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Co-occurring Personality and Substance Use Disorders
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Personality disorders (PDs) have been conceptualized in varying ways throughout the twentieth century. The mental health community has identified PDs as primarily treatable disorders in the DSM-5 (APA, 2013). The previous version of the DSM placed PDs on the Axis II level, indicating a difference between PDs and other mental health diagnoses (APA, 2000). This distinction of Axis II diagnoses indicates disorders that are usually observable in childhood and have ongoing impact throughout the span of the individual’s life. More traditional mental health disorders such as bipolar disorder, anxiety disorder, and substance use disorders were placed on Axis I, indicating the need for treatment of a primary mental health condition, usually with an onset of early adulthood. Additional axes were provided in the DSM-IV, such as Axis III, indicating pertinent patient medical information; Axis IV, identifying environmental and psychosocial factors; and Axis V, giving an individual a score between 1 and 100, indicating the client’s overall level of functioning. Oftentimes, insurance carriers would not reimburse for treatment of Axis II disorders, despite the severity of symptoms experienced by the client (Doweiko, 2009). While clinicians during this time were able to recognize the need for treatment of personality disorders, the lack of reimbursement served to slow the development of evidence-based practices for these disorders.
Psychiatry
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Without utilizing a mutually agreed classification system, each psychiatrist would employ their own idiosyncratic classification. This would make it impossible to communicate, render research impossible, and every clinician would have to write their own textbook! For legal purposes, requiring each expert to employ the same set of diagnostic rules allows for a common language that both sides can understand. It gives both sides in court the opportunity to refer to standard textbooks2,3 for descriptions of the condition and allows for focussed cross-examination. The two most important diagnostic systems employed in psychiatry are: the International Classification of Diseases, now in its 10th edition, abbreviated as ICD-10.4the diagnostic and statistical manual of the American Psychiatric Association, edition 4, abbreviated as DSM-IV.5
Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
It is also important to standardize the selection of patients for clinical trials. In previous studies with IBS, mixed patient samples (e.g., combining those with predominant diarrhea with those having predominant constipation) increased the likelihood that a medication (e.g., to control diarrhea) would not be effective (9). Symptom-based criteria allow patient groups to be targeted to the predicted effects of the treatment (i.e., to treat diarrhea or constipation). Within psychiatry, there is evidence that panic disorder is clinically distinct from generalized anxiety, and is more closely linked to depression, even though anxiety is common to both disorders. Therefore, these disorders are classified separately in DSM-IV. Using these criteria, it was found that patients with panic disorder respond better to antidepressants than patients with generalized anxiety.
A Crosswalk Study of DSM-IV and DSM-5 Criteria for PTSD from the DSM-5 Field Trials
Published in Psychiatry, 2022
Carol S. North, Alina M. Surís, Diana Clarke, Jayme M. Palka, Lamyaa Yousif, Darrel A. Regier
Differences between DSM-IV and DSM-5 criteria are now less important internationally than differences between DSM-5 and ICD-11 criteria, as the latter has attempted to remove symptoms that overlap with other frequently co-occurring disorders such as depressive and anxiety disorders (First et al., 2021; Regier et al., 2013). For epidemiologic studies, even minor differences between prior DSM and ICD criteria have yielded far lower proportions meeting criteria for both, although with similar prevalence rates (Andrews et al., 1999). Looking forward, improving treatments for PTSD and all multi-domain expressions of psychopathology will require a focus on core symptom dimensions that are the object of both research on basic biological and cognitive neuroscience (genotypes and phenotypes) and studies of clinical treatment and disability assessment outcomes (Bar-Haim et al., 2021).
Re-Analyzing Phase III Bremelanotide Trials for “Hypoactive Sexual Desire Disorder” in Women
Published in The Journal of Sex Research, 2021
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was released in 1994 (American Psychiatric Association, 1994). In the late 1990s, when pharmacological treatments to enhance female sexual desire and arousal were in development, the DSM-IV contained the list of “sexual dysfunctions” which could be targeted by such treatments, of which hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) were the most relevant. Drug firms funded the development of measurements for the severity of such “sexual dysfunctions” so that the success of their products could be gauged (Moynihan, 2003). In the DSM-5, published in 2013, HSDD and FSAD were both removed (American Psychiatric Association, 2013). They were replaced by a combined condition of female sexual interest/arousal disorder (FSIAD), a disorder including reduced sexual desire, lack of response to sexual stimuli, and lack of pleasure during sexual activity, impacting at least 75% of sexual encounters and causing significant personal distress over a period of at least six months.
Conceptual and historical evolution of psychiatric nosology
Published in International Review of Psychiatry, 2021
Thus, by the late 1940s multiple distinct nomenclature systems were in use, and the American Psychiatric Association created a new catalogue to supersede them: the ‘Diagnostic and Statistical Manual’ (DSM). It divided mental disorders into two large groups based on aetiological considerations (neurological vs primary psychiatric), although its diagnoses were nonetheless descriptive (American Psychiatric Association, 1952). The first group consisted of neuropsychiatric manifestations of neurological conditions, dementias, and intellectual disabilities, while the second group consisted of psychiatric disorders that were conceptualized in terms of Meyerian reactions similar to Medical 203 (Aragona, 2014; Shorter, 2015). The psychotic disorders carried forward distinctions of involutional psychosis, manic depressive illness, depressive illness, schizophrenia subtypes, and paranoia, but framed them as reactions (American Psychiatric Association, 1952). The DSM-II was released in 1968, amid efforts to align it better with the 8th edition of the International Classification of Diseases, and largely continued the nosology and ontology that was established in the DSM I (Aragona, 2014; Shorter, 2015). Although some commentators (Klerman et al., 1984) have characterized the early DSMs as psychodynamically-influenced, it is increasingly recognized that the manuals were more eclectic in nature and more in line with European psychiatry than has previously been acknowledged (Aragona, 2014; Cooper, 2005).