____________________________________________________________ A Clinician’s Guide to the DSM-5-TR
Prolonged grief disorder was newly added to the DSM-5-TR as a formal diagnosis in the category of Trauma- and Stressor- Related Disorders. Here are the critical points about PGD and its diagnostic requirements in the DSM-5-TR [1]: • Definition : PGD is characterized as a maladaptive grief reaction that persists for an extended period after the death of someone with whom the bereaved had a close relationship. • Time criteria (Criterion A) : ‒ For adults: At least 12 months must have passed since the death ‒ For children and adolescents: At least six months must have passed since the death • Core symptoms (Criterion B) : The person must experience at least one of the following nearly every day for at least the last month: ‒ Intense yearning/longing for the deceased person ‒ Preoccupation with thoughts or memories of the deceased person (for children/adolescents, this may focus on the circumstances of the death) • Additional symptoms (Criterion C) : At least three of the following eight symptoms must be present nearly every day for at least the last month: ‒ Identity disruption (feeling as though part of oneself has died) ‒ Marked sense of disbelief about the death ‒ Avoidance of reminders that the person is dead ‒ Intense emotional pain related to the death ‒ Difficulty moving on with life ‒ Emotional numbness ‒ Feeling that life is meaningless ‒ Intense loneliness • Functional impairment (Criterion D) : The disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. • Cultural considerations (Criterion E) : The duration and severity of the grief reaction must clearly exceed expected social, cultural, or religious norms for the individual’s culture and context. • Differential diagnosis (Criterion F) : The symptoms are not better explained by another mental disorder. The inclusion of PGD in the DSM-5-TR aims to improve the recognition and treatment of maladaptive grief responses, particularly in the context of increased deaths due to the
COVID-19 pandemic. However, its inclusion has also sparked some controversy in the psychiatric community, with debates about the potential medicalization of normal grief processes. UNSPECIFIED MOOD DISORDER The development and inclusion of unspecified mood disorder in the DSM-5-TR represents a vital update aimed at addressing a gap in diagnostic options [1]. This category was added to provide clinicians with a diagnostic option when it is challeng- ing to distinguish between unipolar and bipolar presentations, particularly in cases where irritable mood or agitation predomi- nates. Historically, this category was unintentionally removed from the DSM-5 when the mood disorders diagnostic class was eliminated in favor of separate bipolar and depressive disorder classifications. The inclusion of unspecified mood disorder allows clinicians to avoid prematurely choosing between bipolar disorder and depressive disorder, which can have significant implications for treatment and long-term patient outcomes. The unspecified mood disorder category also enhances com- patibility with other diagnostic systems, such as ICD-10-CM and ICD-11, which include similar classifications. Due to the absence of a mood disorders grouping in the DSM-5-TR, unspecified mood disorder is located within both the depres- sive disorders and the bipolar disorders chapters. It applies to presentations with symptoms characteristic of a mood disorder that cause clinically significant distress or impairment but do not meet the full criteria for any specific mood disorder. This category serves as a diagnostic placeholder when there is insufficient information to make a more specific diagnosis, with the expectation that a more precise diagnosis may be made later as more information becomes available. Overall, including unspecified mood disorder reflects an effort to pro- vide clinicians with greater flexibility in diagnosis, particularly in complex or unclear cases, while aligning the manual more closely with other diagnostic systems. STIMULANT-INDUCED MILD NEUROCOGNITIVE DISORDER The development and inclusion of stimulant-induced mild neurocognitive disorder in the DSM-5-TR represents an essen- tial update to the classification of substance-induced cognitive impairments [1]. Historically, the DSM-IV included a category for persisting dementia resulting from four substance classes: alcohol, sedatives/hypnotics/anxiolytics, inhalants, and other/ unknown substances [18]. The DSM-5 replaced this single dementia category with major and mild neurocognitive disor- ders for these same substance classes [2]. A growing literature on stimulant-induced neurocognitive impairments supported the existence of persistent cognitive deficits resulting from stimulant use, with studies demonstrating that these deficits, while not severe enough to interfere with independence in daily activities, were significant enough to require more tremendous mental effort, compensatory strategies, or accommodation.
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