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Diagnosing Mental Disorders

By on November 9, 2013

Why should you care about the newest diagnostic manual for clinicians, known commonly as the DSM V?

First, know that this manual is evolving guidance by which the psychological field uses to assess what is and what is not a diagnosable disorder. For example, did you know that homosexuality was once listed as a disorder.

Read about the most significant changes to the manual here.

Clinicians and patients also say  the newest psychiatric manual as easy to use and useful for clinical care, according to findings from field trials in routine clinical practice settings of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The results of the field testing were published online today in Psychiatric Services, a peer-reviewed journal of the American Psychiatric Association (APA).

“This is the first time DSM was field tested in routine clinical practice settings. It was important for us to test not just the reliability of the criteria, which we did in our large academic field trials, but also how well the DSM-5 criteria and approach worked for clinicians and patients,” said Darrel A. Regier, MD, MPH, Vice- Chair of the DSM-5 Task Force, and Director of the Division of Research at APA.

“The positive feedback echoes our view that DSM-5 provides clinicians a stronger guidebook to help them deliver the best care possible to patients.”

DSM-5 field trials in routine clinical practice settings were conducted parallel to testing in large academic medical centers to examine how proposed changes fared in small group or solo practices. More than 600 mental health clinicians from various disciplines and 1,200 patients participated in the study to examine the clinical utility and feasibility of draft criteria and dimensional measures.

In adult care, 75 percent of clinicians responded that the DSM-5 approach for all disorders was better or much better than DSM-IV, reporting the most favorable ratings for PTSD, bipolar II disorder, substance use disorders, and somatic symptom disorder. Nearly half of clinicians (46 percent) rated the new manual’s approach as very or extremely easy to use.

Similarly, more than half (51 percent) of clinicians of pediatric patients said that DSM-5’s criteria and cross- cutting and severity measures were very or extremely easy to use. Nearly 85 percent of clinicians treating patients with ADHD rated DSM-5’s approach as better or much better than DSM-IV’s (71 percent, 13 percent). Pediatric clinicians also reported that the DSM-5 approach for all disorders was better or much better than DSM-IV (76 percent).

During the field trials, more than half of adult and pediatric patients, as well as parents of those children, said that they felt the self-assessment questionnaires introduced in DSM-5 would help their clinicians better understand their problems and symptoms. These self-assessments help patients report their own symptoms and can serve as a baseline for measurement-based care, a quality indicator that is already being incorporated in integrated care networks and electronic health record systems.

The latest manual was released in June 2013 and with that the APA is seeking feedback, offering a number of “emerging measures” in Section III of DSM-5. Simply use the provided assessment tools. And note the August update for coding corrections and  adjustments.

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