DSM 5: What to Know for Non-Psych Fields

[futuredoctor10]

thoughts on important differences from DSM 4 to 5 for non-psych providers to know for (a) clinical practice and (b) Step 3?

Thanks!

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[Shikima]

Everyone gets a benzo?

 

[splik]

non psych providers dont use DSM so it doesn't make a difference. i don't even use it. for step-3 possibly changes to schizophrenia diagnosis. also removal of bereavement exclusion for depression. change of abuse/dependence distinction to use disorder.

 

[Merovinge]

On the aggregate DSM V is the least amount of raw change compared to any previous incarnations, so I generally would not worry too much. Here are a few highlights:

Mood Disorders are relatively unchanged - Dysthymia is gone, replaced with persistant depressive disorder, which encompasses dysthymia and double depression (that is you need dysthymia to qualify but you still meet criteria if you have full blown depressive episodes). I have been told it is more explicit that mania provoked by anti-depressants is a substance induced mood disorder and we officially hold off with bipolar diagnosis until unprovoked episode occurs.

Schizophrenia spectrum also relatively unchanged - no subtypes (paranoid, disorganized, residual, catatonic, undifferentiated) as they were not well evidenced based. No special credit for first rank symptoms (e.g. 2 voices having running commentary). Still 6 months of TOTAL sx, 1 month of active psychosis with 2 of the 5 (hallucinations, delusions, disorganization, negative sx, catatonia).

Substance use disorders are overhauled into 1 diagnosis of mild/moderate/severe based on x of 9 sx of dependency/abuse.

New impulse control disorders

Change in somatoform disorder but I think conversion d/o are unchanged

PTSD and OCD no longer classified as anxiety spectrum

In child psych:
Autism spectrum streamlined
DMDD added to take pressure away from over diagnosis of childhood bipolar, which was having awful positive predictive value of adult bipolar
ADHD - Age of onset of sx 12 from 7, otherwise unchanged

I can add more at a later date if you'd like. In the process of revising some texts from DSM IV to V.

 

[NickNaylor]

Everyone gets a benzo?

Preferably Xanax.

 

[Shikima]

Preferably Xanax.

1mg QID because, you know, that's how it's done.

 

[NickNaylor]

1mg QID because, you know, that's how it's done.

On my FM rotation, I saw a patient who was being treated first-line for anxiety with 1 mg Xanax x 4-6 daily PRN. Nice...

 

[Shikima]

On my FM rotation, I saw a patient who was being treated first-line for anxiety with 1 mg Xanax x 4-6 daily PRN. Nice...

 

[AcronymAllergy]

Another difference--they shifted from Dementia to Mild and Major Neurocognitive Disorder due to XXX based primarily on presence/absence of functional impairment. And there's no longer a memory dysfunction requirement; you can receive the diagnosis despite having intact memory.

I'm actually a pretty big fan of the change. Previously, probably 2/3 of what I saw got lumped under Cognitive Disorder NOS.

 

[NickNaylor]

Love how that shifts directly into the credits.

EXCELLENT WORK BOYS, NEXT PATIENT.

 

[whopper]

Gender Identity Disorder renamed to Gender Dysphoric Disorder with some changes in the criteria.

 

[Zenman1]

Heck, I'm trying to figure out exactly how to label a guy with MDD who, since the age of 13, has masturbated up to 7 times a day or had sex with the same amount of people. He doesn't care about the relationship; just wants the release to calm himself down. He had to expand from men to include women also just to have enough participants. I keep worrying whether I shook his hand or not!

 

[splik]

Heck, I'm trying to figure out exactly how to label a guy with MDD who, since the age of 13, has masturbated up to 7 times a day or had sex with the same amount of people. He doesn't care about the relationship; just wants the release to calm himself down. He had to expand from men to include women also just to have enough participants. I keep worrying whether I shook his hand or not!

why would you want to label him? this is compulsive sexual behavior which isn't recognized in the DSM but i have stopped using the DSM anyway. you can diagnose satyriasis which is a billable diagnosis. If you want to use DSM it would be other specified disruptive, impulse-control, and conduct disorders (compulsive sexual behavior). But he almost certainly has narcissistic or borderline personality disorder, typically the former. Even if there isn't, I would bet there is significant narcissistic/borderline pathology. (I have seen about 10 of these patients in the past few months and this was true in every case).

 

[Zenman1]

I want to label him so I can be like all the other folks in this field!

 

[futuredoctor10]

non psych providers dont use DSM so it doesn't make a difference. i don't even use it. for step-3 possibly changes to schizophrenia diagnosis. also removal of bereavement exclusion for depression. change of abuse/dependence distinction to use disorder.

On the aggregate DSM V is the least amount of raw change compared to any previous incarnations, so I generally would not worry too much. Here are a few highlights:

Mood Disorders are relatively unchanged - Dysthymia is gone, replaced with persistant depressive disorder, which encompasses dysthymia and double depression (that is you need dysthymia to qualify but you still meet criteria if you have full blown depressive episodes). I have been told it is more explicit that mania provoked by anti-depressants is a substance induced mood disorder and we officially hold off with bipolar diagnosis until unprovoked episode occurs.

Schizophrenia spectrum also relatively unchanged - no subtypes (paranoid, disorganized, residual, catatonic, undifferentiated) as they were not well evidenced based. No special credit for first rank symptoms (e.g. 2 voices having running commentary). Still 6 months of TOTAL sx, 1 month of active psychosis with 2 of the 5 (hallucinations, delusions, disorganization, negative sx, catatonia).

Substance use disorders are overhauled into 1 diagnosis of mild/moderate/severe based on x of 9 sx of dependency/abuse.

New impulse control disorders

Change in somatoform disorder but I think conversion d/o are unchanged

PTSD and OCD no longer classified as anxiety spectrum

In child psych:
Autism spectrum streamlined
DMDD added to take pressure away from over diagnosis of childhood bipolar, which was having awful positive predictive value of adult bipolar
ADHD - Age of onset of sx 12 from 7, otherwise unchanged

I can add more at a later date if you'd like. In the process of revising some texts from DSM IV to V.

Thanks for the input!