Classification Psychiatric Disorders

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CLASSIFICATION of PSYCHIATRICDISORDERS

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


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OBJECTIVES of CLASSIFYINGPSYCHIATRIC DISORDERS

To distinguish one psychiatric diagnosisfrom another

To enable clinicians to offer the mosteffective treatment

To provide a common language amonghealth care professionalsTo explore the causes of the many mentaldisorders that are still unknown


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OBJECTIVES of CLASSIFYINGPSYCHIATRIC DISORDERS

To monitor treatmentTo aid the legal systemTo determine the incidence and prevalence of

various diseasesTo decide on insurance coverage


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FUNDAMENTAL APPROACHES inPSYCHIATRIC CLASSIFICATION

In psychiatry, etiology and pathophysiology arenot yet well-established.

Thus, most disorders are diagnosed accordingto syndromes


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FUNDAMENTAL APPROACHES inPSYCHIATRIC CLASSIFICATION

DescriptiveDisorders classified according to presenting

symptomsE.g., Diagnostic and Statistical Manual ofMental Disorders


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IMPORTANT CLASSIFICATIONS ofPSYCHIATRIC DISORDERS

Diagnostic and Statistical Manual of MentalDisorders (DSM)

International Statistical Classification ofDiseases and Related HealthProblems(ICD)


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ICD

Currently on its 10th edition (1992)

Published by the World HealthOrganization


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ICDComprehensive classification system of

medical conditions and mentaldisorders

Official medical and psychiatricnosology used throughout most ofthe world


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EVOLUTION of DSM1840 census: recorded frequency ofidiocy/insanity

1880 census: recorded 7 categories ofmental illnessMania MelancholiaMonomania ParesisDementia DipsomaniaEpilepsy


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EVOLUTION of DSM1917: uniform gathering of statistics across

mental hospitals adopted by Bureau ofCensus

1952: DSM I and DSM II


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EVOLUTION of DSM1968: DSM II1980: DSM III1987: DSM III-R1994: DSM IV2000: DSM-IV-TR


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REVISION PROCESS of DSM-IVComprehensive and systematic review of

published literature

Data reanalyses

Field trials


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ORGANIZING PRINCIPLEof DSM

The fundamental element is the syndromeGroup or pattern of symptomsAppear together

Appear temporallyAppear in many individuals


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BASIC FEATURES of DSMDescriptive approach

Describes manifestationsNo theory about causes


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BASIC FEATURES of DSMDiagnostic criteria

List of features that must be presentfor the diagnosis to be made

Increases reliability of diagnosticprocess among clinicians


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BASIC FEATURES of DSMSystematic description of associated features

Age Culture

Gender Risk, coursePrevalence Incidence

Complications Familial pattern

Predisposing factorsDifferential diagnosis


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BASIC FEATURES of DSMDescribes relevant laboratory findings and physical

examination signs and symptoms

Does not describe management or treatment


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BASIC FEATURES of DSMProvides explicit rules when information is

insufficient

Diagnosis to be deferred

Provisional diagnosis


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BASIC FEATURES of DSMProvides rules when patients clinical presentation

and history do not meet full criteria of aprototypical categoryAtypicalResidualNot otherwise specified


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LIMITATIONS of the CATEGORICALAPPROACH of DSM

Does not assume that each category is acompletely discrete entity with absoluteboundaries all individuals are alike in allimportant ways

To be used in clinical, educational and researchsettings


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DSM-IV CLASSIFICATION ofMENTAL DISORDERS

Disorders usually first diagnosed in infancy,childhood or adolescence

Delirium, dementia and amnestic and othercognitive disorders

Mental disorders due to a general medicalcondition not elsewhere classified


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Substance-related disordersSchizophrenia and other psychotic disordersMood disordersAnxiety disorders


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Somatoform disordersFactitious disordersDissociative disordersSexual and gender identity disorders


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Eating disordersSleep disordersImpulse-control disorders not elsewhere

classifiedAdjustment disordersPersonality disordersOther conditions that may be a focus of clinical

attention


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MULTIAXIAL EVALUATIONSystem of evaluating patients along

several variables

Biopsychosocial approach


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MULTIAXIAL EVALUATIONAxis I

Clinical disorders and other conditionsthat may be a focus of clinicalattention


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MULTIAXIAL EVALUATIONAxis II

Personality disordersMental retardationHabitual use of a particular defense

mechanism


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MULTIAXIAL EVALUATIONAxis III

Physical disorderGeneral medical conditioncausativeresult of mental disorderunrelated


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MULTIAXIAL EVALUATIONAxis IV

Psychosocial problemsEnvironmental problemsSignificantly contribute to development

or exacerbation of disorder


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MULTIAXIAL EVALUATIONAxis V

Overall levels of functioning during aparticular timeSocial, occupational and psychological

functioning


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MULTIAXIAL EVALUATION:An Example

AXIS I: Major Depressive Disorder, severe,without psychotic symptoms

AXIS II: Histrionic Personality DisorderAXIS III: Bronchial asthmaAXIS IV: Break-up with boyfriendAXIS V: 41-50 (Serious symptoms orimpairment)


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THANK YOU

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Classification Psychiatric Disorders

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