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CLASSIFICATION of PSYCHIATRIC DISORDERS

VIVIENNE S. CAGUIOA-CLEOFAS, MD, FPPA, FCLPPI

OBJECTIVES of CLASSIFYING PSYCHIATRIC DISORDERS


To distinguish one psychiatric diagnosis from another To enable clinicians to offer the most effective treatment To provide a common language among health care professionals To explore the causes of the many mental disorders that are still unknown

OBJECTIVES of CLASSIFYING PSYCHIATRIC DISORDERS


To monitor treatment To aid the legal system To determine the incidence and prevalence of various diseases To decide on insurance coverage

FUNDAMENTAL APPROACHES in PSYCHIATRIC CLASSIFICATION


In psychiatry, etiology and pathophysiology are not yet well-established. Thus, most disorders are diagnosed according to syndromes

FUNDAMENTAL APPROACHES in PSYCHIATRIC CLASSIFICATION


Descriptive Disorders classified according to presenting symptoms E.g., Diagnostic and Statistical Manual of Mental Disorders

IMPORTANT CLASSIFICATIONS of PSYCHIATRIC DISORDERS


Diagnostic and Statistical Manual of Mental Disorders (DSM) International Statistical Classification of Diseases and Related Health Problems(ICD)

ICD

Currently on its 10th edition (1992)

Published by the World Health Organization

ICD
Comprehensive classification system of medical conditions and mental disorders Official medical and psychiatric nosology used throughout most of the world

DSM
Published by the American Psychiatric Association Official classification system in the U.S. A.

EVOLUTION of DSM
1840 census: recorded frequency of idiocy/insanity 1880 census: recorded 7 categories of mental illness Mania Melancholia Monomania Paresis Dementia Dipsomania Epilepsy

EVOLUTION of DSM
1917: uniform gathering of statistics across mental hospitals adopted by Bureau of Census
1952: DSM I and DSM II

EVOLUTION of DSM
1968: DSM II 1980: DSM III 1987: DSM III-R 1994: DSM IV 2000: DSM-IV-TR

REVISION PROCESS of DSM-IV


Comprehensive and systematic review of published literature Data reanalyses
Field trials

ORGANIZING PRINCIPLE of DSM


The fundamental element is the syndrome Group or pattern of symptoms

Appear together
Appear temporally Appear in many individuals

ORGANIZING PRINCIPLE of DSM


Symptoms may reflect a common Etiological process

Course
Treatment response

BASIC FEATURES of DSM


Descriptive approach
Describes manifestations No theory about causes

BASIC FEATURES of DSM


Diagnostic criteria
List of features that must be present for the diagnosis to be made Increases reliability of diagnostic process among clinicians

BASIC FEATURES of DSM


Systematic description of associated features Age Culture Gender Risk, course Prevalence Incidence Complications Familial pattern Predisposing factors Differential diagnosis

BASIC FEATURES of DSM


Describes relevant laboratory findings and physical examination signs and symptoms
Does not describe management or treatment

BASIC FEATURES of DSM


Provides explicit rules when information is insufficient
Diagnosis to be deferred Provisional diagnosis

BASIC FEATURES of DSM


Provides rules when patients clinical presentation and history do not meet full criteria of a prototypical category
Atypical Residual Not otherwise specified

LIMITATIONS of the CATEGORICAL APPROACH of DSM


Does not assume that each category is a completely discrete entity with absolute boundaries all individuals are alike in all important ways
To be used in clinical, educational and research settings

DSM-IV CLASSIFICATION of MENTAL DISORDERS


Disorders usually first diagnosed in infancy, childhood or adolescence Delirium, dementia and amnestic and other cognitive disorders Mental disorders due to a general medical condition not elsewhere classified

DSM-IV CLASSIFICATION of MENTAL DISORDERS


Substance-related disorders Schizophrenia and other psychotic disorders Mood disorders Anxiety disorders

DSM-IV CLASSIFICATION of MENTAL DISORDERS


Somatoform disorders Factitious disorders Dissociative disorders Sexual and gender identity disorders

DSM-IV CLASSIFICATION of MENTAL DISORDERS


Eating disorders Sleep disorders Impulse-control disorders not elsewhere classified Adjustment disorders Personality disorders Other conditions that may be a focus of clinical attention

MULTIAXIAL EVALUATION
System of evaluating patients along several variables
Biopsychosocial approach

MULTIAXIAL EVALUATION
Axis I
Clinical disorders and other conditions that may be a focus of clinical attention

MULTIAXIAL EVALUATION
Axis II
Personality disorders Mental retardation Habitual use of a particular defense mechanism

MULTIAXIAL EVALUATION
Axis III
Physical disorder General medical condition causative result of mental disorder unrelated

MULTIAXIAL EVALUATION
Axis IV
Psychosocial problems Environmental problems Significantly contribute to development or exacerbation of disorder

MULTIAXIAL EVALUATION
Axis V
Overall levels of functioning during a particular time Social, occupational and psychological functioning

MULTIAXIAL EVALUATION: An Example


AXIS I: Major Depressive Disorder, severe, without psychotic symptoms AXIS II: Histrionic Personality Disorder AXIS III: Bronchial asthma AXIS IV: Break-up with boyfriend AXIS V: 41-50 (Serious symptoms or impairment)

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