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05.05.2015

Depressive disorder nos dsm 5, can chronic insomnia cause depression - Review

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Despite the numerous changes, clinicians will not find DSM-5 to be unfamiliar because the new manual is another revision of recent DSMs.
Psychiatric Times readers have been thoroughly informed by the series of blogs by Allen Frances, MD, concerning the potential dangers that some of the new disorders introduced in DSM-5 may pose. Most of the new disorders are not controversial: DSM-IV-TR not otherwise specified entities have been replaced with the less confusing “other disorder” and “unspecified disorder” entities.
Another group of new disorders, also not controversial, are the 10 “mild” forms of each of the “neurocognitive disorders” (the new term for what was previously dementia). There was a concerted effort to simplify DSM by combining disorders when nothing was clinically lost by such a combination. The reason for the use of identical numbers for multiple entities is that DSM-5 must use only those codes already listed in ICD 9-CM and could not add new numbers.


While some contributors suggested a “paradigm shift” during the development of DSM-5, by the time of its completion on December 2, 2012, the final product retained the style of the last 3 DSMs. Table 1 lists some of the changes from DSM-IV-TR to DSM-5, Table 2 lists the new disorders, Table 3 lists the DSM-IV-TR disorders that have been combined in DSM-5, and Table 4 lists nomenclature changes. With the release of DSM-5 in May, we should begin to find out whether the dire predictions about those disorders are correct. These changes should help focus psychiatry on prevention by providing a name and a code that clinicians can use in the early stages of a neurocognitive disorder. Changing to the combined diagnosis should go smoothly and be easy to explain to patients; however, if problems occur, the clinician may continue using DSM-IV-TR terminology and code. As a result, for example, 292.89 is the number used to code for 31 different DSM-5 substance-related disorders.


In addition, there are about 464 differences between DSMIV and DSM-5 criteria-sets; the vast majority are very minor (eg, the word “individual” has been substituted for “person”).
Section III also includes conditions in need of further research, such as “Internet gaming disorder.” Unlike “other disorder,” “unspecified disorder” is used in cases that do not meet any specific syndrome.
The title and criteria set are completely unchanged in only 10 DSM-IV-TR disorders: conduct disorder, kleptomania, pyromania, and 7 personality disorders—antisocial, avoidant, borderline, dependent, histrionic, narcissistic, and obsessive-compulsive.



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