Classificationin Psychiatric Nursing

LECTURE NO. 3

Learning Objectives

Describe the purpose of classification in psychiatry

Discuss the basis of classification in psychiatry

Enumerate the various categories of psychiatric disorders

Describe the international systems of classification in psychiatry

Introduction

In general, medical conditions can be classified on the basis of:

i. Aetiology

ii. Structural pathology

iii. Symptoms

However, most psychiatric disorders are classified by symptoms only.

Purpose of Classification

The three basic purposes of classification are:

i. Comprehension

ii. Communication

iii. Control of data

Purpose of Classification (cont.)

The purposes of classification can be further expanded as follows:

i. Reduces complexity

ii. Compresses knowledge and facilitates communication

iii. Helps in deciding the treatment

iv. Predicts the course and prognosis of the disorder

v. Controls and compiles data and helps in research

Purpose of Classification (cont.)

Basis of Classification

Psychiatric disorders can be classified into:

i. Functional disorders

ii. Organic disorders

1. Functional disorders

These disorders are a heterogeneous group with no history/clinical examination suggestive of organicity and where the disorders are subclassified on the basis of shared features such as symptoms.

Functional disorders can be classified into: i. Psychosisii. Neurosis

i. Psychosis

Refers to severe forms of psychiatric disordersPatients lack insight into the disorder and lose touch with reality.Patients also are unable to differentiate between subjective experiences and external reality.An example of psychosis is schizophrenia.

ii. Neurosis

Refers to disorders that are less severe than psychosis and the symptoms are closer to normal experiences

Patients do not lose touch with external reality.

2. Organic disorders

These are the disorders in which the history, clinical examination or investigations suggest a cause for the disorder.

Organic disorders can be classified into disorders with:

i. Acute onset

ii. Insidious onset

i. Acute onset

These are the disorders which are usually short-lasting and can be treated by removing or treating the cause of the disorder.

For example, delirium due to diabetes can be reversed by controlling the blood sugar level.

ii. Insidious onset

Are long lasting

Can be superimposed by acute onset disorders

For example, delirium in a patient with dementia.

Categories of Psychiatric Disorders

The modern classificatory systems divide functional disorders into discrete categories such as: i. Psychotic disorders ii. Mood disordersiii. Anxiety disordersiv. Personality disorders v. Childhood and adolescence disordersvi. Miscellaneous

Systems of Classification(cont.)

The two major classification systems used worldwide to classify psychiatric disorders are:

i. International Classification of Diseases (ICD)

ii. Diagnostics and Statistics Manual of Mental Disorders (DSM)

Systems of Classification(cont.)

The ICD-10 and the DSM-IV are parallel and compatible with each other although minor differences in nomenclature of the diagnostic categories and criteria exist between them.

1. The International Classification of Diseases (ICD)

The international standard diagnostic classification for a wide variety of health conditions.

There are many versions of the ICD-10.

ICD-10: Chapter V (F) focuses on mental and behavioural disorders.

2. The Diagnostics and StatisticsManual of Mental Disorders (DSM)

DSM is produced by the American Psychiatric Association (APA).

Only describes mental disorders

The DSM-IV is a multiaxial diagnostic system using 5 axes.

A multiaxial system allows for the recording of detailed information.