Volume_4_Issue_3_Digest

TPC D igest 43 Laura E. Welfare, NCC, is an Associate Professor at Virginia Polytechnic Institute and State University. Ryan M. Cook is a doctoral student at Virginia Polytechnic Institute and State University. Correspondence can be addressed to Laura E. Welfare, 309 E. Eggleston Hall (0302), Blacksburg, VA 24061, welfare@vt.edu. M ajor depressive disorder, bipolar I disorder and schizophrenia are chronic mental health conditions. Adults with these diagnoses often benefit from mental health treatment throughout their lives. The recent revisions to the Diagnostic and Statistical Manual of Mental Disorders ( DSM ), culminating in the 2013 publication of the DSM-5 , included changes to these three disorders. The authors of this article provide the cases of Martha, Bo and Saul, in which readers can see the implications of the DSM changes for clients who are already in treatment. Revisions to major depressive disorder included added descriptors for some symptoms so that clinicians can consistently determine whether criteria are met. In order to emphasize the importance of key symptoms, new specifiers related to anxious distress and mixed features were added. Clients who have anxiety or mixed features in addition to depression often require different treatment strategies, so including this information in the diagnosis may improve treatment efficacy. Revisions to bipolar I disorder also improved clarity by adding rules for frequency and severity of symptoms required for diagnosis. An important exclusion criterion was removed as well. Previously, manic or hypomanic symptoms following antidepressant treatment were not sufficient for a bipolar diagnosis. In DSM-5 , those symptoms do count toward a diagnosis of bipolar disorder, and a practitioner can make the diagnosis if the client meets full criteria for the disorder. Finally, schizophrenia was revised to increase the diagnostic threshold by requiring at least two core symptoms, one of which must be hallucinations, delusions or disorganized speech. The subtypes (e.g., schizophrenia, paranoid type) were removed, Revising Diagnoses for Clients with Chronic Mental Health Issues: Implications of the DSM-5 – DIGEST Laura E. Welfare Ryan M. Cook