Fall 2024 SOWK 581 Week 05 - Understanding and using the DSM-5

Fall 2024 SOWK 581 Week 05 - Understanding and using the DSM-5

title: Fall 2024 SOWK 581 Week 05 - Understanding and using the DSM-5 date: 2024-09-21 00:03:00 location: Heritage University tags:

• Heritage University
• MSW Program
• SOWK 581

presentation_video: description: > Week five is a synchronous class week. We will meet on Saturday (09/21/24) to discuss understanding and using the DSM-5-TR. I will share the slides on MyHeritage as we approach class. Please also make sure that you bring your DSM with you.

Week 05

• General content in diagnoses
• Using the DSM
• AMA - DMS-5-TR Edition

Do we all have the conditions and symptoms in the DSM?

When I first started studying… wondered about symptomology.

General Areas of Consideration

Symptoms (beliefs/experiences, thoughts, feelings, behaviors) Time (period, age, duration) Frequency Intensity (causes clinically significant distress, areas of life/judgment or mood)

Using the DIAGNOSTIC MANUAL

Lets look up: Oppositional Defiant Disorder

Talk in groups about the following and what the diagnostic criteria mean:

• Reactive Attachment Disorder
• Generalized anxiety disorder
• Borderline Personality Disorder

Using a Screening Tool Like the GAIN-SS

Writing a Diagnosis

F33.3 Major Depressive Disorder, Recurrent, Severe with Psychotic Features with Anxious Distress;

Section 0

Q1

1) In your experience how has the DSM-5 changed the criteria for diagnosing certain mental health disorders compared to previous editions, and what impact have these changes had on clinical practice?

2) Why does the DSM-5 specifically include Premenstrual Dysphoric Disorder (PMDD) but not Premenstrual Syndrome (PMS), and what criteria differentiate PMDD from the broader symptoms of PMS? This is a new edition to the DSM-5, how does this affect women in the workplace who experience PMDD?

One. I would say that it has refined those diagnoses so the APA has gone through processes to come and to review diagnoses frequency, interrelate, interrater, inter reliability… And they work to come and make it more clear and more specific based on the best evidence.

Too. Pull out the DSM review the diagnosis maybe a joke about not being able to have experience these things, but which ones connect to me the biggest deal for this is the criteria for intensity that it comes and impacts.

Q2

Good evening Jacob,

A few questions I have are:

How often is the DSM updated?

This most recent version came out in 2022 the DSM five came out in 2013 one way I’ve heard it framed is it’s about 20 years in between major revisions, but I don’t think there’s been enough versions to say that for sure

What is the difference between conducting an MSE with children and adults?

So in understanding, a child, it is going to be based on their cognitive ability and what general expectations that you might have I think as you get younger and younger, it becomes more and more challenging to do some of the components, so for example, most children before seven don’t know The difference between what is real and what is not?? Check age 7??

How do you approach a diagnosis when symptoms overlap between multiple disorders?

There are a number of symptoms that overlapped between diagnoses there’s a section and the big book that I don’t believe is in the smaller book that lists differential diagnoses and considerations that we have consider psychosis psychosis is found in mood disorders and in the schizophrenic schizophrenia spectrum disorder, if there are mood symptoms While experiencing psychosis, we look either to effective disorder or disorder the diagnostic criteria always enough to be exclusive

These are questions I think about considering I am not sure if I want to stay working with young adults for the rest of my career or transition in between to working with adults

Q3

Have you encountered any challenges in using the DSM handbook?

I think one of the biggest challenges to the DSM is and using it is developing a broad enough perspective if you are working in a setting that requires it and my consideration, I’ve tended to try to make the least restrictive diagnoses, and my practice included a focus on the more common diagnoses For example, I didn’t work with anybody and have the need to diagnose things like sexual dysfunction. I mostly worked with lions that had mood or anxiety or conduct disorders behavioral disorders.

Q4

1) Have you ever conducted a mental status exam and found a link between mental illness and a pathway to violence, or is that possible in some cases?

I think the question about mental illness and violence is an important question. The first thing I want to make really clear, especially when you’re talking about disorder is such as schizophrenia and some of the more obvious disorders that they are actually less likely than the rest of the population to come and to be aggressive There are outdoor disorders such as antisocial personality disorder, or conduct disorder that people who have those behaviors have more history of being violent by nature and by the symptom description one area that I am not sure about is regarding people who are on SIM substances, especially when they are using those substances And whether that increases violence

https://www.apa.org/monitor/2021/04/ce-mental-illness

A big factor is co-occurring substance use. “If you have both a mental illness and a substance use diagnosis, the combination is synergistic and dangerous,” Brown says.

The bottom line? “Diagnosis alone is never enough to tell you if someone is likely to be violent again in the future,” says Brown. Instead, a contextual approach is needed that considers symptoms, circumstances, and individual characteristics, among other factors, she says. Persecutory delusions and “command hallucinations.” For people with psychotic disorders such as schizophrenia, studies show that some of the conditions’ positive symptoms can provoke violence. Grandiosity, grandiose delusions, and mania. Grandiosity, a hallmark of the manic and hypomanic phases of bipolar disorder, can likewise play a role in violence and aggression, studies find. Antisocial personality traits. Violence among people with serious mental illness often goes hand in hand with a youthful history of conduct disorder and a present diagnosis of antisocial personality disorder, characterized by disregard for others, deceitfulness, and manipulation of others for personal gain, research also shows

2) When you mentioned in the group forum and suggested the film A Beautiful Mind, do you think that there is a correlation between a person having schizophrenia and also having a psychotic illness, while also having genius? Or can a person be genius because of schizophrenia? I ask this because I have heard this a few times and I am curious.

https://www.psychologytoday.com/us/blog/hide-and-seek/201509/mad-genius-schizophrenia-and-creativity

For Folley and Park, the results of these two experiments support the idea that increased use of the right hemisphere and increased inter-hemispheric communication is related to enhanced creativity in psychosis-prone populations.

Savant skills and autism…

3) In your professional opinion, do you feel that people that struggle with mental illness or behavioral issues have the desire to get better or the desire to give up?

One of the mantras that I have people are doing the best they can with what they have and where they’re at Motivation and a desire for improvement is complicated. I think everybody wants to do better but sometimes their values or what is important to them is different.

4) As a parent, I want my baby boys and my nephews and niece that I also raise to feel good and be happy. What is a peace of advice that you think is important for parents?

I think the biggest thing I would say is love and structure finding ways for them to grow you got their own people

Q5

Hello Jacob,

After watching the video the gentleman said that the individual is not their diagnosis. I agree with that statement!

Yes, people are not just their diagnosis is 100% really agree

How do you work with someone who is focused on their diagnosis (being labeled/in denial) rather than focusing on helping themselves improve their mental health state?

I hear two things first let’s talk about the being in denial. I think there is some education that we can come and provide our clients about purposes of diagnoses why that might be the thing that they’re diagnosed with kind of our clinical judgment around that and just coming and expressing some of those things Weather, they have insight into their symptoms. Some of the impact of symptoms might be where we come and try to work to help develop insight around the first part and somebody who is overly fixated on being diagnosed again I think there is just education that we can come and provide explaining what that means what it looks like

What steps do you initiate, so the individual accepts their diagnosis and works on their symptoms?

In my experience most of the time that is what we work on and deal with I don’t I don’t feel like I’ve had clients who’ve been overly fixated on their diagnoses although I can imagine if somebody feels like they’re being mislabeled that they could be I also do not put a significant amount of time talking about diagram during session unless I feel like there’s a need for some education around what that means why the rationale again

Q6

A couple times now, I have heard how the DSM has been critiqued for not fully capturing the diverse ways mental health issues manifest across cultures. For example, certain cultures might express depression or anxiety in physical symptoms more than emotional ones. How can I remain culturally sensitive while using the DSM to ensure that diagnoses are accurate for clients from diverse backgrounds? Are there alternative frameworks or tools you would recommend?

I don’t think that the DSM is the end I’ll be all it is what is required for being able to come and to gain specific knowledge. Maybe let’s look at generalized anxiety disorder and cultural considerations and cultural related diagnostic issues that it includes to understand this another place to come and to go is to seek consultation there are people with specific credentials that allow them to help consult regarding specialized issues whether it’s with African-Americans children Hispanic population.

My second question go hand- in -hand. I’ve witnessed where people from different cultural backgrounds either experience or express symptoms differently. If culture influences a client’s presentation of symptoms, then how can I make sure to account for that when making a diagnosis. For example, what might be seen as paranoia in one culture could be a normal protective behavior in another. I just want to make sure I am properly accounting for this when potentially diagnosing, especially with mental health disorders.

I think one of the things to think about for this is going back to what makes it clinically significant

Q7

Are there people who work on the DSM every day and make changes to it?

Show the page with the working groups

Can there be malpractice when using the book?

Yes, may expand on incorrect diagnoses, misleading information doing things that are against agency policies or legal obligations

Do doctors have to use the book or reference it to get a reimbursement for it?

Yes, to be able to bill for services you use the codes in the DSM. Eli says a psychiatrist if you’re talking about medical doctors, they use the IDC.

Section 1

Q1

Good morning Dr. Campbell

I have always been fascinated and interested with the diagnostic aspect from the clinician’s side. As an undergrad, I guess I was super excited to go over the DSM but I guess I never fully understood how to navigate it or understand how to fully read and understand a specific diagnosis and take it back to the client. I guess a few of my questions are how do you understand and navigate the book? When in the field and we’re with a client are we able to just pull out the DSM book and find out what is the appropriate diagnosis for the client? Is the DSM book the only way to diagnose someone? Or is there any one way or form? How do you know you are giving the correct diagnosis to a client? Who makes decisions on what to add, remove, adjust, or come up with a new diagnosis? But overall, I’m super excited to learn a lot more about the DSM book.

So the way that you diagnose it from a clinical interview often times this is supported through screeners and assessment forms, depending on the diagnosis and the needs.

There really isn’t another way to make diagnoses that being said all services are not driven based on diagnosis and we don’t always have to seek some sort of reimbursement from insurance

Regarding adding or removing diagnoses, they kind of always stay with you. That’s a part of the important kind of aspect of being cautious with diagnoses. Sometimes clinicians will write historical diagnoses when I completed forms in the school district. I was always careful to know who diagnosed what and like a date of the report for the records that we received with that there are also provisional diagnoses that we might give when we’re still kind of maybe ruling out another diagnosis

As far as how you know if you’ve made the correct diagnosis, I think that it is experience talking through it with a supervisor that you seem to see it fit.

Q2

Good morning Dr. Jacob,

Some questions i have about the DSM-5-TR are:

1. How was the DSM-5-TR developed?

2. Who was involved when creating the DSM-5-TR?

3. How were decisions made about what would be included, removed, or changed?

4. How can you actually diagnose a person using the DSM-5-TR? Like Yovana mentioned, do you just whip it out and just let them know “well, it sounds like you have depression… so i’m diagnosing you with this.”

5. Is it possible for you to mis diagnose someone using the DSM-5-TR?

Q3

Hello Dr. Campbell,

I am also very interested in knowing, how are diagnoses determined to be included in the DSM? Are these the only existing diagnoses used in treatment across the nation? Or how does that work?

Thank you!!!

Q4

In the first few minutes of Ken’s video, he mentions that the DSM-5 requires clinical training to be utilized correctly. What does this training look like? Does it require real-time practice hours? Is this clinical training a requirement by the state?

Q5

Hello Mr. Campbell, through the years the DSM has expanded tremendously since its origination. What do you think the correlation is between the DSM and multibillion dollar pharmaceutical companies if any? Also Kinter referred to others codes as the “V” Codes, can you give me an example?

Q6

Hello,

A few questions I have are when in doubt how do you determine which diagnosis is most appropriate. Is there a process to follow that will assure you that you chose the appropriate diagnostic. Is there a process to follow if you wrongly diagnosed and need to re-diagnose?

Q7

Before I saw this forum I had asked a question about the DSM in another forum but I do have the curiosity to know the answer to my question which was how are you able to distinguish which disorder you are seeing in a client when some disorders have overlapping symptoms and sound the same. Adding to this question I wonder if you see that a client has multiple symptoms that fit into more than one disorder how do you decide which fits more with the client?

Q8

Hello,

While going through the DSM-5- TR I noticed that several of the diagnosis have similar symptoms.

• How often do clinicians over diagnose clients?
• Are there any diagnosis that have been removed from the DSM-5-TR? If so what makes them decide to remove the diagnosis?
• Also, how do they decide when a new diagnosis is added to the DSM-5?

I am aware it takes time to study the DSM-5-TR, so it is nice to give us this space to ask questions. Thank you.

Using the DSM

Talk in groups about the following and what the diagnostic criteria mean: Posttraumatic Stress Disorder Major Depressive Disorder Schizophrenia