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09.06.2014

Major depressive disorder dsm code, definition of major depression in dsm iv - Within Minutes

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Since the classic descriptions, depression has been conceived as an episodic and recurrent illness. This article provides an update on the diagnosis, causation, and treatment of chronic depressive problems, with a focus on the recently introduced diagnostic category of persistent depressive disorder (PDD).
In DSM-III and DSM-IV, the protracted forms of depression have been conceptualized as dysthymia and by the chronic specifier of major depressive episodes. In DSM-III and DSM-IV, dysthymia was trumped by MDD and was only diagnosed if the threshold for a major depressive episode was not met in the initial 2 years of symptoms. While the merger of dysthymia and chronic depression into PDD is well justified by their strong sequential comorbidity and similar implications for prognosis and treatment, several aspects of the new diagnosis are not well supported by evidence and may not be useful.
The assumption that most individuals with chronic depression also fulfill the dysthymia criteria may not hold consistently enough—it creates a group of individuals who suffer from chronic depression but do not receive the PDD diagnosis.
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. Insurance companies are currently revising their reporting and billing procedures to address the changes detailed in DSM-5. Although DSM is not a guideline for medication therapy, the diagnostic clarity that characterizes DSM-5 may influence prescribing trends. Depressive episodes with clear onset and offset and sharp contrast with one’s usual mood and behaviors are perhaps the most conspicuous feature of severe mood disorders.
Major depressive episodes could be specified as chronic if the full criteria were continuously met for 2 years or longer.
This new division of depressive disorders gives more weight to duration than to severity of symptoms. 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. See TABLE 1 for a summary of major changes and their potential impact on medication management. Pharmacists should not only be familiar with the DSM-5 changes, but also review general treatment guidelines for the major mental health conditions. The symptomatic criteria for dysthymia differed in part from those for major depressive episode, with an emphasis on low self-esteem and hopelessness (Table 1). DSM-5 defines PDD on the basis of the set of symptoms for dysthymia, with the assumption that most individuals who meet the full symptoms for MDD also meet criteria for dysthymia. 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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