Diagnosing Mental Disorders

1
Diagnosing Mental Disorders

• Diagnosis A determination that a persons
  problems reflect a particular disorder.

2
Two Systems of Classification in Use Today

• Diagnoses and their symptoms appear in two
  classification systems currently in use the
  ICD-9 and the DSM-IV-TR.
• These are essentially lists of disorders, along
  with descriptions of symptoms and guidelines for
  making the appropriate diagnosis.
• They are not explanatory, merely descriptive.

3
Why Use a System of Classification?

• Gives formal names to clinically observed
  syndromes (clusters of symptoms that tend to
  occur together).
• Offers a common language for research and
  clinical practice.
• Standardizes the use of diagnostic labels,
  enhancing agreement among professionals.

4
ICD-9

• International Classification of Diseases.
• 1883 Emil Kraeplin developed the first modern
  clasification system for abnormal behavior.
• This became the foundation for the International
  Classification of Diseases (ICD-9) used by the
  World Health Organization.
• Kraeplins system also influenced the development
  of the DSM in the U.S.

5
DSM-IV Classification System

• 1952 The American Psychiatric Association
  publishes the first version of the DSM,
  Diagnostic and Statistical Manual.
• Periodical revisions try to keep pace with
  scientific advances and changes in how we regard
  disorders.
• 1994, 2000 DSM-IV and DSM-IV-TR are the versions
  currently in use.

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Features of the DSM-IV

• Provides diagnostic criteria to improve the
  reliability of diagnostic judgments (DSM-IV-TR,
  2000, p. ix)
• Disorders are classified on the basis of current
  observable clinical features (symptoms) and
  behavior patterns.
• Concerned only with accurate description, not
  causal explanations.
• Does not endorse particular theoretical models.

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DSM-IV A Multiaxial System

• The patient is evaluated on 5 separate axes, or
  dimensions.
• This helps to give a fuller picture of the
  individual, to help in planning treatment and
  predicting outcome.
• These 5 dimensions are called AXES

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5 Axes for Evaluating the Patient

• Axis I Clinical Disorders
• Axis II Personality Disorders and Mental
  Retardation
• Axis III General Medical Conditions
• Axis IV Psychosocial and Environmental
  Problems
• Axis V Global Assessment of Functioning

9
Axis I Clinical Syndromes

• The current mental/emotional disorder is listed
  here.
• Not listed on Axis I Personality Disorders and
  Mental Retardation.
• A person can have gt 1 Axis I disorder.

10
Axis II Personality Disorders and Mental
Retardation

• Axis II is reserved for cases in which the person
  is felt to have a long-standing, underlying
  mental disorder.
• If a person does not have an Axis II disorder,
  it is left blank.
• Axis II also used to indicate prominent
  maladaptive personality features or defense
  mechanisms.

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Axis III General Medical Conditions

• Medical conditions are listed here.
• These may or may not be causally linked with the
  axis I disorder.
• This axis helps to ensure good overall care by
  reminding the mental health clinician to consider
  the patients physical health status.

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Axis IV Psychosocial and Environmental Problems

• Problems with primary support group. (family
  crises, sexual/physical abuse, family disruption,
  etc.)
• Problems related to the social environment.
  (social isolation, discrimination, acculturation,
  retirement, etc.)
• Educational, occupational, housing, economic
  problems.
• Legal problems

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Axis V Global Assessment of Functioning

• GAF score is assigned on the basis of clients
  overall ability to function in their life.
• Scale is from 1-100, with 100 indicating superior
  functioning
• E.g. A score of 30 indicates presence of
  psychosis.

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Percent of the U.S. population diagnosed with
psychiatric disorders
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Benefits and Drawbacks of Diagnostic Labeling

• Benefits

• Drawbacks