Specifiers indicating course (e.g., in partial remission, in full remission) may be listed after the diagnosis and are indicated in a number of criteria sets. Where available, severity spec- ifiers are provided to guide clinicians in rating the intensity, frequency, duration, symptom count, or other severity indicator of a disorder. Severity specifiers are indicated by the in- struction ”Specify current severity” in the criteria set and include disorder-specific defini- tions. Descriptivefeatures specifiers have also been provided in the criteria set and convey additional information that can inform treatment planning (e.g., obsessive-compulsive disorder, with poor insight). Not all disorders include course, severity, and / or descriptive features specifiers.
Conditions That May Be a Focus of Ciinicai Attention
In addition to important psychosocial and environmental factors (see ”The Multiaxial Sys- tem” in the ”Introduction” elsewhere in this manual), these chapters in Section II also con- tain other conditions that are not mental disorders but may be encountered by mental health clinicians. These conditions may be listed as a reason for clinical visit in addition to, or in place of, the mental disorders listed in Section II. A separate chapter is devoted to medication-induced disorders and other adverse effects of medication that may be as— sessed and treated by clinicians in mental health practice such as akathisia, tardive dyski- nesia, and dystonia. The description of neuroleptic malignant syndrome is expanded from that provided in DSM—IV-TR to highlight the emergent and potentially life-threatening na- ture of this condition, and a new entry on antidepressant discontinuation syndrome is pro- vided. An additional chapter discusses other conditions that may be a focus of clinical attention. These include relational problems, problems related to abuse and neglect, prob- lems with adherence to treatment regimens, obesity, antisocial behavior, and malingering.
When more than one diagnosis for an individual is given in an inpatient setting, the prin- cipal diagnosis is the condition established after study to be chieﬂy responsible for occa- sioning the admission of the individual. When more than one diagnosis is given for an individual in an outpatient setting, the reason for visit is the condition that is chieﬂy re- sponsible for the ambulatory care medical services received during the visit. In most cases, the principal diagnosis or the reason for visit is also the main focus of attention or treat- ment. It is often difficult (and somewhat arbitrary) to determine which diagnosis is the principal diagnosis or the reason for visit, especially when, for example, a substance- related diagnosis such as alcohol use disorder is accompanied by a non-substance-related diagnosis such as schizophrenia. For example, it may be unclear which diagnosis should
Use of the Manual 23 be considered ”principal” for an individual hospitalized with both schizophrenia and a1- cohol use disorder, because each condition may have contributed equally to the need for admission and treatment. The principal diagnosis is indicated by listing it first, and the re- maining disorders are listed in order of focus of attention and treatment. When the prin- cipal diagnosis or reason for visit is a mental disorder due to another medical condition (e.g., major neurocognitive disorder due to Alzheimer’s disease, psychotic disorder due to malignant lung neoplasm), ICD coding rules require that the etiological medical condition be listed first. In that case, the principal diagnosis or reason for visit would be the mental disorder due to the medical condition, the second listed diagnosis. In most cases, the dis- order listed as the principal diagnosis or the reason for visit is followed by the qualifying