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Diagnosis & Classification of Mental Disorders

Diagnosis & Classification of Mental Disorders. Diagnosis: Mental disorders. Considerations when assessing psychiatric symptoms: Is there a mental illness and if so what is it?. Diagnosis: Mental disorders. ‘mental disorder’? Abnormalities of mood, emotion, cognition, behaviour

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Diagnosis & Classification of Mental Disorders

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  1. Diagnosis & Classification of Mental Disorders

  2. Diagnosis: Mental disorders • Considerations when assessing psychiatric symptoms: • Is there a mental illness and if so what is it?

  3. Diagnosis: Mental disorders • ‘mental disorder’? • Abnormalities of mood, emotion, cognition, behaviour • Signs and symptoms are on continuum, there’s no clear division between health and illness • Manifestations vary age, gender, race

  4. Diagnosis: Mental disorders • Threshold for illness/disorder set by convention • diagnosis linked to the definition of mental illness – difficult to define and operationalise

  5. Diagnosis: Mental disorders • No definitive lesion, laboratory test or abnormality of the brain tissues • Dependent on patient & family reports of intensity and duration of symptoms • Signs from clinician’s mental state assessment and observation of behaviour

  6. Diagnosis: Mental disorders • These cues are grouped together by the clinician into recognisable patterns or syndromes • When a syndrome meets all the criteria for a diagnosis, it constitutes a mental disorder

  7. Diagnosis: Mental disorders • Manifestations of mental disorders do not fall into distinct categories • Categories are broad and overlapping • Any particular patient may manifest symptoms from more than one category

  8. Diagnosis: Mental disorders • Mental illness is heterogeneous- ever changing and difficult to characterise • Current psychiatric classifications are imprecise requiring a constellation of clinical features to define them

  9. Diagnostic reliability • Diagnostic reliability challenged in 1960s – psychiatrist (Szasz 1960/1) plus classic study Rosenhan (1973) • Several studies showed low diagnostic reliability

  10. The reliability of psychiatric diagnosis was limited by the lack of widely accepted and standardized diagnostic criteria • The DSM (APA) and ICD (WHO) were developed to achieved greater objectivity, diagnostic precision and reliability

  11. Diagnostic and Statistical Manual of Mental Disorders (DSM) • DSM 1 – 1952, DSM 11 -1968 • Symptoms were not specified for specific disorders • Causes were associated with subconscious conflicts or maladaptive reactions to life problems • Focus was the differentiation of neurosis and psychosis

  12. DSM • DSM 111 (1980) – Focus how to identify psychiatric disorders in clinical practice on the basis of psychopathology • DSM III-R (1987), DSM-IV (1994), DSM-IV-R (2000) • DSM –V (2013)

  13. Structure of DSM-IV • The DSM-IV organizes each psychiatric diagnosis into five levels (axes) • Axis I: clinical disorders, including major mental disorders, as well as developmental and learning disorders • Axis II: underlying pervasive or personality conditions, as well as mental retardation

  14. Structure of DSM-IV • Axis III: Acute medical conditions and Physical disorders. • Axis IV: psychosocial and environmental factors contributing to the disorder • Axis V: Global assessment of functioning

  15. Structure of DSM-IV • Axis 1 organises mental disorders into 16 major diagnostic classes • For each disorder a specific criteria is set out for making the diagnosis

  16. Structure of DSM-IV • For most disorders symptoms must be sufficient to cause • “clinically significant distress or impairment in social, occupational, or other important areas of functioning“

  17. DSM- 5

  18. International Classification of Diseases (ICD) • ICD-10 came into use in WHO Member States 1994. • This is the latest in a series which has its origins in the 1850s.

  19. ICD-10 • Since the 1990s, the APA and WHO have worked to bring the DSM and the relevant sections of ICD into concordance, but some differences remain

  20. Critique of DSM • Compilation exclusively by US psychiatrists • Continuing debate about validity and reliability • Relationship of DSM authors with drug companies

  21. Critique of DSM • increase in categories driven by financial incentives – capitalise on a best seller • Increased medicalization of normal behaviour • DSM perpetuating the deficiencies of previous classifications – not working towards a more scientific system

  22. Consclusion • Diagnosis rests on clinician judgement about whether symptoms and impairment of functioning meets diagnostic criteria • Cultural/Class differences in emotional expression and social behaviour can be misinterpreted as impairment • Clinicians must be sensitive to the context and meaning of exhibited symptoms

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