“What gets measured gets managed.” Accurate diagnosis is crucial for effective treatment in the field of psychiatry. However, traditional screening tools often focus on a limited set of symptoms focused on a single disorder like depression, leading to potential bias and missed diagnoses.

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In our last article, we gave you 10 reasons why you should use the DSM-5-TR Level Cross-Cutting Symptom measure aka the DSM-XC.

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This article is your go-to guide for how to use the DSM-XC in your practice.

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If you're using Osmind's psychiatry EHR, the DSM-XC comes included, alongside 40+ mood surveys, with progress you can see graphed over time.

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What is the DSM-XC?

The DSM-XC is a tool that helps you assess mental health symptoms across various psychiatric diagnoses. It is a self-report measure consisting of 23 items rated on a 5-point likert scale (0=none, 4=severe) across various domains like depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, and repetitive thoughts/behaviors.

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The American Psychiatric Association (APA) developed the DSM-5-TR Level 1 Cross-Cutting Symptom Measure to help clinicians take a bird’s eye view during initial assessments and then periodically during the course of treatment. This tool acts as a review of systems, screening across a wide range of mental health domains. By asking one or two questions about each domain, the cross-cutting measure helps providers identify areas that require further investigation, ensuring a more accurate and holistic diagnostic approach.

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DSM-XC Administration, Scoring, and Interpretation

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Administration:

‍An adult patient typically completes the DSM-XC as part of the initial assessment process. The measure asks about symptoms experienced in the past two weeks, providing a valuable up-to-date window into current concerns. The APA recommends administering the DSM-XC measure every 3-6 months as a check-in to monitor changes in symptom presentation over time. The measure can be used to track changes in an individual's symptom presentation by administering it at regular intervals as clinically indicated.

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Scoring:

‍Scoring can be done at three levels:

• Item Level: Review individual item scores.

• Domain Level: Sum item scores within each domain.

• Full Survey Level: Sum all item scores.

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However, it is important to note that the factor structure and guidance on interpreting total scores are still being researched. Recent studies have examined the factor structure, with one proposing a two-factor solution and another suggesting a six-factor solution capturing mood, worry, activation, somatic, confusion, and substance use factors.

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Interpretation:

• General Domains: For most domains (except substance use, suicidal ideation, and psychosis), a rating of mild (2) or greater on any item within that domain may serve as a guide for additional clinical inquiry and follow-up assessment.

• Substance Use, Suicidal Ideation, and Psychosis: For these specific domains, a rating of slight (1) or greater on any item may warrant further assessment.

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In summary, the DSM-XC provides a dimensional assessment of cross-cutting psychiatric symptoms, with scoring thresholds to guide further clinical evaluation within specific domains.

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While its overall factor structure is still being investigated to provide guidance on interpreting total scores, the measure serves as a valuable tool for initial assessment and tracking changes in symptom presentation over time.

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The measure asks about the past two weeks, providing a valuable up-to-date review of systems. The measure can be used to track changes in an individual's symptom presentation over time by administering it at regular intervals as clinically indicated.

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Level 2 Measures and Clinical Assessment

In the event that a patient indicates concerns in a certain domain, the next steps are to send any more comprehensive relevant measures regarding that domain and to inquiry during a visit about this particular domain.

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For example, if someone indicated possible difficulties with mania, the Altman Self-Rating Mania Scale would be appropriate. For areas around self-harm, psychosis and cognitive difficulties the next step is a clinical assessment focused on these areas.

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Streamline Clinical Use with Osmind

While the DSM-5-TR Level 1 Cross-Cutting Symptom Measure can simplify psychiatric screening, practices historically have encountered barriers in administering it unless it is a seamless part of their workflow. That's why we've teamed up with the APA to build this tool right into our psychiatry-focused EHR.

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Clinicians can easily access and utilize the cross-cutting measure alongside our library of over 40 other critical assessment tools, such as the PHQ-9 for depression, and the GAD-7 for anxiety.

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By combining these measures in one easy-to-use dashboard, you get access to clear, measurable, and evidence-based graphs of your patient's progress in one place.

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Ready to future-proof your psychiatry practice?

‍Schedule a demo with Osmind today to explore how our platform can help you save time and advance evidence-generating medicine.

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By working together, we can shape the future of mental healthcare to be more data-driven, personalized, and effective for every patient.