Posted: March 8th, 2023
After studying Module 2: Lecture Materials & Resources, (SEE ATTACHED) submit one QUESTION for the week.
Instructions
REQUIREMENTS:
at least 500 words ( 2 pages of content) formatted and cited in current APA style 7 ed with support from at least 3 academic sources which need to be journal articles or books from 2019 up to now. NO WEBSITES allowed for reference entry. Include doi, page numbers, etc. Plagiarism must be less than 10%
EVOLUTION OF THE DIAGNOSTIC STATISTICAL MANUAL OF MENTAL ILLNESS (DSM)
NUR 620: Psychiatric Management I
History of the DSM
Prior to 1980, diagnoses were made based on biological or psychoanalytic theory
Introduction of DSM-III in 1980 revolutionized classification
Classification newly relied on specific lists of symptoms, improving reliability and validity
Diagnoses classified along five “Axes” describing types of problems (e.g. disorder categories, health problems, life stressors)
DSM-IV introduced in 1994
Eliminated previous distinction between psychological vs. organic mental disorders
Reflected appreciation that all disorders are influenced by both psychological and biological factors
DSM-IV-TR (“text revision” of DSM-IV) incorporated new research and slightly altered criteria accordingly
Previously, psychopathology was categorized along five axes. Axis I = Clinical syndromes (most psychological disorders). Axis II = personality disorders and mental retardation (more pervasive), Axis III = relevant medical conditions. Axis IV = Relevant life stressors. Axis V = Global assessment of functioning (0-100 rating). DSM-5 no longer uses the axis system. This information is still taken into account by clinicians, but it’s not discussed in terms of axes.
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The DSM-5
Basic characteristics
Removed axial system
Clear inclusion and exclusion criteria for disorders
Disorders are categorized under broad headings
Empirically-grounded, prototypic approach to classification
New disorder labels are created when groups of individuals are identified whose symptoms are not adequately explained by existing labels
Example: Premenstrual dysphoric disorder
New disorder in DSM-5
Relatively rare and severe emotional disturbance present during the majority of premenstrual phases
Example of new disorder that did not make it into the DSM-5: Mixed anxiety-depression
Insufficient research to justify the creation
DSM-5 represented some changes to classification. One major change is that the Axis system used in DSM-IV-TR was eliminated. NOTE: PMDD is not the same as the colloquial term “PMS”; rather, it is much more persistent, severe and interfering.
For a detailed outline of all changes in DSM-5, see Boettcher et al. 2013 – A Student’s Guide to Important Changes in DSM-5, part of the instructor resources for Barlow/Durand Abnormal Psychology and Durand/Barlow Essentials of Abnormal Psychology.
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Issues with Classifying and Diagnosing Psychological Disorders
Widely used classification systems
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Updated every 10 to 20 years
Current edition (released May 2013): DSM-5
Previous edition called DSM-IV-TR
ICD-10
International Classification of Diseases (ICD-10)
Published by the World Health Organization (WHO)
Unresolved Issues in DSM-5
The problem of comorbidity
Defined as two or more disorders for the same person
High comorbidity is extremely common
Emphasizes reliability, maybe at the expense of validity (i.e., may artificially “split” diagnoses that are very similar)
Dimensional classification:
DSM was intended to move toward a more dimensional approach, but critics say it does not improve much from DSM-IV
Labeling issues and stigmatization
Some labels have negative connotations and may make patients less likely to seek treatment
Discussion Tip: Have students discuss how these problems have changed over time and across diagnoses. Are there differences within this culture in terms of demographic factors (i.e., SES, ethnicity, geography, age)?
THE PSYCHIATRIC INTERVIEW
NUR 620| Psychiatric Management I| Module 2
NOTE:
To change the image on this slide, select the picture and delete it. Then click the Pictures icon in the placeholder to insert your own image.
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Preparing For the Interview
NUR 448
Meet with patients during a consistent time of day, week
Make you space comfortable for you and the patient
Arrange your chair so you can see the clock
Align your chair higher than the patient’s
Signs of an engaged interviewer:
Relaxed
Unhurried
Good eye contact,
Alert to verbal and non-verbal cues
Chief Complaint
What brought the patient in (Why now)? Patient’s own words
OLDCARTS
Onset
Location
Duration
Character
Aggravating Factors
Relieving Factors
Timing Severity
Is there an emergency that should be addressed immediately?
Physical aggression
Self harm or suicide attempt
Alcohol or benzodiazepine withdrawal
Failure to eat or sleep deprivation
Social Versus Therapeutic Communication
Social
Disclosure can be equal
Spontaneous
Meets personal needs of both
Confidentiality might or might not be observed.
Listener could be biased
Therapeutic
Patient-centered
Planned
Directed by professional
Meets patient’s needs
Guides the patient to explore personal issues
Listener objective
Information shared with health team
Techniques
Therapeutic Techniques
Offering self
Active listening
Silence
Empathy
Questioning
SOLUTION
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a widely used tool for the classification and diagnosis of mental illnesses. It has undergone several revisions since its inception in 1952, reflecting changes in diagnostic criteria and understanding of mental illness. The purpose of this paper is to discuss the evolution of the DSM and the impact it has had on the field of psychiatry.
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