DSM-5 Released this Week at APA Annual Meeting With Significant Implications for Primary Care
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), released this week at the annual meeting of the American Psychiatric Association (APA), marks the beginning of a significant change in practice for primary care practitioners.
Primary care practitioners are on the front lines of mental health care, so professional comfort with the updated DSM—the first major update to the standard classification system for mental disorders in more than 20 years—is essential for these practitioners, many of whom regularly treat patients with depression, bipolar disorder, substance abuse, and other mental health disorders.
The new manual was designed with primary care practitioners in mind and will inform the creation of the primary care version of DSM-5, according to David Kupfer, MD, Chair of the DSM-5 Task force. “The goal is to publish a manual that enhances clinical utility in a manner that is concise and more amenable to use in primary care,” he recently wrote.
Although it will take time for clinicians to become acquainted with the new manual, Saundra Jain, MA, PsyD, LPC, believes the new diagnostic system is ultimately more user friendly and will better reflect the problems primary care practitioners encounter each day.
Dr. Jain encourages primary care practitioners to become familiar with the new diagnostic categories that comprise the bulk of their practice and the associated specifiers. “With the use of specifiers, it will be easier to fully understand a patient’s difficulties, as well as comorbid symptoms,” she said.
DSM-5 will have five specifiers for major depressive disorder, grouped under the acronym NEC (Not Elsewhere Classified). NEC takes the place of NOS (Not Otherwise Specified), which was used in DSM-IV. “The new specifiers will give a richer, fuller clinical picture of our patients,” said Dr. Jain.
DSM-5 has a new organizational structure reflecting a number of changes that will be of interest to primary care practitioners. A few of the expected changes are noted below:
- Anxiety Disorders: Post-traumatic stress disorder (PTSD) is now in Trauma- and Stressor-Related Disorders; Agoraphobia is now a category separate from Panic Disorder; and Social Phobia is now called Social Anxiety Disorder.
- Bipolar Disorder: No longer included in Mood Disorders but is now a new category called Bipolar and Related Disorders. Mixed Episodes is removed and replaced with a new specifier, “With Mixed Features.”
- Depressive Disorders: Dysthymia is changed to Chronic Depressive Disorder, and Premenstrual Dysphoric Disorder has been added.
Specifications will be added for sleep-wake disorders too. Each sleep-wake disorder will include greater specification of coexisting conditions—this change highlights the patient’s sleep disorders as well as the bidirectional relationship between sleep disorders and medical and mental disorders. In addition, the DSM-IV category of Primary Insomnia has been renamed Insomnia Disorder in DSM-5.
Another familiar category from DSM-IV, the bereavement exclusion, will not appear in DSM-5, noted Dr. Jain. The DSM-IV bereavement exclusion applied to a major depressive episode that lasted fewer than two months after the death of a loved one. The exclusion was omitted from DSM-5 for several reasons, including to avoid implying that normal grief lasts only two months.
Primary care practitioners will also want to learn about changes to substance use disorders and bipolar disorder, advised Dr. Jain. Once DSM-5 is officially released, practitioners should obtain a copy and begin exploring changes that apply to their practice.
“Get educated about the changes,” said Dr. Jain, who recommends reading about the changes as well as learning in an environment that allows for discussion with colleagues and question and answer periods.
“Then, start applying the information in daily clinical practice,” she said. “Keep handouts and resources easily available as ‘cheat sheets’ while seeing patients until you’re comfortable with the changes. Everyone’s learning curve will be different. I suggest remaining open to the changes, as change usually isn’t easy for most of us, and be willing to spend a little extra time learning about them.”
—Lauren LeBano
If you’re interested in education about DSM-5 and how to implement new diagnostic criteria in primary care practice, you can learn from experts at live sessions in your area. Consultant and Psych Congress Network are teaming up for a series of one-day Regional Meetings beginning June 8th in Chicago.
Visit http://www.psychcongress.com/pcpmentalhealth for details or to register for a local session.
References
1. Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Association. Updated May 3, 2013. http://www.psychiatry.org/dsm5