DSM-5 ™ in Action: Diagnostic and Treatment Implications Section 2, Chapters 5–13 PART 1 of Section 2 Chapters 1–7 by Sophia F. Dziegielewski, PhD, LCSW © 2014 S. Dziegielewski

After completion of this section, participants will be able to:  Identify the major diagnostic categories and the criteria needed for proper diagnostic assessment.  Utilize the dimensional assessment strategy outlined in DSM-5 for two disorders.  Utilize this information to complete the diagnostic assessment. © 2014 S. Dziegielewski

DSM-5 Chapters20 Disorder Categories (2 additional categories ) Neurodevelopmental DisordersSleep-Wake Disorders Schizophrenia Spectrum and the Other Psychotic Disorders Sexual Dysfunctions Bipolar and the Related DisordersGender Dysphoria Depressive DisordersDisruptive, Impulse Control, and Conduct Disorders Anxiety DisordersSubstance-Related and Addictive Disorders Obsessive-Compulsive and the Related Disorders Neurocognitive Disorders Trauma and Stressor-Related DisordersPersonality Disorders Dissociative DisordersParaphilic Disorders Somatic Symptom and Related DisordersOther Mental Disorders Feeding and Eating DisordersMedication-Induced Movement Disorders and Other Adverse Effects of Medication Elimination DisordersOther Conditions That May Be a Focus of Clinical Attention © 2014 S. Dziegielewski

Schizophrenia Spectrum and Other Psychotic Disorders © 2014 S. Dziegielewski

 This section brings together three sections listed separately in DSM-III-R: Schizophrenia, Delusional Disorder and Psychotic Disorder: Not Elsewhere Classified.  Active phase has been increased from one week to one month. Now also includes two new negative symptoms: alogia (e.g., fluency and productivity of speech) and volition (goal-directed behavior and drive).  DSM-IV-TR subtypes not clearly supported in research. Added concept of SCHIZOPHRENIA SPECTRUM: represents the range of disorders that are more likely to occur in family members of individuals with schizophrenia (Schizoaffective Disorder, Schizotypal Personality Disorder, etc.). © 2014 S. Dziegielewski

 In this condition, individuals suffer from characteristic psychotic symptoms and deterioration in adaptive functioning.  The active phase of the disorder must last at least one month with a time frame of at least six months in duration. © 2014 S. Dziegielewski

 Disorganized Type: marked incoherence, lack of systematized delusions, silly affect  Catatonic Type: stupor, rigidity, bizarre posturing, waxy flexibility, excessive motor activity  Paranoid Type: one or more systemized delusions, or auditory hallucinations with a similar theme  Undifferentiated Type: "garbage can" bits of other types  Residual Type: not currently displaying symptoms displayed in the past © 2014 S. Dziegielewski

 Brief Reactive Psychosis: AKA 3-day schizophrenia. Symptoms have existed no longer than a month, last at least a few hours), sudden onset. No direct link to a severe psychosocial stressor required.  Schizophreniform Disorder: Less than six months.  Schizoaffective Disorder: Mood disorder and schizophrenia. Focuses on an uninterrupted phase of illness rather than a lifetime pattern of symptoms. In this disorder the schizophrenia is described with periods of major depressive, manic or mixed episodes.  Substance Induced Psychotic Disorder: Includes both organic delusional disorder and organic hallucinosis. © 2014 S. Dziegielewski

 Could symptoms be culturally related? Latinos may first confer with indigenous healers, curanderos or espiritistas, or Catholic leaders, or both before discussing mental health symptoms with mental health practitioners. African American— controversy continues about the relevance of culture as related to the diagnosis of schizophrenia. © 2014 S. Dziegielewski

 Belief there is a biological component to schizophrenia when psychotropic medication showed a decrease in symptoms related to the disorder.  Although the exact relationship is unknown a clear connection exists with the neurochemical dopamine. © 2014 S. Dziegielewski

 Genetics may be a necessary, but not a sufficient, cause for schizophrenia.  Schizophrenia spectrum represents the range of mental disorders that are more likely to occur in family members of individuals with schizophrenia such as schizoaffective disorder and schizotypal personality disorder. © 2014 S. Dziegielewski

 Schizophrenia is probably not a single disorder.  Clients do not clearly and concisely fit perfectly into an identified diagnostic category.  Multiple problems require a multifaceted approach to intervention.  Some of these problems can easily overlap with other mental health conditions such as the affective disorders (bipolar and depression) or the dementia- or delirium-based disorders. © 2014 S. Dziegielewski

Criterion A : Must have at least ONE of these THREE symptoms  Delusions  Hallucinations  Disorganized Speech © 2014 S. Dziegielewski

Types of Delusions  Persecutory delusions,  Grandiose delusions,  Erotomania (believes falsely another person loves them),  Bizarre,  Thought withdrawal (thoughts are removed), thought insertion,  Nihilistic (major catastrophe will occur) © 2014 S. Dziegielewski

Disorganized Thinking and Disorganized Behavior:  Derailment or loose associations;  Catatonian © 2014 S. Dziegielewski

Hallucinations:  Auditory,  Visual,  Tactile,  Olfactory,  Gustatory. © 2014 S. Dziegielewski

 Diminished emotional expression  Avolition  Anhedonia (decreased ability to experience pleasure)  Asociality (lack of interest in social interactions)  Alogia © 2014 S. Dziegielewski

Difference between mood and affect:  Mood = the general feeling (e.g., depressed) (climate)  Affect = how you show it (e.g., flat or blunted) (weather) © 2014 S. Dziegielewski

 Clinician-Rated Dimensions of Psychosis Symptom Severity (Included in Section 3, p. 743)  Is the scale for the dimensional assessment and addresses the primary positive and negative symptoms.  This is an eight-item measure that addresses symptom severity over the last seven days and is completed by the clinician. Uses a five-point scale from no symptoms = 0 to severe = 4.  Can be done regularly to measure progress, and clinical judgment guides the decisions. © 2014 S. Dziegielewski

 Schizotypal Personality Disorder;  Delusional Disorder;  Brief Psychotic Disorder;  Schizophreniform Disorder;  Schizophrenia;  Schizoaffective Disorder; Substance/Medication-Induced Psychotic Disorder;  Psychotic Disorder Due to Another Medical Condition. © 2014 S. Dziegielewski

 Catatonia— Catatonia Associated With Another Medical Disorder; Catatonia Due to Another Medical Condition; Unspecified Catatonia;  Other Specified Schizophrenia Spectrum and Other Psychotic Disorder (Replaced Shared Psychotic Disorder);  Unspecified Schizophrenia Spectrum and Other Psychotic Disorder. © 2014 S. Dziegielewski

In Section 3 for further study: Attenuated Psychosis Syndrome ◦ Delusions, hallucinations, and disorganized speech—but not as intense as in a psychotic episode ◦ Occur once per week and appear to worsen ◦ Symptoms cause distress or disability © 2014 S. Dziegielewski

 New Name for this category  Reorganization of the disorders within this category to reflect a gradient of psychopathology, from least to most severe  Minor changes to criteria for schizoaffective disorder © 2014 S. Dziegielewski

 Schizotypal personality disorder listed in schizophrenia spectrum but described in the PD section. © 2014 S. Dziegielewski

 Subtype categories are eliminated  Specifiers will be utilized (e.g., catatonia—marked by motor inability and stupor will be used as a specifier) © 2014 S. Dziegielewski