Classification of Mental Disorders

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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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