Klasifikasi Gangguan Jiwa

MENTAL DISORDER
CLASSIFICATION
&
MULTIAXIAL
EVALUATION
Modified of
Dr. Gitayanti Hadisukanto, SpKJ(K)s
Mentally Healthy?
Mentally Healthy
a. Feeling healthy and happily

b. Facing the life challenges
c. Acceptance to others
d. Positive attitude toward their life and others
Mental Disorder or Mentally Ill?
Mentally Ill or Mental Disorder

Clinically significantly disturbance in
mind, feeling, or behaviour
Making distress and dysfunction-disability
for the person and the environment
MENTAL DISORDER
December2009
irmiakusumadewi@yahoo.com
Note:
The concept of normality is
strongly associated with human
values and cultures, which is vary.
What is considered normal in one
culture could be considered
abnormal in another .
MENTAL DISORDER
CLASSIFICATION
December2009
PPDGJ-III
Pedoman
Based
Penggolongan dan Diagnosis

Gangguan Jiwa di Indonesia III
on ICD-10 Classification of
Mental and Behavioural Disorders
(International Classification of
Diseases) & DSM-IV (Diagnosis and
Statistical Manual of Mental Disorder)
8
in 10 blocks:
Blocks F0 F9
F0 F5 are based on
hierarchy
Vertical arrangement of group
based on rank.
A group on a higher rank /
hierarchy have more attributes
than the one on the lower
Blocks
December2009
Grouped
F0
Organic, incl. symptomatic mental disorders
F1
Mental and behavioral disorders due to
psychoactive substance use
F2
Schizophrenia, schizotypal and delusional disorders
(incl. acute and transient psychotic disorders)
F3
Mood (affective) disorders
F4
Neurotic, stress related and somatoform disorders
F5
Behavioral syndromes associated with
physiological disturbances and physical factors 10
December2009
THE GROUPINGS OF MENTAL DISORDERS

BASED ARE:
December2009
F6
Disorders of adult personality and behavior

F7
Mental Retardation
F8
Disorders of psychological development
F9
Behavioral and emotional disorders with
onset usually occurring in childhood and
adolescence
11
due to physiological changes in the brain
December2009
F0
Organic, incl. symptomatic, mental
disorders
12
Dementia in Alzheimers Disease

Vascular Dementia
Dementia in other disease classified elsewhere
Unspecified dementia
Organic amnesic syndrome, not induced by
alcohol and other psychoactive substances
F05 Delirium, not induced by alcohol and other
psychoactive substances
F06 Other mental disorders due to brain damage
and dysfunction and to physical disease
F07 Personality and behavioral disorders due to
brain disease, damage and dysfunction
F09 Unspecified organic or symptomatic mental
disorder
December2009
F00
F01
F02
F03
F04
13
December2009
F1
Mental and behavioral disorders
due to psychoactive substance
use
14
December2009
F1 :MENTAL & BEHAVIORAL DISORDERS

DUE TO PSYCHOACTIVE SUBSTANCE USE
F10.- Mental and behavioral disorders due to use of

alcohol and other substances
F11.-due to use of opioids
F12.-due to use of cannabinoids
F13.-due to use of sedatives or hypnotics
F14.-due to use of cocaine
F15.-due to use of other stimulants incl.caffeine
F16.-due to use of hallucinogens
F17.-due to use of tobacco
F18.-due to use of volatile solvents
F19.-due to multiple drug use and use of other 15
psychoactive substances
Acute intoxication
Harmful use/ Substance abuse
Dependence syndrome
Withdrawal state
Withdrawal state with delirium
Psychotic disorder
Amnesic syndrome / Amnesic disorder
Residual and late-onset psychotic disorder
Other mental and behavioral disorders
Unspecified mental and behavioral disorder
16
F1x.0
F1x.1
F1x.2
F1x.3
F1x.4
F1x.5
F1x.6
F1x.7
F1x.8
F1x.9
December2009
F1 :MENTAL AND BEHAVIORAL

DISORDERS DUE TO PSYCHOACTIVE
SUBSTANCE USE
December2009
F2
Schizophrenia, schizotypal and
delusional disorders (incl. acute and
transient psychotic disorders)
17
The mental disorders in this block

(except Schizotypal disorder) have a
common feature:
psychotic symptoms, e.g. having
hallucinations, delusions and
gross behavioral disturbances
with poor insight to the
psychopathology
December2009
F2
SCHIZOPHRENIA, SCHIZOTYPAL AND
DELUSIONAL DISORDERS ( AND OTHER
PSYCHOTIC DISORDERS
18
December2009
F20 Schizophrenia
F20.0 Paranoid schizophrenia
F20.1 Hebephrenic schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.4 Post-schizophrenic depression
F20.5 Residual schizophrenia
F20.6 Simple schizophrenia
F20.8 Other schizophrenia
F20.9 Schizophrenia, unspecified
19
F21 Schizotypal disorder

F22 Persistent delusional disorders
F23 Acute and transient psychotic
disorders
F24 Induced delusional disorder
F25 Schizoaffective disorders
F28 Other nonorganic psychotic
disorders
December2009
F2 :SCHIZOPHRENIA, SCHIZOTYPAL
AND DELUSIONAL DISORDERS ( AND
OTHER PSYCHOTIC DISORDERS)
20
December2009
F3
Mood (affective) disorders
21
Most of the disorders tend to be

recurrent, and the onset of individual
episodes is often related to stressful
events or situations
Changes in mood or affect, usually to

depression or elation. The mood
changes is usually accompanied by
changes in the overall level of activity
December2009
F3
MOOD ( AFFECTIVE )
DISORDERS
22
F30 Manic episode

F31 Bipolar affective disorder
F32 Depressive episode
F33 Recurrent depressive disorder
F34 Persistent mood (affective
disorder)
F38 Other mood (affective) disorder
F39 Unspecified mood (affective)
disorder
December2009
F3
MOOD (AFFECTIVE) DISORDERS
23
December2009
F4
Neurotic, stress related and
somatoform disorders
24
Mental
disorders in this block have a common

similarity by not having clinically identifiable
physical disease as etiology, neither any
psychotic symptoms nor mood disorder as a
predominant feature,
In some cases there could be a mixture of
symptoms (coexistent depression and anxiety
being by far the most frequent)
A substantial proportion of the mental
disorders in this block have a substantial
(although uncertain ) association with
psychological causation.
December2009
F4 :NEUROTIC, STRESS-RELATED &

SOMATOFORM DISORDERS
25
F4 : NEUROTIC, STRESS RELATED AND

SOMATOFORM DISORDERS
December2009
F40 Phobic anxiety disorders

F41 Other Anxiety disorders
F42 Obsessive-compulsive disorder
F43 Reaction to severe stress, and
adjustment disorders
F44 Dissociative (conversion) disorders
F45 Somatoform disorders
F48 Other neurotic disorders
26
December2009
F5
Behavioral syndromes associated with
physiological disturbances and physical
factors
27
F51 Non organic sleep disorders

F52 Sexual dysfunction, not caused by organic
disorder or disease
F53 Mental and behavioral disorders associated
with puerpuerium, not elsewhere classified
F54 Psychological and behavioral factors
associated with disorders or diseases classified
elsewhere
F55 Abuse of non-dependence producing
substances
F59 Unspecified behavioral syndromes
associated
with physiological disturbances and physical
factors
December2009
F5: BEHAVIORAL SYNDROMES

ASSOCIATED WITH PHYSIOLOGICAL
DISTURBANCES AND PHYSICAL
F50
Eating disorders
FACTORS
28
Disorders of adult personality and

behavior
December2009
F6
29
Includes a variety of clinically significant

conditions and behavior patterns which
tend to be persistent and are the
expression of an individuals
characteristic lifestyle and mode of
relating to self and others.
December2009
F6 : DISORDERS OF ADULT PERSONALITY

AND BEHAVIOR
Some of the these conditions and

patterns of behavior emerge early in the
course of individual development, as a
result of both constitutional factors and
social experience, while others are
acquired later in life.
30
F60 Specific personality disorders
F61 Mixed and other personality disorders

F62 Enduring personality changes, not attributable to
F63 Habit and impulse disorders
F64 Gender identity disorders
F65 Disorders of sexual preference
F66 Psychological and behavioral disorders associated
with sexual development and orientation
F68 Other disorders of adult personality and behavior
brain damage and disease
December2009
F6
DISORDERS OF ADULT PERSONALITY AND
BEHAVIOR
F69 Unspecified disorder of adult personality and

behavior
PS. Homosexuality is not categorized as a mental disorder, it
31
is now identified as a human identity, just like
heterosexuality and any other human identities (race, skin
color , religion, etc.)
Mental retardation is a condition of

arrested or incomplete development of
the mind, which is especially
characterized by impairment of skills
manifested during the developmental
period, which contribute to the overall
level of intelligence, i.e. cognitive,
language, motor, and social abilities (IQ
under 70)
December2009
F7
MENTAL RETARDATION
Adaptive behavior is always impaired

Retardation can occur with or without any
other mental or physical disorder
32
F70 Mild mental retardation (IQ 5069)

F71 Moderate mental retardation
(IQ 3549)
F72 Severe mental retardation
(IQ 20 -34)
F73 Profound mental retardation
(IQ under 20)
F78 Other mental retardation
F79 Unspecified mental retardation
December2009
F7
MENTAL RETARDATION
33
December2009
F8: DISORDERS OF PSYCHOLOGICAL

DEVELOPMENT
Disorders in this block have the following

features in common:
(a) An onset that is invariably during infancy or
childhood
(b) An impairment or delay in the development
of functions that are strongly related to
biological maturation of the central
nervous system
(c) A steady course that does not involve the
34
remissions and relapses that tend to be
characteristic of many mental disorders
F8
DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
December2009
F80 Specific developmental disorders of

speech and language
scholastic skills
motor function
F83 Mixed specific developmental disorders
F84 Pervasive developmental disorders
F88 Other disorders of psychological
development
F89 Unspecified disorder of psychological
35
development
December2009
F9
BEHAVIORAL AND EMOTIONAL DISORDERS WITH
ONSET
USUALLY OCCURRING
F90 Hyperkinetic
disorders IN CHILDHOOD OR
ADOLESCENCE
F91 Conduct disorders
F92 Mixed disorders of conduct and emotions
F93 Emotional disorders with onset specific to
childhood
F94 Disorders of social functioning with onset
specific to childhood and adolescence
F95 Tic disorders
F98 Other behavioral and emotional disorders with
onset usually occurring in childhood and
adolescence
36
F99 Unspecified mental disorder
MULTIAXIAL
EVALUATION
Involves an assessment on
several axes which refers to a
different domain of information
that may help the clinician plan
treatment & predict outcome
December2009
MULTIAXIAL SYSTEM
38
Axis I
Axis II
Axis III
Axis IV
Problems
Axis V
of clinical attention
:Personality Disorder
Mental Retardation
:General Medical Condition
:Psychosocial & Enviromental
:Global Assessment of Functioning
(GAF)
focus
:Clinical Disorder (Block F0F9)

Other conditiona that may be a
December2009
MULTIAXIAL EVALUATION
39
To
understand patients comprehensively
the patients aspects are highlighted,

including his/ her quality of life
Capturing the complexity of clinical situation
Describing the heterogenity of individuals
presenting with the same diagnosis
Promotes the application of biopsychosocial
model in clinical, education & research setting
all
December2009
THE AIM OF MULTIAXIAL EVALUATION
So that
The
therapy could also be planned

comprehensively
40
AXIS I
It
of Clinical Disorders & other

conditions that may be a focus of clinical
attention
All mental disorders from block F0 to F9,
except F6
F6 is Personality Disorder which is
classified in axis II
Block F7, F8 & F9 are mental disorders
which its onset start during childhood or
adolescent
December2009
Consist
can be found in adult if the condition

continues during the adult years
41
Block F0-F6 can be manifested in children &
adolescent too, if the diagnostic criteria is fulfill
code
problems which are not fulfill

diagnostic criterias but make a person
seek for help
or medical conditions that need attention
or therapy.
Life
December2009
AXIS I - CONT
42
Consist
of
disorders and
mental retardation
personality
December2009
AXIS II
43
Physical
Causative:
e.g kidney failure causing
delirium
The result of a mental disorder: e.g
alcohol gastritis secondary to alcohol
dependence
Unrelated to the mental disorder
disorder or general
medical condition that is present
in addition to the mental disorder
The physical condition may be
December2009
AXIS III
44
a medical cond is causative

or causually related to a mental
dis a mental dis due to a
general medical cond is listed on
Axis I & the general med cond is
listed on both Axis I and Axis III
When
December2009
AXIS III - CONT
45
December2009
AXIS IV
To
code the psychosocial & enviromental

problems
that
The
evaluation of of stressor:
Based
on a clinicians assessment oh the stress that an

average person with similar sociocutural values &
circumstances would experience from the psychosocial
stressor
Stressor:
Positve:
e.g job promotion

Negative: loss of a love one
To
contribute significantly to the development or

exacerbation of the current disorder
formulate a treament plan:
Attempt
to remove psychosicial stressor

Help the patient cope with them
46
Psychosocial & enviromental problems:

with primary support group
Problems related to the social enviromental
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 & enviromental problems
Problems
December2009
AXIS IV - CONT
47
Global
Scale
in which clinicians judge patients

overall levels of functioning during a
particular time
At the time of the evaluation
Patients highest level of functioning for at
least a few months during the past year
(GAF)
assessment of functioning
December2009
AXIS V
major area of functioning:
Social func
Occupational func
Psychological func
48
The
GAF scale:
on a continuum of mental health

& mental illness
A 100-point scale
100 representing the highest level of
functioning in all areas
The
Based
December2009
AXIS V - CONT
information of GAF:
Is
useful in planning treatment,

measuring its impact & predicting
outcome
49

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MENTAL DISORDER

a. Feeling healthy and happily

Mental Disorder or Mentally Ill?

Mentally Ill or Mental Disorder

Penggolongan dan Diagnosis

THE GROUPINGS OF MENTAL DISORDERS

Disorders of adult personality and behavior

due to physiological changes in the brain

Dementia in Alzheimers Disease

F1 :MENTAL & BEHAVIORAL DISORDERS

F10.- Mental and behavioral disorders due to use of

F1 :MENTAL AND BEHAVIORAL

The mental disorders in this block

F21 Schizotypal disorder

Most of the disorders tend to be

Changes in mood or affect, usually to

F30 Manic episode

disorders in this block have a common

F4 :NEUROTIC, STRESS-RELATED &

F4 : NEUROTIC, STRESS RELATED AND

F40 Phobic anxiety disorders

F51 Non organic sleep disorders

F5: BEHAVIORAL SYNDROMES

Disorders of adult personality and

Includes a variety of clinically significant

F6 : DISORDERS OF ADULT PERSONALITY

Some of the these conditions and

F60 Specific personality disorders

F61 Mixed and other personality disorders

brain damage and disease

F69 Unspecified disorder of adult personality and

Mental retardation is a condition of

Adaptive behavior is always impaired

F70 Mild mental retardation (IQ 5069)

F8: DISORDERS OF PSYCHOLOGICAL

Disorders in this block have the following

F80 Specific developmental disorders of

:Clinical Disorder (Block F0F9)

understand patients comprehensively

the patients aspects are highlighted,

THE AIM OF MULTIAXIAL EVALUATION

therapy could also be planned

of Clinical Disorders & other

can be found in adult if the condition

problems which are not fulfill

e.g kidney failure causing

a medical cond is causative

AXIS III - CONT

code the psychosocial & enviromental

on a clinicians assessment oh the stress that an

e.g job promotion

contribute significantly to the development or

formulate a treament plan:

to remove psychosicial stressor

Psychosocial & enviromental problems:

in which clinicians judge patients

major area of functioning:

on a continuum of mental health

useful in planning treatment,

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