0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Testing DSM-5 in Routine Clinical Practice Settings: Feasibility and Clinical Utility
Eve K. Mościcki, Sc.D., M.P.H.; Diana E. Clarke, Ph.D., M.Sc.; S. Janet Kuramoto, Ph.D., M.H.S.; Helena C. Kraemer, Ph.D.; William E. Narrow, M.D., M.P.H.; David J. Kupfer, M.D.; Darrel A. Regier, M.D., M.P.H.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201300098
View Author and Article Information

Dr. Mościcki, Dr. Clarke, Dr. Kuramoto, Dr. Narrow, and Dr. Regier are affiliated with the Division of Research, American Psychiatric Association, 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209 (e-mail: emoscicki@psych.org). Dr. Kraemer is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California. Dr. Kupfer is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Parts of this article were presented at the annual meetings of the American Psychiatric Association, Philadelphia, May 5–9, 2012, and the New Clinical Drug Evaluation Unit, Phoenix, Arizona, May 29 to June 1, 2012.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This article describes the clinical utility and feasibility of proposed DSM-5 criteria and measures as tested in the DSM-5 Field Trials in Routine Clinical Practice Settings (RCP).

Methods  RCP data were collected online for six months (October 2011 to March 2012). Participants included psychiatrists, licensed clinical psychologists, clinical social workers, advanced practice psychiatric–mental health nurses, licensed counselors, and licensed marriage and family therapists. Clinicians received staged, online training and enrolled at least one patient. Patients completed self-assessments of cross-cutting symptom domains, disability measures, and an evaluation of these measures. Clinicians conducted diagnostic interviews and completed DSM-5 and related assessments and a clinical utility questionnaire.

Results  A total of 621 clinicians provided data for 1,269 patients. Large proportions of clinicians reported that the DSM-5 approach was generally very or extremely easy for assessment of both pediatric (51%) and adult (46%) patients and very or extremely useful in routine clinical practice for pediatric (48%) and adult (46%) patients. Clinicians considered the DSM-5 approach to be better (57%) or much better (18%) than that of DSM-IV. Patients, including children age 11 to 17 (47%), parents of children age six to ten (64%), parents of adolescents age 11 to 17 (72%), and adult patients (52%), reported that the cross-cutting measures would help their clinicians better understand their symptoms. Similar patterns in evaluations of feasibility and clinical utility were observed among clinicians from various disciplines.

Conclusions  The DSM-5 approach was feasible and clinically useful in a wide range of routine practice settings and favorably received by both clinicians and patients.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Figure 1 Clinician ratings of the usefulness of the DSM-5 approach compared with the DSM-IV approach for selected disorders of pediatric patients age six to 17a

aADHD, attention-deficit hyperactivity disorder

Figure 2 Clinician ratings of the usefulness of the DSM-5 approach compared with the DSM-IV approach for disorders of adult patientsa

aADHD, attention-deficit hyperactivity disorder

Figure 3 Clinician ratings of the usefulness of the DSM-5 approach compared with the DSM-IV approach, by clinician disciplinea

aPsychiatrists: 154 clinicians and 303 patients; licensed doctoral-level clinical psychologists: 77 clinicians and 153 patients; clinical social workers: 111 clinicians and 227 patients; advanced practice psychiatric–mental health nurses: 33 clinicians and 54 patients; licensed counselors: 126 clinicians and 244 patients; licensed marriage and family therapists: 113 clinicians and 228 patients. Total: 621 clinicians and 1,226 patients. Total includes responses not shown separately from seven licensed master’s-level psychologists reporting on 17 patients.

Figure 4 Patients’ and parents’ ratings of the helpfulness of cross-cutting measures for pediatric patients age six to 17a

aADHD, attention-deficit hyperactivity disorder

Figure 5 Adult patients’ ratings of the helpfulness of cross-cutting measuresa

aADHD, attention-deficit hyperactivity disorder

Anchor for Jump
Table 1Primary DSM-5 diagnoses of pediatric and adult patients enrolled in the DSM-5 Field Trials in Routine Clinical Practice Settings
Anchor for Jump
Table 2Clinician ratings of the overall (all disorders) feasibility and clinical utility of proposed DSM-5 criteria and cross-cutting measures in patient assessment
Table Footer Note

a Number of patients for whom responses were provided on the clinical utility questionnaire

Table Footer Note

b For patients with comorbid DSM-5 diagnoses, clinicians were asked to evaluate proposed criteria separately for each diagnosis.

+

References

Regier  DA;  Narrow  WE;  Kuhl  EA  et al:  The conceptual development of DSM-V.  American Journal of Psychiatry 166:645–650, 2009
[CrossRef] | [PubMed]
 
Stengel  E:  Classification of mental disorders.  Bulletin of the World Health Organization 21:601–663, 1959
[PubMed]
 
Clarke  DE;  Narrow  WE;  Regier  DA  et al:  DSM-5 field trials in the United States and Canada, part I: study design, sampling strategy, implementation, and analytic approaches.  American Journal of Psychiatry 170:43–58, 2013
[CrossRef] | [PubMed]
 
Regier  DA;  Narrow  WE;  Clarke  DE  et al:  DSM-5 field trials in the United States and Canada, part II: test-retest reliability of selected categorical diagnoses.  American Journal of Psychiatry 170:59–70, 2013
[CrossRef] | [PubMed]
 
Narrow  WE;  Clarke  DE;  Kuramoto  SJ  et al:  DSM-5 field trials in the United States and Canada, part III: development and reliability testing of a cross-cutting symptom assessment for DSM-5.  American Journal of Psychiatry 170:71–82, 2013
[CrossRef] | [PubMed]
 
 Diagnostic and Statistical Manual of Mental Disorders , 3rd ed.  Washington DC,  American Psychiatric Association, 1980
 
 Diagnostic and Statistical Manual of Mental Disorders , 4th ed.  Washington DC,  American Psychiatric Association, 1994
 
Spitzer  RL;  Forman  JB;  Nee  J:  DSM-III field trials, I: initial interrater diagnostic reliability.  American Journal of Psychiatry 136:815–817, 1979
[PubMed]
 
 Appendix F: Committee on Nomenclature and Statistics: DSM-III field trials: interrater reliability and listing of participants; in  Diagnostic and Statistical Manual of Mental Disorders , 3rd ed.  Washington, DC,  American Psychiatric Association, 1980
 
Davis  W;  Widiger  TA;  Frances  AJ  et al:  Introduction to final volume; in  DSM-IV Sourcebook , vol. 4. Edited by Widiger  TA;  Frances  AJ;  Pincus  HA  et al.  Washington, DC,  American Psychiatric Publishing, 1994
 
Kraemer  HC;  Kupfer  DJ;  Narrow  WE  et al:  Moving toward DSM-5: the field trials.  American Journal of Psychiatry 167:1158–1160, 2010
[CrossRef] | [PubMed]
 
Smart  DR:  Physician Characteristics and Distribution in the US .  Chicago,  American Medical Association, 2012
 
Suarez  AP;  Marcus  SC;  Tanielian  TL  et al:  Trends in psychiatric practice, 1988–1998, III: activities and work settings.  Psychiatric Services 52:1026, 2001
[CrossRef] | [PubMed]
 
AMA Physician Masterfile. Chicago, American Medical Association, Division of Survey and Data Resources. Available at www.ama-assn.org/ama/pub/about-ama/physician-data-resources/physician-masterfile.page
 
Harris  PA;  Taylor  R;  Thielke  R  et al:  Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.  Journal of Biomedical Informatics 42:377–381, 2009
[CrossRef] | [PubMed]
 
Kish  L:  A procedure for objective respondent selection within the household.  Journal of the American Statistical Association 44:380–387, 1949
[CrossRef]
 
Pincus  HA;  Zarin  DA;  Tanielian  TL  et al:  Psychiatric patients and treatments in 1997: findings from the American Psychiatric Practice Research Network.  Archives of General Psychiatry 56:441–449, 1999
[CrossRef] | [PubMed]
 
US Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, HIT Policy Committee:  Request for comment regarding the stage 3 definition of meaningful use of electronic health records (EHRs).  Federal Register 77:7044, 2012
 
Kroenke  K;  Spitzer  RL:  The PHQ-9: a new depression diagnostic and severity measure.  Psychiatric Annals 32:1–7, 2002
 
Coleman  K;  Austin  BT;  Brach  C  et al:  Evidence on the chronic care model in the new millennium.  Health Affairs 28:75–85, 2009
[CrossRef] | [PubMed]
 
 Diagnostic and Statistical Manual of Mental Disorders, 5th ed .  Arlington, Va,  American Psychiatric Association, 2013
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 12.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 1.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 11.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 1.  >
DSM-5™ Clinical Cases > Chapter 4.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles