DSM-V to remove multi-axial system

[PistolPete]

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So the DSM-V will "move to a nonaxial documentation of diagnosis, combining the former Axes I, II, and III, with separate notations for psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V)."

What does this mean exactly? How will the Assessment section change now? How are they going to combine Axis I-III?

 

[shan564]

Source: http://psychcentral.com/blog/archiv...approved-by-american-psychiatric-association/

 

[toothless rufus]

Wonder why?! It's a nice succinct way of delineating all of a patient's problems. Who's actually going to stop using it? Not me.

 

[NJWxMan]

Don't kid yourself...it's a waste of time, space on paper, and GAF scores are never appropriately documented. For axis IV, when do you not see "moderate social issues" etc? Why waste the time of re-writing PMHx on axis III? (You already likely wrote it once, why write it again?) Axis I and Axis II...that's what's important. The most experienced psychiatrists almost never write the 5 axes anyhow.

 

[toothless rufus]

Don't kid yourself...it's a waste of time, space on paper, and GAF scores are never appropriately documented. For axis IV, when do you not see "moderate social issues" etc? Why waste the time of re-writing PMHx on axis III? (You already likely wrote it once, why write it again?) Axis I and Axis II...that's what's important. The most experienced psychiatrists almost never write the 5 axes anyhow.

Eh. I like to use it to have everything in one place. I try to use the GAF legitimately as written in the DSM, although there are "suggestions" to have certain scores for billing that really annoys me. But to each their own.

 

[digitlnoize]

What implications (if any) does this have for Axis II disorders as billable diagnoses?

Like, under the new coding rules, a level 4 visit require "x" number of "problems." Will personality disorders count toward the problem list? Did they already?

 

[Anasazi23]

I was hoping against hope that they would banish all references to Axis IV and V to the depths of hell.

So what do they do instead? Take the three most important axis, combine them, and keep IV and V delineated so that we are tortured by them for another 12 years?

 

[nancysinatra]

I was hoping against hope that they would banish all references to Axis IV and V to the depths of hell.

So what do they do instead? Take the three most important axis, combine them, and keep IV and V delineated so that we are tortured by them for another 12 years?

I'm surprised they didn't do worse, and subdivide Axis IV down into more specific areas that on-call psych interns can address in the middle of the night, like my attendings made me do:

Housing problems (Axis IV)
Vocational problems (Axis V)
Relationship problems (Axis VI)
Transportation problems (Axis VII)

Oh wait--interns don't work in the middle of the night anymore, do they?

 

[PistolPete]

Of course interns work in the middle of the night (not sure if previous comment is being facetious). Or maybe I'm just testy/irritble since I admitted so many freaking people on the weekend overnight.

shan564, the above link I'm aware of... still doesn't clearly explain how all the diagnoses will be written. Is it going to be "Clinical Impression: MDD with psychotic features, Borderline traits, Asthma, HTN" followed by "Axis IV: severe marital stressor, housing difficulty, Axis V: 29"?? That's what I meant in my original question. This looks clustered and disorganized, at least to me.

 

[PikminOC]

I'm surprised they didn't do worse, and subdivide Axis IV down into more specific areas that on-call psych interns can address in the middle of the night, like my attendings made me do:

Housing problems (Axis IV)
Vocational problems (Axis V)
Relationship problems (Axis VI)
Transportation problems (Axis VII)

Oh wait--interns don't work in the middle of the night anymore, do they?

dont forget severity..housing problems, moderate
vocational problems severe
relationship problems in partial sustained remission,
etc

 

[nancysinatra]

dont forget severity..housing problems, moderate
vocational problems severe
relationship problems in partial sustained remission,
etc

Exactly

 

[PikminOC]

What implications (if any) does this have for Axis II disorders as billable diagnoses?

Like, under the new coding rules, a level 4 visit require "x" number of "problems." Will personality disorders count toward the problem list? Did they already?

These are very good questions. There are times when I dont have an Axis 1 but need one for billing.