DSM
What are the 4 domains of the CFI
-Cultural Definition of the Problem (questions 1-3) -Cultural Perceptions of Cause, Context, and Support (questions 4-10) -Cultural Factors Affecting Self-Coping and Past Help Seeking (questions 11-13) -Cultural Factors Affecting Current Help Seeking (questions 14-16).
Overweight or Obesity
278.00 (E66.9) This category may be used when overweight or obesity is a focus of clinical attention.
V code
The distinguishing feature of these V codes is that the issue is the focus of clinical attention and is a pattern of interaction between the members of the relational unit that is associated with clinically significant impairment. Can be used as a primary diagnosis but must be sure that primary mental health diagnosis is ruled out. Some v codes are not reimbursed by insurance companies
Cultural concepts are important to psychiatric diagnosis for several reasons
To avoid misdiagnosis, to obtain useful clinical information, to improve clinical rapport and engagement, to improve therapeutic efficacy, to guide clinical research, to clarify the cultural epidemiology
Other Personal History of Psychological Trauma
V15.49 (Z91.49)
Personal History of Self-Harm
V15.59 (Z91.5)
Nonadherence to Medical Treatment
V15.81 (Z91.19) This category can be used when the focus of clinical attention is nonadherence to an important aspect of treatment for a mental disorder or another medical condition. Reasons for such nonadherence may include discomfort resulting from treatment (e.g., medication side effects), expense of treatment, personal value judgments or religious or cultural beliefs about the proposed treatment, age-related debility, and the presence of a mental disorder
Other Personal Risk Factors
V15.89 (Z91.89)
Wandering Associated With a Mental Disorder
V40.31 (Z91.83) This category is used for individuals with a mental disorder whose desire to walk about leads to significant clinical management or safety concerns. For example, individuals with major neurocognitive or neurodevelopmental disorders may experience a restless urge to wander that places them at risk for falls and causes them to leave supervised settings without needed accompaniment. This category excludes individuals whose intent is to escape an unwanted housing situation
Homelessness
V60.0 (Z59.0) This category should be used when lack of a regular dwelling or living quarters has an impact on an individual's treatment or prognosis
Inadequate Housing
V60.1 (Z59.1) This category should be used when lack of adequate housing has an impact on an individual's treatment or prognosis.
Lack of Adequate Food or Safe Drinking Water
V60.2 (Z59.4)
Extreme Poverty
V60.2 (Z59.5)
Low Income
V60.2 (Z59.6)
Insufficient Social Insurance or Welfare Support
V60.2 (Z59.7) This category should be used for individuals who meet eligibility criteria for social or welfare support but are not receiving such support, who receive support that is insufficient to address their needs, or who otherwise lack access to needed insurance or support programs.
Problem Related to Living Alone
V60.3 (Z60.2) This category should be used when a problem associated with living alone is the focus of clinical attention or has an impact on the individual's treatment or prognosis.
Problem Related to Living in a Residential Institution
V60.6 (Z59.3) This category should be used when a problem (or problems) related to living in a residential institution is a focus of clinical attention or has an impact on the individual's treatment or prognosis.
Discord With Neighbor, Lodger, or Landlord
V60.89 (Z59.2) This category should be used when discord with neighbors, lodgers, or a landlord is a focus of clinical attention or has an impact on the individual's treatment or prognosis
Unspecified Housing or Economic Problem
V60.9 (Z59.9) This category should be used when there is a problem related to housing or economic circumstances other than as specified above
Disruption of Family by Separation or Divorce
V61.03 (Z63.5) This category should be used when partners in an intimate adult couple are living apart due to relationship problems or are in the process of divorce.
Relationship Distress With Spouse or Intimate Partner
V61.10 (Z63.0) This category should be used when the major focus of the clinical contact is to address the quality of the intimate (spouse or partner) relationship or when the quality of that relationship is affecting the course, prognosis, or treatment of a mental or other medical disorder.
Parent-Child Relational Problem
V61.20 (Z62.820) This category should be used when the main focus of clinical attention is to address the quality of the parent-child relationship or when the quality of the parent-child relationship is affecting the course, prognosis, or treatment of a mental or other medical disorder. Typically, the parent-child relational problem is associated with impaired functioning in behavioral, cognitive, or affective domains
Child Affected by Parental Relationship Distress
V61.29 (Z62.898) This category should be used when the focus of clinical attention is the negative effects of parental relationship discord (e.g., high levels of conflict, distress, or disparagement) on a child in the family, including effects on the child's mental or other medical disorders.
Problems Related to Multiparity
V61.5 (Z64.1)
Problems Related to Unwanted Pregnancy
V61.7 (Z64.0)
Upbringing Away From Parents
V61.8 (Z62.29) This category should be used when the main focus of clinical attention pertains to issues regarding a child being raised away from the parents or when this separate upbringing affects the course, prognosis, or treatment of a mental or other medical disorder
Sibling Relational Problem
V61.8 (Z62.891 ) This category should be used when the focus of clinical attention is a pattern of interaction among siblings that is associated with significant impairment in individual or family functioning or with development of symptoms in one or more of the siblings, or when a sibling relational problem is affecting the course, prognosis, or treatment of a sibling's mental or other medical disorder
High Expressed Emotion Level Within Family
V61.8 (Z63.8) Expressed emotion is a construct used as a qualitative measure of the "amount" of emotion—in particular, hostility, emotional overinvolvement, and criticism directed toward a family member who is an identified patient—displayed in the family environment. This category should be used when a family's high level of expressed emotion is the focus of clinical attention or is affecting the course, prognosis, or treatment of a family member's mental or other medical disorder.
Problem Related to Current Military Deployment Status
V62.21 (Z56.82) This category should be used when an occupational problem directly related to an individual's military deployment status is the focus of clinical attention or has an impact on the individual's diagnosis, treatment, or prognosis.
Exposure to Disaster, War, or Other Hostilities
V62.22 (Z65.5)
Personal History of Military Deployment
V62.22 (Z91.82)
Other Problem Related to Employment
V62.29 (Z56.9) Other Problem Related to Employment This category should be used when an occupational problem is the focus of clinical attention or has an impact on the individual's treatment or prognosis. Areas to be considered include problems with employment or in the work environment, including unemployment; recent change of job; threat of job loss; job dissatisfaction; stressful work schedule; uncertainty about career choices; sexual harassment on the job; etc
Academic or Educational Problem
V62.3 (Z55.9) This category should be used when an academic or educational problem is the focus of clinical attention or has an impact on the individual's diagnosis, treatment, or prognosis. Problems to be considered include illiteracy or low-level literacy; lack of access to schooling owing to unavailability or unattainability; problems with academic performance
Acculturation Difficulty
V62.4 (Z60.3) This category should be used when difficulty in adjusting to a new culture (e.g., following migration) is the focus of clinical attention or has an impact on the individual's treatment or prognosis
Social Exclusion or Rejection
V62.4 (Z60.4) This category should be used when there is an imbalance of social power such that there is recurrent social exclusion or rejection by others. ex: bullying, teasing
Target of (Perceived) Adverse Discrimination or Persecution
V62.4 (Z60.5) This category should be used when there is perceived or experienced discrimination against or persecution of the individual based on his or her membership (or perceived membership) in a specific category.
Conviction in Civil or Criminal Proceedings Without Imprisonment
V62.5 (Z65.0)
Imprisonment or Other Incarceration
V62.5 (Z65.1)
Problems Related to Release From Prison
V62.5 (Z65.2)
Problems Related to Other Legal Circumstances
V62.5 (Z65.3)
Uncomplicated Bereavement
V62.82 (Z63.4) This category can be used when the focus of clinical attention is a normal reaction to the death of a loved one
Borderline Intellectual Functioning
V62.89 (R41.83) This category can be used when an individual's borderline intellectual functioning is the focus of clinical attention or has an impact on the individual's treatment or prognosis. Differentiating borderline intellectual functioning and mild intellectual disability (intellectual developmental disorder) requires careful assessment of intellectual and adaptive functions and their discrepancies, particularly in the presence of co-occurring mental disorders that may affect patient compliance with standardized testing procedures
Phase of Life Problem
V62.89 (Z60.0) This category should be used when a problem adjusting to a life-cycle transition (a particular developmental phase) is the focus of clinical attention or has an impact on the individual's treatment or prognosis.
Discord With Social Service Provider, Including Probation Officer, Case Manager, or Social Services Worker
V62.89 (Z64.4)
Victim of Crime
V62.89 (Z65.4)
Victim of Terrorism or Torture
V62.89 (Z65.4)
Other Problem Related to Psychosocial Circumstances
V62.89 (Z65.8)
Religious or Spiritual Problem
V62.89 (Z65.8) This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized church or religious institution
Unspecified Problem Related to Social Environment
V62.9 (Z60.9) This category should be used when there is a problem related to the individual's social environment other than as specified above.
Unspecified Problem Related to Unspecified Psychosocial Circumstances
V62.9 (Z65.9)
Unavailability or Inaccessibility of Other Helping Agencies
V63.8 (Z75.4)
Unavailability or Inaccessibility of Health Care Facilities
V63.9 (Z75.3)
Malingering
V65.2 (Z76.5) The essential feature of malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. Under some circumstances, malingering may represent adaptive behavior—for example, feigning illness while a captive of the enemy during wartime. Malingering should be strongly suspected if any combination of the following is noted: 1. Medicolegal context of presentation (e.g., the individual is referred by an attorney to the clinician for examination, or the individual self-refers while litigation or criminal charges are pending). 2. Marked discrepancy between the individual's claimed stress or disability and the objective findings and observations. 3. Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen. 4. The presence of antisocial personality disorder.
Other Counseling or Consultation
V65.40 (Z71.9) This category should be used when counseling is provided or advice/consultation is sought for a problem that is not specified above or elsewhere in this chapter.ex: spiritual or religious counseling, dietary counseling
Sex Counseling
V65.49 (Z70.9) This category should be used when the individual seeks counseling related to sex education, sexual behavior, sexual orientation, sexual attitudes (embarrassment, timidity), others' sexual behavior or orientation (e.g., spouse, partner, child), sexual enjoyment, or any other sex-related issue.
Problem Related to Lifestyle
V69.9 (Z72.9) This category should be used when a lifestyle problem is a specific focus of treatment or directly affects the course, prognosis, or treatment of a mental or other medical disorder. Examples of lifestyle problems include lack of physical exercise, inappropriate diet, high-risk sexual behavior, and poor sleep hygiene. A problem that is attributable to a symptom of a mental disorder should not be coded unless that problem is a specific focus of treatment or directly affects the course, prognosis, or treatment of the individual.
Adult Antisocial Behavior
V71.01 (Z72.811 ) This category can be used when the focus of clinical attention is adult antisocial behavior that is not due to a mental disorder
Child or Adolescent Antisocial Behavior
V71.02 (Z72.810) This category can be used when the focus of clinical attention is antisocial behavior in a child or adolescent that is not due to a mental disorder
World health organization disability assessment schedule 2.0 (WHODAS 2.0)
a 36-item measure that assesses disability in adults age 18 years and older. It assesses disability across six domains, including understanding and communicating, getting around, self- care, getting along with people, life activities (i.e., household, work, and/or school activities), and participation in society
Outline for Cultural Formulation
a framework for assessing information about cultural features of an individual's mental health problem and how it related to a social and cultural context and history. It includes 5 categories: cultural identity, cultural conceptualizations of distress, psychosocial stressors and cultural features of vulnerability and resilience, cultural features of the relationship between the individual and the clinical, and overall cultural assessment
The DSM-5 Level 1 Cross-Cutting Symptom Measure
a patient- or informant-rated measure that assesses mental health domains that are important across psychiatric diagnoses. It is intended to help clinicians identify additional areas of inquiry that may have significant impact on the individual's treatment and prognosis. In addition, the measure may be used to track changes in the individual's symptom presentation over time. There is an adult version of 23 questions that assess 13 psychiatric domains. There is also a parent/guardian-rated version for children aged 6-17 that consists of 25 questions that assess 12 psychiatric domains
The Cultural Formulation Interview CFI
a set of 16 questions that clinicians may use to obtain information during a mental health assessment about the impact of culture on key aspects of an individual's clinical presentation and care. In the CFI, culture refers to • The values, orientations, knowledge, and practices that individuals derive from membership in diverse social groups (e.g., ethnic groups, faith communities, occupational groups, veterans groups). • Aspects of an individual's background, developmental experiences, and current social contexts that may affect his or her perspective, such as geographical origin, migration, language, religion, sexual orientation, or race/ethnicity. • The influence of family, friends, and other community members (the individual's social network) on the individual's illness experience.
Cultural syndromes
are clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts and that are recognized locally as coherent patterns of experience.
Cultural explanations or perceived causes
are labels, attributions, or features of an explanatory model that indicate culturally recognized meaning or etiology for symptoms, illness, or distress.
Cultural idioms of distress
are ways of expressing distress that may not involve specific symptoms or syndromes, but that provide collective, shared ways of experiencing and talking about personal or social concerns. For example, everyday talk about "nerves" or "depression" may refer to widely varying forms of suffering without mapping onto a discrete set of symptoms, syndrome, or disorder
12 psychiatric domains in the parent/guardian-rated version of the measure level 1 cross-cutting symptom measure
depression, anger, irritability, mania, anxiety, somatic symptoms, inattention, suicidal ideation/attempt, psychosis, sleep disturbance, repetitive thoughts and behaviors, and substance use
13 psychiatric domains in the adult version of Level 1 cross-cutting symptom measure
depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors, dissociation, personality functioning, and substance use
Both the person-centered process of conducting the CFI and the info it elicits are intended to
enhance the cultural validity of diagnostic assessment, facilitate treatment planning, and promote the individual's engagement and satisfaction.
Cultural concepts of distress
refers to ways that cultural groups experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions. Three main types of cultural concepts may be distinguished: cultural syndromes, cultural idioms of distress, cultural explanations or perceived causes
The CFI focuses on
the individual's experience and the social contexts of the clinical problem
when is the CFI helpful
when there is: • Difficulty in diagnostic assessment owing to significant differences in the cultural, religious, or socioeconomic backgrounds of clinician and the individual. • Uncertainty about the fit between culturally distinctive symptoms and diagnostic criteria. • Difficulty in judging illness severity or impairment. • Disagreement between the individual and clinician on the course of care. • Limited engagement in and adherence to treatment by the individual.
