Approaches to classification

Question 1

Two contempory classification systems

Answer 1

• ICD-10 (1992)
• DSM 4 (1994)
• American Psychiatric Association produces DSM system
• WHO commissioned ICD10
• DSM 5 came out in 2013 but there has been much criticism of it and it has not been adopted much except by clinicians communicating with insurers in the USA

Question 2

Operationalised approach

Answer 2

• DSM 3 is an example
• uses precise clinical description of disorders with predefined inclusion and exclusion criteria
• enables algorithm-based clinical diagnosis
• basically a check list

Question 3

Characteristic symptoms

Answer 3

• pertinent for diagnosis

- often found in lots of disorders

Question 4

Discriminating symptoms

Answer 4

• e.g thought insertion

- necessary for diagnosis since they are not found in other diseases

Question 5

Pathognomic symptoms

Answer 5

• if present strongly favour one diagnosis over antoher

- specific to condition

Question 6

Atheoretical approach

Answer 6

• diseases are described according to observed phenomenology
• classification is not based on the understanding of what might be causing the disturbances
• no theory forms the basis of classifications, only neutral observations
• seen in psychoanalysis

Question 7

Descriptive approach

Answer 7

• refers to classifying illnesses on the basis of what constitutes the illness rather than what causes it
• basis of atheoretical approaches

Question 8

Categorical approach

Answer 8

• current classification systems
• we can say if something meets or doesnt meet the diagnostic criteria
• however, gives rise to vague categories and severity is difficult to indicated

Question 9

Multi-axial approach

Answer 9

• helps give holistic assessment
• ICD-10 uses 3 axises. Axis 1- mental disorder, Axis 2- degree of disability, Axis 3- psychosocial problems
• DSM-5 uses 5 axes. Axis 1-clinical disorders, Axis 2-personality disorders/ mental retardation, Axis 3- general medical conditions, Axis 4- psychosocial and environmental problems, Axis 5- Global assessment of functioning

Question 10

ICD-10

Answer 10

• has 21 chapters
• mental disorders= F
• 4 versions of ICD10 for mental disorders exist- CDDG (clinical descriptions and diagnostic guidelines), DCR (diagnositc criteria for research), primary care version, clinical coding manual

Question 11

Proposed changes to ICD11

Answer 11

• presumed aetiological groupings rather than conventional symptoms based groupings
• neurodevelopmental disorders will be in chapter 1
• Bipolar will be split from depressive disorders and placed in a separate chapter
• Dissociative disorders will be split from stress-induced disorders
• OCD will be separated from anxiety disorders
• Factitious disorders will be in separate chapters
• conditions relating to substance missuse will be split up

Question 12

DSM 6

Answer 12

-in 3 sections
Section 1- intro
Section 2- outline
3- list of conditions
-removal of subtypes of schizophrenia, 3 core symptoms (delusions, hallucinations and disorganised speech) seen. Bereavement no longer an exclusion for depression
-aspergers merged with ASD
-ADHD age criteria relaxed
-anorexia does not require amennorhea
-OCD and PTSD are different chapters to Anxiety
-new hoarding disorder, excoriation disorder