New Diagnosis In DSM-5 Research Articles

Atypical Anorexia Nervosa is not atypical at all! Commentary on Walsh et al. (2022).

The introduction of atypical anorexia nervosa (atypAN) as a new diagnosis in DSM-5 has advanced the field by expanding awareness that individuals of all weights can have an eating disorder. However, many clinical and research questions remain, particularly pertaining to whether atypAN and anorexia nervosa (AN) are different conditions or the same condition across the weight spectrum. In this issue of the journal, Walsh et al. describe the results of their systematic review demonstrating that the level of eating disorder-specific psychopathology is significantly higher among individuals with atypAN than among controls, and as high or higher than among individuals with AN. Levels of noneating disorder psychopathology are similar. Individuals with atypAN experience many of the medical complications associated with AN but at a lower frequency. The finding that the clinical features of atypAN are not substantially different from AN supports the possibility that atypAN and AN are the same condition. Further research on epidemiology, genetics, treatment, course and outcome is required to determine whether atypAN and AN are the same or different, but there is a need to update and refine existing terminology and diagnostic classification.

Avoidant/restrictive food intake disorder: what do we know so far?

SUMMARYAvoidant/restrictive food intake disorder (ARFID) was a new diagnosis in DSM-5 and is due to be included in ICD-11. However, confidence in making the diagnosis seems to be low among clinicians. Furthermore, there is no national consensus on care pathways for ARFID and therefore patients tend to be managed across core child and adolescent mental health services, specialist eating disorder services and paediatric services. If not adequately treated, ARFID can result in stunted growth, nutritional deficiency and impaired psychosocial functioning. Research and guidelines for managing this disorder are scarce, owing to low rates of diagnosis. This article aims to improve clinician confidence in the use of ARFID as a diagnosis and explores current consensus on treatment approaches, in order to progress future service planning for this complex and diverse patient group.LEARNING OBJECTIVES•Gain an improved knowledge of the diagnostic criteria for ARFID•Know how to distinguish ARFID from other eating disorders•Understand the current consensus on treatment approaches for ARFIDDECLARATIONS OF INTERESTNone.

Experts Search for Meds to Help Youth With DMDD

Experts Search for Meds to Help Youth With DMDD

3.45 Characteristics and Potential Subtypes of Child and Adolescent Psychiatric Patients With Avoidant Restrictive Food Intake Disorder That Presented to a Tertiary Care Psychiatric Facility

Few studies have been done on avoidant-restrictive food intake disorder, which is a relatively new diagnosis in DSM-5. This retrospective chart review was done to determine clinical characteristics and subtypes within patients with avoidant-restrictive food intake disorder presenting to a tertiary care eating disorder facility.

Longitudinal Associations Between Preschool Disruptive Mood Dysregulation Disorder Symptoms and Neural Reactivity to Monetary Reward During Preadolescence.

Reward-processing abnormalities are thought to be a key feature of various psychiatric disorders and may also play a role in disruptive mood dysregulation disorder (DMDD), a new diagnosis in DSM-5. In the current study, we used event-related potentials (ERP) sensitive to monetary gains (i.e., the reward positivity [RewP]) and losses (i.e., the N200) to examine associations between symptoms of DMDD during early childhood and later reward processing during preadolescence. To assess early emerging DMDD symptoms in a large longitudinal community sample (n=373) of 3-year old children, we administered a diagnostic interview, Preschool Age Psychiatric Assessment (PAPA) with parents. At a later assessment, ∼6 years later, children completed a monetary reward task while an electroencephalogram (EEG) was recorded. Children's lifetime history of psychopathology was also assessed at that time using Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with the child and parent. Multiple regression analyses revealed that age 3 DMDD symptoms predicted an enhanced RewP to monetary rewards in preadolescence. This association is independent of demographics and lifetime history of symptoms of depression, any anxiety disorder, attention-deficit disorder, oppositional defiant disorder, or conduct disorder Conclusions: Early manifestations of DMDD in children as young as 3 years old predicted enhanced reward processing later in development. These findings add to the growing corpus of literature on the pathophysiology of DMDD, and underscore the predictive validity of preschool DMDD on a neural level.

Cognitive behavioral therapy for hoarding disorder: a meta-analysis.

Hoarding disorder (HD) is a new diagnosis in DSM-5 (American Psychiatric Association, 2013). Cognitive-behavioral therapy (CBT) appears promising for the treatment of HD, and has been tested in both individual and group settings. The present study used meta-analytic techniques to examine the overall strength of effect of CBT on HD, as well as on its component symptoms (clutter, difficulty discarding, and acquiring) and associated functional impairment. Potential demographic and treatment-related moderators of CBT response, as well as the presence of clinically significant change were also examined. From 114 published articles, 10 articles comprising 12 distinct HD samples (N = 232) met inclusion criteria and were retained for analysis. HD symptom severity decreased significantly across studies with a large effect size. The strongest effects were seen for difficulty discarding, followed by clutter and acquiring. Functional impairment showed the smallest effect in the moderate range. Female gender, younger age, a greater number of CBT sessions, and a greater number of home visits were associated with better clinical outcomes. Reliable change was found in the majority of samples for each outcome domain. Rates of clinically significant change, however, were lower (percentage ranged from 24 to 43). Thus, in most cases, study patients' post-treatment scores remained closer to the HD range than to the normal range. CBT is a promising treatment for HD, although there is significant room for improvement. Results are discussed in terms of treatment refinement for HD, and additional moderator variables are suggested for further study.

DSM-5: Disruptive mood dysregulation disorder

This paper will describe historical perspectives for the introduction of disruptive mood dysregulation disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), criteria for the diagnosis, as well as information on epidemiology, clinical presentation and longitudinal course, pathophysiology, and treatment. The diagnosis of disruptive mood dysregulation disorder requires frequent, persistent, severe temper outbursts out of proportion to the situation and developmental context in combination with persistent, angry/irritable mood between the temper outbursts. Because of the limited available data, the inclusion of this new diagnosis in DSM-5 has been controversial. Regardless of this controversy, it is clear that youth experiencing such symptoms are highly impaired and utilize significant health services. Therefore, we need to expand our efforts to better understand the complex construct of this phenotype in order to improve the assessment, diagnosis and treatment of this condition.

Domestic squalor and hoarding, a new diagnosis in DSM-5: confined field study

Introduction: Domestic squalor which is caused by many psychiatric and not psychiatric diseases may lead to many serious problems for patients and their intimates. In our country there are not any data about the prevalence and the reasons of these houses. In this study, within the scope of Community Mental Health Service, it is aimed to locate these houses in Zeytinburnu and to gather information about the patients and their intimates and to evaluate the people living in these houses according to Hoarding, a new DSM-5 diagnosis. Methods: Within the scope of Zeytinburnu Community Mental Health Center, some field scanning has been done and domestic squalor have been evaluated with Living Condition Rating Scale for one year. In this scale, the socio-demographic data which have been got from the patients who live in the houses which are labeled as moderate-squalor and severe squalor and features of the disease are evaluated. Findings: Forty-two moderate squalor and severe squalor have been reached in a year in Zeytinburnu and it has been determined that 103 people live in these houses. Sixty people out of 103 have had a psychiatric disease (psychotic disorder 27-26.2%, common developmental disorder and mental retardation 16-15.5%, dementia 7-6.8%, alcohol drug addiction 6-%5.8 and mood disorder 4-3.9%). Forty-one of these people (39.9%) have had the litter houses as a result of inconvenient storage of things. 13 patients who store things show the symptoms of DSM-5 Hoarding disorder. Discussion: Domestic squalor is a serious mental health and social health problem in our country as in developed counties. In other countries, especially there are people who live alone in these houses, whereas in our study it is found that more than one person, whether they are sick or not, live in these houses. It is essential for community mental health centers to determine the psychiatric patients who live in these houses and to be organized to arrange the necessary interventions.

Conceptual issues in the classification of psychosis

To provide an update on the conceptual status of attenuated psychosis syndrome (APS) as a psychiatric disorder. In May 2012, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Task Force announced that the planned introduction of APS as a new diagnosis in DSM-5 was cancelled and that APS was being moved to 'Section III' of the manual as a diagnostic construct requiring more work. Recent studies of APS have reflected this uncertainty and debate over its validity. Before and after the decision in May 2012 to remove APS as a new diagnosis in DSM-5, scientific work has proceeded in a robust manner to shore up the validity of APS as a diagnostic construct. Recent work on APS has revolved around a series of unresolved questions: the actual incidence of conversion of APS to full-blown psychosis, the identification of the subgroup that will convert, the appropriate treatment for APS, the ability of treatment to prevent conversion to psychosis, the wide range of long-term outcomes of APS and finally the decision whether to include APS as a formal psychiatric diagnosis. Although the debate continues, a substantial number of the major researchers have argued that APS does not yet enjoy a degree of validity that warrants inclusion as a formal diagnosis.

Informing the symptom profile of complicated grief

Complicated Grief (CG) is under consideration as a new diagnosis in DSM5. We sought to add empirical support to the current dialogue by examining the commonly used Inventory of Complicated Grief (ICG) scale completed by 782 bereaved individuals. We employed IRT analyses, factor analyses, and sensitivity and specificity analyses utilizing our full sample (n = 782), and also compared confirmed CG cases (n = 288) to noncases (n = 377). Confirmed CG cases were defined as individuals bereaved at least 6 months who were seeking care for CG, had an ICG ≥ 30, and received a structured clinical interview for CG by a certified clinician confirming CG as their primary illness. Noncases were bereaved individuals who did not present with CG as a primary complaint (including those with depression, bipolar disorder, anxiety disorders, and controls) and had an ICG<25. IRT analyses provided guidance about the most informative individual items and their association with CG severity. Factor analyses demonstrated a single factor solution when the full sample was considered, but within CG cases, six symptom clusters emerged: (1) yearning and preoccupation with the deceased, (2) anger and bitterness, (3) shock and disbelief, (4) estrangement from others, (5) hallucinations of the deceased, and (6) behavior change, including avoidance and proximity seeking. The presence of at least one symptom from three different symptom clusters optimized sensitivity (94.8%) and specificity (98.1%). These data, derived from a diverse and predominantly clinical help seeking population, add an important perspective to existing suggestions for DSM5 criteria for CG.

The case for including Attenuated Psychotic Symptoms Syndrome in DSM-5 as a psychosis risk syndrome

The American Psychiatric Association Task Force on DSM-5 has recently proposed consideration of Attenuated Psychotic Symptoms Syndrome as a new diagnosis, based on nearly 15 years of prospective research in centers across the globe. The condition is also known as “psychosis risk syndrome,” “at-risk mental state,” “ultra-high risk,” and “putative prodrome.” We review evidence favoring its inclusion as a new diagnosis in DSM-5 and report new preliminary findings on DSM-IV diagnoses in current clinical use for these patients and on results of diagnostic interviews in unselected volunteers. The main evidence supporting inclusion is: (1) the patients are currently ill, (2) the patients are at high risk for getting worse, (3) no DSM-IV diagnosis accurately captures their current illness or future risk, (4) the diagnosis has been made with reliability and validity in the research setting, and (5) placement in DSM-5 would help promote the needed treatment and prevention research to enable articulation of a standard of care to benefit these patients and their families. Potential harms can be minimized by patient, family, and provider education. It will be important to demonstrate through well-designed field trials whether the diagnostic criteria can be used with reliability in everyday clinical practice.