The authors compared the DSM-III-R with DSM-IV by reviewing the references, mainly DSM-IV Draft Criteria. The purpose of the diagnosis and classification in psychiatric disorders is known to us as its clinical usage and communication media, tool
for the
research, and educational vehicles. But we had to get the training course and experiences until we are familliar with and accustomed with their operating mechanisms. For the more, here in Korea we must get accustomed not only to their verbatims
used in
foreign language and also to their frequent revions. Sooner or later ICD-10 in Koean version well be published. And contemporaneously DSM-IV in English version well be introduced to us for its clinical usage. The authors expected that new
diagnosis
and
classification system in Korean version which contains more native verbatims and culturally santioned Korean version can be made in the near future.
Principles in making change for DSM-IV are indicated as follows such as changes must be made under the empirically based evidence and validated in the field trials but could be done in conservative mays. To the optimal results, systematic and
extensive
work could be done through the cooperativ and concordant communications world-wide.
Summarized changes in DSM-IV in comparison with previous version DSM-III-R were as follows:
1) DSM-IV principally chose the dimensional systems, not the categorical systems which were choosen in the DSM-III-R or it's previous versions. So for the thorough understanding of its concepts we must keep in mind these changes.
2) Previous concept about the organic mental disorder or psychosomatoform had changed fundamentally because of the new knowledge about the physical or pathophysiological understandings about the cause of the functional or psychological
disorders.
3) Special attention on the first psychotic episode cases is paid, and difference between schizophrenia and other acute psychotic conditions may be more illuminated. Negative symptoms in schizophrenia are certificated.
4) In the realms of mood disorders course modifiers and symptom feature modifiers are more specifically defined. As a results more homogenous subtype and it cause can be studied. As an example bipolar type II, rapid cycling subtypes, atypical
depressions, minor depressions ect. Are defined more precisely.
5) For anxiety disorders DSM-III or DSM-III-R had been criticized for its no supporting evidences, so extensive literature review and research data are collected and integrated. Subtype in specific phobias may have its meanings in two different
biological bases and clinical courses. New diagnosis such as acute stress disorder and mixed anxiety/depression are designated. For somatofor disorders, diagnostic criteria of somatization disorders become more concise and clinically evident.
6) In sexual disorder due to its scanty database no specific changes are tried and more conservative attitudes are applied. In eating disorders specifying subtypes such as binge eating type or purging type are validated, so homogeous and
treatment-specific and etiologically identical disease entity are made. In case of sleep disorders new disease entity of sleep paralysis and sleep apnea are added. Overall structructure in classification of sleep disorder is maintained because of
high
inter-rater reliability and stability of diagnosability.
7) in personality disorders, diagnostic criteria terms are refined for more diease-specific, simple, and prominent verbatims are used.
Dimensional approaches and concepts are applied in case of personality disorders and related spectrum disorders e.g. schizotypal personality disorder and schizophrenia spectrum. Borderline personality and mood disorder spectrum, and avoidant
personality
disorder and social phobia spectrum ect. Passive-aggressive personality disorder are removed in personality disorders because it was common factors in personality characteristics and too nonspecific as a disease entity and somewhat culturally
affected
tendency.
Above results could be worked out by the process of collecting and reviewing literatures and reanal;ysis of the datas and applicating the results in field trials. Some of them are not supported by relevant empirical data, but they are chosen for
the
compatibility with the ICD-10 classification.
Nowadays diagnosis and classification in psychiaty are boomed and related papers and research are enormously increased. In clinical pratice and research and educational parts nosologic refinements are regarded as important and critical.
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