Stressor- and trauma-related neuropsychiatric conditions

Opsychiatric disorders. Identify biological and psychosocial aspects of stressor- and trauma-related neuropsychiatric conditions. Discuss resources available for the management of stress and health promotion. “Normal” means that the value falls within 2 SD of the mean/median (approx 96% of the population) – in a normal distribution curve:you capture 68% of the population within 1 SD above & below the median/meanyou capture 95-96% of the population within 2 SD above & below the median/meanWe are usually measuring what are called continuous biologic variables that occur within a particular rangeThese usually will plot out as a “normal” bell-shaped curve you capture 68% of the population within 1 SD above & below the median/mean you capture 95-96% of the population within 2 SD above & below the median/mean We are usually measuring what are called continuous biologic variables that occur within a particular range These usually will plot out as a “normal” bell-shaped curve Examples: serum cholesterol blood pressure temperature Mental disorders:Comparing symptoms and behaviors with the general populationIdentifying patterns that differ from the norm Comparing symptoms and behaviors with the general population Identifying patterns that differ from the norm Treatment depends on the paradigm A paradigm is a “way of thinking about something” Treatments are matched to the paradigm (model) that explains the abnormalities:Medical (treatments are drugs surgery other clinical procedures)Psychodynamic (treatment is psychotherapy)Behavioral (treatments are learning therapies such as behavioral modification)Cognitive (treatment could be cognitive behavioral therapy) Medical (treatments are drugs surgery other clinical procedures) Psychodynamic (treatment is psychotherapy) Behavioral (treatments are learning therapies such as behavioral modification) Cognitive (treatment could be cognitive behavioral therapy) Terminology – these terms are often used interchangeably:MentalBehavioralPsychiatricNeuropsychiatric Mental Behavioral Psychiatric Neuropsychiatric Signs and Symptoms:Signs are observable characteristics that differ from the norm (also called findings) and are considered objective dataSymptoms are what is reported by the patient and are considered subjective data Signs are observable characteristics that differ from the norm (also called findings) and are considered objective data Symptoms are what is reported by the patient and are considered subjective data Patterns:Facts have been accumulating for thousands of years due to the recording of objective and subjective data by diagnosticians.This has led to the knowledge of patterns of normal and abnormal functions.In time when these patterns became descriptively distinctive a disease name was assigned.We are just “making up a name” for a disease based on a recurring collection of symptoms and signsExamples:in 1982 nobody knew about AIDS but they could collect common symptoms and signs and eventually called it a “disease”to diagnose “Metabolic Syndrome” the patient must have 3 out of 5 criteria to fit the diagnosis (the five criteria are hypertension elevated triglycerides elevated blood sugar increased waist measurement low HDL-Cholesterol based on sex). Facts have been accumulating for thousands of years due to the recording of objective and subjective data by diagnosticians. This has led to the knowledge of patterns of normal and abnormal functions. In time when these patterns became descriptively distinctive a disease name was assigned. We are just “making up a name” for a disease based on a recurring collection of symptoms and signs Examples:in 1982 nobody knew about AIDS but they could collect common symptoms and signs and eventually called it a “disease”to diagnose “Metabolic Syndrome” the patient must have 3 out of 5 criteria to fit the diagnosis (the five criteria are hypertension elevated triglycerides elevated blood sugar increased waist measurement low HDL-Cholesterol based on sex). in 1982 nobody knew about AIDS but they could collect common symptoms and signs and eventually called it a “disease” to diagnose “Metabolic Syndrome” the patient must have 3 out of 5 criteria to fit the diagnosis (the five criteria are hypertension elevated triglycerides elevated blood sugar increased waist measurement low HDL-Cholesterol based on sex). Thus all diseases (conditions syndromes) are simply our way of trying to define recurring patterns of collections of signs and symptoms so that we can recommend treatment and study outcomes of treatment or nontreatment. From then on additional findings and cross-references to other disease states are added to the body of knowledge using the disease name. In order to discuss or study these conditions we must agree upon a terminology Often the phrase “by convention” is used – meaning that we are coming together as a group (convening) to define and agree upon these definitions This terminology is also called the nomenclature (naming rules) Over time with new knowledge gained from research and observation the agreed-upon terminology can change This is written by a panel of experts and revised periodically to reflect current knowledge The professional society that authors this manual is the American Psychiatric Association (APA) DSM-5 (the fifth version of the manual) has been released as of May 2013 With each revision there is usually tremendous controversy over proposed changes Making a diagnosis – this may qualify an individual for social services treatments and medications (changes in terminology may enfranchise some and disenfranchise others) Studying individuals with the diagnosis (if the terminology changes older studies may not be as useful since the selection of research subjects may not match the newer designations) Making social policy (much social policy is determined by the impact of illnesses in terms of numbers affected age of those affected and other similar factors) Providing guidance for treatment (both pharmacological and nonpharmacological) In fact drugs marketed in this country are under the auspices of the Food and Drug Administration (FDA) Every drug on the market has certain “indications” (what the drug can be used for) If the terminology changes this could invalidate the accepted use of many medications (and may prevent payment for medications and/or services) Example of changes causing controversy:The DSM-5 will not list Asperger’s Syndrome as a separate diagnosis – it only has Autism Spectrum Disorder as a diagnosis for autism Asperger’s and pervasive developmental disorderMany with prior diagnoses of Asperger’s are concerned that they may not receive services or have the same level of group identity The DSM-5 will not list Asperger’s Syndrome as a separate diagnosis – it only has Autism Spectrum Disorder as a diagnosis for autism Asperger’s and pervasive developmental disorder Many with prior diagnoses of Asperger’s are concerned that they may not receive services or have the same level of group identity Current concepts of psychiatric illnesses are moving towards an appreciation of their neurobiological causes The segregation of illnesses into one category or another is becoming outdated for many of the illnesses included in the DSM Thus the term that is often used is “neuropsychological” or “neuropsychiatric” disorder The removal of the exception for bereavement (grief) in the DSM-5 allows for an immediate diagnosis of depression; this recognizes bereavement as a stressor that can trigger a depressive episode (i.e. depression can be diagnosed without a waiting period for “grieving”). Disruptive mood dysregulation disorder is added as a pediatric diagnosis for children with “persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year” – although some feel this is too broad and will inappropriately label some children the rationale is to reduce the incorrect diagnosis of bipolar disorder. The term “gender identity disorder” will be replaced by “gender dysphoria” (emotional distress about their gender identity). Hoarding will be a separate condition from obsessive compulsive disorder. Excoriation (skin-picking) will be added. Posttraumatic stress disorder will have expanded domains and more symptoms included as descriptors. Substance abuse and substance dependence are combined into one term “substance use disorder” (note this has been in general use already by addiction specialists). Dyslexia remains in the category of learning disorders. Pedophilia has a name change to “pedophilic disorder.” Some disorders that were proposed for inclusion will not be in the manual or will be recommended for further study – including attenuated psychosis syndrome Internet use gaming disorder nonsuicidal self-injury suicidal behavioral disorder hypersexual disorder (sex addiction) anxious depression parental alienation syndrome and sensory processing disorder. The old “axis” organization will be replaced by a simple chapter scheme with chapters arranged so that related disorders will be close to each other. The nervous system includes the brain spinal cord and nerves in the periphery of the body – since these nerves go to every organ and location in the body it is called a “distributed” system. Nerve cells manufacture chemicals called neurotransmitters that allow the cells to communicate with one another and also with other types of cells in the body. Although most of the time these neurotransmitters are released close to their place of action sometimes they are released directly into the bloodstream such as when epinephrine (adrenalin) and norepinephrine (a related chemical) are released into the bloodstream during stress. This means that all the body’s cells and organs will be affected The endocrine system includes a collection of glands that manufacture chemicals called hormones. These are released directly into the bloodstream potentially affecting all the cells and organs of the body. An example is insulin being released from our pancreas into our bloodstream in response to a meal. lifetime prevalence is 10 – 14% can occur at any age symptoms usually begin within 3 months of the trauma 50% of the general population is exposed to a traumatic event in their lifetime either directly or “vicariously” Obviously a large issue in management of military personnel and veterans (may affect up to 13% of returning war veterans) American Psychiatric Association (2013). Section II: Trauma- and Stressor-Related Disorders. Diagnostic and statistical manual of mental health disorders: DSM-5 (5th ed.). Washington DC: American Psychiatric Publishing. DOI: 10.1176/appi.books.9780890425596.991543 “Trauma- and stressor-related disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion. These include reactive attachment disorder disinhibited social engagement disorder posttraumatic stress disorder (PTSD) acute stress disorder and adjustment disorders. Placement of this chapter reflects the close relationship between these diagnoses and disorders in the surrounding chapters on anxiety disorders obsessive-compulsive and related disorders and dissociative disorders.” Directly experiencing the traumatic event(s). Witnessing in person the event(s) as it occurred to others. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend the event(s) must have been violent or accidental. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g. first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Recurrent involuntary and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children there may be frightening dreams without recognizable content. Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children trauma-specific reenactment may occur in play. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Avoidance of or efforts to avoid distressing memories thoughts or feelings about or closely associated with the traumatic event(s). Avoidance of or efforts to avoid external reminders (people places conversations activities objects situations) that arouse distressing memories thoughts or feelings about or closely associated with the traumatic event(s). Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury alcohol or drugs). Persistent and exaggerated negative beliefs or expectations about oneself others or the world Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. Persistent negative emotional state (e.g. fear horror anger guilt or shame). Markedly diminished interest or participation in significant activities. Feelings of detachment or estrangement from others. Persistent inability to experience positive emotions (e.g. inability to experience happiness satisfaction or loving feelings). Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. Reckless or self-destructive behavior. Hypervigilance. Exaggerated startle response. Problems with concentration. Sleep disturbance (e.g. difficulty falling or staying asleep or restless sleep). after an extremely distressing event (combat sexual abuse or rape natural disasters) May involve the patient or be “vicarious” (e.g viewing the event hearing about the event) Jurors in trials for violent crime have suffered PTSD symptoms having just heard the crime evidence being presented in court The response is intense fear & helplessness and/or horror Patient “relives” the event with emotional numbness and:intrusive recurrent recollections of the eventrecurrent distressing dreams of the eventflashbacks/hallucinations (reliving the event like a video loop that won’t stop)intense distress if exposed to symbols or activities or representations of the event (anniversary pictures) intrusive recurrent recollections of the event recurrent distressing dreams of the event flashbacks/hallucinations (reliving the event like a video loop that won’t stop) intense distress if exposed to symbols or activities or representations of the event (anniversary pictures) Psychological (“Talk”) therapy:Cognitive Behavioral Therapy (CBT) individual or group has been shown effectiveThis condition mimics an intense grief reaction thus grief counseling may be of benefit to enable mourning for loss Cognitive Behavioral Therapy (CBT) individual or group has been shown effective This condition mimics an intense grief reaction thus grief counseling may be of benefit to enable mourning for loss Pharmacologic (Drug) Treatment:SSRIs antidepressants – some are FDA approved for this indication e.g. sertraline (Zoloft) paroxetine (Paxil)SNRIs antidepressants – some are FDA approved for this indication e.g. venlafaxine-XR (Effexor-XR)Benzodiazepione tranquilizers (sedatives) are NOT used – there are too many long-term treatment issues (dependence tolerance)Sometimes other drugs are added to antidepressants to augment (add to) their effect; these additional drugs are often atypical antipsychotics (e.g. risperidone) but these do not work well aloneFor nightmares the antihypertensive drug prazosin (Minipress)seems to work (dosing issues and side effects may limit its use) SSRIs antidepressants – some are FDA approved for this indication e.g. sertraline (Zoloft) paroxetine (Paxil) SNRIs antidepressants – some are FDA approved for this indication e.g. venlafaxine-XR (Effexor-XR) Benzodiazepione tranquilizers (sedatives) are NOT used – there are too many long-term treatment issues (dependence tolerance) Sometimes other drugs are added to antidepressants to augment (add to) their effect; these additional drugs are often atypical antipsychotics (e.g. risperidone) but these do not work well alone For nightmares the antihypertensive drug prazosin (Minipress)seems to work (dosing issues and side effects may limit its use) Some experts are now using off-label propranolol (beta-blocker) immediately after the event in order to prevent the onset of PTSD (theory is that sympathetic catecholamines in the brain are needed to “impress” the brain with the event and if these are blocked the PTSD cannot happen); but recent evidence is not convincing of benefit Recent evidence that use of morphine to manage traumatic pain can prevent PTSD associated with trauma; aggressive management of pain is part of PTSD management Also called “Rational Emotive Behavior Therapy” – pioneered by Ellis & Beck A collaborative form of psychotherapy with mental health & primary-care providers (also can be performed with computer programs) Patient has 10-15 visits usually lasting 45 min – 1 hour each Evidence-based success in treating depression anxiety syndromes chronic pain school trauma recidivism crisis intervention (including suicide) chronic fatigue What is it all about? The patient:changes negative patterns of thinking and behaviorlearns to look at the positive aspects of situationshas more awareness of one’s surroundings and the psychological effects created changes negative patterns of thinking and behavior learns to look at the positive aspects of situations has more awareness of one’s surroundings and the psychological effects created Principles:your FEELINGS are due to your THOUGHTSif your thoughts are changed then your feelings will followlearn to recognize cues to bad feelings and trace them to irrational thoughts – replace the irrational thoughts with rational thoughtsrecognize that we have control over our thoughts and our feelings – do not allow “automatic” thoughts to control our mind or our feelings your FEELINGS are due to your THOUGHTS if your thoughts are changed then your feelings will follow learn to recognize cues to bad feelings and trace them to irrational thoughts – replace the irrational thoughts with rational thoughts recognize that we have control over our thoughts and our feelings – do not allow “automatic” thoughts to control our mind or our feelings Basic science – why does it work?PET scans looking at metabolic activity of CNS show changes in areas of the brain such as the frontal cortex cingulate and hippocampussame types of changes are seen with SSRI therapy PET scans looking at metabolic activity of CNS show changes in areas of the brain such as the frontal cortex cingulate and hippocampus same types of changes are seen with SSRI therapy Basic Techniques used in CBT:problem-solving techniques – looking at situations differentlybehavior modification techniques – relaxation deep breathingrecognition of situations and triggers for bad feelingsrecognition of irrational (biased) thoughts and correction of same problem-solving techniques – looking at situations differently behavior modification techniques – relaxation deep breathing recognition of situations and triggers for bad feelings recognition of irrational (biased) thoughts and correction of same Goals in managing pain using CBT:help patients understand that their thoughts and behaviors can affect the pain experience emphasize individual control of pain using cognitive methodstrain patients in effective coping skillsapply and maintain learned coping skills help patients understand that their thoughts and behaviors can affect the pain experience emphasize individual control of pain using cognitive methods train patients in effective coping skills apply and maintain learned coping skills Other forms of CBT:A newer form of CBT includes “mindfulness” activitiesThus this form is often called Mindfulness Based CBT or MBCBTThis has proven helpful in managing difficult-to-treat insomnia anxiety depression and other disorders A newer form of CBT includes “mindfulness” activities Thus this form is often called Mindfulness Based CBT or MBCBT This has proven helpful in managing difficult-to-treat insomnia anxiety depression and other disorders Full list of Clinical Practice Guideline (including PTSD) from the American Psychiatric Association. Full text available in the Ashford Library. Many free books Sarafino E.P. & Smith T.W. (2016). Health psychology: Biopsychosocial interactions (9th ed.). Retrieved from https://vitalsource.comChapter 3: Stress – Its Meaning Impact and SourcesChapter 4: Stress Biopsychosocial Factors and IllnessChapter 5: Coping With and Reducing Stress Chapter 3: Stress – Its Meaning Impact and Sources Chapter 4: Stress Biopsychosocial Factors and Illness Chapter 5: Coping With and Reducing Stress Centers for Disease Control. (2017) Coping with stress after a traumatic event [PDF]. Retrieved from https://www.cdc.gov/violenceprevention/pdf/Copingw…This publication provides an overview of the normal response to stress. It includes information regarding when referral to a mental health specialist should be considered. This publication provides an overview of the normal response to stress. It includes information regarding when referral to a mental health specialist should be considered. Centers for Disease Control. (2016) Understanding school violence [PDF]. Retrieved from https://www.cdc.gov/violenceprevention/pdf/School_…This publication provides information about facts relating to school violence. The fact sheet also includes recommendations for prevention. This publication provides information about facts relating to school violence. The fact sheet also includes recommendations for prevention. National Institute of Mental Health. (2015) Helping children and adolescents cope with violence and disasters for parents of children exposed to violence or disaster: What parents can do [PDF]. Retrieved from https://www.nimh.nih.gov/health/publications/helpi…This publication provides an overview of the parental response to a child’s exposure to a violent event. Additional information about Post Traumatic Stress Disorder (PTSD) is included. This publication provides an overview of the parental response to a child’s exposure to a violent event. Additional information about Post Traumatic Stress Disorder (PTSD) is included. National Institute of Mental Health. (2014) Helping children and adolescents cope with violence and disasters: Police fire and other first responders: What rescue workers can do [PDF] Retrieved from http://ipsi.uprrp.edu/opp/pdf/materiales/helping_r…This publication provides an overview of the response of rescue workers helping children exposed to a violent event. Some general information on post-traumatic stress disorder is also provided. This publication provides an overview of the response of rescue workers helping children exposed to a violent event. Some general information on post-traumatic stress disorder is also provided. National Institute of Mental Health. (2016) Post-traumatic stress disorder. Retrieved from http://www.nimh.nih.gov/health/topics/post-traumat…This website has information for the general public regarding identification risk factors and management of post-traumatic stress disorder (PTSD). Other information includes causes and living with PTSD. This website has information for the general public regarding identification risk factors and management of post-traumatic stress disorder (PTSD). Other information includes causes and living with PTSD. National Institute of Mental Health. (2019) Preventing Youth Violence [PDF]. Retrieved from https://www.cdc.gov/violenceprevention/pdf/yv-fact… This publication provides facts related to youth violence including epidemiologic information and risk factors for involved youth. In addition recommendations for prevention are included. This publication provides facts related to youth violence including epidemiologic information and risk factors for involved youth. In addition recommendations for prevention are included. American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington D.C.: American Psychiatric Publishing.This is the manual of psychiatric diagnostic criteria used by mental health professionals. For this week you will be utilizing Section II: Trauma- and Stressor-Related Disorders. This section in the manual deals with multiple conditions that involve exposure to trauma or are associated with precipitating stressors. Information about various such disorders is provided regarding the diagnostic criteria epidemiology and differential diagnosis across the lifespan. One of the diagnoses listed is that of post-traumatic stress disorder (PTSD) and we will focus on that disorder in the assignment for this week.To access the DSM-5 from the Ashford University Library:Log into the Ashford LibraryClick on “Find Articles & More”Click on “Databases by Subject”Click on “Psychology”Click on “DSM-5 Library”Click on “DSM-5™”Click on “Section II”Click on “Trauma- and This is the manual of psychiatric diagnostic criteria used by mental health professionals. For this week you will be utilizing Section II: Trauma- and Stressor-Related Disorders. This section in the manual deals with multiple conditions that involve exposure to trauma or are associated with precipitating stressors. Information about various such disorders is provided regarding the diagnostic criteria epidemiology and differential diagnosis across the lifespan. One of the diagnoses listed is that of post-traumatic stress disorder (PTSD) and we will focus on that disorder in the assignment for this week.To access the DSM-5 from the Ashford University Library:Log into the Ashford LibraryClick on “Find Articles & More”Click on “Databases by Subject”Click on “Psychology”Click on “DSM-5 Library”Click on “DSM-5™”Click on “Section II”Click on “Trauma- and To access the DSM-5 from the Ashford University Library: Log into the Ashford Library Click on “Find Articles & More” Click on “Databases by Subject” Click on “Psychology” Click on “DSM-5 Library” Click on “DSM-5™” Click on “Section II” Click on “Trauma- and Go to the Ashford University Library (either via the link in the left navigation or the Student Portal) Click the “Advanced Search>>” link under the FindIt@AU search box Enter the name of the disorder you selected from the DSM-5 into the first text box Select “SU Subject Terms” in the drop-down menu next to your disorder Enter Annals of Behavioral Medicine in the second box Select “SO Journal Title/Source” in the drop-down menu next to the publication’s name Click the Search button Click “Relevance” and choose “Date Newest” Evaluate biopsychosocial factors associated with stress and the development of trauma- and stressor-related neuropsychiatric disorders.Identify biological and psychosocial aspects of stressor- and trauma-related neuropsychiatric conditions.Discuss resources available for the management of stress and health promotion.PSY 361 Health PsychologyInstructor GuidancePSY 361 Week 2 Overview: While the course is in session there will be Announcements in the online course to remind you of our current subject content and reading discussion board activities assignments and other important or relevant information. Please be sure to check the course for current Announcements frequently. As always email with ANY questions or concerns or post public comments/questions on the “Ask Your Instructor” forum. Topics this week:Evaluate biopsychosocial factors associated with stress and the development of trauma- and stressor-related neuropsychiatric disorders.Identify biological and psychosocial aspects of stressor- and trauma-related neuropsychiatric conditions.Discuss resources available for the management of stress and health promotion.Reading in Text Chapters 3 4 and 5: lots of information on stress its affect on health and coping. Specific information on health consequences is discussed. Methods of coping with stress are elaborated. Normal vs. Abnormal – making a clinical diagnosis:“Normal” means that the value falls within 2 SD of the mean/median (approx 96% of the population) – in a normal distribution curve:you capture 68% of the population within 1 SD above & below the median/meanyou capture 95-96% of the population within 2 SD above & below the median/meanWe are usually measuring what are called continuous biologic variables that occur within a particular rangeThese usually will plot out as a “normal” bell-shaped curveExamples: serum cholesterol blood pressure temperatureMental disorders:Comparing symptoms and behaviors with the general populationIdentifying patterns that differ from the normHow can we explain “mental” (behavioral neuropsychiatric) disorders:Treatment depends on the paradigmA paradigm is a “way of thinking about something”Treatments are matched to the paradigm (model) that explains the abnormalities:Medical (treatments are drugs surgery other clinical procedures)Psychodynamic (treatment is psychotherapy)Behavioral (treatments are learning therapies such as behavioral modification)Cognitive (treatment could be cognitive behavioral therapy)“Mental” Disorders – What is a Disease Disorder or Condition?Terminology – these terms are often used interchangeably:MentalBehavioralPsychiatricNeuropsychiatricSigns and Symptoms:Signs are observable characteristics that differ from the norm (also called findings) and are considered objective dataSymptoms are what is reported by the patient and are considered subjective dataPatterns:Facts have been accumulating for thousands of years due to the recording of objective and subjective data by diagnosticians.This has led to the knowledge of patterns of normal and abnormal functions.In time when these patterns became descriptively distinctive a disease name was assigned.We are just “making up a name” for a disease based on a recurring collection of symptoms and signsExamples:in 1982 nobody knew about AIDS but they could collect common symptoms and signs and eventually called it a “disease”to diagnose “Metabolic Syndrome” the patient must have 3 out of 5 criteria to fit the diagnosis (the five criteria are hypertension elevated triglycerides elevated blood sugar increased waist measurement low HDL-Cholesterol based on sex).Thus all diseases (conditions syndromes) are simply our way of trying to define recurring patterns of collections of signs and symptoms so that we can recommend treatment and study outcomes of treatment or nontreatment.From then on additional findings and cross-references to other disease states are added to the body of knowledge using the disease name.Expert Consensus Agreement and the DSM-5:In order to discuss or study these conditions we must agree upon a terminologyOften the phrase “by convention” is used – meaning that we are coming together as a group (convening) to define and agree upon these definitionsThis terminology is also called the nomenclature (naming rules)Over time with new knowledge gained from research and observation the agreed-upon terminology can changeDiagnostic & Statistical Manual (DSM):This is written by a panel of experts and revised periodically to reflect current knowledgeThe professional society that authors this manual is the American Psychiatric Association (APA)DSM-5 (the fifth version of the manual) has been released as of May 2013With each revision there is usually tremendous controversy over proposed changesUsing the DSM and consequences of changes in terminology:Making a diagnosis – this may qualify an individual for social services treatments and medications (changes in terminology may enfranchise

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