Dsm psychiatry. DSM-V. Notes on the margins - Circus of Trained Demons named after Korbinian Brodmann - LJ. Diagnostic criteria for ADHD according to the dsm-iv classification

The new American classification of mental disorders DSM-5 has been released to the world

Dutch De Psychiater publishes a brief overview of changes in the new version of the American classification of mental disorders DSM-5:

""DSM-5 consists of three sections: it is (1) an introductory part with instructions for use and a warning about the forensic psychiatric use of DSM-5; (2) diagnostic criteria and codes for routine clinical use; and (3) tools and techniques to inform clinical decision making.

Main changes:

Neurodevelopmental Disorders

The severity of the disorder is determined not by IQ, but by the level of adaptive functioning. Speech disorders have entered the new category of “social communication disorder,” in which some of the syndromes coincide with “autism spectrum disorder.” The category "Autism Spectrum Disorder" replaces the DSM-4 diagnoses of autism, Asperger's syndrome, childhood disintegrative disorder, and unspecified pervasive developmental disorder, all of which cease to exist as stand-alone diagnoses. ADHD can start later (before 12) and is viewed differently in different areas. Learning disorders and movement disorders are organized differently in this chapter and are somewhat combined.

Schizophrenia spectrum and other psychotic disorders

For the diagnosis of schizophrenia, Schneider's first rank symptoms lose their special weight. Diagnosis henceforth requires one positive symptom. Subtypes have been removed in favor of a dimensional indicator of severity. For schizoaffective disorder, the mood aspect is emphasized, while for delusional disorder, pretentious content is no longer excluded - although it is assessed separately. The “catatonia” section has been expanded: this code can now be entered as a related diagnosis (qualifying indicator) for depressive, bipolar and psychotic disorders.

Bipolar and related disorders

Bipolar and related disorders are now separated from depressive disorders and placed in their own category. A clearer definition of mania is given and clarifying indicators are introduced for mixed episodes, which lowers the threshold for the disorder. A residual subcategory of “other” and a qualifying indicator for anxiety symptoms were added.

Depressive disorders

Added “disruptive mood dysregulation disorder” and premenstrual dysphoric disorder. Chronic depression and dysthymia are combined into one diagnosis, now it is “persistent depressive disorder (dysthymia)” with a number of qualifying indicators. Major depressive disorder remained virtually unchanged, although for “subthreshold” symptoms a clarifying indicator “mixed manifestations” was introduced. A qualifying indicator for anxiety distress was also introduced. The basis for the grief exception has been removed.

Anxiety disorders

Obsessive-compulsive disorder and post-traumatic disorder are presented in separate chapters on neurophysiological and epidemiological grounds (see below). The various phobia criteria have been slightly adapted, and agoraphobia and panic have been separated. Panic attacks can act as a clarifying indicator for other diagnoses. The diagnoses of “separation anxiety disorder” and selective mutism are no longer specific “childhood” diagnoses.

Obsessive-compulsive and related disorders

For obsessions and for “Body Dysmorphic Disorder”, clarifying indicators of severity and criticism have been added, incl. ""delusional character"". The same goes for Hoarding Disorder, a completely new diagnosis in the DSM-5, as does Excoriation (Skin-Picking) Disorder. This also includes trichotillomania, and, in addition, exogenous causes of OCD have been added, in particular due to the use of psychoactive substances and medications, as well as in connection with other medical conditions.

Trauma- and stressor-related disorders

For both acute trauma and post-traumatic stress disorder, the stressor criterion has been changed to include witnessing and indirect exposure to the stressor when making a diagnosis. The requirement for direct experience of fear, horror or feelings of helplessness is also eliminated. Avoidance and emotional flattening are separated, and at the same time added to emotional flattening, incl. persistent depressed mood. To the already known symptoms of agitation are added recklessness, (auto) destructive behavior, irritability and aggression. For children and adolescents in puberty, lower diagnostic thresholds are used. Adaptation disorder remained unchanged. Reactive attachment disorder has been moved to this chapter.

Dissociative Disorders

Various changes have been made to the criteria for dissociative identity disorder, including, for example, the perception of identity transition by third parties. Depersonalization and derealization are combined into one disorder. Dissociative fugues ceased to be a separate diagnosis, and became a qualifying indicator in “dissociative amnesia.”

Somatic symptom and related disorders

These are what were previously called somatoform disorders. Somatization disorder, hypochondriasis, pain disorder, and unspecified somatoform disorder have been removed from the DSM. A diagnosis of "disorder with physical symptoms" can be made on an equal basis with a diagnosis from another medical specialty only if the physical symptoms are combined with abnormal thoughts, feelings and behavior. Unexplained medical symptoms play a decisive role only in cases of false pregnancy and conversion (ie, a functional disorder with neurological symptoms). In other cases, one should look for positive symptoms in this group.

Feeding and Eating Disorders

This includes former "children's" diagnoses such as "pica" (absorption of inedible substances) and "rumination" (i.e. regurgitation of food with repeated chewing), but for them the age criterion was removed. There is also a new diagnosis: “Avoidant/Restrictive Food Intake”. Anorexia no longer requires amenorrhea and binge eating, although bulimia nervosa and the new category of Binge-Eating Disorder require binge eating at least once a week.

Sleep-Wake Disorders

There is no longer a division between truly psychiatric and other (“somatic”) sleep disorders in the DSM-5, given the original concept of the related nature of the diagnoses. The chapter presents a large number of sleep disorders described through physical characteristics in relation to circadian rhythms and breathing disorders. This group includes Restless Legs Syndrome and REM Sleep Behavior Disorder. A large diagnostic choice predisposes to move away from the use of “unspecified” diagnoses.

Sexual Dysfunctions

In order to avoid overdiagnosis, the diagnosis thresholds in this group have been raised. Vaginismus is combined with dyspareunia under the category of Genito-Pelvic Pain/Penetration Disorder. Sexual aversion disorder has been removed. All disorders are subtyped based on psychological or combined factors, situation, and achievement.

Gender Dysphoria

Disruptive, impulse control, and conduct disorders

This is also a new chapter, which partially includes the missing chapter "Disorders Usually First Diagnosed in Childhood and Adolescence." In addition to various impulse control disorders, this also includes antisocial personality disorder, duplicated from the chapter on personality disorders. The criteria for oppositional defiant disorder have been revised and strengthened. In Conduct Disorder, the grounds for excluding the diagnosis were removed, but the clarifying indicator “callous-unemotional” was added. Intermittent Explosive Disorder can now be verbal, and the other criteria for the disorder are much more refined.

Substance-related and addictive disorders

This chapter is the first to include a non-substance-induced disorder: gambling addiction. For chemical substances, abuse and dependence are combined under the name Substance Use Disorder. "Traction" appears as a criterion, and problems with the justice authorities are removed. There was a new code for tobacco use disorder, while caffeine was already in the DSM-IV TR. There is a severity criterion, as well as a reference to “under controlled circumstances” or “as maintenance treatment” (for methadone).

This concludes our review. It's far from full. We are dealing only with the first attempts to comprehend the changes that have taken place, taking into account the accumulated knowledge. More detailed information about the relevant sections can be found on the Internet.

Based on materials:

With DSM-III, the multi-axis system was introduced. Patients are classified according to 5 independent parameters (axes). Preparation of DSM-IV began in 1988, and was completed in 1994. The DSM-IV described 400 mental disorders in 17 categories. It, like DSM-III and DSM-III-R, uses a multi-axis system.

ICD-9-CM (ICD-9-CM) codes were used to codify disorders in DSM-IV. The next version (DSM-5) specifies two codes: the ICD-9-CM code and the ICD-10-CM code for statistical purposes. ICD-10: Clinical modification(ICD-10-CM) differs from the usual ICD-10 by also changing names (for example, hebephrenic schizophrenia in ICD-10-CM is called disorganized schizophrenia, as in the DSM).

Removal of homosexuality from the list of mental disorders

DSM-IV-TR

In 2000, a “revised” (English “text revision”, literally "text revision") version of DSM-IV, known as DSM-IV-TR. Diagnostic categories and the vast majority of specific criteria for diagnosis remained unchanged. Text sections have been updated to provide additional information for each diagnosis, as well as some of the diagnostic codes, to maintain consistency with the ICD.

DSM-5

Also associated with recent successful genomic studies of mental disorders that have identified common gene polymorphisms between the mental disorders: schizophrenia, bipolar affective disorder, attention deficit hyperactivity disorder, major depressive disorder, and autism spectrum disorder. These conditions were commonly presented as the first four chapters of the DSM-5. Similarly, authors have tried to group mental disorders based on advances in neuroscience rather than psychopathology.

Collaboration with WHO and APA in the development of DSM-5

Dates of publication of the diagnostic and statistical manual

see also

Notes

1. Burlachuk L. F. Dictionary-reference book on psychodiagnostics. - 3rd ed. - St. Petersburg. : Publishing house "Peter". - pp. 126-128. - 688 p. - ISBN 978-5-94723-387-2.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). - Washington, DC: American Psychiatric Publishing, 1980. - P. 380. - 494 p. - ISBN 978-0-521-31528-9.
3. Stuart H. Fighting the stigma caused by mental disorders: past perspectives, present activities, and future directions (English) // World Psychiatry (English)Russian: journal. - 2008. - October (vol. 7, no. 3). - P. 185-188. -

General information

From a neurological perspective, ADHD is considered a persistent and chronic syndrome for which no cure has been found. Data for the United States population estimate that the disorder is present in 3-5% of people, including both children and adults.

According to the current (as of early 2007) diagnostic criteria, ADHD can be diagnosed beginning in late preschool or school age, since assessment of the child's behavior in at least two settings (e.g., home and school) is necessary to meet the requirements for diagnosis. The presence of learning and social dysfunction is a necessary criterion for the diagnosis of ADHD. The question of the objectivity of diagnosing ADHD and sufficient grounds for prescribing drug treatment remains controversial, due to the lack of uniform diagnostic criteria and methods for assessing symptoms of the disease.

Prevalence

ADHD is more common in boys. The relative prevalence among boys and girls ranges from 3:1 to 9:1, depending on diagnostic criteria, study methods, and study populations (children referred to a physician; schoolchildren; general population). Estimates of the prevalence of ADHD also depend on these same factors (from 1-2% to 25-30%). According to some data, the prevalence of the syndrome among primary schoolchildren is about 10-15%; in boys it occurred 2.8-3 times more often than in girls.

Definition and diagnostic criteria

Currently, the basis for establishing a diagnosis is phenomenological psychological characteristics. Many signs of ADHD only appear occasionally.

Impulsiveness

One of the main signs of ADHD, along with attention disorders, is impulsivity - a lack of control of behavior in response to specific demands. Clinically, these children are often characterized as reacting quickly to situations without waiting for directions and instructions to complete a task, and as not adequately assessing task demands. As a result, they are very careless, inattentive, careless and frivolous. These children are often unable to consider the potentially negative, harmful or destructive (and even dangerous) consequences that may be associated with certain situations or their actions. They often expose themselves to unreasonable, unnecessary risks in order to show off their courage, whims and quirks, especially in front of their peers. As a result, accidents involving poisoning and injury are not uncommon. Children with ADHD are much more likely to recklessly and carelessly damage or destroy someone's property than children without ADHD.

One of the difficulties in diagnosing ADHD is that it is often accompanied by other problems. A small group of people with ADHD suffer from a rare disorder called Tourette syndrome.

Diagnostic criteria for ADHD according to DSM-IV classification

I. Selecting option A or B:

A. INATTENTION To make a diagnosis, the child must have six or more of the following symptoms of inattention that have persisted for at least six months and are severe enough to indicate maladjustment and failure to meet normal age characteristics:

1. Often unable to maintain attention to detail; due to negligence and frivolity, he makes mistakes in school assignments, work and other activities.
2. Usually has difficulty maintaining attention when completing tasks or playing games.
3. Often it seems that the child does not listen to speech addressed to him.
4. Often it is not possible to adhere to the proposed instructions and fully cope with lessons, homework or duties at the workplace (which has nothing to do with negative or protest behavior, or an inability to understand the task).
5. Often has difficulty organizing independent completion of tasks and other activities.
6. Typically avoids involvement in tasks that require long-term mental stress (eg, school assignments, homework).
7. Often loses things needed at school and at home (for example, toys, school supplies, pencils, books, work tools).
8. Easily distracted by extraneous stimuli.
9. Often shows forgetfulness in everyday situations.

B. HYPERACTIVITY. The presence of six or more of the following symptoms of hyperactivity and impulsivity that persist for at least six months and are severe enough to indicate maladjustment and failure to meet normal age characteristics:

1. Restless movements in the hands and feet are often observed; sitting on a chair, spinning, spinning.
2. Frequently gets up from his seat in the classroom during lessons or in other situations where he must remain seated.
3. Often exhibits aimless motor activity: runs, spins, tries to climb somewhere, and in situations where this is unacceptable.
4. Usually cannot play quietly or do leisure activities.
5. He is often in constant motion and behaves “as if he had a motor attached to him.”
6. Often talkative.

IMPULSIVENESS

1. Often answers questions without thinking, without listening to them completely.
2. Usually has difficulty waiting his turn in various situations.
3. Often interferes with others, pesters others (for example, interferes in conversations or games).

II. ( B.) Some symptoms of impulsivity, hyperactivity and inattention begin to cause concern to others before the child reaches seven years of age.

III. ( C.) Problems caused by the above symptoms occur in two or more types of environments (for example, at school and at home).

IV. ( D.) There is strong evidence of clinically significant impairments in social interactions or school learning.

ADHD in adults

It turns out that more than half of children who suffer from this disorder continue to suffer from it into adulthood. In 30-70% of cases, ADHD symptoms continue into adulthood. Many adults who were not diagnosed with this problem in childhood do not realize that this is precisely the reason for their inability to maintain attention, difficulties in learning new material, in organizing the space around them and in interpersonal relationships.

ADHD Treatment Methods

Approaches to the treatment and correction of ADHD and available methods may differ in different countries. However, despite these differences, most experts consider the most effective an integrated approach, which combines several methods, individually selected in each case. Methods of behavior modification, psychotherapy, pedagogical and neuropsychological correction are used. “Drug therapy is prescribed according to individual indications in cases where impairments in cognitive functions and behavioral problems in a child with ADHD cannot be overcome only with the help of non-drug methods.” In the US, the addictive Ritalin is used for treatment.

There are currently several approaches to treating ADHD.

• Neuropsychological. When, with the help of various exercises, we return to the previous stages of ontogenesis and re-build those functions that were formed archaically incorrectly and have already been consolidated. To do this, they need, like any other ineffective pathological skill, to be purposefully revealed, disinhibited, destroyed and a new skill created that is more consistent with effective work. And this is carried out on all three levels of mental activity. This is labor-intensive work that lasts many months. The child is carried for 9 months. And neuropsychological correction is designed for this period. And then the brain begins to work more efficiently, with less energy expenditure. Old archaic connections, relations between the hemispheres are being normalized. Energy, management, active attention are being built.

• Syndromic. Let’s imagine that a personally mature child wants to behave in accordance with the norms, wants to learn, and perceive knowledge. His parents raised him well. He must sit quietly in class. Must be attentive and listen, control yourself. Three difficult tasks at the same time. No adult can do three jobs that are difficult for him. Therefore, syndromic work consists of giving the child an interesting (voluntary) activity. But in this activity there is post-voluntary attention (when we become interested in something and delve into it, we already tense up without additional costs). Therefore, when they say that children with ADHD are able to sit at the computer for a very long time, then this is a completely different attention.

There are outdoor games that only require attention. The child moves according to the conditions of the game, he can be explosive and impulsive. This may help him win. But the game is designed for attention. This function is being trained. Then the function of restraint is trained. At the same time, he may be distracted. Each task is solved as it arrives. This improves each function individually.

But not a single medicine teaches how to behave, so two more directions are added:

• Behavioral or behavioral psychotherapy focuses on certain behavioral patterns, either forming or extinguishing them with the help of encouragement, punishment, coercion and inspiration.

• Work on personality. Family psychotherapy, which shapes the personality and which determines where to direct these qualities (disinhibition, aggressiveness, increased activity).

This entire complex of psychocorrection methods and drug treatment, with timely diagnosis, will help hyperactive children compensate for disorders in time and be fully realized in life.

Pharmacocorrection

Causes of ADHD

The exact cause of ADHD is not known, but several theories exist. The causes of organic disorders can be:

Genetic factors

Specialists from the Medical Genetic Research Center of the Russian Academy of Medical Sciences and the Faculty of Psychology of Moscow State University have established that “most researchers agree that a single cause of the disease cannot be identified and, it seems, will never be possible.” Scientists from the USA, Holland, Colombia and Germany have suggested that 80% of the occurrence of ADHD depends on genetic factors. Of more than thirty candidate genes, three were selected - the dopamine transporter gene, as well as two dopamine receptor genes. However, the genetic prerequisites for the development of ADHD manifest themselves in interaction with the environment, which can strengthen or weaken these prerequisites.

Other commonly associated disorders

Forecast

Persons with this disease are forced to put up with a number of restrictions.

Criticism

ADHD is one of the most controversial and controversial mental disorders. ADHD and its treatment have been questioned since at least the 1970s. The existence of ADHD is questioned by many doctors, teachers, high-ranking politicians, parents and the media. The range of opinions about ADHD is quite wide - from those who do not believe that ADHD exists, to those who believe that there are genetic or physiological preconditions for this condition.

Researchers from Canada's McMaster University have identified five main points of debate:

In 1998, the US National Institutes of Health held a conference on ADHD. At the end of the conference they came to the following conclusion:

“...We do not have an independent, reliable test for ADHD, and there is no evidence to suggest that ADHD is caused by a brain disorder.”

Lack of clarity regarding what qualifies as ADHD and changes in diagnostic criteria have led to confusion. Ethical and legal issues regarding treatment have been major areas of controversy, particularly the use of psychostimulants in treatment, as well as the promotion of stimulants for the treatment of ADHD by groups and individuals who receive money from pharmaceutical companies.

Medical professionals and news outlets have argued that the diagnosis and treatment of the disorder deserve more thorough investigation.

Alternative theories that have been proposed to explain the symptoms of ADHD include Hunter vs. farmer theory, Neurodiversity, and Social construct theory of ADHD.

Some individuals and groups completely deny the existence of ADHD. These include Thomas Szasz, Michel Foucault, and groups such as the Citizens' Commission on Human Rights (CCHR). However, most medical authorities and US courts consider ADHD diagnoses to be legitimate. (See Ritalin class action lawsuits)

Literature

In Russian

• Altherr P., Berg L., Wölfl A., Passolt M. Hyperactive children. Correction of psychomotor development. - M: Publishing center "Academy", 2004
• Bryazgunov I.P., Kasatikova E.V. Restless child or everything about hyperactive children. - M.: Publishing House of the Institute of Psychotherapy, 2002
• Bryazgunov I.P., Kasatikova E.V. Attention deficit with hyperactivity in children. - M.: Medpraktika-M, 2002
• Zavadenko N.N. Hyperactivity and attention deficit in childhood. - M.: Publishing center "Academy", 2005.
• Zavadenko N.N. How to understand a child: children with hyperactivity and attention deficit disorder. - School-Press, 2001
• Zavadenko N.N., Suvorinova N.Yu., Rumyantseva M.V. Attention deficit hyperactivity: risk factors, age dynamics, diagnostic features. - Defectology, 2003, No. 6
• Monina G.B., Lyutova-Roberts E.K., Chutko L.S. Hyperactive children. Psychological and pedagogical correction. - St. Petersburg: Speech, 2007
• Murashova E.V. Children are “mattresses” and children are “disasters”. Hypodynamic and hyperdynamic syndrome" - Ekaterinburg: U-Factoria, 2004.
• Russell A. Barkley, Christina M. Benton. Your naughty child. - St. Petersburg: Peter, 2004
• Chutko L.S., Palchik A.B., Kropotov Yu.D. Attention deficit hyperactivity disorder in children and adolescents. - St. Petersburg: Publishing house SPbMAPO, 2004
• Chutko L.S. Attention deficit hyperactivity disorder and related disorders. - St. Petersburg: Khoka, 2007

In foreign languages

• Hartmann, Thom "Attention Deficit Disorder, A Different Perception" subtitled "A Hunter in a Farmers World".
• Barkley, Russell A. Take Charge of ADHD: The Complete Authoritative Guide for Parents(2005) New York: Guilford Publications.
• Bellak L, Kay SR, Opler LA. (1987) "Attention deficit disorder psychosis as a diagnostic category." Psychiatric Developments, 5 (3), 239-63. PMID 3454965
• Conrad, Peter Identifying Hyperactive Children(Ashgate, 2006).
• Crawford, Teresa I"m Not Stupid! I"m ADHD!
• Green, Christopher, Kit Chee, Understanding ADD; Doubleday 1994; ISBN 0-86824-587-9
• Hannah, Mohab. (2006) Making the Connection: A Parent's Guide to Medication in AD/HD, Washington D.C.: Ladner-Drysdale.
• Joseph, J. (2000). "Not in Their Genes: A Critical View of the Genetics of Attention-Deficit Hyperactivity Disorder", Development Review 20, 539-567.
• Kelly, Kate, Peggy Ramundo. (1993) You Mean I"m Not Lazy, Stupid or Crazy?! A Self-Help Book for Adults with Attention deficit Disorder. ISBN 0-684-81531-1
• Matlen, Terry. (2005) "Survival Tips for Women with AD/HD." ISBN 1886941599
• Ninivaggi, F.J. "Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Rethinking Diagnosis and Treatment Implications for Complicated Cases", Connecticut Medicine. September 1999; Vol. 63, No. 9, 515-521. PMID 10531701

Notes

1. LONI: Laboratory of Neuro Imaging
2. NINDS Attention Deficit-Hyperactivity Disorder Information Page. National Institute of Neurological Disorders and Stroke (NINDS/NIH) February 9, . As of 2007-08-13.
3. Dr. Russell A. Barkley Official Site, Authority ADHD, Attention Deficit Hyperactivity Disorder
4. Attention-Deficit/Hyperactivity Disorder (ADHD). (English) Data from the site Behavenet.com. Information collected on December 11, 2006.
5. Vincent Parrillo Encyclopedia of Social Problems. - SAGE, 2008. - P. 63. - ISBN 9781412941655
6. Treatment of Attention-Deficit/Hyperactivity Disorder. US department of health and human services (December 1999). Retrieved October 2, 2008.
7. Harv Rev Psychiatry 16 (3): 151–66. DOI:10.1080/10673220802167782. PMID 18569037.
8. Developmental psychopathology. - Chichester: John Wiley & Sons, 2006. - ISBN 0-471-23737-X
9. ADD/ADHD Health Center. (English) Information from the site WebMD.com. Data collected December 11, 2006.
10. Attention deficit/hyperactivity disorder. E.D. Belousova, M.Yu. Nikanorova. Department of Psychoneurology and Epileptology, Moscow Research Institute of Pediatrics and Pediatric Surgery, Ministry of Health of the Russian Federation
11. Attention deficit hyperactivity in children: modern approaches to pharmacotherapy N.N. Zavadenko, N.Yu. Suvorinova, N.V. Grigorieva. Department of Nervous Diseases, Faculty of Pediatrics, Russian State Medical University, Moscow
12. RIA News
13. Tragedy in Belgium: is the “American syndrome” to blame?
14. Ritalin addiction help
15. http://www.cchr.ru/press1.html Child psychiatrists in Australia, Finland and Denmark got a slap on the wrist
16. Stimulant medication for the treatment of attention-deficit hyperactivity disorder: evidence-b(i)ased practice? -- Bailly 29 (8): 284 -- Psychiatric Bulletin.
17. Genetics of hyperactivity and attention deficit // Chemistry and life. 2008. No. 1., p. 5
18. Mayes R, Bagwell C, Erkulwater J (2008). "ADHD and the rise in stimulant use among children." Harv Rev Psychiatry 16 (3): 151–66.

Paranoid

Schizoid

Schizotypal

Cluster B (theatrical, emotional or fluctuating disorders):

Antisocial

Border

Hysterical

Narcissistic

Cluster C (anxiety and panic disorders):

Avoidant

Dependent

Obsessive-compulsive

Personality disorders

This section begins with a general definition of personality disorder that applies to each of the 10 specific disorders. All personality disorders are coded on Axis II.

General diagnostic criteria for personality disorder.

A. A long-term pattern of internal experiences and behavior that clearly deviates from cultural expectations. This pattern appears in two (or more) of the following areas:

1 – cognitive sphere (i.e. ways of perceiving or understanding oneself, other people and current events),

2 – affective sphere (i.e. range, intensity, lability, acceptability of emotional reactions),

3 – interpersonal functioning,

4 – impulse control.

B. This long-term pattern is inflexible and pervasive across a wide range of situations of personal and social functioning.

C. This pattern results in overt clinical impairment or impairment in social, occupational, or other important areas of functioning.

D. This pattern is stable and long-lasting, and its establishment can be traced back to at least adolescence or young adulthood.

E. This pattern is not a manifestation or consequence of another mental illness.

F. This pattern is not a direct psychological result of substance use (eg, drugs or medications) or a general health condition (eg, head injury).

Cluster a.

301.0 Paranoid personality disorder

A. Deep distrust and suspicion of others, with an interpretation of the motives of their behavior as malevolent, beginning in youth and present in a variety of contexts, as determined by four (or more) of the following factors:

1- Suspicion, without reasonable grounds, that others are exploiting, harming or deceiving him/her

2- preoccupation with unjustified doubts about the fidelity or reliability of friends or partners

3- reluctance to disclose to others due to unjustified fears that the information received will be maliciously used against him/her

4- looking for hidden meanings or threatening signs in innocuous remarks or events

5- constant hostility, i.e. refusal to forgive insults, insults, ridicule

6- feeling attacks on one's character or reputation that are not visible to others, with an immediate reaction of anger or counterattack

7- repeated suspicions, without sufficient grounds, of the fidelity of a spouse or sexual partner.

B. Does not occur exclusively in association with schizophrenia, mood disorders with psychotic features, other psychotic disorders, and is not a direct physiological result of a medical condition.

Note: If these factors occur before the onset of schizophrenia,” add “premorbid,” for example, “paranoid personality disorder (premorbid).”

IN The basis for the diagnosis of mental disorders is the principles of good clinical practice, including the objectivity and reliability of diagnostic research, which ensures comparability and reproducibility of diagnostic decisions of psychiatrists who have different levels of professional training and work in different countries [ , , ,].

Such objectivity and reliability in modern diagnostic process algorithms is realized through the use of diagnostic and statistical manuals, guidelines, classifications, which include the International Classification of Disease (ICD) and the Diagnostic and Statistical Manual (DSM). The use of classifications and guidelines as diagnostic standards reflects the desire of the professional community to identify the patient's disorders in accordance with clinical reality, while minimizing the influence of subjective factors.

Overcoming the factor of subjectivism is especially important in psychiatry, where methodologies based specifically on subjective assessment have become widespread [,].

In addition to standardization, diagnostic guidelines and classifications are aimed at solving the following problems:

Historically, the situation has developed that the United States uses the DSM, which is developed, updated and implemented by the American Psychiatric Association (APA), while European countries use the ICD, the adoption and updating of which is the prerogative of the World Health Organization (WHO). It should be noted that since 1982, the improvement and development of these two classification systems has been coordinated. Each of the classifications preserves the traditions of national psychiatric schools.

Thus, since 1994, DSM-IV was used in the USA, during the same period ICD-10 was introduced in Europe, which has been in effect in Ukraine since 1998. The implementation of these two classifications in practical work has made it possible to achieve certain progress towards standardizing psychiatric diagnosis.

The development of modern neurosciences (genetics, neurochemistry, neuroimaging methods) in combination with the results of clinical, psychopathological and phenomenological studies has contributed to the accumulation of scientific data in favor of the variability of individual characteristics of psychopathological phenomena included in one diagnostic category of classifications.

The desire to personalize the diagnostic and therapeutic process, to reflect in diagnostic criteria the diversity of psychopathology, the dynamics of disease, the degree of cognitive deficit, the influence of environmental and biological correlates, response to therapy and many other factors became the motive for improvement and development of existing classification systems [,].

Therefore, over the past decade, WHO and APA have been actively preparing new revisions of the DSM and ICD. This work involved experts in the field of psychiatry, neurology, neuroscience, public organizations and consumers of care. The work of numerous expert groups was based on a detailed analysis of evidence in the field of psychopathology, phenomenology, genetics, and neuroimaging. When preparing the classification, experts paid considerable attention to the international compatibility of classifications (DSM and ICD), including the integration of cultural aspects with diagnostic criteria.

In May 2013, the fifth edition of the Diagnostic and Statistical Manual (DSM-5) was published, which is being actively implemented and used in the United States. By that time, the development of ICD-11 was almost completed, but its technical preparation and approval takes some time.

This situation creates difficulties in collecting and transmitting information, in particular in understanding modern diagnostic trends between specialists working on ICD-10 (including doctors in Ukraine) and doctors who use DSM-5. Despite the fact that ICD-10 is a generally recognized diagnostic system, specialists working in the field of mental health, scientists, and researchers involved in clinical trials in our country feel an urgent need to understand and practically master the content of the updated system of diagnostic criteria contained in DSM-5.

Table. DSM-5 Diagnostic Chapters

A comparison of the diagnostic categories of DSM-5 and ICD-10 is presented to your attention in this article. In general characterization of the DSM-5, it should be noted that it used a new validation of features, which allowed all forms of pathology to be combined into groups of disorders (spectrums), thereby limiting the designation of categorical ranges. It must be emphasized that almost all chapters of the classification have undergone transformation to one degree or another. Such changes are due to the fact that the DSM-5 is based not only on the criteria of clinical psychopathology, but also on signs obtained as a result of the development of neuroscience (genetics, neuromorphology, biochemistry, etc.) (table).

The main difference between DSM-5 and previous classifications (DSM-IV and ICD-10) is the transition from the categorical diagnostic principle to the dimensional one. The methodology for this transition includes: the use of specifiers and subtypes, the combination and separation of disorders, the removal of categories and changes in terminology.

The inclusion of severity specifiers in the DSM-5 helps assess the clinical picture and provide information for developing the best treatment strategy, since treatment regimens differ significantly for different degrees of severity.

A comparison of the DSM-5 and ICD-10 classification categories shows that DSM-5 has new categories. - The heading “Mental developmental disorders” combines the pathology of the headings “Mental retardation” (F7) and “Disorders of psychological development” (F8) of ICD-10. The category “Aggressive conditions, impulsive and behavioral disorders” includes conditions that were previously diagnosed in the categories “Mature personality disorders” (F6) and “Unspecified mental disorders” (F99). The DSM-5 Gender Dysphoria section includes ICD-10 Gender Identity Disorders (F64).

The heading “Neurocognitive disorders” contains diagnostic criteria corresponding to various types of dementia and other organic disorders of the heading (F0). Thus, the section “Paraphilias” corresponds to the ICD-10 heading “Disorders of sexual preference” (F65), and the heading “Drug-induced movement disorders and other side effects of pharmacotherapy” includes criteria for diagnosing disorders that developed as side effects. effects of taking antipsychotics and antidepressants (in ICD-10 these manifestations were included in categories G21, G24, G25 and T43).

Many DSM-5 diagnostic chapters are the result of section divisions. In particular, the DSM-5 categories “Bipolar and related disorders” and “Depressive disorders” in ICD-10 were included in the same section “Affective disorders” (F3) of ICD-10. New diagnostic chapters of DSM-5 “Anxiety disorders”, “Obsessive-compulsive and related disorders”, “Disorders associated with mental trauma and stress”, “Mental disorders with a predominance of somatic symptoms and related conditions” in ICD-10 made up the section “Neurotic, stress-related and somatoform disorders” (F4).

The next example of disconnection is the chapter “Sleep Disorders.” Subtypes of sleep disorders associated with breathing disorders are considered in the DSM-5 as separate disorders (obstructive sleep apnea and hypopnea, central apnea, sleep-related hypoventilation). The combination of ICD-10 diagnostic criteria G47 and F51 led to the creation of the DSM-5 chapter “Sleep-Wake Disorders.” The DSM-5 categories Eating and Eating Disorders and Excretion Disorders largely contain the criteria of the ICD-10 categories F50 and F98.

As a clear example of combining categories, we can consider autism spectrum disorder, in which specifiers allow us to highlight the degree of intellectual decline, the structure of speech impairments, concomitant pathology and loss of acquired skills.

Another example of unification is the section on the use of psychoactive substances (PAS) and addictive disorders. The rubric is a combination of two DSM-IV rubrics (substance abuse and dependence). Adding a severity scale to this section makes it possible to diagnose a mild disorder as abuse, and a moderate and severe disorder as a state of dependence on psychoactive substances.

The DSM-5 chapter “Schizophrenia spectrum disorders and other psychotic conditions” contains criteria that are presented in the ICD-10 under the heading “Schizophrenia, schizotypal and delusional disorders” (F2), and “Substance-related disorders and addictive states" - in the heading "Mental and behavioral disorders due to the use of psychoactive substances" (F1).

The use of specifiers and subtypes in DSM-5 makes it possible to individualize the diagnosis and identify subgroups of symptoms that are targets for therapeutic intervention, which corresponds to the dimensional orientation of the classification. An example of the introduction of specifiers is the use of the category “with mixed features,” which is used to diagnose unipolar and bipolar depression and provides for the prescription of specific forms of therapy.

The most revealing subtypes of disorders are presented in the section “Neurocognitive disorders”, which corresponds to the section of dementia and organic cerebral pathology in ICD-10. This section presents etiological subtypes with separate descriptions and criteria for them (Alzheimer's disease, frontotemporal degeneration, pathology with Lewy bodies, vascular pathology, traumatic brain injury, HIV infection, prion infections, Parkinson's disease, Huntington's chorea, etc.) .

Based on a review of the current neuroscience evidence based on clinical relevance, DSM-5 identifies new disorders, the main ones being: pathological hoarding; destructive mood dysregulation disorder (DMDD); compulsive overeating; premenstrual dysphoric disorder; restless legs syndrome; behavior disorder caused by disturbance of the rapid phase of sleep. Commenting on the clinical significance of the introduction of new disorders, it should be emphasized that new disorders, on the one hand, make it possible to improve diagnosis, and on the other, to avoid the stigmatizing influence of a psychiatric diagnosis. In the case of a growing number of bipolar disorders (BD) in childhood, clinicians in certain clinical situations have the opportunity to take children with symptoms of persistent irritability and violation of social norms beyond BD, including them in the DMDD group.

A lively debate among experts and professionals has been sparked by the removal of the DSM-IV category of grief reactions, which allowed bereaved individuals to avoid being diagnosed with a depressive disorder for two months. Experts decided that in this context there is an underdiagnosis of depression, as a result of which patients do not receive adequate treatment. Therefore, the DSM-5 introduced a descriptive characteristic to distinguish between symptoms of “normal” and pathological reactions to bereavement.

The change in terms in the DSM-5 is aimed, first of all, at destigmatizing psychiatric diagnoses, at “mitigating” the psychological consequences that arise in patients and their environment after being diagnosed with such diagnoses as “schizophrenia”, “mental retardation”, “dementia”.

The DSM-5 eliminated the term “mental retardation” and replaced it with the term “intellectual developmental disorder.” The term “dementia” has been replaced by “neurocognitive disorder”, and instead of “substance abuse” and “substance dependence” the term “substance use disorders and addiction” is used.

Considering that all sections of the DSM-5 underwent transformation during the processing process, the description of all updated diagnostic criteria is a lengthy process. This article presents changes in the diagnostic criteria for schizophrenia, bipolar and depressive disorders, which are most often used in scientific research and attract the attention of practicing physicians.

The chapter of DSM-5, which is devoted to schizophrenia spectrum disorders and other psychotic conditions, contains diagnostic criteria for the following forms of pathology:

1. Delusional disorders - 297.1 (F22).

2. Transient psychotic disorders - 298.8 (F23).

3. Schizophreniform disorder - 295.40 (F20.81).

4. Schizophrenia - 295.90 (F20).

5. Schizoaffective disorder - 295.70 (F25.0, F 25.1).

6. Psychotic disorders caused by the use of psychoactive substances and drugs (coding depends on the type of drug that is used).

7. Psychotic disorders caused by other medical conditions (coding depends on the underlying disease).

8. Catatonia associated with other mental disorders - 293.89 (F06.1).

9. Catatonic disorder due to other medical conditions - 293.89 (F06.1).

10. Other schizophrenia spectrum disorders and psychotic disorders - 298.9 (F29).

The main differences between the diagnostic criteria for schizophrenia in DSM-5 and ICD-10

The DSM-5 chapter on bipolar disorders describes diagnostic criteria for the following disorders:

1. BR type I - 295.40-295.46.

2. BR type II - 296.89 (F31.81).

3. Cyclothymic disorders - 301.13 (F34.00).

4. Bipolar and similar disorders caused by the use of psychoactive substances and medications (coding depends on the underlying disease).

5. Bipolar and related disorders caused by other medical conditions (coding depends on the underlying disease).

6. Other bipolar and related disorders - 296.89 (F31.81).

7. Inaccurately bipolar and related disorders - 296.80 (F31.9).

Comparison of diagnostic criteria for bipolar disorder in DSM-5 and ICD-10

Characteristics of severity, state of remission and the presence of psychotic features are qualified in both classifications.

The DSM-5 chapter on depressive disorders includes diagnostic criteria for the following disorders:

1. Destructive mood dysregulation disorder - 296.99 (F34.8).

2. Major depressive disorder - 296.20-296.26 (F32.0-32.5, 32.9), 296.30-296.36 (F33.0-F33.42, 33.9).

3. Persistent depressive disorder (Dysthymia) - 300.4 (34.1).

4. Premenstrual dysphoric disorder - 625.4 (N94.3).

5. Depressive disorder caused by the use of psychoactive substances and drugs (coding depends on the type of drug used).

6. Depressive disorder due to other medical conditions (coding depends on the underlying disease).

7. Other depressive disorders - 311 (F32.8).

8. Unspecified depressive disorders - ----311 (32.9).

Analysis of diagnostic criteria for major depressive disorder in DSM-5 and ICD-10

Summarizing the data presented in the article, it should be noted that DSM-5 is based on a dimensional approach, which provides an assessment of each form of pathology in a single “norm-pathology” continuum using numerous specifiers of subtype, severity, and course, which makes the diagnosis personalized. ICD-10 takes a categorical approach, aiming to define a pathological disorder as a discrete phenomenon.

Elimination of Schneider's first rank symptoms, forms and types of disease used in ICD-10 is a difference in the diagnosis of schizophrenia in DSM-5. It is the DSM-5 diagnostic criteria that include the definition of positive and negative symptoms, social functioning, duration of the disorder and differential diagnostic criteria. The dynamic specification allows you to determine whether a patient has a first episode, several episodes, an exacerbation of the condition, or the degree of remission. In particular, the severity of the condition is assessed on a 5-point scale when determining the main psychopathological dimensions.

Compared to ICD-10, the diagnostic criteria for BD in DSM-5 are expanded by identifying type I BD, introducing a criterion for changes in affect when using antidepressants, diagnosing BD due to the use of psychoactive substances, medications and other medical conditions. Diagnostic classifiers allow the assessment of individual characteristics of BD (with features of anxious distress; rapid cycling; catatonia; mixed features; atypical features, with a seasonal pattern, with peripartum onset, with psychotic features, congruent or incongruent with mood). Instead of the category “mixed episode,” the specifier “with mixed features” is used.

In order to objectify depressive disorders, the diagnostic criteria for depression in DSM-5 provide ample opportunities, which is achieved by introducing new categories (compared to ICD-10):

1) disruptive mood dysregulation disorder (DMDD);

2) persistent depressive disorder (a combination of chronic depression and dysthymia);

3) depressive disorder caused by the use of psychoactive substances, medications or other medical conditions.

The basis for diagnosing MDD is the identification of two leading symptoms: depressed mood and anhedonia (ICD-10 adds “loss of energy”). The use of specifiers allows us to provide an individual approach to the diagnosis of MDD, and descriptive criteria allow us to separate “normal” and “pathopsychological reactions to bereavement.”

In addition, familiarization with the DSM-5 diagnostic criteria for specialists working in the field of mental health in Ukraine opens up wide opportunities for exchanging information and mastering the updated system of diagnostic approaches and criteria.

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A complete list of references, including 17 items, is in the editorial office.