The document discusses epidemiology and classification of mental disorders. It provides information on: 1. Epidemiology studies of mental disorders such as the National Comorbidity Survey and National Survey on Drug Use and Health. 2. Prevalence rates of common mental disorders such as depression, schizophrenia, alcohol dependence, and Alzheimer's disease. 3. Two major classification systems for mental disorders - ICD-10 published by the WHO and DSM-IV published by the American Psychiatric Association. Both systems categorize and define mental disorders.

1. Epidemiology and
classification mental
disorder
by
Burhan Hadi Alsultany

2. Epidemiology
The study of the incidence, prevalence, and distribution of a
disease in a population.
this means that epidemiology answers the questions who, what,
where, when, and “how much” ” for a particular disease.
The study of the distribution and determinants of
health and disease related states in populations,
and the application of this study to control health
problems. (John M. Last)
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3. TYPES EPIDEMIOLOGY STUDY
IN MENTAL DISORDER
• The National Comorbidity Survey (NCS) and the more recent National
Comorbidity Survey – Replication (NCS-R), funded by the National Institute
of Mental Health (NIMH)
• The National Survey on Drug Use and Health (NSDUH), funded by SAMHSA
• The National Epidemiologic Study on Alcohol and Related Conditions
(NESARC), funded by the National Institute on Alcohol Abuse and Alcoholism
(NIAAA) with supplemental support from the National Institute on Drug Abuse
(NIDA)
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4. Forms of Epidemiology
•Clinical Epidemiology
•Descriptive Epidemiology
•Predictive Epidemiology
•Etiologic Epidemiology
•Genetic Epidemiology
•Occupational Epidemiology
•Social Epidemiology
•Spatial Epidemiology
•Surveillance
etc…
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5. Epidemiology: Mental disorder
ADULTS: (UNDER 55)
20% of U.S. adults per year (44 million)
CHILDREN/ADOLESCENTS
20% of 9-17 years old per year (U.S. Surgeon General)
Schizophrenia
(above the age of 18): 45million
Depression: 340million
Both disorders cause
60% Suicide across the globe.
(Desjarlais R et al 1995 WORLD HEALTH REPORT, 2001)
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6. Mental Retardation 4.6%
(total psychiatric diagnoses)
Alcohol Dependence 140 million
(Nations for Mental Health, WHO, 2001)
Alzheimer’s disease: 11 million
Epilepsy: 45 million
(Murray L and Lopez A 1996)
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7. Prevalence (%) by Gender
NIMH Collaborative Psychiatric Epidemiology Surveys
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8. PREVALENCE OF PSYCHIATRIC DISORDERS
IN CHILDREN AND ADOLESCENTS
1. 6-month prevalence rates: 17-27%
• Most common: anxiety disorders
• Conduct and oppositional disorders
• Attention deficit and depressive disorders
2. 12-month prevalence of serious emotional disturbance
in 9-17 year olds: 9-13%
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9. MOOD DISORDERS
 11-14 years for depression and dysthymia
 Average length of depression episode is 7-9 months
ANXIETY DISORDERS
 Separation anxiety and specific phobias: 7-9 years
 Over anxious disorder: 10-13 years
 Social phobia: 15-16 years
 Panic disorder: 17-18 years
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10. Prevalence & Epidemiology
• 450 million people suffer from mental disorders
• Most common: mood disorders
•More women than men
•Development during youth
•Urban Areas = Rural Areas
•Different rates around the world
•Social factors (culture, language, etc)
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11. MENTAL DISORDER
A mental disorder or mental illness is a psychological or
behavioral pattern that occurs in an individual and is
thought to cause distress or disability that is not
expected as part of normal development or culture.
CLASSIFICATION OF MENTAL DISORDERS
Mental disorders are classified as either organic or functional.
• Organic: is caused by a physical illness or injury.
• Functional: has a psychological cause and does not involve brain
damage.
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12. THEREARE FIVE TYPES OF MENTAL DISORDER;
1.ANXIETY DISORDERS
◊ PHOBIA
◊ GENERALIZED ANXIETY DISORDER
◊ SOCIALANXIETY DISORDER
◊ PANIC DISORDER
◊ AGORAPHOBIA
◊ OBSESSIVE-COMPULSIVE DISORDER
◊ POST-TRAUMATIC STRESS DISORDER
2.MOOD & BIPOLAR DISORDERS
♂ MAJOR DEPRESSIVE DISORDER (ATYPICAL,
MELANCHOLIC, PSYCHOTIC, CATATONIC, POSTPARTUM,
SEASONALAFFECTIVE DISORDER)
♂ DYSTHYMIA
♂ DEPRESSIVE DISORDER NOT OTHERWISE SPECIFIED
♂ BIPOLAR DISORDER
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13. 3. PERSONALITYDISORDERS
ECCENTRIC/ODD:
♪ PARANOID PERSONALITYDISORDER
♪ SCHIZOID PERSONALITYDISORDER
♪ SCHIZOTYPALPERSONALITYDISORDER
DRAMATIC/EMOTIONAL:
‡ANTISOCIALPERSONALITYDISORDER
‡ BORDERLINE PERSONALITYDISORDER
‡ HISTRIONIC PERSONALITYDISORDER
‡ NARCISSISTIC PERSONALITYDISORDER
FEAR RELATED:
♪AVOIDANT PERSONALITYDISORDER
♪ DEPENDENT PERSONALITYDISORDER
♪ OBSESSIVE-COMPULSIVE PERSONALITYDISORDER
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14. 4. PSYCHOTIC DISORDERS
♫ SCHIZOPHRENIA
♫ DELUSIONAL DISORDER
♫ SCHIZOAFFECTIVE DISORDER
♫ SCHIZOTYPY
5. EATING DISORDERS
◘ ANOREXIA NERVOSA
◘ BULIMIA NERVOSA
◘ EXERCISE BULIMIAOR BINGE EATING
DISORDER
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15. MODERN MODELS OF MENTAL DISORDER
 Biological model- role of the nervous system in mental disorders.
Seeks to understand such disorders in terms of malfunctions in
portions of the brain, imbalance in various neurotransmitters and
genetic factors
 Psychological model emphasizes psychological factors in the
development of mental disorders; for instance many psychologists
believe that learning play a key role in many mental disorders .e.g.
learning phobias
 Sociocultural factors – emphasizes external factors such as negative
environments – poverty, homelessness, unemployment, inferior
education, prejudice as potential causes of some mental disorders.
 Diathesis-stress model – mental disorders result from a
predisposition for a given disorder (diathesis) and stressors in an
individual’s environment that tend to activate or stimulate the
predisposition.
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16. PSYCHOLOGICAL DISORDER FACTOR
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17. AETIOLOGY
 Genetics
 Biological Factors
 Psychological Factors
 Social Factors
PSYCHOLOGICAL FACTORS
Parental Deprivation
Relationship with Parents
Life Events
Effect of Physical illness
High Express Emotion
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18. CLASSIFICATION OF
MENTAL DISORDER
ICD 10 & DSM IV
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19. INTRODUCTION
Classification is a process by which complex phenomena are
organized into categories, classes or ranks so as bring together
those things that most resemble each other & to separate those
that differ.
Like any growing branch of medicine, psychiatric has been rapid
changes in classification to keep up growing research data
dealing with epidemiology, symptomatology, prognostic factors,
treatment methods & new theories for causation of psychiatric
disorder.
At present there are two major classification in psychiatry,
namely ICD 10 (1992) & DSM IV (1994).
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20. CLASSIFICATION IN MENTAL DISORDER
• severity severe / moderate / mild
depression
• characteristics paranoid / schizophrenia
• aetiology endogenous / exogenous
depression
• prognosis “treatment resistant”
personality disorders /
depression
• age young onset / older onset
dementia
• treatability personality disorders /
schizophrenia
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21. GOALS OF CLASSIFICATION
To enable mental health workers, public
health decision makers, statisticians and
professionals in disciplines relevant to
psychiatry:
– to understand one another
– to share results of research
– to improve and unify training strategies
– to allow all disciplines to record areas specific to
them as fully as they wish to
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22. (International Statistical Classification of
Disease & Related Health Problems)
ICD 10
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23. ICD 10 (INTERNATIONAL STATISTICAL
CLASSIFICATION OF DISEASE RELATED
HEALTH PROBLEMS)
This is WHO’s classification for all diseases & related health
problems.
The chapter ‘F’ classifies psychiatric disorder as mental &
behavioral disorders & codes them on an alphanumeric
system from F00 to F99.
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24. Translated to languages such as :
• Arabic
• Chinese
• English
• French
• German
• Japanese
• Portuguese
• Russian
• Spanish
– Translated into 30+ other languages
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25. Classification of diseases in the International
Classification of Diseases-10
I. Certain infectious and parasitic diseases
II. Neoplasms
III. Diseases of the blood and blood-forming organs, and the immune mechanism
IV. Endocrine, nutritional and metabolic diseases
V. Mental and behavioral disorders
VI. Diseases of the nervous system
VII. Diseases of the eye
VIII. Diseases of the ear
IX. Diseases of the circulatory system
X. Diseases of the respiratory system
XI. Diseases of the digestive system
XII. Diseases of the skin and subcutaneous tissue
XIII. Diseases of the musculoskeletal system
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26. XIV. Diseases of the genitourinary system
XV. Pregnancy, childbirth and the purperium
XVI. Certain conditions originating in the perinatal period
XVII. Congenital malformations and chromosomal abnormalities
XVIII. Symptoms, signs and abnormal clinical and laboratory findings, not
elsewhere classified
XIX. Injury, poisoning and certain other consequences of external causes
XX. External causes of morbidity and mortality
XXI. Factors influencing health status and contact with health services
XXII. Codes for special purposes (e.g. diseases of uncertain etiology)
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27. THE MAIN CATEGORIES IN ICD 10 CHAPTER V:.
F00 – F09 ORGANIC, INCLUDING SYMPTOMATIC, MENTAL DISORDERS
F00 – Dementia in Alzheimer’s disease
F01 – Vascular dementia
F04 – Organic amnestic syndrome
F05 – Delirium
F06 – Other mental disorders due to brain damage & dysfunction & to physical disease
F07 – Personality & behavioral disorders due to brain disease, damage & dysfunction
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28. F10 – F19 MENTAL & BEHAVIORAL DISORDERS DUE TO
PSYCHOACTIVE SUBSTANCE USE
F10 – Mental & behavioral disorders due to use of alcohol
F11 - Mental & behavioral disorders due to use of opioids
F12 – Mental & behavioral disorders due to use of cannabinoids
F13 – Mental & behavioral disorders due to use of sedatives &
hypnotics
F14 – Mental & behavioral disorders due to use of cocaine
F16 – Mental & behavioral disorders due to use of hallucinogens
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29. F20 – F29 SCHIZOPHRENIA, SCHIZOTYPAL &
DELUSIONAL DISORDERS
F20 – Schizophrenia
F20.0 – Paranoid Schizophrenia
F20.1 – Hebephrenic Schizophrenia
F20.2 – Catatonic Schizophrenia
F20.3 – Undifferentiated Schizophrenia
F20.4 – Post-schizophrenia depression
F20.5 – Residual Schizophrenia
F20.6 – Simple Schizophrenia
F21 – Schizotypal disorder
F22 – Persistent delusional disorders
F23 – Acute & Transient psychotic disorders
F24 – Induced Delusional disorders
F25 – Schizoaffective disorders
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30. F30 – F39 MOOD (AFFECTIVE) DISORDERS
F30 – Manic episode
F31 – Bipolar affective disorder
F32 – Depressive episode
F33 – Recurrent depressive disorder
F34 – Persistent mood disorder
F40 – F49 NEUROTIC, STRESS-RAPID &
SOMATO-FORM DISORDERS
F40 – Phobic anxiety disorders
F41 – Other anxiety disorders
F42 – Obsessive – Compulsive disorder
F43 – Reaction severe stress & adjustment disorders
F44 – Disociative (Conversion) disorders
F45 – Somatoform disorders
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31. F50 – F59 BEHAVIORAL SYNDROMES ASSOCIATED WITH
PHYSIOLOGICAL DISTURBANCES & PHYSICAL FACTORS
F50 – Eating Disorders
F51 – Non-organic sleep disorders
F52 – Sexual dysfunction
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32. F60 – F69 DISORDERS OF ADULT PERSONALITY & BEHAVIOR
F60 – Specific personality disorders
F60.0 – Paranoid personality disorders
F60.1 – Schizoid personality disorders
F60.2 – Dissocial personality disorders
F60.3 – Emotionally unstable personality disorder
F60.4 – Histrionic personality disorders
F60.5 – Anankastic personality disorders
F60.6 – Anxious personality disorders
F60.7 – Dependent personality disorders
F61 – Mixed & other personality disorders
F62 – Enduring personality changes, not attributable to brain damage & disease
F63 – Habit & impulse disorders
F64 – Gender identity disorders
F65 – Disorders of sexual preference
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33. F70 – F79 MENTAL RETARDATION
F70 – Mild Mental Retardation
F71 – Moderate Mental Retardation
F72 – Severe Mental Retardation
F73 – Profound Mental Retardation
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34. F80 – F89 DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
F80 – Specific developmental disorders of speech & language
F81 – Specific developmental disorders of scholastic skills
F82 – Specific developmental disorders of motor function
F83 – Mixed specific developmental disorders
F84 – Pervasive developmental disorders
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35. F90 – F98 BEHAVIORAL & EMOTIONAL DISORDERS WITH
ONSET USUALLY OCCURRING IN CHILDHOOD &
ADOLESCENCE
F90 – Hyperkinetic disorders
F91 – Conduct disorders
F93 – Emotional disorders with onset specific to childhood
F94 – Disorders of social functioning with onset specific to
childhood & adolescence
F95 – Tic Disorders
F98 – Other behavioral & emotional disorders with onset
usually occurring in childhood & adolescence
F99 – UNSPECIFIED MENTAL DISORDERS
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36. DSM IV
(DIAGNOSTIC & STATISTICAL MANUAL IV)
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37. DSM IV (DIAGNOSTIC & STATISTICAL MANUAL)
This is the classification of mental disorders by the
American Psychiatric Association (APA). The
pattern adopted by DSM IV is of Multiaxial
systems.
A multiaxial system that evaluates patients along
several versatile contains Five axes. Axis I & II
make up the entire classification which contains
more than 300 specific disorders.
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38. DSM-IV CLASSIFICATION.
1. Disorders usually first diagnosed in infancy ,childhood or adolescence
2. Delirium, Dementia & amnestic, & other cognitive disorders
3. Mental disorders due to a general medical condition
4. Substance related disorders
5. Schizophrenia & other psychotic disorders
6. Mood disorders
7. Anxiety disorders
8. Somatoform disorders
9.Factitious disorders
10.Dissociative disorders
11.Sexual & Gender identity disorders
12.Eating disorders
13.Sleep disorders
14.Impulse control disorders not elsewhere classified
15.Adjustment disorders
16.Personality disorders
17.Other conditions that may be a focus of clinical attention
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39. DSM-IV
THE FIVE AXES OF THE DSM-IV.
Axis I Clinical syndromes. (All mental disorders & criteria for
rating them except personality disorders/mental retardation, also
abuse/neglect)
Axis II Personality disorders, Mental retardation. (Life long deeply
ingrained, inflexible & maladaptive)
Axis III General medical condition. (Any medical condition that
could effect the patients mental state.)
Axis IV Psychosocial & environmental problems. (Stressful events
that have occurred within the previous year)
Axis V global assessment functioning. (How well the patient
performed during the previous year)
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40. DSM-IV & ICD-10.
• DSM-IV
• Larger no. of
discrete categories.
• Uses a multi-axial
system.
• Uses term psychotic.
• Published by APA
• ICD-10
• More general
categories.
• Generally single axis.
But uses broad aetiology.
Uses term neurotic.
• Published by WHO
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