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Classificatory system
in Psychiatry
Dr.Sujit Kumar Kar, MD (Psy)
Lecturer
Department of Psychiatry
King George’s Medical University
Lucknow, U.P
Nosology
Science
of
diagnosis
Diagnosis
• What is diagnosis?
– A complex, but highly essential concept
• Why essential?
1. Facilitates clinical communication
2. Important for the patient
3. Important for the researchers for developing
tools & illness models
4. Important for the physician to plan treatment
5. Helps in choosing choice of treatment
Diagnosis needs
Reliabilit
y !
Validity !
Diagnostic validity!
The Washington
University group
proposed
“Research
Diagnostic
Criteria” for
diagnostic
validity……. All
diagnoses should
be based on
• Precise clinical
description
• Laboratory studies
identifying biological
markers
• Clear delineation from
other disorders
• A characteristic
outcome in follow-up
studies
• Genetic pattern in
family history studies
Disease
Disorder
Syndrome
Illness
ICD
DSM
DSM-5 – 2013
DSM-IV TR – 2000
DSM-IV – 1994
DSM-III R – 1987
DSM-III – 1974
DSM-II – 1968
DSM-I – 1952
•106
disorders, 130
pages
DSM-I – 1952
•182
disorders, 134
pages
DSM-II – 1968
•265 disorder
categories,
494 pages
DSM-III – 1974
•292
disorders, 567
pages
DSM-III R –
1987 •297
disorders, 886
pages
DSM-IV – 1994
DSM-IV TR –
2000
DSM-5 – 2013
DSM-I – 1952
Based on psychoanalytic
concepts of Freud
DSM-II – 1968
Based on psychoanalytic
concepts of Freud
DSM-III – 1974 Neo-Krepelinian concept
DSM-III R – 1987 Neo-Krepelinian concept
DSM-IV – 1994
DSM-IV TR – 2000
DSM-5 – 2013
DSM-I – 1952
DSM-II – 1968
• Robert SpitzerDSM-III – 1974
• Robert SpitzerDSM-III R – 1987
• Allen FrancesDSM-IV – 1994
• Allen FrancesDSM-IV TR – 2000
• David Kufer, Darrel RegierDSM-5 – 2013
Highlights of DSM-5
• Chapters
– Chapter -1: History of psychiatry diagnosis
– Chapter-2: How diagnostic manuals are prepared?
– Chapter-3: How diagnoses are validated?
– Chapter-4: How mental disorders can be separated from
normality?
– Chapter-5: How dimensional assessment could be used?
– Chapter-6: Examines the clinical utility.
– Chapter-7 – 14: Description about frequently used
diagnoses
– Chapter-15: Future of psychiatric diagnoses
Highlights of DSM-5
• Categorization of common clinical features that fits into a
spectrum
• Elimination of multi-axial system
• Personality disorders recognized along with other illness
categories
• Elimination of Axis – V, GAF can be rated on the basis of
disorder severity
• Criteria for GAD, ADHD has been expanded (may lead to
more frequent diagnosis)
• In MDD, grief is no more an exclusion
• “Addiction” term is reintroduced in SUD category
• Overtly aggressive children – Disruptive mood regulation
disorder
ICD
International
Classification of Diseases
•Introduced in 1893
•Mental illnesses were
introduced in ICD-6 in 1949
Chapter V
(F)
F00 to F99
Numbering
system
Diagnosis
• Provisional
• Tentative
• Final
ICD-10
Introduced in 1992 – 93
DCR – Diagnostic Criteria for
Research (Green Book)
CDDG – Clinical Description and
Diagnostic Guidelines (Blue Book)
Classificatory system in psychiatry

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Classificatory system in psychiatry

  • 1. Classificatory system in Psychiatry Dr.Sujit Kumar Kar, MD (Psy) Lecturer Department of Psychiatry King George’s Medical University Lucknow, U.P
  • 3. Diagnosis • What is diagnosis? – A complex, but highly essential concept • Why essential? 1. Facilitates clinical communication 2. Important for the patient 3. Important for the researchers for developing tools & illness models 4. Important for the physician to plan treatment 5. Helps in choosing choice of treatment
  • 5. Diagnostic validity! The Washington University group proposed “Research Diagnostic Criteria” for diagnostic validity……. All diagnoses should be based on • Precise clinical description • Laboratory studies identifying biological markers • Clear delineation from other disorders • A characteristic outcome in follow-up studies • Genetic pattern in family history studies
  • 8. DSM-5 – 2013 DSM-IV TR – 2000 DSM-IV – 1994 DSM-III R – 1987 DSM-III – 1974 DSM-II – 1968 DSM-I – 1952
  • 9. •106 disorders, 130 pages DSM-I – 1952 •182 disorders, 134 pages DSM-II – 1968 •265 disorder categories, 494 pages DSM-III – 1974 •292 disorders, 567 pages DSM-III R – 1987 •297 disorders, 886 pages DSM-IV – 1994 DSM-IV TR – 2000 DSM-5 – 2013
  • 10. DSM-I – 1952 Based on psychoanalytic concepts of Freud DSM-II – 1968 Based on psychoanalytic concepts of Freud DSM-III – 1974 Neo-Krepelinian concept DSM-III R – 1987 Neo-Krepelinian concept DSM-IV – 1994 DSM-IV TR – 2000 DSM-5 – 2013
  • 11. DSM-I – 1952 DSM-II – 1968 • Robert SpitzerDSM-III – 1974 • Robert SpitzerDSM-III R – 1987 • Allen FrancesDSM-IV – 1994 • Allen FrancesDSM-IV TR – 2000 • David Kufer, Darrel RegierDSM-5 – 2013
  • 12. Highlights of DSM-5 • Chapters – Chapter -1: History of psychiatry diagnosis – Chapter-2: How diagnostic manuals are prepared? – Chapter-3: How diagnoses are validated? – Chapter-4: How mental disorders can be separated from normality? – Chapter-5: How dimensional assessment could be used? – Chapter-6: Examines the clinical utility. – Chapter-7 – 14: Description about frequently used diagnoses – Chapter-15: Future of psychiatric diagnoses
  • 13. Highlights of DSM-5 • Categorization of common clinical features that fits into a spectrum • Elimination of multi-axial system • Personality disorders recognized along with other illness categories • Elimination of Axis – V, GAF can be rated on the basis of disorder severity • Criteria for GAD, ADHD has been expanded (may lead to more frequent diagnosis) • In MDD, grief is no more an exclusion • “Addiction” term is reintroduced in SUD category • Overtly aggressive children – Disruptive mood regulation disorder
  • 14. ICD International Classification of Diseases •Introduced in 1893 •Mental illnesses were introduced in ICD-6 in 1949
  • 15. Chapter V (F) F00 to F99 Numbering system
  • 17. ICD-10 Introduced in 1992 – 93 DCR – Diagnostic Criteria for Research (Green Book) CDDG – Clinical Description and Diagnostic Guidelines (Blue Book)