DIAGNOSIS IN PSYCHIATRY
- Depends mainly on signs & symptoms (psychopathology).
- Rarely we use external validation; lab tests, brain imaging, …
- Clinical skills are essential.
1. Dimensional Classification
- Diagnosing individual patients by giving scores on separate dimensions.
- e.g. Psychoticism, neuroticism, introversion and extroversion
2. Multiaxial Approach
- Applied to schemes of classifications in which two or more separate sets of information are coded
- e.g. DSM, ICD
DSM-IV
Diagnostic and Statistical Manual of Mental Disorders
- Published in 2013 by the American Psychiatric Association (APA),
- The official psychiatric coding system used in the United States.
- The first edition (DSM-I) appeared in 1952.
- Neurodevelopmental Disorders
- Schizophrenia Spectrum and Other Psychotic Disorders
- Bipolar and Related Disorders
- Depressive Disorders
- Anxiety Disorders
- Obsessive-Compulsive and Related Disorders
- Trauma and Stressor Related Disorders
- Dissociative Disorders
- Somatic Symptom Disorders
- Feeding and Eating Disorders
- Elimination Disorders
- Sleep-Wake Disorders
- Sexual Dysfunctions
- Gender Dysphoria
- Disruptive, Impulse Control, and Conduct Disorders
- Substance Use and Addictive Disorders (including gambling)
- Neurocognitive Disorders
- Personality Disorders
- Paraphilic Disorders
The number of total disorders in DSM-5 has not increased significantly, but some disorders have now had their importance recognized by being allocated separate chapter headings (e.g., Obsessive Compulsive Disorder). The chapter on Neurodevelopmental Disorders is a new heading containing autism spectrum disorders, intellectual development disorder, and attention/hyperactivity disorder (ADHD). The chapter on Substance Use & Addictive Behaviours will now include gambling disorder. The importance of both Bipolar Disorder and Depressive Disorders is recognized by them being allocated to separate chapters.
Multi Axial System
- Axis I: Psychiatric Diagnosis (Mood disorder due to hypothyroidism, with depressive features)
- Axis II: Personality disorders (No diagnosis / Histrionic personality features)
- Axis III: General Medical Conditions (Hypothyroidism)
- Axis IV: Psychosocial and Environmental Problems (Stresses): Familial / Educational
- Axis V: Global assessment of functioning (GAF): GAF = 45 (on admission)
PSYCHIATRY REFERENCES
-
Diagnostic and Statistical Manual of Mental Disorders.
- 5th Edition, Latest edition.
- American Psychiatric Association.
-
The ICD-10 Classification of Mental and Behavioral Disorders:
- Clinical Descriptions and Diagnostic Guidelines
- Edition by: WHO