Psychiatry

Asher B. Simon, Antonia S. New, Wayne K. Goodman, Asher B. Simon, Antonia S. New, Wayne K. Goodman

• Publisher: Wiley-Blackwell
• Year: 2016
• Print ISBN: 9781118654286
• eBook ISBN: 9781118654255
• Edition: 1
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

The Mount Sinai Expert Guides, published by Wiley and endorsed by Mount Sinai School of Medicine in New York, provide rapid access, point-of-care clinical information on the most common diseases in a range of different therapeutic areas. Each title focuses on a different speciality and emphasis throughout is on providing rapid-access, clear clinical guidance to aid physicians with point-of-care management of their patients.

Each title is edited by a renowned specialist from Mount Sinai, normally the Chair of the department, who is responsible for recruiting key faculty members to author the chapters. A chapter template has been developed to which each chapter author must adhere, so as to ensure complete consistency across all the chapters in each book and also across every book in the series. Accompanying each book is a companion website containing accessory materials such as case studies, video clips, MCQs, patient advice and PQRI/ICD codes.

Mount Sinai Expert Guides: Psychiatry will provide specialist trainees and recently qualified specialists in psychiatry with an extremely clinical, affordable and accessible handbook covering the specialty. It will be used as both a point-of-care resource in the hospital and clinical setting, and also as a refresher guide during preparation for board exams and re-certification.

Focused on providing 100% clinical guidance on the most common conditions that psychologists encounter, it will present the very best in expert information in an attractive, easy to navigate informative and well-structured manner, with features such as key points, potential pitfalls, management algorithms, and national/international guidelines on treatment.

PART 1
Introduction

CHAPTER 1
DSM‐5

Evan Leibu¹ and Michael B. First²

¹ Icahn School of Medicine at Mount Sinai, New York, NY, USA

² Columbia University, New York, NY, USA

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OVERALL BOTTOM LINE

• DSM‐5 involves multiple changes to the DSM‐IV.
• DSM remains a categorical and descriptive method of categorizing symptoms into specified syndromes.
• Diagnostic groupings were reorganized to reflect common putative mechanisms and risk factors.
• The order of the diagnostic groupings attempts to reflect the developmental lifespan.

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Discussion of topic and guidelines

The Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in 1952, has undergone multiple revisions, the most recent being DSM‐5, released in May of 2013. Multiple changes have been made, including changes to diagnostic classes, the addition and removal of diagnoses, and modification of previous diagnoses.

Despite these changes, DSM‐5 remains a mainly categorical and descriptive method of classifying symptoms. Clinical diagnosis continues to be based on sets of symptoms that are clustered into heterogeneous syndromes, which often overlap among disorders. With the exception of those disorders for which the etiology is at least partially known (e.g., trauma and stress‐related disorders, substance‐induced disorders, disorders due to another medical condition), DSM disorders continue to be classified without regard to etiology.

Some of the major changes of DSM‐5 from DSM‐IV include the removal of the multiaxial system and the inclusion of ICD‐10‐CM diagnostic codes to ensure compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Even though it was not possible to modify disorder definitions to reflect the burgeoning understanding of underlying pathophysiological mechanisms, diagnostic groupings were reorganized to reflect common putative mechanisms and risk factors. Moreover, the order of the diagnostic groupings attempts to reflect the developmental lifespan with diagnoses that occur early in the developmental process coming earlier in the classification.

Brief overviews of significant changes made to the diagnostic categories are outlined here in the same order in which they appear in DSM‐5.

Neurodevelopmental disorders

• Intellectual Disability
  • Formerly called mental retardation, severity is no longer determined by IQ range but by impairment in adaptive functioning.
• Global Developmental Delay
  • A new diagnosis for individuals under age 5 with intellectual impairment who are unable to undergo systematic assessment due to age.
• Social (Pragmatic) Communication Disorder
  • A new diagnosis for individuals with deficits in social communication in the absence of other symptoms of autism spectrum disorder or Intellectual Disability.
• Autism Spectrum Disorder
  • This new category reflects the dimensional view that autistic symptoms occur across a spectrum and replaces the DSM‐IV diagnoses of Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, Rett’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.
• Attention‐Deficit/Hyperactivity Disorder
  • The onset requirement has been changed from before age 7 years to prior to age 12. A comorbid diagnosis with autism spectrum disorder is now allowed. The symptom threshold has been lowered for adults from six to five symptoms.
• Specific Learning Disorder
  • The DSM‐IV diagnoses of reading disorder, mathematics disorder, and disorder of written expression have been combined. Impairments in specific academic domains are indicated with specifiers.

Schizophrenia spectrum and other psychotic disorders

• Delusional Disorder
  • Delusions no longer have to be non‐bizarre.
• Schizophrenia
  • Individuals with Schizophrenia now must evidence at least one of the first three items from Criterion A (i.e., delusions, hallucinations, and disorganized speech). In addition, the designation of certain symptoms (e.g., bizarre delusions) as being of special diagnostic significance has been dropped. Subtypes of Schizophrenia (i.e., paranoid, disorganized, catatonic, undifferentiated, and residual) have been removed and replaced with symptom‐based severity dimensions.
• Schizoaffective Disorder
  • Schizoaffective disorder now requires that symptoms meeting criteria for a major mood episode be present for the majority of the disorder’s total lifetime duration.
• Catatonia
  • Diagnostic criteria for a catatonia syndrome, which can apply to psychotic and mood disorders and etiological medical conditions, are now provided.

Bipolar and related disorders

• Bipolar Disorders
  • Increased activity or energy with elevated or irritable mood is now required for a manic or hypomanic episode. The mixed type of manic episode has been removed in favor of a more broadly defined mixed features specifier that can also apply to depressive episodes.

Depressive disorders

• Disruptive Mood Dysregulation Disorder
  • A new diagnosis, characterized by severe and recurrent temper outbursts that are superimposed on a baseline of chronic irritability, has been added to address the misuse of the bipolar disorder diagnosis for chronically irritable children. This diagnosis should only be used in children between ages 6 and 18. It is considered more severe than oppositional defiant disorder and should not be comorbidly diagnosed.
• Major Depressive Disorder
  • To cover the common presentation of comorbid anxiety symptoms, an “anxious distress” specifier (which also can be applied to manic or hypomanic epis...

Table of contents

• Cover
• Title Page
• Table of Contents
• Contributors
• Series Foreword
• Preface
• List of Abbreviations
• About the Companion Website
• PART 1: Introduction
• PART 2: Adult Disorders
• PART 3: Child/Adolescent Disorders
• PART 4: Geriatric Disorders
• PART 5: Special Topics
• Index
• End User License Agreement