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Diagnosing Psychiatric Disorders: The Synchronization of DSM-5 and ICD-10-CM: Page 3 of 5

Diagnosing Psychiatric Disorders: The Synchronization of DSM-5 and ICD-10-CM: Page 3 of 5

National Adaptations of ICDNational Adaptations of ICD
Examples of coding changes from DSM-IV-TR and ICD-9-CM to DSM-5 and ICD-10-CMTable – Examples of coding changes from DSM-IV-TR and ICD-9-CM to DSM-...

An overview of DSM-5

Section I (DSM-5 Basics) consists of an introduction and guide to the use of the manual; Section II describes diagnostic criteria and codes with diagnostic and associated features; Section III includes emerging measures and models. The Appendix highlights changes from DSM-IV to DSM-5 and contains glossaries of technical terms and cultural concepts as well as alphabetical and numerical listings of DSM-5 diagnoses and codes (according to ICD-9-CM and ICD-10-CM).

A total of 22 broad diagnostic categories are described in “Diagnostic Criteria and Codes” (Section II). Detailed diagnostic criteria with coding and recording procedures as well as a list of specifiers are included for each specific disorder listed within a broad category. This is followed by a description of the essential elements and associated features that support the diagnosis, including prevalence, development, and course, as well as risk and prognostic factors. The latter are categorized as environmental, genetic, psychological, and course modifiers. Section II also includes culture- and gender-related diagnostic issues, suicide risk, and functional consequences. Differential diagnosis is briefly discussed, and the main disorder-related comorbidities are highlighted.

Section III (“Emerging Measures and Models”) includes tools and techniques helpful in clinical decision making and in understanding the cultural context of mental disorders as well as in identifying diagnostic conditions that merit further research. Level 1 is a cross-cutting symptom measure that serves as a review of systems across mental disorders, while the Level 2 severity measures (available online at www.psychiatry.org/dsm5) are intended to be used following Level 1 measures “to explore significant responses to the Level 1 screen.”

A severity scale for schizophrenia and the WHO Disability Assessment Schedule, Version 2 (WHODAS 2.0) are included. Used internationally, WHODAS 2.0 assesses functional capacity in 6 domains: understanding and communication, getting around, self-care, getting along with people, activities (household and school/work), and participation in society. Although it is time-intensive, WHODAS 2.0 allows for a standardized tracking method for disability progression or remission.

DSM-5 retains the brief culture-related diagnostic issues within the “Associated Features Supporting Diagnosis” section included in DSM-IV-TR; however, cultural formulation is expanded in Section III, which also includes the cultural formulation interview (CFI). The CFI presents a detailed guide for a culturally informed interview. The “Glossary of Cultural Concepts of Distress” is an additional entry in the Appendix.

Section III also contains proposed disorders for future studies, including an alternative model to diagnose personality disorders. Proposed categories that caused controversy during the development phase were Internet gaming disorder, caffeine use disorder, and suicidal behavior disorder. Other conditions for future studies, such as attenuated psychosis syndrome, depressive episodes with short-duration hypomania, persistent complex bereavement disorder, neurobehavioral disorder associated with prenatal alcohol exposure, and nonsuicidal self-injury, were seen as less problematic.

Key changes in DSM-5

Key changes in DSM-5 include deletion of the multiaxial format along with various degrees of changes within diagnostic categories. The multiaxial format, a conspicuous concept in both DSM-III and DSM-IV, has been deleted from DSM-5 because of limited use by clinicians. Clinical diagnoses—mental disorders, personality disorders, intellectual disability, and other medical conditions formerly listed on Axis I, II, and III in DSM-IV—are now listed together. A select set of the ICD-9-CM V codes and the new ICD-10-CM Z codes are used as a separate notation for psychosocial and contextual factors.

The Global Assessment of Functioning (GAF) scale (Axis V in DSM-IV) was eliminated from DSM-5 because it was deemed an inadequate measure of mental health disability. It was also seen as an insufficient method for assessing determinations of medical necessity for treatment required by managed care organizations or workers’ compensation programs. For clinical use, the WHODAS 2.0 is a more valid and useful instrument to assess disability. In addition to assessing specific areas of functioning, the WHODAS 2.0 provides severity rating on a scale of 1 to 5 that can be used to monitor change over time and to report disability data.

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