CLASSIFICATION OF MENTAL DISORDERS

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CLASSIFICATION OF MENTAL DISORDERS

• by
• Dr.Beena Das T.R.

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DEFINITION FOR PSYCHIATRIC DISORDER

• The simplest way to define is, it is a
  disturbance of (1)Cognition (thought) or (2)
  Conation (action) or (3) Affect (feeling) or any
  disequilibrium between the 3 domains.
• A mental disorder should be a manifestation of
  behavioral, psychological and biological
  dysfunction in person - DSM-1V-TR.

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At present, there are 2 major classification in
psychiatry, namely ICD-10 (1992) and DSM -1V-
TR (2000).

• ICD-10 (International classification of Disease,
  10th Revision, 1992)
• DSM- 1V- TR (Diagnostic and Statistical Manual
  of Mental Disorders, 1V Edition, Text Revised,
  2000)

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1. ICD-10 CLASSIFICATIONS OF MENTAL AND
BEHAVIORAL DISORDERS.

• ORGANIC, INCLUDING SYMPTOMATIC, MENTAL DISORDERS.
  (F00- F09)
• They are due to demonstrable cerebral disease or
  disorder. This may be either primary - due to
  primary brain pathology or secondary due to
  brain dysfunction because of systemic disease.
• The disorder in this section include delirium,
  dementia, organic amnestic syndrome and other
  organic mental disorders.

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2. MENTAL AND BEHAVIORAL DISORDERS DUE TO
PSYCHOACTIVE SUBSTANCE USE. (F10-F19)

• These mental and behavioral disorders are due
  to the use of one or more psychoactive substance.
  
• The disorder in this section
  include acute intoxication, harmful use,
  dependence syndrome, withdrawal state, amnestic
  syndrome and psychotic disorders due to
  psychoactive substance use.

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3. SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL
DISORDERS. (F20-30)

• These mental and behavioral disorders are
  characterized by prominent disturbance of
  thought, perception, affect and or behavior.
• The disorder in this
  includes schizophrenia, schizotypal disorder,
  persistent delusional disorders, acute in
  addition to transient psychotic disorders,
  induced delusional disorder, and schizoaffective
  disorder.

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• MOOD (AFFECTIVE) DISORDERS. (F31-39)
• These mental and behavioral disorders are
  characterized by prominent disturbance of mood.
• The disorder in this
  includes manic episode, depressive episode,
  bipolar affective disorder, recurrent depressive
  disorder and persistent mood disorder.

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5. NEUROTIC, STRESS RELATED AND SOMATOFORM
DISORDERS. (F40-48)

• These mental and behavioral disorders were
  earlier labeled as neurotic disorder with an
  emphasis on psychological causation.
• The disorders in this
  section include anxiety disorders, phobic anxiety
  disorders, obsessive- compulsory disorders, and
  other neurotic disorders.
• There is no category with code number
  F49.

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6. BEHAVIORAL SYNDROMES ASSOCIATED WITH
PHYSIOLOGICAL DISTURBANCE AND PHYSICAL
FACTORS.(F50-59)

• These mental and behavioral disorders that were
  earlier called psychosomatic disorder.
• The disorders in this section
  include eating disorders , non- organic sleep
  disorders, sexual dysfunctions (not caused by
  organic disorder or disease), mental and
  behavioral disorders associated with puerperium,
  and abuse of non-dependence-producing
  substances.

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7. DISORDERS OF ADULT PERSONALITY AND BEHAVIOUR.
(F 60-69)

• These mental and behavioral disorders are the
  persistent expression of an individuals
  characteristic lifestyle and mode relating to
  self and others.
• The disorders in this
  include, specific personality disorders, enduring
  personality changes, habit and impulse disorders,
  gender-identity disorders, disorders of sexual
  preferences, and psychological and behavioral
  disorders associated with sexual development and
  orientation.

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8. MENTAL RETARDATION (F70-79)

• These disorders are arrested or incomplete
  development of the intellectual abilities and
  adaptive behavior, which may or may not be
  associated with other physical or mental
  disorder.
• The disorder in this section
  include, mild, moderate, severe and profound
  Mental Retardation.

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9. DISORDERS OF PSYCHOLOGICAL TREATMENT(F80-89)

• This group includes mental and psychological
  disorders with an onset during infancy or
  childhood and characterized by an impairment or
  delay in the development of functions that are
  strongly related to biological maturation of the
  CNS.

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10. BEHAVIORAL AND EMOTIONAL DISORDERS WITH ONSET
USUALLY OCCURING IN CHILDHOOD AND
ADOLESENCE.(F90-F98)

• These are miscellaneous mental and behavioral
  disorders that have an onset in childhood and
  adolescence.
• The disorders in this
  section include hyperkinetic disorders, conduct
  disorders, mixed disorders of conduct and
  emotions, tic disorders and others.
• 11. UNSPECIFIED MENTAL DISORDERS (F99)

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2. DSM -1V- TR CLASSIFICATION

• 1) DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY,
  CHILDHOOH OR ADOLESENCE
• a) Mental Retardation
• b) Learning Disorders
• c) Motor skill Disorders
• d) Communication Disorder-
• e) Pervasive Developmental Disorders
• f) Attention Deficit and Disruptive Behavior
  Disorders.
• h) Tic Disorders
• i) Elimination Disorders

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2)DELIRIUM, DEMENTIA AND AMNESTIC AND OTHER
COGNITIVE DISORDER.

• a) Delirium
• b) Dementia
• c)Amnestic Disorders
• d) other Cognitive Disorders

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3.)MENTAL DISORDERS DUE TO A GENERAL MEDICAL
CONDITION NOT ELSEWHERE CLASSIFIED

• a) Catatonic Disorder due to general Medical
  condition
• b) personality change due to general Medical
  condition.
• c) Mental Disorders NOS

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4) SUBSTANCE RELATED DISORDERS

• a) Alcohol related disorders
• b) Amphetamine related disorders
• c)Coffine- Related disorders
• d)Cannabis related disorders
• Similarly e)Cocaine , f)Hallucinogen ,
  g)Inhalant, h)nicotidine, j)Opioid etc.

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5) SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

• Schizopheniform disorders
• Schizoaffective disorders
• Delusional disorders
• Brief psychotic disorders
• Shared psychotic disorders
• Psychotic disorder due to general medical
  condition
• Substance- induced psychotic disorder
• Psychotic disorder NOS

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6) MOOD DISORDER

• Depressive disorders
• Bipolar disorders

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7) ANXIETY DISORDERS

• Panic disorder without agoraphobia
• Panic disorder with agarophobia
• Specific phobias
• Obsessive-compulsive disorder
• Post traumatic stress disorder
• Acute stress disorder
• Generalized anxiety disorder

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8) SOMATOFORM DISORDERS

• 9) FACTITIOUS DISORDERS
• 10) DISSOCIATIVE DISORDERS
• 11) SEXUAL AND GENDER IDENTITY DISORDERS

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12) EATING DISORDERS

• Anorexia nervosa
• Bulimia nervosa
• Eating disorder NOS
• 13) SLEEP DISORDERS

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.

• 14) IMPULSE CONTROL DISORDERS NOT ELSEWHERE
  CLASSIFIED
• 15) ADJUSTMENT DISORDERS
• 16) PERSONALITY DISORDER
• 17) OTHER CONDITION THAT MAY BE A FOCUS OF
  CLINICAL ATTENTION
• Psychological factors affecting medical
  conditions
• Medication induced movement disorder
• Relational problems
• Problem related to abuse or neglect

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18) ADDITIONAL CODESMULTIAXIAL SYSTEM

• In DSM-1V- TR, patient is diagnosed in 5 separate
  axis-
• Axis 1 - Clinical psychiatric diagnosis.
• Axis 11- Personality disorders Mental
  retardation.
• Axis 111- General medical conditions.
• Axis 1V- psychosocial and environmental
  problems.
• Axis V Global assessment of functioning
  current in past one year.

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• In ICD-10, multiaxial classification are-
• Clinical descriptions Diagnostic Guidelines
  (CDDG).
• Diagnostic Criteria for Research (DCR).
• Multiaxial classification version.
• Primary care version.

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111. HOMOEOPATHIC CLASSIFICATION OF MENTAL DISEASE

• a) Mental and emotional disease having origin as
  corporeal disease
• b) Mental disease originating predominantly from
  psychogenic causes-
• c) mental disease due to transient explosion of
  latent psora

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RELATION BETWEEN MODERN AND HOMOEOPATHIC
CLASSIFICSTION

• A) Mental and emotional disease having origin
  as corporeal disease includes
• ICD-10.
• 1) organic, including symptomatic,
  mental disorder (F00-F09)
• 2) neurotic, stress-related and
  somatoform disorder (F40-F48)
• 3) behavioral syndromes, associated
  with physiological
• disturbance and physical factors
  (F50- F59)
• DSM
• somatoform disorder
• factitious disorder
• eating disorder
• sleep disorders

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B) Mental disease originating predominantly
from psychogenic causes-

• ICD-10
• schizophrenia, schizotypal and delusional
  disorders.
• Mood disorders
• Disorders of adult personality and behavior.
• Mental retardation.
• Disorders of psychological development.
• Behavioral and emotional disorders with onset
  usually occurring in childhood and adolescence.

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DSM

• 1 Disorder usually first diagnosed in infancy,
  childhood or adolescence.
• 2 Delirium, dementia and amnestic and other
  cognitive disorders
• 3 Mental disorders due to a general medical
  condition not elsewhere classified.
• 4 Substance-related disorders
• 5 Schizophrenia and other psychotic disorders.
• 6 Mood disorders
• 7 Anxiety disorders
• 8 Dissociative disorders
• 9 Sexual and gender identity disorder
• 10 Adjustment disorders.
• 11 Personality disorders

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C. Mental disease due to transient explosion of
latent psora.

• DSM
• Impulsive-control disorders not elsewhere
  classified.

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• DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY,
  CHILDHOOD OR ADOLESENCE

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1. MENTAL RETARDATION

• The essential feature of mental
  retardation is significantly sub average general
  intellectual functioning (IQ), accompanied by
  significant limitations in adaptive functioning
  in at least 2 of the following skills-use of
  community resources, self-direction, functional
  academic skills, work, leisure, health and
  safety. Onset may occur before age 18 years.
  Degree of severity of MR
• Mild MR- IQ level 50-55
• Moderate 35-40 to 50-55
• Severe MR-20-25 to 35-40
• Profound-IQ level below 25 or 20.

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2. LEARNING DISORDERS (ACADEMIC SKILL DISORDERS)

• This is diagnosed when the individuals
  achievement on individually administered,
  standardized tests in reading , mathematics or
  written expression is substantially below that
  for age, schooling and level of intelligence. It
  may persists into adult hood.

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3. READING DISORDER

• It is reading achievement that falls
  substantially below that expected given the
  individuals chronological age, measured
  intelligence and age-appropriate education.

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4. MATHEMATICS DISORDER

• It is mathematical ability that falls
  substantially below that expected for the
  individuals chronological age, measured
  intelligence, and age appropriate education. This
  interferes with academic achievement or with
  activities of daily living that require
  mathematical skills.

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5. DISORDER OF WRITTEN EXPRESSION

• It is writing skills that falls substantially
  below those expected given the individuals
  chronological age, measured intelligence and age
  appropriate education. This interferes with
  academic achievement or with activities of daily
  living that require writing skills.

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6. MOTOR SKILLS DISORDER

• DEVELOPMENT COORDINATION DISORDER
• It is a marked impairment in the
  development of motor coordination. Diagnosis is
  made if it interferes with academic achievement
  or activities of daily living and is not due to
  general medical condition cerebral palsy,
  hemiplagia, muscular dystrophy. It includes
  delayed milestones of sitting, standing, walking
  etc.

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7. COMMUNICATIVE DISORDERS

• EXPRESSIVE LANGUAGE DISORDERS
• It is an impairment in expressive
  language development as demonstrated by score on
  standardized individually administered measures
  of expressive language development substantially
  below those obtained from standardized measures
  of both nonverbal intellectual capacity and
  receptive language development.

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• PHONOLOGICAL DISORDER
• It is failure to use developmentally
  expected speech sounds that are appropriate for
  the individuals age and dialect.
• STUTTERING
• It is disturbance in the normal
  fluency and time pattering of speech that is
  appropriate for the individuals age,
  characterized by frequent repetitions or
  prolongation of sounds or syllables.

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8. PERVASSIVE DEVELOPMENTAL DISORDER

• AUTISTIC DISORDER
• It has markedly abnormal or impaired
  development in social interaction and
  communication and a markedly restricted
  repertoire of activity and interests.
• RETTS DISORDER
• It is development of multiple specific
  deficits following a period of normal functioning
  after birth.
• CHILDHOOD DISINTEGRATIVE DISORDER
• It is a marked regression in multiple
  areas of functioning following a period of at
  least 2 years of apparently normal development.
• ASPERGERS DISORDER
• It is severe and sustained impairment
  in social interaction and the development of
  restricted repetitive patterns of behavior
  interests and activities.

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9. ATTENTION-DEFICIT / HYPERACTIVITY DISORDER.

• CONDUCT DISORDER
• It is a repetitive and persistent
  pattern of behavior in which the basic right of
  others or major age-appropriate societal norms or
  rules are violated.
• OPPOSITIONAL DEFIANT DISORDER..
• It is recurrent pattern of
  negativistic, defiant, disobedient, and hostile
  behavior toward authority figures.

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10. FEEDING AND EATING DIEORDERS OF INFANCy OR
EARLY CHILDHOOD

• PICA
• Eating one or more nonnutritive
  substance on a persistent basis for a period of
  at least one month paint, plastic, string,
  hair, clothes, sand, insects, clay etc.
• RUMINATION DISORDER
• It is the repeated regurgitation and
  re-chewing of food occurring after feeding that
  develops in a infant or child after a period of
  normal functioning and last for at least one
  month.
• ANOREXIA NERVOSA
• Refuses to maintain a minimally normal
  body weight, intensely afraid of gaining weight
• .
• BULIMIA NERVOSA
• Eating in a discrete period of time
  (lt2hr) an amount of food that is definitely
  larger than most individuals would eat under
  similar circumstances.

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11. TIC DISORDER.

• Tic is a sudden, rapid, recurrent, non-rhythmic,
  stereotyped motor movement or vocalization.
• 12. ELIMINATION DISORDER
• ENCOPRESIS
• It is repeated passage of feces into
  inappropriate places - clothing or floor- and is
  mainly involuntary.
• ENURESIS
• Voiding urine during day or at night into
  bed or clothes. This is involuntary.

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13. SEPERATION ANXIETY DISORDER

• Feature is excessive anxiety concerning
  separation from the home or from those to whom
  the person is attached
• SELECTIVE MUTISM
• It is the persistent failure to speak in
  specific social situations where speaking is
  expected, despite speaking in another situations.
• STEREOTYPIC MOVEMENT DISORDER
• It is motor behavior that is repetitive,
  often seemingly driven, and non-functional.

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14.DELIRIUM, DEMENTIA AND AMNESTIC AND OTHER

COGNITIVE DISORDER

• DELIRIUM
• It is characterized by disturbance of
  consciousness and a change in cognition that
  develop over a short period of time.
• DEMENTIA
• Characterized by multiple cognitive
  deficits that include impairment in memory.
• AMESTIC DISORDER
• Characterized by memory impairment in the
  absence of other significant accompanying
  cognitive impairments.

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15. SCHIZOPHRENIA

• It is a mixture of signs and symptoms
  that have been present for one month period,
  associated with marked social or occupational
  dysfunction. The positive symptom appear to
  reflect an excess or distortion of normal
  function, whereas the negative symptom appear to
  reflect a diminution or loss of normal function.
• Paranoid type presence of prominent delusions
  or auditory hallucinations
• Disorganized type- disorganized speech,
  disorganized behavior, inappropriate effect.
• Catatonic type- marked psychomotor disturbance.

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16. MOOD DISORDERS

• Includes disorders that have a
  disturbance in mood as the predominant feature.
  It is divided into 3 parts
• major depressive disorder- characterized by one
  or more major depressive episodes.
• Dysthymic disorder- characterized by at least 2
  year of depressed mood for more days.
• Depressive disorders not otherwise specified-
  includes coding disorders with depressive
  features.

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17.ANXIETY DISORDERS

• Panic attack
• Agarophobia
• Specific phobias
• Social phobias
• Obsessive- compulsive disorder-
• Post-traumatic stress disorder
• Acute stress disorders-
• Generalized anxiety disorder -

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18. SOMATOFORM DISORDER

• Presence of physical symptom that suggests a
  general medical condition-
• Somatization disorder- is a poly symptomatic
  disorder that begins before 30 year.
• Undefined somatization disorder- unexplained
  physical complaint, lasting at least 6 months.
• Conversion disorder- unexplained symptom or
  deficits affecting voluntary motor or sensory
  function suggesting neurological or medical
  condition.
• Pain disorder- pain is predominant.
• Hypochondriasis- preoccupation with fear of
  having or has serious disease.
• Body dysmorphic disorder- preoccupation with
  defect in physical appearance.

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• 19. FACTITIOUS DISORDER
• It is characterized by physical or
  psychological symptom that are intentionally
  produced or feigned in order to assume the sick
  role.
• 20. DISSOCIATIVE DISORDER
• A disruption in the usually integrated
  functions of consciousness, memory, identity or
  perception. It may be sudden or gradual,
  transient or chronic.

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• 21. IMPULSE CONTROL DISORDER
• INTERMITTENT EXPLOSIVE DISORDER.
• Aggressive impulses resulting in
  serious destruction
• KLEPTOMANIA
• Irresistible desire to steal though
  without personal need or monetary purpose
• PYROMANIA
• Presence of multiple episodes of
  deliberate and purposeful fire setting.
• 22. TRICHOTILLOMANIA
• Pulling out of ones own hair that
  results in noticeable hair loss.

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• 23. ADJUSTMENT DISORDER
• Clinically significant emotional or
  behavioral symptoms in response to an
  identifiable psychosocial stressor disappointed
  love, marital problems, business failure, natural
  disaster, homesickness, going to school,
  retirement, etc.

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24. PERSONALITY DISORDERS

• Paranoid PD a pattern of distress and
  suspiciousness.
• Schizoid PD a pattern of detachment from social
  relationship and a restricted range of emotional
  expression.
• Schizotypal PD acute distress in close
  relationship, cognitive or perceptual distortions
  and eccentricities of behavior.
• Antisocial PD pattern of disregard for, and
  violation of, the right of others.
• Borderline PD instability in interpersonal
  relationships, self-image and affects.
• Histrionic PD excessive emotionality and
  attention seeking.
• Narcissistic PD grandiosity, need for
  admiration and lack of empathy.
• Avoidant PD social inhibition, feeling of
  inadequacy, hypersensitivity to negative
  evolution
• Dependent PD - of submissive and clinging
  behavior related to an excessive need to be taken
  care of.
• Obsessive-compulsive PD pattern of
  preoccupation with orderline, perfection and
  control.

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