This document provides an overview of the main themes and diagnostic revisions in the DSM-5. It outlines 10 major changes incorporated in the new manual, including making it more user-friendly, incorporating a spectrum perspective, adding dimensionality, reflecting a developmental perspective, increasing emphasis on culture and gender, enhancing diagnostic information, matching ICD codes, reinventing it as a living document, introducing a hybrid diagnostic model, and using more biologically-based criteria. It also reviews revisions to several diagnostic categories such as neurodevelopmental disorders, schizophrenia spectrum disorders, bipolar disorders, depressive disorders, anxiety disorders, and trauma-related disorders.
The dimensional approach to classifying mental disorders focuses on the extent or degree to which a person exhibits certain characteristics rather than categorizing them into diagnostic types. It involves profiling individuals along multiple dimensions like anxiety, mood variation, and personality traits and comparing their scores to population norms. This provides richer data about a case by capturing severity on a continuum rather than just presence or absence of symptoms. Grading and tracking dimensions over time can help monitor treatment effectiveness.
The document provides an overview of the history and development of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It discusses the key changes between editions, from the initial DSM-I in 1952 to the current DSM-5 from 2013. Major revisions in DSM-5 include eliminating the multi-axial system, replacing many disorder names, combining and reorganizing certain diagnoses, and emphasizing dimensional assessments and cultural factors in diagnosis. The goal is to improve clinical utility, reliability and cultural sensitivity in defining and classifying mental disorders.
DSM - Diagnostic and Statistical Manual of Mental Disorders,
It is the handbook used by health care professionals as an authoritative guide to the diagnosis of mental disorders.
ICD 11 proposed changes - A New Perspective On An Old DreamMohamed Sedky
The document discusses proposed changes in the ICD-11 classification system compared to previous versions. Some key points:
- Neurodevelopmental disorders are reorganized, and autism is now classified as autism spectrum disorder.
- Schizophrenia subtypes are removed, and specifiers are added for symptoms. Catatonia is now a separate entity.
- Bipolar II disorder is added as a new category under mood disorders.
- New disorders are added such as binge eating disorder, gaming disorder, and body dysmorphic disorder.
- The classification of PTSD is narrowed, and complex PTSD is proposed as a new category. Prolonged grief disorder is added.
This document provides an overview and critical evaluation of changes between the DSM-IV and DSM-5 diagnostic systems. It summarizes the evolution of the DSM from a prototype-based approach to a checklist-based approach. The DSM-5 integrated dimensional aspects into diagnoses and reorganized some disorders. It added several new diagnoses and changed names of some existing diagnoses. Critic Allen Frances believes some DSM-5 changes could lead to overdiagnosis and misdiagnosis by expanding what is considered abnormal. The document discusses both positive and negative aspects of the changes between DSM editions.
This document provides an overview of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It discusses the purposes of psychiatric diagnosis, two diagnostic approaches (descriptive and psychological), dimensions of diagnosis (categorical vs dimensional; monothetic vs polythetic), historical versions of the DSM, innovations in DSM-III, changes in DSM-5 structure, and considerations of culture in diagnosis. The document serves to introduce clinicians to the classification and organization of mental disorders in the DSM-5.
Core slides from my presentation about the new DSM diagnostic system. The full presentation has more zing but I removed some to streamline and to whet the appetite.
The dimensional approach to classifying mental disorders focuses on the extent or degree to which a person exhibits certain characteristics rather than categorizing them into diagnostic types. It involves profiling individuals along multiple dimensions like anxiety, mood variation, and personality traits and comparing their scores to population norms. This provides richer data about a case by capturing severity on a continuum rather than just presence or absence of symptoms. Grading and tracking dimensions over time can help monitor treatment effectiveness.
The document provides an overview of the history and development of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It discusses the key changes between editions, from the initial DSM-I in 1952 to the current DSM-5 from 2013. Major revisions in DSM-5 include eliminating the multi-axial system, replacing many disorder names, combining and reorganizing certain diagnoses, and emphasizing dimensional assessments and cultural factors in diagnosis. The goal is to improve clinical utility, reliability and cultural sensitivity in defining and classifying mental disorders.
DSM - Diagnostic and Statistical Manual of Mental Disorders,
It is the handbook used by health care professionals as an authoritative guide to the diagnosis of mental disorders.
ICD 11 proposed changes - A New Perspective On An Old DreamMohamed Sedky
The document discusses proposed changes in the ICD-11 classification system compared to previous versions. Some key points:
- Neurodevelopmental disorders are reorganized, and autism is now classified as autism spectrum disorder.
- Schizophrenia subtypes are removed, and specifiers are added for symptoms. Catatonia is now a separate entity.
- Bipolar II disorder is added as a new category under mood disorders.
- New disorders are added such as binge eating disorder, gaming disorder, and body dysmorphic disorder.
- The classification of PTSD is narrowed, and complex PTSD is proposed as a new category. Prolonged grief disorder is added.
This document provides an overview and critical evaluation of changes between the DSM-IV and DSM-5 diagnostic systems. It summarizes the evolution of the DSM from a prototype-based approach to a checklist-based approach. The DSM-5 integrated dimensional aspects into diagnoses and reorganized some disorders. It added several new diagnoses and changed names of some existing diagnoses. Critic Allen Frances believes some DSM-5 changes could lead to overdiagnosis and misdiagnosis by expanding what is considered abnormal. The document discusses both positive and negative aspects of the changes between DSM editions.
This document provides an overview of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It discusses the purposes of psychiatric diagnosis, two diagnostic approaches (descriptive and psychological), dimensions of diagnosis (categorical vs dimensional; monothetic vs polythetic), historical versions of the DSM, innovations in DSM-III, changes in DSM-5 structure, and considerations of culture in diagnosis. The document serves to introduce clinicians to the classification and organization of mental disorders in the DSM-5.
Core slides from my presentation about the new DSM diagnostic system. The full presentation has more zing but I removed some to streamline and to whet the appetite.
This document provides an overview of dissociative disorders, including:
- Their classification in both ICD-10 and DSM-5 systems.
- Epidemiological findings that dissociative symptoms are common in the general population.
- Etiological theories including information processing theories and the discrete behavioral state model.
- A history of conceptualizations from ancient theories to modern understandings of dissociation and dissociative disorders.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)Hemangi Narvekar
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), offers a common language and standard criteria for the classification of mental disorders.
The document provides an overview of the changes between editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It discusses the evolution of the DSM from earlier editions to the current DSM-5, which was approved in 2013. Some key changes in the DSM-5 include combining and splitting certain diagnoses, adding several new disorders, removing the multiaxial system, and including emerging measures and models for further study. The document outlines these changes in detail and provides background on the development process of the DSM-5.
This document provides an overview of delusions from multiple perspectives. It defines delusions, describes the types and content of delusions, and explains several theories about the formation and maintenance of delusional beliefs, including psychodynamic, learning, theory of mind, role of emotions, and attributional bias approaches. It also discusses factors such as conviction, extension, bizarreness, and pressure that contribute to delusional severity.
The document discusses changes to the diagnosis of personality disorders in DSM-5. It notes that only borderline personality disorder showed good reliability in DSM-5 field trials. It introduces new concepts like cross-cutting symptom measures and assessing personality functioning. An alternative dimensional trait model for personality disorders is presented in DSM-5 for research purposes only. ICD-11 beta criteria also take a dimensional approach without specific subtypes. The multiaxial system is removed from DSM-5.
Classification in Psychiatry
The concept, reliability, validity, advantages and disadvantages of different classification systems, controversies in psychiatry classification
The document provides an overview of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It discusses the history and development of the DSM from its first edition in 1952 to the current DSM-5 from 2013. Major improvements in DSM-5 compared to previous editions include a developmental and lifespan approach, integration of cultural issues, inclusion of latest genetic and neuroimaging evidence, and restructuring of certain disorders. The document also compares the DSM to the ICD classification system and outlines some ongoing controversies regarding categorical diagnosis of mental disorders.
The document provides information on neuropsychological tests, including:
- Psychological tests must be reliable, valid, and have norms to be considered tests.
- Tests are used to assess intelligence, aptitude, achievement, personality traits, and more.
- Objective tests use standardized questions while projective tests allow subjective responses.
- Tests can be individual, group-based, or use batteries of assessments.
- Examples of tests described include the Bender Gestalt Test for perception, Wisconsin Card Sorting Test for executive functions, and others.
Epidemiological studies in psychiatry in IndiaSujit Kumar Kar
Epidemiological studies in psychiatry have been conducted in India for over 60 years, starting with Dr. K.C. Dube's 1961 study in Agra. Initial studies found wide variation in prevalence rates of psychiatric disorders from 9.5 to 370 per 1000 population. Landmark international studies provided more standardized approaches. However, Indian studies were inadequate to assess non-psychotic disorders. Substance use epidemiological studies included the National Household Survey and Drug Abuse Monitoring System. The National Mental Health Survey was the largest nationwide survey and found treatment gaps of 73-85% for mental disorders. Ongoing national surveys continue to inform mental healthcare in India.
Classificatory systems - Advantages & DisadvantagesHemangi Narvekar
Classification of Diseases/Disorders are important to improve treatment and prevention efforts. Two important classification system used in the field of Mental Disorders are DSM -V and ICD -10. Here we will discuss Strengths and Weaknesses of both.
This document discusses intelligence, IQ, IQ tests, and methods for estimating pre-morbid IQ. It defines intelligence and outlines several theories of intelligence. It explains what IQ is and how IQ tests work. It also discusses major IQ tests like the Wechsler scales and Stanford-Binet. The document outlines various methods for estimating an individual's intellectual abilities before any brain damage or disease onset, including using preserved abilities, historical records, and comparing pre-and post-injury test performance.
The document compares and contrasts the ICD-11 and DSM-V classification systems for mental disorders. It provides details on their similarities such as both being used by health professionals for diagnosis. It outlines many of their differences such as ICD-11 being used internationally while DSM-V is mainly used in the US. The document also provides side by side comparisons of the classification categories and disorders covered in each system, noting where they are aligned and where classifications differ between the two.
This document provides an overview of the clinical interview process. It discusses the characteristics of a clinical interview, including that it is a one-on-one conversation between a professional and client in a professional setting. It describes the different types and structures of interviews, such as intake interviews, case history interviews, mental status exams, crisis interviews, and diagnostic interviews. Communication strategies for building rapport and conducting the interview are also covered, along with considerations for different populations and common pitfalls.
MENTAL HEALTH MUST BE BROADLY DEFINED IN TERMS THAT ARE CULTURALLY SENSITIVE AND INCLUSIVE.
THE CRITERIA FOR MENTAL HEALTH MUST BE EMPIRICALLY AND LONGITUDINALLY VALIDATED.
VALIDATION MEANS PAYING SPECIAL ATTENTION TO CROSS-CULTURAL STUDIES.
The document discusses psychiatric classification systems. It provides an overview of key concepts like nosology, syndrome, disease, and disorder. It describes the purposes of psychiatric classification as communication, control of disorders, and comprehension. It discusses important criteria for a good classification like reliability, validity, utility, and ease of use. Challenges in psychiatric classification are the reliance on subjective reports and lack of objective measures. The document contrasts categorical and dimensional models of classification and provides examples of disorders where a dimensional approach is favored. It provides a brief history of major classification systems and describes current systems like DSM-5 and ICD-11.
Schizophrenia Spectrum & Other Psychotic Disorders for NCMHCE StudyJohn R. Williams
The document provides an overview of schizophrenia spectrum and other psychotic disorders according to the DSM-5. It discusses key features of psychotic disorders including delusions, hallucinations, and disorganized thinking. It then summarizes several psychotic disorders - brief psychotic disorder, delusional disorder, schizophrenia, schizoaffective disorder, substance/medication-induced psychotic disorder, and psychotic disorder due to another medical condition. For each disorder, it outlines diagnostic criteria and treatment approaches including medications, therapy, and monitoring.
This document discusses precision psychiatry and the use of various "omics" technologies to advance precision medicine approaches in psychiatry. It outlines how genomics, pharmacogenomics, transcriptomics, and metabolomics can provide insights into the pathophysiology of mental illnesses and help determine individualized treatment approaches. Challenges include the complexity of gene-environment interactions, barriers to implementing pharmacogenomic testing in clinical practice, and the need for more work to develop multi-omics biomarkers that can predict disease risk and treatment response at the individual level.
Impact of culture on mental illness/ Transcultural Psychiatry Dr. Amit Chougule
This document discusses the impact of culture on mental illness and psychiatry. It begins by defining culture and the components of culture. It then discusses how culture shapes psychopathology in various ways such as pathogenic, pathoplastic, and pathofacilitative effects. Culture also impacts psychodynamics through variables like dependency versus autonomy, linguistic competence, cognitive styles, and social support systems. Overall, the document examines how culture influences the expression and experience of mental illness as well as psychiatric diagnosis and treatment across different cultures.
The document discusses theory of mind, including:
1) Defining theory of mind as the ability to infer mental states like beliefs, desires, intentions in oneself and others and understand they may differ.
2) The two main theories of how theory of mind develops are the theory-theory, which proposes it is based on learned folk psychology, and simulation theory, which suggests imagining oneself in another's perspective.
3) Theory of mind develops through childhood, starting with imitation and joint attention, then understanding knowledge, beliefs, and later false beliefs around ages 3-5. Neuroimaging research implicates temporal pole, medial prefrontal cortex, and posterior superior temporal sulcus in theory of mind.
The document summarizes the key differences between the DSM-IV and DSM-5 diagnostic manuals. It explains that the DSM-IV used a multi-axial system to classify mental disorders across five axes, while the DSM-5 simplified this system. It also outlines some of the biggest changes in the DSM-5, including modifying categorization of disorders, unifying autism spectrum disorders, removing childhood bipolar disorder, revising ADHD diagnosis, adding PTSD symptom details, reclassifying dementia, and changing "mental retardation" to "intellectual disability".
This document provides an overview of dissociative disorders, including:
- Their classification in both ICD-10 and DSM-5 systems.
- Epidemiological findings that dissociative symptoms are common in the general population.
- Etiological theories including information processing theories and the discrete behavioral state model.
- A history of conceptualizations from ancient theories to modern understandings of dissociation and dissociative disorders.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)Hemangi Narvekar
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), offers a common language and standard criteria for the classification of mental disorders.
The document provides an overview of the changes between editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It discusses the evolution of the DSM from earlier editions to the current DSM-5, which was approved in 2013. Some key changes in the DSM-5 include combining and splitting certain diagnoses, adding several new disorders, removing the multiaxial system, and including emerging measures and models for further study. The document outlines these changes in detail and provides background on the development process of the DSM-5.
This document provides an overview of delusions from multiple perspectives. It defines delusions, describes the types and content of delusions, and explains several theories about the formation and maintenance of delusional beliefs, including psychodynamic, learning, theory of mind, role of emotions, and attributional bias approaches. It also discusses factors such as conviction, extension, bizarreness, and pressure that contribute to delusional severity.
The document discusses changes to the diagnosis of personality disorders in DSM-5. It notes that only borderline personality disorder showed good reliability in DSM-5 field trials. It introduces new concepts like cross-cutting symptom measures and assessing personality functioning. An alternative dimensional trait model for personality disorders is presented in DSM-5 for research purposes only. ICD-11 beta criteria also take a dimensional approach without specific subtypes. The multiaxial system is removed from DSM-5.
Classification in Psychiatry
The concept, reliability, validity, advantages and disadvantages of different classification systems, controversies in psychiatry classification
The document provides an overview of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It discusses the history and development of the DSM from its first edition in 1952 to the current DSM-5 from 2013. Major improvements in DSM-5 compared to previous editions include a developmental and lifespan approach, integration of cultural issues, inclusion of latest genetic and neuroimaging evidence, and restructuring of certain disorders. The document also compares the DSM to the ICD classification system and outlines some ongoing controversies regarding categorical diagnosis of mental disorders.
The document provides information on neuropsychological tests, including:
- Psychological tests must be reliable, valid, and have norms to be considered tests.
- Tests are used to assess intelligence, aptitude, achievement, personality traits, and more.
- Objective tests use standardized questions while projective tests allow subjective responses.
- Tests can be individual, group-based, or use batteries of assessments.
- Examples of tests described include the Bender Gestalt Test for perception, Wisconsin Card Sorting Test for executive functions, and others.
Epidemiological studies in psychiatry in IndiaSujit Kumar Kar
Epidemiological studies in psychiatry have been conducted in India for over 60 years, starting with Dr. K.C. Dube's 1961 study in Agra. Initial studies found wide variation in prevalence rates of psychiatric disorders from 9.5 to 370 per 1000 population. Landmark international studies provided more standardized approaches. However, Indian studies were inadequate to assess non-psychotic disorders. Substance use epidemiological studies included the National Household Survey and Drug Abuse Monitoring System. The National Mental Health Survey was the largest nationwide survey and found treatment gaps of 73-85% for mental disorders. Ongoing national surveys continue to inform mental healthcare in India.
Classificatory systems - Advantages & DisadvantagesHemangi Narvekar
Classification of Diseases/Disorders are important to improve treatment and prevention efforts. Two important classification system used in the field of Mental Disorders are DSM -V and ICD -10. Here we will discuss Strengths and Weaknesses of both.
This document discusses intelligence, IQ, IQ tests, and methods for estimating pre-morbid IQ. It defines intelligence and outlines several theories of intelligence. It explains what IQ is and how IQ tests work. It also discusses major IQ tests like the Wechsler scales and Stanford-Binet. The document outlines various methods for estimating an individual's intellectual abilities before any brain damage or disease onset, including using preserved abilities, historical records, and comparing pre-and post-injury test performance.
The document compares and contrasts the ICD-11 and DSM-V classification systems for mental disorders. It provides details on their similarities such as both being used by health professionals for diagnosis. It outlines many of their differences such as ICD-11 being used internationally while DSM-V is mainly used in the US. The document also provides side by side comparisons of the classification categories and disorders covered in each system, noting where they are aligned and where classifications differ between the two.
This document provides an overview of the clinical interview process. It discusses the characteristics of a clinical interview, including that it is a one-on-one conversation between a professional and client in a professional setting. It describes the different types and structures of interviews, such as intake interviews, case history interviews, mental status exams, crisis interviews, and diagnostic interviews. Communication strategies for building rapport and conducting the interview are also covered, along with considerations for different populations and common pitfalls.
MENTAL HEALTH MUST BE BROADLY DEFINED IN TERMS THAT ARE CULTURALLY SENSITIVE AND INCLUSIVE.
THE CRITERIA FOR MENTAL HEALTH MUST BE EMPIRICALLY AND LONGITUDINALLY VALIDATED.
VALIDATION MEANS PAYING SPECIAL ATTENTION TO CROSS-CULTURAL STUDIES.
The document discusses psychiatric classification systems. It provides an overview of key concepts like nosology, syndrome, disease, and disorder. It describes the purposes of psychiatric classification as communication, control of disorders, and comprehension. It discusses important criteria for a good classification like reliability, validity, utility, and ease of use. Challenges in psychiatric classification are the reliance on subjective reports and lack of objective measures. The document contrasts categorical and dimensional models of classification and provides examples of disorders where a dimensional approach is favored. It provides a brief history of major classification systems and describes current systems like DSM-5 and ICD-11.
Schizophrenia Spectrum & Other Psychotic Disorders for NCMHCE StudyJohn R. Williams
The document provides an overview of schizophrenia spectrum and other psychotic disorders according to the DSM-5. It discusses key features of psychotic disorders including delusions, hallucinations, and disorganized thinking. It then summarizes several psychotic disorders - brief psychotic disorder, delusional disorder, schizophrenia, schizoaffective disorder, substance/medication-induced psychotic disorder, and psychotic disorder due to another medical condition. For each disorder, it outlines diagnostic criteria and treatment approaches including medications, therapy, and monitoring.
This document discusses precision psychiatry and the use of various "omics" technologies to advance precision medicine approaches in psychiatry. It outlines how genomics, pharmacogenomics, transcriptomics, and metabolomics can provide insights into the pathophysiology of mental illnesses and help determine individualized treatment approaches. Challenges include the complexity of gene-environment interactions, barriers to implementing pharmacogenomic testing in clinical practice, and the need for more work to develop multi-omics biomarkers that can predict disease risk and treatment response at the individual level.
Impact of culture on mental illness/ Transcultural Psychiatry Dr. Amit Chougule
This document discusses the impact of culture on mental illness and psychiatry. It begins by defining culture and the components of culture. It then discusses how culture shapes psychopathology in various ways such as pathogenic, pathoplastic, and pathofacilitative effects. Culture also impacts psychodynamics through variables like dependency versus autonomy, linguistic competence, cognitive styles, and social support systems. Overall, the document examines how culture influences the expression and experience of mental illness as well as psychiatric diagnosis and treatment across different cultures.
The document discusses theory of mind, including:
1) Defining theory of mind as the ability to infer mental states like beliefs, desires, intentions in oneself and others and understand they may differ.
2) The two main theories of how theory of mind develops are the theory-theory, which proposes it is based on learned folk psychology, and simulation theory, which suggests imagining oneself in another's perspective.
3) Theory of mind develops through childhood, starting with imitation and joint attention, then understanding knowledge, beliefs, and later false beliefs around ages 3-5. Neuroimaging research implicates temporal pole, medial prefrontal cortex, and posterior superior temporal sulcus in theory of mind.
The document summarizes the key differences between the DSM-IV and DSM-5 diagnostic manuals. It explains that the DSM-IV used a multi-axial system to classify mental disorders across five axes, while the DSM-5 simplified this system. It also outlines some of the biggest changes in the DSM-5, including modifying categorization of disorders, unifying autism spectrum disorders, removing childhood bipolar disorder, revising ADHD diagnosis, adding PTSD symptom details, reclassifying dementia, and changing "mental retardation" to "intellectual disability".
The document outlines various mental disorders, neurological disorders, and other conditions that may require clinical attention as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It includes over 20 broad categories of disorders with numerous specific disorders listed under each category such as neurodevelopmental disorders, schizophrenia spectrum disorders, depressive disorders, neurocognitive disorders, and substance abuse disorders. It also covers other conditions related to medical, environmental, and psychosocial issues.
The document provides a historical overview of the DSM-5 and describes some of the key changes between DSM-IV and DSM-5. It discusses how the DSM-5 was developed over many years through an extensive review process involving thousands of comments. The DSM-5 reorganizes diagnoses across the lifespan and encourages use of assessment measures. Several neurodevelopmental disorders saw name changes and clarified criteria in the DSM-5.
- The document discusses changes in the DSM-5 from the DSM-IV. It summarizes that much of the DSM-5 is unchanged but some diagnoses were reclassified, criteria were clarified, and only 15 new diagnoses were added. It also notes that the DSM-5 no longer uses the multi-axial system and instead provides non-axial documentation of diagnoses.
- Specific changes are discussed for depressive disorders, anxiety disorders, obsessive-compulsive and related disorders. For example, disruptive mood dysregulation disorder is a new diagnosis, and premenstrual dysphoric disorder is now in the main DSM-5 rather than the appendix. The document also discusses general changes like modifications to
Differences between dsm IV and DSM5 , in child psychiatryاحمد البحيري
The document summarizes some of the key differences between the DSM-IV and DSM-5 classifications of psychological disorders in children and adolescents. It notes that the DSM-5 takes a dimensional approach rather than categorical, recognizes significant sharing of symptoms between disorders, and reorganizes some disorders into different categories. Specific changes include intellectual disabilities replacing mental retardation, a new neurodevelopmental disorders category, changes to certain disorder names and criteria, and an emphasis on development and lifespan considerations.
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This can be used like flashcards or as a presentation.
The document summarizes key aspects of neurocognitive disorders as outlined in Chapter 7. It describes three main groups - delirium, major or minor neurocognitive disorders (dementia), and amnestic disorders. Delirium is a temporary state of confusion that can have various causes and usually resolves quickly if the underlying cause is treated. Dementia involves a gradual loss of cognitive abilities that impairs daily life; it has various causes like Alzheimer's disease or vascular issues. Assessment and management aim to address any underlying causes or provide support, as the condition is often not reversible.
The document discusses the classification of mental disorders according to two major systems - ICD-10 and DSM-IV. ICD-10 is the World Health Organization's classification system that codes psychiatric disorders from F00 to F99. DSM-IV is the diagnostic manual published by the American Psychiatric Association that uses a multi-axial system with five axes to evaluate patients. Some key differences between the two systems are that ICD-10 is intended for clinical work, research, and primary care globally while DSM-IV is in English only and includes social consequences in its diagnostic criteria.
This document summarizes key changes between the DSM-IV and DSM-5 diagnostic criteria and classifications. Some notable changes include: renaming intellectual disability and removing subtypes of schizophrenia; adding social communication disorder and disruptive mood dysregulation disorder; modifying the criteria for autism spectrum disorder, bipolar disorder, and major depressive disorder; removing the bereavement exclusion for major depression; and consolidating language, social anxiety, and specific phobia criteria.
A quick overview of best practice treatments for mental disorders. Great for personal study, as flashcards, for study for the NCMHCE or similar exams, or as a presentation.
The document provides an overview of changes in the DSM-5 relating to substance use disorders and addictive disorders. Key points include:
- Substance use disorders are now called substance-related and addictive disorders to reflect that behaviors can be addictive even without substances.
- Criteria for individual substance use disorders (alcohol, cannabis, hallucinogens, inhalants, etc.) are provided, including new specifiers for severity levels.
- Withdrawal symptoms and intoxication criteria are also specified for each substance.
- The chapter aims to better capture addictive behaviors and the biological underpinnings of addiction.
Proof version: Bishop, D., & Rutter, M. (2008). Neurodevelopmental disorders: conceptual approaches. In M. Rutter, D. Bishop, D. Pine, S. Scott, J. Stevenson, E. Taylor & A. Thapar (Eds.), Rutter's Child and Adolescent Psychiatry (pp. 32-41). Oxford: Blackwell.
Neurodevelopmental disorders: are our current diagnostic labels fit for purpose?Dorothy Bishop
Slides from a talk given at University of Western Australia on Tuesday 2nd October 2012, This lecture was co-hosted by the ARC Centre of Excellence in Cognition and
its Disorders and the Institute of Advanced Studies, University of Western Australia
Evolution of Mental Health Psychiatric Nursing PracticeEric Pazziuagan
The document discusses the history of mental health from ancient times to the present. It covers topics like the moral treatment movement, development of asylums and community-based care, key figures like Pinel and Tuke who advocated more humane treatment, diagnostic classifications like the DSM, and the establishment of the National Center for Mental Health in the Philippines. It provides context on the evolution of perspectives and approaches to mental illness over time.
The document outlines the 9 anxiety disorders classified in the DSM-5: separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, substance/medication-induced anxiety disorder, and anxiety disorder due to another medical condition. Each disorder is defined based on DSM-5 criteria, including common causes, symptoms, and treatments. The document aims to guide mental health practitioners in properly diagnosing anxiety disorders using the standardized DSM-5 definitions and classifications.
The document discusses mental health and mental illness. It defines mental health as maintaining successful mental activity and fulfilling relationships while adapting to change. Mental illness occurs when the brain is not functioning properly, disrupting thinking, emotions, behavior, or physical functioning. Common symptoms include sleep problems, mood swings, and difficulty focusing. Mental illness is caused by a complex interplay between genetics and environment and results in abnormal brain functioning. While some illnesses begin in childhood, others often emerge during adolescence. Most people with mental illness can live productive lives with treatment. The document encourages seeking help from others if experiencing prolonged sadness, anger, or risky behaviors.
This document provides an overview and agenda for a presentation on the transition to the DSM-5 diagnostic manual. The presentation includes discussing the changes between the DSM-IV and DSM-5, an overview of the new DSM-5 structure and criteria, and implications for billing. Major changes highlighted include separating mood disorders, adding new diagnoses like disruptive mood dysregulation disorder in children, and removing the multiaxial system in favor of a dimensional assessment.
The Diagnostic and Statistical Manual of Mental Disorders, mosyrettcc
The Diagnostic and Statistical
Manual of Mental Disorders,
Fifth Edition (DSM-5)
Cardwell C. Nuckols, PhD
[email protected]
www.cnuckols.com
mailto:[email protected]�
HISTORY OF THE DSM
• 1840 1 Dx – U.S. Census – Idiocy/Insanity
– Also in the 1840s, southern alienists discovered a
malady called Drapetomania - the inexplicable, mad
longing of a slave for freedom.
• 1880 7 Dx’s – U.S. Census
– Mania – mostly as defined today, a condition
characterized by severely elevated mood.
– Melancholia – would be noted as depression today.
– Monomania - Pathological obsession with a single
subject or idea. Excessive concentration of interest
upon one particular subject or idea. The difference
between monomania and passion can be very subtle
and difficult to recognize.
– Paresis – general or partial paralysis. (This would not
be the last time that a physical affliction crept into
the psychological arena; among the disorders
described in the DSM-IV –TR is snoring, or Breathing
Related Sleep Disorder 780.59, pp. 615-622).
– Dementia – as described today as characterized by
multiple cognitive deficits that include impairment
in memory (most common Alzheimer's).
– Dipsomania - An insatiable craving for alcoholic
beverages.
– Epilepsy
HISTORY OF THE DSM
• 1940 – 26 Dx's (ICD-6; WHO)
– Which took its nomenclature from the US Army and
Veterans Administration nomenclature. The WHO system
included 10 categories for psychoses, 9 for
psychoneuroses, and 7 for disorders of character,
behavior, and intelligence)
• 1952 DSM – 106 Dx’s
– DSM-I included 3 categories of psychopathology: organic
brain syndromes, functional disorders, and mental
deficiency. These categories contained 106
diagnoses. Only one diagnosis, Adjustment Reaction of
Childhood/Adolescence, could be applied to children.
• 1968 DSM-II – 185 Dx’s (revised DSM-II, 1974)
– It had 11 major diagnostic categories. Increased attention
was given to the problems of children and adolescence
with the categorical addition of Behavior Disorders of
Childhood-Adolescence.
– This category included Hyperkinetic Reaction,
Withdrawing Reaction, Overanxious Reaction, Runaway
Reaction, Unsocialized Aggressive Reaction, and Group
Delinquent Reaction.
HISTORY OF THE DSM
Up until December 26, 1974 Homosexuality was considered a form of
deviant behavior and was a psychiatric condition.
HISTORY OF THE DSM
• 1980 DSM-III – 265 Dx’s (roughly coincided with
ICD-9, but differed from the ICD-9 which still listed
disorders for statistical reasons as opposed to
clinical utility).
– DSM-III included multiaxial system.
– Explicit diagnostic criteria.
– Descriptive approach neutral to etiology theory.
– Unlike its predecessors, DSM-III, it was based on
scientific evidence. Its reliability was improved with
the addition of explicit diagnostic criteria and
structured interviews.
– Although ICD and DSM were similar in term ...
The Diagnostic and Statistical Manual of Mental Disorders, .docxtodd241
The Diagnostic and Statistical
Manual of Mental Disorders,
Fifth Edition (DSM-5)
Cardwell C. Nuckols, PhD
[email protected]
www.cnuckols.com
mailto:[email protected]�
HISTORY OF THE DSM
• 1840 1 Dx – U.S. Census – Idiocy/Insanity
– Also in the 1840s, southern alienists discovered a
malady called Drapetomania - the inexplicable, mad
longing of a slave for freedom.
• 1880 7 Dx’s – U.S. Census
– Mania – mostly as defined today, a condition
characterized by severely elevated mood.
– Melancholia – would be noted as depression today.
– Monomania - Pathological obsession with a single
subject or idea. Excessive concentration of interest
upon one particular subject or idea. The difference
between monomania and passion can be very subtle
and difficult to recognize.
– Paresis – general or partial paralysis. (This would not
be the last time that a physical affliction crept into
the psychological arena; among the disorders
described in the DSM-IV –TR is snoring, or Breathing
Related Sleep Disorder 780.59, pp. 615-622).
– Dementia – as described today as characterized by
multiple cognitive deficits that include impairment
in memory (most common Alzheimer's).
– Dipsomania - An insatiable craving for alcoholic
beverages.
– Epilepsy
HISTORY OF THE DSM
• 1940 – 26 Dx's (ICD-6; WHO)
– Which took its nomenclature from the US Army and
Veterans Administration nomenclature. The WHO system
included 10 categories for psychoses, 9 for
psychoneuroses, and 7 for disorders of character,
behavior, and intelligence)
• 1952 DSM – 106 Dx’s
– DSM-I included 3 categories of psychopathology: organic
brain syndromes, functional disorders, and mental
deficiency. These categories contained 106
diagnoses. Only one diagnosis, Adjustment Reaction of
Childhood/Adolescence, could be applied to children.
• 1968 DSM-II – 185 Dx’s (revised DSM-II, 1974)
– It had 11 major diagnostic categories. Increased attention
was given to the problems of children and adolescence
with the categorical addition of Behavior Disorders of
Childhood-Adolescence.
– This category included Hyperkinetic Reaction,
Withdrawing Reaction, Overanxious Reaction, Runaway
Reaction, Unsocialized Aggressive Reaction, and Group
Delinquent Reaction.
HISTORY OF THE DSM
Up until December 26, 1974 Homosexuality was considered a form of
deviant behavior and was a psychiatric condition.
HISTORY OF THE DSM
• 1980 DSM-III – 265 Dx’s (roughly coincided with
ICD-9, but differed from the ICD-9 which still listed
disorders for statistical reasons as opposed to
clinical utility).
– DSM-III included multiaxial system.
– Explicit diagnostic criteria.
– Descriptive approach neutral to etiology theory.
– Unlike its predecessors, DSM-III, it was based on
scientific evidence. Its reliability was improved with
the addition of explicit diagnostic criteria and
structured interviews.
– Although ICD and DSM were similar in term.
The document provides an overview of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It defines mental disorders and outlines the purposes of the DSM. It then reviews the history and major changes between editions of the DSM from the first edition in 1952 to the most recent fifth edition in 2013. Key highlights include the introduction of specific diagnostic criteria, changes to certain diagnoses like replacing mental retardation with intellectual disability, and the reorganization of certain disorders into different categories.
The document provides an overview of the development of the DSM diagnostic system from its origins in the 1920s to the current DSM-5. It discusses the key editions including DSM-I in 1952, DSM-II in 1968, DSM-III in 1980 which introduced a more empirical and reliable approach, and DSM-IV in 1994. It then summarizes the process of developing DSM-5 from 1999 to 2013, which placed greater emphasis on research and dimensional assessments. The document outlines some of the major changes between DSM-IV and DSM-5, including removing the multiaxial system, incorporating dimensional assessments, and revising subtypes and specifiers.
This document discusses diagnostic classification, descriptive assessment, treatment planning, and prediction in clinical psychology. It describes how diagnostic classification is not the only goal and defines abnormal behavior. Descriptive assessment pays attention to client assets and adaptation. Treatment planning addresses finding the most effective treatment for each individual case. Prediction involves prognosis, future performance, and dangerousness.
This document provides an overview of clinical assessment and diagnosis of psychological disorders. It discusses the basic steps in the diagnostic process, including taking a history, mental status examination, and various assessment methods like clinical interviews, behavioral observations, medical exams, and psychological testing. Reliability, validity, and standardization are important concepts in assessment. The document also examines criticisms of diagnostic classification systems like the DSM and ICD.
The document provides an overview of psychological assessment and diagnosis of mental disorders. It discusses the definition of abnormal behavior and approaches to classification of mental disorders. The diagnostic process involves clinical interviews, observations, medical exams, and psychological testing to evaluate individuals for potential psychological disorders. Cultural factors must be considered in any psychological assessment.
The document discusses the history and evolution of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It summarizes the key changes between editions of the DSM from the first edition in 1952 to the most recent fifth edition in 2013. These include changes in the number of diagnoses, the inclusion of explicit diagnostic criteria, and the removal of disorders like homosexuality. The DSM aims to provide a common language for diagnosing mental disorders but there have been criticisms of its lack of validity.
The document provides a history of the Diagnostic and Statistical Manual of Mental Disorders (DSM) from its first edition in 1952 to the current fifth edition from 2013. It summarizes the major changes between editions, including removing homosexuality as a disorder in 1974 and shifting to explicit diagnostic criteria in 1980. The DSM aims to provide a common language for diagnosing mental disorders but also has limitations due to issues with validity and reliability between editions.
The document provides a history of the Diagnostic and Statistical Manual of Mental Disorders (DSM) from its first edition in 1952 to the current fifth edition from 2013. It summarizes the major changes between editions, including the addition of explicit diagnostic criteria and an emphasis on reliability and validity of diagnoses. The DSM aims to provide a common language for clinicians and researchers for classifying and diagnosing mental disorders.
10.27.08(a): Psychiatric Classification and TerminologyOpen.Michigan
Slideshow is from the University of Michigan Medical
School's M2 Psychiatry sequence
View additional course materials on Open.Michigan: openmi.ch/med-M2Psych
The document discusses the history and editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It summarizes the key changes between each edition of the DSM from the first edition in 1952 to the most recent fifth edition in 2013. These include removing homosexuality as a disorder, adding explicit diagnostic criteria, and eliminating the axis system in favor of listing disorder categories. The DSM aims to provide a common language for diagnosing and studying mental disorders.
The document discusses the history and evolution of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It summarizes the key changes between editions of the DSM from the first edition in 1952 to the current DSM-5 published in 2013. These include the addition of explicit diagnostic criteria, changes in disorders included, and the elimination of the multiaxial system in DSM-5. The DSM aims to provide a common language for diagnosing mental disorders but is not intended as the definitive classification and continues to be revised as research progresses.
The document discusses diagnosis in psychiatry. It defines diagnosis as conclusions made about a client's problems and complaints that are used to plan care. Taxonomy involves classifying data into appropriate diagnostic categories. The DSM-IV-TR and ICD-10 are the main classification systems used internationally. They organize mental disorders into axes or chapters and provide diagnostic criteria. However, classification systems receive criticism for being overly broad and influenced by culture. Accurate diagnosis is still important for guiding treatment and care plans.
This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions of each concept which is then followed by basic theories that try explain each concept.followed by basic theories that try explain each concept.This power point presentation provides basic concepts in motivation and emotions. It provides definitions
The classification of mental disorders has evolved over time based on the work of Kraepelin who originally classified disorders into two major groups: schizophrenia and manic-depressive psychosis. This helped establish mental disorders as organic conditions and formed the basis for diagnostic systems like the DSM and ICD. The DSM and ICD take different approaches in their classification but both aim to improve reliability through explicit diagnostic criteria. However, studies show poor reliability between psychiatrists due to subjective interpretation of information and cultural differences in diagnosis.
The document summarizes some of the major changes between the DSM-IV and the newly released DSM-5. Some key points:
1) The DSM-5 removes the multiaxial system of diagnosis and replaces it with a new assessment approach without arbitrary boundaries between disorders.
2) Several new disorders have been added, some combined, and a few eliminated. The number of chapters has increased from 17 to 22.
3) Each diagnosis now follows a standardized structure providing diagnostic criteria, prevalence, course, and differential diagnosis.
4) Future revisions will use a "living document" approach denoted by numbers (e.g. DSM-5.1) instead of Roman numer
Classification systems in psychiatry part 2 dsm5vickasen
This document provides an overview of proposed changes to the DSM-5 classification system. It discusses the development process, organizational structure, proposed disorder names and categories, and major proposed changes. Some key changes include integrating dimensional approaches, changing some terminology and removing the clinical significance criterion. It also outlines proposed changes to specific disorder categories like autism, psychosis, mood disorders, personality disorders, and trauma/stressor disorders. The conclusion notes that DSM-5 is a work in progress with room for further improvement in future editions.
This document discusses neurodevelopmental and neurocognitive disorders. Neurodevelopmental disorders begin in childhood and may continue into adulthood, ranging from specific to global impairments. They include specific learning/language disorders, ADHD, autism spectrum disorders, and intellectual disabilities. Neurocognitive disorders represent a decline in mental function impacting independent functioning and may occur at any time in life due to factors like brain injury, diseases, infection, or stroke. The assignment requires assessing a patient presenting with a neurodevelopmental or neurocognitive disorder using a psychiatric evaluation template and identifying at least three differential diagnoses.
The document provides an overview of psychiatric classification systems. It discusses the definition and advantages of classification, as well as key terms and historical approaches including etiological, descriptive, categorical, and dimensional.
It then describes the development of major classification systems including the DSM and ICD. The DSM is the diagnostic manual published by the American Psychiatric Association while the ICD is published by the World Health Organization. The document outlines the various editions of the DSM from DSM-I to the current DSM-5. It also discusses other classification systems and tools used in psychiatry such as the Chinese Classification of Mental Disorders and the Research Domain Criteria.
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Launching a Private Practice: Strategies for Clinical Psychologists and Menta...James Tobin, Ph.D.
In this presentation, Dr. Tobin provides a set of attitudinal and pragmatic recommendations for beginning a private practice in the mental healthcare professions. The central elements of private practice including ethical, legal, marketing, financial, and supervisory factors are introduced. Beyond this, Dr. Tobin suggests that the transition from "trainee" to "entrepreneur" is often fraught with conflict centering on archaic dispositional tendencies residing in many psychologists and psychotherapists. Reviewing Alice Miller's characterization of the "gifted child," Dr. Tobin suggests that many early-career practitioners suppress self-concerned drives and aspirations including financial reward. Yet, establishing a successful clinical practice is a gradual and complex process, one that necessitates a personal resolution of two fundamentally opposed value systems: adherence to the needs of the other vs. the needs of one's self. Professional development is portrayed as the negotiation of these opposing forces across one's career.
In this presentation, Dr. Tobin utilizes Alice Miller's characterization of the "gifted child" to suggest that many graduate students in clinical psychology and psychotherapy trainees have suffered early emotional trauma. A consequence of this trauma is a psychological and emotional investment in the mental healthcare professions as a means of continuing to adhere to a particular relational role. For Dr. Tobin, what is problematic about this professional aspiration is the characterological residue from early deprivations which often emerges in trainees' narcissistic and/or co-dependent tendencies as they begin to engage in the therapeutic role. Breaking from these tendencies affords greater perceptional and relational freedoms, an important training and supervisory milestone for trainees and early-career psychotherapists.
Improving Writing and Critical Thinking Competence in Psychology: A Primer a...James Tobin, Ph.D.
This manual was composed to support psychology students' ability at the undergraduate and graduate levels to write more effectively in a variety of contexts within academic and applied settings. The primer is not meant to be a comprehensive writing guide, but focuses instead on the core components of scholarly writing, critical thinking, and the formulation and execution of original ideas. The relevance of these competencies for clinical psychology training is emphasized throughout the manual. Exercises are provided to help the instructor and/or student with practice experiences to support the refinement of the ideas and skills presented.
Socializing the Psychotherapist-in-Training to an Alternative Form of Related...James Tobin, Ph.D.
According to Dr. Tobin, the supervision of psychologists-in-training must facilitate a central transition for the trainee. A major aspect of the trainee is socially-normed attitudes and tendencies which infiltrate the clinical situation and typically impede the development of a distinct "space" or interpersonal field on which psychotherapy relies. Dr. contends that the the supervisory situation and the unfolding dynamics between the supervisor and trainee should optimally support the trainee's capacity to experience him- or herself, and the other, in a more refined mode that liberates the dyad from the psychological and emotional restraints and inhibitions associated with social conventionality.
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The Dynamics of Process and Content in Parent-Teen Communication: A Coding Ma...James Tobin, Ph.D.
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Clinical Case Formulation & Treatment Planning: A Fact-to-Inference Strategy...James Tobin, Ph.D.
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Utilizing clips from the feature films "Ali" and "Magnolia," Dr. Tobin emphasizes the importance of regret in adult development. When pursued in psychotherapy, regrets a patient experiences serve as a bridge into vital aspects of emotional development, mourning, and self-integration. Further, Dr. Tobin introduces the notions of "otherness" and "non-meaning" and characterizes their relevance for personal and existential experience.
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Doctoral programs consistently struggle with professional competence among their trainees, and numerous studies report significant numbers of expulsions from graduate study based on academic or nonacademic grounds. Widely attributed to Jung (1951), the wounded healer archetype assumes that clinicians, like all persons, have been negatively impacted by their personal histories, traumas, and interpersonal stressors. According to co-authors James Tobin and Anya Oleynik, a key role and responsibility of graduate programs in the helping professions and advanced training sites involves not only a gatekeeping function, but the capacity to identify and remediate students whose own personal challenges may be effectively resolved and transformed into the strengths ascribed to the wounded healer ideal.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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The DSM-5: Overview of Main Themes and Diagnostic Revisions
1. The DSM-5:
Overview of Main Themes
and Diagnostic Revisions
James Tobin, Ph.D. | November 2, 2013
Presented at the Symposium on DSM-5
Sponsored by OCPA and the American
School of Professional
Psychology/Argosy University
2. 2
Abstract
• DSM-5 represents the field’s most recent
attempt at revising the DSM-IV-TR diagnostic
nomenclature. In this presentation, I will
outline the primary efforts of the DSM-5 Task
Force and the major diagnostic changes that
were incorporated in the new manual, with an
emphasis on the disorders of adulthood.
3. 3
Abstract
• The most promising changes are the
organization of mental illness as a spectrum, the
addition of dimensionality to specifier
descriptions, lifespan/development and cultural
refinements, and the articulation of a new hybrid
model of mental illness.
4. 4
Abstract
• In the context of these gains, I also will provide a
summary of the major controversies
surrounding the DSM-5, including misgivings
about lower thresholds to qualify for numerous
diagnoses and the related concern that we may
now run the risk of pathologizing “normal”
human functioning.
6. 6
Acknowledgements
• Zur Institute (2013). DSM-5 – friend or foe? A
comprehensive breakdown of changes and
controversies. CE Online Course. Retrieved
from
http://www.zurinstitute.com/dsm5course.html.
• Nevid, J. (2013, April 4). Getting ready for
DSM-5. Retrieved from
http://www.youtube.com/watch?v=3akfbnmhO
M8.
7. 7
Acknowledgements
• Dingle, A. (2013, July 30). The new DSM-5.
Retrieved from
http://www.youtube.com/watch?v=C9pru53Uc
bA.
• American Psychiatric Publishing (2013): Fact
sheet: Highlights of changes from DSM-IV-TR to
DSM-5. Retrieved from
http://www.psychiatry.org/practice/dsm/dsm5.
8. 8
DSM-IV, -IV-TR, and -5 Publication
Dates and Page Lengths
• DSM-IV-TR: First issued in 1994 (968 pages).
• DSM-IV-TR: Revised in 2000 (988 pages).
• DSM-5:Update initiated in 1999 and finally
published on May 17, 2013 (947 pages).
9. 9
DSM-5: Sections of the Manual
• Section I: Introduction and information on
how to use the manual.
• Section II: Diagnostic criteria and codes.
• Section III: Emerging measures and
models, conditions that require further
research, a glossary, cultural concepts of
distress, and names of persons involved in the
manual’s development.
• Appendix.
10. 10
How Was the DSM-5 Developed?
• APA organized groups of experts in distinct
areas to assess diagnostic categories and
disorders;
• Came up with consensus viewpoints on
symptomatic descriptors;
• Field-tested new descriptors to determine
revised diagnostic criteria (cluster sets and
thresholds).
• Presented to APA Board Trustees for sign-off.
12. 12
Primary Goals of DSM-5 Task Force in
Creating the New Manual
• Increase cultural sensitivity;
• Deepen the clinician’s understanding of the
client;
• Increase awareness of the neurobiology
underpinning mental disorders;
• Appraise the role of social and contextual factors
associated with psychiatric symptoms.
From Zur Institute (2013)
13. 13
Change #1. Make More User-Friendly
• The multiaxial system has been abandoned.
• Axes I, II, and III have been combined.
• All clinical disorders are simply listed in order of
priority (no real hierarchy of axes implied).
• No more GAF (people tended to use very
idiosyncratically, and did not follow the
symptom severity x impairment rating codes).
15. 15
Change #2. Incorporate a Spectrum
Perspective
• Based on two emerging realizations in the field
(Zur Institute, 2013):
(1) There is not much evidence that
disorders are actually categorically
distinct from one another (both within
and across diagnostic categories).
(2) The distinction between “normal”
and “abnormal” behavior is, ultimately,
arbitrary.
16. 16
Change #2. Incorporate a Spectrum
Perspective
• Example: OCD is removed from the “Anxiety
Disorders” category (DSM-IV-TR) and
repositioned in a new category called
“Obsessive-Compulsive and Related Disorders”
(DSM-5).
• The beam of light going into the prism
(underlying core factor of anxiety)
splits into several separate but
related diagnostic categories.
17. 17
Change #2. Incorporate a Spectrum
Perspective
• The 20 newly-refined diagnostic categories of
mental disorders depict updated groupings
of all disorders, with each grouping
sharing similar characteristics.
• Has resulted in a fair amount of reshuffling of
the deck, e.g., “Neurodevelopmental Disorders”
(includes Autism Spectrum Disorder,
ADHD, and other disorders reflecting
abnormal brain development).
19. 19
Change #3. Incorporate Dimensionality
• Diagnostic thresholds (categorical/qualitative)
are now supplemented by the degree to which
the diagnosis is present
(dimensional/quantitative).
• Severity ratings (from minimal to more extreme
levels): typically, symptom counts.
20. 20
Change #4. Reflect a Developmental
Perspective
• (1) Chapter structure of DSM-5 follows a
neurodevelopmental life span approach
(congruent with the system used by the ICD
[World Health Organization]):
Early development: Neurodevelopmental
Disorders; Schizophrenia Spectrum and
Other Psychotic Disorders; etc.
Adolescence/early adulthood:
Depressive Disorders; Anxiety Disorders; etc.
Later life: Neurocognitive Disorders.
21. 21
Change #4. Reflect a Developmental
Perspective
(2) For specific disorders, variations of symptom
presentations across the lifespan are described.
22. 22
Change #5. Increase the Emphasis on
Culture and Gender
• Cultural information and gender differences are
included wherever relevant.
• Previous cultural formulation replaced with the
Cultural Formulation Interview (CFI; pp.
750-757), a structured clinical interview that
assesses the client’s subjective view of cultural
factors re: the presentation of symptoms (effort
is to diminish the clinician’s own cultural
biases).
23. 23
Change #6. Enhance Descriptive
Information for Diagnoses
• Many specifiers provided.
• Severity ratings provided.
• Not Otherwise Specified (NOS) deleted, but here
is what they came up with instead: if not meet
full criteria for the disorder use “Other
Specified” (need to give a reason)
or “Unspecified Disorder”
(don’t need to give a reason).
24. 24
Change #7. Match the International
Classification of Diseases (ICD) Codes
• DSM-5 includes equivalent ICD-9 and ICD-10
codes.
• The U.S. will adopt the ICD-10 in October, 2014;
however, by that time, most of the world will
already be using ICD-11.
25. 25
Change #8. Reinvent DSM To Be a
“Living” Document
• DSM-5 (Arabic numeral) vs. DSM-IV-TR
(Roman numeral).
• More readily incorporate advances generated by
new research, neuroscience, and investigations
re: the genetics of psychiatric illness.
27. 27
Change #9. Introduce the Potential
of the So-called “Hybrid” Model
• The Personality Disorders (PDs) essentially remain
the same in DSM-5 as in DSM-IV-TR.
• However, in Section III of DSM-5 they introduce a
hybrid (category and dimensional synthesized)
model of PDs:
Level of impairment of personality
functioning (dimensional) with ....
An evaluation of personality traits
(categorical)
28. 28
Change #9. Introduce the Potential
of the So-called “Hybrid” Model
• Five broad domains of personality traits:
(1) Negative Affectivity
(2) Detachment
(3) Antagonism
(4) Disinhibition
(5) Psychoticism
• As a field, we are moving closer
to defining what the core elements
of psychiatric health/personality actually are.
29. 29
Change #10. Use Biologically-based
Diagnostic Criteria
• For some disorders, DSM-5 employs objective
measures (genetic workups, neuroimaging, neurochemistry) into the
criteria sets.
• David Kupfer, M.D., the co-chair of the DSM-5
Task Force, indicated a keen interest in genetic
tests/brain scanning/biomarkers/laboratory
tests, but admitted that the field is not quite
there yet.
30. 30
Part III. A Select Review of Revised
Diagnostic Categories and Disorders in
DSM-5
32. 32
“Neurodevelopmental Disorders”: Shifts
Disorder Name
Used To Be In (DSM-IVTR)
Now In (DSM-5):
Separation Anxiety
“Disorders Usually First
Diagnosed in Infancy,
Childhood and Adolescence”
“Anxiety Disorders”
Selective Mutism
“Disorders Usually First
Diagnosed in Infancy,
Childhood and Adolescence”
“Anxiety Disorders”
33. 33
“Schizophrenia Spectrum and Other
Psychotic Disorders”
•
•
•
•
•
•
•
•
Schizotypal (Personality) Disorder
Delusional Disorder
Brief Psychotic Disorder
Schizophreniform Disorder
Schizophrenia
Schizoaffective Disorder
Substance/Medication-Induced Psychotic Disorder
Psychotic Disorder Due to Another Medical
Condition
• Catatonia
• Other/Unspecified
34. 34
“Schizophrenia Spectrum and Other
Psychotic Disorders”: Shifts
Disorder Name
Used To Be In (DSMIV-TR)
Now In (DSM-5)
Schizotypal
(Personality)
Disorder
Axis II Personality
Disorders
“Schizophrenia Spectrum
and Other Psychotic
Disorders” and “Personality
Disorders”
Schizophrenia
Subtypes include
Paranoid, Disorganized,
Catatonic,
Undifferentiated, and
Residual
Subtypes removed
35. 35
“Schizophrenia Spectrum and Other
Psychotic Disorders”: Criteria/Notes
• Delusions, hallucinations, disordered thinking
(speech), and grossly disorganized or abnormal
motor behavior (including catatonia) maintained.
• DSM-5 minimizes importance of negative
symptoms; emphasis is more on positive symptoms.
• Can now specify severity (how many symptoms the
person has): see dimensional rating scale
“Clinician-Rated Dimensions of Psychosis
Symptom Severity” in Section III of the DSM5 Manual (pp. 742-744).
36. 36
“Bipolar and Related Disorders”
•
•
•
•
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Substance/Medication-Induced Bipolar and
Related Disorder
• Bipolar and Related Disorder Due to Another
Medical Condition
• Other and Unspecified
37. 37
“Bipolar and Related Disorders”:
Shifts
• Depressive Disorders and Bipolar Disorders no
longer listed under the umbrella category of
“Mood Disorders” (as was the case in DSM-IVTR).
38. 38
“Bipolar and Related Disorders”:
Criteria/Notes
• The primary criteria for manic and hypomanic
episodes now include an emphasis on changes in
activity and energy as well as mood.
• More specifiers added (p. 127):
e.g., “With anxious distress”: capture
anxiety symptoms.
39. 39
“Depressive Disorders”
•
•
•
•
•
Disruptive Mood Dysregulation Disorder
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive
Disorder
• Other and Unspecified
40. 40
“Depressive Disorders”: Shifts
Disorder Name
Used To Be In (DSM-IVTR)
Now In (DSM-5)
Disruptive Mood
Dysregulation Disorder
--
“Depressive Disorders”
Premenstrual Dysphoric
Disorder
Disorders in Need of Further
Research
“Depressive Disorders”
Persistent Depressive
Disorder (Dysthymia)
“Dysthymic Disorder” in the
“Depressive Disorders”
subcategory of Mood
Disorders
“Depressive Disorders”
Bereavement
V62.82
Major Depressive Disorder
(MDD could not be
diagnosed if symptoms were
due to loss)
MDD diagnosed even if
symptoms are related
to grief
41. 41
“Depressive Disorders”: Criteria/Notes
• MDD: essentially the same criteria set.
• A major depressive episode with at least 3 manic
symptoms is now coded with the specifier “with
mixed features” (see pg. 162).
• Persistent Depressive Disorder (Dysthymia):
what used to be known as “double
depression” (refractory major depressive
episodes along with chronic sub-threshold
depressive symptoms).
42. 42
“Depressive Disorders”: Controversies
• DMDD: Are we fostering the pathologizing of
temper outbursts?
• Removal of the bereavement exclusion for MDD:
Are we over-pathologizing the normal
bereavement process?
44. 44
“Anxiety Disorders”: Shifts
Disorder Name
Used To Be In (DSM-IV-TR)
Now In (DSM-5)
Separation Anxiety
Disorder
“Disorders Usually First Diagnosed in
Infancy, Childhood and Adolescence”
“Anxiety Disorders”
Selective Mutism
“Disorders Usually First Diagnosed in
Infancy, Childhood and Adolescence”
“Anxiety Disorders”
Agoraphobia
Panic Disorder Without Agoraphobia and
Agoraphobia With or Without Panic
Disorder in “Anxiety Disorders”
Panic Disorder and
Agoraphobia de-linked but
still fall under “Anxiety
Disorders”
OCD
“Anxiety Disorders”
“Obsessive Compulsive and
Related Disorders”
Acute Stress Disorder
“Anxiety Disorders”
“Trauma and StressorRelated Disorders”
PTSD
“Anxiety Disorders”
“Trauma and StressorRelated Disorders”
Body Dysmorphic
Disorder
“Somatoform Disorders”
“Obsessive Compulsive and
Related Disorders”
45. 45
“Anxiety Disorders:” The
Controversy of the New GAD Criteria
• Symptom duration lowered from 6 to 3 months.
• Associated symptoms of anxiety and worry
lowered from 3 to 1 symptoms needed.
• Aaron Beck has indicated this will result in a rise
of “false positive” GAD diagnoses.
47. 47
“Trauma- and Stressor-Related
Disorders”
Disorder Name
Used To Be In (DSM-IV-TR)
Now In (DSM-5)
Reactive Attachment
Disorder
“Disorders Usually First Diagnosed in
Infancy, Childhood and Adolescence”
“Trauma and StressorRelated Disorders”
Disinhibited Social
Engagement Disorder
--
“Trauma and StressorRelated Disorders”
PTSD
“Anxiety Disorders”
“Trauma and StressorRelated Disorders”
Acute Stress Disorder
“Anxiety Disorders”
“Trauma and StressorRelated Disorders”
Adjustment Disorders
“Adjustment Disorders”
“Trauma and StressorRelated Disorders”
48. 48
“Trauma- and Stressor-Related
Disorders”: Criteria/Notes
• Adjustment Disorders no longer a residual
category (DSM-IV-TR subtypes retained).
• Reactive Attachment Disorder and Disinhibited
Social Engagement Disorder (resembles ADHD):
both are the result of social neglect or other
situations that limit a young child’s opportunity
to form selective attachments.
• For PTSD, attempted to specify “trauma” as
an actual or threatened death, serious
injury or sexual violation.
49. 49
“Trauma- and Stressor-Related
Disorders”: Controversy
• New criteria (i.e., “Emotional reactions to
the traumatic event [fear, helplessness,
horror]” [p. 274] no longer being necessary)
may dilute what is actually deemed “traumatic.”
• Diagnosis may occur for people who have not
had direct exposure but merely learned about a
violent traumatic event suffered by a loved one.
51. 51
“Substance-Related and Addictive
Disorders”: Criteria/Notes
• “Abuse” and “dependence” have been collapsed
into a single diagnostic category (addictions
exist on a continuum: the spectrum perspective).
• Severity of diagnoses (dimensionality) rated as
mild, moderate, or severe, based on the number
of symptoms.
52. 52
“Substance-Related and Addictive
Disorders”: Controversies
• “First-time substance abusers are now lumped
together with heroine addicts” (Zur Institute,
2013);
• Category has been expanded beyond
psychoactive substances:
53. 53
“Neurocognitive Disorders”
• Delirium
• Major Neurocognitive Disorder (with Etiological
Subtypes)
Alzheimer’s Disease
Vascular Disease
Traumatic Brain Injury
HIV Infections
Parkinson’s Disease
Huntington’s Disease
Substance/Medication.
• Mild Neurocognitive Disorder (specifiers
correspond to the disease process to which the
cognitive decline is due)
59. 59
(#1) Assessment Measures
World Health Organization Disability Assessment
Schedule 2.0 (WHODAS)
•
•
•
•
•
•
Understanding and communicating
Getting around
Self-care
Getting along with people
Life activities (household, work, or school)
Participation in society
64. 64
Amazon Review: Jonathan Karmel
• “This book, by a well-respected psychiatrist who was very
involved in the creation of the 4th edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-IV), argues
that a high percentage of people diagnosed with mental illness
are actually normal. He thinks this trend of diagnostic
inflation may be exacerbated and there may be diagnostic
hyperinflation with the publication of DSM-5 in May 2013.
• The book begins by attempting to do something that DSM-5
fails to do: define what is normal and what is abnormal. The
author concludes that there is no good definition of normal
and that psychology ought to simply take a utilitarian
approach: a diagnosis should exist if it is useful. What makes
it useful is if it can actually be used as a tool to help people
who are suffering.
65. 65
Amazon Review: Jonathan Karmel
• In retrospect, the author is glad that he was conservative and
did not add many new diagnoses to DSM-IV, but he wishes he
had been more aggressive about purging diagnoses which
were not evidence-based. He faults DSM-IV for contributing
to over-diagnosis of ADHD and autism in children.
• The author provides a number of explanations for diagnostic
inflation. One is a desire for psychologists to identify
symptoms indicating that a person is going to get mental
illness, just like doctors are now wont to order tests and
prescribe drugs to prevent the onset of physical disease. The
problem is that preventative medicine is mostly a waste of
money and can be harmful for both physical and mental
illness.
66. 66
Amazon Review: Jonathan Karmel
• The author believes the biggest culprit is Big
Pharma. As soon as the drug companies began
direct to consumer marketing, advertisements
convinced people that they had some form of mental
illness and should "ask their doctor" about various
prescription drugs.
• The author cites some very alarming statistics about
the number of people taking prescription drugs,
some with serious side effects, even though there is
no real reason to believe the people have actual
mental illness.”
67. 67
Amazon Review: Jonathan Karmel
• Finally, people have a mistaken belief that they
should feel great all the time. People think that they
have some kind of mental illness when they are
actually just experiencing normal, bad events and/or
feelings that people typically have.
• The author is a complete believer in mental health
treatment and actually laments that there is not
enough mental health treatment for people who
truly need it. But I think the author makes a
convincing case that way too many normal people
are being diagnosed with mental illness.
68. 68
#1. Will We Overdiagnose with the
DSM-5?
• The dimensional perspective has a risk of overpathologizing (i.e., pathologize normal behavior
and/or normalize pathologic symptoms);
usually referred to as the “reduced
threshold” problem.
• May lead to stigma/mislabeling of those who
would do better without a psychiatric diagnosis.
69. 69
#2. Are DSM-5 Diagnoses Valid?
• Allen Frances: DSM-5 introduces new, invalid
diagnoses and contends the DSM-5 Task Force is
merely helping the drug companies.
70. 70
#2. Are DSM-5 Diagnoses Valid?
National Institute of Mental Health
(NIMH) director Thomas Insel
announced that it would no longer use
DSM diagnoses in research projects
due to the manual’s lack of validity.
• He contends the manual should be used solely
as a dictionary so that clinicians share the
same descriptions of symptoms.
71. 71
#2. Are DSM-5 Diagnoses Valid?
• Research indicates that 2 clinicians agree on a
diagnosis of major depression only 60 percent of
the time (Zur Institute, 2013).
72. 72
#3. Was the Process of Development
of the Manual Flawed?
• Development was shrouded in secrecy; changes
were not empirically supported.
• Were the work groups merely flying by seat of
their pants?
• DSM-5 diagnoses are based on a consensus
about clusters of clinical symptoms, not
on any objective laboratory measure (in
medicine: symptoms rarely indicate the best
choice of treatment).
73. 73
#4. Are the DSM-5 Diagnoses Irrelevant to
the Cause and Treatment of
Psychological Problems?
• Despite changes in the DSM-5, it remains “a
topographical symptom map” (Zur Institute,
2013): does not capture causal pathways that
give rise to and maintain illness.
75. 75
#5. Is the DSM Experiencing an
Identity Crisis?
• It is not clear if the DSM-5 is a diagnostic tool, a
treatment tool, a research tool, or some combination
of all of these: Is the DSM a good example of
Multiple Personality Disorder?
• Different groups use the DSM too loosely or too
rigidly (little pragmatic consensus) (Zur Institute,
2013).
76. 76
How, in What Ways, for What Patients,
under What Therapeutic Conditions Does
Diagnostic Nomenclature Help or Hinder?
77. 77
Final Words
• The therapeutic process remains the best
diagnostic tool, providing the clinician with a
view of the patient’s regressive tendencies and
relational potential.
• How psychiatric diagnosis is used between
patient and therapist is a relational event that
deserves careful consideration and processing.
78. 78
Final Words
• Mental illness as a spectrum will ultimately
provide clinicians with greater flexibility, as the
focus will not solely be on distinct syndromes
but underlying etiological factors and associated
symptomatic features as well.
79. 79
Final Words
• As a field, we must remain aware of our
narcissistic preference for certainty vs.
uncertainty, which often translates into our
tendency to organize the complexities of nature
prematurely or erroneously.
80. 80
Final Words
• The clinician uses the diagnostic nomenclature
yet remains skeptical of its ultimate authority
and truth.