DSM5 WORKSHOP PRESENTATIONS

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DSM5 WORKSHOPPRESENTATIONS

09h00-09h15General changesMilligan09h15-09h30Developmental disordersVogel / de Vries09h30-09h45Neurocognitive disordersLewis09h45-10h00Mood disordersHorn10h00-10h15Anxiety disorders10h15-10h30Psychotic disorders10h30-10h45Tea break10h45-11h00Personality 11h45Eating disordersHoare11h45-12h00Substance Abusede Clercq12h00-12h15Intellectual disabilityGanasen12h15-12h45General DiscussionLouwTimmermans

Introduction to the DSM-5Dr Pete MilliganJanuary 2014

History DSM-I (1952)DSM-II (1968)DSM-III (1980)DSM-III-R (1987)DSM-IV (1994)DSM-IV-TR (2000)DSM-5 (2013)

Predicting the DSM-V Year of publication – 200731 member task force25 advisory committeesChairperson’s surname begins with “T”1026 pages415 000 wordsBrown cover390 disorders1 800 diagnostic criteria11 appendicesWill sell 1 140 000 copiesGenerate 40 000 000 in revenue for the APABlashfield and Fuller (1996), Journal of Nervous & Mental Disease, Vol 184(1), pp 4-7

Predicting the DSM-V Year of publication – 2007(2013)31 member task force(35)25 advisory committees(22)Chairperson’s surname begins with “T”1026 pages(DSM-IV 900)(947)415 000 words(DSM-IV 324 000)Brown cover(Purple)390 disorders(DSM-IV 357) (348)1 800 diagnostic criteria(DSM-IV 1 500) (?)11 appendices(DSM-IV 10)(7)Will sell 1 140 000 copies(?)Generate 40 000 000 in revenue for the APABlashfield and Fuller (1996), Journal of Nervous & Mental Disease, Vol 184(1), pp 4-7(David Kupfer)(?)(? 230 000 000)

Organisational Structure Harmonization with ICD-11– Includes ICD-9-CM and ICD-10-CM codes Developmental and Lifespan Considerations– Sequential Order starting with Neurodevelopmentaldisorders– Also used within chapters Dimensional approach– Internalizing (eg. anxiety, depressive, somatic) vsExternalizing (eg. impulsive, disruptive conduct andsubstance use)

Organisational Structure Neurodevelopmental DisordersInternalizing DisordersExternalizing DisordersNeurocognitive DisordersOther Disorders New groups:Eg. Obsessive – Compulsive and Related Disorders,Trauma and Stressor-Related Disorders

Chapters Neurodevelopmental DisordersSchizophrenia-Spectrum and Other Psychotic DisordersBipolar and Related DisordersDepressive DisordersAnxiety DisordersObsessive-Compulsive and Related DisordersTrauma and Stressor-Related DisordersDissociative DisordersSomatic Symptom and Related DisordersFeeding and Eating DisordersElimination DisordersSleep-Wake DisordersSexual Dysfunctions

Chapters Gender DysphoriaDisruptive, Impulse-Control, and Conduct DisordersSubstance-Related and Addictive DisordersNeurocognitive DisordersPersonality DisordersParaphilic DisordersOther Mental DisordersMedication-Induced Movement Disorders and OtherAdverse Effects of Medication Other Conditions That May Be a Focus of ClinicalAttention

Cultural Issues Expanded Chapter on Cultural Formulation including acultural formulation interview(CFI). Culture-bound syndrome replaced by:1. Cultural Syndrome: a cluster or group of co-occurring,relatively invariant symptoms found in a specific culturalgroup, community, or context.2. Cultural idiom of distress: a linguistic term, phrase, or wayof talking about suffering among individuals of a culturalgroup.3. Cultural explanation or perceived cause: a label,attribution, or feature of an explanatory model thatprovides a culturally conceived aetiology or cause forsymptoms, illness, or distress.

Gender Differences Refers to ‘gender differences’ rather than ‘sexdifferences’ throughout Gender-specific symptoms added to thediagnostic criteria Gender-related specifiers used where relevant Other issues pertinent to diagnosis andgender considerations included in mostchapters in a section labelled “Gender-RelatedDiagnostic Issues”

Other Specified and Unspecified Disordersand Disorders Previous NOS designation replaced with:– Other Specified Disorder: Name of category followedby the specific reason eg. Clinically significant depressive episode, but falls short ofdiagnostic threshold for MDE “other specified depressivedisorder, depressive episode with insufficient symptoms”.– Unspecified Disorder: Name of category, reason notgiven eg. Acute admission to casualty with a depressive episode,but final diagnosis not yet clear “unspecified depressivedisorder”.

Disorders due to Another MedicalCondition Indicate if due to another medical condition.– Include the name of the other medical conditionin the name of the mental disorder eg. Bipolar disorder due to hyperthyroidism.– Code other medical condition first, then mentaldisorder due to the medical condition

The Multiaxial System Nonaxial documentation of diagnosis (formerly Axis I,II and III)– Principal Diagnosis: The condition chiefly responsible for currentadmission.– List principal diagnosis first followed by others in order of focus ofattention and treatment.– Can use “provisional” as a specifier where there is a strongpresumption that full criteria will be met. Record important psychosocial and contextual factors (formerly AxisIV) using ICD-9-CM V codes or ICD-10-CM Z codes Disability (formerly Axis V): GAF dropped. WHODAS 2.0 included forfurther study.– 36 item, self-administered scale.– Rates difficulty in specific areas of functioning in past 30 days.– Simple or complex methods for calculating summary score.

Emerging Measures and Models Assessment Measures– DSM-5 Self-Rated Level 1 Cross-Cutting SymptomMeasure – Adult– Parent/Guardian-Rated DSM-5 Level 1 Cross-CuttingSymptom Measure – Child Age 6-17– Clinician-Rated Dimensions of Psychosis SymptomSeverity– WHODAS 2.0 Cultural Formulation– Cultural Formulation Interview (CFI)

Emerging Measures and Models Alternative DSM-5 Model for Personality Disorders Conditions for further study––––––Attenuated Psychosis SyndromeDepressive Episodes with Short-Duration HypomaniaPersistent Complex Bereavement DisorderCaffeine Use DisorderInternet Gaming DisorderNeurobehavioural Disorder Associated with PrenatalAlcohol Exposure– Suicidal Behavior Disorder– Nonsuicidal Self-Injury

Transition from the DSM-IV-TR to theDSM-5Examinations administered in 2014:Candidates sitting the FC Psych(SA) Part IIexamination in 2014 (March/May andAugust/October) will be required to have a goodunderstanding of DSM-5 terminology and of theconceptual and category changes from the DSMIV-TR for both the written and clinical/oralexaminations. The long case presentation andthe diagnostic formulation may, however, followDSM-IV-TR nosology and criteria.

Transition from the DSM-IV-TR to theDSM-5Examinations administered in 2015:As of March/May 2015, candidates sitting the FCPsych(SA) Part II examinations will be required to befully versed in the DSM-5 classification system for boththe written and clinical/oral examinations. Candidateswill be required to familiarise themselves with DSM-5criteria and compare and cross-reference them withDSM-IV-TR criteria. The long case presentation anddiagnostic formulation should conform to the DSM-5. Asuggested format for the case presentation is beingprepared and will be made available by June 2014.

Dr Pete MilliganValkenberg HospitalDepartment of Psychiatry and Mental HealthUniversity of Cape TownPeter.milligan@westerncape.gov.za

DSM-IV to DSM-5 in Child &Adolescent PsychiatryProf Petrus de VriesSue Struengmann Professor of Child& Adolescent Psychiatry

DSM in Child & Adolescent PsychiatryNeurodevelopmental Disorders Number of changes New terms, new groupings, new subdivisions,new specifiers, some changes in criteria

Test (True or False)1. We no longer use the term mental retardation. Wediagnose intellectual disability.2. The correct DSM-5 term for a child with autism is autisticspectrum disorder.3. Asperger no longer exists in DSM-5.4. ADHD has had a change in the age of onset criterion.5. ODD and Conduct disorders are not neurodevelopmentaldisorders in DSM-5.6. Selective Mutism is classified as an anxiety disorder inDSM-5.7. To have Tourette’s you no longer need to have evidence ofimpairment or distress caused by the disturbance.

Disorders usually first diagnosedin infancy, childhood oradolescence (DSM-IV) Mental RetardationLearning DisordersMotors Skills DisorderCommunication DisordersPervasive Developmental DisorderAttention deficit and disruptive behaviourdisordersFeeding and eating disorders of infancyand early childhoodTic disordersElimination DisordersOther –separation anxietydisorderSelective mutismReactive Attachment Disorderof I/early ChildhoodStereotypical movementdisorderNOSNeurodevelopmentalDisorders (DSM-5)

Disorders usually first diagnosedin infancy, childhood oradolescence (DSM-IV) Mental RetardationLearning DisordersMotors Skills DisorderCommunication DisordersPervasive Developmental DisorderAttention deficit and disruptive behaviourdisordersFeeding and eating disorders of infancyand early childhoodTic disordersElimination DisordersOther –separation anxietydisorderSelective mutismReactive Attachment Disorderof I/early ChildhoodStereotypical movementdisorderNOSNeurodevelopmentalDisorders (DSM-5) Intellectual (developmental) disability Communication disordersAutism Spectrum DisordersADHDSpecific Learning DisorderMotor Disorders– Developmental coordin. dis– Stereotypical movement dis– Tic disordersOther Specified NeurodevelopmentalDisorderUnspecified NeurodevelopmentalDisorder

Communication Disorders Language DisorderCombination of DSM-IV Expressive Language Disorderand Mixed Receptive-Expressive Language Disorder Speech Sound DisorderPhonological Disorder in DSM-IV Childhood-onset fluency Disorder (stuttering)Stuttering in DSM-IV Social (Pragmatic) Communication DisorderNot in DSM-IV Unspecified Communication Disorder

Autism Spectrum Disorder

Autistic DisorderRett’s DisorderChildhood DisintegrativeDisorderAsperger’s DisorderPDD NOSSpecifiers:With or without IDWith or without language impairmentAssociated with a known medical or geneticcondition or environmental factorAssociated with another NDD or other Dis.With CatatoniaSeverity (3 clinical levels)Lord & Jones, JCPP, 2012

Attention-Deficit/HyperactivityDisorderA. Inattention Criteria – similar, more developmental examples;Hyperactivity/Impulsivity Criteria – similar, more developmentalexamples Requires 6 in childhood; 5 after age 17B. Age-of-onset: before 12y (DSM-IV 7)C. Several (vs ‘some’) inattentive and h-I symptoms in two ormore settingsD. Evidence of interference or reducing quality of functioningE. Context of other disorders (ASD no longer exclusion)Specifiers – (vs subtypes): Combined; Pred Inatt; Pred H/ImpulSpecifiers – partial remissionSpecifiers – severity: mild, moderate, severe

Specific Learning Disorder Difficulties learning and using academic skills;reworded criteria, more developmental andless ‘measurement’ focused Grouped all together vs DSM-IV (readingdisorder, maths disorder, disorder of writtenexpression) Specifiers: impairment in reading, writtenexpression, mathematics Specifier: severity

Motor Disorders Developmental Coordination Disorder Stereotypical Movement Disorder Tic disorders*– Tourette’s Disorder– Persistent (Chronic) Motor or Vocal Tic disorder– Provisional (vs Transient) tic disorder– Other specified tic disorder– Unspecified Tic disorder* ‘disturbance causes marked distress or significant impairment in social,occupational or other important areas of functioning’ – removed in DSM5

Disorders usually first diagnosedin infancy, childhood oradolescence (DSM-IV) Mental RetardationLearning DisordersMotors Skills DisorderCommunication DisordersPervasive Developmental DisorderAttention deficit and disruptive behaviourdisordersFeeding and eating disorders of infancyand early childhoodTic disordersElimination DisordersOther –separation anxietydisorderSelective mutismReactive Attachment Disorderof I/early ChildhoodStereotypical movementdisorderNOSNeurodevelopmentalDisorders (DSM-5) Intellectual (developmental) disability Communication disordersAutism Spectrum DisordersADHDSpecific Learning DisorderMotor Disorders– Developmental coordin. dis– Stereotypical movement dis– Tic disordersOther Specified NeurodevelopmentalDisorderUnspecified NeurodevelopmentalDisorder

Disorders usually first diagnosed ininfancy, childhood or adolescence(DSM-IV) Mental RetardationLearning DisordersMotors Skills DisorderCommunication DisordersPervasive Developmental DisorderAttention deficit and disruptive behaviourdisordersFeeding and eating disorders of infancyand early childhoodTic disordersElimination DisordersOther –separation anxietydisorderSelective mutismReactive Attachment Disorderof I/early ChildhoodStereotypical movementdisorderNOSNeurodevelopmentalDisorders (DSM-5) Intellectual (developmental) disability Communication disordersAutism Spectrum DisordersADHDSpecific Learning DisorderMotor Disorders– Developmental coordin. dis– Stereotypical movement dis– Tic disordersOther Specified NeurodevelopmentalDisorderUnspecified NeurodevelopmentalDisorder

Not in Neurodevelopmental Disorders Disruptive Behaviour Disorders Disruptive,Impulse-Control, and Conduct Disorders Feeding and eating disorders of infancy and earlychildhood Feeding and Eating Disorders Elimination Disorders Elimination Disorders Separation anxiety disorder and selective mutism Anxiety Disorders Reactive attachment disorder of infancy/earlychildhood Trauma- and Stressor-RelatedDisorders

Test (True or False)1. We no longer use the term mental retardation. Wediagnose intellectual disability.2. The correct DSM-5 term for a child with autism is autisticspectrum disorder.3. Asperger no longer exists in DSM-5.4. ADHD has had a change in the age of onset criterion.5. ODD and Conduct disorders are not neurodevelopmentaldisorders in DSM-5.6. Selective Mutism is classified as an anxiety disorder inDSM-5.7. To have Tourette’s you no longer need to have evidence ofimpairment or distress caused by the disturbance.

Test (True or False)1. We no longer use the term mental retardation. Wediagnose intellectual disability. TRUE2. The correct DSM-5 term for a child with autism is autisticspectrum disorder. FALSE3. Asperger no longer exists in DSM-5. TRUE4. ADHD has had a change in the age of onset criterion.TRUE5. ODD and Conduct disorders are not neurodevelopmentaldisorders in DSM-5. TRUE6. Selective Mutism is classified as an anxiety disorder inDSM-5. TRUE7. To have Tourette’s you no longer need to have evidence ofimpairment or distress caused by the disturbance. TRUE

DSM-5NeurocognitiveDisordersIan Storm Lewis

Neurocognitive DisordersReplaces “Delirium, dementia, amnesic andother cognitive disorders”DeliriumMild Neurocognitive disorderMajor Neurocognitive disorder

Subtypese.g. Major Neurocognitive disorder due to Alzheimer’s diseaseAlzheimer’s diseaseFrontotemporal lobardegenerationLewy body diseaseVascular diseaseTraumatic brain injurySubstance/medication useHIV infectionPrion diseaseParkinson’s diseaseHuntington’s diseaseAnother medical conditionMultiple aetiologiesUnspecified

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09h15-09h30 Developmental disorders Vogel / de Vries 09h30-09h45 Neurocognitive disorders Lewis 09h45-10h00 Mood disorders Horn 10h00-10h15 Anxiety disorders Louw 10h15-10h30 Psychotic disorders Timmermans 10h30-10h45 Tea break 10h45-11h00 Personality disorders Kaliski 11h15-11h30 PTSD Benson-M

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