The dsmiv and_icd10_classification_systems_(background)
- 1. THE DSM AND ICD PSYCHIATRIC CLASSIFICATION SYSTEMS
- 2. FACILITATES CHARACTERIZATION, COMMUNICATION AND RESEARCH COMPLEXITY OF PHENOMENA ARE REDUCED TWO VIEWS: DIMENSIONALIZERS – DIMENSIONS OF FUNCTIONING,DIFFERENT PSYCHIATRIC D/O CATEGORIZERS – SPECIFIC GROUPS OF SYMPTOMS – REFLECT PSYCHIATRIC SYNDROMES
- 3. IMPORTANCE OF CLASSIFICATION FOR PSYCHIATRIC DIAGNOSIS DISTINGUISH BET DIFF PSYCHIATRIC DIAGNOSIS COMMON LANGUAGE AMONGST HEALTH PROFESSIONALS ENSURES RELIABILITY,COMMUNICATION AND STATISTICAL REPORTING EFFECTIVE TREATMENT STANDARD FRAME OF REFERENCE TEACHING-INTERNATIONAL REFERENCE SYSTEMS
- 4. IMPORTANCE OF CLASSIFICATION CONT. PUBLIC ACESS – IMPROVES COMMUNICATION IMPROVES RELIABILITY OF PSYCHIATRIC DIAGNOSIS IN RESEARCH SETTINGS UNDERSTANDING OF CAUSES AND PROCESSES OF MENTAL DISORDERS
- 5. TWO MOST ACCEPTED PSYCHIATRIC CLASSIFICATIONS DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM IV TR) INTERNATIONAL CLASSIFICATION OF DISEASES (ICD 10) CLINICAL DESCRIPTIONS BASED ON PHENOMENOLOGICAL APPROACHES
- 6. DSM CATEGORICAL CLASSIFICATION DIVIDES MENTAL DISORDERS CRITERIA SETS – DEFINING FEATURES
- 7. HISTORY AND BACKGROUND FIRST DSM – AMERICAN PSYCHIATRIC ASSOCIATION COMMITTEE DSM II – 1968 DSM III – 1980 REVISED DSM III – 1987 DSM III-R – 1987 DSM IV – 1994 DSM-IV-TR – 2000
- 8. HISTORY AND BACKGROUND WHO – ICD-6 SECTION ON MENTAL DISORDERS APA – VARIANT OF ICD-6 DSM-1 – FIRST OFFICIAL MANUAL OF CLINICAL MENTAL DISORDERS PSYCHOBIOLOGICAL VIEW
- 9. HISTORY AND BACKGROUND DSM-II CORRELATED WITH ICD-8 DSM-III CORRELATED WITH 1CD-9 DSM-III – EXPLICIT DIAGNOSTIC CRITERIA – MULTI-AXIAL SYSTEM – DESCRIPTIVE MEDICAL NOMENCLATURE
- 10. HISTORY AND BACKGROUND DSM-III-R – EMPIRICAL RESEARCH DSM-IV – SYSTEMATIC REVIEWS AND FOCUSED FIELD TRIALS GOAL – INCREASE PRACTICALITY AND CLINICAL UTILITY DSM IV-TR – NOS CATEGORY
- 11. DSM IV-TR OFFICIAL CODING SYSTEM IN USA ATHEORETICAL APPROACH TO CAUSES DESCRIBES MANIFESTATIONS AND DESCRIPTIONS OF CLINICAL FEATURES OF MENTAL D/O SPECIFIC DIAGNOSTIC CRITERIA CRITERIA INCREASE RELIABILITY
- 12. DSM IV-TR SYSTEMATIC DESCRIPTIONS: AGE CULTURE GENDER FEATURES PREVALENCE, INCIDENCE RISK , COURSE COMPLICATIONS PREDISPOSING FACTORS FAMILIAL PATTERNS DIFFERENTIAL DIAGNOSIS LAB FINDINGS PHYSICAL EXAMINATION SIGNS AND SYMPTOMS
- 13. DSM IV-TR 365 DISORDERS 17 SECTIONS PROPOSED DIAGNOSTIC CRITERIA
- 14. DSM IV-TR ORGANIZATIONAL PLAN 16 MAJOR DIAGNOSTIC CLASSES OTHER CONDITIONS THAT MAY BE FOCUS OF CLINICAL ATTENTION 11 APPENDICES DIFFERENTIAL DX GLOSSARY CHANGES IN DSM-IV-TR CLASSIFICATION WITH ICD-10 CULTURAL FORMULATION, ETC
- 15. AIMS OF DSM IV-TR CLEAR DIAGNOSTIC CATEGORIES DX, COMMUNICATION, STUDY AND TREAT DIAGNOSTIC CRITERIA FOR RESEARCH PURPOSES RECORD KEEPING, DATA COLLECTION REPORTING TO 3RD PARTIES – GOVN, PRIVATE INSURERS SUBTYPES SPECIFIERS INCREASED SPECIFICITY
- 16. AIMS OF DSM IV-TR CLINICAL DECISIONS RX SETTING MODE OF RX DURATION OF RX
- 17. SEVERITY AND COURSE SPECIFIERS MILD, MODERATE, SEVERE ONLY WHEN FULL CRITERIA MET INTENSITY OF S AND S IMPAIRMENT IN OCCUPATIONAL AND FUNCTIONAL IMPAIRMENT MR CONDUCT D/O MANIC EPISODE MAJOR DEPRESSIVE EPISODE
- 18. SEVERITY AND COURSE SPECIFIERS PARTIAL REMISSION – FULL CRITERIA PREVIOUSLY MET FULL REMISSION – NO LONGER S AND S, STILL CLINICALLY RELEVANT PARTIAL AND FULL REMISSION FOR: MANIC EPISODE MAJOR DEPRESSIVE EPISODE SUBSTANCE DEPENDANCE PRIOR HISTORY – USEFUL TO NOTE HX OF CRITERIA PREVIOUSLY MET BUT NOW RECOVERED
- 19. RECURRENCE FULL CRITERIA NO LONGER MET PARTIAL, FULL REMISSION, RECOVERY DO NOT MEET FULL THRESHOLD OF D/O ACCORDING TO SPECIFIED CRITERIA
- 20. NOS CATEGORIES DIVERSITY OF CLINICAL PRESENTATION 4 SITUATIONS: – CRITERIA NOT MET FOR SPECIFIC D/O EG ATYPICAL, MIXED PICTURE – DOES NOT CONFORM TO DSM IV CLASSIFICATION BUTCLINICAL SIGNIFICANT DISTRESS – AETIOLOGY UNCERTAIN – INSUFFICIENT DATA, INCONSISTENT INFORMATION
- 21. MULTIAXIAL ASSESSMENT 5 AXES – I – CLINICAL D/O, OTHER CONDITIONS FOCUS OF CLINICAL ATTENTION – II – PERSONALITY D/O – III – GMC – IV – PSYCHOSOCIAL, ENVIRONMENTAL – V – GAF
- 22. MULTIAXIAL ASSESSMENT DIFFERENT DOMAINS OF INFORMATION PLAN RX AND PREDICT OUTCOME ORGANIZING, COMMUNICATING CLINICAL INFORMATION CAPTURES COMPLEXITY OF CLINICAL SITUATION HETEROGENEITY OF PATIENT BIOPSYCHOSOCIAL MODEL
- 23. AXIS I PRINCIPAL DX AXIS II CAN ALSO BE PRINCIPAL DIAGNOSIS – MUST BE FOLLOWED BY ‘PRINCIPAL DX’ OR ‘REASON FOR VISIT’
- 24. AXIS II PERSONALITY D/O MR MALADAPTIVE PERSONALITY FEATURES DEFENCE MECHANISMS MORE THAN 1 DX
- 25. AXIS III GMC RELEVANT TO MENTAL D/O NO LINK BUT INCLUDED IF: OVERALL UNDERSTANDING OF PT AXIS I PSYCHOLOGICAL REACTION TO AXIS II THOROUGHNESS OF EVALUATION ENHANCES COMMUNICATION BETWEEN HEALTH PROFESSIONALS PROGNOSTIC AND RX IMPLICATION
- 26. AXIS IV PYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS THAT AFFECT DX ,RX AND PX: – PROBLEMS WITH PRIMARY SUPPORT GROUPS – PROBLEMS RELATED TO SOCIAL ENVIRONMENT – EDUCATIONAL PROBLEMS – HOUSING PROBLEMS – ECONOMIC PROBLEMS – PROBLEMS WITH ACCESS TO HEALTH CARE SERVICES
- 27. AXIS IV – PROBLEMS RELATED TO ACCESS TO HEALTH CARE SERVICES – PROBLEMS RELATED TO INTERACTION WITH LEGAL SYSTEM/CRIME – OTHER PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS
- 28. AXIS V GLOBAL ASSESSMENT OF FUNCTIONING CLINICIANS JUDGEMENT – OVERALL LEVEL OF FUNCTIONING PLANNING RX PREDICTING OUTCOME GAF SCALE
- 29. GAF SCALE TRACKS CLINICAL PROGRESS SOCIAL,OCCUPATIONAL AND PSYCHOLOGICAL FUNCTIONING 2 COMPONENTS – SYMPTOM SEVERITY AND FUNCTIONING REFLECTS WORSE OF 2 CURRENT PERIOD S/T ADMISSION, DISCHARGE ETC
- 30. ADVANTAGES DSM IV-TR WIDESPREAD USE – EASE OF COMMUNICATION CLEAR DEFINITION AND DELINEATIONS COMPATIBILITY WITH ICD10 REPORTING DIAGNOSTIC DATA COLLECTION OF DIAGNOSTIC DATA
- 31. ADVANTAGES CONT CATEGORICAL MODEL – VALID THRESHOLDS FOR CASE IDENTIFICATION WITH CLEAR BOUNDARIES BETWEEN CLASSES MULTIAXIAL EVALUATION PROMOTES COMPREHENSIVE BIOPSYCHOSOCIAL APPROACH
- 32. LIMITATIONS OF DSM IV-TR
- 33. FORENSIC SETTING RISK OF INFORMATION MISUSED INSUFFICIENT TO ESTABLISH MI, COMPETENCY AND CRIMINAL RESPONSIBILITY NO IMPLICATIONS FOR DEGREE OF CONTROL OVER BEHAVIOURS ASSOCIATED WITH MI FACILITATES LEGAL DECISIONS
- 34. CLINICAL JUDGEMENT INDIVIDUALS WITH APPROPRIATE CLINICAL TRAINING CANNOT BE APPLIED MECHANICALLY
- 35. ETHNIC AND CULTURAL IMPLICATIONS CHALLENGING IF PT AND CLINICIAN FROM DIFFERENT BACKGROUNDS INCORRECTLY DIAGNOSE PSYCHOPATHOLOGY INCORRECT PERSONALITY DIAGNOSTIC CRITERIA ACROSS DIFFERENT CULTURAL SETTINGS ALLOWANCES MADE BY DSM DISCUSSES CULTURAL VARIATIONS CULTURE BOUND SYNDROMES CULTURAL FORMULATION
- 36. TREATMENT PLANNING CLINICIAN REQUIRED TO OBTAIN INFORMATION ABOVE THAT OF DIAGNOSTIC CRITERIA
- 37. CATEGORICAL APPROACH CATEGORIES OF MENTAL ILLNESS NOT MUTUALLY EXCLUSIVE INDIVIDUALS ARE HETEROGENOUS NO CONSIDERATION OF PATIENTS NARRATIVE HISTORY
- 38. LIMITATIONS OF DSMIV-TR CONT NOT USEFUL FOR RESEARCH – HINDERS INVESTIGATIONS INTO AET, PATHOPHYS, GENETICS NOT RELIABLE INTERCLINICIAN TOOL PATIENTS NOT INCORPORATED IN RX CHOICES COMPLICATED-284 POTENTIAL DX LESS VALIDITY- BEREAVEMENT CONCEPTUAL INCONSISTENCY
- 39. LIMITATIONS OF DSM IV-TR INCONSISTENCIES WITH REMISSION STATUS EXCUSION OF PSYCHODYNAMIC AND PSYCHOSOCIAL PERSPECTIVES UNCERTAINTY OF INTERPRETING ‘CLINICALLY SIGNIFICANT’ CRITERIA MULTIAXIAL SYSTEM- TIME CONSUMING, NOT USED AXES IV, V- DUBIOUS RELIABILITY AND VALIDITY
- 40. ICD 10 INTERNATIONAL CLASSIFICATION OF DISEASES CLASSIFICATION FOR EPIDEMIOLOGICAL AND HEALTH MANAGEMENT PURPOSES WHO
- 41. HISTORY AND BACKGROUND 1853 – INTERNATIONAL STATISTICAL CONGRESS – W. FARR REVISED OVER NEXT DECADES 1946 – WHO – INTERNATIONAL LIST OF CAUSES IF MORBIDITY 1948 – 6TH REVISION 1975 – 9TH REVISION-BEGINNING OF ICD 9TH REVISION – DESCRIPTIONS OF CATEGORIES OF CHAPTER V – MENTAL D/O
- 42. HX AND BACKGROUND 1989 – 10TH REVISION ALPHANUMERICAL CODING SCHEME OF 1 LETTER FOLLOWED BY 3 NUMBERS INCREASE IN NUMBER OF CATEGORIES, SEPARATE CHAPTERS
- 43. ICD 10 CHAPTER V – MENTAL D/O CHAPTER VI – NEUROLOGICAL D/O CHAPTER XIX – CLASSIFICATION OF INJURIES – POISONING CHAPTER XVIII – S AND S, ABN CLINICAL AND LAB FINDINGS CATEGORIES DENOTED BY LETTER 1ST NO – MAIN GROUP 2ND NO – CATEGORY WITHIN GROUP 4TH CHARACTER – FURTHER SUBDIVISION F32.2 – SEVERE DEPRESSIVE EPISODE WITHOUT PSYCHOTIC SYMPTOMS
- 44. ICD 10 SCZ – 5TH CHARACTER – SPECIFY COURSE F20.01 – PARANOID SCZ, EPISODIC WITH PROGRESSIVE DEFICIT DIFFERENT VERSIONS – FLEXIBILITY AND ACCEPTIBILITY TO VARIOUS USERS
- 45. ICD 10 CLINICAL DESCRIPTIONS AND DIAGNOSTIC GUIDELINES FOR GENERAL CLINICAL, EDUCATIONAL AND SERVICE USE DIAGNOSTIC CRITERIA FOR RESEARCH PRIMARY CARE VERSION MULTIAXIAL VERSION
- 46. CLINICAL DESCRIPTIONS… EACH CATEGORY ACCOMPANIED BY GLOSSARY OF BRIEF DEFINITIONS FURTHER DEFINED SET OF CRITERIA CRITERIA LESS PRECISE THAN DSM ALLOWS CLINICIANS TO USE IN DAILY PRACTICE
- 47. DIAGNOSTIC CRITERIA FOR RESEARCH TWO NB ANNEXES CULTURE SPECIFIC D/O PROVISIONAL CRITERIA FOR UNCERTAIN NOSOLOGICAL STATUS – BIPOLAR D/O II
- 48. MULTIAXIAL VERSION ADULT PSYCHIATRY – 3 AXES CATEGORIZE CLINICAL SYNDROME LEVEL OF FUNCTIONAL CAPACITY/ DISABILITY CATEGORIES OF IMPORTANCE IN THE UNDERSTANDING OF THE D/O
- 49. MULTIAXIAL VERSION MENTAL D/O OF CHILDHOOD 6 AXES: CLINICAL PSYCHIATRIC SYNDROMES SPECIFIC D/O OF PSYCHOLOGIC DEVELOPMENT INTELLECTUAL LEVEL MEDICAL CONDITIONS ASSOCIATED ABNORMAL PSYCHOSOCIAL SITUATION GLOBAL ASSESSMENT OF PSYCHOSOCIAL DISABILITY
- 50. PRIMARY CARE VERSION FEWER CATEGORIES GENERAL PRACTITIONER, PRIMARY HEALTH CARE STAFF, PSYCHIATRISTS, OTHERS 2 CARDS WAY THAT CONDITION IS RECOGNIZED AND DIAGNOSED ADVICE ON MX
- 51. ADVANTAGES OF ICD 10 SIMPLICITY OF STRUCTURE AND USE USED BY SPECIAL GROUPS, STILL COMPATIBLE WITH ORIGINAL CLASSIFICATION COMPATIBILITY WITH NATIONAL AND OTHER WIDELY USED CLASSIFICATIONS DIFFERENCES KEPT TO MINIMUM CONTINUITY OVER TIME BASED ON INTERNATIONAL CONSENSUS
- 52. ADVANTAGES OF ICD 10 BASED ON INTERNATIONAL CONSENSUS SEVERAL VERSIONS – ALL COMPATIBLE WITH EACH OTHER SEVERAL LANGUAGES ADDITIONAL PUBLICATIONS FACILITATE ITS USE RESPONSIVE TO NEEDS OF PRACTICE CATEGORIES FOR DIAGNOSIS FREQUENTLY USED BUT NOSOLGY UNCERTAIN
- 53. ADVANTAGES OF ICD 10 AVOIDS ‘SOCIAL FUNCTIONING’ AS DIAGNOSTIC INDICATOR RECENTLY INTRODUCED DX OF PUBLIC HEALTH INTERES MILD COGNITIVE D/O TERMINOLOGY EASY TO USE SIGNIFICANT EXPANSION OF ACUTE PSYCHOTIC D/O-DEVELOPING COUNTRIES CATEGORICAL CLASSIFICATION
- 54. LIMITATIONS OF ICD 10 CATEGORICAL CLASSIFICATION-DISCRETE ENTITY VIEW OF PSYCH D/O
- 55. LIMITATIONS OF CURRENT OPERATIONAL APPROACHES TO DIAGNOSIS FOCUS ON EPISODE RATHER THAN LIFETIME EXPERIENCE HIERARCHIES LEAD TO LOSS OF INFO BOUNDARIES BET CATEGORIES ARE ARBITRARY BOUNDARIES BET CATEGORIES REQUIRE SUBSTANTIAL SUBJECTIVE JUDGEMENT DIAGNOSTIC CATEGORIES ARE UNHELPFUL IN DETERMINING SEVERITY
- 56. LIMITATIONS OF CURRENT OPERATIONAL APPROACHES TO DIAGNOSIS SUBCLINICAL CASES NOT ACCOMODATED FULLY NOS CATEGORIES HIGHLY HETEROGENOUS INCREASED GAPS BETWEEN RESEARCH FINDINGS AND DEFINITIONS OF CURRENT DIAGNOSTIC SYSTEMS – SACRIFICES VALIDITY FOR RELIABILITY
- 57. DIFFERENCES BETWEEN DSM AND ICD DSM IV-TR ICD10 PRODUCED BY APA WHO ONE GROUP OF DISEASES, DIRECT NUMBER OF CLASSIFICATIONS INTEREST TO PARTICULAR – EVEN CLASSIFICATION OF PROFESSIONAL GROUP REASON FOR CONTACT NATIONAL DIAGNOSTIC STATUTORY RESPONSIBILITY CLASSIFICATION FOR RELIABLE REPORTING OF DISEASES AND HEALTH STATES TO THE WORLD POPULATION SINGLE SET OF OPERATIONAL INTERRELATED VERSIONS DIAGNOSTIC CRUTERIA FOR ALL ADDRESSING DIFFERENT USERS USERS IN SPECIFIC CONTEXTS
- 58. DIFFERENCES BETWEEN DSM AND ICD 10 DSM IV-TR ICD10 DEFINITIONAL DIFFERENCES- DX OF HARMFUL USE FOCUSES SUBSTANCE D/O=FOCUS ON ON DAMAGE TO USER’S NEGATIVE CONSEQUENCES PHYSICAL AND MENTAL HEALTH ACUTE STRESS D/O-DX ONLY WIDER RANGE OF RESPONSES- FOR SEVERE DISSOCIATIVE MILD ANXIETY TO SEVERE REACTIONS DISSOCIATION DIFFERENCES IN DIAGNOSTIC MINIMUM 3/12 CRITERIA-DURATION, FREQUENCY ETC-DELUSIONAL D/O-3/12 DIFFERENCES IN HYPOCHONDRIASIS EXCLUSIONARY CRITEIA- HYPOCHONDRIASIS CONCEPTUAL DIFFERENCES OF CONCEPTUAL DIFFERENCES OF DISORDERS DISORDERS
- 63. DSMV CURRENTLY IN CONSULTATION, PLANNING AND PREPARATION DUE FOR PUBLICATION IN 2012/13 WORK GROUPS TO ADDRESSS MAJOR GAPS
- 64. DEVELOPMENTAL ISSUES REFINE PSYCHIATRIC ASSESSMENT TECHNIQUE ACROSS DEVELOPMENTAL STAGES METHODS TO INTEGRATE DEVELOPMENTAL ASSESSMENTS INTO DIAGNOSTIC PROCESSING
- 65. DEFINING MENTAL ILLNESS FACILITATING DIAGNOSTIC PROCESSES IN NON-PSYCHIATRIC SETTINGS APPLICABILITY OF CRITERIA ACROSS DIFFERENT CULTURAL SETTINGS VALIDATINGDIAGNOSTIC CRITERIA INCREASING COMPATIBILITY BETWEEN DSM V AND ICD 10 DIMENSIONAL APPROACH MORE SUPERIOR
- 66. PERSONALITY DISORDERS DIMENSIONAL MODEL MAY BE SUPERIOR, MORE RELIABLE, SPECIFIC AND CLINICALLY INFORMATIVE SHOULD THERE BE INDEPENDENCE AND DISTINCTIVENESS BETWEEN AXIS I AND AXIS II PERSONALITY D/O BOTH FREQUENTLY CO-EXIST AXIS II OFTEN A SIGNIFICANT COMPLICATING FACTOR TO AXIS I
- 67. RELATIONAL PROBLEMS PAINFUL PERSISTENT BEHAVIOURAL PROBLEMS THAT SERIOUSLY AFFECT JUDGEMENT INCLUSION IN DSMV
- 68. PROPOSED CHANGES TO DSM IV-TR DX ELIMINATE ASPERGERS SYNDROME AS SEPARATE D/O MERGE UNDER AUTISM SPECTRUM D/ O SEVERITY CAN BE RATED- SEVERE, MODERATE, MILD
- 69. PROPOSED NEW DSM V DX COMPLEX POST TRAUMATIC STRESS D/O DEPRESSIVE PERSONALITY D/O NEGATIVISTIC ( PASSIVE-AGGRESSIVE ) PD POST TRAUMATIC EMBITTERMENT D/O RELATIONAL D/O PD AND MR AS AXIS I D/O SLUGGISH COGNITIVE TEMPERAMENT
- 70. REFERENCES KAPLAN AND SADDOCK’S COMPREHENSIVE TEXTBOOK OF PSYCHIATRY, 9TH EDITION 2009 KAPLAN AND SADDOCK’S SYNOPSIS OF PSYCHIATRY,10TH EDITION DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS:DSM IV TR- APA 2000 A RESEARCH AGENDA FOR DSM V. KUPFER,D; FIRST,M;REGIER,D FIRST M.HARMONISATION OF ICD-11 AND DSM- V: OPPORTUNITIES AND CHALLENGES.BJP 2009;195:382-390 JABLENSKY A.TOWARDS ICD-11 AND DSM-V:ISSUES BEYOND HARMONISATION.BJP 2009;195:379-381 CRADDOCK,MICHAEL O.RETHINKING PSYCHOSIS.WORLD PSYCHIATRY 2007;6(2):84-91
- 71. REFERENCES DISTINGUISHING BETWEEN VALIDIDTY AND UTILITY OF PSYCHIATRIC DIAGNOSIS. KWNDELL R,JABLESKY A.AMJ 2003;160:4-12 CLINICAL UTILITY AS A CRITERION FOR REVISING PSYCHIATRIC DIAGNOSIS. FIRST M,WILLIAMS J,USTUN B, PEELE R. AMJ 2004;161;946-954 AMERICAN ASSOCIATION OF COMMUNITY PSYCHIATRIST’S VIEWS ON GENERAL FEATURES OF DSM-IV. BELL C,SOWERS W, THOMPSON K. PSYCHIATRIC SERVICES,2008;59:687-689