Det nye diagnosesystem DSM november 2013 LOS Torsten Warrer

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1 Det nye diagnosesystem DSM november 2013 LOS Torsten Warrer

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4 1 ud af 176 diagnoser har ens kriterier: Forbigående tics DSM-IV Vs. ICD-10

5 Moderne diagnoser "looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science, will require openness to rethinking traditional categories. It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior,"

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7 DSM-IV (1994) Axis I: all diagnoses except mental retardation and personality disorder Axis II: personality disorders and mental retardation Axis III: acute medical conditions Axis IV: psychosocial and environmental factors making things worse Axis V: Global Assessment of Functioning (GAF), or a number between 0 and 100 that reflects patients' well-being.

8 DSM-V : Hvordan gør man? Task force Arbejdsgrupper Studiegrupper Field studies fra universitetshospitaler til praksis Samarbejde med ICD modtager gerne kommentarer!

9 DSM-V : Hvorfor lave om? Lidelser eller tilstande der har fælles genetisk grundlag, samme hjernefund, samme symptomer Målrette diagnose og behandling Stimulere og målrette forskning Mild, moderate, severe, very severe

10 Kategorier Downs syndrom Depression ADHD Knoglebrud Skizofreni Mani Cutting

11 Dimensioner NORMAL/RASK NEUROTISK GRÆNSEPSYKOTISK PSYKOTISK

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13 Dimensioner Psykotisk depression Affektive lidelser Personlighedsforstyrrelser ADHD Autisme

14 Autisme i ICD-10 F84.0 Infantil autisme F84.1 Atypisk autisme F84.2 Rett s syndrome F84.3 Anden disintegrativ forstyrrelse i barndommen F84.4 Hyperaktivitetsforstyrrelse med mental retardering og bevægelsesstereotypier F84.5 Asperger's syndrom F84.8 Andre gennemgribende udviklingsforstyrrelser F84.9 Gennemgribende udviklingsforstyrrelse, uspecificeret F88 Andre psykiske udviklingsforstyrrelser F89 Psykisk udviklingsforstyrrelse, uspecificeret

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17 Autisme Gennemgribende udviklingsforstyrrelser Mangelfuldt socialt samspil Forstyrret sprogudvikling Begrænset, stereotyp, repetitiv adfærd

18 US autism rates from 1996 to 2006

19 Hans Asperger 1944 «autistische Psychopathie»

20 Leo Kanner 1943 "Autistic Disturbances of Affective Contact

21 Indtil 1971 blandes autisme med skizofreni Childhood schizophrenia Infantile psychosis Autism/Autistic disorder ICD /95 og DSM-IV 1994 : Gennemgribende udviklingsforstyrrelser Autisme spektrum forstyrrelser

22 Aspergers syndrom Som autisme, men uden sprogforsinkelse, og evt. med særinteresser i stedet for stereotyp adfærd. Asperger 1944

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25 Matematik +-x:? DSM-IV Mindst 6 af 12 symptomer i 3 grupper Interaktion, kommunikation, sterotypi: DSM-V 2 grupper: Social-kommunikativt, stereotypi: 2688 muligheder! 6 muligheder!

26 DSM-5 Autism Spectrum Disorder Must meet criteria A, B, C, and D:

27 C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms together limit and impair everyday functioning.

28 A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction, 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

29 B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

30 Nyheder for autisme : Det sociale og det kommunikative område slås sammen - fordi forskning viser, at det gør de alligevel næsten altid Øget eller svækket sensitivitet overfor sanseoplevelser kommer ind som kriterier Sprogforsinkelse udgår som kriterium det er mere noget, der påvirker tilstanden, og kan diagnosticeres separat Aspergers berømmelse slut

31 Severity Levels Level 3 Requiring very substantial support Level 2 Requiring substantial support Level 1 Requiring support

32 KRITIK i USA Vil færre blive diagnosticeret? Også af dem som har diagnosen? Så bevillingerne forsvinder?

33 Nogle andre nyheder Mental retardation bliver til "intellectual disability (intellectual developmental disorder) Man skelner ikke længere mellem akut og kronisk PTSD Før-skolebørn kan have PTSD Binge eating disorder Hoarding disorder Internet gaming disorder. Ikke at forveksle med Internet gambling disorder