classificatin in psychiatry

8/9/2019 classificatin in psychiatry

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CLASSIFICATION IN

PSYCHIATRYCHAIR PERSON : DR. B. N.

GANGADHAR,

PRESENTER: DR. NITHIN

KONDAPURAM.


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OUTLINE

CONCEPTS IN DIAGNOSIS & CLASSIFICATION

PROS AND CONS OF DIAGNOSIS

HISTORY OF CLASSIFICATION IN PSYCHIATRY

CURRENT CLASSIFICATION SYSTEMS

FUTURE PERSPECTIVES


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INTRODUCTION

CLASSIFICATIONclassifcation !"l#s$%'(

"#$s)%n* n.

+A s,st-.atic a//an0-.-nt into class-s o/ 0/o12s3

+T)- s,st-.atic 0/o12in0 o' o/0anis.s into cat-0o/i-son t)- 4asis o'

-5ol1tiona/, o/ st/1ct1/al /-lations)i2s 4-t6--n t)-.7

*Stedman's Medical Dictionary,29th


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8

Dia0nosis an9 classifcation a/- a .-ans

o' 5i-6in0 t)- 6o/l9:

Sa/to/i1s N

;S,st-. o' cat-0o/i-s to 6)ic) .o/4i9-ntiti-s a/- assi0n-9 acco/9in0 to

-sta4lis)-9 c/it-/ia=P ?@


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WHY DO WE NEED TO CLASSIFY?

TO PLAN

SERVICES

CLASSIFICATION

TO UNDERSTANDDISEASES

TO DETERMINETREATMENT

COMMUNICATION

CONTROL

TO STATEPROGNOSIS

TO PERMITRESEARCH


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T)- 1lti.at- 21/2os- o' classifcation is to i.2/o5-

t/-at.-nt an9 2/-5-ntion

Diso/9-/s can 4- t/-at-9 6it)o1t "no6l-90- o'

-tiolo0, 41t co.2/-)-nsion is 9-si/-9 as it 1s1all,

l-a9s to .o/- -B-cti5- t/-at.-nt an9 2/-5-ntion

Dalal P Si5a"1.a/ T3 Mo5in0 to6a/9s ICD?? an9 DSMV Conc-2t an9 -5ol1tion o'2s,c)iat/ic classifcation3 In9ian = Ps,c)iat/, @7??@


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ssifcation can 4- 2-/'o/.-9 in s-5-/al 6a,s

BY MEDICAL PSYCHIATRIC

CLINICALSYNDROME

MIGRANE SCHIZOPHRENIA

PATHOLOGICALPROCESS

ULCERATIVECOLITIS

ALZHEIMERSDEMENTIA

DEVIATION FROMNORM

HYPERTENSION PERSONALITYDISORDER

HYPOTHETICAL

PROCESS

- DISSOCIATIVE

DISORDER

ETIOLOGY TUBERCULOSIS PTSD

Dalal P Si5a"1.a/ T3 Mo5in0 to6a/9s ICD?? an9 DSMV Conc-2t an9 -5ol1tion o'2s,c)iat/ic classifcation3 In9ian = Ps,c)iat/, @7??@


8/52World Health Organization. Family of International Classifications

REUIREMENTS OF AN INTERNATIONALCLASSIFICATION

!.C"#$%&'&()*+&

.W&-&/(&

0.A11&$234&

5.R&*34&

6.C"()&%+32*+&

7.C"#$32*4& 8*2'

$%&+*"9) 13))*/132*"()

13))*/132*"( " "2'&% )&12"%) ;)"1*3*()9%3(1&

M&&2*(= 2'& (&&) " +3%*"9) 9)&%)

=a4l-ns", A -n9-ll RE3 C/it-/ia 'o/ ass-ssin0 a classifcation in 2s,c)iat/,3 In Ma M-9ito/3 Ps,c)iat/ic 9ia0nosis an9 classifcation3 -st S1ss-Q =o)n il-, an9 sons Lt97 3 223 ?K


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APPROACHES TO PSYCHIATRICCLASSIFICATION

TIOLOGICAL VS DESCRIPTIVE

SYNDROME VS SYMPTOM

CATEGORICAL VS DIMENSION


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HISTORY OF PSYCHIATRIC CLASSIFICATION

>C ;S,n9/o.- S-nil- D-.-ntia< E0,2tP/inc- Pta) Hot-2

J >C S1.-/ian & E0,2t /-'-/-nc- toM-lanc)olia an9 H,st-/ia

?8 >C Hin91 A,1/5-9a on- o' ;Astan0a< 6as>)1ta Vi9,a7 6it)o1t 2),sicalca1sation

8J >C K Hi22oc/at-s J con9itions an9 8t-.2-/a.-nts ?

CENTURIES


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HISTORY OF PSYCHIATRIC CLASSIFICATION

EMIL RAEPELIN !?J?@J*

ADOLF MEYER !?JJ?@*

PAUL EUGEN >LEULER!??@@*

SIGMUND FREUD !?J?@@*


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DEVELOPMENT OF NEUROSIS

E5ol1tion o' t)- conc-2t o' sc)io2)/-nia3 !F/o. Tan9on R Nas/alla) HA -s)a5an MS3 Sc)io2)/-nia ;1st t)-'acts3< 8 Clinical '-at1/-s an9 conc-2t1aliation3 Sc)io2)/ R-s @7???K


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EMIL RAEPELINMANIC DEPRESSIVE

INSANITY

LEONHARDCOINED THE TERM

>IPOLAR

ANGST AND PERRISUNIPOLAR VS >IPOLAR

DEPRESSION

EVOLUTION OF CLASSIFICATION OFBIPOLAR AFFECTIVE DISORDER

?@?@ ?@ ?@JJ ?@

THE NAME >IPOLARDISORDER AS

ADOPTED IN DSM III

)tt2WW6663/c2s,c)3ac31"Wfl-sWsa.2l-c)a2t-/W4i2ol


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EVOLUTION OF CLASSIFICATION OFNEUROSIS

EARLY ?8SSCRUPULOS

!"#

? INSTITUTIONALIA

TION =3E3D Es1i/ol

?8SOREN IEREGAARD

EARLY THCENTURYFREUD

THEORIES

?s?sDESCRIPTION OF

VARIOUS O>SESSIONS

ANXIETY >Y PHYSICIANS

LATE ?Js CLERGYMEN

>ATTISTA SCARAMELLI SHAESPEARES MAC>ETH

END OF ?@THCENTURYCONSESUS A>OUT

NEUROSIS


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?@PIERRE =ANET

?@?JSIGMUND

FRUED

DISORDEROFRELARD

DISO

RDER

OFC

ONTRO

L

DSM ?

CATEGORIES

ICD J

CATEGORIE

S

OPIUMMORPHINE

ARSENIC

COGNITIVE>EHAVIORAPPROACH

EVOLUTION OF CLASSIFICATION OFNEUROSIS ANXIETY

DISORDERS

O>SESSIVECOMPULSIV

E ANDRELATED

DISORDERS

DS

MH

8CATEGOR

IES

JSU>

CATEG

ORIESLi.4ic

F/otost/iatal


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EVOLUTION OF CLASSIFICATION OFSUBSTANCE USE

Alcohol and drug abuse

under Sociopathic

ersonality

!isturbances

first to recognize substance

abuse "including drug abuse#

and substance dependence as

conditions separate from

substance abuse alone

psychoacti$e

substance

abuse

DSM?

DSMIII

DSMIIIR


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HISTORY OF PRESENT PSYCHIATRICCLASSIFICATION?@ Int-/national list o' ca1s- o' 9-at)

?@? APA Dia0nostic s,st-. 6it) @ illn-ss

?@8 o/l9 6a/ II littl- 1s- o' APA 9ia0nostics

?@8@ Int-/national Classifcation o' Dis-as-sJ

SECTION ON MENTAL DISORDERS WAS A&

FIRST TIME

?@ DRAFT OF T)- D*3=(")2*1 3( S232*)2*13

M3(93o' M-ntal Diso/9-/s !DSM*?@ T)- D*3=(")2*1 3( S232*)2*13 M3(93o'

M-ntal Diso/9-/s I

?@ Int-/national Classifcation o' Dis-as-s
https://www.google.co.in/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CBwQFjAA&url=http://www.who.int/whosis/icd10/&ei=AZz3U4POF9bm8AXJpIK4BA&usg=AFQjCNHjUcoeAdI617cQ6L18Os1nKCU8pw&bvm=bv.73612305,d.dGc


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?@J T)- Dia0nostic an9 Statistical Man1al o' M-ntal

Diso/9-/s II?@ Int-/national Classifcation o' Dis-as-s @

?@ T)- Dia0nostic an9 Statistical Man1al o' M-ntal

Diso/9-/s III?@ T)- Dia0nostic an9 Statistical Man1al o' M-ntal

Diso/9-/s III R-5is-9

?@@ Int-/national Classifcation o' Dis-as-s ?

?@@8 T)- Dia0nostic an9 Statistical Man1al o' M-ntal

Diso/9-/s IV

T)- Dia0nostic & Statistical Man1al o' M-ntal

HISTORY PRESENT OF PSYCHIATRICCLASSIFICATION


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COMMON CLASSIFICATORY SYSTEMS INPSYCHIATRY

I(2&%(32*"(3 C3))*/132*"( " D*)&3)&)

D*3=(")2*1 @ S232*)2*13 M3(93o' M-ntalDiso/9-/s !DSM*

R&)&3%1' D*3=(")2*1 C%*2&%*3

FEIGHNERS

SPITZERS

D*&%&(2 (32*"(3 13))*/132*"()


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INTERNATIONAL CLASSIFICATION OF DISEASES

!60 Fi/st Int-/national Statistical Con'-/-nc-

!0 A9o2tion o' t)- Int-/national Statistical Classifcation o'

Ca1s-s o' D-at)

!0 R-5ision o' List o' Ca1s-s o' D-at) !ICD*Cat3 83

M-ntal 9is-as-s an9 9-fci-nc,

3. M&(23 &/1*&(1>

4. S1'*"$'%&(*3

1. M3(*1 &$%&))*+& $)>1'")*)

. O2'&% #&(23 *)&3)&)


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INTERNATIONAL CLASSIFICATION OF DISEASES

!57 HO is -nt/1st-9 6it) tas" to 2/-2a/- 72'

/-5ision an9 to -sta4lis) an Int-/national List o' Ca1s-s

o' Mo/4i9it,

!5 F*%)2 W"% H&32' A))>:

A"$2*"( " M3(93 " 2'& I(2&%(32*"(3

S232*)2*13 C3))*/132*"( " D*)&3)&), I(9%*&), @

C39)&) " D&32' ;ICD-71li.ia n-/5osa >o9, 9,s.o/2)ic D3

83E.otionall, 1nsta4l- 2-/sonalit, D3


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SHORTCOMINGS OF CLASSIFICATORY SYSTEM

R-s1lts '/o. t6in st19i-s )a5- "ontra'i"te't)- ass1.2tion

t$at se!arate s(n'romes $ave a 'i*erent un'erl(in%

%eneti" basis.-0 GAD Mao/ 9-2/-ssi5- 9iso/9-/ s)a/-

0-n-tic /is" 'acto/3!-n9l-/?@J*

A9o2tion o' t)- "ate%ori"al 'e#nition.i0)t )a5- $in'ere'

resear"$in t)- -tiolo0, o' t)- 2s,c)iat/ic 9iso/9-/s3 DSM V

cat-0o/i-s i' consi9-/-9 -1i5al-nt to 9is-as-s is .o/- li"-l, to

o4sc1/- t)an to -l1ci9at- /-s-a/c) fn9in0s3


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REGROUPING DIAGNOSIS

DSMIVWICD? G/o12in0s 4as-9 2/i.a/il, on

co..on 2/-s-ntin0 s,.2to.

-303 anQi-t, 9iso/9-/

DSMWICD?? G/o12in0s 4as-9 as .1c) as 2ossi4l-

on co..on 1n9-/l,in0 -tiolo0ical 'acto/s

-303 O4s-ssi5-Co.21lsi5- an9 /-lat-9 9iso/9-/s

2/-s1.-9 1n9-/l,in0 co..on n-1/o4iolo0ical 'acto/s


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REGROUPING DIAGNOSIS

S122o/t-9 c/-ation o' a 9ia0nostic 0/o12in0 4as-9

on -tiolo0icall, associat-9 6it) st/-ss'1l li'-

ci/c1.stanc-s

Gi5-n t)at ot)-/ ICD?? 9iso/9-/s .a, 4- associat-9

6it) st/-sso/s !-303 .ao/ 9-2/-ssion* t)-s- a/-

9iB-/-ntiat-9 4, 4-in0 9-fnitionall, associat-9 6it)

st/-ss3


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EPECTATIONS IN ICD !!

CODE

Eac) ;c)a/act-/< /-2/-s-nts a l-5-l in t)- )i-/a/c),7

-303 f/st ICD? c)a/act-/ is c)a2t-/7 al2)a4-tic

nat1/- allo6s 'o/ J 4asic 9i5isions o/ c)a2t-/s N1.-/ic 9-ci.al nat1/- o' ot)-/ c)a/act-/s li.its

-ac) l-5-l to ? 9i5isions

Di5ision o' .-ntal 9iso/9-/s into ? 4loc"s c/-at-9s14o2ti.al 0/o12in0s !-3033 F8 N-1/otic St/-ss

/-lat-9 an9 so.ato'o/. 9iso/9-/s*


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ICD?? 6ill no lon0-/ /-st/ict c)a/act-/ 2lac-s to?7 inst-a9 6ill 4- al2)a4-tic o/ -ls- t6o 9i0it 2-/

c)a/act-/ Cons-1-ntl, 8 4loc" 9i5isions -Q2-ct-9

!-303 Fo/.-/ F 9iso/9-/s >-)a5io/al s,n9/o.-sassociat-9 6it) 2),siolo0ical 9ist1/4anc-s an9

2),sical 'acto/s 6ill -ac) 0-t t)-i/ o6n 4loc" -303

-atin0 9iso/9-/s sl--2 9iso/9-/s s-Q1al 9,s'1nctions-tc3*


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ICD !! CODES

A NEURODEVELOPMENTAL DISORDERS

> SCHIOPHRENIA SPECTRUM AND PRIMARY

PSYCHOTIC DISORDERS

C >IPOLAR AND RELATED DISORDERS

D DEPRESSIVE DISORDERS

E ANXIETY AND FEAR RELATED DISORDERS

F DISORDERS SPECIFICALLY ASSOCIATED ITH

STRESS

G DISSOCIATIVE DISORDERS


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H >ODILY DISTRESS AND PSYCHOLOGICAL AND

>EHAVIORAL FACTORS ASSOCIATED ITH DISEASES

CLASSIFIED ELSEHERE

I O>SESSIVE COMPULSIVE AND RELATED

DISORDERS

= FEEDING AND EATING DISORDERS

ELIMINATION DISORDERS

L SLEEP DISORDERS

M SEXUAL DYSFUNCTIONS AND COMPULSIVE

SEXUAL >EHAVIOR DISORDER

N ACUTE SU>STANCE INTOXICATION

O HARMFUL USE OF SU>STANCES


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P SU>STANCE DEPENDENCE

SU>STANCE ITHDRAAL SYNDROME

R SU>STANCEINDUCED MENTAL DISORDERS T DISRUPTIVE >EHAVIOR AND DISSOCIAL

DISORDERS

U DISORDERS OF PERSONALITY V PARAPHILIC DISORDERS

FACTITIOUS DISORDERS

X NEUROCOGNITIVE DISRODERS

Y MENTAL AND >EHAVIORAL DISORDERS

ATTRI>UTA>LE TO DISORDERS OR DISEASES

CLASSIFIED ELSEHERE

ALTERNATE WAYS OF CLASSIFICATION


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ALTERNATE WAYS OF CLASSIFICATION

?3 >as-9 on!s("$o'(nami" 'e&ense me"$anisms +sta%es o& libi'inal 'evelo!ment3 !Ps,c)oanal,sts*

3 >as-9 on sco/-s on 4att-/i-s o' "o%nitive +

!ro,e"tive tests3 !Ps,c)olo0ists*3

3 >as-9 on co.2/-)-nsi5- anal,sis o' t)- total

be$avioral re!ertoire3

83 >as-9 on treatment res!onse.

3 >as-9 on "ourse + out"omeo' illn-ss-s3


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FUTURE SCENARIOS

ONE CLASSIFICATION

A CLASSIFICATORY SYSTEM >ASED ON

NEUROSCIENCES

NEUROANATOMY

NEUROPHYSIOLOGICAL NEUROPATHOLOGICAL

NEUROCHEMISTRY

NEUROPSYCHOLOGICALGENETIC RESEARCH

CATEGORICAL ITH DIMENSIONAL

OUTLINE OF THE POSSIBLE FUTURE


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OUTLINE OF THE POSSIBLE FUTURECLASSIFICATION SYSTEM

AJ*) I: Genot(!e.

AJ*) II:Neurobiolo%i"al 2)-not,2-3

AJ*) III:1e$avioral2)-not,2-3

AJ*) VI:2nvironmental.o9if-/sW2/-ci2itants3

AJ*) V:T$era!euti"sta/0-ts & /-s2ons-s3

!12'-/ D= *


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