DSM-5 Made Easy
Below I've begun to collect some of the questions posed concerning mental health evaluation and diagnosis. I will never reveal full names, and I will often edit the material for clarity and brevity.
Hello Dr. Morrison,
What is the difference between Diagnosis Made Easy & DSM-V Made Easy?
Thanks, Lynn
My response:
The first, Diagnosis Made Easier, is my explanation of all that i have learned in 50 years -- about how to use the information available to mental health care professionals in the service of making a diagnosis. And that, of course, allows effective treatment.
The second book you mention, DSM-5 Made Easy, presents the very complicated material in the official DSM-5, released in 2013 by the American Psychiatric Association, in a form that is more easily understandable by us mere mortals. I've used lots of case presentations to illustrate.
Thanks for asking.
James Morrison
____________________
Hi there!
I love the DSM-5 Made Easy!
I didn’t even buy DSM-5 — we have an office copy. J
Debating with two colleagues today about the Made easy version—were the codes you used ICD-10 or ICD-9?
I felt like it was ICD-10 from my reading of the book.
We were doing a quiz type thing on an insurance website and I found all the codes easily in the chart and one person kept saying they were ICD-9. I said this book was likely published after DSM 5 as it is based on learning the DSM5 why would it be ICD 9 plus in the intro it talks about how you structure the book.
Tina
My response:
Thank you for your kind words. I put an incredible amount of effort into trying to make the DSM more comprehensible, and even a bit more user friendly.
As to your specific question regarding ICD, you and your colleagues are both right, but you are a bit more right than are they. Here's the explanation:
As you can read in the Introduction (page 9), ICD-10 was coming out just as the book was going to press. (In fact, it was then delayed for a year, until October 2015). I used the new ICD-10 codes as my primary identifiers, but provided the ICD-9 codes in [square brackets] for those who hadn't yet made the switch.
Best wishes,
James Morrison
____________________________
Dr. Morrison,
My question is regarding the DSM coding for Ecstasy (MDMA) disorders. Would you code is under amphetamine use disorder OR hallucinogen use disorder. I've been coding it under hallucinogen even with it's chemical make-up falling into more of the methamphetamine class of drugs. Your sidebar lists Ecstasy/MDMA in the stimulant-related disorders section and you state it has "structural similarities to both amphetamines and mescaline, one of the hallucinogens...." on page 451.
Regards,
Jack
My response:
The answer to your question about MDMA isn't especially easy. Yes, because it has features of each, it is listed with the stimulants and with other hallucinogens. DSM-5 mentions it in both sections, and so does DSM-5 Made Easy. So, how should one code it? Neither source gives much guidance.
I can think of two approaches. 1) Pick a category and stick with it. That would be easy, and no one could fault you for it. 2) Choose the category based on the main symptoms you encounter in the specific patient (wakefulness and agitation, say, as opposed to depersonalization and hallucinations). Number 2 takes a little more work, perhaps, but it might covey just a tad more information than #1, so it is probably the one I'd use. Wish I had thought about this when I was writing the book. Maybe, with thanks to you, in the next edition...
James Morrison
_______________________________
Hello Dr. Morrison,
I am reading your book DSM-5 made easy and it has made me feel so much more at ease with understanding the DSM and diagnosing clients when I begin my professional career. While I was reading the book I understood your stance on the WHODAS and the GAF. I see why the GAF would provide better results in diagnosing the clients. I am just having some trouble understanding the WHODAS; my MSW program requires it. How would I be able to use that scale effectively?
Thank you,
Kimberly
My response:
I am glad DSM-5 Made Easy is a help to you.
The fact that WHODAS is required by some training programs is new information for me. Of course, how you use the scale depends on what you need from it -- presumably, predictions as to future needs for the patient/client as well as prognosis for treatment. The use will not be much different from your use of the GAF.
What's really hard about WHODAS is implementing it. To that end, I've created an Excel spreadsheet that automates the math; all you have to do is fill it in with the relevant information. Each line is scored 1 to 5 [1=none; 2=mild; 3=mod; 4=severe; 5=extreme or can't do], and the numbers are summed for each domain and for the overall assessment. With the spreadsheet, it's a relative breeze. The copy I have attached includes my evaluation of a patient from DSM-5 Made Easy (he is Lyonel Childs, who has schizophrenia). There is space for you to enter a patient of your own. It should then compute the WHODAS for that patient.
[And, for anyone else who would like a free copy of the WHODAS Excel template, just email me. I'll respond as fast as I can.]
James Morrison
_______________________________
Hello Dr. Morrison,
I wanted to thank you for writing DSM-5 Made Easy. I am a 3rd year medical student on my psych rotation and I have found several other psych books that were painful to read... I have enjoyed reading your synopsis of the different disorders and the vignettes with the discussion of why the patient’s disorder is not another disorder - this has been the best part of the book! ...
I did want to mention 2 things that I hope you might address in future editions. 1) In your vignette for BPD you state that Josephine’s stake out of James’s apartment could be seen as a frantic effort to avoid abandonment. I see this differently, because in the vignettes it states that she is there to confront him so I would think that she is there not to salvage the relationship and avoid abandonment but rather to “let him have it”... 2) It would be nice if you put a list of treatment options at the end of the diagnoses...
Rafael
My response:
Thanks for your kind words. I'm always glad when people are learning what they need to know about mental health diagnosis. As to your questions:
1. A confrontation doesn't have to be for purposes of combat (though it often is); in Josephine's case, it could instead have been to clarify, to cajole, to beg -- or perhaps, all of these. Any such motivation could be seen as an attempt to maintain a connection. For some troubled people, any kind of interaction is better than none at all.
2. I agree that treatment options would be good, but then, it would have to be an entirely different kind of book.
James Morrison
Hello Dr. Morrison,
What is the difference between Diagnosis Made Easy & DSM-V Made Easy?
Thanks, Lynn
My response:
The first, Diagnosis Made Easier, is my explanation of all that i have learned in 50 years -- about how to use the information available to mental health care professionals in the service of making a diagnosis. And that, of course, allows effective treatment.
The second book you mention, DSM-5 Made Easy, presents the very complicated material in the official DSM-5, released in 2013 by the American Psychiatric Association, in a form that is more easily understandable by us mere mortals. I've used lots of case presentations to illustrate.
Thanks for asking.
James Morrison
____________________
Hi there!
I love the DSM-5 Made Easy!
I didn’t even buy DSM-5 — we have an office copy. J
Debating with two colleagues today about the Made easy version—were the codes you used ICD-10 or ICD-9?
I felt like it was ICD-10 from my reading of the book.
We were doing a quiz type thing on an insurance website and I found all the codes easily in the chart and one person kept saying they were ICD-9. I said this book was likely published after DSM 5 as it is based on learning the DSM5 why would it be ICD 9 plus in the intro it talks about how you structure the book.
Tina
My response:
Thank you for your kind words. I put an incredible amount of effort into trying to make the DSM more comprehensible, and even a bit more user friendly.
As to your specific question regarding ICD, you and your colleagues are both right, but you are a bit more right than are they. Here's the explanation:
As you can read in the Introduction (page 9), ICD-10 was coming out just as the book was going to press. (In fact, it was then delayed for a year, until October 2015). I used the new ICD-10 codes as my primary identifiers, but provided the ICD-9 codes in [square brackets] for those who hadn't yet made the switch.
Best wishes,
James Morrison
____________________________
Dr. Morrison,
My question is regarding the DSM coding for Ecstasy (MDMA) disorders. Would you code is under amphetamine use disorder OR hallucinogen use disorder. I've been coding it under hallucinogen even with it's chemical make-up falling into more of the methamphetamine class of drugs. Your sidebar lists Ecstasy/MDMA in the stimulant-related disorders section and you state it has "structural similarities to both amphetamines and mescaline, one of the hallucinogens...." on page 451.
Regards,
Jack
My response:
The answer to your question about MDMA isn't especially easy. Yes, because it has features of each, it is listed with the stimulants and with other hallucinogens. DSM-5 mentions it in both sections, and so does DSM-5 Made Easy. So, how should one code it? Neither source gives much guidance.
I can think of two approaches. 1) Pick a category and stick with it. That would be easy, and no one could fault you for it. 2) Choose the category based on the main symptoms you encounter in the specific patient (wakefulness and agitation, say, as opposed to depersonalization and hallucinations). Number 2 takes a little more work, perhaps, but it might covey just a tad more information than #1, so it is probably the one I'd use. Wish I had thought about this when I was writing the book. Maybe, with thanks to you, in the next edition...
James Morrison
_______________________________
Hello Dr. Morrison,
I am reading your book DSM-5 made easy and it has made me feel so much more at ease with understanding the DSM and diagnosing clients when I begin my professional career. While I was reading the book I understood your stance on the WHODAS and the GAF. I see why the GAF would provide better results in diagnosing the clients. I am just having some trouble understanding the WHODAS; my MSW program requires it. How would I be able to use that scale effectively?
Thank you,
Kimberly
My response:
I am glad DSM-5 Made Easy is a help to you.
The fact that WHODAS is required by some training programs is new information for me. Of course, how you use the scale depends on what you need from it -- presumably, predictions as to future needs for the patient/client as well as prognosis for treatment. The use will not be much different from your use of the GAF.
What's really hard about WHODAS is implementing it. To that end, I've created an Excel spreadsheet that automates the math; all you have to do is fill it in with the relevant information. Each line is scored 1 to 5 [1=none; 2=mild; 3=mod; 4=severe; 5=extreme or can't do], and the numbers are summed for each domain and for the overall assessment. With the spreadsheet, it's a relative breeze. The copy I have attached includes my evaluation of a patient from DSM-5 Made Easy (he is Lyonel Childs, who has schizophrenia). There is space for you to enter a patient of your own. It should then compute the WHODAS for that patient.
[And, for anyone else who would like a free copy of the WHODAS Excel template, just email me. I'll respond as fast as I can.]
James Morrison
_______________________________
Hello Dr. Morrison,
I wanted to thank you for writing DSM-5 Made Easy. I am a 3rd year medical student on my psych rotation and I have found several other psych books that were painful to read... I have enjoyed reading your synopsis of the different disorders and the vignettes with the discussion of why the patient’s disorder is not another disorder - this has been the best part of the book! ...
I did want to mention 2 things that I hope you might address in future editions. 1) In your vignette for BPD you state that Josephine’s stake out of James’s apartment could be seen as a frantic effort to avoid abandonment. I see this differently, because in the vignettes it states that she is there to confront him so I would think that she is there not to salvage the relationship and avoid abandonment but rather to “let him have it”... 2) It would be nice if you put a list of treatment options at the end of the diagnoses...
Rafael
My response:
Thanks for your kind words. I'm always glad when people are learning what they need to know about mental health diagnosis. As to your questions:
1. A confrontation doesn't have to be for purposes of combat (though it often is); in Josephine's case, it could instead have been to clarify, to cajole, to beg -- or perhaps, all of these. Any such motivation could be seen as an attempt to maintain a connection. For some troubled people, any kind of interaction is better than none at all.
2. I agree that treatment options would be good, but then, it would have to be an entirely different kind of book.
James Morrison