Differences between dsm-IV and dsm-IV TR?

Question

I know that IV is not so fresh as IV TR, but all my psychology books still compare icd10 and dsm IV, so, as i decided to write my extended essay about this, i would like to know what speciffic things difference dsm IV from dsm IV TR

Answer 1

There is not a huge amount of difference in the diagnostic criteria between the DSM - IV and the DSM - IV TR. The huge changes happened in the earlier years - especially between the DSM - II and III and III-R. If you take the IV - TR and read the introduction at the beginning of the book it tells you exactly what they changed.
This peice from the Wikepedia might help you:

Brief history

Users should be reminded that the manual is, to an extent, a historical document. The science used to create categories, taxonomies, and diagnoses is based on statistical models. These systems are thus subject to the limitations of the methods used to create them. Deconstructive critics assert that DSM invents illnesses and behaviors. Detractors of DSM argue that patients frequently fail to fit into any particular category or fall into several, that time limits and numbers of clinical characteristics required for a categorisation are arbitrary and that attention directed towards finding a suitable DSM category for a patient would be better spent discussing possible life-history events that precipitated a mental disturbance or monitoring treatment. Since effective treatment is the aim of the psychiatric profession they would argue that it makes more sense to regard ailments on the basis of how they should be treated rather than on deciding what clinically irrelevant differences place them in one category and not another. This would allow for the modular treatment of different sets of symptoms, for instance prescribing antidepressants for a deficit of serotonin and tranquillisers to deal with acute anxiety.
The first edition (DSM-I) was published in 1952, and had about 106 different disorders.
DSM-II was published in 1968.
Both of these editions were strongly influenced by the psychodynamic approach, which provides no sharp distinction between normal and abnormal. All disorders are considered reactions to environmental events, with mental disorders existing on a continuoum of behavior. In this sense, everyone is more or less abnormal. The people with more severe abnormalities have more severe difficulties with functioning.
The classificatory structure of early editions of the DSM was rooted in a distinction between two poles of mental disorder, psychosis and neurosis. A psychosis is a severe mental disorder characterized by a disconnection from reality. Psychoses typically involve hallucinations, delusions, and illogical thinking. A neurosis, however, is a milder mental disorder characterized by distortions of reality, but not a complete break with reality. Neuroses typically involve anxiety and depression.
Among the most noted examples of controversial diagnoses is the classifying in the DSM-II of homosexuality as a mental disorder, a classification that was removed by vote of the APA in 1973 after three years of various gay activists groups demonstrating at APA meetings (see also homosexuality and psychology).
In 1980, with DSM-III, the psychodynamic view was abandoned and the biomedical model became the primary approach, introducing a clear distinction between normal and abnormal. The DSM became atheoretical since it had no preferred etiology for mental disorders.
In 1986 the DSM-III-R appeared as a revision of DSM-III. Many criteria were changed.
In 1994, it evolved into DSM-IV. This work is currently in its fourth edition.
The most recent version is the 'Text Revision' of the DSM-IV, also known as the DSM-IV-TR, published in 2000. The vast majority of the criteria for the diagnosis were not changed from DSM-IV. The text in between the criteria was updated.
DSM-V, is tentatively scheduled for publication in 2011, with initial planning having begun in 1999. The APA Division of Research expects to begin forming DSM development workgroups in 2007 [1].
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A multiaxial approach

The Diagnostic and Statistical Manual of Mental Disorders, presently in its fourth revised (IV-TR, 2000) edition, systemizes psychiatric diagnosis in five axes:
Axis I: major mental disorders, developmental disorders and learning disabilities
Axis II: underlying pervasive or personality conditions, as well as mental retardation
Axis III: any nonpsychiatric medical condition ("somatic")
Axis IV: social functioning and impact of symptoms
Axis V: Global Assessment of Functioning (on a scale from 100 to 0)
Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, and schizophrenia. Common Axis II disorders include borderline personality disorder, schizotypal personality disorder, antisocial personality disorder, narcissistic personality disorder, and mild mental retardation.
The contents of the DSM are determined by experts whose mandate is to create a set of diagnoses that are replicable and meaningful. While the classification system was originally intended to enhance research into both diagnosis and treatment, the nomenclature is now widely used by both clinicians and insurance companies.
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Limitations


The DSM is intended for use by mental health professionals, and for use in research and administration. Appropriate use of the diagnostic criteria requires extensive clinical training, and its contents "cannot simply be applied in a cookbook fashion" [2]. APA notes that diagnostic labels are primarily for use as a "convenient shorthand" among professionals for the same symptoms. Further, people sharing the same diagnosis/label may not have the same etiology (cause), or require the same treatment (the DSM contains no information on treatment or cause for this reason). The range and breadth of the DSM represents an extensive scope. Impotence, premature ejaculation, jet lag, caffeine addiction, and bruxism are examples of surprising inclusions and are but only several that non-psychiatrists might not consider to be mental illnesses.
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Most people using the manual use it more for codes to put into reports, for insurance claims and in Social Medicine countries for billing the system. (Hopefully they are more focussed on helping patients to get better by using good psychotherapeutic practices that are fit to the individual client and/or medical and applicable "alternative" methods - not the DSM for healing)

The following from the current manual's website might help you in your writing: http://www.dsmivtr.org/index.cfm

In many ways the diagnostic codes constitute the most “clinically relevant” part of DSM-IV-TR. For many clinicians, the three, four, and five digit codes associated with each DSM-IV-TR disorder are the only components of the diagnostic system used on a daily basis. These codes have direct relevance to the practical bottom line of clinical practice: no diagnostic code, no payment.

Many people wonder why the diagnostic codes seem so illogically assigned. Why don't they start at 1 and go to 100, for instance? However much we would have liked to make the numbering system simple and straightforward, the APA does not control the DSM-IV diagnostic codes. All of the codes are taken from the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), the official coding system used by the United States Government and all private insurers to classify medical conditions and causes of injury or death. (Click here for more information about ICD-9-CM and to download a copy). The diagnostic codes for mental disorders, which have been designated to range from 290-319 are but a small part of this much larger system (which goes from 1-999). When the ICD-9 system was originally devised in the early 1970's, the codes were assigned according to a particular logical scheme: three digit codes were the highest order categories (e.g., Senile and presenile organic conditions, Alcoholic psychoses, Schizophrenic disorders, Affective psychoses, Paranoid states, etc.), most of which were divided further into ten four digit categories (eg. 290.0 Senile dementia uncomplicated, 290.1 Presenile dementia, ... 290.9 Unspecified senile psychotic condition) and most of these divided further into five digit categories.

DSM-IV-TR diagnostic codes have been selected by carefully perusing the ICD-9-CM system and picking the ICD-9-CM code that best corresponds to each DSM-IV-TR category. Since all DSM-IV-TR diagnostic codes represent valid ICD-9-CM codes, clinicians can use the DSM-IV-TR codes in any situation in which a valid ICD-9-CM code is required (e.g., Medicare and other insurance forms). Thus, the HIPAA requirement for clinicians and hospitals to use ICD-9-CM codes for diagnostic purposes is met by using the codes in the DSM-IV-TR. The continued use of the DSM-IV-TR diagnostic criteria for psychiatric diagnosis has been officially sanctioned by the Center for Medicare Services, according to two statements in the Frequently Asked Questions section of the CMS web site. In response to the question “Can clinicians continue current practice and use the DSM-IV diagnostic criteria?,” the site states “clinicians may continue to base their diagnostic decisions on the DSM-IV criteria, and, if so, to crosswalk those decisions to the appropriate ICD-9-CM codes. In addition, it is still perfectly permissible for providers and others to use the DSM-IV codes, descriptors and diagnostic criteria for other purposes, including medical records, quality assessment, medical review, consultation and patient communications.” (Click here for the complete entry on the CMS web site) Furthermore, in response to the question “Can mental health practitioners, agencies, institutions and others still use DSM-IV diagnostic criteria, even though DSM-IV has not been adopted as a HIPAA code set?,” the site notes that “the basic purpose for adopting code sets under HIPAA is to standardize the ‘data elements' used in the electronic processing of certain administrative and financial health care transactions. While the patient's diagnosis is a data element used in such transactions, the criteria considered by the clinician in reaching a diagnosis are not. Practitioners are free to use the DSM-IV diagnostic criteria—or any other diagnostic guidelines—without any HIPAA-related concerns.” (Click here for the complete entry on the CMS web site)

Note that in some cases, several DSM-IV-TR disorders share the same ICD-9-CM code. This is not a mistake—DSM-IV-TR in some cases includes greater diagnostic specificity than ICD-9-CM. For example, ICD-9-CM only recognizes alcohol-induced dementia, amnestic disorder, and psychotic disorders and does not include specific categories for alcohol-induced mood, anxiety, and sleep disorders. Thus, all of these DSM-IV-TR categories share the same ICD-9-CM, 291.89, which corresponds to the ICD-9-CM category “Other alcohol-induced disorder.”

There are two caveats to the coding compatibility between DSM-IV-TR and ICD-9-CM:

1) Updates are made to the entire ICD-9-CM diagnostic coding system by the US Government on a yearly basis, with changes becoming mandatory each January 1st. When DSM-IV-TR was initially printed in May 2000, all diagnostic codes were updated to insure that they were up-to-date (to reflect coding changes effective the following October 2000). Since May 2000, there have been four cycles of coding changes (October 2001, October 2002, October 2003 and October 2004). The following coding changes reflect all of the coding changes (through October 2004) that affect DSM-IV-TR. (Note: DSM-IV-TR is periodically reprinted as supplies at the publisher run low. At the time of each printing, diagnostic codes are updated to reflect these annual updates). See below for a list of all coding changes made in DSM-IV-TR since its initial printing in May 2000.

2) Although all codes in DSM-IV-TR are valid ICD-9-CM codes, technical differences in ICD-9-CM coding rules can result in slightly different results when looking up codes in DSM-IV-TR vs. ICD-9-CM, mainly in the order that the codes are listed. This is of interest primarily to coders. Click here for a complete (and mostly arcane) explanation of all such differences.

Coding Changes in DSM-IV-TR since May 2000 Publication

1) There have been two changes in diagnostic coding that affect the DSM-IV-TR codes themselves. The first, effective October 1, 2004, is that the code for Narcolepsy has been changed to 347.00 from 347. The second, effective October 1, 2003, is that code for Age-Related Cognitive Decline has been changed to 780.93 from 780.9.

2) Two changes in diagnostic codes reflect changes in general medical condition codes that impact on DSM-IV-TR coding.

Dementia Due to Parkinson's Disease: on Axis III, one should now code: 331.82 Dementia with Lewy Bodies

Dementia Due to Pick's Disease: on Axis III, one should now code 331.11 Pick's disease.

3) Appendix G in DSM-IV-TR includes a list of “ICD-9-CM Codes for Selected General Medical Conditions and Medication-Induced Disorders.” Changes in ICD-9-CM codes for general medical conditions have necessitated the following updates:

Page 868: Encephalopathy, unspecified. Should be 348.30* (instead of 348.3*)

Page 869: Myasthenia gravis. Should be 358.00* (instead of 358.0)

Page 869: Pick's disease. Should be 331.11 (instead of 331.1)

Page 872: Dwarfism, pituitary. Should be 253.3 (instead of 252.2)

Page 872: Hyperaldosteronism. Should be 255.10* (instead of 255.1)

Page 874: Diverticulitis of colon, unspecified should be 562.11 (instead of 562.10)

Page 874: Diverticulitis of colon, with hemorrhage should be 562.13 (instead of 562.12)

Page 874: Diverticulosis of colon, unspecified, should be 562.10 (instead of 562.11)

Page 874: Diverticulosis of colon, with hemorrhage should be 562.12 (instead of 562.13)

Page 875: Hypertrophy, prostatic, benign (BPH). Should be 600.00* (instead of 600.0)

Page 875: Thalassemia. Should be 282.49* (instead of 282.4)

I hope that this helps. Knowing the DSM s are important in your study of psychology and learning them can seem overwhelming. However, they are only a part of your study of psychology that can, if you put your heart into it as well, really be a profession that you can practice to really help people make a difference in their lives and circumstances. Good luck!

Answer 2

Dsm Iv Tr Dementia

Answer 3

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Answer 4

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Answer 5

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