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The definition of attention-deficit/hyperactivity disorder (ADHD) has been updated in the fifth edition
of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to more accurately characterize
the experience of affected adults. This revision is based on nearly two decades of research showing that
ADHD, although a disorder that begins in childhood, can continue through adulthood for some people.

Previous editions of DSM did not provide appropriate guidance to clinicians in diagnosing adults with
the condition. By adapting criteria for adults, DSM-5 aims to ensure that children with ADHD can continue
to get care throughout their lives if needed.
Changes to the Disorder
ADHD is characterized by a pattern of behavior, present in multiple settings (e.g., school and home),
that can result in performance issues in social, educational, or work settings. As in DSM-IV, symptoms
will be divided into two categories of inattention and hyperactivity and impulsivity that include behaviors
like failure to pay close attention to details, difficulty organizing tasks and activities, excessive talking,
fidgeting, or an inability to remain seated in appropriate situations.

Children must have at least six symptoms from either (or both) the inattention group of criteria and
the hyperactivity and impulsivity criteria, while older adolescents and adults (over age 17 years) must
present with five. While the criteria have not changed from DSM-IV, examples have been included to
illustrate the types of behavior children, older adolescents, and adults with ADHD might exhibit. The
descriptions will help clinicians better identify typical ADHD symptoms at each stage of patients’ lives.

Using DSM-5, several of the individual’s ADHD symptoms must be present prior to age 12 years, compared
to 7 years as the age of onset in DSM-IV. This change is supported by substantial research published
since 1994 that found no clinical differences between children identified by 7 years versus later
in terms of course, severity, outcome, or treatment response.

DSM-5 includes no exclusion criteria for people with autism spectrum disorder, since symptoms of both
disorders co-occur. However, ADHD symptoms must not occur exclusively during the course of schizophrenia
or another psychotic disorder and must not be better explained by another mental disorder,
such as a depressive or bipolar disorder, anxiety disorder, dissociative disorder, personality disorder, or
substance intoxication or withdrawal.

Care Beyond Childhood
The ADHD diagnosis in previous editions of DSM was written to help clinicians identify the disorder in
children. Almost two decades of research conclusively show that a significant number of individuals
diagnosed with ADHD as children continue to experience the disorder as adults. Evidence of this came
from studies in which individuals were tracked for years or even decades after their initial childhood
diagnosis. The results showed that ADHD does not fade at a specific age.
Studies also showed that the DSM-IV criteria worked as well for adults as they did for children but that
a lower threshold of symptoms (five instead of six) was sufficient for a reliable diagnosis.

2 • DSM-5 Attention Deficit/Hyperactivity Disorder Fact Sheet
In light of the research findings, DSM-5 makes a special effort to address adults affected by ADHD to
ensure that they are able to get care when needed.

DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric
Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process.

The upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will include
a new chapter on Obsessive-Compulsive and Related Disorders to reflect the increasing evidence
of these disorders’ relatedness to one another and distinction from other anxiety disorders, as well as
to help clinicians better identify and treat individuals suffering from these disorders.

Disorders grouped in this new chapter have features in common such as an obsessive preoccupation
and repetitive behaviors. The disorders included in this new chapter have enough similarities to group
them together in the same diagnostic classification but enough important differences between them to
exist as distinct disorders.

Disorders in this chapter include obsessive-compulsive disorder, body dysmorphic disorder and trichotillomania
(hair-pulling disorder), as well as two new disorders: hoarding disorder and excoriation (skinpicking)
disorder.

Hoarding Disorder
Hoarding disorder is characterized by the persistent difficulty discarding or parting with possessions,
regardless of the value others may attribute to these possessions. The behavior usually has harmful effects—emotional,
physical, social, financial, and even legal—for the person suffering from the disorder
and family members. For individuals who hoard, the quantity of their collected items sets them apart
from people with normal collecting behaviors. They accumulate a large number of possessions that
often fill up or clutter active living areas of the home or workplace to the extent that their intended use
is no longer possible.

Symptoms of the disorder cause clinically significant distress or impairment in social, occupational
or other important areas of functioning including maintaining an environment for self and/or others.
While some people who hoard may not be particularly distressed by their behavior, their behavior can
be distressing to other people, such as family members or landlords.

Hoarding disorder is included in DSM-5 because research shows that it is a distinct disorder with distinct
treatments. Using DSM-IV, individuals with pathological hoarding behaviors could receive a diagnosis
of obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder, anxiety
disorder not otherwise specified or no diagnosis at all, since many severe cases of hoarding are not
accompanied by obsessive or compulsive behavior. Creating a unique diagnosis in DSM-5 will increase
public awareness, improve identification of cases, and stimulate both research and the development of
specific treatments for hoarding disorder.

This is particularly important as studies show that the prevalence of hoarding disorder is estimated at
approximately two to five percent of the population. These behaviors can often be quite severe and
even threatening. Beyond the mental impact of the disorder, the accumulation of clutter can create a
public health issue by completely filling people’s homes and creating fall and fire hazards.
2 • Obsessive Compulsive and Related Disorders
Excoriation (Skin-Picking) Disorder
Excoriation (skin-picking) disorder is characterized by recurrent skin picking resulting in skin lesions.

Individuals with excoriation disorder must have made repeated attempts to decrease or stop the skin
picking, which must cause clinically significant distress or impairment in social, occupational or other
important areas of functioning. The symptoms must not be better explained by symptoms of another
mental disorder.

This disorder is included in DSM-5 because of substantial scientific literature on excoriation’s prevalence,
diagnostic validators and treatment. Studies show that the prevalence of excoriation is estimated
at approximately two to four percent of the population. Resulting problems may include medical issues
such as infections, skin lesions, scarring and physical disfigurement.

Process for a New Diagnosis
New diagnoses were included in DSM-5 only after a comprehensive review of the scientific literature;
full discussion by Work Group members; review by the DSM-5 Task Force, Scientific Review Committee,
and Clinical and Public Health Committee; and, finally, evaluation by the American Psychiatric Association’s
Board of Trustees. Trustees approved the final diagnostic criteria for DSM-5 in December 2012.
DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American
Psychiatric
Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process.

http://www.healthyclassmate.com/the-top-celebrities-with-mental-illness/2/

New Medicines:

Questions to ask the Doctor?

Ask the following questions if your doctor recommends a new medicine for your health condition.

General Questions:

What is the name of the medicine?_______________________________________________________________________ Brand name (trade name) Generic name (chemical name)?

What will the medicine do (for example, decrease blood pressure)? ____________________________________________

Why do I need this medicine? ____________________________________________________________________________

Are there any other medicine or treatment options? _________________________________________________________

Is medicine covered by my provincial health plan? __________________________________________________________

Is a generic form of the medicine available and appropriate for me? ___________________________________________

Can I start with a prescription for a few days to make sure the medicine agrees with me? _________________________

Questions to ask about taking this Medicine?

How is the medicine taken (for example, orally [by mouth] or through a skin patch)? _____________________________

What amount do I take each time (dose)? __________________________________________________________________

How often should it be taken (for example, 3 times a day)? ___________________________________________________

When? ________________________________________________________________________________________________

1 Should I take it with or without food? _____________________________________________________________________

What should I avoid while taking it (for example, certain foods, activities, other medicines, or alcohol)? ______________

Will it interact with other medicines I am currently taking or other medical conditions? ____________________________

Yes No If yes, what might occur? _________________________________________________________________________

What are the common side effects (those that do not usually cause problems)? ___________________________________

What side effects should I report if I experience them? _______________________________________________________

What do I do if I miss a dose? ____________________________________________________________________________

How long will I need to take this medicine (days, weeks, months)? _____________________________________________

How will I know that the medicine is helping? _______________________________________________________________

What is the next step if this medicine doesn’t work? __________________________________________________________

Reminders

• Be sure you understand your doctor’s instructions. _________________________________________________________

• State any concerns you have about taking the medicine. ____________________________________________________

For example, ask if “4 doses daily” means taking a dose every 6 hours around the clock or just during regular waking hours. _______________________________________________________________________________________________

Anti Psychotics for the Treatment of Bipolar Disorder

Examples

First-generation, or typical, anti psychotic medicine
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Second-generation, or atypical, anti psychotic medicines
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These medicines are available in liquid, tablet, or injectable form.

How It Works

These medicines balance certain chemicals in the brain (neurotransmitters). It is not clear exactly how these medicines work for the treatment of bipolar disorder. But they quickly improve manic episodes.

Why It Is Used

Each of these medicines has been approved by Health Canada’s Therapeutic Products Directorate (TPD) to treat bipolar disorder. Some medicines work better for some people than for others. Second-generation anti psychotic medicines may have fewer side effects than first-generation anti psychotic medicines. Be sure to talk with your doctor about how the medicine is working for you. Sometimes you might need to try more than one type of medicine before you find one that works best for you.
These medicines have all been found to be an effective treatment of manic episodes. Other anti psychotic medicines, such as olanzapine, are also being studied for the treatment of depression in bipolar disorder.

How Well It Works

Drugs in this classification work quickly in the treatment of bipolar disorder, especially in older adults. These medicines have all been found to be an effective treatment of manic episodes. Some studies show the combination of an antipsychotic and a mood stabilizer may be more effective than a mood stabilizer alone. 1

Side Effects

All medicines have side effects. But many people don’t feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
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• Usually the benefits of the medicine are more important than any minor side effects.
• Side effects may go away after you take the medicine for a while.
• If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

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Call 911 or other emergency services right away if you have:
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• Trouble breathing.
• Swelling of your face, lips, tongue, or throat.

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Call your doctor if you have:
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• Hives.

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Neuroleptic Malignant Syndrome (NMS) is an extremely rare but serious side effect that has been reported by people who take anti psychotic medicines. NMS causes life-threatening problems with your body’s ability to regulate its temperatures.
Call 911 or other emergency services right away if you have a fever and:
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• Muscle rigidity.
• Fast or irregular heartbeat.
• Rapid breathing.
• Severe sweating.

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Other side effects of anti psychotic medicines include:
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• Weight gain.
• Restlessness.
• Sleepiness.
• High Cholesterol or High blood sugar
• Movement disorders, such as Tardive Dyskinesia.
• Managing side effects

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It may take several attempts to find the right dose and medicine to treat your bipolar symptoms. Effectiveness and side effects for each medicine vary from person to person.
Some side effects are minor. You can manage these through lifestyle changes such as exercise, relaxation techniques, and diet changes. Other side effects can be more serious and require changes to the dose or type of medicine.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Before you take an anti psychotic medicine, be sure to tell your doctor if you have:
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• A heart condition.
• A seizure disorder.
• Problems with liver function.
• Problems with blood pressure.
• Diabetes or high blood sugar.
• Constipation.
• A history of breast cancer.
• Problems with swallowing.
• Problems with fainting.

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These medicines should be started in low doses. Talk with your doctor about any other medicines you may be taking to make sure there are no negative drug interactions.
You may need regular liver tests, blood tests, and blood pressure monitoring while taking an anti psychotic medicine. Your doctor may also monitor your weight and blood sugar.
Avoid herbal stimulants (such as ma huang, ginseng, or kola) while taking an anti psychotic medicine.
Talk to your doctor or pharmacist about drinking grapefruit juice while taking an anti psychotic medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases the chances of having serious side effects.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don’t take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do.

Advice for women

Women who use this medicine during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.