INTRODUCTION
The term nosolo (taken from the
Greek word "nosos" meaning disease) refers to the systematization of
knowledge for the identification and classification of diseases. The
classification of mental disorders, also known as psychiatric nosology
or taxonomy, is a key aspect of psychiatry and other mental health professions
and an important issue for consumers and providers of mental health services.
There are currently two widely
established systems for classifying mental illness
1.
Chapter V of the International Classification of
Diseases (ICD-IO) produced by the World Health Organization.
2.
The Diagnostic and Statistical Manual of Mental
Disorders (DSM) produced by the American Psychiatric Association (APA).
PURPOSE OF THE DIAGNOSTIC SYSTEM
The purposes of the diagnostic
system are:
·
to have a guide to the cause and therefore ,the
treatment of the mental disorders
·
to provide a language with which all mental
health professionals can communicate to give names for the various mental
syndromes which will serve as a shorthand way of describing the entities that
the mental health professionals deals with ,enabling efficient communication
·
to study the natural history of a particular
disease and develop effective treatment bv defining the characteristics of
disease and how it differs from the other similar disorders
·
to develop an understanding about the causes of
the various mental disorders and thus to develop an effective treatment
·
to classify the conditions that people have ,not
the people themselves (eg;there should be no references to a schizophrenic or
depressive "but rather to a patient with schizophrenia or depression)
1. THE INTERNATIONAL CLASSIFICATION
OF DISEASES (ICD-IO)
The ICD is the intemational standard
diagnostic classification for all general epidemiological, many health
management purposes and clinical use. These include the analysis of the general
health situation of population groups and monitoring of the incidence and
prevalence of diseases and other health problems in relation to other variables
such as the characteristics and circumstances of the individuals affected, reimbursement,
resource allocation, quality and guidelines.
SALIENT FEATURES OF ICD 10
Multiaxial classification: having
triaxial system
·
Axis I--Clinical diagnoses
·
Axis II- Disabilities
·
Axis III--Contextual factors
Axis I--Clinical diagnoses: This
axis accommodates mental and non- mental (Reneral medical) disorders.
underlying fundamental commonality alnong all illness
Axis II- Disabilities: This axis
appraises the consequences of illness in terms of impairment in the performance
of basic social roles.
Axis III - contextual factors: This axis attempts to
portray the context of illness in terms of several ecological domains. These
include problems related to the family or primary support group, general social
environment education, employment, housing, legal issues, family history of
illness lifestyle.
Versions of ICD 10
·
Clinical descriptions and diagnostic guidelines
(CDDG)
·
Diagnostic criteria for research (DCR)
·
Multi axial classification version
·
Primary care version
·
Short glossary
* alpha numerical system of
classification
ICD - 10 CLASSIFICATION OF MENTAL
DISORDERS (Mental and Behavioral disorder
)
Mental and behavioral disorders are
housed within chapter V of ICD - 10. It
is coded with the letter F. After the letter F the first digit of the chapter V
diagnostic codes denotes 10 major classes of mental and behavioral disorders-
F00 to F 99.
The 2 and 3 digit (3rd and 4th
character) identify progressively finer categories. E.g. the code F30.2
sequentially denotes the mental chapter, mood disorders class, manic episode,
and the presence of psychotic symptoms.
F00-F99 - Mental and behavioral
disorders
·
(F00-F09) Organic, including symptomatic, mental
disorders
·
(Fl0-F19) Mental and behavioural disorders due
to psychoactive substance use
·
(F20-F29) Schizophrenia, schizotypal and
delusional disorders
·
(F30-F39) Mood (affective) disorders
·
(F40-F48) Neurotic, stress-related and
somatoform disorders
·
(F50-F59) Behavioural syndromes associated with
physiological disturbances and physical factors
·
(F60-F69) Disorders of adult personality and
behavior
·
(F70-F79) Mental retardation
·
(F80-F89) Disorders of psychological development
·
(F90-F98) Behavioural and emotional disorders
with onset usually occurring in childhood and adolescence
·
(F99) Unspecified mental disorder
II. DSM (DIAGNOSTIC AND
STATISTICAL MANUAL OF MENTAL DISORDERS)
The Diagnostic and Statistical
Manual of Mental Disorders, published by the American Psychiatric Association,
is the handbook used most often in diagnosing mental disorders in the United
States and other countries.
It is intended to be applicable in a
wide array of contexts and used by clinicians and researchers of manv different
orientations (e g., biological, psychodynamic, cognitive. behavioral,
interpersonal, family/systems)
DSM-IV (Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition), published in 1994, was
the last major revision of the DSM. A text revision of the DSM-IV called
DSM-IV-TR was published in May 2000.
DSM-5 (formerly known as
DSM-V) is the fifth edition of the American Psychiatric Association's (APA)
Diagnostic and Statistical Manual of Mental Disorders. The DSM-5 was published
on May 18, 2013, superseding the DSM-IV-TR, which was published in 2000. In
most respects DSM-5 is not greatly changed from DSM-IV-TR. Notable innovations include
dropping Asperger syndrome as a distinct classification; loss of subtype
classifications for variant foms of schizophrenia; dropping the
"bereavement exclusion" for depressive disorders; a revised treatment
and naming of gender identity disorder to Gender dysphoria, and a new gambling
disorder.
BASIC FEATURES OF DSM-IV:
It is used by mental health
professionals of all disciplines. It strives to be neutral or a theoretical
with regard to causes. It attempts to describe what the manifestations of the mental
disorders are. Specified diagnostic criteria are provided for each mental
disorder.
It systematically describes each
disorder in terms of its associated features. Specific age, culture, gender
related features, prevalence, incidence, predisposing factors, course,
complications, familial pattern, differential diagnosis.
It provides explicit rules to be
used when the information is insufficient or the patient's clinical
presentation and history do not meet the required criteria of a prototypical
category. (Atypical type. residual, or not otherwise specified).
MULTIAXIAL EVALUATION:
Multi-axial system
The DSM-IV organizes each
psychiatric diagnosis into five levels (axes) relating to different aspects of
disorder or disability:
·
Axis I: clinical disorders, including major
mental disorders, as well as developmental and learning disorders
·
Axis II: underlying pervasive or personality
conditions, as well as mental retardation
·
Axis III: Acute medical conditions and physical
disorders.
·
Axis IV: psychosocial and environmental factors
contributing to the disorder
·
Axis V: Global Assessment of Functioning or
Children's Global Assessment Scale for children under the age of 18. (on a
scale from 100 to l)
USE OF THE DSM
·
In mental health profession: Many mental health
professionals use this book to help cominunicate a patient's diagnosis after an
evaluation.
·
Use of the DSM is for research purposes. Studies
done on specific diseases often recruit patients whose symptoms match the
criteria listed in the DSM for that disease.
·
Student's reference may also refer to the DSM to
learn criteria required for their courses.
CLASSFICATION:
It lists 365 disorders in 17 sections, along
with some diagnostic criteria proposed for further study are included in the
appendix.
DIFFERENCE BETWEEN DSM-IV AND ICD-I0
|
|
ICD -10
|
DSM IV
|
|
Origin
|
World health organization
|
American psychiatric association
|
|
Presentation
|
Different version
for clinical work ,research and primary care
  |
A single version
|
|
Language
|
Available in all widely spoken languages
|
English version only
|
|
Structure
|
Tri axial
|
Five axis
|
|
Content
|
Diagnostic criteria do not include social consequences of the disorder
|
Diagnostic criteria usually include occupational and other areas of
function
|
INDIAN CLASSIFICATION
l . Psychosis (Functional,
Affective, Organic)
2.Neurosis (Anxiety, Depressive,
Hysterical, phobic, Obsessive Compulsive)
3.Special Disorders
a)Childhood disorders
b)Personality disorders
c)Substance Abuse
d)Psycho physiological disorders
e)Mental Retardation
REFERENCES
l. Kaplan HI, Sadock BJ. Synopsis of
Psychiatry, Behavioral Sciences/ Clinical Psychiatry .9th ed. HongKong: William
and Wilkinson Publishers; 1998.
2.Keltner ML.Psychiatric Nursing .4th
ed.Bostrom: Mosby Publishers; 2003.
3.Mary TC. Psychiatric Mental Health
Nursing - Concept of Care 3rd ed. Philadelphia:F.A. Davis Publishers ;2002
4.Ahuja N .A Short Text Book of
Psychiatry 5th Ed. New Delhi: Jaypee Medical Brothers Publishers .2002
5. Benjamine James Sadock, Virginia
Sadock. Concise Text Book Of Clinical Psychiatry. Lippincott, New York, 2008.
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