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THE DSM AND ICD     PSYCHIATRICCLASSIFICATION SYSTEMS
FACILITATES CHARACTERIZATION,COMMUNICATION AND RESEARCHCOMPLEXITY OF PHENOMENA AREREDUCEDTWO VIEWS:    DIMENSIONALIZERS – ...
IMPORTANCE OF CLASSIFICATION FOR     PSYCHIATRIC DIAGNOSIS DISTINGUISH BET DIFF PSYCHIATRIC DIAGNOSIS COMMON LANGUAGE AMON...
IMPORTANCE OF CLASSIFICATION            CONT.PUBLIC ACESS – IMPROVES COMMUNICATIONIMPROVES RELIABILITY OF PSYCHIATRICDIAGN...
TWO MOST ACCEPTED PSYCHIATRIC       CLASSIFICATIONSDIAGNOSTIC AND STATISTICALMANUAL OF MENTAL DISORDERS(DSM IV TR)INTERNAT...
DSMCATEGORICAL CLASSIFICATIONDIVIDES MENTAL DISORDERSCRITERIA SETS – DEFINING FEATURES
HISTORY AND BACKGROUNDFIRST DSM – AMERICAN PSYCHIATRICASSOCIATION COMMITTEEDSM II – 1968DSM III – 1980REVISED DSM III – 19...
HISTORY AND BACKGROUNDWHO – ICD-6SECTION ON MENTAL DISORDERSAPA – VARIANT OF ICD-6DSM-1 – FIRST OFFICIAL MANUAL OFCLINICAL...
HISTORY AND BACKGROUNDDSM-II CORRELATED WITH ICD-8DSM-III CORRELATED WITH 1CD-9DSM-III    –   EXPLICIT DIAGNOSTIC CRITERIA...
HISTORY AND BACKGROUNDDSM-III-R – EMPIRICAL RESEARCHDSM-IV – SYSTEMATIC REVIEWS ANDFOCUSED FIELD TRIALSGOAL – INCREASE PRA...
DSM IV-TROFFICIAL CODING SYSTEM IN USAATHEORETICAL APPROACH TO CAUSESDESCRIBES MANIFESTATIONS ANDDESCRIPTIONS OF CLINICAL ...
DSM IV-TRSYSTEMATIC DESCRIPTIONS:   AGE   CULTURE   GENDER FEATURES   PREVALENCE, INCIDENCE   RISK , COURSE   COMPLICATION...
DSM IV-TR365 DISORDERS17 SECTIONSPROPOSED DIAGNOSTIC CRITERIA
DSM IV-TR ORGANIZATIONAL           PLAN16 MAJOR DIAGNOSTIC CLASSESOTHER CONDITIONS THAT MAY BE FOCUSOF CLINICAL ATTENTION1...
AIMS OF DSM IV-TRCLEAR DIAGNOSTIC CATEGORIESDX, COMMUNICATION, STUDY AND TREATDIAGNOSTIC CRITERIA FOR RESEARCHPURPOSESRECO...
AIMS OF DSM IV-TRCLINICAL DECISIONS        RX SETTING        MODE OF RX        DURATION OF RX
SEVERITY AND COURSE      SPECIFIERSMILD, MODERATE, SEVERE ONLY WHENFULL CRITERIA METINTENSITY OF S AND SIMPAIRMENT IN OCCU...
SEVERITY AND COURSE        SPECIFIERSPARTIAL REMISSION – FULL CRITERIAPREVIOUSLY METFULL REMISSION – NO LONGER S AND S,STI...
RECURRENCEFULL CRITERIA NO LONGER METPARTIAL, FULL REMISSION,RECOVERYDO NOT MEET FULL THRESHOLD OFD/O ACCORDING TO SPECIFI...
NOS CATEGORIESDIVERSITY OF CLINICALPRESENTATION4 SITUATIONS:– CRITERIA NOT MET FOR SPECIFIC D/O EG  ATYPICAL, MIXED PICTUR...
MULTIAXIAL ASSESSMENT5 AXES – I – CLINICAL D/O, OTHER CONDITIONS   FOCUS OF CLINICAL ATTENTION – II – PERSONALITY D/O – II...
MULTIAXIAL ASSESSMENTDIFFERENT DOMAINS OFINFORMATIONPLAN RX AND PREDICT OUTCOMEORGANIZING, COMMUNICATINGCLINICAL INFORMATI...
AXIS IPRINCIPAL DXAXIS II CAN ALSO BE PRINCIPALDIAGNOSIS – MUST BE FOLLOWED BY‘PRINCIPAL DX’ OR ‘REASON FOR VISIT’
AXIS IIPERSONALITY D/OMRMALADAPTIVE PERSONALITYFEATURESDEFENCE MECHANISMSMORE THAN 1 DX
AXIS IIIGMC RELEVANT TO MENTAL D/ONO LINK BUT INCLUDED IF:         OVERALL UNDERSTANDING OF PT         AXIS I PSYCHOLOGICA...
AXIS IVPYCHOSOCIAL AND ENVIRONMENTALPROBLEMS THAT AFFECT DX ,RX AND PX:– PROBLEMS WITH PRIMARY SUPPORT  GROUPS– PROBLEMS R...
AXIS IV– PROBLEMS RELATED TO ACCESS TO  HEALTH CARE SERVICES– PROBLEMS RELATED TO INTERACTION  WITH LEGAL SYSTEM/CRIME– OT...
AXIS VGLOBAL ASSESSMENT OF FUNCTIONINGCLINICIANS JUDGEMENT – OVERALLLEVEL OF FUNCTIONINGPLANNING RXPREDICTING OUTCOMEGAF S...
GAF SCALETRACKS CLINICAL PROGRESSSOCIAL,OCCUPATIONAL ANDPSYCHOLOGICAL FUNCTIONING2 COMPONENTS – SYMPTOM SEVERITYAND FUNCTI...
ADVANTAGES DSM IV-TRWIDESPREAD USE – EASE OFCOMMUNICATIONCLEAR DEFINITION ANDDELINEATIONSCOMPATIBILITY WITH ICD10REPORTING...
ADVANTAGES CONTCATEGORICAL MODEL – VALIDTHRESHOLDS FOR CASEIDENTIFICATION WITH CLEARBOUNDARIES BETWEEN CLASSESMULTIAXIAL E...
LIMITATIONS OF DSM IV-TR
FORENSIC SETTINGRISK OF INFORMATION MISUSEDINSUFFICIENT TO ESTABLISH MI,COMPETENCY AND CRIMINALRESPONSIBILITYNO IMPLICATIO...
CLINICAL JUDGEMENTINDIVIDUALS WITH APPROPRIATECLINICAL TRAININGCANNOT BE APPLIED MECHANICALLY
ETHNIC AND CULTURAL      IMPLICATIONSCHALLENGING IF PT AND CLINICIAN FROMDIFFERENT BACKGROUNDSINCORRECTLY DIAGNOSEPSYCHOPA...
TREATMENT PLANNINGCLINICIAN REQUIRED TO OBTAININFORMATION ABOVE THAT OFDIAGNOSTIC CRITERIA
CATEGORICAL APPROACHCATEGORIES OF MENTAL ILLNESS NOTMUTUALLY EXCLUSIVEINDIVIDUALS ARE HETEROGENOUSNO CONSIDERATION OF PATI...
LIMITATIONS OF DSMIV-TR          CONTNOT USEFUL FOR RESEARCH – HINDERSINVESTIGATIONS INTO AET, PATHOPHYS,GENETICSNOT RELIA...
LIMITATIONS OF DSM IV-TRINCONSISTENCIES WITH REMISSIONSTATUSEXCUSION OF PSYCHODYNAMIC ANDPSYCHOSOCIAL PERSPECTIVESUNCERTAI...
ICD 10INTERNATIONAL CLASSIFICATION OFDISEASESCLASSIFICATION FOR EPIDEMIOLOGICALAND HEALTH MANAGEMENT PURPOSESWHO
HISTORY AND BACKGROUND1853 – INTERNATIONAL STATISTICALCONGRESS – W. FARRREVISED OVER NEXT DECADES1946 – WHO – INTERNATIONA...
HX AND BACKGROUND1989 – 10TH REVISIONALPHANUMERICAL CODING SCHEMEOF 1 LETTER FOLLOWED BY 3NUMBERSINCREASE IN NUMBER OFCATE...
ICD 10CHAPTER V – MENTAL D/OCHAPTER VI – NEUROLOGICAL D/OCHAPTER XIX – CLASSIFICATION OFINJURIES – POISONINGCHAPTER XVIII ...
ICD 10SCZ – 5TH CHARACTER – SPECIFYCOURSEF20.01 – PARANOID SCZ, EPISODICWITH PROGRESSIVE DEFICITDIFFERENT VERSIONS – FLEXI...
ICD 10CLINICAL DESCRIPTIONS AND DIAGNOSTICGUIDELINES FOR GENERAL CLINICAL,EDUCATIONAL AND SERVICE USEDIAGNOSTIC CRITERIA F...
CLINICAL DESCRIPTIONS…EACH CATEGORY ACCOMPANIED BYGLOSSARY OF BRIEF DEFINITIONSFURTHER DEFINED SET OF CRITERIACRITERIA LES...
DIAGNOSTIC CRITERIA FOR RESEARCH TWO NB ANNEXES CULTURE SPECIFIC D/O PROVISIONAL CRITERIA FOR UNCERTAIN NOSOLOGICAL STATUS...
MULTIAXIAL VERSIONADULT PSYCHIATRY – 3 AXES        CATEGORIZE CLINICAL SYNDROME        LEVEL OF FUNCTIONAL CAPACITY/      ...
MULTIAXIAL VERSIONMENTAL D/O OF CHILDHOOD6 AXES:   CLINICAL PSYCHIATRIC SYNDROMES   SPECIFIC D/O OF PSYCHOLOGIC DEVELOPMEN...
PRIMARY CARE VERSIONFEWER CATEGORIESGENERAL PRACTITIONER, PRIMARYHEALTH CARE STAFF,PSYCHIATRISTS, OTHERS2 CARDS   WAY THAT...
ADVANTAGES OF ICD 10SIMPLICITY OF STRUCTURE AND USEUSED BY SPECIAL GROUPS, STILLCOMPATIBLE WITH ORIGINALCLASSIFICATIONCOMP...
ADVANTAGES OF ICD 10BASED ON INTERNATIONAL CONSENSUSSEVERAL VERSIONS – ALL COMPATIBLEWITH EACH OTHERSEVERAL LANGUAGESADDIT...
ADVANTAGES OF ICD 10AVOIDS ‘SOCIAL FUNCTIONING’ ASDIAGNOSTIC INDICATORRECENTLY INTRODUCED DX OF PUBLICHEALTH INTERES MILD ...
LIMITATIONS OF ICD 10CATEGORICAL CLASSIFICATION-DISCRETEENTITY VIEW OF PSYCH D/O
LIMITATIONS OF CURRENT OPERATIONAL      APPROACHES TO DIAGNOSISFOCUS ON EPISODE RATHER THAN LIFETIMEEXPERIENCEHIERARCHIES ...
LIMITATIONS OF CURRENT OPERATIONAL      APPROACHES TO DIAGNOSIS SUBCLINICAL CASES NOT ACCOMODATED FULLY NOS CATEGORIES HIG...
DIFFERENCES BETWEEN DSM AND ICD         DSM IV-TR                       ICD10PRODUCED BY APA                 WHOONE GROUP ...
DIFFERENCES BETWEEN DSM AND ICD 10          DSM IV-TR                    ICD10 DEFINITIONAL DIFFERENCES-   DX OF HARMFUL U...
DSMVCURRENTLY IN CONSULTATION,PLANNING AND PREPARATIONDUE FOR PUBLICATION IN 2012/13WORK GROUPS TO ADDRESSS MAJORGAPS
DEVELOPMENTAL ISSUESREFINE PSYCHIATRIC ASSESSMENTTECHNIQUE ACROSSDEVELOPMENTAL STAGESMETHODS TO INTEGRATEDEVELOPMENTAL ASS...
DEFINING MENTAL ILLNESSFACILITATING DIAGNOSTIC PROCESSES INNON-PSYCHIATRIC SETTINGSAPPLICABILITY OF CRITERIA ACROSSDIFFERE...
PERSONALITY DISORDERSDIMENSIONAL MODEL MAY BE SUPERIOR,MORE RELIABLE, SPECIFIC AND CLINICALLYINFORMATIVESHOULD THERE BE IN...
RELATIONAL PROBLEMSPAINFUL PERSISTENT BEHAVIOURALPROBLEMS THAT SERIOUSLY AFFECTJUDGEMENTINCLUSION IN DSMV
PROPOSED CHANGES TO DSM IV-TR            DX  ELIMINATE ASPERGERS SYNDROME  AS SEPARATE D/O  MERGE UNDER AUTISM SPECTRUM D/...
PROPOSED NEW DSM V DXCOMPLEX POST TRAUMATIC STRESS D/ODEPRESSIVE PERSONALITY D/ONEGATIVISTIC ( PASSIVE-AGGRESSIVE ) PDPOST...
REFERENCESKAPLAN AND SADDOCK’S COMPREHENSIVE TEXTBOOK OFPSYCHIATRY, 9TH EDITION 2009KAPLAN AND SADDOCK’S SYNOPSIS OF PSYCH...
REFERENCESDISTINGUISHING BETWEEN VALIDIDTY AND UTILITYOF PSYCHIATRIC DIAGNOSIS. KWNDELLR,JABLESKY A.AMJ 2003;160:4-12CLINI...
The dsmiv and_icd10_classification_systems_(background)
The dsmiv and_icd10_classification_systems_(background)
The dsmiv and_icd10_classification_systems_(background)
The dsmiv and_icd10_classification_systems_(background)
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The dsmiv and_icd10_classification_systems_(background)

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Transcript of "The dsmiv and_icd10_classification_systems_(background)"

  1. 1. THE DSM AND ICD PSYCHIATRICCLASSIFICATION SYSTEMS
  2. 2. FACILITATES CHARACTERIZATION,COMMUNICATION AND RESEARCHCOMPLEXITY OF PHENOMENA AREREDUCEDTWO VIEWS: DIMENSIONALIZERS – DIMENSIONS OF FUNCTIONING,DIFFERENT PSYCHIATRIC D/O CATEGORIZERS – SPECIFIC GROUPS OF SYMPTOMS – REFLECT PSYCHIATRIC SYNDROMES
  3. 3. IMPORTANCE OF CLASSIFICATION FOR PSYCHIATRIC DIAGNOSIS DISTINGUISH BET DIFF PSYCHIATRIC DIAGNOSIS COMMON LANGUAGE AMONGST HEALTH PROFESSIONALS ENSURES RELIABILITY,COMMUNICATION AND STATISTICAL REPORTING EFFECTIVE TREATMENT STANDARD FRAME OF REFERENCE TEACHING-INTERNATIONAL REFERENCE SYSTEMS
  4. 4. IMPORTANCE OF CLASSIFICATION CONT.PUBLIC ACESS – IMPROVES COMMUNICATIONIMPROVES RELIABILITY OF PSYCHIATRICDIAGNOSIS IN RESEARCH SETTINGSUNDERSTANDING OF CAUSES ANDPROCESSES OF MENTAL DISORDERS
  5. 5. TWO MOST ACCEPTED PSYCHIATRIC CLASSIFICATIONSDIAGNOSTIC AND STATISTICALMANUAL OF MENTAL DISORDERS(DSM IV TR)INTERNATIONAL CLASSIFICATION OFDISEASES (ICD 10)CLINICAL DESCRIPTIONS BASED ONPHENOMENOLOGICAL APPROACHES
  6. 6. DSMCATEGORICAL CLASSIFICATIONDIVIDES MENTAL DISORDERSCRITERIA SETS – DEFINING FEATURES
  7. 7. HISTORY AND BACKGROUNDFIRST DSM – AMERICAN PSYCHIATRICASSOCIATION COMMITTEEDSM II – 1968DSM III – 1980REVISED DSM III – 1987DSM III-R – 1987DSM IV – 1994DSM-IV-TR – 2000
  8. 8. HISTORY AND BACKGROUNDWHO – ICD-6SECTION ON MENTAL DISORDERSAPA – VARIANT OF ICD-6DSM-1 – FIRST OFFICIAL MANUAL OFCLINICAL MENTAL DISORDERSPSYCHOBIOLOGICAL VIEW
  9. 9. HISTORY AND BACKGROUNDDSM-II CORRELATED WITH ICD-8DSM-III CORRELATED WITH 1CD-9DSM-III – EXPLICIT DIAGNOSTIC CRITERIA – MULTI-AXIAL SYSTEM – DESCRIPTIVE MEDICAL NOMENCLATURE
  10. 10. HISTORY AND BACKGROUNDDSM-III-R – EMPIRICAL RESEARCHDSM-IV – SYSTEMATIC REVIEWS ANDFOCUSED FIELD TRIALSGOAL – INCREASE PRACTICALITY ANDCLINICAL UTILITYDSM IV-TR – NOS CATEGORY
  11. 11. DSM IV-TROFFICIAL CODING SYSTEM IN USAATHEORETICAL APPROACH TO CAUSESDESCRIBES MANIFESTATIONS ANDDESCRIPTIONS OF CLINICAL FEATURESOF MENTAL D/OSPECIFIC DIAGNOSTIC CRITERIACRITERIA INCREASE RELIABILITY
  12. 12. DSM IV-TRSYSTEMATIC DESCRIPTIONS: AGE CULTURE GENDER FEATURES PREVALENCE, INCIDENCE RISK , COURSE COMPLICATIONS PREDISPOSING FACTORS FAMILIAL PATTERNS DIFFERENTIAL DIAGNOSIS LAB FINDINGS PHYSICAL EXAMINATION SIGNS AND SYMPTOMS
  13. 13. DSM IV-TR365 DISORDERS17 SECTIONSPROPOSED DIAGNOSTIC CRITERIA
  14. 14. DSM IV-TR ORGANIZATIONAL PLAN16 MAJOR DIAGNOSTIC CLASSESOTHER CONDITIONS THAT MAY BE FOCUSOF CLINICAL ATTENTION11 APPENDICES DIFFERENTIAL DX GLOSSARY CHANGES IN DSM-IV-TR CLASSIFICATION WITH ICD-10 CULTURAL FORMULATION, ETC
  15. 15. AIMS OF DSM IV-TRCLEAR DIAGNOSTIC CATEGORIESDX, COMMUNICATION, STUDY AND TREATDIAGNOSTIC CRITERIA FOR RESEARCHPURPOSESRECORD KEEPING, DATA COLLECTIONREPORTING TO 3RD PARTIES – GOVN, PRIVATEINSURERSSUBTYPESSPECIFIERSINCREASED SPECIFICITY
  16. 16. AIMS OF DSM IV-TRCLINICAL DECISIONS RX SETTING MODE OF RX DURATION OF RX
  17. 17. SEVERITY AND COURSE SPECIFIERSMILD, MODERATE, SEVERE ONLY WHENFULL CRITERIA METINTENSITY OF S AND SIMPAIRMENT IN OCCUPATIONAL ANDFUNCTIONAL IMPAIRMENTMRCONDUCT D/OMANIC EPISODEMAJOR DEPRESSIVE EPISODE
  18. 18. SEVERITY AND COURSE SPECIFIERSPARTIAL REMISSION – FULL CRITERIAPREVIOUSLY METFULL REMISSION – NO LONGER S AND S,STILL CLINICALLY RELEVANTPARTIAL AND FULL REMISSION FOR: MANIC EPISODE MAJOR DEPRESSIVE EPISODE SUBSTANCE DEPENDANCEPRIOR HISTORY – USEFUL TO NOTE HX OFCRITERIA PREVIOUSLY MET BUT NOWRECOVERED
  19. 19. RECURRENCEFULL CRITERIA NO LONGER METPARTIAL, FULL REMISSION,RECOVERYDO NOT MEET FULL THRESHOLD OFD/O ACCORDING TO SPECIFIEDCRITERIA
  20. 20. NOS CATEGORIESDIVERSITY OF CLINICALPRESENTATION4 SITUATIONS:– CRITERIA NOT MET FOR SPECIFIC D/O EG ATYPICAL, MIXED PICTURE– DOES NOT CONFORM TO DSM IV CLASSIFICATION BUTCLINICAL SIGNIFICANT DISTRESS– AETIOLOGY UNCERTAIN– INSUFFICIENT DATA, INCONSISTENT INFORMATION
  21. 21. MULTIAXIAL ASSESSMENT5 AXES – I – CLINICAL D/O, OTHER CONDITIONS FOCUS OF CLINICAL ATTENTION – II – PERSONALITY D/O – III – GMC – IV – PSYCHOSOCIAL, ENVIRONMENTAL – V – GAF
  22. 22. MULTIAXIAL ASSESSMENTDIFFERENT DOMAINS OFINFORMATIONPLAN RX AND PREDICT OUTCOMEORGANIZING, COMMUNICATINGCLINICAL INFORMATIONCAPTURES COMPLEXITY OF CLINICALSITUATIONHETEROGENEITY OF PATIENTBIOPSYCHOSOCIAL MODEL
  23. 23. AXIS IPRINCIPAL DXAXIS II CAN ALSO BE PRINCIPALDIAGNOSIS – MUST BE FOLLOWED BY‘PRINCIPAL DX’ OR ‘REASON FOR VISIT’
  24. 24. AXIS IIPERSONALITY D/OMRMALADAPTIVE PERSONALITYFEATURESDEFENCE MECHANISMSMORE THAN 1 DX
  25. 25. AXIS IIIGMC RELEVANT TO MENTAL D/ONO LINK BUT INCLUDED IF: OVERALL UNDERSTANDING OF PT AXIS I PSYCHOLOGICAL REACTION TO AXIS IITHOROUGHNESS OF EVALUATIONENHANCES COMMUNICATION BETWEENHEALTH PROFESSIONALSPROGNOSTIC AND RX IMPLICATION
  26. 26. AXIS IVPYCHOSOCIAL AND ENVIRONMENTALPROBLEMS THAT AFFECT DX ,RX AND PX:– PROBLEMS WITH PRIMARY SUPPORT GROUPS– PROBLEMS RELATED TO SOCIAL ENVIRONMENT– EDUCATIONAL PROBLEMS– HOUSING PROBLEMS– ECONOMIC PROBLEMS– PROBLEMS WITH ACCESS TO HEALTH CARE SERVICES
  27. 27. AXIS IV– PROBLEMS RELATED TO ACCESS TO HEALTH CARE SERVICES– PROBLEMS RELATED TO INTERACTION WITH LEGAL SYSTEM/CRIME– OTHER PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS
  28. 28. AXIS VGLOBAL ASSESSMENT OF FUNCTIONINGCLINICIANS JUDGEMENT – OVERALLLEVEL OF FUNCTIONINGPLANNING RXPREDICTING OUTCOMEGAF SCALE
  29. 29. GAF SCALETRACKS CLINICAL PROGRESSSOCIAL,OCCUPATIONAL ANDPSYCHOLOGICAL FUNCTIONING2 COMPONENTS – SYMPTOM SEVERITYAND FUNCTIONINGREFLECTS WORSE OF 2CURRENT PERIOD S/T ADMISSION,DISCHARGE ETC
  30. 30. ADVANTAGES DSM IV-TRWIDESPREAD USE – EASE OFCOMMUNICATIONCLEAR DEFINITION ANDDELINEATIONSCOMPATIBILITY WITH ICD10REPORTING DIAGNOSTIC DATACOLLECTION OF DIAGNOSTIC DATA
  31. 31. ADVANTAGES CONTCATEGORICAL MODEL – VALIDTHRESHOLDS FOR CASEIDENTIFICATION WITH CLEARBOUNDARIES BETWEEN CLASSESMULTIAXIAL EVALUATION PROMOTESCOMPREHENSIVE BIOPSYCHOSOCIALAPPROACH
  32. 32. LIMITATIONS OF DSM IV-TR
  33. 33. FORENSIC SETTINGRISK OF INFORMATION MISUSEDINSUFFICIENT TO ESTABLISH MI,COMPETENCY AND CRIMINALRESPONSIBILITYNO IMPLICATIONS FOR DEGREE OFCONTROL OVER BEHAVIOURSASSOCIATED WITH MIFACILITATES LEGAL DECISIONS
  34. 34. CLINICAL JUDGEMENTINDIVIDUALS WITH APPROPRIATECLINICAL TRAININGCANNOT BE APPLIED MECHANICALLY
  35. 35. ETHNIC AND CULTURAL IMPLICATIONSCHALLENGING IF PT AND CLINICIAN FROMDIFFERENT BACKGROUNDSINCORRECTLY DIAGNOSEPSYCHOPATHOLOGYINCORRECT PERSONALITY DIAGNOSTICCRITERIA ACROSS DIFFERENT CULTURALSETTINGSALLOWANCES MADE BY DSM DISCUSSES CULTURAL VARIATIONS CULTURE BOUND SYNDROMES CULTURAL FORMULATION
  36. 36. TREATMENT PLANNINGCLINICIAN REQUIRED TO OBTAININFORMATION ABOVE THAT OFDIAGNOSTIC CRITERIA
  37. 37. CATEGORICAL APPROACHCATEGORIES OF MENTAL ILLNESS NOTMUTUALLY EXCLUSIVEINDIVIDUALS ARE HETEROGENOUSNO CONSIDERATION OF PATIENTSNARRATIVE HISTORY
  38. 38. LIMITATIONS OF DSMIV-TR CONTNOT USEFUL FOR RESEARCH – HINDERSINVESTIGATIONS INTO AET, PATHOPHYS,GENETICSNOT RELIABLE INTERCLINICIAN TOOLPATIENTS NOT INCORPORATED IN RXCHOICESCOMPLICATED-284 POTENTIAL DXLESS VALIDITY- BEREAVEMENTCONCEPTUAL INCONSISTENCY
  39. 39. LIMITATIONS OF DSM IV-TRINCONSISTENCIES WITH REMISSIONSTATUSEXCUSION OF PSYCHODYNAMIC ANDPSYCHOSOCIAL PERSPECTIVESUNCERTAINTY OF INTERPRETING‘CLINICALLY SIGNIFICANT’ CRITERIAMULTIAXIAL SYSTEM- TIME CONSUMING,NOT USEDAXES IV, V- DUBIOUS RELIABILITY ANDVALIDITY
  40. 40. ICD 10INTERNATIONAL CLASSIFICATION OFDISEASESCLASSIFICATION FOR EPIDEMIOLOGICALAND HEALTH MANAGEMENT PURPOSESWHO
  41. 41. HISTORY AND BACKGROUND1853 – INTERNATIONAL STATISTICALCONGRESS – W. FARRREVISED OVER NEXT DECADES1946 – WHO – INTERNATIONAL LIST OFCAUSES IF MORBIDITY1948 – 6TH REVISION1975 – 9TH REVISION-BEGINNING OF ICD9TH REVISION – DESCRIPTIONS OFCATEGORIES OF CHAPTER V – MENTAL D/O
  42. 42. HX AND BACKGROUND1989 – 10TH REVISIONALPHANUMERICAL CODING SCHEMEOF 1 LETTER FOLLOWED BY 3NUMBERSINCREASE IN NUMBER OFCATEGORIES, SEPARATE CHAPTERS
  43. 43. ICD 10CHAPTER V – MENTAL D/OCHAPTER VI – NEUROLOGICAL D/OCHAPTER XIX – CLASSIFICATION OFINJURIES – POISONINGCHAPTER XVIII – S AND S, ABN CLINICALAND LAB FINDINGSCATEGORIES DENOTED BY LETTER1ST NO – MAIN GROUP2ND NO – CATEGORY WITHIN GROUP4TH CHARACTER – FURTHER SUBDIVISIONF32.2 – SEVERE DEPRESSIVE EPISODEWITHOUT PSYCHOTIC SYMPTOMS
  44. 44. ICD 10SCZ – 5TH CHARACTER – SPECIFYCOURSEF20.01 – PARANOID SCZ, EPISODICWITH PROGRESSIVE DEFICITDIFFERENT VERSIONS – FLEXIBILITYAND ACCEPTIBILITY TO VARIOUS USERS
  45. 45. ICD 10CLINICAL DESCRIPTIONS AND DIAGNOSTICGUIDELINES FOR GENERAL CLINICAL,EDUCATIONAL AND SERVICE USEDIAGNOSTIC CRITERIA FOR RESEARCHPRIMARY CARE VERSIONMULTIAXIAL VERSION
  46. 46. CLINICAL DESCRIPTIONS…EACH CATEGORY ACCOMPANIED BYGLOSSARY OF BRIEF DEFINITIONSFURTHER DEFINED SET OF CRITERIACRITERIA LESS PRECISE THAN DSMALLOWS CLINICIANS TO USE IN DAILYPRACTICE
  47. 47. DIAGNOSTIC CRITERIA FOR RESEARCH TWO NB ANNEXES CULTURE SPECIFIC D/O PROVISIONAL CRITERIA FOR UNCERTAIN NOSOLOGICAL STATUS – BIPOLAR D/O II
  48. 48. MULTIAXIAL VERSIONADULT PSYCHIATRY – 3 AXES CATEGORIZE CLINICAL SYNDROME LEVEL OF FUNCTIONAL CAPACITY/ DISABILITY CATEGORIES OF IMPORTANCE IN THE UNDERSTANDING OF THE D/O
  49. 49. MULTIAXIAL VERSIONMENTAL D/O OF CHILDHOOD6 AXES: CLINICAL PSYCHIATRIC SYNDROMES SPECIFIC D/O OF PSYCHOLOGIC DEVELOPMENT INTELLECTUAL LEVEL MEDICAL CONDITIONS ASSOCIATED ABNORMAL PSYCHOSOCIAL SITUATION GLOBAL ASSESSMENT OF PSYCHOSOCIAL DISABILITY
  50. 50. PRIMARY CARE VERSIONFEWER CATEGORIESGENERAL PRACTITIONER, PRIMARYHEALTH CARE STAFF,PSYCHIATRISTS, OTHERS2 CARDS WAY THAT CONDITION IS RECOGNIZED AND DIAGNOSED ADVICE ON MX
  51. 51. ADVANTAGES OF ICD 10SIMPLICITY OF STRUCTURE AND USEUSED BY SPECIAL GROUPS, STILLCOMPATIBLE WITH ORIGINALCLASSIFICATIONCOMPATIBILITY WITH NATIONAL ANDOTHER WIDELY USED CLASSIFICATIONSDIFFERENCES KEPT TO MINIMUMCONTINUITY OVER TIMEBASED ON INTERNATIONAL CONSENSUS
  52. 52. ADVANTAGES OF ICD 10BASED ON INTERNATIONAL CONSENSUSSEVERAL VERSIONS – ALL COMPATIBLEWITH EACH OTHERSEVERAL LANGUAGESADDITIONAL PUBLICATIONS FACILITATE ITSUSERESPONSIVE TO NEEDS OF PRACTICECATEGORIES FOR DIAGNOSISFREQUENTLY USED BUT NOSOLGYUNCERTAIN
  53. 53. ADVANTAGES OF ICD 10AVOIDS ‘SOCIAL FUNCTIONING’ ASDIAGNOSTIC INDICATORRECENTLY INTRODUCED DX OF PUBLICHEALTH INTERES MILD COGNITIVE D/OTERMINOLOGY EASY TO USESIGNIFICANT EXPANSION OF ACUTEPSYCHOTIC D/O-DEVELOPING COUNTRIESCATEGORICAL CLASSIFICATION
  54. 54. LIMITATIONS OF ICD 10CATEGORICAL CLASSIFICATION-DISCRETEENTITY VIEW OF PSYCH D/O
  55. 55. LIMITATIONS OF CURRENT OPERATIONAL APPROACHES TO DIAGNOSISFOCUS ON EPISODE RATHER THAN LIFETIMEEXPERIENCEHIERARCHIES LEAD TO LOSS OF INFOBOUNDARIES BET CATEGORIES AREARBITRARYBOUNDARIES BET CATEGORIES REQUIRESUBSTANTIAL SUBJECTIVE JUDGEMENTDIAGNOSTIC CATEGORIES ARE UNHELPFUL INDETERMINING SEVERITY
  56. 56. LIMITATIONS OF CURRENT OPERATIONAL APPROACHES TO DIAGNOSIS SUBCLINICAL CASES NOT ACCOMODATED FULLY NOS CATEGORIES HIGHLY HETEROGENOUS INCREASED GAPS BETWEEN RESEARCH FINDINGS AND DEFINITIONS OF CURRENT DIAGNOSTIC SYSTEMS – SACRIFICES VALIDITY FOR RELIABILITY
  57. 57. DIFFERENCES BETWEEN DSM AND ICD DSM IV-TR ICD10PRODUCED BY APA WHOONE GROUP OF DISEASES, DIRECT NUMBER OF CLASSIFICATIONSINTEREST TO PARTICULAR – EVEN CLASSIFICATION OFPROFESSIONAL GROUP REASON FOR CONTACTNATIONAL DIAGNOSTIC STATUTORY RESPONSIBILITYCLASSIFICATION FOR RELIABLE REPORTING OF DISEASES AND HEALTH STATES TO THE WORLD POPULATIONSINGLE SET OF OPERATIONAL INTERRELATED VERSIONSDIAGNOSTIC CRUTERIA FOR ALL ADDRESSING DIFFERENTUSERS USERS IN SPECIFIC CONTEXTS
  58. 58. DIFFERENCES BETWEEN DSM AND ICD 10 DSM IV-TR ICD10 DEFINITIONAL DIFFERENCES- DX OF HARMFUL USE FOCUSES SUBSTANCE D/O=FOCUS ON ON DAMAGE TO USER’S NEGATIVE CONSEQUENCES PHYSICAL AND MENTAL HEALTH ACUTE STRESS D/O-DX ONLY WIDER RANGE OF RESPONSES- FOR SEVERE DISSOCIATIVE MILD ANXIETY TO SEVERE REACTIONS DISSOCIATION DIFFERENCES IN DIAGNOSTIC MINIMUM 3/12 CRITERIA-DURATION, FREQUENCY ETC-DELUSIONAL D/O-3/12 DIFFERENCES IN HYPOCHONDRIASIS EXCLUSIONARY CRITEIA- HYPOCHONDRIASIS CONCEPTUAL DIFFERENCES OF CONCEPTUAL DIFFERENCES OF DISORDERS DISORDERS
  59. 59. DSMVCURRENTLY IN CONSULTATION,PLANNING AND PREPARATIONDUE FOR PUBLICATION IN 2012/13WORK GROUPS TO ADDRESSS MAJORGAPS
  60. 60. DEVELOPMENTAL ISSUESREFINE PSYCHIATRIC ASSESSMENTTECHNIQUE ACROSSDEVELOPMENTAL STAGESMETHODS TO INTEGRATEDEVELOPMENTAL ASSESSMENTSINTO DIAGNOSTIC PROCESSING
  61. 61. DEFINING MENTAL ILLNESSFACILITATING DIAGNOSTIC PROCESSES INNON-PSYCHIATRIC SETTINGSAPPLICABILITY OF CRITERIA ACROSSDIFFERENT CULTURAL SETTINGSVALIDATINGDIAGNOSTIC CRITERIAINCREASING COMPATIBILITY BETWEENDSM V AND ICD 10DIMENSIONAL APPROACH MORE SUPERIOR
  62. 62. PERSONALITY DISORDERSDIMENSIONAL MODEL MAY BE SUPERIOR,MORE RELIABLE, SPECIFIC AND CLINICALLYINFORMATIVESHOULD THERE BE INDEPENDENCE ANDDISTINCTIVENESS BETWEEN AXIS I ANDAXIS II PERSONALITY D/OBOTH FREQUENTLY CO-EXISTAXIS II OFTEN A SIGNIFICANTCOMPLICATING FACTOR TO AXIS I
  63. 63. RELATIONAL PROBLEMSPAINFUL PERSISTENT BEHAVIOURALPROBLEMS THAT SERIOUSLY AFFECTJUDGEMENTINCLUSION IN DSMV
  64. 64. PROPOSED CHANGES TO DSM IV-TR DX ELIMINATE ASPERGERS SYNDROME AS SEPARATE D/O MERGE UNDER AUTISM SPECTRUM D/ O SEVERITY CAN BE RATED- SEVERE, MODERATE, MILD
  65. 65. PROPOSED NEW DSM V DXCOMPLEX POST TRAUMATIC STRESS D/ODEPRESSIVE PERSONALITY D/ONEGATIVISTIC ( PASSIVE-AGGRESSIVE ) PDPOST TRAUMATIC EMBITTERMENT D/ORELATIONAL D/OPD AND MR AS AXIS I D/OSLUGGISH COGNITIVE TEMPERAMENT
  66. 66. REFERENCESKAPLAN AND SADDOCK’S COMPREHENSIVE TEXTBOOK OFPSYCHIATRY, 9TH EDITION 2009KAPLAN AND SADDOCK’S SYNOPSIS OF PSYCHIATRY,10THEDITIONDIAGNOSTIC AND STATISTICAL MANUAL OF MENTALDISORDERS:DSM IV TR- APA 2000A RESEARCH AGENDA FOR DSM V. KUPFER,D;FIRST,M;REGIER,DFIRST M.HARMONISATION OF ICD-11 AND DSM- V:OPPORTUNITIES AND CHALLENGES.BJP 2009;195:382-390JABLENSKY A.TOWARDS ICD-11 AND DSM-V:ISSUES BEYONDHARMONISATION.BJP 2009;195:379-381CRADDOCK,MICHAEL O.RETHINKING PSYCHOSIS.WORLDPSYCHIATRY 2007;6(2):84-91
  67. 67. REFERENCESDISTINGUISHING BETWEEN VALIDIDTY AND UTILITYOF PSYCHIATRIC DIAGNOSIS. KWNDELLR,JABLESKY A.AMJ 2003;160:4-12CLINICAL UTILITY AS A CRITERION FOR REVISINGPSYCHIATRIC DIAGNOSIS. FIRST M,WILLIAMSJ,USTUN B, PEELE R. AMJ 2004;161;946-954AMERICAN ASSOCIATION OF COMMUNITYPSYCHIATRIST’S VIEWS ON GENERAL FEATURESOF DSM-IV. BELL C,SOWERS W, THOMPSON K.PSYCHIATRIC SERVICES,2008;59:687-689
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