When a discussion about mental health and mental illness arises, there are several key themes which inevitably come to the surface.
A popular reoccurring one in this discussion is the stigma associated with mental illness.
It wasn’t that long ago that we didn’t dare talk about it. If we were struggling with our mental health we kept quiet instead of exposing ourselves to the risk of being the subject of neighbourhood gossip and shame.
On January 16, Dr. Phil Klassen, Vice-President of Medical Affairs at Ontario Shores, provided an update on the last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) during his presentation at Grand Rounds.
DSM-5 was released in May, 2013 and Dr. Klassen expects an updated version to follow within the next few years.
The DSM is the tool used to diagnose mental disorders, which guides treatment decisions and informs prognosis.
In highlighting some of the changes in the latest DSM version, Dr. Klassen pointed to greater transparency within the tool and noted revisions were based on research and consensus information.
Dr. Klassen noted reliability as a key element of the latest DSM version. Some factors impacting the reliability of DSM are language barriers and diagnosis based on a single interview. The DSM, which is typically more reliable in diagnosing adults than children, is more effective when an individual has been interviewed more than once.
Notable Revisions in DSM-5
Fewer symptoms required for adults to meet criteria
Emphasizes adaptive function over measured IQ
Mild and Major Neurocognitive disorder replaces the term dementia
Autism Spectrum Disorders
Tightening of criteria will likely reduce prevalence
Mood distruptance has to be more prominent
Bereavement exclusion deleted
Premenstrual Dysphoric Disorder
Now an official mood disorder
Obsessive Compulsive Disorders
Expanded to include various disorders including hoarding disorder and body-focused repetitive behavior disorders
Criteria broadened for Bulimia Nervosa and binge eating disorder
It has been amazing to observe the advancements of technology within healthcare over the years.
These advancements have created opportunities to enhance quality and safety of healthcare in many aspects. One example includes the improvement in medication management processes as a result of the development and use of computerized physician order entry, electronic medication administration records with barcode supported medication verification. This is often referred to as a ‘Closed Loop Medication Management’ process. This change can be a leap in practice for some clinicians with less comfort and/or familiarity with the use of technology in their daily practices. However, there has been robust evidence demonstrating this strategy to prevent medication errors, including errors resulting in adverse drug events and those related to timing of medication.