DSM-5: Potential Impact of Key Changes on Pharmacy Practice

Tammie Lee Demler, BS, PharmD, MBA, BCPP


US Pharmacist 

In This Article

Impact on Medication Therapy

DSM-5 includes a number of new diagnoses, and the diagnoses of some disorders have been combined or eliminated entirely. Most diagnosed mental health conditions are treated based on consensus guidelines and FDA-approved medication therapy; however, for some disorders, there are no formally approved medications to treat the core disorder. Some conditions, despite available approved therapy, are subject to off-label prescribing. In the case of disorders that have no approved treatment, therapy targets symptoms resulting from the primary condition. See Table 1 for a summary of major changes and their potential impact on medication management.

Another key change in DSM-5 is the discontinuation of the familiar multiaxial diagnostic system. Prior to the new edition, practitioners could address patients' medical needs by assessing the Axis III medical diagnoses and evaluating the psychiatric needs in Axes I and II. In the five-axis system, the total score served as a guide for assessing need for treatment, measuring treatments over time, and predicting treatment outcomes. DSM-5 moves to a nonaxial documentation of diagnosis, combining former Axes I, II, and III and providing separate notations for psychosocial factors (formerly Axis IV) and global assessment of function and disability (formerly Axis V).