2 - Diagnosis & Classification in Psychiatry

Diagnosis & Classification in
Psychiatry
Dr. Waddah Alalmaei

Psychiatry & Normality
• How To Distinguish normal psychological
experience & abnormal one ?
Definition
A mental disorder is a syndrome characterized by
clinically significant disturbance in an individual’s
cognition, emotion regulation, or behavior that
reflects a dysfunction in the psychological,
biological, or developmental processes underlying
mental functioning.
• Mental disorders are usually associated with
significant distress or disability in social, occupational,
or other important activities.
• An expectable or culturally approved response to a
common stressor or loss, such as the death of a loved
one, is not a mental disorder.
• Socially deviant behavior (e.g., political, religious, or
sexual) and conflicts that are primarily between the
individual and society are not mental disorders unless
the deviance or conflict results from a dysfunction in
the individual, as described above.
Importance Of Diagnosis
Communication
Comperhension
Research
Organizing principles of contemporary
classifications
• Organic and functional
– Organic disorders are disorders with structural brain
pathology that can be detected by clinical assessment or
usual tests. E.g. delirium, dementia, substance-induced
mental disorders, and medication-induced mental disorders.
– Functional disorders are psychiatric disorders without obvious
structural brain pathology. E.g. Schizophrenia, mood
disorders, anxiety disorders, adjustment disorders
– This distinction between organic and functional has begun to
appear less helpful now, because sophisticated modem
techniques of investigation have revealed underlying
neuropathology in some disorders previously considered
functional.
Features Suggestive of Organic Mental
Disorders (CNS pathology)
• Disturbed consciousness +/- other cognitive
disturbance in: attention, concentration,
orientation or memory.
• Physical illness (e.g. diabetes, hypertension).
• Vital signs disturbances (e.g. fever, high BP).
• Neurological features (e.g. ataxia, dysarthria).
• Neurosis and psychosis
– In modern usage, the term psychosis refer broadly to sever
psychiatric disorders.
– Lack of insight is often suggested criterion for psychosis.
– Inability to distinguish between subjective experience and
external reality is somewhat more straightforward criterion
for psychosis.
– Neurosis Generally less severe forms of psychiatry
disorders in which the patient is able to distinguish
between subjective experience and reality. No lack of
insight, delusions or hallucinations
psychosis neurosis
Mental disorders in which the patient lacks Generally less severe forms of psychiatry
insight and is unable to distinguish between disorders in which the patient is able to
subjective experience and external reality, as distinguish between subjective experience
evidenced by disturbances in thinking and external reality.
(delusions), perception (hallucinations), or
behavior (e.g. violence). No lack of insight, delusions or
hallucinations.
Examples: schizophrenia, severe mood
disorders, delusional disorders. It can be due Examples: dysthymic disorder, anxiety, panic
to an organic cause (organic psychosis) e.g. & phobic disorders.
delirium, dementia, substance abuse, head
injury. Features are abnormal in quantity (e.g.
excessive fear and avoidance).
Features are abnormal in quality (e.g.
delusions, hallucinations).
current diagnoses are primarily syndrome based.
They rely heavily on clinical observations that signs

and symptoms co-occur in groups of patients and
also that they have a characteristic course and
response to treatment.
syndromes: collections of symptoms that tend to co-

occur and appear to have a characteristic course and
outcome
Current & Official psychiatric
classifications
• ICD-10
– was endorsed by the Forty-third World Health Assembly
in May 1990 and came into use in WHO Member States as
from 1994. The 11th revision of the classification has
already started and will continue until 2017.
– The International Classification of Diseases (ICD) is an
international standard diagnostic classification for a wide
variety of health conditions. Chapter V focuses on "mental
and behavioural disorders" and consists of 10 main groups
ICD- 10
• F0: Organic, including symptomatic, mental disorders
• F1: Mental and behavioural disorders due to use of psychoactive substances
• F2: Schizophrenia, schizotypal and delusional disorders
• F3: Mood [affective] disorders
• F4: Neurotic, stress-related and somatoform disorders
• F5: Behavioural syndromes associated with physiological disturbances and physical
factors
• F6: Disorders of personality and behaviour in adult persons
• F7: Mental retardation
• F8: Disorders of psychological development
• F9: Behavioural and emotional disorders with onset usually occurring in childhood
and adolescence
• In addition, a group of "unspecified mental disorders".
DSM-5
Classification (May
2013) is an
evidence-based
manual useful in
accurately and
consistently
diagnose mental
disorders
PROBLEMS in CLASSIFYING PSYCHIATRIC
DISORDERS
• Psychiatry, in contrast to other branches of medicine, relies
on the patient's own subjective report of symptoms and the
doctor's observation of patient behavior to arrive at a
diagnosis.
• Psychiatry lacks objective and independent criteria for
sorting out psychiatric disorders.
• Psychiatric disorders are manifested by a quantitative
deviation in behavior, ideation and emotion from a
normative concept and it is difficult to define normal human
behavior.
• Psychiatric symptoms are highly nonspecific and quite
unstable over time.
Etiology in Psychiatry
The Complexity of etiology in Psychiatry
1. Time factor: causes are often remote in time from
the effect they produce.
2. Single cause may lead to several psychological effects
e.g. deprivation from parental affection may lead to
depression or conduct disorder in children and
adolescents.
3. Single effect may arise from several causes e.g.
depression may be due to accumulation of several
causes like endocrinopathies, psychosocial stresses
and side effects of some drugs.
4. Most psychiatric disorders are multifactorial.
Effect Predisposing Precipitating Aggravating Maintaining
Nature
E.g. Genetic E.g. First dose E.g. Further E.g. Continuation
Bio predisposition of cannabis abuse of cannabis abuse
e.g. panic abuse
disorder
E.g. Abnormal E.g. Sudden or E.g. Further E.g. Continuation
psycho- personally severe psychological of such stresses
traits with poor psychological stresses
stress stress
adaptation
E.g. Parental Marriage E.g. Marital E.g. continuation
social separation conflict of marital
problems
Main causative factors in psychiatry:
A. Genetic : e.g. in schizophrenia , mood disorders , panic
disorder and agoraphobia.
B. Neuropathological: e.g. dementias ,delirium.
C. Endocrinopathological: e.g. hyperthyroidism /
hypothyroidism.
D. Pharmacological: side effects of medications e.g. steroids >
mood changes.
E. Social: e.g. marital discord /occupational problems/financial
difficulties.
F. Psychological : behavioral ,cognitive , or psychodynamic
problems (subconscious processes that
Psychiatry & Cultural beliefs
Evil Eye , Possession ,Witchcraft
?????
‫النظرة االجتماعية ال تمثل الشرع‬
‫تماما )‬ ‫( ال تطابق تماما و ال تخالف‬
‫مبالغة وتعميم وقلة علم بالشرع وبالطب‬
‫تجاوزات شرعية وأخالقية وطبية‬

‫تأثير العين والمس والسحر على صحة البشر ثابت‬
‫أما الكيفية والعالمات لكل منها فلم ترد بالتحديد‬
‫الرقية الشرعية لالستشفاء ال لتشخيص األمراض وأسبابها‬

‫اآلثار السلبية لألفكار المجتمعية الخاطئة‬
‫● حرمان المرضى من العالج الطبي السليم‬
‫● التدخل في التشخيص والجزم بناء على خبرات شخصية‬
‫● التدخل في طريقة التداوي دون مسئولية‬
‫● إيذاء المرضى بالضرب والكهرباء وغيرها‬

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What are some of the organizing principles of contemporary psychiatric classifications?

What are some of the main causative factors considered in psychiatry?

Diagnosis & Classification in

Dr. Waddah Alalmaei

They rely heavily on clinical observations that signs

syndromes: collections of symptoms that tend to co-

‫تماما )‬ ‫( ال تطابق تماما و ال تخالف‬

‫مبالغة وتعميم وقلة علم بالشرع وبالطب‬

‫تجاوزات شرعية وأخالقية وطبية‬

‫أما الكيفية والعالمات لكل منها فلم ترد بالتحديد‬

‫الرقية الشرعية لالستشفاء ال لتشخيص األمراض وأسبابها‬

‫● التدخل في التشخيص والجزم بناء على خبرات شخصية‬

‫● التدخل في طريقة التداوي دون مسئولية‬

‫● إيذاء المرضى بالضرب والكهرباء وغيرها‬

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