A Clinician’s Guide to the DSM-5-TR _ ___________________________________________________________
NO DIAGNOSIS OR CONDITION Including a code for “no diagnosis or condition” in the DSM- 5-TR represents an essential addition to the manual, addressing a longstanding need in clinical practice and documentation [1]. This new code allows clinicians to indicate that a compre- hensive diagnostic evaluation was conducted explicitly, but no mental disorder or condition warranting clinical attention was found. The development of this code stemmed from the recognition that there are situations where individuals undergo mental health assessments but do not meet the criteria for any mental disorder. Nevertheless, there was previously no standardized way to document this outcome. The addition of this code serves several vital purposes in clini- cal practice. It clearly communicates that a thorough evaluation was performed, even when no diagnosis was made. This is particularly useful in contexts where the absence of a diagnosis needs to be formally recorded, such as in administrative or billing processes. The code also helps differentiate between cases where no disorder is present versus cases with insufficient information to diagnose. Furthermore, it can be valuable in research settings, allowing for more accurate categorization of study participants. Including this code in the DSM-5-TR reflects the manual’s ongoing efforts to improve the accuracy and utility of clinical documentation in mental health care, providing clinicians with a more comprehensive set of tools for describing the outcomes of their diagnostic assessments.
In the DSM-5-TR, cocaine-induced mild neurocognitive disorder and amphetamine-type substance–induced mild neurocognitive disorder were added to acknowledge the increasing evidence that chronic stimulant use can lead to lasting cognitive impairments, even after cessation of use [1]. This inclusion provides a diagnostic category for clinicians to capture the cognitive effects of stimulant use accurately. While specific diagnostic criteria are not detailed in the search results, it likely follows the general structure for substance- induced disorders, requiring evidence of cognitive decline that is etiologically related to stimulant use. The inclusion of this disorder allows for better recognition and potential treatment of cognitive impairments associated with stimulant use. It may facilitate research into the long-term effects of such substances on cognitive functioning. Overall, this addition aligns stimulant-induced cognitive impairments with other recognized substance-induced neurocognitive disorders in the DSM, reflecting an ongoing effort to refine and update the manual based on emerging research and clinical observations in substance-related disorders. The diagnostic criteria for stimulant-induced mild neurocogni- tive disorder are as follows [1]: • Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on (Criterion A): ‒ Concern about a mild decline in cognitive function, expressed by the individual, a knowledgeable informant, or the clinician. ‒ A modest impairment in cognitive performance, documented by objective cognitive assessment. • The cognitive deficits do not interfere with independence in everyday activities. However, greater effort, compensatory strategies, or accommodation may be required to maintain independence (Criterion B). • The cognitive deficits do not occur exclusively in the context of delirium (Criterion C). • The cognitive deficits are not better explained by another mental disorder (Criterion D). Additionally, the clinician should specify the etiological subtype if possible (e.g., due to Alzheimer disease, vascular disease, traumatic brain injury, etc.). The presence or absence of behavioral disturbances should be noted. For some etiologi- cal subtypes, the level of certainty of the diagnosis (possible or probable) can be specified. It is important to note that while these criteria help identify mild neurocognitive disorder, clinical judgment and compre- hensive assessment are crucial for accurate diagnosis.
CASE STUDY Case Presentation
Sarah, a 32-year-old woman, was referred to the outpatient psychiatric clinic by her primary care physician due to persistent depressive symptoms and difficulty functioning in daily life. Background Fifteen months ago, Sarah’s mother died suddenly from a heart attack at age 58. Sarah and her mother had been extremely close, speaking daily and seeing each other multiple times per week. Sarah described her mother as her “best friend” and primary source of emotional support. Symptoms Since her mother’s death, Sarah has experienced: • Intense yearning and longing for her mother daily • Preoccupation with thoughts and memories of her mother • Difficulty accepting the reality of the loss • Avoidance of places and activities that remind her of her mother
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