1. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-IV-TR) (DSM-V coming this May)

2. What do we use it for?  Education  Diagnosis  Treatment Planning

3. Multiaxial Reporting  Assessment that focuses on several domains that may help a clinician plan treatment and predict outcomes.  Provides a convenient format for organizing and communicating clinical information.  5 Axis areas…

4. Axis I Clinical Disorders & Other Conditions That May Be a Focus of Clinical Attention  Examples…  Substance-Related Disorders  Mood Disorders  Anxiety Disorders  Schizophrenia and Other Psychotic Disorders  Eating Disorders

5. Axis II Personality Disorders & Mental Retardation  Examples…  Paranoid Personality Disorder  Borderline Personality Disorder  Obsessive-Compulsive Personality Disorder  Mental Retardation

6. Axis III General Medical Conditions  Examples…  Infections & Parasitic Diseases  Immunity Disorders  Diseases of the Respiratory System  Injury and Poisoning

7. Axis IV *Used to report problems that may affect the diagnosis, treatment, and prognosis of mental disorders. Psychosocial and Environmental Problems *These problems can develop as a consequence of a diagnosis *May be problems that should be considered in treatment plan  Problems with primary support group Death of a family member Disruption of family by divorce, estrangement Parental overprotection Birth of a sibling

8. Axis IV, cont.  Educational problems Illiteracy Academic problems  Economic problems Extreme Poverty  Professional/Job problems Unemployment Stressful work schedule

9. Axis V Global Assessment of Functioning *Used to report clinician’s judgment of an individual’s level of functioning *Useful in planning treatment, measuring its impact, and predicting outcome GAS Scale

10. Example Multiaxial Report  Axis I:296.4 Bipolar 1 Disorder, Mixed, Severe with Psychotic Features 314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type  Axis II:799.9 Diagnosis Deferred (pending gathering of info)  Axis III:343.9 Palsy, cerebral  Axis IV:Psycho-social stressors, early childhood abuse and neglect, academic difficulties  Axis V:70

11. Diagnostic Criteria  There are 2 areas of diagnostic criteria that must be met for each diagnosis in the DSM  Inclusion Criteria “Must-have” symptoms Length of time symptoms exhibited  Exclusion Criteria “Cannot-have” symptoms or related diagnoses

12. Example Diagnostic Criteria  307.42 Primary Insomnia Criterion A (inclusion):  Nonrestorative sleep that lasts for at least 1 month Criterion B (inclusion):  Causes clinically significant distress or impairment in social, occupational, or other important ares of functioning Criteria C & D (exclusion):  Does not occur exclusively during the course of another sleep disorder (C) or mental disorder (D) Criterion E (exclusion):  Is not due to the direct physiological effects of a substance or a general medical condition