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Classification of the psychiatric illness
- 1. Classification ofClassification of Psychiatric illnessPsychiatric illness
- 2. Why do we need classification? • Diagnostic Criteria – Syndromes – Operational definitions • To share the knowledge about an illness (aetiology, course, prognosis, treatment options etc.) • Epidemiological purposes • Health Information Systems • Planning services • Research purposes
- 3. International classification in Psychiatry •ICD (International Classification of diseases) •DSM (Diagnostic and Statistical Manual of mental disorders)
- 4. Chapter V of ICD10 • F0 – Organic, including symptomatic mental disorders • F1 – Mental and behavioral disorders due to psychoactive substances • F2 – Schizophrenia, schizotypal and delusional disorders • F3 – Mood disorders • F4 – Neurotic, stress related and somatoform disorders • F5 – Behavioural pattern associated with psychological disturbances and physical illness • F6 – Disorders of adult personality and behaviours • F7 – Mental retardation • F8 – Disorders of psychological development • F9 - Behavioral and emotional disorders with onset during childhood and adolescence
- 7. Mental illness (Chap.V or F code) Acute Organic (F0, F1) Chronic Functional Others (F5, F6, F7, F8, F9) Psychosis (F2, F3) Neurosis(F4) (Minor Mental Health Disorders) Anxiety Depression Somatoform Disorders OCD PTSDSchizophrenia Bipolar
- 8. Differentiation of major mental illness Organic disorder • Clouding of consciousness • Disorientation • Memory disturbances • Known physical pathology • Positive physical & investigatory findings • Treat the underlying condition/s Functional disorder • Clear consciousness • Well oriented • No memory disturbance • No known organic pathology • Negative physical and investigatory findings • Treat the psychiatric conditions
- 9. Organic disorders Acute • Sudden onset • Short duration • Altered level of consciousness • Good prognosis if cause R, reversible • Prototype e.g.(Delirium, Post ictal confusion) Chronic • Insidious onset • Slow progression • Generally conscious • Memory disturbances • Poor Prognosis, irreversible • Prototype (e.g.Dementia)
- 10. Functional disorders Psychosis • Major Mental illness • Incomprehensible • Endogenous • Usually needs admission • Needs medication • Poor insight • Rehabilitation and long term care is needed in Scz • Eg: Schizophrenia, • Manic Depressive Disorder Neurosis • Minor mental illness • Comprehensible • Exogenous • Could be managed outside • Psychotherapy, relaxation • Good insight • Temporary- remove stress, some may need long term support • Eg: Anxiety, Reactive Depression, somatization
- 11. Other Conditions • Sexual problems • Child and adolescence problems • Personality disorders • Eating disorders • Sleep disorders • Mental Retardation
Editor's Notes
- This is a simplified model of a highly complex set of relationships between genotype and clinical phenotype. Starting at the level of genetic variation (lowest tier in figure), we have represented DNA structural variation (in purple) as contributing particularly to neurodevelopmental disorders and associated particularly with enduring cognitive and functional impairment. Single gene variants, of which there are many, are shown as asterisks. In general, even single base-pair changes in a gene may influence multiple biological systems because genes typically have multiple functions and produce proteins that interact with multiple other proteins. For simplicity, we have shown only an example of a variant that influences three biological systems (blue asterisk and arrows) and another that influences only one system (black asterisk and arrow). Variation in the relevant biological systems is influenced by genotype at many genetic loci and by environmental exposures/experiences both historically during development and currently to influence the dynamic state of the systems. The relevant biological systems influence the neural modules that comprise the key relevant functional elements of the brain (shown as solid turquoise circles). Typically, multiple biological systems influence each neural module. The (abnormal) functioning of the neural modules together influences the domains of psychopathology experienced and ultimately the clinical syndromes. We have ordered some important clinical syndromes along a single major axis with a gradient of decreasing proportional neurodevelopmental contribution to causation and reciprocal increasing gradient of proportion of episodic affective disturbance (we use the term ‘mental retardation’ in the diagram because it is understood internationally, but recognise that the terms intellectual disability and learning disability are commonly used in the UK). The single axis is a simplifying device – there is substantial individual variation and it is recognised that, for example, it is not uncommon for individuals diagnosed with autism to experience substantial mood pathology. GWAS- Genome-wide association studies
- Psychiatric disorders overlap and might be extremes of personality traits. Genetic vulnerabilities for psychiatric disorders are shown as emerging from the extreme end of normal population variations of personality, illustrated as different background shades of mood, anxiety, cognitive processing and volition. Volition, which was introduced by Kraepelin155, combines the will or the drive to do something with energy and activity level. Genetic factors affecting levels of these underlying traits, in interaction with additional genetic and environmental factors, can lead to psychiatric disorders — shown here are bipolar disorder, schizophrenia, depression and anxiety disorders — the symptoms and genetic risk factors of which are in part unique and in part overlapping. Psychosis and panic are pathological traits and are not a formal diagnostic category, but are associated with several psychiatric diagnoses. Because not all disorders can be covered in two dimensions, interactions and overlaps exist in many more dimensions than can be represented here (for example, depression and anxiety are also present in schizophrenia).
- F0 Dementias and other organic brain syndromes F1 Mental Disorders due to substance misuse F2 Schizophrenia and other non-affective psychosis F3 Affective Disorders F4 Neurotic, Stress-related and somatoform disorders F5 Disorders of eating, sleep and sexual functioning F6 Personality disorders F7 Mental Retardation F8 Disorders of psychological development F9 Behavioural and emotional disorders with onset in childhood and adolescence