DSM-IV-TR

[Buster]

I was sitting in Barnes and Nobel and picked up a copy of DSM-IV-TR

 

I found:

 

293.84 -- Anxiety Disorder due to a General Medical Condition

 

This was surprisingly close:"The essential feature of Anxiety Disorder due to a general medical condition is clinically significant anxiety that is judged to be due to the direct physiological effects of a general medical condition. Symptoms can include prominent, generalized anxiety symptoms, Panic Attacks, or obsessions or compulsions (criterion A). There must be evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition (Criterion . ..."

"Although there are no infallible guidelines for determining whether the relationship between the anxiety symptoms and the general medical condition is etiological, several considerations provide some guidance in this area. One consideration is the presence of a temporal association between the onset, exacerbation, or remission of the general medical condition and the anxiety symptoms. A second consideration is the presence or features that are atypical of a primary Anxiety Disorder (e.g., atypical age at onset or course, or absence of family history)...."

 

Similarly, within the 300.3 OCD, the DSM-IV-TR has under prevalence of OCD:

"Community studies of children and adolescents have estimates a lifetime prevalence of 1%-2.3% and a 1-year prevalence of 0.7%. Research indicates that prevalence rates of Obsessive-Compulsive Disorder are similar in many different cultures around the world."

 

Then later under course:

"Modal age at onset is earlier in males than in females: between 6 and 15 years for males and between age 20 and 29 years for females. For the most part, onset is gradual, but acute onset has been noted in some cases. The majority of individuals have a chronic waxing and waning course, with exacerbation of symptoms that may be related to stress. About 15% show progressive deterioration in occupational and social functioning. About 5% have an episodic course with minimal or no symptoms between episodes."

 

There are no references provided in the sections so it isn't know which studies are being referenced for the above position -- but this is what the doctor/psychiatrist/... is reading.

 

I loved the next section Differential Diagnosis :

 

"Obsessive-Compulsive Disorder must be distinguished from Anxiety Disorder Due to a General Medical Condition..."

 

There's more but it made me think there was room within the DSM-IV-TR for PANDAS under the 293.84 coding.

 

Buster

[memom]

That is very close. Now, need to get insurance companies to go the next step and provide treatment when needed for that code with IVIG.

 

The real problem is coding correctly. It has become a fulltime job in medical offices and to get it right is tough. Coding manuals are 3 inches thick. Imaging seeing patients every 10 minutes, the amount of time it takes to get the coding correct is longer than diagnosing the problem. Crazy.

 

Ellie

[thereishope]

Well, DSM V is under construction and there is no intent to include PANDAS, PITAND, or anything of the such in the new publication. The rough draft of the DSM V is available online for viewing and commenting.

 

http://www.dsm5.org/Pages/Default.aspx

Edited April 15, 2010 by Vickie

[kimballot]

Thanks, Buster, Memom and Vickie-

 

I did not realize that DSM IV TR had this medically based anxiety disorder as a classification. From Vickie's link, it looks like they are keeping the disorder but possibly removing the following:

 

C. The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder With Anxiety in which the stressor is a serious general medical condition).

 

I also noticed that the proposed DSM V has a similar medically-based tic category (go to http://www.dsm5.org/ProposedRevisions/Page...n.aspx?rid=395). It looks like the DSM V is open for comments. I don't know if they are looking for comments from families and patients (though I think we should all register and comment)... it seems that it would be good for some of our healthcare providers to comment, though -

 

I've not been on this forum long. Are we encouraging the PANDAS docs and other healthcare providers to be involved in this?

Edited April 15, 2010 by kimballot

[thereishope]

Anyone can comment. You set up an account first. I wrote them over a month ago. Never heard back.

 

I think there's mixed feelings/opinions whether PANDAS or PITAND should be listed in the DSM 5 amongst PANDAS parents.

[kimballot]

Thanks - I can understand some of the conflict about including PANDAS / PITAND - especially since there are likely different subgroups of PANDA, the role of strep is not clear, and the name may change in the next few years as we learn more about the disorder.

 

It seems that having a classification for medically-based tics and medically-based OCD is a good thing, though, and can serve as a diagnostic category that represents our kids better than the general Ticss or OCD category.

[thereishope]

Received this today. don't know if it's on that website...

 

Only 5 days left to leave comments at the DSM-5.org Web site about proposed revisions to DSM. April 20, 2010, will be the last day to submit feedback. Be sure to register today!

[kimballot]

Now Isn't That timely! Let's comment!!

[NancyD]

Sue Swedo is chairing the neurodevelopmental disorders work group for DSM V.