DSM-5 and Psychiatric note Flashcards
Post-World War II History of DSM
● U.S. Army & the VA develop classification system
● Psychophysiological, personality, & acute
disorders
● 1952 APA Committee on Nomenclature &
Statistics created DSM-I
● 1st official manual focusing on clinical utility
1980: DSM III
1994 DSM IV
● 6 year effort involving >1000 individuals and
other professional organizations
● Comprehensive review of literature to
establish firm empirical basis
● Classification changes
● Diagnostic criteria sets
● Descriptive text
2013 DSM 5
o Definition of a mental disorders modified
o Multi-axial Assessment Diagnosis eliminated
o Continued emphasis on evidence
o Better assessment of symptom severity
o Handling co-occurring disorders
o Reducing diagnoses previously called “Not Otherwise Specified (NOS)”
o Better specificity of “treatment targets” for clinicians
DSM-5: Definition of a Mental Disorder
“A mental disorder is a syndrome characterized by clinically significant
disturbance in an individual’s cognition, emotion regulation [emphasis added],
or behavior that reflects a dysfunction in the psychological, biological, or
developmental processes [emphasis added] underlying mental functioning.
DSM-V and Austism
In DSM IV there were separate disorders:
- Autistic disorder
- Asperger’s disorder
- Childhood disintegrative disorder
- Pervasive developmental disorder,
NOS
DSM-5 combines all these disorders into a single new disorder called:
“Autism Spectrum Disorder (ASD)”
DSM 5 change to ADHD
DSM-5: ADHD
1. Age of onset
○ Symptoms required to begin by age 12 (instead of 7)
2. 5 symptoms required in any subsection (instead of 6)
The revised criteria may result in over-diagnosis of ADHD, with prevalence
rates already ranging 5-15% worldwide
Biggest advantages to current DSM
● Consistent Diagnosis:
● Common Language:
● Researching Disease:
● Researching Treatment:
Standard Medical Evaluation
versus Psychiatric Evaluation
Standard Medical
● Much more objective
● Several external validating
criteria (blood & imaging tests)
● High diagnostic reliability
Psychiatric
● Much more subjective
● No external validating criteria
(such as blood & imaging tests)
● Lower diagnostic reliability
First Part of the two part psychiatric evaluation
● Histories (e.g., psychiatric, medical, family)
Second part of two part psychiatric exam
● Mental Status Examination
Systematically reviews:
● Patient’s emotional functioning
● Patient’s cognitive functioning
Psychiatric History allows the PA to understand
dives much further into the record of the
patient’s life:
● Who the patient is
● Where the patient has come from
● Where the patient is likely to go in the future
● The patient’s individual personality characteristics
● Insights regarding the nature of patient’s relationships
Major area of difference in psychiatric history when compared to standard medical history
Personal History