Classification of Psychiatric Disorders

BIOPSYCHOSOCIAL MODEL DIAGNOSIS & CLASSIFICATION IN PSYCHIATRY

Etiology

• Nature
• Nurture

Investigations

• Lab test
• IQ Scales
• Social report

Manifestations & Diagnosis

• Signs, Symptoms & Diagnosis

Management Plan

• Drugs
• Psycho Intervention
• Social Intervention
• Spiritual Support

Types of Classification

1. Categorical Classification:

• Grouping disorders into separate entities according to symptom – pattern, course and outcome.

• It includes hierarchal categories:

  • Organic mental disorders then functional psychotic disorders (e.g. Schizophrenia) then neurotic disorder (e.g. generalized anxiety disorder) then personality disorders.

• Also it includes built-in hierarchy of significance within the disorders themselves.

  e.g.: Anxiety symptoms occur commonly with depressive disorder.

Psychiatric Disorders

• Organic
  (Body)
  Detectable bio. etiology.

  • Acute
    • Delirium
    • Wernicke’s
  • Chronic
    • Dementia
    • Korsakoff
  • Others
    • Alcohol …
    • Head Injury
    • Etc…

• Non-Organic
  (Mind) functional No detectable bio. etiology.
  Neurotransmitter’s disturbance.

  • Psychoses
    • Schizophrenia
    • Mood disorders
    • Etc…
  • Neuroses
    • Anxiety disorders
    • Adjustment dis.
    • Dysthymia
    • Dissociative dis.
  • Others
    • Personality dis.
    • Sleep disorder
    • Sex disorder
    • Etc…

Clues for Diagnostic Categories .. 6 Gates

Organic

• Organic
  • Dementia
    • Alzheimer’s type, vascular dementia, dementia due to a general medical condition, substance induced persisting dementia,
    • Delirium
• Drugs
  • Stimulants
  • Opioid
  • Cannabis
  • Alcohol
  • others

Psychosis

• .
  • Schizophrenia
  • Schizoaffective
    • Psychotic due to medical condition,
  • substance-induced psychotic
• Mood
  • Depressive dis
  • Bipolar disorder
  • dysthymia dis
  • cyclothymia dis
  • mood dis due to a general medical condition
  • Substance-induced mood disorder

Neurotic

• Anxiety, Stress
  • Anxiety dis
  • Stress related dis
  • Substance-related dis
• Personality
  • Custer A
  • Custer B
  • Custer C

Cues Suggestive of Organic Etiology

Disturbance of:

1. Consciousness
2. Cognitive Functions
   • a. Attention and concentration
   • b. Orientation: time, place & person
   • c. Memory: immediate, recent and remote
3. Vital Signs

Presence of:Z

1. Visual hallucinations
2. Neurological signs e.g. Dysarthria
3. Physical illness HTN, DM, …
4. Old age

delirium medical issue, due electrolyte, fever, sol’s, inflammation

Primary VS Secondary Psychiatric Disorders

Feature	Primary Psychiatric Disorders	Secondary Psychiatric Disorders
Etiology	Multi-factorial	One diagnosable systemic medical disease, CNS disease, or substance
Examples	- Schizophrenia	- Depression due to SLE
	- Major depressive disorder	- Psychosis due to amphetamine
In Medicine	Like Essential hypertension	Like secondary HTN due to renal artery stenosis
Clues Suggestive of Being
Primary	- Normal consciousness & vital signs	- Disturbance of consciousness or vital signs
	- Presence of:	- Presence of:
	1. Auditory hallucinations	1. Non-auditory hallucinations (e.g. visual)
	2. Soft neurological signs	2. Hard neurological signs
	3. Young age onset	3. Physical illness
		4. Old age onset

Broad Classification of Psychiatric Disorders

Feature	PSYCHOSIS	NEUROSIS…
Insight & Reality Testing	Impaired insight & reality testing	Intact insight & reality testing
Judgment	Impaired judgment	Good judgment
Quality of Symptoms	Abnormal quality of symptoms	Abnormal quantity of symptoms
Psychotic Features	Presence of active/positive psychotic features (e.g., delusions, hallucinations) and negative features (e.g., poverty of thoughts & speech, lack of ambition, initiation, and restricted affect)	No psychotic features
Examples	E.g., schizophrenia	E.g., anxiety disorders
Severity	Refers broadly to severe forms of mental disorders.	Generally less severe than psychosis.
Examples	1. Organic mental diseases	1. GAD (Generalized Anxiety Disorder)
	2. Schizophrenia	2. OCD (Obsessive-Compulsive Disorder)
	3. Affective disorders	3. Phobic disorders
		4. Panic disorder
Characteristics	Greater severity	Symptoms are closer to normal experience e.g., anxiety
	Lack of insight
	Patient’s inability to distinguish between subjective experience and reality e.g., hallucinations, delusions.

Positive Psychotic Features

Major disturbances in:

• A: Mood e.g., extreme euphoria.
• B: Behavior e.g., disorganized behavior.
• C: Thinking e.g., delusions, FOI.
• Perception e.g., hallucination.

Negative Features

• A: Restricted affect.
• B: Lack of ambition, initiation, & self-neglect.
• C: Poverty of thoughts & speech.
• Poor self-care & hygiene.

Summary

• Diagnosis in psychiatry is based mainly on clinical features.
• There are 2 main systems of classification; ICD & DSM.
• Multiaxial Record.
• Organic vs. Functional.
• Cues suggestive of organic mental disorder.
• Psychosis vs. Neurosis.
• Positive vs. Negative features.

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