Escolar Documentos
Profissional Documentos
Cultura Documentos
Christopher K. Varley, MD
Disclosure to Audience
No one involved in the planning or presentation of this activity has any relevant financial relationships
with a commercial interest to disclose
DSM-5 Revisions
DSM-IVs organizational structure failed to
reflect shared features or symptoms of
related disorders and diagnostic groups (like
psychotic disorders with bipolar disorders, or
internalizing (depressive, anxiety, somatic)
and externalizing (impulse control, conduct,
substance use) disorders.
DSM-5 restructuring better reflects these
interrelationships, within and across
diagnostic chapters
DSM-5 Revisions
DSM-IV does not adequately address the
lifespan perspective, including variations of
symptom presentations across the
developmental trajectory, or cultural perspectives
DSM-5s chapter structure, criteria revisions, and
text outline actively address age and
development as part of diagnosis and
classification
Culture is similarly discussed more explicitly to
bring greater attention to cultural variations in
symptom presentations
DSM-5 Revisions
DSM-5 represents an opportunity to better
integrate neuroscience and the wealth of
findings from neuroimaging, genetics,
cognitive research, and the like, that have
emerged over the past several decades all
of which are vital to diagnosis and treatment
development
DSM-5 Revisions
The multiaxial system in DSM-IV is not required
to make a mental disorder diagnosis and has not
been universally used
DSM-5 has moved to a nonaxial documentation
of diagnosis (formerly Axes I, II, and III), with
separate notations for important psychosocial
and contextual factors (formerly Axis IV) and
disability (formerly Axis V)
This approach is consistent with established
WHO and ICD guidance to consider the
individuals functional status separately from his
or her diagnoses or symptom status
Clustering of Chapters
Neurodevelopmental Disorders
Emotional (Internalizing) Disorders
Somatic Disorders
Externalizing Disorders
Neurocognitive Disorders
Personality Disorders
DSM-5 Chapters
Neurodevelopmental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive and Related Disorders
Trauma-and Stressor-Related Disorders
Dissociative Disorders
Somatic Symptom Disorders
Feeding and Eating Disorders
Changes in Terminology
Not Otherwise Specified (NOS) has been used as a
catch-all for patients who didnt fit into the more specific
categories. NOS language is eliminated in DSM-5.
There will now be an option for designating Not
Elsewhere Classified (NEC) which will typically include a
list of specifiers as to why the patients clinical condition
doesnt meet a more specific disorder.
The phrase general medical condition is replaced in
DSM-5 with another medical condition where relevant
across all disorders.
These classification changes will help providers with the
transition to ICD-10 in October 2014. DSM-5 includes
the ICD-10 diagnoses in parentheses.
DSM-5:
Autistic Disorder
Aspergers Disorder
PDD-NOS
CDD
3 become 2
Impairment in Social Interaction
Deficits in social communication
and social interaction
Qualitative impairment in
communication
3.
Highly restricted, fixated interests that are abnormal in intensity or focus
(e.g., strong attachment to or preoccupation with unusual objects, excessively
circumscribed or perseverative interests).
4.
Hyper- or hypo-reactivity to sensory input or unusual interest in sensory
aspects of the environment (e.g., apparent indifference to pain/temperature,
adverse response to specific sounds or textures, excessive smelling or
touching of objects, visual fascination with lights or movement).
Severity
Level
Social Communication
Level 3
Level 2
Level 1
Requiring support
Highlights: Catatonia
In DSM-5, all contexts require three catatonic symptoms
(from a total of 12 characteristic symptoms).
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
an other specified diagnosis.
Neurodevelopmental Disorders
Intellectual Disabilities
DSM 5 Code
319
(no longer
use 317,
318)
315.8
319
315.8
319
319
Communication Disorders
DSM 5 Code
315.39
Language Disorder
315.39
315.39
315.39
315.35
315.39
307.9
315.35
315.39
307.9
299.00 (no
longer use
299.80)
299.00
Attention-Deficit/Hyperactivity Disorders
DSM 5 Code
314.01
314.00
314.01
314.01
314.01
315.00
315.2
315.1
315.00
315.2
315.1
Motor Disorders
DSM 5 Code
315.4
315.4
307.3
Developmental Coordination
Disorder
Stereotypic Movement Disorder
307.23
Tourettes Disorder
307.23
307.22
307.22
307.21
307.21
307.20
307.20
307.20
307.20
307.3
315.8
Other Specified
Neurodevelopmental Disorder
Unspecified Neurodevelopmental
Disorder
315.8
315.9
315.9
ICD 9 Code
301.22
301.22
297.1
298.8
298.8
295.40
Schizophreniform Disorder
295.40
295.90
Schizophrenia
295.90
295.70
295.70
298.8
298.9
Unspecified Psychosis
293.81
293.82
293.89
293.89
781.99 +
293.89
298.8
298.9
297.1
293.81
293.82
293.89
293.89
781.99 +
293.89
ICD 9 Code
296.XX
(range
from
296.41 to
296.56)
296.89
Bipolar I Disorder
-see DSM 5 for specifiers for
severity, manic or depressed,
psychotic features, and
remission status
Bipolar II Disorder
296.XX
301.13
Cyclothymic Disorder
301.13
293.83
293.83
296.89
296.89
296.80
296.89
296.80
Depressive Disorders
DSM 5 Code
ICD 9 Code
296.99
296.99
296.21296.26
300.4
625.4
293.83
311
311
296.21296.26
300.4
NOT IN
CIS
293.83
311
311
Dysthymic Disorder
NOT IN CIS
Anxiety Disorders
DSM 5 Code
ICD 9 Code
309.21
309.21
313.23
Selective Mutism
313.23
300.29
300.29
300.01
Specific Phobia
-specify in note the phobic
stimulus
Social Anxiety Disorder (Social
Phobia)
Panic Disorder
300.22
Agoraphobia
300.22
300.02
300.02
293.84
300.09
300.0
300.23
300.23
300.01
300.00
ICD 9 Code
300.3
Obsessive-Compulsive Disorder
300.3
300.7
300.7
300.3
Hoarding Disorder
300.3
312.39
Trichotillomania (Hair-Pulling
Disorder)
Excoriation (Skin-Picking)
Disorder
Obsessive-Compulsive and
Related Disorder Due to Another
Medical Condition
Other Specified ObsessiveCompulsive and Related Disorder
Unspecified ObsessiveCompulsive and Related Disorder
312.39
698.4
294.8
300.3
300.3
Obsessive-Compulsive Disorders
698.4
Excoriation, neurotic
294.8
300.3
300.3
Obsessive-Compulsive Disorders
ICD 9 Code
313.89
313.89
313.89
313.89
309.81
309.81
308.3
308.3
309.0
309.9
309.89
Adjustment Disorders
309.0
309.9
309.89
309.9
309.9
Dissociative Disorders
DSM 5 Code
ICD 9 Code
300.14
300.14
300.12
Dissociative Amnesia
300.12
300.6
Depersonalization/Derealization
Disorder
Other Specified Dissociative
Disorder
Unspecified Dissociative
Disorder
300.6
300.15
300.15
300.15
300.15
ICD 9 Code
300.82
300.82
Somatoform Disorder
300.7
300.7
Hypochondriasis
300.11
316
300.19
300.89
300.82
300.89
300.82
Undifferentiated Somatoform
Disorder
ICD 9 Code
307.52
Pica
307.52
307.53
Rumination Disorder
307.53
307.59
307.1
307.51
Bulimia Nervosa
307.51
307.51
307.51
Compulsive overeating
307.59
307.59
307.50
307.50
Elimination Disorders
DSM 5 Code
ICD 9 Code
307.6
Enuresis
307.6
307.7
Encopresis
307.7
788.39
787.60
788.30
787.60
788.39
787.60
788.30
787.60
Incontinence of Urine
Incontinence of Feces
Gender Dysphoria
DSM 5 Code
ICD 9 Code
302.6
302.85
Gender Dysphoria
-in children
-in adolescents and adults
302.6
302.85
302.6
302.6
302.6
302.6
ICD 9 Code
313.81
313.81
312.34
312.34
312.81
312.82
312.89
301.7
Conduct Disorder
-Childhood-onset
-Adolescent onset
-Unspecified onset
Antisocial Personality Disorder
312.81
312.82
312.89
301.7
312.33
Pyromania
312.33
312.32
Kleptomania
312.32
312.89
312.9
305.00
303.90
291.9
305.00
303.90
291.9
Alcohol Abuse
Alcohol Dependence
Alcohol Related Disease or
Syndrome
Cannabis-Related Disorders
DSM 5 Code
305.20
304.30
292.9
305.20
304.30
292.9
Cannabis Abuse
Cannabis Dependence
Cannabis Related Disorder
Cannabis-Related Disorders
DSM 5 Code
319
(no longer
use 317,
318)
315.8
319
ICD 9
Code
319
315.8
319
305.90
304.90
292.9
ICD 9
Code
305.90
304.90
292.9
SUMMARY
-Approach at Seattle Childrens Hospital
DSM 5 is now in effect and new criteria should be used
in clinical practice. Desk reference manuals have been
ordered for all outpatient psychiatry providers.
We will no longer use the Multi-axial diagnosis. This
language will be removed from 3M Templates and
providers who dictate should stop using this format.
Insurance companies and other payers may take
several months to get caught up to changes. Only use
old terminology if required by a payor.
Use the DSM 5 ICD 9 code crosswalk to help with
correct coding in CIS for fee sheets.
Use diagnostic checklists to help with fidelity during the
diagnostic process.
Date: 08/21/2013
Starting Time: 12:00 pm
Topic: Overview of the DSM 5 Changes
Presenter(s): Christopher K. Varley, MD University of WA School of Medicine
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Based on this activity, what will you do differently in your practice? _______________________________________
Topics of Interest for future Seminars: _______________________________________________________________
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