A Clinician’s Guide to the DSM-5-TR _ ___________________________________________________________
ATTENUATED PSYCHOSIS SYNDROME Attenuated psychosis syndrome (APS) is characterized by the presence of attenuated (less severe) psychotic symptoms that do not meet the full criteria for a psychotic disorder. These symptoms typically include delusions, hallucinations, or disorganized speech in a milder form, with relatively intact reality testing. The inclusion of APS in the DSM aims to identify individu- als who may be at high risk for developing a full psychotic disorder, particularly schizophrenia. To meet the criteria for APS, symptoms must have begun or worsened in the past year, be present at least once per week in the last month, and cause distress or disability to the individual [1]. Notably, the symptoms should not be better explained by another mental disorder or substance use. The concept of APS has sparked debate in the psychiatric community, with some arguing for its potential in early intervention and prevention of psychosis. In contrast, others express concerns about potential overdiagnosis and stigmatization. As research continues, the status of APS may evolve in future editions of the DSM. Proposed Criteria for APS • At least one of the following symptoms is present and is of sufficient severity or frequency to warrant clinical attention: ‒ Attenuated delusions ‒ Attenuated hallucinations ‒ Attenuated disorganized speech • Symptom(s) must have been present at least once per week for the past month. • Symptom(s) must have begun or worsened in the past year. • Symptom(s) is sufficiently distressing and disabling to the individual to warrant clinical attention. • Symptom(s) is not better explained by another mental disorder, including a depressive or bipolar disorder with psychotic features, and is not attributable to the physiological effects of a substance or another medical condition. • Criteria for any psychotic disorder have never been met. DEPRESSIVE EPISODES WITH SHORT-DURATION HYPOMANIA Depressive episodes with short-duration hypomania is a con- dition included in the Conditions for Further Study section of the DSM-5-TR, indicating that more research is needed before it can be considered an official diagnosis. This proposed disorder is characterized by individuals who experience major depressive episodes along with brief periods of hypomania that last less than four days. These short hypomanic episodes
Including these codes in the DSM-5-TR aims to draw atten- tion to the importance of assessing and documenting NSSI, potentially leading to improved identification and treatment of individuals engaging in these behaviors.
DISORDERS RECOMMENDED FOR FURTHER STUDY
Section III Conditions for Further Study in the DSM serves several important purposes: • Research promotion : This section includes proposed diagnostic categories and criteria sets that require further research before they can be considered official diagnoses in the main sections of the DSM. The DSM encourages and stimulates additional research to validate these proposed disorders by including these conditions. • Provisional recognition : This provides provisional recognition for conditions with some empirical support but is not well-established enough to be included in formal diagnoses. This allows clinicians and researchers to have a common language for discussing these potential disorders. • Clinical utility testing : Including these conditions allows for testing their clinical utility in real-world settings. Clinicians can use these proposed criteria sets and provide feedback on their usefulness and validity. • Future development : This section serves as a developmental ground for future additions to the main diagnostic categories in subsequent DSM editions. • Addressing emerging issues : This allows the DSM to be responsive to emerging mental health issues and new research findings without prematurely including them as official diagnoses. • Continuity and evolution : It bridges current diagnostic practices and potential future directions in psychiatric nosology. • Transparency : The DSM demonstrates transparency in developing new diagnostic categories by including these proposed disorders. • Flexibility : This section allows for more flexibility in considering new diagnostic entities compared to the more established categories in the main sections of the manual. Thus, the Conditions for Further Study section plays a crucial role in the ongoing development and refinement of psychiatric diagnosis, balancing the need for diagnostic stability with the importance of incorporating new research findings and clini- cal observations.
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