Term Paper on "DSM5, DSM 4 TR and Neurocognitive Disorders"

Term Paper 6 pages (1872 words) Sources: 3

[EXCERPT] . . . .

Neuro-Cognitive Disorders in DSM 5 &

REFINING, EXPANDING, CONTINUING WORK

Neuro-cognitive Disorders in DSM 5 and DSM -- IV

Neurocognitive Disorders

The first of five clusters of mental disorders covers neurocognitive disorders, i.e., dementia, delirium, amnestic and other cognitive disorders in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV and Organic, including Symptomatic Mental Disorders in the tenth revision of the International Classification of Diseases or ICD (Sachev et al., 2009). The term neurocognitive has replaced cognitive and organic, respectively, in these two documents. The disorders in this cluster distinguish themselves as possessing demonstrable neural substrate abnormalities, cognitive symptoms and deficits. The causes of these disorders vary but they share common neurobiological characteristics for mental disorders than any of the other clusters (Sachev et al.).

Essential Psychopathology

Delirium is a cognitive disorder characterized mainly by a decreased awareness of one's environment or a clouding of consciousness (Maxmen & Ward, 1995). Its signs occur without warning for many hours to days, and fluctuate erratically especially at night and in the dark. Other signs and symptoms are agitation and fright, illusions, hallucinations, incoherent speech, disturbed cycle of sleep and wakefulness and disorientation with time and place. Behavioral change can be sudden and unexplained. Accidents often occur in delirious patients. The cause may be medical, surgical, chemical or neurological or sensory isolation, often in an intensive or cardiac care unit. It can be mistaken for normal personality traits, dementia, strokes or schizophrenia. Management consists of all measures to keep the patient alive, prevent brain damage and self-farm. Review of family history, referral to a physician, careful nursing care, constant observation and physical control are also often called for (Maxmen & Ward).

Dementia involves a loss of intellectual abilities, particularly memory, judgment, abstract thinking and language, personality changes and impulse control (Maxmen & Ward, 1995). The condition may be gradual or sudden, as after a fall or head injury. Deterioration of functions may go unnoticed for months or years or taken as the result of normal aging. Its subtypes are Alzheimer's disease as the most common, vascular dementia, dementia association with medical conditions, and substance-induced dementia. Secondary dementias are treatable. Dementia is life-shortening and renders patient susceptible to medical illness and delirium. Incidence rises with age, often between 70 and 80. Biological causes differ according to subtype, which psychological causes depend on one's personality and circumstances. During diagnosis, it may be mistaken for delirium, pseudo-dementia, depression, Management or treatment may be in the form of biomedical interventions, such as calming drugs, or psychosocial interventions, consisting of appropriate patient care and family counseling (Maxmen & Ward).

Amnesiic Disorders involve loss of memory, often due to a specific occurrence, such as a strike at the hippocampus, toxins like alcohol (Maxmen & Ward, 1995). Memory of remote events may deteriorate while other mental functions remain. These disorders are managed by eliminating alcohol use and exposure to toxins, improving nutrition and controlling hypertension (Maxmen & Ward).

DSM-IV-TR

Organic mental disorders were grouped into 1. delirium, dementia, and amnestic and other cognitive disorders; 2. mental disorders due to a general medical condition; and 3) substance-related disorders (American Psychological Association, 2000).

A delirium is described as a disturbance of consciousness and changed cognition, which develops within a short period (American Psychological Association, 2000). It can be caused by a medical condition, a substance, to multiple causes, or some unknown or indeterminate factor. Other features are a disturbed sleep-wake cycle, disturbed psychomotor behavior, emotional disturbances especially at night or when stimulated, and nonspecific abnormalities, like tremor or changes in reflex and muscle tone. Cultural and educational backgrounds are important considerations when evaluating cases. Children, older adults and men are especially susceptible. It is most prevalent among those aged 55 or older in the general population; about 10-15% among hospitalized older persons upon admission; 60% among nursing home residents aged 75 and older; 30-40% of hospitalized AIDS patients; and up to 80% among those with terminal illnesses. It is most commonly mis-diagnosed as dementia because of memory loss, which is common between these disorders. It must also be distinguished from brief psychotic disorders and mood disorders with psychosis and from fear, anxiety and dissociative symptoms, and acute stress disorder (American Psychological Association).

Dementia is a condition of multiple cognitive deficits as the direct effects of some general medical condition, a substance or multiple causes (American Psychological Association, 2000). Dementia disorders share a common symptom but differ in their causes. These causes are Alzheimer's Disease, vascular, HIV disease, head trauma, Parkinson's Disease, Huntington's Disease, Pick's Disease, Creutszfeldt-Jakob Disease, other general medical conditions, substances, and multiple causes. Memory impairment is its most essential feature, accompanied by aphasia, apraxia, agnosia, or disturbed executive functioning. It usually develops late in life, especially beyond age 85. It is progressive and irreversible. It can be mis-diagnosed as delirium, amnestic disorder or another type of dementia, mental retardation, manic-depressive disorder, malingering and factitious disorder, or the normal deterioration of cognitive abilities due to aging (American Psychological Association).

Amnestic Disorders are disturbances in memory functioning due to the effects of a medical concition or a substance (American Psychological Association, 2000). They share the common symptom of memory impairment but differ in causes. Causes identified are a general medical condition, a substance and unspecified factors. They are accompanied by confusion and disorientation, some attention problems, denial of the condition, lack of initiative and changed personality function. Traumatic brain injury, stroke or cerebrovascular injury or exposure to neurotoxic substance, prolonged substance abuse, neurotoxic exposure or sustained nutritional deficiency may lead to these disorders. It may be mistaken for dissociative amnesia or dissociative disorders or memory disturbances caused by intoxication or withdrawal from some abused drugs. They should also be differentiated from malingering and factitious disorder (American Psychological Association).

These neurocognitive disorders or NCD are delirium and major NCD, mild NCD and theie etiological subtypes (American Psychological Association, 2013). These major or mild subtype are NCD caused by Alzheimer's Disease, vascular NCD, NCD with Lewy bodies, NCD caused by Parkinson's Disease, frontotemporal NCD, NCD cused by traumatic brain injury, NCD caused by the HIV infection, NCD from multiple causes, and unspecified NCDs NCD covers disorders characterized mainly by chronic function deficit, which are acquired more than developmental. Impaired cognition is present since birth or early in life. NCDs are unique categories because they are syndromes wherein the underlying causes can be determined (American Psychological Association).

The criteria for these disorders were designed upon consultation with experts in each of the disorders and after aligning with the consensus criteria for each (American Psychological Association, 2013). Dementia was categorized a major NCD. DSM-5 also recognizes and listed less severe cognitive impairments as mild NCDs derived from DSM-IV as "Cognitive Disorder not Otherwise Specified. Syndromes and the different subtypes are provided. Many NCDs coexist with one another and are thus characterized under various chapter subheadings. Dementia is retained as referring to degenerative dementia in older adults. DSM-5, however, uses NCD for younger persons afflicted with impairment caused by traumatic brain injury or HIV. Moreover, NCD has a broader coverage than dementia in which persons suffering from substantial decline in one category may be accorded with diagnosis for the Amnestic Disorder category of DSM-IV, now recognized as a major NCD caused by another medical condition and for which the term dementia is not applicable. The criteria for the different NCDs are based on their defined cognitive domain. Each key domain provides a working definition, symptoms of the impairments in everyday activities, and examples of assessments. The domains and clinical guidelines enable the diagnosis of the NCDs, their levels and their subtypes (American Psychological Association).

2. Comparison and Contrast between DSM4 TR and DSM 5

The Task Force that produced DSM-5 was guided by two principles (Ganguli et al. 2012). It was to propose changes according to advances in scientific knowledge, current views and clinical practices. These changes were to come from a full awareness of the controversies and challenges in the field. The other principle was to avoid making those changes just for the sake of making them. The Task Force was conscious of the disruptive and even expensive nature of all change. Fortunately, most of the disorders were the subject of extensive, intense and productive research since DSM-IV. In comparison with DSM-IV, the underlying pathology -- and the etiology in some - for most of the disorders in DSM-5 is known. Our group defined broad categories using descriptive rather than etiologic concepts. It defined categories of disorders where the primary clinical deficit is cognitive function. The Task Force also concentrated on disorders, which were acquired more than those that were developmental. These were disorders in which impaired cognition did not exist since birth or early in life. They must be the result of a decline from earlier functioning (Ganguli et al.).

The DSM-IV-TR also limited mental disorders to those within the individual (Heyman et al., 2009). It gave little attention to clinically significant behavioral or psychological syndromes or patterns between… READ MORE

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