Mild neurocognitive disorder is a new category for all of the nine neurocognitive disorders included in the DSM-5.
It’s a change that is bound to be of interest to patients—and to the families and caregivers of patients—who did not meet previous DSM-IV criteria for dementia but who are nevertheless clinically impaired. In Understanding Mental Disorders: Your Guide to DSM-5, published this month by American Psychiatric Publishing, mild neurocognitive disorder is defined like this: “A slight decline in at least one area of a person’s mental function—such as attention, ability to plan and make decisions, memory and learning, language, and motor skills—that causes concern from a loved one or a doctor, or is confirmed by testing.”
Following the format and organization of the clinician’s version of DSM-5, the new layperson’s guide covers all of the mental disorders in DSM-5, explaining each in clear, concise language.
Neurocognitive disorders comprise the 17th chapter in the manual, followed by chapters on personality disorders and paraphilic disorders. The nine neurocognitive disorders covered in the chapter are Alzheimer’s disease (AD), frontotemporal degeneration, Lewy body disease, vascular disease, traumatic brain injury, HIV infection, prion disease, Parkinson’s disease, and Huntington’s disease. A 10th disorder, called delirium, which is defined as a short-term state of confusion and reduced attention, is also listed in this section.
In an interview with Psychiatric News last year, Dan Blazer, M.D., Ph.D., chair of the Neurocognitive Disorders Work Group, said that inclusion of mild neurocognitive disorder in DSM-5 reflects a body of research that has emerged since DSM-IV demonstrating that individuals with AD and other neurocognitive disorders may begin showing mild signs of cognitive impairment years before their diagnosis and may have neuropathological changes even before the onset of mild symptoms.
“In recent years, research across the entire field of neurocognitive disorders, but especially Alzheimer’s, is indicating that we need to move ‘upstream’ in terms of making a diagnosis,” he said.
All of the chapters include features that will be useful to patients and families, such as the following “Tips for Caregivers” included in the chapter on neurocognitive disorders:
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Know what resources are available: Learn about the different levels of care your loved one will need depending on the stages of illness. Adult day programs, in-home assistance, and visiting nurses are just some of the services that can help you manage day-to-day tasks.
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Get help: Don’t try to do everything yourself. Ask family and friends for support. The Alzheimer’s Association 24/7 Helpline at (800) 272-3900 and local support groups are also good sources for comfort.
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Practice relaxation techniques: Meditation, breathing exercises, yoga, and visualization are just a few of the simple techniques that can help relieve stress.
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Take time for yourself: Although it may be hard to find time to do things just for you, it’s important for your well-being to take time each week for an activity you enjoy or to stay connected to friends and family.
The chapter on personality disorders covers in detail the criteria for borderline, antisocial, and schizotypal personality disorders. Other personality disorders described in lesser detail are paranoid, schizoid, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive personality disorders.
“All people have personality traits that make them unique and different from others,” the manual explains. “These traits are lasting patterns of how someone tends to think about and relate to his or her own world, others, and self. … A personality disorder reflects deeper, more severe problems that can greatly impair how someone thinks, feels, lives, works, and perceives and loves others.”
Many of the chapters in the layperson’s guide include a patient story, drawn from real clinical vignettes with name and other identifying information changed (see sidebar).
The most important change to the chapter on paraphilic disorders is the distinction between paraphilias—defined as atypical sexual interests—and “paraphilic disorders.” According to the manual, “[p]eople with paraphilic disorders have a paraphilia that causes distress; impairs work, social, or other key functions; or causes harm or risk of harm to self or others. These disorders often involve repeated, intense sexual fantasies and urges that the person then enacts in real life. … People with these disorders devote great time and energy to satisfying their sexual preference, and it may well cause problems in their job, marriage, and other aspects of life.”
The eight paraphilic disorders that appear in DSM-5 are discussed in this chapter: voyeuristic, exhibitionistic, frotteuristic, sexual masochism, sexual sadism, pedophilic, fetishistic, and transvestic disorders.
“The change to the manual recognizes that you could practice sexual masochism or cross-dressing without having a mental disorder,” Ray Blanchard, Ph.D., chair of the Work Group on Paraphilic Disorders for DSM-5, told Psychiatric News in an interview last year. “The two routes to upgrading a paraphilia to a paraphilic disorder are either because it causes distress or impairment in functioning or because the paraphilia inherently involves individuals who are nonconsenting and who have been used to gratify the paraphilia in real life and not just in fantasy.” ■
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Understanding Mental Disorders, including ordering information and links to previous articles in
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