This newsletter includes information about DSM-5-TR, which will be released this year. It will include fully revised text and references, updated diagnostic criteria, and ICD-10-CM codes since DSM-5.
We also share practical tips for treating premenstrual mood syndromes, key points from a presentation on pharmacotherapies for stimulant use disorder, and our practical research summaries (Quick Takes).
DSM-5 TR Is Coming
DSM-5 was published in May 2013, which had several changes, such as swapping from Roman numerals to standard Arabic, eliminating the multiaxial system, and reclassifying many disorders.
Criticism of DSM-5 was mostly related to the expansion of diagnostic criteria, which could increase the number of persons with a mental illness and pathologize normal behaviors.
- When will DSM-5 TR be published?
- It will be released in March 2022.
- How does the APA decide which changes will be included in the DSM-5-TR?
- A task force and workgroup determine whether diagnoses need to be removed or changed.
- Decisions to include a diagnosis are based on careful consideration of the scientific advances in research underlying a disorder.
- Is this the first update to DSM-5?
- No, a supplement is published at regular intervals to reflect coding updates, changes, or corrections. Changes are made on a rolling basis, as warranted by advances in the science of mental disorders.
- Can anyone propose a change to DSM?
- Yes, anyone can initiate the process for consideration of a proposal for changes to DSM through the APA website, following the guide to submitting proposals for changes.
- Proposals require the submission of supportive information.
- What will be the most significant updates in DSM-5-TR?
- Updated diagnostic criteria and ICD-10-CM codes
- A new disorder, prolonged grief disorder (PGD)
- Codes for suicidal behavior without the requirement of any other diagnosis
- Considerations of the impact of racism and discrimination on mental disorders
- Has PGD been identified as an entity previously?
- DSM-IV and ICD-10 did not distinguish between normal and prolonged grief. However, in 2018, the WHO included it in ICD-11.
- Why is PGD important now?
- Studies dating back several decades suggest that many people experience persistent difficulties associated with bereavement, which are substantially prolonged beyond culturally normed expectations.
- PGD has become more prevalent because there have been more than 60,000 deaths due to COVID. You can read more here.
Premenstrual Mood Syndromes, With Lauren Osborne, M.D.
In this interview, Dr. Lauren Osborne discusses premenstrual mood syndromes, specifically risk factors and biological mechanisms underlying these. She also offers valuable insights regarding its management and discusses the use of novel medications, such as brexanolone and drospirenone, for the treatment of these syndromes.
Interview highlights include the following:
- Determination of hormone levels is generally not necessary for patients experiencing PMDD and/or PME of another psychiatric disorder.
- For patients with PMDD and premenstrual exacerbation of depressive symptoms, SSRIs are a good first choice. For patients with premenstrual exacerbation of bipolar symptoms, symptom-based adjustments of atypical antipsychotics may be helpful.
Learn more and earn 0.5 CME credits here.
Pharmacotherapies for Stimulant Use Disorder
In this presentation, Dr. Andrew Saxon reviews the use of pharmacologic agents for the treatment of stimulant use disorder. He discusses the central role of dopamine in stimulant use as well as the course, assessment, and diagnosis of stimulant use disorder. He likewise reviews the evidence for the use of various psychopharmacologic agents for these disorders, such as antidepressants and naltrexone for methamphetamine use disorder and topiramate and methylphenidate for cocaine use disorder.
Stimulant Replacement Therapies for Methamphetamine Use Disorder and Amphetamine Use Disorder
- Amphetamines as a replacement pharmacotherapy for methamphetamine use disorder do not show benefit.
- MPH shows a positive signal, particularly for patients who have underlying ADHD.
- There is a need to study MPH in larger studies before it can be considered the go-to medication for methamphetamine use disorder.
Learn more and earn 1.0 CME credits here.
Quick Takes: Informing Your Practice
Effects on Suicidal Risk: Comparison of Clozapine to Other Newer Medicines Indicated to Treat Schizophrenia or Bipolar Disorder
- Clozapine reduces the risk of suicide for patients with schizophrenia. This is not a “class effect” of antipsychotics; it’s specific to clozapine. Learn more.
Prospects for New Drugs to Treat Binge Eating Disorder
- Binge eating disorder is, in part, an impulse-control problem.
- Stimulant medications, which improve impulse control, improve BED.
- Lisdexamfetamine has an FDA indication, but other stimulants may work as well. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
Listen to Our Podcast: Psychopharm Updates
Don’t miss out on the latest updates in psychopharmacology! Each episode of our podcast showcases one of our products on a regular basis: Video lectures, Quick Takes, and Expert Consultations. We update our feed every 5 days.
References
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR™). (n.d.). APA – Publishing appi.org. https://appi.org/products/dsm
