Differences between dsm IV and DSM5 , in child psychiatry

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Differences between dsm IV and DSM5 , in child psychiatry

  1. 1. Differences between DSM-IV and DSM5 , in diagnosing Psychological and Emotional Disorders in Children and Adolescents Dr. Ahmed ALbehairy, M.D Consultant of Psychiatry REF: DSM5, C. Nuckols, PhD, George Haarman Psy.D
  2. 2. Broad Aspects in DSM 5 Organizational Structure Changes
  3. 3. DSM-5DSM-5 - “…the boundaries between many disorder ‘categories’ are more fluid over the life course than DSM-IV recognized, and many symptoms assigned to a single disorder may occur, at varying levels of severity, in many other disorders.” - Scientific evidence places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms.
  4. 4. DSM-5DSM-5 • “DSM is a medical classification of disorders and as such serves as a historically determined cognitive schema imposed on clinical and scientific information to increase its comprehensibility and utility.”
  5. 5. DSM-5DSM-5 Personality Disorders are discussed in 2 areas, 1) DIAGNOSTIC CRITERIA & CODES, and 2) EMERGING MEASURES & MODELS (Alternative Model for Personality Disorders) . First represents an update of the text associated with the same criteria found in DSM-IV-TR, whereas 2nd discussion I includes the proposed research model for personality disorder diagnosis and conceptualization.
  6. 6. DSM-5DSM-5 • Harmonization with ICD-11 ( International Classification of Disease) – DSM-5 and proposed structure of ICD-11 are working toward consistency – ICD-10 is scheduled for US implementation in October 2014 – ICD-9 codes are used in DSM-5 • Dimensional Approach to Diagnosis – Previous DSM’s considered each diagnosis categorically separate from health and other diagnoses – Doesn’t capture the widespread sharing of symptoms and risk factors (why we had some many NOS diagnoses)
  7. 7. Dimensional Approach toDimensional Approach to DiagnosisDiagnosis • Shared neural substrates • Family traits • Genetic risk factors • Specific environmental risk factors • Biomarkers • Temperamental antecedents • Abnormalities of emotional or cognitive processing • Symptom similarity • Course of illness • High comorbidity • Shared treatment response.
  8. 8. Dimensional Approach toDimensional Approach to DiagnosisDiagnosis • It is demonstrated that the clustering of disorders according to internalizing and externalizing factors represent an empirically supported framework. Within both the internalizing group (anxiety, depression and somatic) and externalizing group (impulsive, disruptive conduct and substance use), the sharing of genetic and environmental risk factors likely explains the comorbidities
  9. 9. DSM-5DSM-5 Developmental and Lifespan Considerations: – Begins with diagnoses that occur early in life (neurodevelopmental and schizophrenia spectrum), followed by diagnoses that more commonly manifest in adolescence and young adulthood (bipolar, depressive and anxiety disorders and ends with diagnoses relevant to adulthood and later life (neurocognitive disorders). – After neurodevelopmental disorders, see groups of internalizing (emotional and somatic) disorders, externalizing disorders, neurocognitive disorders and other disorders.
  10. 10. DSM-5DSM-5 Developmental and Lifespan Considerations: – Cultural Issues – Gender Differences – Use of Other Specified and Unspecified Disorders » Replaces NOS designation » Other Specified used when clinician wishes to communicate the specific reason the presentation does not meet criteria for diagnoses » If clinician does not choose to specify the reason Unspecified Disorder is used
  11. 11. Differences between DSM-IV and DSM5 • General changes. • Coding and reporting procedures. • Specific disorders.
  12. 12. World Health Organization Disability assessment Schedule 2.0
  13. 13. Psychiatric Disorders in Children In DSM5 • RED = NEW LABEL. • BLUE = NEW CORRELATION . In DSM-IV • Green = moved
  14. 14. DSM-IV Disorders usually first diagnosed in infancy, childhood, or adolescence )DSM-IV): 10 LABELS 1-Mental retardation ( on axis II) mild MR moderate MR severe MR profound MR MR, severity unspecified. 2- Learning disorders Reading dis. Mathematics dis Disorder of written expression Learning disorder NOS DSM5 Neurodevelopment disorders. 7 LABELS 1-ntellectual disability Mild Moderate Severe Profound Global developmental delay Unspecified intellectual disability 2- Specific learning disorder Specify if With impairment in reading With impairment in written expression With impairment in mathematics. Specify severity ( mild , moderate , sever).
  15. 15. Intellectual disabilities (I.D) • Intellectual disabilities (I.D) is a term more consistent with international thinking . • Diagnostic specifier in I.D includes not only psychometry ( IQ),but also adaptive functions of daily life activities.
  16. 16. 3- Motor skills disorder. Developmental coordination disorder. 4- Tic disorders Tourette’s dis Chronic motor or vocal tic disorder. Transient tic disorder NOS 3-Motors disorders : Developmental coordination disorder. Stereotype movement disorder ( specify with or without self injurious / specify known medica,genetic,neurodevep,enviro n/ specify severity). Tic disorders Tourette’s dis Persistant ( chronic) motor or vocal tic disorder. Provisional tic disorder Other specified unspecified
  17. 17. 5-Communication disorders: expressive language disorder. Mixed receptive expressive language disorder. Phonological disorder. Stuttering Communication dis NOS. 6- Pervasive developmental disorders Autistic disorder Rett’s disorder Childhood disintigrative dis Asperger Pervasive developmental disorders NOS 4-Communication disorders: Language disorder Speech sound disorder Childhood fluency disorder (stuttering ) Social (pragmatic ) communication disorder Unspecified 5- Autism spectrum disorder specify known medica,genetic,neurodevep,enviro n/ specify severity specify if intellectual imparement
  18. 18. 7-ADHD and disruptive behavior ADHD ADHD NOS Conduct dis Oppositional defiant Disruptive behavior NOS 8- Feeding & eating disorders of infancy or childhood Pica Rumination Feeding dis of infancy and children 9- Elimination disorders Encorporesis Enuresis not due to GMC, N,D,N&D 10 -Other disorders of infancy, childhood , adolescence Separation anxiety mutism Reactive attachment disorder Stereotype movement disorder NOS 6- ADHD Specify severity, specify in partial remission Other specified ADHD Unspecified ADHD 7- Other neurodevelopmental disorder Other specified unspecified
  19. 19. DSM5 • FEEDING AND EATING DISORDERS Pica In children , in adult Rumination disorder avoidant/restrictive food intake A.N ( specify restricting , binge/purging) B.N Binge eating Other unspecified
  20. 20. DSM5 Elimination disorders. Disruptive , impulse control and conduct conduct and oppositional defiant move to it . Trauma and stressors related disorders Reactive attachment disorder move to it and divided to RAD and disinhibited social engagment dis.
  21. 21. DSM5 • Anxiety disorders : separation anxiety disorder and selective mutism move to it .
  22. 22. THANK YOU

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