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Classification of Psychiatric disorders
1. U G C L A S S
D E P T . O F P S Y C H I A T R Y
Classification of Psychiatric
disorders
2. Classification
Def:- The process of putting things into groups based
on ways that they are alike (merriam dictionary)
Classification of diseases:- System of categories to
which morbid entities are assigned according to
some established criteria.
โDiagnosis and classification are means of viewing
the worldโ (Sartorius,N.1988).
4. Classification in Psychiatryโฆ
Classification ideally must be based on aetiology ๏
but do we know the aetiology???
Until we know the cause of the various mental
illnesses ๏ what to do???
So a Pragmatic/ Practical approach to classification
is being followed.
5. Why do we need classification?
Enable us to care for our patients,
To communicate with other health professionals,
To communicate between different geographical
boundaries,
To carry out high-quality research &
Based on epidemiological data to plan services.
6. Definitions
Syndrome:- It is a constellation of symptoms that are
unique as a group.
๏ก May contain some symptoms that occur in other syndromes
also, but
๏ก It is the particular combination of symptoms that makes the
syndrome specific.
In psychiatry many syndromes began as one specific
and striking symptom.
7. Definitions
Sometimes the symptoms of the syndrome seem to
have a meaningful coherence.
Ex, a case of mania may present with-
๏ก cheerfulness,
๏ก over-activity,
๏ก pressure of speech and
๏ก flight of ideas, all these can be understood as arising from the
elevated mood.
8. Definitions
Mental disorder:
๏ก Clinically significant behavioral or psychological syndrome
or pattern that occurs in an individual,
๏ก Associated with persistent distress/disability,
๏ก Or with significantly increased risk of suffering death, pain,
disability or an important loss of freedom.
Psychiatric nosology: branch of medicine
concerned with the classification and description of
psychiatric disorders.
9. Earlier Classifications
Initial classification ๏ either arising from disease of
the brain or those with no such basis, i.e. organic &
functional.
As knowledge of neurobiological processes is
increasing, their original meaning is being lost.
Schizophrenia & BPAD were examples of functional
disorders, but the the role of genetics and of neuro-
pathological abnormalities shows that there is at
least some organic basis for these disorders.
These categories of classification (i.e. organic versus
functional) are absurd now!!!...
10. Organic syndromes
Classified into acute, sub-acute & chronic.
Most common feature is alteration in consciousness.
It includes delirium.
It also includes substance use disorders due to use of
alcohol, cannabis, opium etc..,
Chronic organic states include various dementias,
generalized and focal, as well as amnestic disorders.
In modern classification they find their place in Foo
to F19.
11. Functional syndromes
Refers to those syndromes where there is no
apparent coarse brain disease.
Although increasingly it is recognized that some finer
variety of brain disease may exist, often at a cellular
level.
It was customary to divide these functional disorders
into neurosis and psychosis.
12. Neurosis Psychosis
Believed to have insight
into their illness.
Only a part of their
personality involved in
the disorder.
Intact reality testing.
Believed to lack insight
into their illness.
Whole of the
personality is distorted.
A false environment is
constructed out of their
distorted subjective
experience.
Functional disorders
13. Neurosis
Neurosis- difficult to define, broad, more info conveyed if
specific diagnosis used.
Used as aetiological meaning in psychodynamic
writings.
Not in used DSM 4.
Retained in ICD-10 โneurotic stress related somatoform
disordersโ.
Used as non precise term.
14. Psychosis
Was used in ICD-9.
Psychosis- little use in classifying disorders.
Difficult to define, broad category.
Used as ICD-10 โacute & transient psychotic
disordersโ.
Used in DSM-4 โPsychotic disorders NOSโ.
15. Neurotic v/s Psychotic
Oversimplification!!!...
Many individuals with neurotic conditions have
๏ก No insight,
๏ก Far from accepting their illness &
๏ก May minimise or deny it totally.
While people with schizophrenia may seek help willingly
during or before episodes of relapse.
Moreover, personality
๏ก Can be changed significantly by non-psychotic disorders such as
depressive illness,
๏ก It may be intact in some people with psychotic disorders such as
persistent delusional disorder.
16. Modern classificatory systems
ICD -10- International Classification of Diseasesโ
Clinical descriptions and diagnostic guidelines
DSM-4-TR- Diagnostic and Statistical Manual of
Mental Disorders - 4th edition, Text Revision
DSM 5- 5Th edition of the text.
17. ICD
VERSION YEAR
ICD 1 1900
ICD 2 1910
ICD 3 1921
ICD 4 1930
ICD 5 1939
VERSION YEAR
ICD 6 1949
ICD 7 1958
ICD 8A 1968
ICD 9 1979
ICD 10 1999
ICD 11 2015
18. DSM
VERSION YEAR NO. DIAGNOSIS
DSM I 1952 106
DSM II 1968 182
DSM III 1980 265
DSM III R 1987 265
DSM IV 1994 365
DSM IV TR 2000 365
DSM 5 2013 400+
19. ICD-10 Chapter 5
Different versions-
๏ก Clinical descriptions & diagnostic guidelines (CDDG)
๏ก Diagnostic criteria for research (DCR)
๏ก Primary Care version
๏ก Multi-axial system
Chapter 5, F category (mental disorder).
New alphanumeric format-more categories.
Descriptive classification.
Groupings based on presumed aetiology e.g.
organic, non-organic psychotic etc..,
20. ICD- multi axial diagnosis
Axis I - Clinical diagnoses, both mental and general
medical disorders, personality disorders & Mental
retardation.
Axis II โ Disablements, this axis appraises the
consequences of illness in terms of impairment in
the performance of basic social roles.
Axis III - Contextual Factors, portrays the context of
illness in terms of several ecological domains.
21. DSM IV TR
Axis 1- Mental disorder
Axis 2- Personality disorders/ Mental retardation
Axis 3- General medical conditions
Axis 4- Psychosocial stressors
Axis 5- GAF (General Activity of Functioning)
DSM 5- does not has the axis diagnosisโฆ
22. ICD-10 v/s DSM IV
ICD-10: 1992
International-WHO
Different criteria for clinical
& research
All languages
Separate multi-axial
Not include social factors
(international)
Part of general classification
Alpha numerical
classification (F19, F25 etc..)
DSM IV: 1994
APA
One version
English
Multi-axial
Includes social factors
(national)
Only mental disorders
Numerical classification
(313.13, 256.21 etc..).
23. Diagnosis in ICD
F00-F09: Organic, including symptomatic, mental
disorders.
F10--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.
24. Diagnosis in ICD
F50-F59: Behavioural syndromes associated with
physiological disturbances and physical factors.
F60-F69: Disorders of adult personality and
behaviour.
F70-F79: Mental retardation.
F80-F89: Disorders of psychological development.
F90-F98: Behavioural and emotional disorders with
onset usually occurring in childhood and
adolescence.
25. Categorical Dimensional/ Spectrum
Based on separate (but may be
overlapping) categories of
disorders.
Termed as โNeo-Kraepelinian"
(after the psychiatrist Kraepelin).
It is intended to be atheoretical
with regard to aetiology.
Achieved widespread acceptance
in psychiatry, and
Generally been found to have
improved inter-rater reliability.
Ex:- Bipolar affective disorder,
Autism, Aspergers syndrome etc..
Based on broader underlying
"spectra", where each spectrum
links together a range of related
categorical diagnoses and
nonthreshold symptom patterns.
They are intended to be
theoretical with regard to
aetiology.
Problem- limited practical value
in clinical practice where yes/no
decisions often need to be made.
Ex:- Bipolar spectrum, Autistic
spectrum disorders etc..
Classification
