the dsmiv and_icd10_classification_systems_(background)
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TRANSCRIPT
THE DSM AND ICD THE DSM AND ICD PSYCHIATRIC PSYCHIATRIC
CLASSIFICATION SYSTEMSCLASSIFICATION SYSTEMS
FACILITATES CHARACTERIZATION, FACILITATES CHARACTERIZATION, COMMUNICATION AND RESEARCH COMMUNICATION AND RESEARCH
COMPLEXITY OF PHENOMENA ARE COMPLEXITY OF PHENOMENA ARE REDUCEDREDUCED
TWO VIEWS:TWO VIEWS:
DIMENSIONALIZERS – DIMENSIONS OF DIMENSIONALIZERS – DIMENSIONS OF FUNCTIONING,DIFFERENT FUNCTIONING,DIFFERENT PSYCHIATRIC D/OPSYCHIATRIC D/O
CATEGORIZERS – SPECIFIC GROUPS CATEGORIZERS – SPECIFIC GROUPS OF SYMPTOMS – REFLECT OF SYMPTOMS – REFLECT PSYCHIATRIC SYNDROMESPSYCHIATRIC SYNDROMES
IMPORTANCE OF CLASSIFICATION FOR IMPORTANCE OF CLASSIFICATION FOR PSYCHIATRIC DIAGNOSISPSYCHIATRIC DIAGNOSIS
DISTINGUISH BET DIFF PSYCHIATRIC DISTINGUISH BET DIFF PSYCHIATRIC DIAGNOSISDIAGNOSIS
COMMON LANGUAGE AMONGST HEALTH COMMON LANGUAGE AMONGST HEALTH PROFESSIONALS ENSURES PROFESSIONALS ENSURES RELIABILITY,COMMUNICATION AND RELIABILITY,COMMUNICATION AND STATISTICAL REPORTINGSTATISTICAL REPORTING
EFFECTIVE TREATMENTEFFECTIVE TREATMENT
STANDARD FRAME OF REFERENCESTANDARD FRAME OF REFERENCE
TEACHING-INTERNATIONAL REFERENCE TEACHING-INTERNATIONAL REFERENCE SYSTEMSSYSTEMS
IMPORTANCE OF CLASSIFICATION IMPORTANCE OF CLASSIFICATION CONT.CONT.
PUBLIC ACESS – IMPROVES COMMUNICATIONPUBLIC ACESS – IMPROVES COMMUNICATION
IMPROVES RELIABILITY OF PSYCHIATRIC IMPROVES RELIABILITY OF PSYCHIATRIC DIAGNOSIS IN RESEARCH SETTINGSDIAGNOSIS IN RESEARCH SETTINGS
UNDERSTANDING OF CAUSES AND UNDERSTANDING OF CAUSES AND PROCESSES OF MENTAL DISORDERSPROCESSES OF MENTAL DISORDERS
TWO MOST ACCEPTED PSYCHIATRIC TWO MOST ACCEPTED PSYCHIATRIC CLASSIFICATIONSCLASSIFICATIONS
DIAGNOSTIC AND STATISTICAL DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS MANUAL OF MENTAL DISORDERS (DSM IV TR)(DSM IV TR)
INTERNATIONAL CLASSIFICATION OF INTERNATIONAL CLASSIFICATION OF DISEASES (ICD 10)DISEASES (ICD 10)
CLINICAL DESCRIPTIONS BASED ON CLINICAL DESCRIPTIONS BASED ON PHENOMENOLOGICAL APPROACHESPHENOMENOLOGICAL APPROACHES
DSMDSM
CATEGORICAL CLASSIFICATIONCATEGORICAL CLASSIFICATION
DIVIDES MENTAL DISORDERSDIVIDES MENTAL DISORDERS
CRITERIA SETS – DEFINING FEATURESCRITERIA SETS – DEFINING FEATURES
HISTORY AND BACKGROUNDHISTORY AND BACKGROUND
FIRST DSM – AMERICAN PSYCHIATRIC FIRST DSM – AMERICAN PSYCHIATRIC ASSOCIATION COMMITTEEASSOCIATION COMMITTEEDSM II – 1968DSM II – 1968DSM III – 1980DSM III – 1980REVISED DSM III – 1987REVISED DSM III – 1987DSM III-R – 1987DSM III-R – 1987DSM IV – 1994DSM IV – 1994DSM-IV-TR – 2000DSM-IV-TR – 2000
HISTORY AND BACKGROUNDHISTORY AND BACKGROUND
WHO – ICD-6WHO – ICD-6
SECTION ON MENTAL DISORDERSSECTION ON MENTAL DISORDERS
APA – VARIANT OF ICD-6APA – VARIANT OF ICD-6
DSM-1 – FIRST OFFICIAL MANUAL OF DSM-1 – FIRST OFFICIAL MANUAL OF CLINICAL MENTAL DISORDERSCLINICAL MENTAL DISORDERS
PSYCHOBIOLOGICAL VIEWPSYCHOBIOLOGICAL VIEW
HISTORY AND BACKGROUNDHISTORY AND BACKGROUND
DSM-II CORRELATED WITH ICD-8DSM-II CORRELATED WITH ICD-8
DSM-III CORRELATED WITH 1CD-9DSM-III CORRELATED WITH 1CD-9
DSM-IIIDSM-III– EXPLICIT DIAGNOSTIC CRITERIAEXPLICIT DIAGNOSTIC CRITERIA– MULTI-AXIAL SYSTEMMULTI-AXIAL SYSTEM– DESCRIPTIVE MEDICAL DESCRIPTIVE MEDICAL
NOMENCLATURENOMENCLATURE
HISTORY AND BACKGROUNDHISTORY AND BACKGROUND
DSM-III-R – EMPIRICAL RESEARCHDSM-III-R – EMPIRICAL RESEARCH
DSM-IV – SYSTEMATIC REVIEWS AND DSM-IV – SYSTEMATIC REVIEWS AND FOCUSED FIELD TRIALSFOCUSED FIELD TRIALS
GOAL – INCREASE PRACTICALITY AND GOAL – INCREASE PRACTICALITY AND CLINICAL UTILITYCLINICAL UTILITY
DSM IV-TR – NOS CATEGORYDSM IV-TR – NOS CATEGORY
DSM IV-TRDSM IV-TR
OFFICIAL CODING SYSTEM IN USAOFFICIAL CODING SYSTEM IN USA
ATHEORETICAL APPROACH TO CAUSESATHEORETICAL APPROACH TO CAUSES
DESCRIBES MANIFESTATIONS AND DESCRIBES MANIFESTATIONS AND DESCRIPTIONS OF CLINICAL FEATURES OF DESCRIPTIONS OF CLINICAL FEATURES OF MENTAL D/OMENTAL D/O
SPECIFIC DIAGNOSTIC CRITERIASPECIFIC DIAGNOSTIC CRITERIA
CRITERIA INCREASE RELIABILITYCRITERIA INCREASE RELIABILITY
DSM IV-TRDSM IV-TRSYSTEMATIC DESCRIPTIONS:SYSTEMATIC DESCRIPTIONS:
AGEAGECULTURECULTUREGENDER FEATURESGENDER FEATURESPREVALENCE, INCIDENCEPREVALENCE, INCIDENCERISK , COURSERISK , COURSECOMPLICATIONSCOMPLICATIONSPREDISPOSING FACTORSPREDISPOSING FACTORSFAMILIAL PATTERNSFAMILIAL PATTERNSDIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSISLAB FINDINGSLAB FINDINGSPHYSICAL EXAMINATION SIGNS AND SYMPTOMSPHYSICAL EXAMINATION SIGNS AND SYMPTOMS
DSM IV-TRDSM IV-TR
365 DISORDERS365 DISORDERS
17 SECTIONS17 SECTIONS
PROPOSED DIAGNOSTIC CRITERIAPROPOSED DIAGNOSTIC CRITERIA
DSM IV-TR ORGANIZATIONAL DSM IV-TR ORGANIZATIONAL PLANPLAN
16 MAJOR DIAGNOSTIC CLASSES16 MAJOR DIAGNOSTIC CLASSESOTHER CONDITIONS THAT MAY BE FOCUS OTHER CONDITIONS THAT MAY BE FOCUS OF CLINICAL ATTENTIONOF CLINICAL ATTENTION11 APPENDICES11 APPENDICES
DIFFERENTIAL DXDIFFERENTIAL DXGLOSSARYGLOSSARYCHANGES IN DSM-IV-TRCHANGES IN DSM-IV-TRCLASSIFICATION WITH ICD-10CLASSIFICATION WITH ICD-10CULTURAL FORMULATION, ETCCULTURAL FORMULATION, ETC
AIMS OF DSM IV-TRAIMS OF DSM IV-TR
CLEAR DIAGNOSTIC CATEGORIESCLEAR DIAGNOSTIC CATEGORIES
DX, COMMUNICATION, STUDY AND TREATDX, COMMUNICATION, STUDY AND TREAT
DIAGNOSTIC CRITERIA FOR RESEARCH PURPOSESDIAGNOSTIC CRITERIA FOR RESEARCH PURPOSES
RECORD KEEPING, DATA COLLECTIONRECORD KEEPING, DATA COLLECTION
REPORTING TO 3REPORTING TO 3RDRD PARTIES – GOVN, PRIVATE PARTIES – GOVN, PRIVATE INSURERSINSURERS
SUBTYPESSUBTYPES
SPECIFIERSSPECIFIERS
INCREASED SPECIFICITYINCREASED SPECIFICITY
AIMS OF DSM IV-TRAIMS OF DSM IV-TR
CLINICAL DECISIONSCLINICAL DECISIONS
RX SETTINGRX SETTING
MODE OF RXMODE OF RX
DURATION OF RXDURATION OF RX
SEVERITY AND COURSE SEVERITY AND COURSE SPECIFIERSSPECIFIERS
MILD, MODERATE, SEVERE ONLY WHEN MILD, MODERATE, SEVERE ONLY WHEN FULL CRITERIA METFULL CRITERIA MET
INTENSITY OF S AND SINTENSITY OF S AND S
IMPAIRMENT IN OCCUPATIONAL AND IMPAIRMENT IN OCCUPATIONAL AND FUNCTIONAL IMPAIRMENTFUNCTIONAL IMPAIRMENT
MRMR
CONDUCT D/OCONDUCT D/O
MANIC EPISODEMANIC EPISODE
MAJOR DEPRESSIVE EPISODEMAJOR DEPRESSIVE EPISODE
SEVERITY AND COURSE SEVERITY AND COURSE SPECIFIERSSPECIFIERS
PARTIAL REMISSION – FULL CRITERIA PREVIOUSLY PARTIAL REMISSION – FULL CRITERIA PREVIOUSLY METMET
FULL REMISSION – NO LONGER S AND S, STILL FULL REMISSION – NO LONGER S AND S, STILL CLINICALLY RELEVANT CLINICALLY RELEVANT
PARTIAL AND FULL REMISSION FOR:PARTIAL AND FULL REMISSION FOR:MANIC EPISODEMANIC EPISODEMAJOR DEPRESSIVE EPISODEMAJOR DEPRESSIVE EPISODESUBSTANCE DEPENDANCESUBSTANCE DEPENDANCE
PRIOR HISTORY – USEFUL TO NOTE HX OF PRIOR HISTORY – USEFUL TO NOTE HX OF CRITERIA PREVIOUSLY MET BUT NOW RECOVEREDCRITERIA PREVIOUSLY MET BUT NOW RECOVERED
RECURRENCERECURRENCE
FULL CRITERIA NO LONGER METFULL CRITERIA NO LONGER MET
PARTIAL, FULL REMISSION, PARTIAL, FULL REMISSION, RECOVERYRECOVERY
DO NOT MEET FULL THRESHOLD OF DO NOT MEET FULL THRESHOLD OF D/O ACCORDING TO SPECIFIED D/O ACCORDING TO SPECIFIED CRITERIACRITERIA
NOS CATEGORIESNOS CATEGORIES
DIVERSITY OF CLINICAL DIVERSITY OF CLINICAL PRESENTATIONPRESENTATION4 SITUATIONS:4 SITUATIONS:– CRITERIA NOT MET FOR SPECIFIC D/O EG CRITERIA NOT MET FOR SPECIFIC D/O EG
ATYPICAL, MIXED PICTUREATYPICAL, MIXED PICTURE– DOES NOT CONFORM TO DSM IV DOES NOT CONFORM TO DSM IV
CLASSIFICATION BUTCLINICAL CLASSIFICATION BUTCLINICAL SIGNIFICANT DISTRESSSIGNIFICANT DISTRESS
– AETIOLOGY UNCERTAINAETIOLOGY UNCERTAIN– INSUFFICIENT DATA, INCONSISTENT INSUFFICIENT DATA, INCONSISTENT
INFORMATIONINFORMATION
MULTIAXIAL ASSESSMENTMULTIAXIAL ASSESSMENT
5 AXES5 AXES
– I – CLINICAL D/O, OTHER CONDITIONS I – CLINICAL D/O, OTHER CONDITIONS FOCUS OF CLINICAL ATTENTIONFOCUS OF CLINICAL ATTENTION
– II – PERSONALITY D/OII – PERSONALITY D/O
– III – GMCIII – GMC
– IV – PSYCHOSOCIAL, ENVIRONMENTALIV – PSYCHOSOCIAL, ENVIRONMENTAL
– V – GAFV – GAF
MULTIAXIAL ASSESSMENTMULTIAXIAL ASSESSMENT
DIFFERENT DOMAINS OF INFORMATIONDIFFERENT DOMAINS OF INFORMATION
PLAN RX AND PREDICT OUTCOMEPLAN RX AND PREDICT OUTCOME
ORGANIZING, COMMUNICATING ORGANIZING, COMMUNICATING CLINICAL INFORMATIONCLINICAL INFORMATION
CAPTURES COMPLEXITY OF CLINICAL CAPTURES COMPLEXITY OF CLINICAL SITUATIONSITUATION
HETEROGENEITY OF PATIENTHETEROGENEITY OF PATIENT
BIOPSYCHOSOCIAL MODELBIOPSYCHOSOCIAL MODEL
AXIS IAXIS I
PRINCIPAL DXPRINCIPAL DX
AXIS II CAN ALSO BE PRINCIPAL AXIS II CAN ALSO BE PRINCIPAL DIAGNOSIS – MUST BE FOLLOWED BY DIAGNOSIS – MUST BE FOLLOWED BY ‘PRINCIPAL DX’ OR ‘REASON FOR VISIT’‘PRINCIPAL DX’ OR ‘REASON FOR VISIT’
AXIS IIAXIS II
PERSONALITY D/OPERSONALITY D/O
MRMR
MALADAPTIVE PERSONALITY MALADAPTIVE PERSONALITY FEATURESFEATURES
DEFENCE MECHANISMSDEFENCE MECHANISMS
MORE THAN 1 DXMORE THAN 1 DX
AXIS IIIAXIS III
GMC RELEVANT TO MENTAL D/OGMC RELEVANT TO MENTAL D/O
NO LINK BUT INCLUDED IF:NO LINK BUT INCLUDED IF:
OVERALL UNDERSTANDING OF PTOVERALL UNDERSTANDING OF PT
AXIS I PSYCHOLOGICAL AXIS I PSYCHOLOGICAL REACTION TO AXIS IIREACTION TO AXIS II
THOROUGHNESS OF EVALUATIONTHOROUGHNESS OF EVALUATION
ENHANCES COMMUNICATION BETWEEN ENHANCES COMMUNICATION BETWEEN HEALTH PROFESSIONALSHEALTH PROFESSIONALS
PROGNOSTIC AND RX IMPLICATIONPROGNOSTIC AND RX IMPLICATION
AXIS IVAXIS IV
PYCHOSOCIAL AND ENVIRONMENTAL PYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS THAT AFFECT DX ,RX AND PX:PROBLEMS THAT AFFECT DX ,RX AND PX:– PROBLEMS WITH PRIMARY SUPPORT PROBLEMS WITH PRIMARY SUPPORT
GROUPSGROUPS– PROBLEMS RELATED TO SOCIAL PROBLEMS RELATED TO SOCIAL
ENVIRONMENTENVIRONMENT– EDUCATIONAL PROBLEMSEDUCATIONAL PROBLEMS– HOUSING PROBLEMSHOUSING PROBLEMS– ECONOMIC PROBLEMSECONOMIC PROBLEMS– PROBLEMS WITH ACCESS TO HEALTH PROBLEMS WITH ACCESS TO HEALTH
CARE SERVICESCARE SERVICES
AXIS IVAXIS IV
– PROBLEMS RELATED TO ACCESS TO PROBLEMS RELATED TO ACCESS TO HEALTH CARE SERVICESHEALTH CARE SERVICES
– PROBLEMS RELATED TO INTERACTION PROBLEMS RELATED TO INTERACTION WITH LEGAL SYSTEM/CRIMEWITH LEGAL SYSTEM/CRIME
– OTHER PSYCHOSOCIAL AND OTHER PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS ENVIRONMENTAL PROBLEMS
AXIS VAXIS V
GLOBAL ASSESSMENT OF FUNCTIONINGGLOBAL ASSESSMENT OF FUNCTIONING
CLINICIANS JUDGEMENT – OVERALL CLINICIANS JUDGEMENT – OVERALL LEVEL OF FUNCTIONINGLEVEL OF FUNCTIONING
PLANNING RXPLANNING RX
PREDICTING OUTCOMEPREDICTING OUTCOME
GAF SCALEGAF SCALE
GAF SCALEGAF SCALE
TRACKS CLINICAL PROGRESSTRACKS CLINICAL PROGRESS
SOCIAL,OCCUPATIONAL AND SOCIAL,OCCUPATIONAL AND PSYCHOLOGICAL FUNCTIONINGPSYCHOLOGICAL FUNCTIONING
2 COMPONENTS – SYMPTOM SEVERITY 2 COMPONENTS – SYMPTOM SEVERITY AND FUNCTIONINGAND FUNCTIONING
REFLECTS WORSE OF 2REFLECTS WORSE OF 2
CURRENT PERIOD S/T ADMISSION, CURRENT PERIOD S/T ADMISSION, DISCHARGE ETCDISCHARGE ETC
ADVANTAGES DSM IV-TRADVANTAGES DSM IV-TR
WIDESPREAD USE – EASE OF WIDESPREAD USE – EASE OF COMMUNICATIONCOMMUNICATION
CLEAR DEFINITION AND CLEAR DEFINITION AND DELINEATIONSDELINEATIONS
COMPATIBILITY WITH ICD10COMPATIBILITY WITH ICD10
REPORTING DIAGNOSTIC DATAREPORTING DIAGNOSTIC DATA
COLLECTION OF DIAGNOSTIC DATACOLLECTION OF DIAGNOSTIC DATA
ADVANTAGES CONTADVANTAGES CONT
CATEGORICAL MODEL – VALID CATEGORICAL MODEL – VALID THRESHOLDS FOR CASE THRESHOLDS FOR CASE IDENTIFICATION WITH CLEAR IDENTIFICATION WITH CLEAR BOUNDARIES BETWEEN CLASSESBOUNDARIES BETWEEN CLASSES
MULTIAXIAL EVALUATION PROMOTES MULTIAXIAL EVALUATION PROMOTES COMPREHENSIVE BIOPSYCHOSOCIAL COMPREHENSIVE BIOPSYCHOSOCIAL APPROACHAPPROACH
LIMITATIONS OF DSM IV-TRLIMITATIONS OF DSM IV-TR
FORENSIC SETTINGFORENSIC SETTING
RISK OF INFORMATION MISUSEDRISK OF INFORMATION MISUSED
INSUFFICIENT TO ESTABLISH MI, INSUFFICIENT TO ESTABLISH MI, COMPETENCY AND CRIMINAL COMPETENCY AND CRIMINAL RESPONSIBILITYRESPONSIBILITY
NO IMPLICATIONS FOR DEGREE OF NO IMPLICATIONS FOR DEGREE OF CONTROL OVER BEHAVIOURS CONTROL OVER BEHAVIOURS ASSOCIATED WITH MIASSOCIATED WITH MI
FACILITATES LEGAL DECISIONSFACILITATES LEGAL DECISIONS
CLINICAL JUDGEMENTCLINICAL JUDGEMENT
INDIVIDUALS WITH APPROPRIATE INDIVIDUALS WITH APPROPRIATE CLINICAL TRAININGCLINICAL TRAINING
CANNOT BE APPLIED MECHANICALLYCANNOT BE APPLIED MECHANICALLY
ETHNIC AND CULTURAL ETHNIC AND CULTURAL IMPLICATIONSIMPLICATIONS
CHALLENGING IF PT AND CLINICIAN FROM CHALLENGING IF PT AND CLINICIAN FROM DIFFERENT BACKGROUNDSDIFFERENT BACKGROUNDSINCORRECTLY DIAGNOSE INCORRECTLY DIAGNOSE PSYCHOPATHOLOGYPSYCHOPATHOLOGYINCORRECT PERSONALITY DIAGNOSTIC INCORRECT PERSONALITY DIAGNOSTIC CRITERIA ACROSS DIFFERENT CULTURAL CRITERIA ACROSS DIFFERENT CULTURAL SETTINGSSETTINGSALLOWANCES MADE BY DSMALLOWANCES MADE BY DSM
DISCUSSES CULTURAL VARIATIONSDISCUSSES CULTURAL VARIATIONSCULTURE BOUND SYNDROMESCULTURE BOUND SYNDROMESCULTURAL FORMULATIONCULTURAL FORMULATION
TREATMENT PLANNINGTREATMENT PLANNING
CLINICIAN REQUIRED TO OBTAIN CLINICIAN REQUIRED TO OBTAIN INFORMATION ABOVE THAT OF INFORMATION ABOVE THAT OF DIAGNOSTIC CRITERIA DIAGNOSTIC CRITERIA
CATEGORICAL APPROACHCATEGORICAL APPROACH
CATEGORIES OF MENTAL ILLNESS NOT CATEGORIES OF MENTAL ILLNESS NOT MUTUALLY EXCLUSIVEMUTUALLY EXCLUSIVE
INDIVIDUALS ARE HETEROGENOUSINDIVIDUALS ARE HETEROGENOUS
NO CONSIDERATION OF PATIENTS NO CONSIDERATION OF PATIENTS NARRATIVE HISTORYNARRATIVE HISTORY
LIMITATIONS OF DSMIV-TR LIMITATIONS OF DSMIV-TR CONTCONT
NOT USEFUL FOR RESEARCH – HINDERS NOT USEFUL FOR RESEARCH – HINDERS INVESTIGATIONS INTO AET, PATHOPHYS, INVESTIGATIONS INTO AET, PATHOPHYS, GENETICSGENETICS
NOT RELIABLE INTERCLINICIAN TOOLNOT RELIABLE INTERCLINICIAN TOOL
PATIENTS NOT INCORPORATED IN RX PATIENTS NOT INCORPORATED IN RX CHOICESCHOICES
COMPLICATED-284 POTENTIAL DXCOMPLICATED-284 POTENTIAL DX
LESS VALIDITY- BEREAVEMENTLESS VALIDITY- BEREAVEMENT
CONCEPTUAL INCONSISTENCYCONCEPTUAL INCONSISTENCY
LIMITATIONS OF DSM IV-TRLIMITATIONS OF DSM IV-TR
INCONSISTENCIES WITH REMISSION INCONSISTENCIES WITH REMISSION STATUSSTATUSEXEXCUSION OF PSYCHODYNAMIC AND CUSION OF PSYCHODYNAMIC AND PSYCHOSOCIAL PERSPECTIVESPSYCHOSOCIAL PERSPECTIVESUNCERTAINTY OF INTERPRETING UNCERTAINTY OF INTERPRETING ‘CLINICALLY SIGNIFICANT’ CRITERIA‘CLINICALLY SIGNIFICANT’ CRITERIAMULTIAXIAL SYSTEM- TIME CONSUMING, MULTIAXIAL SYSTEM- TIME CONSUMING, NOT USED NOT USED AXES IV, V- DUBIOUS RELIABILITY AND AXES IV, V- DUBIOUS RELIABILITY AND VALIDITYVALIDITY
ICD 10ICD 10
INTERNATIONAL CLASSIFICATION OF INTERNATIONAL CLASSIFICATION OF DISEASESDISEASESCLASSIFICATION FOR EPIDEMIOLOGICAL CLASSIFICATION FOR EPIDEMIOLOGICAL AND HEALTH MANAGEMENT PURPOSESAND HEALTH MANAGEMENT PURPOSES
WHOWHO
HISTORY AND BACKGROUNDHISTORY AND BACKGROUND
1853 – INTERNATIONAL STATISTICAL 1853 – INTERNATIONAL STATISTICAL CONGRESS – W. FARRCONGRESS – W. FARR
REVISED OVER NEXT DECADESREVISED OVER NEXT DECADES
1946 – WHO – INTERNATIONAL LIST OF 1946 – WHO – INTERNATIONAL LIST OF CAUSES IF MORBIDITYCAUSES IF MORBIDITY
1948 – 61948 – 6THTH REVISION REVISION
1975 – 91975 – 9THTH REVISION-BEGINNING OF ICD REVISION-BEGINNING OF ICD
99THTH REVISION – DESCRIPTIONS OF REVISION – DESCRIPTIONS OF CATEGORIES OF CHAPTER V – MENTAL D/OCATEGORIES OF CHAPTER V – MENTAL D/O
HX AND BACKGROUNDHX AND BACKGROUND
1989 – 101989 – 10THTH REVISION REVISION
ALPHANUMERICAL CODING SCHEME ALPHANUMERICAL CODING SCHEME OF 1 LETTER FOLLOWED BY 3 OF 1 LETTER FOLLOWED BY 3 NUMBERSNUMBERS
INCREASE IN NUMBER OF INCREASE IN NUMBER OF CATEGORIES, SEPARATE CHAPTERSCATEGORIES, SEPARATE CHAPTERS
ICD 10ICD 10
CHAPTER V – MENTAL D/OCHAPTER V – MENTAL D/OCHAPTER VI – NEUROLOGICAL D/OCHAPTER VI – NEUROLOGICAL D/OCHAPTER XIX – CLASSIFICATION OF INJURIES CHAPTER XIX – CLASSIFICATION OF INJURIES – POISONING– POISONINGCHAPTER XVIII – S AND S, ABN CLINICAL AND CHAPTER XVIII – S AND S, ABN CLINICAL AND LAB FINDINGSLAB FINDINGSCATEGORIES DENOTED BY LETTERCATEGORIES DENOTED BY LETTER11STST NO – MAIN GROUP NO – MAIN GROUP22NDND NO – CATEGORY WITHIN GROUP NO – CATEGORY WITHIN GROUP44THTH CHARACTER – FURTHER SUBDIVISION CHARACTER – FURTHER SUBDIVISIONF32.2 – SEVERE DEPRESSIVE EPISODE F32.2 – SEVERE DEPRESSIVE EPISODE WITHOUT PSYCHOTIC SYMPTOMSWITHOUT PSYCHOTIC SYMPTOMS
ICD 10ICD 10
SCZ – 5SCZ – 5TH TH CHARACTER – SPECIFY CHARACTER – SPECIFY COURSECOURSE
F20.01 – PARANOID SCZ, EPISODIC F20.01 – PARANOID SCZ, EPISODIC WITH PROGRESSIVE DEFICITWITH PROGRESSIVE DEFICIT
DIFFERENT VERSIONS – FLEXIBILITY DIFFERENT VERSIONS – FLEXIBILITY AND ACCEPTIBILITY TOAND ACCEPTIBILITY TO VARIOUS USERS VARIOUS USERS
ICD 10ICD 10
CLINICAL DESCRIPTIONS AND DIAGNOSTIC CLINICAL DESCRIPTIONS AND DIAGNOSTIC GUIDELINES FOR GENERAL CLINICAL, GUIDELINES FOR GENERAL CLINICAL, EDUCATIONAL AND SERVICE USEEDUCATIONAL AND SERVICE USE
DIAGNOSTIC CRITERIA FOR RESEARCHDIAGNOSTIC CRITERIA FOR RESEARCH
PRIMARY CARE VERSIONPRIMARY CARE VERSION
MULTIAXIAL VERSIONMULTIAXIAL VERSION
CLINICAL DESCRIPTIONS…CLINICAL DESCRIPTIONS…
EACH CATEGORY ACCOMPANIED BY EACH CATEGORY ACCOMPANIED BY GLOSSARY OF BRIEF DEFINITIONSGLOSSARY OF BRIEF DEFINITIONS
FURTHER DEFINED SET OF CRITERIAFURTHER DEFINED SET OF CRITERIA
CRITERIA LESS PRECISE THAN DSMCRITERIA LESS PRECISE THAN DSM
ALLOWS CLINICIANS TO USE IN DAILY ALLOWS CLINICIANS TO USE IN DAILY PRACTICEPRACTICE
DIAGNOSTIC CRITERIA FOR RESEARCHDIAGNOSTIC CRITERIA FOR RESEARCH
TWO NB ANNEXESTWO NB ANNEXES
CULTURE SPECIFIC D/OCULTURE SPECIFIC D/O
PROVISIONAL CRITERIA FOR UNCERTAINPROVISIONAL CRITERIA FOR UNCERTAIN NNOSOLOGICAL STATUS – BIPOLAR D/O IIOSOLOGICAL STATUS – BIPOLAR D/O II
MULTIAXIAL VERSIONMULTIAXIAL VERSION
ADULT PSYCHIATRY – 3 AXESADULT PSYCHIATRY – 3 AXES
CATEGORIZE CLINICAL SYNDROMECATEGORIZE CLINICAL SYNDROME
LEVEL OF FUNCTIONAL LEVEL OF FUNCTIONAL CAPACITY/DISABILITYCAPACITY/DISABILITY
CATEGORIES OF IMPORTANCE IN CATEGORIES OF IMPORTANCE IN THE UNDERSTANDING OF THE D/OTHE UNDERSTANDING OF THE D/O
MULTIAXIAL VERSIONMULTIAXIAL VERSION
MENTAL D/O OF CHILDHOODMENTAL D/O OF CHILDHOOD
6 AXES:6 AXES:CLINICAL PSYCHIATRIC SYNDROMESCLINICAL PSYCHIATRIC SYNDROMES
SPECIFIC D/O OF PSYCHOLOGIC DEVELOPMENTSPECIFIC D/O OF PSYCHOLOGIC DEVELOPMENT
INTELLECTUAL LEVELINTELLECTUAL LEVEL
MEDICAL CONDITIONSMEDICAL CONDITIONS
ASSOCIATED ABNORMAL PSYCHOSOCIAL ASSOCIATED ABNORMAL PSYCHOSOCIAL SITUATIONSITUATION
GLOBAL ASSESSMENT OF PSYCHOSOCIAL GLOBAL ASSESSMENT OF PSYCHOSOCIAL DISABILITYDISABILITY
PRIMARY CARE VERSIONPRIMARY CARE VERSION
FEWER CATEGORIESFEWER CATEGORIES
GENERAL PRACTITIONER, PRIMARY GENERAL PRACTITIONER, PRIMARY HEALTH CARE STAFF, HEALTH CARE STAFF, PSYCHIATRISTS, OTHERSPSYCHIATRISTS, OTHERS
2 CARDS2 CARDSWAY THAT CONDITION IS RECOGNIZED WAY THAT CONDITION IS RECOGNIZED AND DIAGNOSEDAND DIAGNOSED
ADVICE ON MXADVICE ON MX
ADVANTAGES OF ICD 10ADVANTAGES OF ICD 10
SIMPLICITY OF STRUCTURE AND USESIMPLICITY OF STRUCTURE AND USE
USED BY SPECIAL GROUPS, STILL USED BY SPECIAL GROUPS, STILL COMPATIBLE WITH ORIGINAL COMPATIBLE WITH ORIGINAL CLASSIFICATIONCLASSIFICATION
COMPATIBILITY WITH NATIONAL AND COMPATIBILITY WITH NATIONAL AND OTHER WIDELY USED CLASSIFICATIONSOTHER WIDELY USED CLASSIFICATIONS
DIFFERENCES KEPT TO MINIMUMDIFFERENCES KEPT TO MINIMUM
CONTINUITY OVER TIMECONTINUITY OVER TIME
BASED ON INTERNATIONAL CONSENSUSBASED ON INTERNATIONAL CONSENSUS
ADVANTAGES OF ICD 10ADVANTAGES OF ICD 10
BASED ON INTERNATIONAL CONSENSUSBASED ON INTERNATIONAL CONSENSUSSEVERAL VERSIONS – ALL COMPATIBLE SEVERAL VERSIONS – ALL COMPATIBLE WITH EACH OTHERWITH EACH OTHERSEVERAL LANGUAGESSEVERAL LANGUAGESADDITIONAL PUBLICATIONS FACILITATE ITS ADDITIONAL PUBLICATIONS FACILITATE ITS USEUSERESPONSIVE TO NEEDS OF PRACTICERESPONSIVE TO NEEDS OF PRACTICECATEGORIES FOR DIAGNOSIS CATEGORIES FOR DIAGNOSIS FREQUENTLY USED BUT NOSOLGY FREQUENTLY USED BUT NOSOLGY UNCERTAINUNCERTAIN
ADVANTAGES OF ICD 10ADVANTAGES OF ICD 10
AVOIDS ‘SOCIAL FUNCTIONING’ AS AVOIDS ‘SOCIAL FUNCTIONING’ AS DIAGNOSTIC INDICATORDIAGNOSTIC INDICATOR
RECENTLY INTRODUCED DX OF PUBLIC RECENTLY INTRODUCED DX OF PUBLIC HEALTH INTERES MILD COGNITIVE D/OHEALTH INTERES MILD COGNITIVE D/O
TERMINOLOGY EASY TO USETERMINOLOGY EASY TO USE
SIGNIFICANT EXPANSION OF ACUTE SIGNIFICANT EXPANSION OF ACUTE PSYCHOTIC D/O-DEVELOPING COUNTRIESPSYCHOTIC D/O-DEVELOPING COUNTRIES
CATEGORICAL CLASSIFICATIONCATEGORICAL CLASSIFICATION
LIMITATIONS OF ICD 10LIMITATIONS OF ICD 10
CATEGORICAL CLASSIFICATION-DISCRETE CATEGORICAL CLASSIFICATION-DISCRETE ENTITY VIEW OF PSYCH D/OENTITY VIEW OF PSYCH D/O
LIMITATIONS OF CURRENT OPERATIONAL LIMITATIONS OF CURRENT OPERATIONAL APPROACHES TO DIAGNOSISAPPROACHES TO DIAGNOSIS
FOCUS ON EPISODE RATHER THAN LIFETIME FOCUS ON EPISODE RATHER THAN LIFETIME EXPERIENCEEXPERIENCE
HIERARCHIES LEAD TO LOSS OF INFOHIERARCHIES LEAD TO LOSS OF INFO
BOUNDARIES BET CATEGORIES ARE BOUNDARIES BET CATEGORIES ARE ARBITRARYARBITRARY
BOUNDARIES BET CATEGORIES REQUIRE BOUNDARIES BET CATEGORIES REQUIRE SUBSTANTIAL SUBJECTIVE JUDGEMENTSUBSTANTIAL SUBJECTIVE JUDGEMENT
DIAGNOSTIC CATEGORIES ARE UNHELPFUL IN DIAGNOSTIC CATEGORIES ARE UNHELPFUL IN DETERMINING SEVERITYDETERMINING SEVERITY
LIMITATIONS OF CURRENT OPERATIONAL LIMITATIONS OF CURRENT OPERATIONAL APPROACHES TO DIAGNOSISAPPROACHES TO DIAGNOSIS
SUBCLINICAL CASES NOT ACCOMODATED SUBCLINICAL CASES NOT ACCOMODATED FULLYFULLY
NOS CATEGORIES HIGHLY HETEROGENOUSNOS CATEGORIES HIGHLY HETEROGENOUS
INCREASED GAPS BETWEEN RESEARCH INCREASED GAPS BETWEEN RESEARCH FINDINGS AND DEFINITIONS OF CURRENT FINDINGS AND DEFINITIONS OF CURRENT DIAGNOSTIC SYSTEMS – SACRIFICES VALIDITY DIAGNOSTIC SYSTEMS – SACRIFICES VALIDITY FOR RELIABILITYFOR RELIABILITY
DIFFERENCES BETWEEN DSM AND ICDDIFFERENCES BETWEEN DSM AND ICD
DSM IV-TRDSM IV-TR
PRODUCED BY APAPRODUCED BY APA
ONE GROUP OF DISEASES, DIRECT ONE GROUP OF DISEASES, DIRECT INTEREST TO PARTICULAR INTEREST TO PARTICULAR PROFESSIONAL GROUPPROFESSIONAL GROUP
NATIONAL DIAGNOSTIC NATIONAL DIAGNOSTIC CLASSIFICATIONCLASSIFICATION
SINGLE SET OF OPERATIONAL SINGLE SET OF OPERATIONAL DIAGNOSTIC CRUTERIA FOR ALL DIAGNOSTIC CRUTERIA FOR ALL USERSUSERS
ICD10ICD10
WHOWHO
NUMBER OF CLASSIFICATIONS NUMBER OF CLASSIFICATIONS – EVEN CLASSIFICATION OF – EVEN CLASSIFICATION OF REASON FOR CONTACTREASON FOR CONTACT
STATUTORY RESPONSIBILITY STATUTORY RESPONSIBILITY FOR RELIABLE REPORTING OF FOR RELIABLE REPORTING OF DISEASES AND HEALTH DISEASES AND HEALTH STATES TO THE WORLD STATES TO THE WORLD POPULATIONPOPULATION
INTERRELATED VERSIONS INTERRELATED VERSIONS ADDRESSING DIFFERENT ADDRESSING DIFFERENT USERS IN SPECIFIC CONTEXTSUSERS IN SPECIFIC CONTEXTS
DIFFERENCES BETWEEN DSM AND ICD 10DIFFERENCES BETWEEN DSM AND ICD 10
DSM IV-TRDSM IV-TRDEFINITIONAL DIFFERENCES-DEFINITIONAL DIFFERENCES-SUBSTANCE D/O=FOCUS ON SUBSTANCE D/O=FOCUS ON NEGATIVE CONSEQUENCESNEGATIVE CONSEQUENCES
ACUTE STRESS D/O-DX ONLY ACUTE STRESS D/O-DX ONLY FOR SEVERE DISSOCIATIVE FOR SEVERE DISSOCIATIVE REACTIONSREACTIONS
DIFFERENCES IN DIAGNOSTIC DIFFERENCES IN DIAGNOSTIC CRITERIA-DURATION, CRITERIA-DURATION, FREQUENCY ETC-DELUSIONAL FREQUENCY ETC-DELUSIONAL D/O-3/12D/O-3/12
DIFFERENCES IN EXCLUSIONARY DIFFERENCES IN EXCLUSIONARY CRITEIA- HYPOCHONDRIASISCRITEIA- HYPOCHONDRIASIS
CONCEPTUAL DIFFERENCES OF CONCEPTUAL DIFFERENCES OF DISORDERSDISORDERS
ICD10ICD10DX OF HARMFUL USE FOCUSES DX OF HARMFUL USE FOCUSES ON DAMAGE TO USER’S ON DAMAGE TO USER’S PHYSICAL AND MENTAL HEALTHPHYSICAL AND MENTAL HEALTH
WIDER RANGE OF RESPONSES-WIDER RANGE OF RESPONSES-MILD ANXIETY TO SEVERE MILD ANXIETY TO SEVERE DISSOCIATIONDISSOCIATION
MINIMUM 3/12MINIMUM 3/12
HYPOCHONDRIASISHYPOCHONDRIASIS
CONCEPTUAL DIFFERENCES OF CONCEPTUAL DIFFERENCES OF DISORDERSDISORDERS
DSMVDSMV
CURRENTLY IN CONSULTATION, CURRENTLY IN CONSULTATION, PLANNING AND PREPARATIONPLANNING AND PREPARATION
DUE FOR PUBLICATION IN 2012/13DUE FOR PUBLICATION IN 2012/13
WORK GROUPS TO ADDRESSS MAJOR WORK GROUPS TO ADDRESSS MAJOR GAPSGAPS
DEVELOPMENTAL ISSUESDEVELOPMENTAL ISSUES
REFINE PSYCHIATRIC ASSESSMENT REFINE PSYCHIATRIC ASSESSMENT TECHNIQUE ACROSS TECHNIQUE ACROSS DEVELOPMENTAL STAGESDEVELOPMENTAL STAGES
METHODS TO INTEGRATE METHODS TO INTEGRATE DEVELOPMENTAL ASSESSMENTS DEVELOPMENTAL ASSESSMENTS INTO DIAGNOSTIC PROCESSINGINTO DIAGNOSTIC PROCESSING
DEFINING MENTAL ILLNESSDEFINING MENTAL ILLNESS
FACILITATING DIAGNOSTIC PROCESSES IN FACILITATING DIAGNOSTIC PROCESSES IN NON-PSYCHIATRIC SETTINGSNON-PSYCHIATRIC SETTINGS
APPLICABILITY OF CRITERIA ACROSS APPLICABILITY OF CRITERIA ACROSS DIFFERENT CULTURAL SETTINGSDIFFERENT CULTURAL SETTINGS
VALIDATINGDIAGNOSTIC CRITERIAVALIDATINGDIAGNOSTIC CRITERIA
INCREASING COMPATIBILITY BETWEEN INCREASING COMPATIBILITY BETWEEN DSM V AND ICD 10DSM V AND ICD 10
DIMENSIONAL APPROACH MORE SUPERIORDIMENSIONAL APPROACH MORE SUPERIOR
PERSONALITY DISORDERSPERSONALITY DISORDERS
DIMENSIONAL MODEL MAY BE SUPERIOR, DIMENSIONAL MODEL MAY BE SUPERIOR, MORE RELIABLE, SPECIFIC AND CLINICALLY MORE RELIABLE, SPECIFIC AND CLINICALLY INFORMATIVEINFORMATIVE
SHOULD THERE BE INDEPENDENCE AND SHOULD THERE BE INDEPENDENCE AND DISTINCTIVENESS BETWEEN AXIS I AND DISTINCTIVENESS BETWEEN AXIS I AND AXIS II PERSONALITY D/OAXIS II PERSONALITY D/O
BOTH FREQUENTLY CO-EXISTBOTH FREQUENTLY CO-EXIST
AXIS II OFTEN A SIGNIFICANT AXIS II OFTEN A SIGNIFICANT COMPLICATING FACTOR TO AXIS ICOMPLICATING FACTOR TO AXIS I
RELATIONAL PROBLEMSRELATIONAL PROBLEMS
PAINFUL PERSISTENT BEHAVIOURAL PAINFUL PERSISTENT BEHAVIOURAL PROBLEMS THAT SERIOUSLY AFFECT PROBLEMS THAT SERIOUSLY AFFECT JUDGEMENTJUDGEMENT
INCLUSION IN DSMVINCLUSION IN DSMV
PROPOSED CHANGES TO DSM IV-TR PROPOSED CHANGES TO DSM IV-TR DXDX
ELIMINATE ASPERGERS SYNDROME ELIMINATE ASPERGERS SYNDROME AS SEPARATE D/OAS SEPARATE D/O
MERGE UNDER AUTISM SPECTRUM MERGE UNDER AUTISM SPECTRUM D/OD/O
SEVERITY CAN BE RATED- SEVERE, SEVERITY CAN BE RATED- SEVERE, MODERATEMODERATE, , MILDMILD
PROPOSED NEW DSM V DXPROPOSED NEW DSM V DX
COMPLEX POST TRAUMATIC STRESS D/OCOMPLEX POST TRAUMATIC STRESS D/O
DEPRESSIVE PERSONALITY D/ODEPRESSIVE PERSONALITY D/O
NEGATIVISTIC ( PASSIVE-AGGRESSIVE ) PDNEGATIVISTIC ( PASSIVE-AGGRESSIVE ) PD
POST TRAUMATIC EMBITTERMENT D/OPOST TRAUMATIC EMBITTERMENT D/O
RELATIONAL D/ORELATIONAL D/O
PD AND MR AS AXIS I D/OPD AND MR AS AXIS I D/O
SLUGGISH COGNITIVE TEMPERAMENTSLUGGISH COGNITIVE TEMPERAMENT
REFERENCESREFERENCES
KAPLAN AND SADDOCK’S COMPREHENSIVE TEXTBOOK OF KAPLAN AND SADDOCK’S COMPREHENSIVE TEXTBOOK OF PSYCHIATRY, 9PSYCHIATRY, 9THTH EDITION 2009 EDITION 2009KAPLAN AND SADDOCK’S SYNOPSIS OF PSYCHIATRY,10KAPLAN AND SADDOCK’S SYNOPSIS OF PSYCHIATRY,10THTH EDITIONEDITIONDIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS:DSM IV TR- APA 2000DISORDERS:DSM IV TR- APA 2000A RESEARCH AGENDA FOR DSM V. KUPFER,D; A RESEARCH AGENDA FOR DSM V. KUPFER,D; FIRST,M;REGIER,DFIRST,M;REGIER,DFIRST M.HARMONISATION OF ICD-11 AND DSM- V: FIRST M.HARMONISATION OF ICD-11 AND DSM- V: OPPORTUNITIES AND CHALLENGES.BJP 2009;195:382-390OPPORTUNITIES AND CHALLENGES.BJP 2009;195:382-390JABLENSKY A.TOWARDS ICD-11 AND DSM-V:ISSUES BEYOND JABLENSKY A.TOWARDS ICD-11 AND DSM-V:ISSUES BEYOND HARMONISATION.BJP 2009;195:379-381HARMONISATION.BJP 2009;195:379-381CRADDOCK,MICHAEL O.RETHINKING PSYCHOSIS.WORLD CRADDOCK,MICHAEL O.RETHINKING PSYCHOSIS.WORLD PSYCHIATRY 2007;6(2):84-91PSYCHIATRY 2007;6(2):84-91
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DISTINGUISHING BETWEEN VALIDIDTY AND UTILITY DISTINGUISHING BETWEEN VALIDIDTY AND UTILITY OF PSYCHIATRIC DIAGNOSIS. KWNDELL OF PSYCHIATRIC DIAGNOSIS. KWNDELL R,JABLESKY A.AMJ 2003;160:4-12R,JABLESKY A.AMJ 2003;160:4-12
CLINICAL UTILITY AS A CRITERION FOR REVISING CLINICAL UTILITY AS A CRITERION FOR REVISING PSYCHIATRIC DIAGNOSIS. FIRST M,WILLIAMS PSYCHIATRIC DIAGNOSIS. FIRST M,WILLIAMS J,USTUN B, PEELE R. AMJ 2004;161;946-954J,USTUN B, PEELE R. AMJ 2004;161;946-954
AMERICAN ASSOCIATION OF COMMUNITY AMERICAN ASSOCIATION OF COMMUNITY PSYCHIATRIST’S VIEWS ON GENERAL FEATURES PSYCHIATRIST’S VIEWS ON GENERAL FEATURES OF DSM-IV. BELL C,SOWERS W, THOMPSON K. OF DSM-IV. BELL C,SOWERS W, THOMPSON K. PSYCHIATRIC SERVICES,2008;59:687-689PSYCHIATRIC SERVICES,2008;59:687-689