TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 237 usual behavior” (APA, 2013). In the list of seven symptoms under criterion B, two were revised for greater clarity. The DSM-5 notes that distractibility can be either reported or observed. Psychomotor agitation is defined as “purposeless non-goal-directed activity” (APA, 2013, p. 124). Criterion C from the DSM-IV-TR states that the episode in question must truly be a manic episode, not a mixed one. Mixed episodes were removed entirely from the DSM-5 as they were exceedingly rare, and instead a specifier denoting mixed features was added (Coryell, 2013). Additionally, the exclusion for manic- like episodes caused by antidepressant treatment was also removed. That is, in the DSM-IV-TR , if the manic symptoms follow antidepressant treatment such as medication, light therapy or electroconvulsive treatment, they are not considered symptoms of a true manic episode. In the DSM-5 , that exclusion is removed. If a client displays symptoms that meet the criteria for a manic episode, the diagnosis can be given regardless of previous antidepressant treatment. Additional descriptors also were added to the criteria for a hypomanic episode, although the diagnosis continues to describe individuals who display manic symptoms, but do not show clinically significant impairment. The elevated, expansive or irritable mood must be present for 4 consecutive days and for most of the day. The antidepressant exclusion also is removed from the hypomanic episode criteria, but clinicians are cautioned not to interpret irritability or agitation as sufficient for diagnosis. Bipolar I specifiers for severity and course remain the same, except that the psychotic features specifier is now coded separately from severity, as described above in major depressive disorder. Similarly, the specifiers with anxious distress and with mixed features were added to the bipolar disorders. Schizophrenia How schizophrenia is conceptualized did not change from the DSM-IV-TR to the DSM-5, but the criteria for the diagnosis did change significantly. In the DSM-IV-TR , criterion A stated that two or more of the following symptoms must be present for at least 1 month unless successfully treated: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms. An additional note permitted diagnosis with only one symptom of delusions or hallucinations if bizarre or persistent. The DSM-5 increases the diagnostic threshold by requiring the presence of delusions, hallucinations or disorganized speech (as opposed to the diagnosis being possible based on disorganized behavior and negative symptoms alone) and removing the single symptom option for meeting criterion A. The duration requirement remains the same as in DSM-IV-TR : at least 1 month of active symptoms in a time period of at least 6 months of impairment. Criterion D remains the schizoaffective disorder and mood disorder exclusion, but the text was revised to define how frequently manic or depressive symptoms must be present in order to meet full criteria. The DSM-5 specifies that mood symptoms must be present for at least half of the total duration of active and residual psychotic phases in order to be considered (APA, 2013). The specifiers about the episodic or continuous symptoms and remission were changed in the DSM-5 and the subtypes were removed entirely. Course specifiers were revised for clarity and now include descriptors for first episode, multiple episodes, continuous or unspecified. These specifiers are not used until the disorder has been present for 1 year. In the DSM-5 , the subtypes are not included as part of the diagnosis. For example, DSM-IV- TR language such as 295.30 schizophrenia, paranoid type is no longer used. The types are still described under the delusional disorder criteria, but the differentiated types of schizophrenia are no longer endorsed. Almost all schizophrenia diagnoses are now coded 295.90 schizophrenia, except for those individuals who have catatonia, and their diagnoses are coded 293.89. In the DSM-5 , the Clinician-Rated Severity of Psychosis Symptoms Severity scale was added (APA, 2013). The rating scale and other instruments are available online at http:// psychiatry.org/practice/dsm/dsm5/online-assessment-measures . Clinicians are instructed to rate the presence of symptoms over the previous 7 days across eight dimensions. The dimensions, rated from 0 ( no presence )