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DSM IV

The Diagnostic and Statistical Manual DSM-IV (DSM) .

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1992 (the Diagnostic and Statistical Manual DSM-IV),.

1993 International Classification of Diseases ICD-10 1952 .. 1918 . 130 106 .The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers.

The DSM has attracted controversy and criticism as well as praise. There have been five revisions since it was first published in 1952, gradually including more mental disorders, though some have been removed and are no longer considered to be mental disorders.

The manual evolved from systems for collecting census and psychiatric hospital statistics, and from a manual developed by the US Army, and was dramatically revised in 1980. The last major revision was the fourth edition ("DSM-IV"), published in 1994, although a "text revision" was produced in 2000. The fifth edition ("DSM-V") is currently in consultation, planning and preparation, due for publication in May 2013.[1]ICD-10 Chapter V: Mental and behavioural disorders, part of the International Classification of Diseases produced by the World Health Organization (WHO), is another commonly-used guide, more so in Europe and other parts of the world. The coding system used in the DSM-IV is designed to correspond with the codes used in the ICD, although not all codes may match at all times because the two publications are not revised synchronously.

Contents

History

2.1 DSM-I (1952)

2.2 DSM-II (1968)

2.3 DSM-III (1980)

2.4 DSM-III-R (1987)

2.5 DSM-IV (1994)

2.6 DSM-IV-TR (2000)Multi-axial systemThe DSM-IV organizes each psychiatric diagnosis into five levels (axes) relating to different aspects of disorder or disability: Axis I: Clinical disorders, including major mental disorders, and learning disorders

Axis II: Personality disorders and mental retardation (although developmental disorders, such as Autism, were coded on Axis II in the previous edition, these disorders are now included on Axis I)

Axis III: Acute medical conditions and physical disorders

Axis IV: Psychosocial and environmental factors contributing to the disorder

Axis V: Global Assessment of Functioning or Children's Global Assessment Scale for children and teens under the age of 18

Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, phobias, and schizophrenia.

Common Axis II disorders include personality disorders: paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder, and mental retardation.

Common Axis III disorders include brain injuries and other medical/physical disorders which may aggravate existing diseases or present symptoms similar to other disorders.

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EJ Khantzian Recent clinical observations and psychiatric diagnostic findings of drug-dependent individuals suggest that they are predisposed to addiction because they suffer with painful affect states and related psychiatric disorders. The drugs that addicts select are not chosen randomly. Their drug of choice is the result of an interaction between the psychopharmacologic action of the drug and the dominant painful feelings with which they struggle. Narcotic addicts prefer opiates because of their powerful muting action on the disorganizing and threatening affects of rage and aggression. Cocaine has its appeal because of its ability to relieve distress associated with depression, hypomania, and hyperactivity. .

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, , . ( )1. What is the Window Period?

The window period is the length of time after infection that it takes for a person to develop enough specific antibodies to be detected by our current testing methods. If an individual engages in unsafe sex or shares drug injection equipment and becomes infected, the body will make antibodies to fight HIV. When enough antibodies are developed, the HIV antibody test will come back positive. Each person's body responds to HIV infection a little differently, so the window period varies slightly from person to person. HIV is most commonly diagnosed in adolescents and adults through HIV antibody testing. However, there are also tests that diagnose HIV infection by detecting certain parts of the genetic material of HIV. PCR tests (polymerase chain reaction, often the same tests used to monitor the viral load response to HIV therapy) are used to diagnose HIV infection in infants and to make the diagnosis of acute HIV infection. These HIV PCR tests are used when the clinical suspicion is high for acute HIV infection, the standard screening antibody tests are negative, and the confirmatory Western blot tests are either negative or in determinant. Viral culture may also be performed in certain circumstances to diagnose HIV, but this method is now rarely ever used.

2. How Has Our Understanding of the Window Period Changed Over the Years?

Early in the epidemic, our testing methods were not as sensitive as they are today. Doctors and public health officials wanted to make sure that people who engaged in risk behaviors for HIV were tested long enough after their risk to be sure that anyone who was actually infected would test positive. The Centers for Disease Control currently states that people with possible exposure to HIV, who test negative, should be re-tested 6 months after the possible exposure to ensure that sufficient time has elapsed to make antibodies. Improvements in HIV testing technology, increasing laboratory experience with testing and the ability to better monitor early infection through PCR testing have contributed greatly to our understanding of the window period and have provided increased confidence that virtually all cases of HIV infection can be detected by the standard antibody screening tests 3 months after the possible exposure.

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