The dsmiv and_icd10_classification_systems_(background)

THE DSM AND ICD THE DSM AND ICD PSYCHIATRIC PSYCHIATRIC

CLASSIFICATION SYSTEMSCLASSIFICATION SYSTEMS

FACILITATES CHARACTERIZATION, FACILITATES CHARACTERIZATION, COMMUNICATION AND RESEARCH COMMUNICATION AND RESEARCH

COMPLEXITY OF PHENOMENA ARE COMPLEXITY OF PHENOMENA ARE REDUCEDREDUCED

TWO VIEWS:TWO VIEWS:

DIMENSIONALIZERS – DIMENSIONS OF DIMENSIONALIZERS – DIMENSIONS OF FUNCTIONING,DIFFERENT FUNCTIONING,DIFFERENT PSYCHIATRIC D/OPSYCHIATRIC D/O

CATEGORIZERS – SPECIFIC GROUPS CATEGORIZERS – SPECIFIC GROUPS OF SYMPTOMS – REFLECT OF SYMPTOMS – REFLECT PSYCHIATRIC SYNDROMESPSYCHIATRIC SYNDROMES

IMPORTANCE OF CLASSIFICATION FOR IMPORTANCE OF CLASSIFICATION FOR PSYCHIATRIC DIAGNOSISPSYCHIATRIC DIAGNOSIS

DISTINGUISH BET DIFF PSYCHIATRIC DISTINGUISH BET DIFF PSYCHIATRIC DIAGNOSISDIAGNOSIS

COMMON LANGUAGE AMONGST HEALTH COMMON LANGUAGE AMONGST HEALTH PROFESSIONALS ENSURES PROFESSIONALS ENSURES RELIABILITY,COMMUNICATION AND RELIABILITY,COMMUNICATION AND STATISTICAL REPORTINGSTATISTICAL REPORTING

EFFECTIVE TREATMENTEFFECTIVE TREATMENT

STANDARD FRAME OF REFERENCESTANDARD FRAME OF REFERENCE

TEACHING-INTERNATIONAL REFERENCE TEACHING-INTERNATIONAL REFERENCE SYSTEMSSYSTEMS

IMPORTANCE OF CLASSIFICATION IMPORTANCE OF CLASSIFICATION CONT.CONT.

PUBLIC ACESS – IMPROVES COMMUNICATIONPUBLIC ACESS – IMPROVES COMMUNICATION

IMPROVES RELIABILITY OF PSYCHIATRIC IMPROVES RELIABILITY OF PSYCHIATRIC DIAGNOSIS IN RESEARCH SETTINGSDIAGNOSIS IN RESEARCH SETTINGS

UNDERSTANDING OF CAUSES AND UNDERSTANDING OF CAUSES AND PROCESSES OF MENTAL DISORDERSPROCESSES OF MENTAL DISORDERS

TWO MOST ACCEPTED PSYCHIATRIC TWO MOST ACCEPTED PSYCHIATRIC CLASSIFICATIONSCLASSIFICATIONS

DIAGNOSTIC AND STATISTICAL DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS MANUAL OF MENTAL DISORDERS (DSM IV TR)(DSM IV TR)

INTERNATIONAL CLASSIFICATION OF INTERNATIONAL CLASSIFICATION OF DISEASES (ICD 10)DISEASES (ICD 10)

CLINICAL DESCRIPTIONS BASED ON CLINICAL DESCRIPTIONS BASED ON PHENOMENOLOGICAL APPROACHESPHENOMENOLOGICAL APPROACHES

DSMDSM

CATEGORICAL CLASSIFICATIONCATEGORICAL CLASSIFICATION

DIVIDES MENTAL DISORDERSDIVIDES MENTAL DISORDERS

CRITERIA SETS – DEFINING FEATURESCRITERIA SETS – DEFINING FEATURES

HISTORY AND BACKGROUNDHISTORY AND BACKGROUND

FIRST DSM – AMERICAN PSYCHIATRIC FIRST DSM – AMERICAN PSYCHIATRIC ASSOCIATION COMMITTEEASSOCIATION COMMITTEEDSM II – 1968DSM II – 1968DSM III – 1980DSM III – 1980REVISED DSM III – 1987REVISED DSM III – 1987DSM III-R – 1987DSM III-R – 1987DSM IV – 1994DSM IV – 1994DSM-IV-TR – 2000DSM-IV-TR – 2000


WHO – ICD-6WHO – ICD-6

SECTION ON MENTAL DISORDERSSECTION ON MENTAL DISORDERS

APA – VARIANT OF ICD-6APA – VARIANT OF ICD-6

DSM-1 – FIRST OFFICIAL MANUAL OF DSM-1 – FIRST OFFICIAL MANUAL OF CLINICAL MENTAL DISORDERSCLINICAL MENTAL DISORDERS

PSYCHOBIOLOGICAL VIEWPSYCHOBIOLOGICAL VIEW


DSM-II CORRELATED WITH ICD-8DSM-II CORRELATED WITH ICD-8

DSM-III CORRELATED WITH 1CD-9DSM-III CORRELATED WITH 1CD-9

DSM-IIIDSM-III– EXPLICIT DIAGNOSTIC CRITERIAEXPLICIT DIAGNOSTIC CRITERIA– MULTI-AXIAL SYSTEMMULTI-AXIAL SYSTEM– DESCRIPTIVE MEDICAL DESCRIPTIVE MEDICAL

NOMENCLATURENOMENCLATURE


DSM-III-R – EMPIRICAL RESEARCHDSM-III-R – EMPIRICAL RESEARCH

DSM-IV – SYSTEMATIC REVIEWS AND DSM-IV – SYSTEMATIC REVIEWS AND FOCUSED FIELD TRIALSFOCUSED FIELD TRIALS

GOAL – INCREASE PRACTICALITY AND GOAL – INCREASE PRACTICALITY AND CLINICAL UTILITYCLINICAL UTILITY

DSM IV-TR – NOS CATEGORYDSM IV-TR – NOS CATEGORY

DSM IV-TRDSM IV-TR

OFFICIAL CODING SYSTEM IN USAOFFICIAL CODING SYSTEM IN USA

ATHEORETICAL APPROACH TO CAUSESATHEORETICAL APPROACH TO CAUSES

DESCRIBES MANIFESTATIONS AND DESCRIBES MANIFESTATIONS AND DESCRIPTIONS OF CLINICAL FEATURES OF DESCRIPTIONS OF CLINICAL FEATURES OF MENTAL D/OMENTAL D/O

SPECIFIC DIAGNOSTIC CRITERIASPECIFIC DIAGNOSTIC CRITERIA

CRITERIA INCREASE RELIABILITYCRITERIA INCREASE RELIABILITY

DSM IV-TRDSM IV-TRSYSTEMATIC DESCRIPTIONS:SYSTEMATIC DESCRIPTIONS:

AGEAGECULTURECULTUREGENDER FEATURESGENDER FEATURESPREVALENCE, INCIDENCEPREVALENCE, INCIDENCERISK , COURSERISK , COURSECOMPLICATIONSCOMPLICATIONSPREDISPOSING FACTORSPREDISPOSING FACTORSFAMILIAL PATTERNSFAMILIAL PATTERNSDIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSISLAB FINDINGSLAB FINDINGSPHYSICAL EXAMINATION SIGNS AND SYMPTOMSPHYSICAL EXAMINATION SIGNS AND SYMPTOMS

DSM IV-TRDSM IV-TR

365 DISORDERS365 DISORDERS

17 SECTIONS17 SECTIONS

PROPOSED DIAGNOSTIC CRITERIAPROPOSED DIAGNOSTIC CRITERIA

DSM IV-TR ORGANIZATIONAL DSM IV-TR ORGANIZATIONAL PLANPLAN

16 MAJOR DIAGNOSTIC CLASSES16 MAJOR DIAGNOSTIC CLASSESOTHER CONDITIONS THAT MAY BE FOCUS OTHER CONDITIONS THAT MAY BE FOCUS OF CLINICAL ATTENTIONOF CLINICAL ATTENTION11 APPENDICES11 APPENDICES

DIFFERENTIAL DXDIFFERENTIAL DXGLOSSARYGLOSSARYCHANGES IN DSM-IV-TRCHANGES IN DSM-IV-TRCLASSIFICATION WITH ICD-10CLASSIFICATION WITH ICD-10CULTURAL FORMULATION, ETCCULTURAL FORMULATION, ETC

AIMS OF DSM IV-TRAIMS OF DSM IV-TR

CLEAR DIAGNOSTIC CATEGORIESCLEAR DIAGNOSTIC CATEGORIES

DX, COMMUNICATION, STUDY AND TREATDX, COMMUNICATION, STUDY AND TREAT

DIAGNOSTIC CRITERIA FOR RESEARCH PURPOSESDIAGNOSTIC CRITERIA FOR RESEARCH PURPOSES

RECORD KEEPING, DATA COLLECTIONRECORD KEEPING, DATA COLLECTION

REPORTING TO 3REPORTING TO 3RDRD PARTIES – GOVN, PRIVATE PARTIES – GOVN, PRIVATE INSURERSINSURERS

SUBTYPESSUBTYPES

SPECIFIERSSPECIFIERS

INCREASED SPECIFICITYINCREASED SPECIFICITY

AIMS OF DSM IV-TRAIMS OF DSM IV-TR

CLINICAL DECISIONSCLINICAL DECISIONS

RX SETTINGRX SETTING

MODE OF RXMODE OF RX

DURATION OF RXDURATION OF RX

SEVERITY AND COURSE SEVERITY AND COURSE SPECIFIERSSPECIFIERS

MILD, MODERATE, SEVERE ONLY WHEN MILD, MODERATE, SEVERE ONLY WHEN FULL CRITERIA METFULL CRITERIA MET

INTENSITY OF S AND SINTENSITY OF S AND S

IMPAIRMENT IN OCCUPATIONAL AND IMPAIRMENT IN OCCUPATIONAL AND FUNCTIONAL IMPAIRMENTFUNCTIONAL IMPAIRMENT

MRMR

CONDUCT D/OCONDUCT D/O

MANIC EPISODEMANIC EPISODE

MAJOR DEPRESSIVE EPISODEMAJOR DEPRESSIVE EPISODE

SEVERITY AND COURSE SEVERITY AND COURSE SPECIFIERSSPECIFIERS

PARTIAL REMISSION – FULL CRITERIA PREVIOUSLY PARTIAL REMISSION – FULL CRITERIA PREVIOUSLY METMET

FULL REMISSION – NO LONGER S AND S, STILL FULL REMISSION – NO LONGER S AND S, STILL CLINICALLY RELEVANT CLINICALLY RELEVANT

PARTIAL AND FULL REMISSION FOR:PARTIAL AND FULL REMISSION FOR:MANIC EPISODEMANIC EPISODEMAJOR DEPRESSIVE EPISODEMAJOR DEPRESSIVE EPISODESUBSTANCE DEPENDANCESUBSTANCE DEPENDANCE

PRIOR HISTORY – USEFUL TO NOTE HX OF PRIOR HISTORY – USEFUL TO NOTE HX OF CRITERIA PREVIOUSLY MET BUT NOW RECOVEREDCRITERIA PREVIOUSLY MET BUT NOW RECOVERED

RECURRENCERECURRENCE

FULL CRITERIA NO LONGER METFULL CRITERIA NO LONGER MET

PARTIAL, FULL REMISSION, PARTIAL, FULL REMISSION, RECOVERYRECOVERY

DO NOT MEET FULL THRESHOLD OF DO NOT MEET FULL THRESHOLD OF D/O ACCORDING TO SPECIFIED D/O ACCORDING TO SPECIFIED CRITERIACRITERIA

NOS CATEGORIESNOS CATEGORIES

DIVERSITY OF CLINICAL DIVERSITY OF CLINICAL PRESENTATIONPRESENTATION4 SITUATIONS:4 SITUATIONS:– CRITERIA NOT MET FOR SPECIFIC D/O EG CRITERIA NOT MET FOR SPECIFIC D/O EG

ATYPICAL, MIXED PICTUREATYPICAL, MIXED PICTURE– DOES NOT CONFORM TO DSM IV DOES NOT CONFORM TO DSM IV

CLASSIFICATION BUTCLINICAL CLASSIFICATION BUTCLINICAL SIGNIFICANT DISTRESSSIGNIFICANT DISTRESS

– AETIOLOGY UNCERTAINAETIOLOGY UNCERTAIN– INSUFFICIENT DATA, INCONSISTENT INSUFFICIENT DATA, INCONSISTENT

INFORMATIONINFORMATION

MULTIAXIAL ASSESSMENTMULTIAXIAL ASSESSMENT

5 AXES5 AXES

– I – CLINICAL D/O, OTHER CONDITIONS I – CLINICAL D/O, OTHER CONDITIONS FOCUS OF CLINICAL ATTENTIONFOCUS OF CLINICAL ATTENTION

– II – PERSONALITY D/OII – PERSONALITY D/O

– III – GMCIII – GMC

– IV – PSYCHOSOCIAL, ENVIRONMENTALIV – PSYCHOSOCIAL, ENVIRONMENTAL

– V – GAFV – GAF

MULTIAXIAL ASSESSMENTMULTIAXIAL ASSESSMENT

DIFFERENT DOMAINS OF INFORMATIONDIFFERENT DOMAINS OF INFORMATION

PLAN RX AND PREDICT OUTCOMEPLAN RX AND PREDICT OUTCOME

ORGANIZING, COMMUNICATING ORGANIZING, COMMUNICATING CLINICAL INFORMATIONCLINICAL INFORMATION

CAPTURES COMPLEXITY OF CLINICAL CAPTURES COMPLEXITY OF CLINICAL SITUATIONSITUATION

HETEROGENEITY OF PATIENTHETEROGENEITY OF PATIENT

BIOPSYCHOSOCIAL MODELBIOPSYCHOSOCIAL MODEL

AXIS IAXIS I

PRINCIPAL DXPRINCIPAL DX

AXIS II CAN ALSO BE PRINCIPAL AXIS II CAN ALSO BE PRINCIPAL DIAGNOSIS – MUST BE FOLLOWED BY DIAGNOSIS – MUST BE FOLLOWED BY ‘PRINCIPAL DX’ OR ‘REASON FOR VISIT’‘PRINCIPAL DX’ OR ‘REASON FOR VISIT’

AXIS IIAXIS II

PERSONALITY D/OPERSONALITY D/O

MRMR

MALADAPTIVE PERSONALITY MALADAPTIVE PERSONALITY FEATURESFEATURES

DEFENCE MECHANISMSDEFENCE MECHANISMS

MORE THAN 1 DXMORE THAN 1 DX

AXIS IIIAXIS III

GMC RELEVANT TO MENTAL D/OGMC RELEVANT TO MENTAL D/O

NO LINK BUT INCLUDED IF:NO LINK BUT INCLUDED IF:

OVERALL UNDERSTANDING OF PTOVERALL UNDERSTANDING OF PT

AXIS I PSYCHOLOGICAL AXIS I PSYCHOLOGICAL REACTION TO AXIS IIREACTION TO AXIS II

THOROUGHNESS OF EVALUATIONTHOROUGHNESS OF EVALUATION

ENHANCES COMMUNICATION BETWEEN ENHANCES COMMUNICATION BETWEEN HEALTH PROFESSIONALSHEALTH PROFESSIONALS

PROGNOSTIC AND RX IMPLICATIONPROGNOSTIC AND RX IMPLICATION

AXIS IVAXIS IV

PYCHOSOCIAL AND ENVIRONMENTAL PYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS THAT AFFECT DX ,RX AND PX:PROBLEMS THAT AFFECT DX ,RX AND PX:– PROBLEMS WITH PRIMARY SUPPORT PROBLEMS WITH PRIMARY SUPPORT

GROUPSGROUPS– PROBLEMS RELATED TO SOCIAL PROBLEMS RELATED TO SOCIAL

ENVIRONMENTENVIRONMENT– EDUCATIONAL PROBLEMSEDUCATIONAL PROBLEMS– HOUSING PROBLEMSHOUSING PROBLEMS– ECONOMIC PROBLEMSECONOMIC PROBLEMS– PROBLEMS WITH ACCESS TO HEALTH PROBLEMS WITH ACCESS TO HEALTH

CARE SERVICESCARE SERVICES

AXIS IVAXIS IV

– PROBLEMS RELATED TO ACCESS TO PROBLEMS RELATED TO ACCESS TO HEALTH CARE SERVICESHEALTH CARE SERVICES

– PROBLEMS RELATED TO INTERACTION PROBLEMS RELATED TO INTERACTION WITH LEGAL SYSTEM/CRIMEWITH LEGAL SYSTEM/CRIME

– OTHER PSYCHOSOCIAL AND OTHER PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS ENVIRONMENTAL PROBLEMS

AXIS VAXIS V

GLOBAL ASSESSMENT OF FUNCTIONINGGLOBAL ASSESSMENT OF FUNCTIONING

CLINICIANS JUDGEMENT – OVERALL CLINICIANS JUDGEMENT – OVERALL LEVEL OF FUNCTIONINGLEVEL OF FUNCTIONING

PLANNING RXPLANNING RX

PREDICTING OUTCOMEPREDICTING OUTCOME

GAF SCALEGAF SCALE

GAF SCALEGAF SCALE

TRACKS CLINICAL PROGRESSTRACKS CLINICAL PROGRESS

SOCIAL,OCCUPATIONAL AND SOCIAL,OCCUPATIONAL AND PSYCHOLOGICAL FUNCTIONINGPSYCHOLOGICAL FUNCTIONING

2 COMPONENTS – SYMPTOM SEVERITY 2 COMPONENTS – SYMPTOM SEVERITY AND FUNCTIONINGAND FUNCTIONING

REFLECTS WORSE OF 2REFLECTS WORSE OF 2

CURRENT PERIOD S/T ADMISSION, CURRENT PERIOD S/T ADMISSION, DISCHARGE ETCDISCHARGE ETC

ADVANTAGES DSM IV-TRADVANTAGES DSM IV-TR

WIDESPREAD USE – EASE OF WIDESPREAD USE – EASE OF COMMUNICATIONCOMMUNICATION

CLEAR DEFINITION AND CLEAR DEFINITION AND DELINEATIONSDELINEATIONS

COMPATIBILITY WITH ICD10COMPATIBILITY WITH ICD10

REPORTING DIAGNOSTIC DATAREPORTING DIAGNOSTIC DATA

COLLECTION OF DIAGNOSTIC DATACOLLECTION OF DIAGNOSTIC DATA

ADVANTAGES CONTADVANTAGES CONT

CATEGORICAL MODEL – VALID CATEGORICAL MODEL – VALID THRESHOLDS FOR CASE THRESHOLDS FOR CASE IDENTIFICATION WITH CLEAR IDENTIFICATION WITH CLEAR BOUNDARIES BETWEEN CLASSESBOUNDARIES BETWEEN CLASSES

MULTIAXIAL EVALUATION PROMOTES MULTIAXIAL EVALUATION PROMOTES COMPREHENSIVE BIOPSYCHOSOCIAL COMPREHENSIVE BIOPSYCHOSOCIAL APPROACHAPPROACH

LIMITATIONS OF DSM IV-TRLIMITATIONS OF DSM IV-TR

FORENSIC SETTINGFORENSIC SETTING

RISK OF INFORMATION MISUSEDRISK OF INFORMATION MISUSED

INSUFFICIENT TO ESTABLISH MI, INSUFFICIENT TO ESTABLISH MI, COMPETENCY AND CRIMINAL COMPETENCY AND CRIMINAL RESPONSIBILITYRESPONSIBILITY

NO IMPLICATIONS FOR DEGREE OF NO IMPLICATIONS FOR DEGREE OF CONTROL OVER BEHAVIOURS CONTROL OVER BEHAVIOURS ASSOCIATED WITH MIASSOCIATED WITH MI

FACILITATES LEGAL DECISIONSFACILITATES LEGAL DECISIONS

CLINICAL JUDGEMENTCLINICAL JUDGEMENT

INDIVIDUALS WITH APPROPRIATE INDIVIDUALS WITH APPROPRIATE CLINICAL TRAININGCLINICAL TRAINING

CANNOT BE APPLIED MECHANICALLYCANNOT BE APPLIED MECHANICALLY

ETHNIC AND CULTURAL ETHNIC AND CULTURAL IMPLICATIONSIMPLICATIONS

CHALLENGING IF PT AND CLINICIAN FROM CHALLENGING IF PT AND CLINICIAN FROM DIFFERENT BACKGROUNDSDIFFERENT BACKGROUNDSINCORRECTLY DIAGNOSE INCORRECTLY DIAGNOSE PSYCHOPATHOLOGYPSYCHOPATHOLOGYINCORRECT PERSONALITY DIAGNOSTIC INCORRECT PERSONALITY DIAGNOSTIC CRITERIA ACROSS DIFFERENT CULTURAL CRITERIA ACROSS DIFFERENT CULTURAL SETTINGSSETTINGSALLOWANCES MADE BY DSMALLOWANCES MADE BY DSM

DISCUSSES CULTURAL VARIATIONSDISCUSSES CULTURAL VARIATIONSCULTURE BOUND SYNDROMESCULTURE BOUND SYNDROMESCULTURAL FORMULATIONCULTURAL FORMULATION

TREATMENT PLANNINGTREATMENT PLANNING

CLINICIAN REQUIRED TO OBTAIN CLINICIAN REQUIRED TO OBTAIN INFORMATION ABOVE THAT OF INFORMATION ABOVE THAT OF DIAGNOSTIC CRITERIA DIAGNOSTIC CRITERIA

CATEGORICAL APPROACHCATEGORICAL APPROACH

CATEGORIES OF MENTAL ILLNESS NOT CATEGORIES OF MENTAL ILLNESS NOT MUTUALLY EXCLUSIVEMUTUALLY EXCLUSIVE

INDIVIDUALS ARE HETEROGENOUSINDIVIDUALS ARE HETEROGENOUS

NO CONSIDERATION OF PATIENTS NO CONSIDERATION OF PATIENTS NARRATIVE HISTORYNARRATIVE HISTORY

LIMITATIONS OF DSMIV-TR LIMITATIONS OF DSMIV-TR CONTCONT

NOT USEFUL FOR RESEARCH – HINDERS NOT USEFUL FOR RESEARCH – HINDERS INVESTIGATIONS INTO AET, PATHOPHYS, INVESTIGATIONS INTO AET, PATHOPHYS, GENETICSGENETICS

NOT RELIABLE INTERCLINICIAN TOOLNOT RELIABLE INTERCLINICIAN TOOL

PATIENTS NOT INCORPORATED IN RX PATIENTS NOT INCORPORATED IN RX CHOICESCHOICES

COMPLICATED-284 POTENTIAL DXCOMPLICATED-284 POTENTIAL DX

LESS VALIDITY- BEREAVEMENTLESS VALIDITY- BEREAVEMENT

CONCEPTUAL INCONSISTENCYCONCEPTUAL INCONSISTENCY

LIMITATIONS OF DSM IV-TRLIMITATIONS OF DSM IV-TR

INCONSISTENCIES WITH REMISSION INCONSISTENCIES WITH REMISSION STATUSSTATUSEXEXCUSION OF PSYCHODYNAMIC AND CUSION OF PSYCHODYNAMIC AND PSYCHOSOCIAL PERSPECTIVESPSYCHOSOCIAL PERSPECTIVESUNCERTAINTY OF INTERPRETING UNCERTAINTY OF INTERPRETING ‘CLINICALLY SIGNIFICANT’ CRITERIA‘CLINICALLY SIGNIFICANT’ CRITERIAMULTIAXIAL SYSTEM- TIME CONSUMING, MULTIAXIAL SYSTEM- TIME CONSUMING, NOT USED NOT USED AXES IV, V- DUBIOUS RELIABILITY AND AXES IV, V- DUBIOUS RELIABILITY AND VALIDITYVALIDITY

ICD 10ICD 10

INTERNATIONAL CLASSIFICATION OF INTERNATIONAL CLASSIFICATION OF DISEASESDISEASESCLASSIFICATION FOR EPIDEMIOLOGICAL CLASSIFICATION FOR EPIDEMIOLOGICAL AND HEALTH MANAGEMENT PURPOSESAND HEALTH MANAGEMENT PURPOSES

WHOWHO


1853 – INTERNATIONAL STATISTICAL 1853 – INTERNATIONAL STATISTICAL CONGRESS – W. FARRCONGRESS – W. FARR

REVISED OVER NEXT DECADESREVISED OVER NEXT DECADES

1946 – WHO – INTERNATIONAL LIST OF 1946 – WHO – INTERNATIONAL LIST OF CAUSES IF MORBIDITYCAUSES IF MORBIDITY

1948 – 61948 – 6THTH REVISION REVISION

1975 – 91975 – 9THTH REVISION-BEGINNING OF ICD REVISION-BEGINNING OF ICD

99THTH REVISION – DESCRIPTIONS OF REVISION – DESCRIPTIONS OF CATEGORIES OF CHAPTER V – MENTAL D/OCATEGORIES OF CHAPTER V – MENTAL D/O

HX AND BACKGROUNDHX AND BACKGROUND

1989 – 101989 – 10THTH REVISION REVISION

ALPHANUMERICAL CODING SCHEME ALPHANUMERICAL CODING SCHEME OF 1 LETTER FOLLOWED BY 3 OF 1 LETTER FOLLOWED BY 3 NUMBERSNUMBERS

INCREASE IN NUMBER OF INCREASE IN NUMBER OF CATEGORIES, SEPARATE CHAPTERSCATEGORIES, SEPARATE CHAPTERS

ICD 10ICD 10

CHAPTER V – MENTAL D/OCHAPTER V – MENTAL D/OCHAPTER VI – NEUROLOGICAL D/OCHAPTER VI – NEUROLOGICAL D/OCHAPTER XIX – CLASSIFICATION OF INJURIES CHAPTER XIX – CLASSIFICATION OF INJURIES – POISONING– POISONINGCHAPTER XVIII – S AND S, ABN CLINICAL AND CHAPTER XVIII – S AND S, ABN CLINICAL AND LAB FINDINGSLAB FINDINGSCATEGORIES DENOTED BY LETTERCATEGORIES DENOTED BY LETTER11STST NO – MAIN GROUP NO – MAIN GROUP22NDND NO – CATEGORY WITHIN GROUP NO – CATEGORY WITHIN GROUP44THTH CHARACTER – FURTHER SUBDIVISION CHARACTER – FURTHER SUBDIVISIONF32.2 – SEVERE DEPRESSIVE EPISODE F32.2 – SEVERE DEPRESSIVE EPISODE WITHOUT PSYCHOTIC SYMPTOMSWITHOUT PSYCHOTIC SYMPTOMS

ICD 10ICD 10

SCZ – 5SCZ – 5TH TH CHARACTER – SPECIFY CHARACTER – SPECIFY COURSECOURSE

F20.01 – PARANOID SCZ, EPISODIC F20.01 – PARANOID SCZ, EPISODIC WITH PROGRESSIVE DEFICITWITH PROGRESSIVE DEFICIT

DIFFERENT VERSIONS – FLEXIBILITY DIFFERENT VERSIONS – FLEXIBILITY AND ACCEPTIBILITY TOAND ACCEPTIBILITY TO VARIOUS USERS VARIOUS USERS

ICD 10ICD 10

CLINICAL DESCRIPTIONS AND DIAGNOSTIC CLINICAL DESCRIPTIONS AND DIAGNOSTIC GUIDELINES FOR GENERAL CLINICAL, GUIDELINES FOR GENERAL CLINICAL, EDUCATIONAL AND SERVICE USEEDUCATIONAL AND SERVICE USE

DIAGNOSTIC CRITERIA FOR RESEARCHDIAGNOSTIC CRITERIA FOR RESEARCH

PRIMARY CARE VERSIONPRIMARY CARE VERSION

MULTIAXIAL VERSIONMULTIAXIAL VERSION

CLINICAL DESCRIPTIONS…CLINICAL DESCRIPTIONS…

EACH CATEGORY ACCOMPANIED BY EACH CATEGORY ACCOMPANIED BY GLOSSARY OF BRIEF DEFINITIONSGLOSSARY OF BRIEF DEFINITIONS

FURTHER DEFINED SET OF CRITERIAFURTHER DEFINED SET OF CRITERIA

CRITERIA LESS PRECISE THAN DSMCRITERIA LESS PRECISE THAN DSM

ALLOWS CLINICIANS TO USE IN DAILY ALLOWS CLINICIANS TO USE IN DAILY PRACTICEPRACTICE

DIAGNOSTIC CRITERIA FOR RESEARCHDIAGNOSTIC CRITERIA FOR RESEARCH

TWO NB ANNEXESTWO NB ANNEXES

CULTURE SPECIFIC D/OCULTURE SPECIFIC D/O

PROVISIONAL CRITERIA FOR UNCERTAINPROVISIONAL CRITERIA FOR UNCERTAIN NNOSOLOGICAL STATUS – BIPOLAR D/O IIOSOLOGICAL STATUS – BIPOLAR D/O II


ADULT PSYCHIATRY – 3 AXESADULT PSYCHIATRY – 3 AXES

CATEGORIZE CLINICAL SYNDROMECATEGORIZE CLINICAL SYNDROME

LEVEL OF FUNCTIONAL LEVEL OF FUNCTIONAL CAPACITY/DISABILITYCAPACITY/DISABILITY

CATEGORIES OF IMPORTANCE IN CATEGORIES OF IMPORTANCE IN THE UNDERSTANDING OF THE D/OTHE UNDERSTANDING OF THE D/O


MENTAL D/O OF CHILDHOODMENTAL D/O OF CHILDHOOD

6 AXES:6 AXES:CLINICAL PSYCHIATRIC SYNDROMESCLINICAL PSYCHIATRIC SYNDROMES

SPECIFIC D/O OF PSYCHOLOGIC DEVELOPMENTSPECIFIC D/O OF PSYCHOLOGIC DEVELOPMENT

INTELLECTUAL LEVELINTELLECTUAL LEVEL

MEDICAL CONDITIONSMEDICAL CONDITIONS

ASSOCIATED ABNORMAL PSYCHOSOCIAL ASSOCIATED ABNORMAL PSYCHOSOCIAL SITUATIONSITUATION

GLOBAL ASSESSMENT OF PSYCHOSOCIAL GLOBAL ASSESSMENT OF PSYCHOSOCIAL DISABILITYDISABILITY

PRIMARY CARE VERSIONPRIMARY CARE VERSION

FEWER CATEGORIESFEWER CATEGORIES

GENERAL PRACTITIONER, PRIMARY GENERAL PRACTITIONER, PRIMARY HEALTH CARE STAFF, HEALTH CARE STAFF, PSYCHIATRISTS, OTHERSPSYCHIATRISTS, OTHERS

2 CARDS2 CARDSWAY THAT CONDITION IS RECOGNIZED WAY THAT CONDITION IS RECOGNIZED AND DIAGNOSEDAND DIAGNOSED

ADVICE ON MXADVICE ON MX

ADVANTAGES OF ICD 10ADVANTAGES OF ICD 10

SIMPLICITY OF STRUCTURE AND USESIMPLICITY OF STRUCTURE AND USE

USED BY SPECIAL GROUPS, STILL USED BY SPECIAL GROUPS, STILL COMPATIBLE WITH ORIGINAL COMPATIBLE WITH ORIGINAL CLASSIFICATIONCLASSIFICATION

COMPATIBILITY WITH NATIONAL AND COMPATIBILITY WITH NATIONAL AND OTHER WIDELY USED CLASSIFICATIONSOTHER WIDELY USED CLASSIFICATIONS

DIFFERENCES KEPT TO MINIMUMDIFFERENCES KEPT TO MINIMUM

CONTINUITY OVER TIMECONTINUITY OVER TIME

BASED ON INTERNATIONAL CONSENSUSBASED ON INTERNATIONAL CONSENSUS


BASED ON INTERNATIONAL CONSENSUSBASED ON INTERNATIONAL CONSENSUSSEVERAL VERSIONS – ALL COMPATIBLE SEVERAL VERSIONS – ALL COMPATIBLE WITH EACH OTHERWITH EACH OTHERSEVERAL LANGUAGESSEVERAL LANGUAGESADDITIONAL PUBLICATIONS FACILITATE ITS ADDITIONAL PUBLICATIONS FACILITATE ITS USEUSERESPONSIVE TO NEEDS OF PRACTICERESPONSIVE TO NEEDS OF PRACTICECATEGORIES FOR DIAGNOSIS CATEGORIES FOR DIAGNOSIS FREQUENTLY USED BUT NOSOLGY FREQUENTLY USED BUT NOSOLGY UNCERTAINUNCERTAIN


AVOIDS ‘SOCIAL FUNCTIONING’ AS AVOIDS ‘SOCIAL FUNCTIONING’ AS DIAGNOSTIC INDICATORDIAGNOSTIC INDICATOR

RECENTLY INTRODUCED DX OF PUBLIC RECENTLY INTRODUCED DX OF PUBLIC HEALTH INTERES MILD COGNITIVE D/OHEALTH INTERES MILD COGNITIVE D/O

TERMINOLOGY EASY TO USETERMINOLOGY EASY TO USE

SIGNIFICANT EXPANSION OF ACUTE SIGNIFICANT EXPANSION OF ACUTE PSYCHOTIC D/O-DEVELOPING COUNTRIESPSYCHOTIC D/O-DEVELOPING COUNTRIES

CATEGORICAL CLASSIFICATIONCATEGORICAL CLASSIFICATION

LIMITATIONS OF ICD 10LIMITATIONS OF ICD 10

CATEGORICAL CLASSIFICATION-DISCRETE CATEGORICAL CLASSIFICATION-DISCRETE ENTITY VIEW OF PSYCH D/OENTITY VIEW OF PSYCH D/O

LIMITATIONS OF CURRENT OPERATIONAL LIMITATIONS OF CURRENT OPERATIONAL APPROACHES TO DIAGNOSISAPPROACHES TO DIAGNOSIS

FOCUS ON EPISODE RATHER THAN LIFETIME FOCUS ON EPISODE RATHER THAN LIFETIME EXPERIENCEEXPERIENCE

HIERARCHIES LEAD TO LOSS OF INFOHIERARCHIES LEAD TO LOSS OF INFO

BOUNDARIES BET CATEGORIES ARE BOUNDARIES BET CATEGORIES ARE ARBITRARYARBITRARY

BOUNDARIES BET CATEGORIES REQUIRE BOUNDARIES BET CATEGORIES REQUIRE SUBSTANTIAL SUBJECTIVE JUDGEMENTSUBSTANTIAL SUBJECTIVE JUDGEMENT

DIAGNOSTIC CATEGORIES ARE UNHELPFUL IN DIAGNOSTIC CATEGORIES ARE UNHELPFUL IN DETERMINING SEVERITYDETERMINING SEVERITY

LIMITATIONS OF CURRENT OPERATIONAL LIMITATIONS OF CURRENT OPERATIONAL APPROACHES TO DIAGNOSISAPPROACHES TO DIAGNOSIS

SUBCLINICAL CASES NOT ACCOMODATED SUBCLINICAL CASES NOT ACCOMODATED FULLYFULLY

NOS CATEGORIES HIGHLY HETEROGENOUSNOS CATEGORIES HIGHLY HETEROGENOUS

INCREASED GAPS BETWEEN RESEARCH INCREASED GAPS BETWEEN RESEARCH FINDINGS AND DEFINITIONS OF CURRENT FINDINGS AND DEFINITIONS OF CURRENT DIAGNOSTIC SYSTEMS – SACRIFICES VALIDITY DIAGNOSTIC SYSTEMS – SACRIFICES VALIDITY FOR RELIABILITYFOR RELIABILITY

DIFFERENCES BETWEEN DSM AND ICDDIFFERENCES BETWEEN DSM AND ICD

DSM IV-TRDSM IV-TR

PRODUCED BY APAPRODUCED BY APA

ONE GROUP OF DISEASES, DIRECT ONE GROUP OF DISEASES, DIRECT INTEREST TO PARTICULAR INTEREST TO PARTICULAR PROFESSIONAL GROUPPROFESSIONAL GROUP

NATIONAL DIAGNOSTIC NATIONAL DIAGNOSTIC CLASSIFICATIONCLASSIFICATION

SINGLE SET OF OPERATIONAL SINGLE SET OF OPERATIONAL DIAGNOSTIC CRUTERIA FOR ALL DIAGNOSTIC CRUTERIA FOR ALL USERSUSERS

ICD10ICD10

WHOWHO

NUMBER OF CLASSIFICATIONS NUMBER OF CLASSIFICATIONS – EVEN CLASSIFICATION OF – EVEN CLASSIFICATION OF REASON FOR CONTACTREASON FOR CONTACT

STATUTORY RESPONSIBILITY STATUTORY RESPONSIBILITY FOR RELIABLE REPORTING OF FOR RELIABLE REPORTING OF DISEASES AND HEALTH DISEASES AND HEALTH STATES TO THE WORLD STATES TO THE WORLD POPULATIONPOPULATION

INTERRELATED VERSIONS INTERRELATED VERSIONS ADDRESSING DIFFERENT ADDRESSING DIFFERENT USERS IN SPECIFIC CONTEXTSUSERS IN SPECIFIC CONTEXTS

DIFFERENCES BETWEEN DSM AND ICD 10DIFFERENCES BETWEEN DSM AND ICD 10

DSM IV-TRDSM IV-TRDEFINITIONAL DIFFERENCES-DEFINITIONAL DIFFERENCES-SUBSTANCE D/O=FOCUS ON SUBSTANCE D/O=FOCUS ON NEGATIVE CONSEQUENCESNEGATIVE CONSEQUENCES

ACUTE STRESS D/O-DX ONLY ACUTE STRESS D/O-DX ONLY FOR SEVERE DISSOCIATIVE FOR SEVERE DISSOCIATIVE REACTIONSREACTIONS

DIFFERENCES IN DIAGNOSTIC DIFFERENCES IN DIAGNOSTIC CRITERIA-DURATION, CRITERIA-DURATION, FREQUENCY ETC-DELUSIONAL FREQUENCY ETC-DELUSIONAL D/O-3/12D/O-3/12

DIFFERENCES IN EXCLUSIONARY DIFFERENCES IN EXCLUSIONARY CRITEIA- HYPOCHONDRIASISCRITEIA- HYPOCHONDRIASIS

CONCEPTUAL DIFFERENCES OF CONCEPTUAL DIFFERENCES OF DISORDERSDISORDERS

ICD10ICD10DX OF HARMFUL USE FOCUSES DX OF HARMFUL USE FOCUSES ON DAMAGE TO USER’S ON DAMAGE TO USER’S PHYSICAL AND MENTAL HEALTHPHYSICAL AND MENTAL HEALTH

WIDER RANGE OF RESPONSES-WIDER RANGE OF RESPONSES-MILD ANXIETY TO SEVERE MILD ANXIETY TO SEVERE DISSOCIATIONDISSOCIATION

MINIMUM 3/12MINIMUM 3/12

HYPOCHONDRIASISHYPOCHONDRIASIS

CONCEPTUAL DIFFERENCES OF CONCEPTUAL DIFFERENCES OF DISORDERSDISORDERS

DSMVDSMV

CURRENTLY IN CONSULTATION, CURRENTLY IN CONSULTATION, PLANNING AND PREPARATIONPLANNING AND PREPARATION

DUE FOR PUBLICATION IN 2012/13DUE FOR PUBLICATION IN 2012/13

WORK GROUPS TO ADDRESSS MAJOR WORK GROUPS TO ADDRESSS MAJOR GAPSGAPS

DEVELOPMENTAL ISSUESDEVELOPMENTAL ISSUES

REFINE PSYCHIATRIC ASSESSMENT REFINE PSYCHIATRIC ASSESSMENT TECHNIQUE ACROSS TECHNIQUE ACROSS DEVELOPMENTAL STAGESDEVELOPMENTAL STAGES

METHODS TO INTEGRATE METHODS TO INTEGRATE DEVELOPMENTAL ASSESSMENTS DEVELOPMENTAL ASSESSMENTS INTO DIAGNOSTIC PROCESSINGINTO DIAGNOSTIC PROCESSING

DEFINING MENTAL ILLNESSDEFINING MENTAL ILLNESS

FACILITATING DIAGNOSTIC PROCESSES IN FACILITATING DIAGNOSTIC PROCESSES IN NON-PSYCHIATRIC SETTINGSNON-PSYCHIATRIC SETTINGS

APPLICABILITY OF CRITERIA ACROSS APPLICABILITY OF CRITERIA ACROSS DIFFERENT CULTURAL SETTINGSDIFFERENT CULTURAL SETTINGS

VALIDATINGDIAGNOSTIC CRITERIAVALIDATINGDIAGNOSTIC CRITERIA

INCREASING COMPATIBILITY BETWEEN INCREASING COMPATIBILITY BETWEEN DSM V AND ICD 10DSM V AND ICD 10

DIMENSIONAL APPROACH MORE SUPERIORDIMENSIONAL APPROACH MORE SUPERIOR

PERSONALITY DISORDERSPERSONALITY DISORDERS

DIMENSIONAL MODEL MAY BE SUPERIOR, DIMENSIONAL MODEL MAY BE SUPERIOR, MORE RELIABLE, SPECIFIC AND CLINICALLY MORE RELIABLE, SPECIFIC AND CLINICALLY INFORMATIVEINFORMATIVE

SHOULD THERE BE INDEPENDENCE AND SHOULD THERE BE INDEPENDENCE AND DISTINCTIVENESS BETWEEN AXIS I AND DISTINCTIVENESS BETWEEN AXIS I AND AXIS II PERSONALITY D/OAXIS II PERSONALITY D/O

BOTH FREQUENTLY CO-EXISTBOTH FREQUENTLY CO-EXIST

AXIS II OFTEN A SIGNIFICANT AXIS II OFTEN A SIGNIFICANT COMPLICATING FACTOR TO AXIS ICOMPLICATING FACTOR TO AXIS I

RELATIONAL PROBLEMSRELATIONAL PROBLEMS

PAINFUL PERSISTENT BEHAVIOURAL PAINFUL PERSISTENT BEHAVIOURAL PROBLEMS THAT SERIOUSLY AFFECT PROBLEMS THAT SERIOUSLY AFFECT JUDGEMENTJUDGEMENT

INCLUSION IN DSMVINCLUSION IN DSMV

PROPOSED CHANGES TO DSM IV-TR PROPOSED CHANGES TO DSM IV-TR DXDX

ELIMINATE ASPERGERS SYNDROME ELIMINATE ASPERGERS SYNDROME AS SEPARATE D/OAS SEPARATE D/O

MERGE UNDER AUTISM SPECTRUM MERGE UNDER AUTISM SPECTRUM D/OD/O

SEVERITY CAN BE RATED- SEVERE, SEVERITY CAN BE RATED- SEVERE, MODERATEMODERATE, , MILDMILD

PROPOSED NEW DSM V DXPROPOSED NEW DSM V DX

COMPLEX POST TRAUMATIC STRESS D/OCOMPLEX POST TRAUMATIC STRESS D/O

DEPRESSIVE PERSONALITY D/ODEPRESSIVE PERSONALITY D/O

NEGATIVISTIC ( PASSIVE-AGGRESSIVE ) PDNEGATIVISTIC ( PASSIVE-AGGRESSIVE ) PD

POST TRAUMATIC EMBITTERMENT D/OPOST TRAUMATIC EMBITTERMENT D/O

RELATIONAL D/ORELATIONAL D/O

PD AND MR AS AXIS I D/OPD AND MR AS AXIS I D/O

SLUGGISH COGNITIVE TEMPERAMENTSLUGGISH COGNITIVE TEMPERAMENT

REFERENCESREFERENCES

KAPLAN AND SADDOCK’S COMPREHENSIVE TEXTBOOK OF KAPLAN AND SADDOCK’S COMPREHENSIVE TEXTBOOK OF PSYCHIATRY, 9PSYCHIATRY, 9THTH EDITION 2009 EDITION 2009KAPLAN AND SADDOCK’S SYNOPSIS OF PSYCHIATRY,10KAPLAN AND SADDOCK’S SYNOPSIS OF PSYCHIATRY,10THTH EDITIONEDITIONDIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS:DSM IV TR- APA 2000DISORDERS:DSM IV TR- APA 2000A RESEARCH AGENDA FOR DSM V. KUPFER,D; A RESEARCH AGENDA FOR DSM V. KUPFER,D; FIRST,M;REGIER,DFIRST,M;REGIER,DFIRST M.HARMONISATION OF ICD-11 AND DSM- V: FIRST M.HARMONISATION OF ICD-11 AND DSM- V: OPPORTUNITIES AND CHALLENGES.BJP 2009;195:382-390OPPORTUNITIES AND CHALLENGES.BJP 2009;195:382-390JABLENSKY A.TOWARDS ICD-11 AND DSM-V:ISSUES BEYOND JABLENSKY A.TOWARDS ICD-11 AND DSM-V:ISSUES BEYOND HARMONISATION.BJP 2009;195:379-381HARMONISATION.BJP 2009;195:379-381CRADDOCK,MICHAEL O.RETHINKING PSYCHOSIS.WORLD CRADDOCK,MICHAEL O.RETHINKING PSYCHOSIS.WORLD PSYCHIATRY 2007;6(2):84-91PSYCHIATRY 2007;6(2):84-91

REFERENCESREFERENCES

DISTINGUISHING BETWEEN VALIDIDTY AND UTILITY DISTINGUISHING BETWEEN VALIDIDTY AND UTILITY OF PSYCHIATRIC DIAGNOSIS. KWNDELL OF PSYCHIATRIC DIAGNOSIS. KWNDELL R,JABLESKY A.AMJ 2003;160:4-12R,JABLESKY A.AMJ 2003;160:4-12

CLINICAL UTILITY AS A CRITERION FOR REVISING CLINICAL UTILITY AS A CRITERION FOR REVISING PSYCHIATRIC DIAGNOSIS. FIRST M,WILLIAMS PSYCHIATRIC DIAGNOSIS. FIRST M,WILLIAMS J,USTUN B, PEELE R. AMJ 2004;161;946-954J,USTUN B, PEELE R. AMJ 2004;161;946-954

AMERICAN ASSOCIATION OF COMMUNITY AMERICAN ASSOCIATION OF COMMUNITY PSYCHIATRIST’S VIEWS ON GENERAL FEATURES PSYCHIATRIST’S VIEWS ON GENERAL FEATURES OF DSM-IV. BELL C,SOWERS W, THOMPSON K. OF DSM-IV. BELL C,SOWERS W, THOMPSON K. PSYCHIATRIC SERVICES,2008;59:687-689PSYCHIATRIC SERVICES,2008;59:687-689

Health & Medicine

The dsmiv and_icd10_classification_systems_(background)