Abstract
A previously published paper (Schultz Psychological Injury and Law 3: 271–288, 2010) on forensic considerations regarding neurocognitive disorders within the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5; American Psychiatric Association, 2013) reviewed evidence for internal and external validity, as well as the fairness and utility of the proposed classification. Given recent publication of the DSM-5, in May 2013, the current paper provides an update on this review. It focuses on changes in the final version of the neurocognitive disorders section of the DSM-5 as compared with the earlier proposal in 2010 and raises a range of new conceptual, methodological, and clinical practice issues related to this classification. An examination of forensic neuropsychologists’ diagnostic choices and their associated pitfalls follows. Discussion extends to the unresolved issue of disorder threshold, associated risks of overdiagnosis of mild neurocognitive disorder and underdiagnosis of major neurocognitive disorder, and the absence of a moderately severe disorder classification. Methodological concerns in diagnostic determinations, especially with DSM-5 Criteria A and B, issues associated with subtypes and specifiers, as well as functional assessments of activities of daily living, now embedded in the diagnosis, follow. Subtype omissions and methodological inconsistencies are highlighted.The vulnerability of neuropsychologists and psychiatrists during courtroom testimony on neurocognitive disorders-particularly with conceptual, methodological, and practical issues-will be addressed through clinical and forensic practice recommendations.
Similar content being viewed by others
References
Adhikari, N. K., Tansey, C. M., McAndrews, M. P., Matté, A., Pinto, R., Cheung, A. M., et al. (2011). Self-reported depressive symptoms and memory complaints in survivors five years after ARDS. Chest, 140(6), 1484–1493.
American Educational Research Association (AERA), American Psychological Association (APA), & National Council on Measurement in Education. (1999). Standards for educational and psychological testing. Washington, DC: Author.
American Psychiatric Association (APA) (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
American Psychiatric Association (APA) (2010). Proposed draft revisions to DSM disorders and criteria. Retrieved from APA website: http://www.dsm5.org/Pages/Default.aspx
American Psychiatric Association (APA) (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Azoulay, E., & Moss, M. (2012). Embracing physical and neuropsychological dysfunction in acute lung injury survivors: The time has come. American Journal of Respiratory and Critical Care Medicine, 185(5), 470–471.
Bares, K. K., Pliskin, N. H., Heilbronner, R. L., Primeau, M., Meyer, G. M., Kelley, K. M., et al. (1994). Nature of memory deficits in electrical injury patients. Proceedings of the Twenty-Second Annual Meeting of the International Neuropsychological Society, Cincinnati, OH, 1(4), 377.
Barrash, J., Kealey, G. P., & Janus, T. J. (1996). Neurobehavioral sequelae of high voltage electrical injuries: Comparison with traumatic brain injury. Applied Neuropsychology, 3, 75–81.
Chudasama, S., Goverman, J., Donaldson, J. H., van Aalst, J., Cairns, B. A., & Hultman, C. S. (2010). Does voltage predict return to work and neuropsychiatric sequelae following electrical burn injury? Annals of Plastic Surgery, 64(5), 522–525.
Collie, A., & Maruff, P. (2001). An analysis of systems of classifying mild cognitive impairment in older people. The Australian and New Zealand Journal of Psychiatry, 36, 133–140.
Duff, K., & McCaffrey, R. J. (2001). Electrical injury and lightning injury: A review of their mechanisms and neuropsychological, psychiatric, and neurological sequelae. Neuropsychology Review, 11(2), 101–116.
Echemendia, R. J., & Julian, L. J. (2001). Electrical injury and lightning injury: A review of their mechanisms and neuropsychological, psychiatric, and neurological sequelae. Neuropsychology Review, 11, 2.
FitzGerald, A., Aditya, H., Prior, A., McNeill, W., & Pentland, B. (2010). Anoxic brain injury: Clinical patterns and functional outcomes. A case of 93 cases. Brain Injury, 24(11), 1311–1324.
Frances, A. (2010a, February 11). Re: Opening Pandora’s box: The 19 worst suggestions for DSM5 [Web log message]. Retrieved from http://www.psychiatrictimes.com/dsm/content/article/10168/1522341
Frances, A. (2010b, July 6). Re: Normality is an endangered species: Psychiatric fads and overdiagnosis [Web log message]. Retrieved from http://www.psychiatrictimes.com/dsm-5/content/article/10168/1598676?CID=rss
Frances, A. (2010c). The forensic risks of DSM-V and how to avoid them. Journal of the American Academy of Psychiatry, 38, 11–14.
Groth-Marnat, G. (Ed.). (2000). Neuropsychological assessment in clinical practice: A guide to test interpretation and integration. New York, NY: John Wiley & Sons.
Heaton, R., Grant, C., & Matthews, C. (1991). Comprehensive norms for an expanded Halstead–Reitan battery. Odessa, FL: Psychological Assessment Resources.
Hopkins, R. O., Weaver, L. K., Collingridge, D., Parkinson, R. B., Chan, K. J., & Orme, J. F., Jr. (2005). Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 171(4), 340–347.
Hopkins, R. O., Weaver, L. K., Pope, D., Orme, J. F., Bigler, E. D., & Larson-Loher, V. (1999). Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 160(1), 50–56.
Janus, T. J., & Barrash, J. (1996). Neurologic and neurobehavioral effects of electric and lightning injuries. Journal of Burn Care & Rehabilitation, 17, 409–415.
Jeste, D., Blacker, D., Blazer, D., Ganguli, M., Grant, I., Paulsen, J., et al. (2010). Neurocognitive disorders: A proposal from the DSM-5 neurocognitive disorders working group. DSM-5 Neurocognitive Criteria. Retrieved from: http://www.dsm5.org/Proposed%20Revision%20Attachments/APA%20Neurocognitive%20Disorders%20Proposal%20for%20DSM-5.pdf
Kurz, A. F., & Lautenschlager, N. T. (2010). The concept of dementia: Retain, reframe, rename or replace? International Psychogeriatrics, 22, 37–42.
Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment (4th ed.). New York, NY: Oxford University Press.
Luis, C. A., Lowenstein, D. A., Acevedo, A., Barker, W. W., & Duara, R. (2003). Mild cognitive impairment: Directions for future research. Neurology, 61, 438–444.
Matthews, F. E., Stephan, B. C. M., Bond, J., McKeith, I., & Brayne, C. (2007). Operationalisation of mild cognitive impairment: A graphical approach. PLoS Medicine, 4, 1615–1619.
Neary, D., Snowden, J. S., Gustafson, L., Passant, U., Stuss, D., Black, S., et al. (1998). Frontotemporal lobar degeneration: A consensus on clinical diagnostic criteria. Neurology, 51, 1546–1554.
Petersen, R. C., & O’Brien, J. (2006). Mild cognitive impairment should be considered for DSM-V. Journal of Geriatric Psychiatry and Neurology, 19, 147–154.
Pliskin, N. H., Capelli-Schellpfeffer, M., Law, R. T., Malina, A. C., Kelley, K. M., & Lee, R. C. (1998). Neuropsychological symptom presentation after electrical injury. The Journal of Trauma: Injury, Infection, and Critical Care, 44, 709–715.
Ritchie, K., Artero, S., & Touchon, J. (2001). Classification criteria for mild cognitive impairment. Neurology, 56, 37–42.
Rondinelli, R. D. (Ed.). (2009). Guides to the evaluation of permanent impairment (6th ed. revised). Chicago, IL: American Medical Association Press.
Sachdev, P., Andrews, G., Hobbs, M. J., Sunderland, M., & Anderson, T. M. (2009). Neurocognitive disorders: Cluster 1 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 39, 2001–2012.
Schultz, I. Z. (2010). Neurocognitive disorders in DSM-V: Forensic perspective. Psychological Injury & Law, 3, 271–288.
Visser, P. J. (2006). Mild cognitive impairment. In M. S. J. Pathy, A. J. Sinclair, & J. E. Morley (Eds.), Principles and practice of geriatric medicine (4th ed.). New York, NY: Wiley.
Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L.-O., et al. (2004). Mild cognitive impairment—Beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.
Conflict of Interest
Dr. Schultz has a limited private medico-legal practice specializing in complex neuropsychological disability cases referred both by plaintiff and defense lawyers.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schultz, I.Z. DSM-5 Neurocognitive Disorders: Validity, Reliability, Fairness, and Utility in Forensic Applications. Psychol. Inj. and Law 6, 299–306 (2013). https://doi.org/10.1007/s12207-013-9174-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12207-013-9174-7