cannot see them unless the client tells them
Diagnosis with the DSM-IV: ● For a person to meet criteria for a disorder we look for 3 things
syndromes
- clusters of signs and symptoms that occur together as a recognizable condition that support a Dx
Diagnosis with the DSM-IV
“Issues”
- problems of living
- non-reimbursable and not for diagnosing with the DSM IV
- (use of this term exemplifies counselor’s lack of skill level!) …
- also don’t use the term “concerns” either.
Diagnosis with the DSM-IV
Diagnostic Codes
- First 3 numbers are the number of the disorder, then other numbers indicate items such as severity
Diagnosis with the DSM-IV
Severity
- mild, moderate, or severe – some have subtypes to them (delusional disorder – 7 subtypes)
