The following document was written by Dr Satvir Singh FRANZCP (Aust), FRCPsych (UK), MSc (Lon), MRCPsych (UK), DPM, MBBS Consultant Psychiatrist & Lead Consultant for Undergraduate Medical Education (psychiatry) Kent & Medway NHS and Social Care Partnership Trust
Canterbury, Kent in Dec 2007.
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A perfect clinical diagnosis would usually predict the possible underlying causative factor/s, the patho-physiology, clinical signs and symptoms, response to the treatment and the course of the illness. Such perfect diagnoses are possible in various infectious diseases and to an extent, in surgery. However, in General Medicine and in particular, in psychological medicine, this perfect concept of disease is not possible. This is because of our limited knowledge about the underlying causes of mental disorders and any other objective measurable standard tests. Probably, some organic brain disorders, such as Dementia of Alzheimer’s Type, Lewy Body Dementia and Vascular Dementia can be separated clinically, but to be definite about he diagnosis, one would have to rely on brain biopsy and more often on autopsy results.
A specific disease process is further understood and classified by the clinician by its consequences, such as the impairment, disability and handicaps that may be caused. However, in psychiatry, the ultimate consequences may be very similar despite the differing underlying psychological and biological processes.
In psychiatry, the concept of “disease” does not encompass all of the above. Hence the broad term of “disorder” is often in use and not “disease.”
It is relevant and important to classify mental disorders for two very good reasons:
There are two principle methods of classification categories that are in current use:
The DSM-IV is a multi-axial diagnostic system where there are 5 Axes, namely:
Axis – 1: Main clinical diagnosis, currently under review and is the focus of attention and treatment.
Axis – 2: Personality Type/Disorder, Learning Disability
Axis – 3: Physical Disorders/Conditions
Axis – 4: Psychosocial Stress Factors
Axis – 5: Functioning Level in the last 12 months
The ICD-10 (WHO, 1992) is single Axis, which is widely used, but it is also available in a different format, for use in Primary Care and for research with multi-axial system.
The ICD-10 guidelines and criteria do not include the social consequences of a disorder while DSM-IV includes impairment in social functions.
In both the systems, the main categories are as follows:
Author:
Dr Satvir Singh
FRANZCP (Aust), FRCPsych (UK), MSc (Lon), MRCPsych (UK), DPM, MBBS
Consultant Psychiatrist & Lead Consultant for Undergraduate Medical Education(psychiatry)
Kent & Medway NHS and Social Care Partnership Trust
Canterbury, Kent
References