DSM 5 psychiatry. DSM-V. Marginal Notes - Corbinian Brodmann Circus of Trained Demons - LJ. Revision of diagnostic criteria

System DSM American Psychiatric Association - Diagnostic and Statistical Manual of Mental Disorders(Handbook on the diagnosis and statistics of mental disorders) - is a classification system for mental disorders that rivals the ICD (Original English version: American Psychiatric Association, 1994; German version: American Psychiatric Association, 1996). Recently, DSM-IV- Roman numerals indicate the number of revisions - which canceled DSM-III-R(American Psychiatric Association, 1989). DSM-IV compiled from extensive expert reports and field research. DSM-IV subdivided into 17 major groups (including the Other Clinically Relevant Issues group; see Table 6.2), each major group includes units (disorders). For example, the main group of anxiety disorders includes 12 different forms(for example: panic disorder without agoraphobia; other examples can be found in the chapters on the classification and diagnosis of disorders of functioning patterns). Individual units are described in the form of a systematized condensed textbook, the text contains, as a rule, the following points: diagnostic signs ( general description picture disorder), subtypes and / or additional encodings, coding rules, belonging signs and disorders; special cultural, age and sex characteristics; frequency of diseases; flow; family distribution pattern; differential diagnosis (but not indications for treatment). Disorders are identified through operational diagnosis. In the English-language version (American Psychiatric Association, 1994), units of disorders are designated by ICD-9-CM codes and a verbal description (for example, “300.20 Specific Phobia”), in the German-language version (American Psychiatric Association, 1996) - ICD-9-CM codes, ICD-10 and verbal description (for example, "300.29 (F40.2) Specific phobias").

DSM-IV corresponds to ICD-10 in the following paragraphs (shown in Table 6.1): purpose of classification, logic of classes, properties of classes, classification unit, basis of classification, data sources, formal accuracy. In some points, it differs from the ICD-10.

- Scope:DSM-IV - only mental disorders; ICD-10 - all diseases.

- Selection of units: More focused on empirical research (cf. sources in Sourcebooks; Widinger et al., 1994, 1996).

- Definition of units: in relation to definitions DSM-IV meets the criteria of the ICD-10 study: operational diagnostics are consistently implemented here. ICD-10 takes into account less explicitly than DSM-IV that symptomatology can lead to a decrease in various functions.

- Assignment rules: thanks to operational diagnostics, explicit assignment rules (in ICD-10 - partly implicit, partly explicit). Additionally in DSM-IV there is a so-called decision tree, which is not in the ICD-10. This allows the examiner to have a graphical diagram to include or exclude specific disorders (see chapter 37).

Other differences DSM-IV from ICD-10:

- Number of versions:DSM-IV published in a single version, ICD-10 has several versions (see above).

- Description form:DSM-IV compiled in the form of textbook text (see above), and ICD-10 contains only general descriptions.

- Multi-axis diagnostics: in ICD-10, multi-axis diagnostics is under preparation, in DSM-IV it is an explicit component. V DSM-IV the following axes are postulated (overview of axes categories I and II: see table 6.2):

Axis I. Clinical disorders, other clinically relevant problems (conditions that cannot be attributed to any mental disorder, but give rise to observation or treatment).

Axis II. Personality disorders, mental retardation (in the category of disorders that are diagnosed mainly in infancy, childhood or adolescence).

Axis III. Somatic diseases.

Axis IV. Psychosocial problems and problems caused by environment(9 main areas, eg housing or economic problems).

Axis V. Global recording of the level of functioning (scale with 10 divisions; the time span related to the current situation, or, for example, the highest level for at least 2 months in the past year).

Axes I, II, III contain official DSM-IV diagnoses; axes IV and V are optional, they are used for special clinical and research purposes. There can be various gradations along the axes from I to IV. The multi-axis approach makes it possible for a comprehensive diagnosis, which takes into account, among other things, psychosocial aspects. From a psychological point of view, however, axes IV and V seem too global and one-sided to differentiate psychosocial conditions. Thus, for example, factors of overload without taking coping into account are only to a limited extent informative. So far, these axes are not used either in the clinic or in research projects.

- Diagnostic differences: detailed differences appear in some diagnoses: identical in ICD-10 and DSM-IV concepts do not always have identical content. Therefore, you should clearly indicate which system is being diagnosed.

Despite all the differences, between the ICD-10 and DSM-IV there is a clear convergence. The survey methods given in section 2.5 partially allow to simultaneously put ICD- and DSM-diagnoses, so it becomes possible to compare results in different systems.

With DSM-III, a multi-axis system has been introduced. Patients are classified according to 5 independent parameters (axes). DSM-IV preparation began in 1988 and was completed in 1994. The DSM-IV described 400 mental disorders in 17 categories. It also uses a multi-axis system like the DSM-III and DSM-III-R.

To codify disorders in the DSM-IV, the ICD-9-CM codes (ICD-9-CM) were used. The next version (DSM-5) specifies two codes: the ICD-9 -KM code and the ICD-10 -KM code for statistical purposes. ICD-10: Clinical modification(ICD-10-KM) differs from the usual ICD-10 also in changed names (for example, hebephrenic schizophrenia in the ICD-10-KM is called disorganized schizophrenia, as in the DSM).

Removal of homosexuality from the list of mental disorders

DSM-IV-TR

In 2000, the "revised" (English "text revision", literally "Text revision") a version of DSM-IV known as DSM-IV-TR. The diagnostic categories and the vast majority of specific diagnostic criteria have remained unchanged. Updated text sections providing Additional information for each diagnosis, as well as some of the diagnostic codes to maintain consistency with the ICD.

DSM-5

Also linked to recent successful studies of the genome of mental disorders, which have identified common gene polymorphisms between mental disorders: schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, major depressive disorder, and autism spectrum disorder. These states have been accepted as the first four chapters of the DSM-5. Similarly, the authors have tried to group mental disorders based on advances in neuroscience rather than psychopathology.

Collaboration with WHO and APA on the development of the DSM-5

Issue dates of the diagnostic and statistical manual

see also

Notes (edit)

1. Burlachuk L.F. Dictionary-reference book on psychodiagnostics. - 3rd ed. - SPb. : Publishing house "Peter". - S. 126-128. - 688 p. - ISBN 978-5-94723-387-2.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). - Washington, DC: American Psychiatric Publishing, 1980. - P. 380. - 494 p. - ISBN 978-0-521-31528-9.
3. Stuart H. Fighting the stigma caused by mental disorders: past perspectives, present activities, and future directions // World Psychiatry (English)Russian: journal. - 2008. - October (vol. 7, no. 3). - P. 185-188. -

Paranoid

Schizoid

Schizotypal

Cluster B (theatrical, emotional or hesitant disorders):

Antisocial

Border

Hysterical

Narcissistic

Cluster C (Anxiety and Panic Disorders):

Avoiding

Dependent

Obsessive-compulsive

Personality disorders

This section begins with a general definition of personality disorder that applies to each of the 10 specific disorders. All personality disorders are coded on axis II.

General diagnostic criteria for personality disorder.

A. A long-term pattern of internal experiences and behavior that clearly deviates from cultural expectations. This pattern appears in two (or more) areas of the following:

1 - cognitive sphere (i.e. ways of perceiving or understanding oneself, other people and current events),

2 - affective sphere (i.e. range, intensity, lability, acceptability of emotional reactions),

3 - interpersonal functioning,

4 - control of impulses.

C. This long-term pattern is inflexible and pervasive in a wide range of situations of personal and social functioning.

C. This pattern results in overt clinical impairment or impairment in social, occupational, or other important areas of functioning.

D. This pattern is stable and long-term, and its establishment can be traced back at least to adolescence or adolescence.

F. This pattern is not a manifestation or consequence of another mental illness.

F. This pattern is not a direct psychological result of substance use (such as drugs or medication) or general health conditions (such as head trauma).

Cluster a.

301.0 Paranoid personality disorder

A. Deep mistrust and suspicion towards others, with the interpretation of the motives of their behavior as malevolent, which began in adolescence and is present in a variety of contexts, which is determined by four (or more) of the following factors:

1- suspicion, without good reason, that others are exploiting, harming or deceiving him / her

2- concern about undue doubts about the loyalty or reliability of friends or partners

3- unwillingness to disclose to others due to unjustified fears that the information received is maliciously used against him / her

4- search for hidden meanings or threatening signs of harmless remarks or events

5- constant ill will, i.e. refusal to forgive insults, insults, ridicule

6- feeling attacked on your character or reputation that are not visible to others, with an immediate reaction of anger or counterattack

7- repeated suspicions, without sufficient grounds, of the fidelity of a spouse or sexual partner.

B. Does not occur solely in connection with schizophrenia, mood disorders with psychotic traits, other psychotic disorders, and is not a direct physiological result of health conditions.

Note: If these factors occur before the onset of schizophrenia, "add" premorbid, "for example," paranoid personality disorder (premorbid) ".

New American Classification of Mental Disorders DSM-5 Released

Dutch De Psychiater publishes a summary of the changes in the new version of the American DSM-5 classification of mental disorders:

"" DSM-5 is divided into three sections: it is (1) an introductory part with instructions for use and a warning about forensic psychiatric use of the DSM-5; (2) diagnostic criteria and codes for routine clinical use; and (3) tools and techniques to inform clinical decision making.

Major changes:

Neurodevelopmental Disorders

The severity of the disorder is not measured by IQ, but by the level of adaptive functioning. Speech disorders have entered a new category "social communication disorder", in which some of the syndromes coincide with "autism spectrum disorder". The Autism Spectrum Disorder category appears to replace the DSM-4 diagnoses of autism, Asperger's syndrome, disintegrative disorder childhood and unspecified general developmental disorder, all of which cease to exist as independent diagnoses. ADHD can start later (before 12) and is treated differently in different areas. Learning and movement disorders are organized differently in this chapter and are somewhat combined.

Schizophrenia spectrum and other psychotic disorders

For the diagnosis of schizophrenia, symptoms of the first rank of Schneider lose their special weight. One positive symptom is required to make a diagnosis henceforth. Subtypes removed - in favor of a dimensional severity index. For schizoaffective disorder, the mood aspect is emphasized, and for delusional disorder, pretentious content is no longer excluded - although it is assessed separately. The "catatonia" section has been expanded: this code can now be used as a contiguous diagnosis (clarifying indicator) for depressive, bipolar and psychotic disorders.

Bipolar and related disorders

Bipolar and similar disorders are now separated from depressive disorders and put into a separate category. A clearer definition of mania is given and clarifying indicators for mixed episodes are introduced, which lowers the threshold for disorder. Added residual "other" subcategory and a clarifying indicator for anxiety symptoms.

Depressive disorders

Added disruptive mood dysregulation disorder and premenstrual dysphoric disorder. Chronic depression and dysthymia are combined into one diagnosis, now it is "persistent depressive disorder (dysthymia)" "with a number of specifying indicators. Major depressive disorder remained practically unchanged, however, for the "" subthreshold "" symptomatology, the specifying indicator "mixed manifestations" was introduced. A clarifying indicator for anxiety distress has also been introduced. Removed grounds for exclusion for grief.

Anxiety disorders

Obsessive-compulsive disorder and post-traumatic disorder for neurophysiological and epidemiological reasons are placed in separate chapters (see below). Various criteria of phobia are slightly adapted, and agoraphobia and panic are separated. Panic attacks can act as a clarifying indicator for other diagnoses. Separation anxiety disorder and selective mutism are no longer specific childish diagnoses.

Obsessive-compulsive and related disorders

For obsessions and for "Body Dysmorphic Disorder" "added clarifying indicators of severity and criticism, incl. "" delusional character "". The same goes for Hoarding Disorder, a completely new diagnosis in DSM-5, as well as Excoriation (Skin-Picking) Disorder. This also included trichotillomania, and, in addition, exogenous causes of OCD were added, in particular, due to the use of psychoactive substances and drugs, as well as in connection with other medical conditions.

Trauma- and stressor-related disorders

For both acute trauma and post-traumatic stress disorder, the stressor criterion has been changed: now, when making a diagnosis, the experience received in the role of a witness and the indirect effect of the stressor are taken into account. The requirement for direct experience of fear, horror, or feelings of helplessness is also excluded. Avoidance and emotional flattening are decoupled, and at the same time, to emotional flattening, incl. persistent depressed mood. Recklessness, (auto) destructive behavior, irritability and aggression are added to the already known symptoms of arousal. Lower diagnostic thresholds are used for children and adolescents in puberty. Adjustment disorder remained unchanged. Reactive attachment disorder has been moved to this chapter.

Dissociative Disorders

Various changes have been made to the criteria for dissociative identity disorder, including, for example, the perception of identity transition by third parties. Depersonalization and derealization are combined into one disorder. Dissociative fugues have ceased to be a separate diagnosis, and have become a clarifying indicator in "dissociative amnesia."

Somatic symptom and related disorders

This is what was previously called somatoform disorders. Removed somatization disorder, hypochondria, pain disorder, and unspecified somatoform disorder from DSM. The diagnosis of "disorder with somatic symptoms" "can be made on an equal basis with the diagnosis from another medical specialty only if somatic symptoms are combined with abnormal thoughts, feelings and behavior. Unexplained medical symptoms play a decisive role only in false pregnancy and conversion (i.e. functional disorder with neurological symptoms). In other cases, positive symptoms should be sought in this group.

Feeding and Eating Disorders

This includes the former "childish" diagnoses, such as "pica" (absorption of inedible substances) and "rumination" (that is, regurgitation of food with repeated chewing), but for them it was removed age criterion... There is also a new diagnosis: Avoidant / Restrictive Food Intake. Anorexia no longer requires amenorrhea and binge eating episodes, although for bulimia nervosa and the new Binge-Eating Disorder category, binge eating attacks should occur at least once a week.

Sleep-Wake Disorders

There is no longer any division into truly psychiatric and other ("somatic") sleep disorders in the DSM-5, given the original concept of a contiguous nature of diagnoses. The chapter presents a large number of sleep disorders, described through physical characteristics in relation to circadian rhythms and breathing disorders. This group includes Restless legs syndrome and REM Sleep Behavior Disorder. A large diagnostic choice predisposes to avoid the use of "unspecified" "diagnoses.

Sexual Dysfunctions

In order to avoid overdiagnosis, the thresholds for diagnosis in this group are raised. Vaginismus is combined with dyspareunia in the Genito-Pelvic Pain / Penetration Disorder category. Removed sexual aversion disorder. All disorders are subtyped based on psychological or combined factors, situation and achievement.

Gender Dysphoria

Disruptive, impulse control, and conduct disorders

This is also a new chapter, which includes part of the missing chapter "Disorders Usually First Diagnosed in Childhood and Adolescence." In addition to a variety of impulse control disorders, this includes antisocial personality disorder, duplicated from the chapter on personality disorders. Revised and weighted criteria for oppositional defiant disorder. Conduct Disorder removed the reason for excluding a diagnosis, but added a callous-unemotional qualifier. Intermittent Explosive Disorder can now be verbal, and the rest of the criteria for this disorder has been sharpened significantly.

Substance-related and addictive disorders

This chapter introduces for the first time a non-chemical disorder called gambling addiction. For chemical substances abuse and dependence are grouped under the title Substance Use Disorder. "Traction" "appears as a criterion, and problems with the justice authorities have been removed. A new code for tobacco-related disorders emerged, while caffeine was already in the DSM-IV TR. There is a criterion of severity, as well as the mention of ““ in controlled circumstances ”” or ““ as maintenance treatment ”” (for methadone).

This concludes our review. It is far from complete. We are dealing only with the first attempts to comprehend the changes that have taken place, taking into account the accumulated knowledge. More details on the relevant sections can be found on the Internet.

Based on materials: