Diagnosis of Mental Disorders using classification

1. Diagnosis
M.S Sara Dawod

2. Introduction
• Diagnosis is a conclusion that the expert made
about the clients problems and complaints
and it is used to plan care for the client.
• Taxonomy is the practice and science of
classification and it is used to organize and
categorize the data into appropriate, care
guiding diagnosis.

3. Medical diagnosis
• It is a medical term that summarizes the
symptoms and clinical manifestations of
illness.
• Medical psychiatric diagnosis is made by the
psychiatrist or clinical psychologist. For
instance, schizophrenia and major depression
are medical diagnosis.

4. Diagnosis
• It revels two meanings:
1. To distinguish: process of sorting out various
categories of illness and weighing
information for and against such categories
to identify pts disorder.
2. To know thoroughly: process of obtaining
comprehensive characterization of
individuals condition (multiaxial model).

5. Introduction
• In psychiatric, classification has two
components:
• taxonomy: establishing diagnostic groupings.
• Diagnosis: applying those groupings to
individual cases.

6. Taxonomy for writing the diagnosis
• Taxonomy for diagnosis is useful for mental
health practitioners (MHP) to make accurate
diagnosis in their clinical practice.
• It provides a listing of standardized labels
representing health problems and responses
to illness and helps build a scientific
foundation for the mental health profession.

7. Classification of mental disorders
• The first multiaxial thinking was Hippocratic
approach before the DSMs were developed.
• He intensified 6 conditions:
1. Phrenitis acute mental disorders C fever.
2. Mania acute mental disorders without fever.
3. Melancholia (all winds of chromic mental
disorders).
4. Epilepsy.
5. Scythian disease= transvestitisim.

8. Classification of mental disorders
• The primary approach to the classification of
psychopatholgy was the “great professor
approach” by prominent psychiatrics,
including Pinel (1801/1806), Griesinger
(1861/1867),Kraepelin (1907/1923),
Bleuler(1916/ 1924 ), and Schneider (1959).

9. Classification of mental disorders
• The first formal multaxial system was
proposed by Essen and Wohlfahrt in 1947 and
there are more than 15 multiaxial diagnotic
system.

10. Purposes of classification
• Communication: enables users to
communicate with each other about the
disorders.
• Control: to prevent occurrence or modify their
courses with treatment.
• Comprehension: understanding the causes of
mental disorders, their development and
maintenance.

11. The DSM-IV-TR = diagnostic and statistical manual of
mental Disorders. Text revision, Fourth edition.
• This taxonomy is universally used by psychiatrists
and some therapists in the diagnosis of psychiatric
illnesses.
• The DSM-IV-TR classifies mental disorders into
categories. It describes each disorder and provides
diagnostic criteria to distinguish one from another.
• It was first published in 1952 by American
Psychiatric Association (DSM-I) and revised 1965
(DSM-II), 1980 (DSM-III), and 1994 published (DSM-
IV) and revised in 2000 (DSM-IV-TR).

12. The DSM-IV-TR = diagnostic and statistical manual of
mental Disorders. Text revision, Fourth edition.
• The DSM-IV-TR used multiaxial system:
• Axis I: clinical disorders and other conditions
that could be a focus of clinical disorders.
• Axis II: personality disorders& mental
retardation.
• Axis III: general medical conditions.
• Axis IV: psychosocial and environmental
problems.
• Axis V: global assessment of functioning (GAF)
within the last six months.

13. The DSM-IV-TR = diagnostic and statistical manual of
mental Disorders. Text revision, Fourth edition.
• More than one diagnosis could be listed under
the first three axes.
• On axis IV, educational, housing, social,
environmental, support groups, legal
problems, occupational difficulties, economic
problems are listed on.

14. The DSM-IV-TR = diagnostic and statistical manual of
mental Disorders. Text revision, Fourth edition.
• General framework: clinician are cautioned
not to diagnose symptoms unless they are
atypical and problematic within a persons
culture.
• Culture may shapes the language used to
describe symptoms.

15. The international statistical classification of
diseases and related health problems (ICD)
• There are three axes of the ICD-10 :
• Axis I: clinical diagnosis including mental and
physical disorders.
• Axis II: disablements: to assess the impact of
an illness or health problem on social and
physical functioning.
• Axis III: contextual factors, to identify any
problems in the family or social context that
might have a bearing on the health condition.

16. Criticism of the two modules
• Too many diagnosis: contains more than 300
different diagnosis and comorbidity is the norm
rather than the exception.
• These books may invent illness and behaviors,
many times, the patient fails to fit into any
particular category or fall into several categories.
Hence, the professional tries to fit the patient
into approximate category.
• Some claim that diagnostic criteria should be
based on how they should be treated rather than
on deciding what clinically irrelevant differences
place them in one category and not another.

17. Criticism of the two modules
• The criteria, and the way they are applied by
individual clinicians may influence by cultural
variables. What is considered a mental illness
changes over time and from culture to
another.
• Gender may influence diagnostic criteria.
Women show a different clinical picture than
men for many mental disorders.

18. Criticism of the two modules
• The criteria and classification system of the
DSM are based on the majority opinion of
people who represent American mental
health specialties. Therefore, the content of
the DSM doesn't reflect all opinions on the
subject of psychopathology, nor are there any
objective standards to which it can adhere.

19. General criticism of diagnosis of
mental illness
• Fear of labeling such as schizophrenia.
• Social stigma and negative consequences.
• Loss information about the person (e.g. use
depressive or schizophrenic to describe
patient) instead you should use (pt with
schizophrenia).

20. Classification of mental disorders
• Disease/disorder verses syndrome:
• Disorders with relatively known etiologies.
• Syndromes are varied in causal factors or have
unknown causality. It is a group of symptoms,
affect, thought or behaviors that present
together in clinical presentation (e.g. specific
phobia).

21. Classification of mental disorders
• Categorical versus dimensional diagnosis:
• Categorical strategy: where there are clear
boundaries between things and all members
of the class are homogenous with regard to
their defining features.
• Oranges and bananas are categorized under
fruits.

22. Classification of mental disorders
• The DSM-IV-TR a categorical model used to
give a diagnostic label to patients. They are
popular because they define a threshold for
treatment but not define severity (e.g BP,
depression).
• Dimensional methods emphasize using scale
(1-10) and describe disorder according to
continuum of severity. This approach is useful
with mental retardation and borderline cases
of the illness. (threshold of DX and treatment).

23. The international statistical classification of
diseases and related health problems (ICD)
• ICD: the manual of the international
classification of diseases which was first
published in 1948 by WHO (ICD-6).
• This is an alternative guide for diagnosis that is
mostly used by physicians and psychiatrists.
(ICD-8) was published in 1966 and (ICD-9) in
1975.
• There is a tenth version published in 1992
called (ICD-10).

24. ICD-10 mental and behavioral disorders
• F1 Organic including symptomatic mental disorders.
• F2 Mental and behavioral disorders due to psychoactive
substance use.
• F3 Mood/affective disorders.
• F4 Neurotic, stress related and somatoform disorders.
• F5 Behavioral syndromes associated with physiological
disturbance and physical factors.
• F6 Disorders of adult personality and behavior.
• F7 Mental retardation.
• F8 Disorders of psychological development.
• F9 Behavioral and emotional disorders with an onset
usually occurring in childhood and adolescence.

25. classification of mental disorders
• The prototype approach bridges the gap between the
categorical and dimensional method of diagnosis.
• These prototype descriptions are presented in
paragraph form rather than list form and are
psychologically richer and more detailed than DSM-IV
criterion sets (which are limited to seven to nine
features per disorder.
• To make a diagnosis, diagnosticians rate the overall
similarity or “match” between a patient and the
prototype using a 5-point rating scale.

26. classification of mental disorders
• Polythetic versus monothetic criteria:
• Polythetic: the diagnosis is made even if the
presentation includes only a proposition of
the symptoms defining the disorder. This
method was used in DSM-III-R.
• Monotheist criteria: all the symptoms/ item
must be present for the diagnosis to be made.

27. classification of mental disorders
• Multiple diagnosis and co-morbidity:
• Multiple diagnosis: the person may have many mental
disorders at the same time and treatment is given
according to sign and symptoms of each one.
• In DSM-III-R, there were 292 different diagnosis.
Multiple diagnosis are the trend now in psychiatry.
• Co-morbidity: refers to relationship between two or
more disorders. Sometimes, a disorder predispose to
another or more. The presence of the illness might
increase the risk of having another one or two
conditions. (multiple personality disorder may
indicate childhood sexual abuse).

28. classification of mental disorders
• Core versus discriminating features:
• Core: the major symptoms that should be
presented to make diagnosis (definition of
illness).
• Discriminating features: symptoms that maximize
its distinction from near neighbors.
• However core symptoms sometimes are poor at
discriminating the disorder (e.g. hallucination in
schizophrenia, sadness in depression are core
aspects of these disorders but they are not very
discriminating because they are present in near
neighbor).

29. classification of mental disorders
• How do we balance attention to core features against
attention to discriminating features?
• This is done through balancing sensitivity;(the degree to
which the item is typical of the disorder and useful in
depicting it) against specificity (which reflects its
discriminatory value).
• For specificity, attention should be done for comparison
between groups or settings.
• For instance, impulsivity is present in borderline personality
disorder with a person in outpatient clinic but not in one
who is in prison or hospitalized under massive drug
treatment.
• To choose criteria based on discriminating criteria, we
should determine performance in widest range of settings
and groups.

30. Common disorders in
the metal health field :
• Eating disorder (bulimia, anorexia, obesity).
• D. sexual dysfunctions.
• E. psychosomatic disorders.
• F. somatoform disorders.
• G. psychosexual disorders (sexual deviations).
• H. sleep disorders (insomnia, hypersomnia, nightmare).
• I. personality disorders.
• J. dissociative disorders (multiple personality, amnesia).
• K. drug abuse and alcoholism.
• L. organic mental disorders delirium, dementia, Alzheimer's
disease, epilepsy.

31. Common disorders in
the metal health field :
• M. childhood and adolescence disorders:
• Mental handicap (disability, retardation).
• Anxiety disorders.
• Conduct disorder.
• Sleep walking terror.
• Infantile autism.
• Physical disorders (stuttering, enuresis).
• Adjustment disorders.
• Pervasive developmental disorder.

32. Common disorders in
the metal health field :
• A. psychotic disorders
• These are the major mental illness in which
the pt develops grossly impaired reality
testing, delusions and hallucinations.
• Schizophrenic disorders.
• Paranoid disorders.
• Affective disorders or mood disorders.

33. Common disorders in
the metal health field :
• B. anxiety disorders/neurotic disorders
• These are the minor mental disorders in which
the personality is maintained intact, and the
patient aware of his illness.
• Anxiety state.
• Phobias.
• Panic attack/ disorder.
• Obsessive-compulsive disorder.
• Post-traumatic stress disorder.

34. Diagnosis related to care plan
example: schizophrenia
• Noncompliance related to refusal to take
prescribed psychotropic medication.
• Disturbed sleep pattern related to the
presence auditory hallucination.
• Ineffective coping related to fear

35. Diagnosis related to care plan
example: schizophrenia
• Disturbed thought process related to the
presence of persecutory delusion.
• Disturbed sensory perception related to the
presence of visual hallucination.
• Self care deficit related to poor personal
hygiene.
• Impaired verbal communication related to
thought disturbance.