1. DSM-5: Just the Basics (Excerpt from 6 hr CEU training)
Debbie Spaeth, LMFT, LPC, LADC
Quest MHSA, LLC

2. Diagnostic & Statistical Manual of Mental Disorders - 5
Purpose: Assist trained clinicians in Dx of Mental Dis’ as part of case formulation assessment that leads to a fully informed (cultural/social) Tx Plan for each individual. Manual makes NO recommendations for Tx or Forensics- Compentency/Criminal Resp./Disability
Dx Criteria Sets: Summarize characteristic syndromes of signs/symptoms that point to underlying disorder, follows developmental path
Published by American Psychiatric Association

3. A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. MD's are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a MD. Socially deviant behavior (political/religious/sexual) and conflicts that are primarily between the individual and society are not MD unless the deviance/conflict results from a dysfunction in the individual, as described above.

4. DSM-5: Diagnostic Elements
Assessment
Dx Criteria and Descriptors
Subtypes and Specifiers
Course
Severity

5. Hierarchy determined by order of the Focus of Tx
Principal Diagnosis
Hierarchy determined by order of the Focus of Tx
Primary Dx - reason for appointment or admission
Secondary Dx - lesser focus
Tertiary Dx - least focus
Comorbidity = MH Dx first and Medical 2nd

6. Consider patient’s functional status separately from Dx or symptoms
No Multi-Axial
Consider patient’s functional status separately from Dx or symptoms
Axis I, II, & III are combined
IV is now displayed in V and ICD Z codes
V/GAF is now WHODAS - World Health Org Disability Assess Schedule, 36 item self admin w/domains

7. Development and course Risk and prognostic factors
Diagnostic Criteria
Diagnostic features
Associated features
Prevalence
Development and course
Risk and prognostic factors
Culture-related diagnostic issues
Gender-related diagnostic issues
Suicide risk
Functional consequences
Differential diagnosis
Comorbidity

8. Culture/Gender Related Issues Suicide Risk Functional Consequences
Dx Criteria - Cont
Culture/Gender Related Issues
Suicide Risk
Functional Consequences
Differential Diagnosing
Comorbidity

9. Provisional & Differential Dxs
#1: Does not meet full criteria
Strong presumption that full criteria will be met
“provisional” is written after Dx on record
#2: Differential Dx = similar but distinct
“Other Specified”- title, w/insufficient symptoms
“Unspecified”- clinician does not reveal specifics

10. Usual Dx is the current presentation of Patient
Course
Usual Dx is the current presentation of Patient
Can be full presentation
Recurrent presentation
Previous Dx noted by partial or full remission

11. Indicated “Specify Current Severity” criteria set
Intensity
Frequency
Duration
Symptom Count
Indicated “Specify Current Severity” criteria set

12. Descriptive Features Specifiers
Additional Information that can inform Tx Planning
“with poor insight”

13. WHO, CMS, CDC, Prevention’s Nat Cent Health Stat
International Coding
WHO, CMS, CDC, Prevention’s Nat Cent Health Stat
Purpose: Data Collection, Billing, Mortality/Effect
Official Date: October 14, 2014
Oklahoma Date: Can begin January 1, 2014
ICD-9 and ICD-10 are included in the Manual
DSM and ICD-11 plan towards unity

14. Digits 1-3 relate to the diagnostic category
4, 5, & 6th digit coding
Digits 1-3 relate to the diagnostic category
Allows increased specificity of Dx
Subtypes: mutually exclusive phenominological subgroupings w/in a Dx, indicated by “Specify whether” instruction in the criteria set.
Specifiers: not mutually exclusive, so multiple spcifiers may be listed, indicated by “Specify” or “Specify if” instruction in the criteria set.

15. Subtype/Specifiers and ICD-9 & 10
International Statistical Classification of Diseases and Related Health Problems - World Health Org.
Majority of the Subtypes and Specifiers cannot be coded in ICD-9 or 10 systems (Medicaid/MCR), but some 4 & 5th codes covered in ICD
Use S&S in the Dx Title on documentation if not supported in ICD coding

16. Diagnosis & Format, examples
1) (F91.1) Conduct Disorder, child onset, w/ limited prosocial emotions, severe V61.03 (Z63.5) Disruption of Fmaily by Divorce; (T74.12XD) Subsequent encounter; V60.2 (Z59.5) Extreme Poverty 2) (F90.2) Attention-deficit hyperactivity disorder, combined presentation; Other factors: V62.3 (Z55.9) Academic underachievement 3) Case #2: (F60.81) Narcissistic Personality Disorder; V62.29 (Z56.9) Other Problem Rltd to Employment 4) (F41.0) Panic Disorder; Other factors: (T74.11XD) Spouse/Partner Violence, subsequent encounter; V61.03 (Z63.5 Disruption of family by divorce (recent); V60.2 (Z59.7) Low income;.

17. Measures and Models

18. Cross-Cutting Symptom Measure
Adult Self-rated Level 1 CCSM - pg 738/9
13 domains: Depression, Anger, Mania, Anxiety, Somatic Symptoms, Suicidal Ideation, Psychosis, Sleep, Memory, Repetitive Thoughts/Behaviors, Dissociation, Personality Functioning, and Substance Use
Mild or Greater = Further Inquiry for Level 2
All Level 2 tools -

19. Parent/Guar rated Level 1 for 6-17 yoa, pg 740/1
CCSM contd.
Parent/Guar rated Level 1 for 6-17 yoa, pg 740/1
12 domains: Somatic Symptoms, Sleep, Inattention, Depression, Anger, Irritabiity, Mania, Anxiety, Psychosis, Retetitive Thoughts/Behaviors, Substance Use, and Suicidal Ideation/Attempts
Mild or Greater = Further Inquiry for Level 2
All Level 2 tools -

20. Other Assessment Tools
Clinician-Rated Dimensions of Psychosis Symptom Severity
World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)

21. Cultural Formulation Interview (CFI) pgs. 752-7 Definition of Problem
Perceptions of Cause/Context/Support
Self-Coping and Past/Current Help Seeking
Patient or Informant

22. Alternative Personality Disorders Model
Level of Personality Functioning Scale
Self - Identity & Self Direction
Level of Impairment Scale: 0 none - 4 extreme
Interpersonal - Empathy & Intimacy
Definitions of Personality Dis Trait Domains/Facets

23. Attenuated Psychosis Syndrome
Study Conditions
Attenuated Psychosis Syndrome
Depressive Episodes w/Short-Duration Hypomania
Persistent Complex Bereavement Disorder
Caffeine Use Disorder
Internet Gaming Disorder
Neurobehavioral Dis Assoc w/Prenatal Alcohol Exp
Suicidal Behavior Disorder/Nonsuicidal Self Injury

24. Glossary of Cultural Concepts of Distress
Appendix
DSM-IV to DSM-5 changes
Glossary of Terms
Glossary of Cultural Concepts of Distress
Alphabetical/Numerical Listings
ICD 9 and 10 Listings
Index

25. Debbie Spaeth, LMFT, LPC, LADC