A Clinician’s Guide to the DSM-5-TR _ ___________________________________________________________
NEW DIAGNOSTIC ENTRIES IN DSM-5-TR
Diagnostic Entity Description
Key Features
Prolonged grief disorder
Prolonged grief disorder (PGD) is characterized by a persistent, intense longing for or preoccupation with a deceased loved one, accompanied by significant emotional distress and functional impairment lasting at least 12 months after the loss (6 months for children and adolescents). PGD is distinct from normal grief and other disorders like depression or PTSD. Its inclusion in the DSM-5-TR aims to improve the recognition and treatment of maladaptive grief responses. Unspecified mood disorder is used for presentations that include symptoms characteristic of mood disorders but do not meet the full criteria for any specific mood disorder in either the bipolar or depressive categories. This diagnosis is applied when the clinician chooses not to specify the reason that the criteria are not met for a specific mood disorder, or when there is insufficient information to make a more specific diagnosis. This category is particularly useful in clinical situations where immediate treatment decisions need to be made, but the full diagnostic picture is not yet clear, such as in emergency room settings. Stimulant-induced mild neurocognitive disorder is characterized by persistent cognitive deficits resulting from stimulant use, particularly cocaine and amphetamine-type substances. The cognitive impairments are not severe enough to interfere significantly with independence in everyday activities but are severe enough to require more significant mental effort, use of compensatory strategies, or accommodation. This diagnosis was added to the existing types of substance-induced mild neurocognitive disorders (such as those induced by alcohol, inhalants, and sedatives) in recognition of the growing evidence that chronic stimulant use can lead to persistent cognitive impairments, even after cessation of use.
1. Intense yearning for the deceased or preoccupation with thoughts/memories of them 2. At least 3 of 8 additional symptoms, such as: • Identity disruption • Disbelief about the death • Avoidance of reminders • Intense emotional pain • Difficulty reintegrating into life • Emotional numbness • Feeling life is meaningless • Intense loneliness 3. The symptoms cause clinically significant distress or impairment. 4. The grief reaction exceeds cultural, social, or religious norms. 5. The symptoms are not better explained by another mental disorder. 1. The presence of mood disorder symptoms that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 2. The symptoms do not meet the full criteria for any specific bipolar or depressive disorder. 3. It allows clinicians to avoid prematurely choosing between bipolar disorder and depressive disorder when the presentation is unclear or information is limited. 4. It provides a diagnostic option for cases where it is challenging to determine whether the appropriate diagnostic class is bipolar or depressive, especially when irritable mood or agitation predominates. 5. The diagnosis can serve as a temporary placeholder until more information becomes available to make a more specific diagnosis. 1. Evidence of cognitive decline from a previous level of performance in one or more cognitive domains (e.g., complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition). 2. The cognitive deficits do not occur exclusively during the course of delirium and persist beyond the usual duration of intoxication and acute withdrawal. 3. There is evidence from the history, physical examination, or laboratory findings that the deficits are etiologically related to the persisting effects of stimulant use. 4. The deficits cause mild interference in independence in everyday activities. 5. The deficits are not better explained by another mental disorder. Table 1 continues on next page.
Unspecified mood disorder
Stimulant-induced mild neurocognitive disorder
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