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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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DSM-IV CLASSIFICATION ofMENTAL DISORDERS
Substance-related disordersSchizophrenia and other psychotic disordersMood disordersAnxiety disorders
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DSM-IV CLASSIFICATION ofMENTAL DISORDERS
Somatoform disordersFactitious disordersDissociative disordersSexual and gender identity disorders
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DSM-IV CLASSIFICATION ofMENTAL DISORDERS
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