Dm-5 Changes To Geriatric Practice

7th Spring Conference–FOSTERING MENTAL WELLNESS IN OLDER ADULTS-Arizona Geriatrics Society
DSM-5 UPDATE FOR THOSE

WORKING WITH OLDER ADULTS
Ole J. Thienhaus, MD
Professor and Chair
Department of Psychiatry
College of Medicine
The University of Arizona, Tucson
Learning  Discuss the differential diagnoses of major neurocognitive disorders.

 Explain the concept of cross-cutting symptoms.
Objectives:  Explain how the Global Assessment of Functioning is addressed in DSM-5.
DISCLOSURE OF COMMERCIAL SUPPORT

Ole J. Thienhaus, MD does not have a significant financial interest or other relationship
with manufacturer(s) of commercial product(s) and /or provider(s) of commercial services
discussed in this presentation.
The information in this document may not be reproduced or disclosed to unauthorized parties without the prior consent of
the Arizona Geriatrics Society.
2014 Arizona Geriatrics Society All Rights Reserved
1
DSM-5:
Changes Relevant to Geriatric ___________________________________
Practice ___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Conceptual Development of DSM ___________________________________

DSM-III ___________________________________
DSM-I DSM-II
Glossary Reconceptualization
Presumed
etiology definitions Explicit criteria ___________________________________
(emphasis on reliability
rather than validity) ___________________________________
DSM-5
___________________________________
New approaches
considered
DSM–IV
DSM-III-R ___________________________________
(dimensional, Criteria broadened
Requires clinically
spectra, Most hierarchies
developmental, culture,
significant distress
dropped
___________________________________
or impairment
impairment thresholds,
living document)
Copyright © 2013. American Psychiatric Association.
___________________________________
___________________________________
 DSM-III-R: Hierarchical arrangement
partially abandoned, but… ___________________________________
___________________________________
 DSM-IV: Strict separation between ___________________________________
disorders continues
___________________________________
 DSM-5: ?? ___________________________________
2
Perceived Shortcomings in DSM-IV ___________________________________

 High rates of comorbidity ___________________________________
♦ High use of –NOS category ___________________________________
___________________________________
♦ Treatment non-specificity
___________________________________
♦ Inability to find laboratory markers/
tests ___________________________________
___________________________________
♦ DSM is starting to hinder research
progress Copyright © 2013. American Psychiatric Association.
New Developments ___________________________________

 Pressures to improve “validity” ___________________________________
 Move toward an “etiologically based” classification ___________________________________
 Are there data in these areas that can be helpful in ___________________________________
developing/changing/refining diagnoses?
Cognitive or behavioral science
Family studies and molecular genetics
___________________________________
Neuroscience—NIMH RDoC Program
Functional and structural imaging
___________________________________
___________________________________
Strategies for Improving DSM ___________________________________
 Incorporate research into the revision ___________________________________

and evolution of the classification
___________________________________
 Move beyond a process of clinical
consensus and build diagnoses on a ___________________________________
foundation of empirical findings from
scientific disciplines ___________________________________
 Seek multidisciplinary, international ___________________________________

scientific participation in the task of
planning the DSM-5 revision ___________________________________
3
___________________________________
___________________________________
___________________________________
DSM-5 Classification Structure ___________________________________
___________________________________
___________________________________
___________________________________
DSM-5 Structure ___________________________________

 Section I: DSM-5 Basics ___________________________________
 Section II: Essential Elements: Diagnostic ___________________________________
Criteria and Codes
___________________________________
 Section III: Emerging Measures and
Models ___________________________________
 Appendix
___________________________________
 Index
___________________________________
Section I ___________________________________
 Brief DSM-5 developmental history ___________________________________

 Guidance on use of the manual ___________________________________
 Definition of a mental disorder ___________________________________
 Cautionary forensic statement ___________________________________
 Brief DSM-5 classification summary ___________________________________
___________________________________
4
Section II:
Chapter Structure ___________________________________
A. Neurodevelopmental Disorders ___________________________________
B. Schizophrenia Spectrum and Other Psychotic
Disorders ___________________________________
C. Bipolar and Related Disorders ___________________________________
D. Depressive Disorders
E. Anxiety Disorders ___________________________________
F. Obsessive-Compulsive and Related Disorders ___________________________________
G. Trauma- and Stressor-Related Disorders
H. Dissociative Disorders
___________________________________
Section II:
J. Somatic Symptom and Related Disorders ___________________________________
K. Feeding and Eating Disorders
___________________________________
L. Elimination Disorders
M. Sleep-Wake Disorders ___________________________________
N. Sexual Dysfunctions ___________________________________
P. Gender Dysphoria
___________________________________
___________________________________
Section II:
Q. Disruptive, Impulse-Control, and Conduct Disorders
___________________________________
R. Substance-Related and Addictive Disorders
S. Neurocognitive Disorders ___________________________________
T. Personality Disorders
___________________________________
U. Paraphilic Disorders
V. Other Disorders ___________________________________
Medication-Induced Movement Disorders and Other
Adverse Effects of Medication ___________________________________
Other Conditions That May Be a Focus of Clinical ___________________________________
Attention
5
Section III: Purpose ___________________________________

 Section III serves as a designated location, ___________________________________
separate from diagnostic criteria, text, and
clinical codes, for items that appear to have ___________________________________
initial support in terms of clinical use but
require further research before being ___________________________________
officially recommended as part of the main
body of the manual ___________________________________
• This separation clearly conveys to readers that the
content may be clinically useful and warrants review, ___________________________________
but is not a part of an official diagnosis of a mental
disorder and cannot be used as such ___________________________________
Section III: Content ___________________________________

 Section III: Emerging Measures and ___________________________________
Models
• Assessment Measures ___________________________________
• Cultural Formulation ___________________________________
• Alternative DSM-5 Model for Personality
Disorders ___________________________________
• Conditions for Further Study ___________________________________
___________________________________
Section III: Content ___________________________________

 Section III, Conditions for Further Study ___________________________________
… with possible relevance for geriatrics:
___________________________________
• Persistent Complex Bereavement Disorder
___________________________________
• Caffeine Use Disorder
• Internet Gaming Disorder ___________________________________
• Suicidal Behavior Disorder
• Non-suicidal Self-Injury ___________________________________
___________________________________
6
Appendix: Content ___________________________________

• Highlights of Changes From DSM-IV to DSM-5
___________________________________
• Glossary of Technical Terms
• Glossary of Cultural Concepts of Distress ___________________________________
• Alphabetical Listing of DSM-5 Diagnoses and Codes
(ICD-9-CM and ICD-10-CM) ___________________________________
• Numerical Listing of DSM-5 Diagnoses and Codes
(ICD-9-CM) ___________________________________
• Numerical Listing of DSM-5 Diagnoses and Codes
(ICD-10-CM) ___________________________________
• DSM-5 Advisors and Other Contributors
___________________________________
Changes in Specific DSM Disorder Numbers;
Combination of New, Eliminated, and Combined ___________________________________
Disorders
(net difference = ‐15) ___________________________________
___________________________________
DSM‐IV DSM‐5
___________________________________
Specific Mental Disorders* 172 157

___________________________________
___________________________________
*NOS (DSM-IV) and Other Specified/Unspecified (DSM-5) conditions are counted
separately.
___________________________________
Changes from NOS to
Other Specified/Unspecified ___________________________________
(net difference = +24)
DSM‐IV DSM‐5
___________________________________
NOS (DSM‐IV) and Other ___________________________________
Specified/Unspecified 41 65
(DSM‐5) ___________________________________
Other Specified and Unspecified Disorders in DSM‐5 replaced ___________________________________
the Not Otherwise Specified (NOS) conditions in DSM‐IV to
maintain greater concordance with the official International ___________________________________
Classification of Diseases (ICD) coding system. This statistical
accounting change does not signify any new specific mental
disorders. ___________________________________
7
What’s Happened to “NOS”? ___________________________________

 Other Specified … ___________________________________
• Clinician writes down which criterion ___________________________________
for the diagnosis is not met or
insufficiently met ___________________________________
 Unspecified … ___________________________________
• Clinician does not write down which
criterion for the diagnosis is not met or ___________________________________
insufficiently met, usually because ___________________________________
there is insufficient information
___________________________________
___________________________________
Highlights of Specific Disorder
Revisions and Rationales ___________________________________
___________________________________
(selected for relevance to geriatrics)
___________________________________
___________________________________
___________________________________
Schizophrenia
(Schizophrenia Spectrum and Other Psychotic Disorders) ___________________________________
 Elimination of special treatment of bizarre
delusions and “special” hallucinations in Criterion ___________________________________
A (characteristic symptoms)
___________________________________
• Rationale: This was removed due to the poor reliability
in distinguishing bizarre from non-bizarre delusions.
___________________________________
 At least one of two required symptoms to meet
Criterion A must be delusions, hallucinations, or ___________________________________
disorganized speech
• Rationale: This will improve reliability and prevent ___________________________________
individuals with only negative symptoms and catatonia
from being diagnosed with schizophrenia. ___________________________________
8
Schizophrenia (cont’d) ___________________________________

 Deletion of specific subtypes ___________________________________
• Rationale: DSM-IV’s subtypes were shown to
have very poor reliability and validity. They ___________________________________
also failed to differentiate from one another
based on treatment response and course. ___________________________________
___________________________________
___________________________________
___________________________________
Schizoaffective Disorder ___________________________________

 Now based on the lifetime (rather than ___________________________________
episodic) duration of illness in which the mood
and psychotic symptoms described in Criterion ___________________________________
A occur
• Rationale: The criteria in DSM-IV have demonstrated ___________________________________
poor reliability and clinical utility, in part because the
language in DSM-IV regarding the duration of illness ___________________________________
is ambiguous. This revision is consistent with the
language in schizophrenia and in mood episodes,
which explicitly describe a longitudinal rather than ___________________________________
episodic course. Similarly applying a longitudinal
course to schizoaffective disorder will aid in its ___________________________________
differential diagnosis from these related disorders.
Catatonia ___________________________________
 Now exists as a specifier for
neurodevelopmental, psychotic, mood and ___________________________________
other mental disorders; as well as for other
medical disorders (catatonia due to another ___________________________________
medical condition)
___________________________________
• Rationale: As represented in DSM-IV, catatonia was
under-recognized, particularly in psychiatric ___________________________________
disorders other than schizophrenia and psychotic
mood disorders and in other medical disorders. It
was also apparent that inclusion of catatonia as a ___________________________________
specific condition that can apply more broadly across
the manual may help address gaps in the treatment ___________________________________
of catatonia.
9
Mania and Hypomania

(Bipolar and Related Disorders) ___________________________________
 Inclusion of increased energy/activity as a ___________________________________
Criterion A symptom of mania and
hypomania ___________________________________
• Rationale: This will make explicit the
requirement of increased energy/activity in ___________________________________
order to diagnose bipolar I or II disorder (which
is not required under DSM-IV) and will improve ___________________________________
the specificity of the diagnosis.
___________________________________
___________________________________
Mania and Hypomania

___________________________________
 “With anxious distress” also added as a ___________________________________
specifier for bipolar (and depressive)
disorders ___________________________________
• Rationale: The co-occurrence of anxiety with
depression is one of the most commonly seen ___________________________________
comorbidities in clinical populations. Addition
of this specifier will allow clinicians to indicate ___________________________________
the presence of anxiety symptoms that are not
reflected in the core criteria for depression ___________________________________
and mania but nonetheless may be
meaningful for treatment planning. ___________________________________
Bereavement Exclusion
(Depressive Disorders) ___________________________________
 Eliminated from major depressive episode ___________________________________
(MDE)
• Rationale: In some individuals, major loss – ___________________________________
including but not limited to loss of a loved one –
can lead to MDE or exacerbate pre-existing ___________________________________
depression. Individuals experiencing both
conditions can benefit from treatment but are ___________________________________
excluded from diagnosis under DSM-IV. Further,
the 2-month timeframe required by DSM-IV
suggests an arbitrary time course to ___________________________________
bereavement that is inaccurate. Lifting the
exclusion alleviates both of these problems. ___________________________________
10
Hoarding Disorder
(Obsessive-Compulsive and Related Disorders) ___________________________________
 Newly added to DSM-5 ___________________________________
• Rationale: Clinically significant hoarding is
prevalent and can have direct and indirect ___________________________________
consequences on the health and safety of
patients as well as that of others (e.g., ___________________________________
dependents, neighbors). Inclusion will
increase the chances of these individuals ___________________________________
receiving treatment.
___________________________________
___________________________________
Substance Use Disorder (SUD)

(Substance-Related and Addictive Disorders) ___________________________________
 Consolidate substance abuse with substance ___________________________________
dependence into a single disorder called
substance use disorder ___________________________________
• Rationale: Dependence is a misunderstood term
that has negative connotations when in fact it ___________________________________
refers to normal patterns of withdrawal that can
occur from the proper use of medications. ___________________________________
___________________________________
___________________________________
Substance Use Disorder (cont’d) ___________________________________

• Rationale continued: Further, studies from clinical ___________________________________
and general populations indicate DSM-IV
substance abuse and dependence criteria
represent a singular phenomenon but ___________________________________
encompassing different levels of severity. Mild
SUD (2-3/11 criteria) will be coded with the DSM- ___________________________________
IV substance abuse code to reflect the intent but
not reality of considering substance abuse less ___________________________________
severe than substance dependence. Moderate
(4-5/11 criteria) and severe (6+/11 criteria) SUD
will be coded with DSM-IV substance ___________________________________
dependence codes.
___________________________________
11
Substance Use Disorder (cont’d) ___________________________________

 Removal of one of the DSM-IV abuse criteria ___________________________________
(legal consequences), and addition of a new
criterion for SUD diagnosis (craving or strong ___________________________________
desire or urge to use the substance)
• Rationales: The legal criterion had poor clinical ___________________________________
utility and its relevance to patients varied based
on local laws and enforcement of those laws. ___________________________________
Addition of craving as a symptom is highly
validated, based on clinical trials and brain ___________________________________
imaging data, and may hold potential as a future
biomarker for the diagnosis of SUD.
___________________________________
Neurocognitive Disorders (NCD) ___________________________________

 Use of the term major neurocognitive ___________________________________
disorder rather than dementia
• Rationale: The term dementia is usually ___________________________________
associated with neurodegenerative conditions
occurring in older populations, as in ___________________________________
Alzheimer’s disease and Lewy Body dementia.
However, DSM-5’s major NCD refers to a ___________________________________
broad range of possible etiologies that can
occur even in young adults, such as major ___________________________________
NCD due to traumatic brain injury or HIV
infection. ___________________________________
Mild NCD ___________________________________

 Newly added to DSM-5 ___________________________________
• Rationale: Patients with mild NCD are
frequently seen in clinics and in research ___________________________________
settings, and there is widespread consensus
throughout the field that these populations can ___________________________________
benefit from diagnosis and treatment. The
clinical utility of such a diagnosis also is highly ___________________________________
supported in the literature.
___________________________________
___________________________________
12
NCD Subtypes ___________________________________

 Elevation of DSM-IV etiological subtypes ___________________________________
(e.g., frontotemporal dementia, dementia
with Lewy Bodies) to separate, independent ___________________________________
disorders
• Rationale: Separate criteria for 10 etiologies were ___________________________________
developed based on clinical need and to reflect
the best clinical practices endorsed by ___________________________________
neurologists, neuropsychiatrists, and others who
routinely work with these patients. Etiological ___________________________________
criteria provide clarity for clinicians, more
accurate diagnoses for patients, and support for
researchers in uncovering potential biomarkers ___________________________________
that may inform diagnosis in the future.
Neurocognitive Severity Complication ICD-9 ICD-10

Disorder (NCD)
Prob. Alzheimer’s Major Behav. Dist. 331.0 294.11 G30.9 F02.81
Prob. Alzheimer’s Major None 331.0 294.10 G30.9 F02.80

___________________________________
Poss. Alzheimer’s Major Unspecified 331.9 No code G31.9 No code
Prob. FTD Major Behav. Dist. 331.19 294.11 G31.09 F02.81

___________________________________
Prob. FTD Major None 331.19 294.10 G31.09 F02.80
Poss. FTD Major Unspecified 331.9 No code G31.9 No code ___________________________________

Prob. Lewy Bodies Major Behav. Dist. 331.82 294.11 G31.83 F02.81
Prob. Lewy Bodies Major None 331.82 294.10 G31.83 F02.80

___________________________________
Poss. Lewy Bodies Major Unspecified 331.9 No code G31.9 No code
Prob. Vascular Major Behav. Dist. 290.40 No code F01.51 No code

___________________________________
Prob. Vascular Major None 290.40 No code F01.50 No code
___________________________________
Poss. Vascular Major Unspecified 331.9 No code G31.9 No code
Mild Vascular Mild Unspecified 331.83 No code G31.84 No code

___________________________________
TBI Major Behav. Dist. 907.0 294.11 S06.2X9S F02.81
TBI Major None 907.0 294.10 S06.2X9S F02.80
“Diagnosis: Alzheimer’
Alzheimer’s” ___________________________________
Neurocognitive
Disorder (NCD)
Severity Complication ICD-9 ICD-10
___________________________________
Prob. Alzheimer’s Major Behav. Dist. 331.0 294.11 G30.9 F02.81
Prob. Alzheimer’s Major None 331.0 294.10 G30.9 F02.80

___________________________________
Poss. Major Unspecified 331.9 No code G31.9 No code
Alzheimer’s
___________________________________
___________________________________
___________________________________
___________________________________
13
Personality Disorders (PD) ___________________________________

 All 10 DSM-IV PDs remain intact in Section II. However,
Section III contains an alternate, trait-based approach to ___________________________________
assessing personality and PDs that includes specific PD
types (e.g., borderline, antisocial) but allows for the rating of
traits and facets, facilitating diagnosis in individuals who ___________________________________
meet core criteria for a PD but do not otherwise meet a
specific PD type. ___________________________________
• Rationale: A hybrid model with both dimensional and
categorical approaches is included in Section III. This ___________________________________
model calls for evaluation of impairments in personality
functioning and characterizes five broad areas of
pathological personality traits. It identifies six PD types, ___________________________________
each defined by both impairments in personality functioning
and a pattern of impairments in personality traits. We will
evaluate the strengths and weaknesses of the model, ___________________________________
leading to greater understanding of the causes and
treatments of PDs.
___________________________________
___________________________________
Optional Section III Measures ___________________________________
Recommended for Further Study ___________________________________
and Evaluation
___________________________________
___________________________________
___________________________________
Optional Measurements in DSM-5 ___________________________________

 Assess patient characteristics not necessarily
included in diagnostic criteria but of high ___________________________________
relevance to prognosis, treatment planning and
outcome for most patients ___________________________________
 In DSM-5, these include: ___________________________________
• Level 1 and Level 2 Cross-Cutting Symptom
assessments ___________________________________
• Diagnosis-specific Severity ratings
• Disability assessment
___________________________________
 May be patient, informant, or clinician completed, ___________________________________
depending on the measure
14
Level 1 Cross-Cutting Symptom Measure ___________________________________

 Referred to as “cross-cutting” because it calls ___________________________________
attention to symptoms relevant to most, if not
all, psychiatric disorders (e.g., mood, anxiety,
sleep disturbance, substance use, suicide) ___________________________________
• Self-administered by patient ___________________________________
• 13 symptom domains for adults
• 12 symptoms domains for children 11+, parents ___________________________________
of children 6+
• Brief—1-3 questions per symptom domain
___________________________________
• Screen for important symptoms, not for specific ___________________________________
diagnoses (i.e., “cross-cutting”)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
15
Level 2 Cross-Cutting Measure ___________________________________

 Completed when the corresponding Level 1 ___________________________________
item is endorsed at the level of “mild” or
greater (for most but not all items, i.e. ___________________________________
psychosis and inattention)
• Gives a more detailed assessment of the ___________________________________
symptom domain
• Largely based on pre-existing, well-validated
___________________________________
measures, including the SNAP-IV
(inattention); NIDA-modified ASSIST ___________________________________
(substance use); and PROMIS ® forms
(anger, sleep disturbance, emotional distress) ___________________________________
Example of a Level 2 Cross-

Cross-cutting Assessment: Sleep
Please respond to each item by choosing one option per question.
In the past SEVEN (7) DAYS....

Not at all A little
bit
Somewhat Quite a
bit
Very
much
___________________________________
My sleep was restless.  1 2 3 4 5
___________________________________
I was satisfied with my sleep.  5 4 3 2 1
My sleep was refreshing.  5 4 3 2 1 ___________________________________

I had difficulty falling asleep.  1 2 3 4 5
___________________________________
In the past SEVEN (7) DAYS.... Never Rarely Sometime Often Always
s
I had trouble staying asleep.  1 2 3 4 5 ___________________________________
 1 2 3 4 5
I had trouble sleeping.
___________________________________
I got enough sleep.  5 4 3 2 1
In the past SEVEN (7) DAYS… Very Poor Poor Fair Good Very
___________________________________
My sleep quality was...  5 4 3 2 good
1
Diagnosis-Specific Severity Measures ___________________________________

 For documenting the severity of a specific ___________________________________
disorder using, for example, the frequency
and intensity of its component symptoms ___________________________________
 Can be administered to individuals with:
• A diagnosis meeting full criteria
___________________________________
• An “other specified” diagnosis, esp. a clinically ___________________________________
significant syndrome that does not meet
diagnostic threshold ___________________________________
 Some clinician-rated, some patient-rated
___________________________________
16
World Health Organization Disability

Assessment Schedule (WHODAS 2.0) ___________________________________
 WHODAS 2.0 is the recommended, but not ___________________________________
required, assessment for disability
 Corresponds to disability domains of ICF ___________________________________
 Developed for use in all clinical and general
population groups ___________________________________
 Tested world-wide and in DSM-5 Field Trials ___________________________________
 36 questions, self-administered with clinician
review ___________________________________
 For Adult Patients
• Child version developed by DSM-5, not yet approved ___________________________________
by WHO
WHODAS Domains ___________________________________

 Understanding and communicating ___________________________________
 Getting around ___________________________________
 Self Care
 Getting along with people
___________________________________
 Life activities ___________________________________
• household
___________________________________
• work or school
 Participation in Society ___________________________________
Accessing the Measures ___________________________________

 Print: ___________________________________
• Level 1 X-C Adult and Parent
___________________________________
• Psychosis Severity
• Adult Disability ___________________________________
 Online:
• All Level 1 and Level 2 X-C
___________________________________
• All Disorder Severity ___________________________________
• Adult Disability
 www.psychiatry.org/dsm5 ___________________________________
17
___________________________________
___________________________________
___________________________________
Use of DSM-5
___________________________________
___________________________________
___________________________________
___________________________________
Definition of a Mental Disorder

___________________________________
 The diagnosis of a mental disorder ___________________________________
should have clinical utility: it should help
clinicians to determine prognosis, ___________________________________
treatment plans, and potential treatment ___________________________________
outcomes for their patients. However, the
diagnosis of a mental disorder is not ___________________________________
equivalent to a need for treatment.
___________________________________
___________________________________
Definition of a Mental Disorder

___________________________________
___________________________________
 Until incontrovertible etiological or
pathophysiological mechanisms are ___________________________________
identified to fully validate specific
disorders or disorder spectra, the most ___________________________________
important standard for the DSM-5 ___________________________________
disorder criteria will be their clinical utility.
___________________________________
___________________________________
18
Structure of Disorder Chapters ___________________________________

 Criteria ___________________________________
 Subtypes and/or specifiers
 Severity
___________________________________
• Codes and recording procedures ___________________________________
 Explanatory text (new or expanded)
___________________________________
• Diagnostic and associated features;
prevalence; development and course; risk and ___________________________________
prognosis; culture- and gender-related factors;
diagnostic markers; functional consequences;
differential diagnosis; comorbidity ___________________________________
Making a Diagnosis ___________________________________

 Administer cross-cutting assessments ___________________________________
(suggested)
 Administer WHODAS 2.0 (suggested, not ___________________________________
required)
 Conduct clinical interview (informed in part
___________________________________
by assessment scores) ___________________________________
 Determine whether or not diagnostic
threshold is met ___________________________________
 Consider subtypes and/or specifiers ___________________________________
Making a Diagnosis ___________________________________

 Consider contextual information, disorder ___________________________________
text (e.g., course, differential), distress,
clinician judgment ___________________________________
 Diagnosis is given
• Administer severity assessments (suggested) ___________________________________
 Apply codes and follow instructions as per ___________________________________
coding and recording procedures
 Develop treatment plan and outcome ___________________________________
monitoring approach
___________________________________
19
New DSM-5 Diagnoses Code Issues ___________________________________

 Dual coding provided to account for lag ___________________________________
between DSM-5’s publication and official
implementation of ICD-10-CM codes (October
1, 2014) ___________________________________
 Codes accompany each criteria set ___________________________________
• Some codes are used for multiple disorders
 In select places, unique codes are given for
___________________________________
subtypes, specifiers, and severity
___________________________________
 For neurocognitive and substance/medication-
induced disorders, coding depends on further ___________________________________
specification

DSM-5 Disorder ICD-9-CM ICD-9-CM Title ICD-10-CM ICD-10-CM Title
Code Code
F80.89
___________________________________
Social (Pragmatic) 315.39 Other Other
Communication developmental developmental
Disorder speech or disorders of speech ___________________________________
language and language
disorder ___________________________________
Disruptive Mood 296.99 Other Specified F34.8 Other Persistent
Dysregulation Episodic Mood Mood [Affective] ___________________________________
Disorder Disorder Disorder
Premenstrual 625.4 Premenstrual N94.3 Premenstrual ___________________________________

Dysphoric tension tension syndrome
Disorder (from syndromes
DSM-IV appendix)
___________________________________

DSM-5 Disorder ICD-9-CM ICD-9-CM Title ICD-10-CM ICD-10-CM Title
Hoarding
Code
300.3 Obsessive
Code
F42 Obsessive
___________________________________
Disorder Compulsive Compulsive Disorder
Disorders ___________________________________
Excoriation (Skin 698.4 dermatitis factitia L98.1 factitial dermatitis
[artefacta]
Picking) Disorder
Binge Eating 307.51 bulimia nervosa F50.2 bulimia nervosa
___________________________________
Disorder (from
DSM-IV Appendix) ___________________________________
Substance Use Coding will be applied based on severity: ICD codes associated with
Disorders substance abuse will be used to indicated mild SUD; ICD codes
associated with substance dependence will be used to indicate
___________________________________
moderate or severe SUD
___________________________________
20

 When using DSM-5 diagnoses, clinicians ___________________________________
should note the name of the disorder next to
___________________________________
the code listing, since no distinct code yet
exists for some diagnoses. ___________________________________
 The APA has been working with insurers to ___________________________________
ensure that DSM-5 diagnoses are recognized
as distinct entities. ___________________________________
___________________________________
John Stuart Mill ___________________________________

The tendency has always been strong to ___________________________________
believe that whatever received a name must
be an entity or being, having an independent ___________________________________
existence of its own. And if no real entity
answering to the name could be found, men ___________________________________
did not for that reason suppose that none
existed, but imagined that it was something ___________________________________
particularly abstruse and mysterious.
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
21

Dm-5 Changes To Geriatric Practice

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7th Spring Conference–FOSTERING MENTAL WELLNESS IN OLDER ADULTS-Arizona Geriatrics Society

DSM-5 UPDATE FOR THOSE

Learning  Discuss the differential diagnoses of major neurocognitive disorders.

DISCLOSURE OF COMMERCIAL SUPPORT

Conceptual Development of DSM ___________________________________

Perceived Shortcomings in DSM-IV ___________________________________

New Developments ___________________________________

Strategies for Improving DSM ___________________________________

 Incorporate research into the revision ___________________________________

 Seek multidisciplinary, international ___________________________________

DSM-5 Structure ___________________________________

 Brief DSM-5 developmental history ___________________________________

Copyright © 2013. American Psychiatric Association.

Section III: Purpose ___________________________________

Section III: Content ___________________________________

Section III: Content ___________________________________

Appendix: Content ___________________________________

Specific Mental Disorders* 172 157

What’s Happened to “NOS”? ___________________________________

Schizophrenia (cont’d) ___________________________________

Schizoaffective Disorder ___________________________________

Mania and Hypomania

Mania and Hypomania

Substance Use Disorder (SUD)

Substance Use Disorder (cont’d) ___________________________________

Substance Use Disorder (cont’d) ___________________________________

Neurocognitive Disorders (NCD) ___________________________________

Mild NCD ___________________________________

NCD Subtypes ___________________________________

Neurocognitive Severity Complication ICD-9 ICD-10

Prob. Alzheimer’s Major None 331.0 294.10 G30.9 F02.80

Prob. FTD Major Behav. Dist. 331.19 294.11 G31.09 F02.81

Poss. FTD Major Unspecified 331.9 No code G31.9 No code ___________________________________

Prob. Lewy Bodies Major None 331.82 294.10 G31.83 F02.80

Prob. Vascular Major Behav. Dist. 290.40 No code F01.51 No code

Mild Vascular Mild Unspecified 331.83 No code G31.84 No code

TBI Major None 907.0 294.10 S06.2X9S F02.80

Prob. Alzheimer’s Major None 331.0 294.10 G30.9 F02.80

Personality Disorders (PD) ___________________________________

Optional Measurements in DSM-5 ___________________________________

Level 1 Cross-Cutting Symptom Measure ___________________________________

Level 2 Cross-Cutting Measure ___________________________________

Example of a Level 2 Cross-

In the past SEVEN (7) DAYS....

My sleep was refreshing.  5 4 3 2 1 ___________________________________

Diagnosis-Specific Severity Measures ___________________________________

World Health Organization Disability

WHODAS Domains ___________________________________

Accessing the Measures ___________________________________

Definition of a Mental Disorder

Definition of a Mental Disorder

Structure of Disorder Chapters ___________________________________

Making a Diagnosis ___________________________________

Making a Diagnosis ___________________________________

New DSM-5 Diagnoses Code Issues ___________________________________

New DSM-5 Diagnoses Code Issues ___________________________________

Premenstrual 625.4 Premenstrual N94.3 Premenstrual ___________________________________

New DSM-5 Diagnoses Code Issues ___________________________________

New DSM-5 Diagnoses Code Issues ___________________________________

John Stuart Mill ___________________________________

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