Question

Many factors influenced the development, content, and sequencing of the DSM-5. Name one or two of the factors mostly impacts the clinical practice and was presented and discussed in this course for 8 of the DSM-5 disorders.

Many factors influenced the development, content, and sequencing of the DSM-5. Name one or two of the factors mostly impacts the clinical practice and was presented and discussed in this course for 8 of the Disorders which is Schizophrenia Spectrum and Other Psychotic Disorders , Neurodevelopmental Disorder, Bipolar and Related disorder ,Depressive disorder , Anxiety disorder , Obsessive-Compulsive and Related disorders, Dissociative Disorders , Somatic Symptom and Related Disorders.

Answer 1

The edition of Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the product of more than 10 years of effort by hundreds of international experts in all aspects of mental health. Their dedication and hard work have yielded an authoritative volume that defines and classifies mental disorders in order to improve diagnoses, treatment, and research. Used by clinicians and researchers to diagnose and classify mental disorders, the criteria are concise and explicit, intended to facilitate an objective assessment of symptom presentations in a variety of clinical settings—inpatient, outpatient, partial hospital, consultation-liaison, clinical, private practice, and primary care. New features and enhancements make DSM–5 easier to use across all settings. Learn more about some of the new organization and features of the DSM–5 and the diagnostic differences between DSM–IV–TR and DSM–5 below.

The DSM-5 is based on explicit disorder criteria, which taken together constitute a “nomenclature” of mental disorders, along with an extensive explanatory text that is fully referenced for the first time in the electronic version of this DSM. Although there is a more limited ICD-10 set of criteria for research, the current WHO proposal for ICD-11 will be to provide more general clinical descriptions and guidelines without the adoption of separate research criteria. The intent of joint APA and WHO collaborative efforts to date has been to develop a common research base for the revision of both DSM-5 and ICD-11, through the NIH supported conference meetings and a series of “harmonization meetings”. The developers of the DSM-5 sought to maintain and, where possible, enhance the consistency of DSM and ICD revisions for clinical guidance – a challenging task given that revisions to each were not entirely concurrent (the publication of the ICD-11 is projected for 2015). However, a DSM-ICD harmonization coordinating group was organized early in the development process, under the direction of Steven Hyman, chair of the WHO's International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and a DSM-5 Task Force member.

Schizophrenia Spectrum and Other Psychotic Disorders

1. Schizophrenia-

Two changes were made to DSM-IV Criterion A for schizophrenia. The first change is the elimination of the special attribution of bizarre delusions and Schneiderian first-rank auditory hallucinations (e.g., two or more voices conversing). In DSM-IV, only one such symptom was needed to meet the diagnostic requirement for Criterion A, instead of two of the other listed symptoms. This special attribution was removed due to the nonspecificity of Schneiderian symptoms and the poor reliability in distinguishing bizarre from nonbizarre delusions. Therefore, in DSM-5, two Criterion A symptoms are required for any diagnosis of schizophrenia. The second change is the addition of a requirement in Criterion A that the individual must have at least one of these three symptoms: delusions, hallucinations, and disorganized speech. At least one of these core “positive symptoms” is necessary for a reliable diagnosis of schizophrenia.

2. Schizophrenia subtype

The DSM-IV subtypes of schizophrenia (i.e., paranoid, disorganized, catatonic, undifferentiated, and residual types) are eliminated due to their limited diagnostic stability, low reliability, and poor validity. These subtypes also have not been shown to exhibit distinctive patterns of treatment response or longitudinal course. Instead, a dimensional approach to rating severity for the core symptoms of schizophrenia is included in Section III to capture the important heterogeneity in symptom type and severity expressed across individuals with psychotic disorders.

3. Schizoaffective Disorder

The primary change to schizoaffective disorder is the requirement that a major mood episode be present for a majority of the disorder’s total duration after Criterion A has been met. This change was made on both conceptual and psychometric grounds. It makes schizoaffective disorder a longitudinal instead of a cross-sectional diagnosis—more comparable to schizophrenia, bipolar disorder, and major depressive disorder, which are bridged by this condition. The change was also made to improve the reliability, diagnostic stability, and validity of this disorder, while recognizing that the characterization of patients with both psychotic and mood symptoms, either concurrently or at different points in their illness, has been a clinical challenge.