Dr.

Ravi Paul

Purpose: To bring sense out of a mass of chaotic information It involves grouping of material into various categories according to some known characteristic which is shared in common by members within that category

To provide a common language among health care professionals leading to easy comprehension and effective communication In psychiatry comprehension implies understanding the nature, causes and course of an illness and factors influencing them

By knowing the common characteristics of a particular group, details of its individual members are easily understood Educational, research, administrative, legal, clinical

 The

Diagnostic and Statistical Manual of Mental Disorders (DSM) developed by the American Psychiatric Association in collaboration with other groups of mental health professionals, and The International Classification of Diseases (ICD), developed by the World Health Organization.

International Statistical Congress prepared The International Classification of Causes of Death 1893 The death list was subsequently replaced by causes of morbidity The list was periodically revised every 10 years When WHO came into being the 6th Revision of International Statistical Classification of Diseases and Causes of Death was produced ICD-8 1965 ICD-9 1978 ICD-10 1992 It is available in different versions and different languages

 Chapter

V of ICD-10 was designed to be used internationally for the classification of all diseases. Section (F) is devoted to Mental and Behavioural Disorders Alphanumeric coding system F00 to F99 Alphabet F stands for Mental Disorders The first digit after F stands for the main group of psychiatric disorder F0 ( Organic including symptomatic mental disorders) F3 (Mood Disorders) The second digit after F stands for the sub- category F00 (Dementia in Alzheimers Disease, F01 (Vascular Dementia)

F00-F09 F10-F19 F20-F29 F30-F39 F40-F49 F50-F59

ORGANICINCLUDING SYMPTOMATIC MENTAL DISORDERS MENTAL AND BEHAVIOURAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE USE SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL DISORDERS MOOD DISORDERS NEUROTIC, STRESS RELATED AND SOMATOFORM DISORDERS BEHAVIOURAL SYNDROME ASSOCIATED WITH PHYSIOLOGICAL DISTURBANCE AND PHYSICAL FACTORS DISORDERS OF PERSONALITY AND BEHAVIOUR MENTAL RETARDATION DISORDERS OF PSYCHOLOGICAL DEVELOPMENT BEHAVIOURAL AND EMOTIONAL DISORDERS WITH ONSET USUALLY OCCURING IN CHILDHOOD AND ADOLESCENCE

F60-F69 F70-F79 F80-F89 F90-F99

 Schizophrenia

F20, schizotypal F21 and delusional disorders F22 The digit after the decimal indicates the sub-type of the disorder F20.0 Paranoid Schizophrenia; F20.1 Hebephrenic; F20.2 Catatonic The fifth character is used to classify course F20.00 Continuous; F20.11 Episodic with progressive deficit; F20.25 Episodic with complete remission

 In

1952, the American Psychiatric Association's Committee on Nomenclature and Statistics published the first edition of DSM (DSM-I). Five editions have been published since then: DSM-II (1968); DSM-III (1980); a revised DSM-III, DSM-III-R (1987); DSM-IV (1994); and DSM-IV-TR (TR stands for Text Revision) (2000).

 DSM-IV-TR

was designed to correspond to the 10th revision of ICD (ICD-10), developed in 1992. The DSM-IV-TR is the official psychiatric coding system used in the United States. This was done to ensure uniform reporting of national and international health statistics. All categories used in DSM-IV-TR are found in ICD-10, but not all ICD-10 categories are in DSM-IV-TR.

Axis Axis Axis Axis

I: Clinical Disorder II: Personality Disorder/ Mental Retardation III: General Medical Condition IV: Psychosocial and Environmental Problems

Problems with primary support group Problems related to the social environment Educational problems Occupational problems Housing problems Economic problems Problems with access to health care services Problems related to interaction with the legal system/crime Other psychosocial and environmental problems

Axis V: Global Assessment of Functioning

Mild: Few, if any, symptoms are present in excess of those required to make the diagnosis and symptoms result in no more than minor impairment in social or occupational functioning. Moderate: Symptoms or functional impairment between mildand severeare present. Severe: Many symptoms are present in excess of those required to make the diagnosis, or several symptoms that are particularly severe are present, or the symptoms result in marked impairment in social or occupational functioning.

In Partial Remission: The full criteria for the disorder were previously met but currently only some of the symptoms or the signs of the disorder remain In Full Remission: No longer are any symptoms or signs of the disorder present, but it is still clinically relevant to note the disorder. Remission Vs Recovery: including the characteristic course of the disorder, the length of time since the last period of disturbance, the total duration of the disturbance, and the need for continued evaluation or prophylactic treatment

 When

a person has more than one Axis I disorder, the principal diagnosis is indicated by listing it first. According to DSM-IV-TR, the principal diagnosis is the condition chiefly responsible for the signs and symptoms of the individual's disorder. It may be difficult in situations of dual diagnosis (a substance-related diagnosis such as alcohol dependence accompanied by a non substance-related diagnosis such as schizophrenia), which is the principal diagnosis.

 Example

1: Depression Mr. Phiri is a 35 year old man who has presented with symptoms of low mood for last 2 months. These symptoms started after he was told that his job may be terminated because of the current financial crisis in the company. He felt very hopeless and helpless and resorted to drinking heavily and would come to work drunk. He has been a very shy individual who would find very difficult to handle situations on his own and would rely on others for making decision for him.

 Example

1: Depression Axis I Major depressive disorder, single episode, severe without psychotic features Alcohol abuse Axis II Dependent personality disorder Axis III None Axis IV Threat of job loss (current) Axis V GAF = 35

 Axis

I Alcohol Abuse Axis II No diagnosis Axis III Otitis media, recurrent Axis IV Victim of child neglect (current) Axis V GAF = 53

 Mrs.

Sakala is a 65 year old suffering from hypothyroidism for last 5 years. Currently she presented with low mood, lack of sleep and no interests in day to day activities. During the recent visit to her Ophthalmologist it was found that her angle closure glaucoma is worsening rapidly.

Axis I

293.83

Mood disorder due to hypothyroidism, with depressive features No diagnosis Hypothyroidism Chronic angle-closure glaucoma None

Axis II Axis III

V71.09 244.9 365.23

Axis IV Axis V GAF = 45 GAF = 65

(on admission) (at discharge)