Archive for the ‘diagnosis’ tag
Classification of Mental Disorders & Multi-Axial Assessment (DSM IV-TR & ICD 10)
Classification of Mental Disorders &
(DSM IV-TR & ICD 10)
Diagnosis involves accumulation, interpretation & categorization of data. The main aim of this is to enable the clinician to use the most effective treatments available for that condition and to allow them to make accurate assessment of prognosis.
The Importance of diagnosis:
- Allows inter-professional communication
- Allows us to select appropriate treatments for patients
- Allows assessment of prognosis
- Allows scientific research to be preformed
However psychiatric diagnoses have been criticized because:
- They provide little information about aetiology
- They can carry pejorative connotation (negative labeling)
- Patients don’t always fall into neat categories. Some may have some but not all of the characteristic features of one or more different diagnostic categories (hence the terms schizoaffective & Borderline Personality)
- The uniqueness of an individual patient is lost when labels are applied; one cannot fully convey a patient’s predicament with a single label
- Historically psychiatric diagnosis has low reliability & Validity (in general psychotic conditions have high reliability and neurotic conditions low reliability)
Both current diagnosis in psychiatry are categorical and can be monothetic (i.e. all criteria must be present e.g. Hypochodriasis) or Polythetic (some must be present e.g. Borderline Personality Disorders).
The International Classification of Diseases (ICD-10) 1992
Mental Disorders are described within chapter V (F) of the ICD 10. There are 10 categories within this chapter & each is further subdivided into further 10.
Categories are denoted by the letter F (for Mental Disorders chapter), followed by a number for the main group (e.g. F3 for Mood Disorders), followed by a further number for the category within the group (e.g. F32 for depressive episode). A fourth character (or third no) is used if it is necessary to subdivide further (e.g. F32.2 for severe depressive episode without psychotic symptoms)
Different versions of the ICD 10 are available & it is therefore flexible and acceptable to a variety of users for a variety of purposes:
1. Clinical descriptions & diagnostic guidelines: for general clinical, educational & service use.
2. Diagnostic criteria for research
3. Primary care version.
4. Multiaxial version.
Main categories in ICD-10
F0 Organic, including symptomatic, mental disorders (e.g. dementia)
F1 Mental & Behavioral Disorders due to psychoactive substance use
F2 Schizophrenia, schizotypal & delusional disorders
F3 Mood (affective) disorder
F5 Behavioral syndromes associated with physiological disturbance & physical factors (e.g. Eating Disorders, sexual dysfunction)
F6 Disorders of adult personality & behavior (Personality Disorders and gender identity sexual preference.
F8 Disorders of psychological development (language and Speech Disorders)
Diagnostic & Statistical Manual of Mental Disorder (DSM) IV-TR (revised):
Published by the American Psychiatric Association (APA), it is a multi-axial classification. An assessment on several axes, each of which refers to a different domain of information that may help the clinician plan treatment & predict outcome:
- Provide more information about the patient than does a single category
- Facilitate comprehensive & systemic evaluation
- Provide a format for organizing & communicating clinical information & for reflecting the complexity of clinical situations
- Promotes the application of the biopsychosocial model
However, multiaxial system increase the time involved in making the diagnosis, are therefore not easy to apply in everyday clinical practice. Axes IV & V offer rather crude measurement of dubious reliability & validity.
Axis I Clinical Disorders (may be >1)
Axis III General Medical Condition (potentially relevant to the Mental Disorder)
Axis IV Psychosocial & Environmental Problems (which may affect the diagnosis, treatment or prognosis of the mental disorder)
Axis V Global Assessment of Functioning (GAF): Psychological, social & occupational functioning on a hypothetical continuum of mental health-illness, on a scale 0-100.
State whether GAF is for the current period, at discharge or admission. Exclude impairment due to physical or environmental limitations.
1. Stevens L, Rodin I, Psychiatry: An illustrated colour text, Churchill Livingstone 2001
2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006
3. World Health Organisation (WHO): ICD10 Classification of Mental and Behavioural Disorders (1992)
4. American Psychiatric Association. The Diagnostic and statistical Manual of Mental Disorders (DSM-IV).1994
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The Diagnostic and Statistical Manual of Mental Disorders (DSM)
Care to Know if You Have Dual Diagnosis?
Dual diagnosis is sometimes called co-morbidity, concurrent Disorders, co-occurring illness, co-occurring disorder, double trouble, and dual disorder. Even the professional field of literature is full of confusion as to what term should be used to describe dual diagnosis.
A person should be diagnosed as having dual diagnosis if one has a psychosocial issue and at the same time experiencing multiple illnesses of which it can be more than two. Example is a person which has both a psychiatric diagnosis and a substance abuse diagnosis from either drug or alcohol or perhaps both.
This problem affects an individual’s physical, psychological, social and spiritual functions and therefore unable to relate to themselves and to others. Actually, each of the illnesses interacts with each other causing more complications than it already is. Sometimes, the symptoms overlap from each other creating a mask and difficulty for its diagnosis and treatment.
Usually, a person does not acknowledge that he or she has a co-occurring disorder and may sincerely try to be treated from just one illness. Normally the psychosocial disorder is unacceptable to many. What happens then is that though a patient becomes successful in the drug or alcohol abuse, the psychological illness can take over making the need to go back to the use of either drug or alcohol and the cycle continues. In time, failure and alienation results in this great tragedy that can lower a person’s self-esteem.
Numerous forms of psychiatric illnesses and different problems in alcohol or drug abuse make it difficult to categorize dual diagnosis. However, there are general patterns that have been seen among patients namely: psychiatric symptoms may be covered up or masked by alcohol or drug use, alcohol or drug use or the withdrawal from alcohol or other drugs can mimic or give the appearance of some psychiatric illness, untreated chemical dependency can contribute to a reoccurrence of psychiatric symptoms, and untreated psychiatric illness can contribute to an alcohol or drug relapse.
Other problems and consequences that are associated with dual disorder include: family problems or problems in intimate relationships, isolation and social withdrawal, financial problems, employment or school problems, high risk behavior while driving, multiple admission for chemical dependency services due to relapse, multiple admissions for psychiatric care, increased emergency room admissions, increased need for health care services, legal problems, and possible incarceration and homelessness.
Dual diagnosis is more common than one can imagine. According to a report published by the Journal of the American Medical Association, thirty-seven percent of alcohol abusers and fifty-three percent of drug abusers also have at least one Serious Mental Illness. Of all people diagnosed as Mentally Ill, 29 percent abuse either alcohol or drugs.
An individual is in dual recovery when they are actively following a program that focuses on their recovery needs for both their chemical dependency and their psychiatric illness.
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What is Integrated Treatment?