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DSM 5 Changes: Schizophrenia & Psychotic Disorders

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DSM 5 Changes: Schizophrenia & Psychotic Disorders

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Beschreibung

Short description of changes in DSM 5 in Schizophrenia Categories.

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  1. 1. DSM-5 Changes: Schizophrenia & Psychotic Disorders Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has a number of changes to schizophrenia and other psychotic disorders. Asit Kumar Maurya Banaras Hindu University Varanasi, India
  2. 2. Schizophrenia Two changes were made to the primary symptom criteria for schizophrenia. 1. 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.
  3. 3. 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.”
  4. 4. 2. The second change was the requirement for a person to now have at least one of three “positive” symptoms of schizophrenia: • Hallucinatios • Delusions • Disorganized speech The APA believes this helps increase the reliability of a schizophrenia diagnosis.
  5. 5. Schizophrenia subtypes • Schizophrenia subtypes have been dumped in the DSM-5 because of their “limited diagnostic stability, low reliability, and poor validity,” according to the APA. (The old DSM-IV had specified the following schizophrenia subtypes: paranoid, disorganized, catatonic, undifferentiated, and residual type.) • The APA also justified the removal of schizophrenia subtypes from the DSM-5 because they didn’t appear to help with providing better targeted treatment, or predicting treatment response.
  6. 6. • The APA proposes that clinicians instead use 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.” Section III is the new section in the DSM-5 that includes assessments, as well as diagnoses needing further research.
  7. 7. Schizoaffective Disorder • The biggest change to schizoaffective disorder is that a major mood episode must be present for a majority of the time the disorder has been present in the person. • The APA says 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 depresive disorder, which are bridged by this condition.
  8. 8. • 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.”
  9. 9. Delusional Disorder • Mirroring the change in the schizophrenia diagnostic criteria, delusions in delusion disorder are no longer required to be of the “non-bizarre” type. A person can now be diagnosed with delusional disorder with bizarre delusions, via a new specifier in the DSM-5. • Delusional disorder is no longer separated from shared delusional disorder.
  10. 10. Catatonia • In DSM-IV, two out of five symptom clusters were required if the context was a psychotic or mood disorder, whereas only one symptom cluster was needed if the context was a general medical condition. In DSM-5, all contexts require three catatonic symptoms (from a total of 12 characteristic symptoms). • In DSM-5, all contexts require three catatonic symptoms (from a total of 12 characteristic symptoms).
  11. 11. • In DSM-5, catatonia may be diagnosed as a specifier for depressive, bipolar, and psychotic disorders; as a separate diagnosis in the context of another medical condition; or as another specified diagnosis.
  12. 12. Reference: • Grohol, J. (2014). DSM-5 Changes: Schizophrenia & Psychotic Disorders. Psych Central. Retrieved on August 19, 2015, from http://pro.psychcentral.com/dsm-5-changes- schizophrenia-psychotic-disorders/004336.html • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author

Beschreibung

Short description of changes in DSM 5 in Schizophrenia Categories.

Transkript

  1. 1. DSM-5 Changes: Schizophrenia & Psychotic Disorders Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has a number of changes to schizophrenia and other psychotic disorders. Asit Kumar Maurya Banaras Hindu University Varanasi, India
  2. 2. Schizophrenia Two changes were made to the primary symptom criteria for schizophrenia. 1. 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.
  3. 3. 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.”
  4. 4. 2. The second change was the requirement for a person to now have at least one of three “positive” symptoms of schizophrenia: • Hallucinatios • Delusions • Disorganized speech The APA believes this helps increase the reliability of a schizophrenia diagnosis.
  5. 5. Schizophrenia subtypes • Schizophrenia subtypes have been dumped in the DSM-5 because of their “limited diagnostic stability, low reliability, and poor validity,” according to the APA. (The old DSM-IV had specified the following schizophrenia subtypes: paranoid, disorganized, catatonic, undifferentiated, and residual type.) • The APA also justified the removal of schizophrenia subtypes from the DSM-5 because they didn’t appear to help with providing better targeted treatment, or predicting treatment response.
  6. 6. • The APA proposes that clinicians instead use 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.” Section III is the new section in the DSM-5 that includes assessments, as well as diagnoses needing further research.
  7. 7. Schizoaffective Disorder • The biggest change to schizoaffective disorder is that a major mood episode must be present for a majority of the time the disorder has been present in the person. • The APA says 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 depresive disorder, which are bridged by this condition.
  8. 8. • 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.”
  9. 9. Delusional Disorder • Mirroring the change in the schizophrenia diagnostic criteria, delusions in delusion disorder are no longer required to be of the “non-bizarre” type. A person can now be diagnosed with delusional disorder with bizarre delusions, via a new specifier in the DSM-5. • Delusional disorder is no longer separated from shared delusional disorder.
  10. 10. Catatonia • In DSM-IV, two out of five symptom clusters were required if the context was a psychotic or mood disorder, whereas only one symptom cluster was needed if the context was a general medical condition. In DSM-5, all contexts require three catatonic symptoms (from a total of 12 characteristic symptoms). • In DSM-5, all contexts require three catatonic symptoms (from a total of 12 characteristic symptoms).
  11. 11. • In DSM-5, catatonia may be diagnosed as a specifier for depressive, bipolar, and psychotic disorders; as a separate diagnosis in the context of another medical condition; or as another specified diagnosis.
  12. 12. Reference: • Grohol, J. (2014). DSM-5 Changes: Schizophrenia & Psychotic Disorders. Psych Central. Retrieved on August 19, 2015, from http://pro.psychcentral.com/dsm-5-changes- schizophrenia-psychotic-disorders/004336.html • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author

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