Dr. DSM Comes to Denver

Dr. Michael First Lectures

Dr. DSM Comes to Denver

Dr. Michael First is a Professor of Clinical Psychiatry at Columbia University, a Research Psychiatrist at the Biometrics Department at the NY State Psychiatric Institute and maintains a private practice in Manhattan. He is internationally recognized as the expert on psychiatric diagnoses and assessment. He assisted in editing the DSM-V and the DSM-IV-TR.

The DSM-V was published in May 2013 and it took over a decade to revise. As there were many substantive additions, deletions, and changes made to it, doctors and lawyers that work with this publication need guidance regarding how it changed the shape of treatment and diagnosis of mental disorders. Dr. First can roll the changes to the new manual off his tongue as if he was reciting the Miranda Warnings.

In his presentation at the Forum, Dr. First’s clear admonition was that lawyers and clinicians should be careful when using the DSM in forensic settings. The manual was designed to be used in a clinical setting, or rather to enable clinicians to diagnose, communicate about, study and treat mental illnesses. It was not created to determine legal responsibility, competency, or insanity. But when it is used appropriately, it can assist decision makers. And, most importantly, as echoed by Dr. Bursztajn, the diagnosis does not define the person, much more is needed than a diagnosis to understand an individual’s mental health issues and needs.

Dr. First ran through some of the most relevant changes to the DSM for the attendees of the Forum, including new diagnostic definitions which will create more cases of PTSD, Schizophrenia, Delusional Disorder, Major Depressive Disorder, Substance Abuse Disorder and adult ADHD. Also added, was Mild Neurocognitive Disorder – a disorder that could fit the category of individuals that meet a cognitive impairment as Michele LaVigne presented on. And, although the DSM is not a forensic device, we all know that judges like labels so maybe this will convince some that your clients really are incompetent because they finally have a label!

Dr. First also discussed the new diagnostic definitions which are narrow and will exclude cases that would have been met in the DSM-IV, such as Autism Spectrum Disorder and Paraphilias (this change will ensure that only individuals aroused by paraphilic focus – not just look at something with paraphilic focus can be given this diagnosis). The new disorders he discussed were Social Communication Disorder, Disruptive Mood Dysregulation Disorder, Premenstrual Dysphoric Disorder, Cannabis Withdrawal and Caffeine Withdrawal.

His analysis of the amended definition of Intellectual Disability was interesting. Now for the first time, the IQ score of 70 or below is no longer included in the diagnostic criteria. It seems that finally, the doctors are realizing that how a person functions, how they communicate or how they get along in life maybe more of an indicator of a person’s disability rather than a score on a test. Good news.