Classification of Mental Disorders-COG.ppt

Psychiatry

1. Monday, May 27, 2024 1COG 2010 DAKAJ

2. Objectives
To understand the basis of classification in ICD 10 &
DSM IV
To appreciate the purpose of classification
To familiarise oneself the commonly used
classification.
Monday, May 27, 2024 2COG 2010 DAKAJ

3. Being sane in an insane place!!!
Rosenhan (1973)
8 ‘normal’ people presented themselves at the admissions
office of 12 different psychiatric hospitals in the USA.
Hearing voices,etc all 8 admitted with
(schizophrenia/manic depression).
Eventually discharged with diagnosis of schiz/Manic d-
press in remission.
The only people suspicious of them were the patients it
took between 7 and 52 days for them to convince staff they
were well enough to be discharged.
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4. But there’s more!!!
In a second study members of a teaching
hospital were advised about the results of the
original study and warned they would receive
pseudo patients trying to gain entry. Each
member of staff were asked to rate who was
genuine and who was the fake.
193 patients were admitted
41 were confidentially alleged to be impostors
23 were suspected by one psychiatrist
19 were suspected by another psychiatrist and
another member of staff.
Monday, May 27, 2024 4COG 2010 DAKAJ

5. Classification of mental Disorders.
All systems of mental disorders and diagnosis
stem from the work of Kraepelin.
He claimed certain groups of symptoms occur
together often, thus allowing us to call them
diseasesor syndromes.
He regarded each mental illness as distinct
from all others with its own origins, symptoms,
course and outcomes.
Monday, May 27, 2024 5COG 2010 DAKAJ

6. Classification cont…
He originally classified two major groups:
Dementia praecox(Schizophrenia)
Manic-depressive psychosis(faulty
metabolism).
This helped to establish the organic nature of
mental disorders and formed the basis of the
Diagnostic statistical manual of mental
disorders(DSM).
Monday, May 27, 2024 6COG 2010 DAKAJ

7. Classification cont..
This helped to establish the organic nature of
mental disorders and formed the basis of the:
Diagnostic statistical manual of mental
disorders(DSM). The APA’s official classification system
The International classification Of Diseases
(ICD). Published by the World Health Organisation (WHO)
His classification is also embodied in the Mental health Act
(1983). The act contains three major categories of mental
disturbances.
Mental illness, personality Disorder, and Mental impairment.
Monday, May 27, 2024 7COG 2010 DAKAJ

8. DSM-IV-TR & ICD-10.
DSM-IV-TR
Larger no. of discrete
categories.
Uses a multi-axial
system.
Uses term psychotic.
ICD-10
More general
categories.
Generally single axis.
But uses broad aetiology.
Uses term neurotic.
Monday, May 27, 2024 8COG 2010 DAKAJ

9. Purpose of classification
Communication: among clinicians, between science and
practice.Provides vocabulary for professionals to communicate.
Clinical shorthand
Clinical: facilitate identification treatment, and prevention of
mental disorders.Inform effective treatment selection
Research: test treatment efficacy and understand etiology
Education: teach psychopathology
Information Management: measure and pay for care
Administrative functions e.g. Medical aids, legal system.
Provides information on prognosis.
Monday, May 27, 2024 9COG 2010 DAKAJ

10. ICD-10
It was agreed whilst being constructed that because of the
incomplete and often controversial state of knowledge about the
aetiology of most psychiatric disorders, the classification would
be worked out on a descriptive basis.
Implying that disorders should be grouped according to
similarities and differencesof symptoms and signs so that a
particular disorder should occur in only one place.
However it soon became clear this would not appeal to clinicians
(they like to make aetiology very important!!) This therefore
makes the ICD-10 impure from a taxonomicpoint of view, but
still more likely to be used by clinicians than the DSM-IV-TR.
Monday, May 27, 2024 10COG 2010 DAKAJ

11. The use of diagnostic criteria
Both systems have introduced explicit operational
criteria for diagnosis. That is:
For each disorder there is a specified list of
symptoms, all of which must be present, for a
specified period of time, in relation to age and
gender, stipulation as to what other diagnoses
mustn’t be present and the personal and social
consequences of the disorder.
The aim is to make diagnosis more reliable and valid
by laying down rules for the inclusion or exclusion of
cases.
Monday, May 27, 2024 11COG 2010 DAKAJ

12. ICD 10
1. F0-F09 Organic, including symptomatic, mental
disorders
Disorders of organic aetiology are grouped in this
subchapter, independent of whether they contain
psychotic or non-psychotic symptoms
Use of the term ‘organic' does not imply that
conditions elsewhere in the classification are non-
organic in the sense of having no cerebral substrate
Monday, May 27, 2024 12COG 2010 DAKAJ

13. Cont’
Dementia may contain irreversible and reversible
cases, and this term has been expanded similarly to
DSM-IV, although one criterion is a duration of at least
6 months
Derelium is also in this chapter
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14. F10-F19 Mental and behavioural disorders due
to psychoactive substance use
Compilation of all mental and behavioural disorders
due to psychoactive substances
Substance or class of substances (e.g. F10 Alcohol)
responsible for the disorder is indicated
It is possible to differentiate acute intoxication,
harmful use, dependence syndrome, withdrawal state
with or without delirium, different psychotic
disorders, amnesic syndrome, and a number of other
disorders
Monday, May 27, 2024 14COG 2010 DAKAJ

15. Cont’
2. Syndromes of which the most conspicuous
manifestations are in the areas of perception
(hallucinations), thought contents (delusions), or
mood and emotion (depression, elation, anxiety), or in
the overall pattern of personality and behaviour
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16. F20-29 Schizophrenia, schizotypal
and delusional disorders
Covers schizophrenia, acute psychotic disorders,
schizoaffective disorders, delusional disorders, and
schizotypal disorders
Before schizophrenia can be diagnosed the symptoms
have to be observed for at least 1 month,
Unlike DSM-IV where symptoms should be observed
for 6 months before using this diagnosis, although
only 1 month is required with florid psychotic
symptoms.
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17. F30-39 Mood (affective) disorders
Single manic episodes are coded as F30, while
recurrent manic episodes are now coded as bipolar
affective disorder (F31), regardless of whether or not
there has been a previous depressive episode
Structure of this chapter resembles that of DSM-IV,
but unfortunately the grades of severity of the
depressive disorders are based on slightly different
criteria.
Monday, May 27, 2024 17COG 2010 DAKAJ

18. F40-49 Neurotic, stress-related,
and somatoform disorders
Disorders in this subchapter are divided into a large
number of categories
Dissociative disorders are divided into seven
subcategories
No distinction between conversion and dissociation as
in DSM-IV
Reactions to severe stress and adjustment disorders are
enumerated according to time criteria and severity
Aetiology is generally accepted to mean exceptional
mental stress or special life events.
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19. F50-F59 Behavioural syndromes associated with
physiological disturbances and physical factors
Eating disorders, non-organic sleep disorders, sexual
dysfunction, mental and behavioural disorders
associated with the puerperium, and abuse of non-
dependence-producing substances
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20. F60-F69 Disorders of adult
personality and behaviour
Specific personality disorders are coded in this
subchapter , e.g impulsive type , borderline type etc
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21. Remaining chapters
F70-F79Mental retardation,
F80-F89Disorders of psychological development(e.g
speech disorders), and
F90 F98Behavioural and emotional disorders with
onset during childhood and adolescence are mainly
used in child and adolescent psychiatry.
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22. Cont’
Clinically oriented classification.
Psychopathological syndrome and another for the
underlying disorder recording.
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23. Diagnosis as per DSM-IV-TR Multiaxial
Classification Scheme
The American Psychiatric Association uses a
multiaxialclassification system for diagnoses. Criteria
and codes for each diagnosis are outlined in their
Diagnosticand Statistical Manual of Mental Disorders,
4th edition, text revision (DSM-IV-TR).
Axis I: All diagnoses of mental illness (including
substance abuse and developmental disorders), not
including personality disorders and mental
retardation
Axis II: Personality disorders and mental retardation
Axis III: General medical conditions
Monday, May 27, 2024 23COG 2010 DAKAJ

24. Cont’
Axis IV: Psychosocial and environmental problems
(e.g., homelessness, divorce, etc.)
Axis V: The Global Assessment of Function (GAF),
which rates overall level of daily functioning (social,
occupational, and psychological) on a scale of 0 to 100.
(See table on next page.) Rate current GAF vs. high
GAF during the past year.
Monday, May 27, 2024 24COG 2010 DAKAJ

25. DSM-IV-TR (1994)
DSM IV (1994):
ØEffort to develop a consistent worldwide system of
classification that would be compatible with the ICD-
10.
ØHuge review of all research on psychopathology to
update the classification system.
ØDistinction between organically based disorders and
psychologically based disorders was eliminated.
ØIncreased considerations of cultural factors.
Monday, May 27, 2024 25COG 2010 DAKAJ

26. DSM-IV Classification.
1. Disorders usually first diagnosed in infancy, childhood
or adolescence
2.Delirium, Dementia & amnestic, & other cognitive
disorders
3.Mental disorders due to a general medical condition
4.Substance related disorders
E.gAlcohol use Disorders
Alcohol dependance
Alcohol abuse
Alcohol induced disorders
Alcohol intoxication
Alcohol withdrawal
Alcohol induced mood disorder
5.Schizophrenia & other psychotic disorders
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27. cont
6.Mood disorders
Depressive disorders
MDD
Dysthymic disorder
Bipolar disorders
Bipolar I
Bipolar II
Cyclothymic Disorder
Mood Disorder due to (GMC, Substances)
Monday, May 27, 2024 27COG 2010 DAKAJ

28. Cont’
7. Anxiety disorders
Panic disorder with agoraphobia
Specific phobia
Social phobia
Obsessive-Compulsive disorder
Posttraumatic stress disorder
Acute stress disorder
Generalised Anxiety disorder
Anxiety disorder due to (substances, etc)
Monday, May 27, 2024 28COG 2010 DAKAJ

29. DSM-IV Classification.
9. Somatoform disorders
10.Factitious disorders
11.Dissociative disorders
12.Sexual & Gender identity disorders
13.Eating disorders
14.Sleep disorders
15.Impulse control disorders not elsewhere classified
16.Adjustment disorders
17.Personality disorders
18.Other conditions that may be a focus of clinical
attention
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30. DSM-IV-TR
The five axes of the DSM-IV-TR.
Axis I Clinical syndromes. (All mental disorders & criteria for
rating them except personality disorders/mental retardation,
also abuse/neglect)
Axis II Personality disorders, Mental retardation. (Life long
deeply ingrained, inflexible & maladaptive)
Axis III General medical condition. (Any medical condition that
could effect the patients mental state.)
Axis IVPsychosocial & environmental problems. (Stressful
events that have occurred within the previous year)
Axis V global assessment functioning. (How well the patient
performed during the previous year)
Monday, May 27, 2024 30COG 2010 DAKAJ

31. Example of Diagnosis:
Patient: Johnnie Walker
Axis I: Major depressive Disorder
Axis II: Narcissistic Personality Disorder
–some features only
Axis III: Poor liver functioning, frequent
migraines.
Axis IV: Recently retrenched
Axis V: 65

32. Finnish
Any questions
Thanks for being around to hear.
Monday, May 27, 2024 32COG 2010 DAKAJ