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
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.
“Diagnosis and classification are means of viewing
the world” (Sartorius,N.1988).
4. Classification in Psychiatry…
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
To carry out high-quality research &
Based on epidemiological data to plan services.
Syndrome:- It is a constellation of symptoms that are
unique as a group.
May contain some symptoms that occur in other syndromes
It is the particular combination of symptoms that makes the
In psychiatry many syndromes began as one specific
and striking symptom.
Sometimes the symptoms of the syndrome seem to
have a meaningful coherence.
Ex, a case of mania may present with-
pressure of speech and
flight of ideas, all these can be understood as arising from the
Clinically significant behavioral or psychological syndrome
or pattern that occurs in an individual,
Associated with persistent distress/disability,
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
9. Earlier Classifications
Initial classification either arising from disease of
the brain or those with no such basis, i.e. organic &
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
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
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
Intact reality testing.
Believed to lack insight
into their illness.
Whole of the
personality is distorted.
A false environment is
constructed out of their
Neurosis- difficult to define, broad, more info conveyed if
specific diagnosis used.
Used as aetiological meaning in psychodynamic
Not in used DSM 4.
Retained in ICD-10 “neurotic stress related somatoform
Used as non precise term.
Was used in ICD-9.
Psychosis- little use in classifying disorders.
Difficult to define, broad category.
Used as ICD-10 “acute & transient psychotic
Used in DSM-4 “Psychotic disorders NOS”.
15. Neurotic v/s Psychotic
Many individuals with neurotic conditions have
Far from accepting their illness &
May minimise or deny it totally.
While people with schizophrenia may seek help willingly
during or before episodes of relapse.
Can be changed significantly by non-psychotic disorders such as
It may be intact in some people with psychotic disorders such as
persistent delusional disorder.
16. Modern classificatory systems
ICD -10- International Classification of Diseases–
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.
ICD 1 1900
ICD 2 1910
ICD 3 1921
ICD 4 1930
ICD 5 1939
ICD 6 1949
ICD 7 1958
ICD 8A 1968
ICD 9 1979
ICD 10 1999
ICD 11 2015
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
Clinical descriptions & diagnostic guidelines (CDDG)
Diagnostic criteria for research (DCR)
Primary Care version
Chapter 5, F category (mental disorder).
New alphanumeric format-more categories.
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
Axis II – 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 diagnosis…
22. ICD-10 v/s DSM IV
Different criteria for clinical
Not include social factors
Part of general classification
classification (F19, F25 etc..)
DSM IV: 1994
Includes social factors
Only mental disorders
(313.13, 256.21 etc..).
23. Diagnosis in ICD
F00-F09: Organic, including symptomatic, mental
F10--F19: Mental and behavioural disorders due to
psychoactive substance use.
F20-F29: Schizophrenia, schizotypal and delusional
F30-F39: Mood [affective] disorders.
F40-F48: Neurotic, stress-related and somatoform
24. Diagnosis in ICD
F50-F59: Behavioural syndromes associated with
physiological disturbances and physical factors.
F60-F69: Disorders of adult personality and
F70-F79: Mental retardation.
F80-F89: Disorders of psychological development.
F90-F98: Behavioural and emotional disorders with
onset usually occurring in childhood and
25. Categorical Dimensional/ Spectrum
Based on separate (but may be
overlapping) categories of
Termed as “Neo-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
Problem- limited practical value
in clinical practice where yes/no
decisions often need to be made.
Ex:- Bipolar spectrum, Autistic
spectrum disorders etc..