An overview of the DSM-5: changes, controversy, and implications for psychiatric nursing.

Scheduled for publication in May 2013, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), will guide clinical diagnoses, treatment plans, medication choices and protocols, insurance reimbursements, and research agendas throughout the United States. It will also serve as a reference manual for clinicians around the world. This primary diagnostic source used by psychiatric and mental health providers is undergoing significant change in organization and content relative to the previous edition. This article provides a general overview of what to expect in the DSM-5, highlighting major aspects of the revision. Included is a list of the proposed diagnostic categories and an overview of some of the debate and discussion accompanying the changes. Implications for psychiatric nurses and psychiatric nursing are presented.

DSM-5: historical perspectives.

The first major attempts to categorize psychiatric disorders in the United States occurred in the mid-1800s, when census data were collected that included "insanity" and "idiocy" of household members. In Europe, Florence Nightingale promoted the use of non-fatal disease classification for morbidity and treatment in 1860. By the late 1800s, Kraepelin categorized disorders, and his sixth edition of the Compendium der Psychiatrie was widely adopted by both Europeans and Americans. In 1952, the American Psychiatric Association published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Since then, the manual has been periodically updated, expanded, and edited to reflect social and scientific beliefs about the etiology and categorization of psychiatric illness and care. In this article, we explore the historical and ongoing development of the DSM and its implications for psychiatric nurses.

Promoting Self-Care Management among Persons with Serious Mental Illness and HIV.

People with a serious mental illness (SMI) along with HIV have complex health conditions. This population also has high rates of poverty, difficulty in sustaining regular housing, and limited supportive networks. Typically, the combination of psychotropic and HIV medication regimens is complicated, changes frequently, and requires coordination among multiple providers. Furthermore, fragmented and divided primary health care and mental health care systems present substantial barriers for these individuals and for the public health nurses who care for them. In this paper, we present "real world" case studies of individuals with SMI and HIV and the self-care management strategies used by nurses to address medication and treatment management, build interpersonal skills, and develop sustainable health networks. The case studies can be used for quality improvement discussions among practicing public health nurses and for instructing nursing students in a self-care management approach.