Classification and Diagnosis in Psychiatry

د.وليد عزيز العميدي Classification and Diagnosis in Psychiatry

There are major difficulties in classification and diagnosis in psychiatry :-
- What are psychiatrists talking about , i.e. what is a mental illness ? and when is a mental state abnormal ? how do you decide ?
- Psychiatric symptoms and signs are not specific .
- Delusions and hallucinations occur in schizophrenia , mania and severe depression .
- Depression can be the primary problem or part of another disorder .
- There are no reliable biological markers.
- Psychiatrists change their minds and cannot agree.
WHAT ARE MENTAL DISORDERS ? this term should include the following elements :
- A behavioral or psychological syndrome.
- Associated with distress or disability.
- Associated with a risk of incurring death , pain or disability.
- Not culturally appropriate.
- The disorder is a manifestation of dysfunction in the individual .
- Not merely a conflict between the individual and society.
Mental disorders are diagnosed at different levels :
- Aetiological , e.g. general paralysis of the insane.
- Pathological , e.g. Alzheimer`s disease.
- Clinical symptoms , e.g. schizophrenia.
Some major divisions :
- Categorical VS. dimensional : for most areas of psychiatry a categorical approach to classification is taken ( this is schizophrenia , that is obsessive compulsive disorder , and so forth ) . this can lead to defining rather disparate symptoms and signs under the same rubric. Sometimes the person display a little anxiety , little depression and perhaps some phobic elements too , under these circumstances it may be more sensible to define the person`s symptoms along a series of axes rather than in a categorical manner .
- Organic VS. functional : clinically defined disorders for which no underlying neuropathology could be demonstrated known as functional disorders ( schizophrenia , anxiety disorders …..) . with sophisticated techniques of investigation , more of the biology of the functional disorders is now known (e.g. neurochemistry of depression ). As a result , the historical division between organic and functional has begun to appear unhelpful.
- Psychotic VS. neurotic : psychotic patients have delusions and hallucinations , and have lost the ability to test reality in the normal way . neurotic patients recognize their states as abnormal and do not suffer from delusions or hallucinations. The term neurotic has been omitted from the most recent major classification.

-Current psychiatric classifications :
DSM-5
A fifth edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders was published in 2013 called DSM-5. It contains the official nomenclature used by psychiatrists and other mental health professionals in the United States.
ICD
It is the classification system developed by the World Health Organization (WHO) called the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
DSM-5 CLASSIFICATION
The DSM-5 lists 22 major categories of mental disorders, comprising more than 150 discrete illnesses. The organization of the disorders in DSM-5 attempts to follow the lifespan. Thus, neurodevelopmental disorders that occur early in life are listed first in the classification system, and neurocognitive disorders that occur toward the end of life are listed last.

1- Neurodevelopmental Disorders
These disorders are usually first diagnosed in infancy, childhood, or adolescence.
1- Intellectual Disability or Intellectual Developmental Disorder (previously called mental retardation in DSM-IV).
2- Communication Disorders.
3- Autism Spectrum Disorder.
4- Attention-Deficit/Hyperactivity Disorder (ADHD).
5- Specific Learning Disorders. These are maturational deficits in development that are associated with difficulty in acquiring specific skills in reading (also known as dyslexia), in written expression, or in mathematics (also known as dyscalculia.
6- Motor Disorders. Analogous to learning disorders, motor disorders are diagnosed when motor coordination is substantially below expectations based on age and intelligence and when coordination problems significantly interfere with functioning. There are three major types of motor disorders: (1) developmental coordination disorder is an impairment in the development of motor coordination (e.g., delays in crawling or walking, dropping things, or poor sports performance); (2) stereotypic movement disorder consists of repetitive motion activity (e.g., head banging and body rocking); and (3) tic disorder is characterized by sudden involuntary, recurrent, and stereotyped movement or vocal sounds. There are two types of tic disorders; The first is Tourette’s disorder, characterized by motor and vocal tics, including coprolalia, and the second is persistent chronic motor or vocal tic disorders marked by a single motor or vocal tic.



2- Schizophrenia Spectrum and Other Psychotic Disorders
1- Schizophrenia.
2- Delusional Disorder.
3- Brief Psychotic Disorder.
4- Schizophreniform Disorder.
5- Schizoaffective Disorder.
6- Substance/Medication-Induced Psychotic Disorder.
7- Psychotic Disorder Due to Another Medical Condition.
8- Catatonia.

3- Bipolar and Related Disorders
Bipolar I Disorder.
Bipolar II Disorder.
Cyclothymic Disorder.
Bipolar Disorder Due to Another Medical Condition
Substance/Medication-Induced Bipolar Disorder.

4- Depressive Disorders
Major Depressive Disorder
Persistent Depressive Disorder or Dysthymia
Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive Disorder.
Depressive Disorder Due to Another Medical Condition.
Other Specified Depressive Disorder. This diagnostic category includes two subtypes: (1) recurrent depressive episode, which is a depression that lasts between 2 to 13 days and that occurs at least once a month, and (2) short-duration depressive episode, which is a depressed mood lasting from 4 to 14 days and which is nonrecurrent.
Unspecified Depressive Disorder. This diagnostic category includes four major subtypes: (1) melancholia, which is a severe form of major depression characterized by hopelessness, anhedonia, and psychomotor retardation, and which also carries with it a high risk of suicide; (2) atypical depression, which is marked by a depressed mood that is associated with weight gain instead of weight loss and with hypersomnia instead of insomnia; (3) peripartum depression, which is a depression that occurs around parturition or within 1 month after giving birth (called post-partum depression in DSM-IV); and (4) seasonal pattern, which is a depressed mood that occurs at a particular time of the year, usually winter (also known as seasonal affective disorder [SAD]).
Disruptive Mood Dysregulation Disorder.

5- Anxiety Disorders:
Panic Disorder.
Agoraphobia.
Specific Phobia.
Social Anxiety Disorder or Social Phobia.
Generalized Anxiety Disorder.
Anxiety Disorder Due to Another Medical Condition.
Substance/Medication-Induced Anxiety Disorder.
Separation Anxiety Disorder.
Selective Mutism.

6- Obsessive-Compulsive and Related Disorders
Obsessive-Compulsive Disorder (OCD).
Body Dysmorphic Disorder.
Hoarding Disorder.
Trichotillomania or Hair-Pulling Disorder.
Excoriation or Skin-Picking Disorder.
Substance/Medication-Induced Obsessive-Compulsive Disorder.
Obsessive-Compulsive Disorder Due to Another Medical Condition.
Other Specified Obsessive-Compulsive and Related Disorder. This category includes a group of disorders such as obsessional jealousy in which one person has repeated thoughts about infidelity in the spouse or partner. It must be distinguished from a delusional belief such as Koro, which is a disorder found in South and East Asia in which the person believes the genitalia are shrinking and disappearing into the body; and body-focused repetitive behavior disorder in which the person engages in a compulsive behavioral pattern such as nail biting or lip chewing.

7- Trauma- or Stressor-Related Disorder
Reactive Attachment Disorder.
Disinhibited Social Engagement Disorder.
Posttraumatic Stress Disorder (PTSD).
Acute Stress Disorder. .
Adjustment Disorders.
Persistent Complex Bereavement Disorder.

8- Dissociative Disorders
Dissociative Amnesia.
Dissociative Fugue
Dissociative Identity Disorder.
Depersonalization/Derealization Disorder.

9- Somatic Symptom and Related Disorders
Somatic Symptom Disorder.
Illness Anxiety Disorder.
Functional Neurological Symptom Disorder.
Psychological Factors Affecting Other Medical Conditions.
Factitious Disorder.
Other Specified Somatic Symptom and Related Disorder.

10- Feeding and Eating Disorders
Anorexia Nervosa.
Bulimia Nervosa.
Binge Eating Disorder.
Pica.
Rumination Disorder.
Avoidant/Restrictive Food Intake Disorder.
Elimination Disorders




11- Sleep-Wake Disorders
Insomnia Disorder.
Hypersomnolence Disorder.
Parasomnias
Narcolepsy.
Breathing-Related Sleep Disorders.
Restless Legs Syndrome.
Substance/Medication-Induced Sleep Disorder.
Circadian Rhythm Sleep-Wake Disorders.

12- Sexual Dysfunctions
Delayed Ejaculation.
Erectile Disorder.
Female Orgasmic Disorder.
Female Sexual Interest/Arousal Disorder.
Genito-Pelvic Pain/Penetration Disorder.
Male Hypoactive Sexual Desire Disorder.
Premature or Early Ejaculation.
Substance/Medication-Induced Sexual Dysfunction.
Other Unspecified Sexual Dysfunction.
Gender Dysphoria

13- Disruptive, Impulse-Control, and Conduct Disorders
Oppositional Defiant Disorder.
Intermittent Explosive Disorder.
Conduct Disorder.
Pyromania.
Kleptomania.

14- SUBSTANCE-RELATED DISORDERS
Substance-Induced Disorders.
Substance Use Disorders.
Alcohol-Related Disorders.
Other Alcohol-Induced Disorders.
Gambling Disorder.

15- NEUROCOGNITIVE DISORDERS
These are disorders characterized by changes in brain structure and function that result in impaired learning, orientation judgment, memory, and intellectual functions. (They were previously called dementia, delirium, amnestic, and other cognitive disorders in DSM-IV.) They are divided into three categories.
Delirium.
Mild Neurocognitive Disorder.
Major Neurocognitive Disorder.






16- Personality Disorders
Paranoid Personality Disorder.
Schizoid Personality Disorder.
Schizotypal Personality Disorder
Obsessive-Compulsive Personality Disorder (OCPD).
Histrionic Personality Disorder.
Avoidant Personality Disorder.
Antisocial Personality Disorder.
Narcissistic Personality Disorder.
Borderline Personality Disorder .
Dependent Personality Disorder.