Most updated dsm
Diagnostic Criteria, Inclusivity, and Racial Equity
- The DSM-5 released updates to its diagnostic and taxonomic criteria in March 2022 as the DSM-5-TR, including the addition of prolonged grief disorder.
- Codes for clinicians have been altered, which may improve the insurance claims process for certain mental health conditions.
- Cultural, racial, and ethnic factors, as well as gender inclusivity, have been intentionally reviewed and updated in the new DSM-5-TR.
As the stigma around mental health continues to fade, the field itself is changing — some might say for the better.
In March 2022, American Psychiatric Association (APA) Publishing released a Text Revision (TR) to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to add clarity around certain mental health conditions and diagnostic criteria and codes.
Highlights in the newly updated DSM-5-TR include the addition of prolonged grief disorder as a condition, as well as symptom codes for suicidal behavior and nonsuicidal self-injury.
The APA also consulted culture and equity professionals to acknowledge the historical role of racial discrimination in clinical diagnoses. Language throughout the DSM-5-TR was updated to promote inclusivity for People of Color and marginalized groups.
The DSM-5-TR has refined some of its diagnostic criteria and codes, which may better inform how mental health professionals work with their clients and how they file claims with insurance companies.
Although the DSM-5-TR cannot fully address the unique experiences and situations of every individual, improved diagnostic criteria may help clinicians identify their clients’ disorders or conditions with more accuracy.
“For the [clients] whose symptoms are not fully represented in the present DSM-5, this is a start to treatment planning and more thoughtfully diagnosing,” said Kendra Kubala, PsyD, a trauma psychologist in Pennsylvania and New York and Psych Central Advisory Board member, in an email.
Prolonged grief disorder
The DSM-5-TR added symptoms associated with prolonged grief disorder to its list of diagnostic criteria.
Now, clinicians can make a formal diagnosis for those who have faced difficulty coping with loss for an extended period of time.
Still, everyone’s grieving process is different, and there’s some controversy among clinicians when it comes to linking a person’s experiences of loss to a mental health disorder.
“I think these [clients] would generally get lumped into adjustment disorders or depression diagnoses,” said Karin Gepp, PsyD, a clinical psychologist in New York and Psych Central Advisory Board member, said in an email.
“But studies have shown that 1 in 10 adults may experience prolonged grief — especially now, with this pandemic having killed so many people suddenly, this is a really important addition,” she said.
Diagnostic criteria
According to the DSM-5-TR, the diagnostic criteria for prolonged grief includes:
- a persistent grief response for a duration of longer than 12 months (6 months for a child)
- symptoms that significantly interrupt a person’s day-to-day functioning
- experiences that can’t be attributed to another condition, such as major depressive disorder (MDD) or post-traumatic stress disorder (PTSD)
Unspecified mood disorder
The DSM-5 removed “unspecified mood disorder” as a diagnosis in its 2013 update, which meant that clinicians had to diagnose their clients with a specific mood disorder instead.
The DSM-5-TR has reverted to the “unspecified” diagnosis to include a range of possible mood disorders, which may help clinicians avoid potential misdiagnoses.
“Unspecified mood disorder has been reinstated to provide diagnosis to someone whose presenting symptoms do not fit neatly under bipolar or depressive disorders,” Kubala said.
According to Gepp, distinguishing between bipolar disorder and depressive disorders takes time. Often, symptoms concurrent with bipolar disorder are not always noticeable at the onset.
“When a patient is misdiagnosed with depression and prescribed an SSRI, this could push that person into a manic episode,” Gepp explained.
According to Gepp, the DSM-5-TR reinstating unspecified mood disorder allows practitioners more time to observe a client’s symptoms to provide a more accurate diagnosis and subsequent prescription.
Nonsuicidal self-harm
The DSM-5-TR has added self-harm without the presence of suicidality to its list of diagnoses.
Because not everyone who has engaged in self-harm may do so with the intent of ending their life, lumping it into suicidality could blur assessments made by clinicians.
“It’s good to differentiate those, as there [are] many people who self-harm without an intention of suicide,” Gepp said. “The intent of the injury is the focus, which makes it easier to track the behaviors for us and assess risk.”
In addition, diagnostic codes for suicidal behavior without the presence of other mental health disorders have been included in the new updates.
The DSM-5-TR includes changes to its language around gender and gender identity to help reduce stigma by clarifying that these aspects of a person are not selected by choice.
This includes the more accurate and inclusive changes of:
- “desired gender” to “experienced gender”
- “cross-sex medical procedure” to “gender-affirming medical procedure”
- “natal male/native female” to “individual assigned male/female at birth”
Roberto Lewis-Fernandez, MD, a professor of clinical psychiatry at Columbia University and chair of the DSM-5-TR Cross-Cutting Culture Review Group, told Psych Central that reviewing the DSM through a lens of equity and inclusion and making appropriate changes were high on the committees’ priority list.
Debra Rose Wilson, PhD, MSN, RN, a professor, holistic healthcare practitioner, and Psych Central Advisory Board member, said the addition of racial and cultural perspectives in the DSM-5-TR is beneficial.
“If we’re going to be talking about this, then we should talk about social norms and cultural norms and how they’re going to be different depending on race and where you live, and I think that’s worth identifying,” Wilson said by phone.
According to Lewis-Fernandez, future iterations of the DSM-5 will likely incorporate further changes, specifically around how social, sociocultural, and genetic disorder causations intersect, all with the goal of enabling clients to be seen within a more holistic framing.
“The role of social determinants of mental health has been increasingly recognized in recent years,” he said. “DSM-5-TR started to incorporate this information but there is still more that needs to be done in this area.”
The DSM-5-TR’s acknowledgment of how race and discrimination have historically impacted mental health care is a step forward in creating more safe and inclusive environments for People of Color and marginalized groups.
But barriers to quality mental health care still exist, such as cost factors, health insurance, and enough access to culturally competent counselors and therapists.
According to Kubala, the varied opinions and shifting cultural dynamics within the mental health field speak to the necessity of ongoing updates to the DSM. As research in the field continues to evolve, so will the manual.
“It’s always beneficial to have an open dialogue between [clients], providers, and the public regarding mental illness, and ways in which the field is continually evolving in an effort to provide the most comprehensive, sensitive, research-based, compassionate, appropriate treatment,” Kubala said.
Diagnostic Criteria, Inclusivity, and Racial Equity
- The DSM-5 released updates to its diagnostic and taxonomic criteria in March 2022 as the DSM-5-TR, including the addition of prolonged grief disorder.
- Codes for clinicians have been altered, which may improve the insurance claims process for certain mental health conditions.
- Cultural, racial, and ethnic factors, as well as gender inclusivity, have been intentionally reviewed and updated in the new DSM-5-TR.
As the stigma around mental health continues to fade, the field itself is changing — some might say for the better.
In March 2022, American Psychiatric Association (APA) Publishing released a Text Revision (TR) to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to add clarity around certain mental health conditions and diagnostic criteria and codes.
Highlights in the newly updated DSM-5-TR include the addition of prolonged grief disorder as a condition, as well as symptom codes for suicidal behavior and nonsuicidal self-injury.
The APA also consulted culture and equity professionals to acknowledge the historical role of racial discrimination in clinical diagnoses. Language throughout the DSM-5-TR was updated to promote inclusivity for People of Color and marginalized groups.
The DSM-5-TR has refined some of its diagnostic criteria and codes, which may better inform how mental health professionals work with their clients and how they file claims with insurance companies.
Although the DSM-5-TR cannot fully address the unique experiences and situations of every individual, improved diagnostic criteria may help clinicians identify their clients’ disorders or conditions with more accuracy.
“For the [clients] whose symptoms are not fully represented in the present DSM-5, this is a start to treatment planning and more thoughtfully diagnosing,” said Kendra Kubala, PsyD, a trauma psychologist in Pennsylvania and New York and Psych Central Advisory Board member, in an email.
Prolonged grief disorder
The DSM-5-TR added symptoms associated with prolonged grief disorder to its list of diagnostic criteria. Now, clinicians can make a formal diagnosis for those who have faced difficulty coping with loss for an extended period of time.
Still, everyone’s grieving process is different, and there’s some controversy among clinicians when it comes to linking a person’s experiences of loss to a mental health disorder.
“I think these [clients] would generally get lumped into adjustment disorders or depression diagnoses,” said Karin Gepp, PsyD, a clinical psychologist in New York and Psych Central Advisory Board member, said in an email.
“But studies have shown that 1 in 10 adults may experience prolonged grief — especially now, with this pandemic having killed so many people suddenly, this is a really important addition,” she said.
Diagnostic criteria
According to the DSM-5-TR, the diagnostic criteria for prolonged grief includes:
- a persistent grief response for a duration of longer than 12 months (6 months for a child)
- symptoms that significantly interrupt a person’s day-to-day functioning
- experiences that can’t be attributed to another condition, such as major depressive disorder (MDD) or post-traumatic stress disorder (PTSD)
Unspecified mood disorder
The DSM-5 removed “unspecified mood disorder” as a diagnosis in its 2013 update, which meant that clinicians had to diagnose their clients with a specific mood disorder instead.
The DSM-5-TR has reverted to the “unspecified” diagnosis to include a range of possible mood disorders, which may help clinicians avoid potential misdiagnoses.
“Unspecified mood disorder has been reinstated to provide diagnosis to someone whose presenting symptoms do not fit neatly under bipolar or depressive disorders,” Kubala said.
According to Gepp, distinguishing between bipolar disorder and depressive disorders takes time. Often, symptoms concurrent with bipolar disorder are not always noticeable at the onset.
“When a patient is misdiagnosed with depression and prescribed an SSRI, this could push that person into a manic episode,” Gepp explained.
According to Gepp, the DSM-5-TR reinstating unspecified mood disorder allows practitioners more time to observe a client’s symptoms to provide a more accurate diagnosis and subsequent prescription.
Nonsuicidal self-harm
The DSM-5-TR has added self-harm without the presence of suicidality to its list of diagnoses.
Because not everyone who has engaged in self-harm may do so with the intent of ending their life, lumping it into suicidality could blur assessments made by clinicians.
“It’s good to differentiate those, as there [are] many people who self-harm without an intention of suicide,” Gepp said. “The intent of the injury is the focus, which makes it easier to track the behaviors for us and assess risk.”
In addition, diagnostic codes for suicidal behavior without the presence of other mental health disorders have been included in the new updates.
The DSM-5-TR includes changes to its language around gender and gender identity to help reduce stigma by clarifying that these aspects of a person are not selected by choice.
This includes the more accurate and inclusive changes of:
- “desired gender” to “experienced gender”
- “cross-sex medical procedure” to “gender-affirming medical procedure”
- “natal male/native female” to “individual assigned male/female at birth”
Roberto Lewis-Fernandez, MD, a professor of clinical psychiatry at Columbia University and chair of the DSM-5-TR Cross-Cutting Culture Review Group, told Psych Central that reviewing the DSM through a lens of equity and inclusion and making appropriate changes were high on the committees’ priority list.
Debra Rose Wilson, PhD, MSN, RN, a professor, holistic healthcare practitioner, and Psych Central Advisory Board member, said the addition of racial and cultural perspectives in the DSM-5-TR is beneficial.
“If we’re going to be talking about this, then we should talk about social norms and cultural norms and how they’re going to be different depending on race and where you live, and I think that’s worth identifying,” Wilson said by phone.
According to Lewis-Fernandez, future iterations of the DSM-5 will likely incorporate further changes, specifically around how social, sociocultural, and genetic disorder causations intersect, all with the goal of enabling clients to be seen within a more holistic framing.
“The role of social determinants of mental health has been increasingly recognized in recent years,” he said. “DSM-5-TR started to incorporate this information but there is still more that needs to be done in this area.”
The DSM-5-TR’s acknowledgment of how race and discrimination have historically impacted mental health care is a step forward in creating more safe and inclusive environments for People of Color and marginalized groups.
But barriers to quality mental health care still exist, such as cost factors, health insurance, and enough access to culturally competent counselors and therapists.
According to Kubala, the varied opinions and shifting cultural dynamics within the mental health field speak to the necessity of ongoing updates to the DSM. As research in the field continues to evolve, so will the manual.
“It’s always beneficial to have an open dialogue between [clients], providers, and the public regarding mental illness, and ways in which the field is continually evolving in an effort to provide the most comprehensive, sensitive, research-based, compassionate, appropriate treatment,” Kubala said.
Autism Diagnosis – nakedheart.online
ASD Diagnostic Tools
Currently, there are no medical tests that confirm or refute the presence of autism in a child. Diagnostics is carried out in the form of interviews with parents and other people involved in child care. His behavior is being monitored.
Structured diagnostic tests are used to evaluate behavior.
The most common screening in Russia is M-CHAT-R (The Modified Checklist for Autism in Toddlers, Revised) - a modified version of the autism screening questionnaire. It consists of 20 questions that parents need to answer and allows you to determine the possible risk of autism in a child aged 1.5–2.5 years. The test questions take a few minutes to answer. nine0005
A more complex tool is CARS (Childhood Autism Rating Scale) - a rating scale for autism in a child. Typically, CARS is used by a specialist in combination with clinical observation, interaction with the child, and a structured interview with caring adults. In Russia, the translation of the previous version of CARS, available on the Internet, is widely used. This scale applies to children aged two to four years. An updated and improved version is available in English - CARS2. It has two versions: CARS2-ST for children under six years old and CARS2-HF for children over six years old with higher communication skills.
The tool helps to assess the severity of impairments in different areas of a child's development and draw a conclusion about whether we really observe signs of ASD in a particular child. It should be noted that CARS is not a diagnostic tool either. nine0005
ADOS and ADI-R are the most reliable diagnostic tools for ASD and are often used together. These scales are available in Russian. They are used by professionals for evaluation and diagnosis.
Criteria for diagnosing ASD
Turning to a specialist for a diagnosis, you must first make sure that he owns the modern diagnostic tools listed above. In our country, for the official statement of any diagnosis, ICD-10 is used - the International Classification of Diseases of the 10th revision. Its criteria and descriptive base also make it possible to diagnose ASD. Using all of the above tools makes this task easier, and the diagnosis more accurate and reliable. nine0005
Parents have the right to insist on a correct diagnosis.
If the conclusion obtained is in doubt, it is necessary to seek the opinions of other specialists with sufficient clinical experience and professional qualifications for this.
Currently, the current criteria for diagnosing ASD are based on the DSM-5 classification. It is the most up-to-date guide for diagnosing autism among professionals around the world. These criteria will also be reflected in ICD-11 when it enters into force in 2022. nine0005
DSM-5 provides the most up-to-date and comprehensive toolkit for understanding a child with autism's behavior, symptoms, and basic levels of severity for autism spectrum disorders.
In DSM-5, all components of autism spectrum disorders are divided into two main sections ("autism dyad"): (A) lack of social communication and social interaction and (B) limited, repetitive patterns of behavior, interests or activities.
The first part of the RAS (A) dyad consists of the following subsections:
- A1 - problems initiating and maintaining social interaction
- A2 - problems with non-verbal communication
- A3 - problems understanding social situations and social relationships
The second part of the RAS dyad (B) consists of the following subsections:
- B1 - atypical speech, movement and play
- B2 - rituals and resistance to change
- B3 - over-obsession with objects or interests
- B4 - atypical sensory behavior
At the same time, the diagnosis of "autism spectrum disorder" should be made only in cases where the manifestations of the "dyad of autism" affect daily behavior: if it is difficult for a person to interact with relatives, peers and other people, to develop skills, including speech, to be flexible and switch from one task to another.
If there are no difficulties in everyday life, then there is no violation. The point of making a diagnosis should not be to put a "label" on a person, but to help him cope with the difficulties caused by the violation, help him realize his potential and live in society together with other people. nine0005
Associated problems
Most often, autism manifests itself in the form of difficulties with social communication and limited repetitive behavior. But, in addition to this, the child may have poorly developed speech and other cognitive impairments may be observed. Also, the main symptoms can be accompanied by completely different health problems. They make diagnosing autism even more difficult. For example, autism is often associated with disorders such as epilepsy, genetic syndromes, gastrointestinal disorders, ADHD. That is, they coexist side by side, but do not cause each other (in the scientific literature, this is called comorbidity). nine0005
Another important aspect is that behavioral disorders, manifestations of aggression, self-aggression and other forms of unwanted behavior are not related to the diagnostic criteria for ASD.
In most cases, these manifestations are due to the insufficient development of the child's communication, as well as the peculiarities of his environment. Understanding children's communication needs and an appropriate program of assistance can help reduce problem behaviors and develop academic and social skills in a less restrictive environment. nine0053
Synology Announces the Official Release of DiskStation Manager 4.1 / Sudo Null IT News
Synology has released the final version of DiskStation Manager (DSM) 4.1. In just 50 days, the DSM beta has received over 80,000 downloads, making it Synology's most successful operating system to date.
DiskStation Manager 4.1 offers:
- Virtualization support: DSM 4.1 supports VMware vSphere 5 VAAI (vStorage API for Array Integration). VAAI support includes hardware locking (ATS), block zeroing and full copy. DiskStation or RackStation improves the performance of ESXi servers and optimizes the use of storage resources, providing more efficient virtualization capabilities.
nine0028 - Business Applications: Updated Syslog server provides a quick view of the activity log, has a rich notification service, and a customizable log archive, which makes it easier to manage logs on the network (for IT professionals). The Cloud Station application service offers users an easy way to automatically synchronize files up to 5GB in size, with the ability to split them into two folders at the same time. In accordance with IT policies, this application supports HTTPS tunneling and proxy to establish a secure connection. The updated mail server is designed with an intuitive interface that allows users to instantly view email and access data. The new development also provides SMTP/SMTPS network protocols, email address aliases, multi-domain support, a spam filter, and an autoresponder. nine0028
- Robust File Sharing Solution: DSM 4.1 features improved data consolidation capabilities, allowing users to synchronize shared folders across multiple DiskStation and RackStation.
File sharing becomes not only more efficient with FXP support, but also more secure with SFTP support in line with enterprise security standards. In addition, DSM 4.1 allows you to control the number of user connections and speed, which limits the maximum allowed bandwidth load, ensuring quality of service. nine0028 - Rich multimedia features. The latest Video Station features a user-friendly and modern interface that automatically collects and provides information about all video files, providing a convenient way to organize collections. With an external USB DTV tuner, you can watch live TV programs or set up a convenient recording scheme yourself. . Photo Station allows you to view photos not only in chronological order, but also provides geographic location data. Audio Station, thanks to the updated stylish interface, allows each user to create a personal audio library, and when listening, it displays the text of the composition with the current line highlighted on the screen. Even in the absence of an Internet connection, iOS users can enjoy their favorite music stored in the cache.
