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Classification in Psychiatry

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Richard Duffy

on 7 March 2014

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Transcript of Classification in Psychiatry


Psychosis: severe mental disorder, lack of insight, inability to distinguish between subjective experience and reality - delusions and hallucinations

Neurosis: less severe mental disorder, closer to normal experience
Neurosis and Psychosis
Enable clinicians to communicate with one another
Enable research to be conducted with comparable groups of patients
Enable planning of services
Treatment standardised
Need for classification
The term illness is used loosely in everyday speech

It is important to have a good definition of mental illness for ethical and legal reasons
Compulsory admission/treatment
Forensic psychiatry-criminal responsibility
What is Mental Illness?
APA

Precise operational criteria

Multi-axial
I Clinical syndrome
II Personality disorder/ Learning Disability
III Physical conditions
IV Psychosocial stressors
V Adaptive functioning
DSM IV
WHO

Designed for use in different cultures

Descriptive statements
ICD 10
Discriminating symptoms: occur in the defined condition but seldom in other conditions

Characteristic symptoms: occur frequently in the defined condition but also occur in other conditions

Operational definitions: specification of a category by a series of precise inclusion and exclusion statements- ICD 10 and DSM IV
Diagnostic Criteria


Many patients do not fall neatly into categories
Allows a deeper understanding of a patients problems
Can give a greater meaning ot a diagnosis
Dimensional
Classification
Discrete entities
Binary outcomes
Useful for treatment, prognosis and research
ICD-10, DSM IV
Categorical
Classification

Distracts from the understanding of unique personal difficulties
Labeling may increase a persons difficulties - attract stigma
Narrows the focus of the clinician and can only focus on diagnosis
Problems with
classification
Consequences of illness or disorder

Impairment: pathological deficit

Disability: stable persistent limitation of function which results from impairment and the individuals psychological reaction to it

Handicap: social dysfunction
Impairment,
disability
and handicap
Mental illness should not be defined in terms of socially deviant behaviour

The term “sick” is often misused if a person commits a particularly cruel murder or grossly abnormal sexual act

Behaviours are appraised differently in different countries and at different times-homosexuality is no longer listed as a mental disorder in DSM-IV
Illness and socially
deviant behaviour
Absence of health
Suffering
Pathological process
May result in incapacity
Illness
The term mental disorder is often used instead of mental illness- WHO, APA
However both are used legally in Ireland
Mental Disorder
‘A state of mind of a person that affects the person’s thinking, perceiving, emotion or judgment and seriously impairs the mental function of the person to the extent that he or she requires care or medical treatment in his or her own interest or in the interest of other persons’.
MHA 2001
Classification in Psychiatry
Dr Richard Duffy, MRCPsych
Special lecturer

Mental
illness

Neurotic/
Psychotic

Categorical
Vs.
Dimensional

"Borderline" Personality disorder
Pseudo-psychotic features in times of extreme stress
ICD-10 and DSM-IV
Neurotic
Psychotic
Vs.
Dimensional
Categorical
International Pilot Study into Schizophrenia (IPSS) (WHO 1973)
Similar symptoms but wide geographical difference in diagnosis.
E.g. Rates of schizophrenia was much higher in New York and Moscow then London despite patients having similar symptoms.
Rosenhan Experiment: “On being sane in insane places” Science 179 (4070) 250-8.
Psuedopatients who presented to psychiatric hospitals pretending to have auditory hallucinations.
Great variety in how psuedopatients were treated
F00: Organic mental disorders (eg. dementia)
F10: Psychoactive substance usage
F20: Psychotic disorders (Schizophrenia)
F30: Affective Disorders (depression/bipolar disorder)
F40: Neurotic disorders (anxiety related)
F50: Behavioural syndromes associated with physiological disturbances (eating disorders)
F60: Behavioural syndromes not associated with physiological disturbances (personality disorders)
F70: Mental Retardation
F80: Disorders of psychological development
F90: Behavioural and Emotional problems usually developed in childhood.
Historical reason for classification
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