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MENTAL DISORDER

CLASSIFICATION
&
MULTIAXIAL EVALUATION

Dr. Gitayanti Hadisukanto, SpKJ(K)

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MENTAL DISORDER
CLASSIFICATION

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PPDGJ-III
 Pedoman Penggolongan dan
Diagnosis Gangguan Jiwa di
Indonesia III
• Based on ‘ICD-10 Classification of Mental
and Behavioural Disorders’ (International
Classification of Diseases) & DSM-IV
(Diagnosis and Statistical Manual of
Mental Disorder)

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 The manifestations of human
behavior is usually manifested in
three aspects:
1. Behavior
2. Thinking
3. Emotion

Note:
• Not all manifestation of the three
aspects that looks different with “normal
behavior” are mental disorders

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Mental Disorder
Is a clinically significant behavior or
psychological syndrome associated with
distress or disability, not just an expected
response to a particular event or limited to
relations between a person and society.

Note:
The term “normal” for human behavior in connotation with the
concept of mental disorder is not used anymore, because the
concept of “normality” is strongly associated with human values
and cultures, which is very diverse. What is considered
“normal” in one culture could be considered “abnormal” in
another culture.

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Mental disorders are grouped in 10 blocks:

Blocks F0 – F9

Blocks F0 –F5 are based on hierarchy


• Hierarchy means the (vertical) arrangement of


groups based on rank.
• A group on a higher rank / higher hierarchy
meansthat the group has more attributes than the
ones on the lower rank / hierarchy

The consequence of this hierarchical system in


block F0 – F5 is that
• one cannot diagnose a mental disorder categorized
in a lower hierarchy of F0 – F5, unless mental
disorders with similar features at the higher
hierarchy in block F0 – F5 have been eliminated
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 F60: Specific personality disorders

 F61: Mixed personality disorders

 Block F7: Mental retardation

 Blocks F7,F8 and F9


• are mental disorders which onset are in
infancy or childhood (or adolescence),
some of these disorders, (like block F8)
can also be used for adults if the
condition continues during the adult years
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The groupings of Mental Disorders based are:

 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 8
 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
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F0
Organic, incl. symptomatic, mental disorders

Mental disorders in this block are the


result of physiological changes in the
brain,

Note:
this is in contrast with mental
disorders which are the result of a of
psychological impact of knowing about
having a physical disease)

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F0: Organic, incl. symptomatic, mental disorders

F00 Dementia in Alzheimer’s Disease


F01 Vascular Dementia
F02 Dementia in other disease classified elsewhere
F03 Unspecified dementia
F04 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
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F1
Mental and 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
psychoactive substances
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F1
Mental and behavioral disorders due to psychoactive
substance use

The types of mental disorders are:


F1x.0 Acute intoxication
F1x.1 Harmful use/ Substance abuse
F1x.2 Dependence syndrome
F1x.3 Withdrawal state
F1x.4 Withdrawal state with delirium
F1x.5 Psychotic disorder
F1x.6 Amnesic syndrome / Amnestic disorder
F1x.7 Residual and late-onset psychotic disorder
F1x.8 Other mental and behavioral disorders
F1x.9 Unspecified mental and behavioral disorder
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F2
Schizophrenia, schizotypal and delusional disorders ( and other psychotic
disorders

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

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F2
Schizophrenia, schizotypal and delusional disorders
( and other psychotic disorders)

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 schizophenia
• F20.8 Other schizophrenia
• F20.9 Schizophrenia, unspecified 15
F2
Schizophrenia, schizotypal and delusional disorders
( and other psychotic disorders)

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
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F3
Mood ( affective ) disorders
Fundamental disturbance in the
mental disorders in this block is:
a change in mood or affect, usually
to depression or elation. The mood
change is usually accompanied by a change
in the overall level of activity

Most of the disorders tend to be


recurrent, and the onset of individual
episodes is often related to stressful
events or situations 17
F3
Mood (affective) disorders

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

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F4
Neurotic, stress-related and somatoform disorders

 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.
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F4
Neurotic, stress related and somatoform disorders

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
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F5
Behavioral syndromes associated with physiological disturbances
and physical factors

F50 Eating disorders


F51 Non organic sleep disorders
F52 Sexual dysfunction, not caused by organic
disorder or disease
F53 Mental and behavioral disorders associated
with puerperium, 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 21
F6
Disorders of adult personality and behavior

This block includes a variety of clinically


significant conditions and behavior patterns
which tend to be persistent and are the
expression of an individual‘s characteristic
lifestyle and mode of relating to self and
others.

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.
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F6
Disorders of adult personality and behavior
F60 Specific personality disorders
F61 Mixed and other personality disorders
F62 Enduring personality changes, not attributable to
brain damage and disease
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
F69 Unspecified disorder of adult personality and
behavior
PS. Homosexuality is not categorized as a mental disorder, it is
now identified as a human identity, just like heterosexuality and
any other human identities (race, skin color , religion, etc.)
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F7
Mental retardation
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)

Adaptive behavior is always impaired

Retardation can occur with or without any


other mental or physical disorder

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F7
Mental retardation

F70 Mild mental retardation (IQ 50–69)


F71 Moderate mental retardation
(IQ 35–49)
F72 Severe mental retardation
(IQ 20 -34)
F73 Profound mental retardation
(IQ under 20)
F78 Other mental retardation
F79 Unspecified mental retardation
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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

remissions and relapses that tend to be


characteristic of many mental disorders
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F8
Disorders of psychological development

F80 Specific developmental disorders of


speech and language
F81 Specific developmental disorders of
scholastic skills
F82 Specific developmental disorders of
motor function
F83 Mixed specific developmental disorders
F84 Pervasive developmental disorders
F88 Other disorders of psychological
development
F89 Unspecified disorder of psychological
development 27
F9
Behavioral and emotional disorders with onset usually occurring in childhood or
adolescence

F90 Hyperkinetic disorders


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
F99 Unspecified mental disorder
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MULTIAXIAL EVALUATION

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MULTIAXIAL SYSTEM
Involves an assessment on several
axes which refers to a different domain
of information that may help the
clinician plan treatment & predict
outcome

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The aim of multiaxial evaluation
 To understand patients comprehensively
• all the patient’s 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
So that

 The therapy could also be planned


comprehensively 31
MULTIAXIAL EVALUATION

 Axis I :Clinical Disorder (Block F0–F9)


Other conditiona that may be a focus
of clinical attention
 Axis II :Personality Disorder
Mental Retardation
Axis III :General Medical Condition
Axis IV :Psychosocial & Enviromental Problems
Axis V :Global Assessment of Functioning
(GAF)

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AXIS I
 Consist 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
• It can be found in adult if the condition
continues during the adult years
• Block F0-F6 can be manifested in children &
adolescent too, if the diagnostic criteria is fulfill 33
AXIS I - cont
 Z code
• Life problems which are not fulfill
diagnostic criterias but make a person
seek for help
• or medical conditions that need attention
or therapy.

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AXIS II
 Consist of
• personality disorders and
• mental retardation

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AXIS III
 Physical disorder or general medical
condition that is present in addition
to the mental disorder
 The physical condition may be

• 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
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AXIS III - cont

When 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

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AXIS IV
 To code the psychosicial & enviromental
problems
• that contribute significantly to the development or
exacerbation of the current disorder
 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 formulate e treament plan:
• Attempt to remove psychosicial stressor
• Help the patient cope with them
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AXIS IV - cont
Psychosocial & enviromental problems:
• 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

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AXIS V
 Global assessment of functioning
(GAF)
• 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


• 3 major area of functioning:
 Social func
 Occupational func

 Psychological func
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AXIS V - cont
 The GAF scale:
• Based on a continuum of mental health &
mental illness
• A 100-point scale
• 100 representing the highest level of
functioning in all areas

 The information of GAF:


• Is useful in planning treatment, measuring
its impact & predicting outcome
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