Classification and Diagnosis in Psychiatry
I. Introduction
The Diagnostic and Statistical Manual of Mental Disorders, Text Revision, fourth edition (DSM-IV-TR), published in 2000 by the American Psychiatric Association, is the official classification system used by all mental health professionals to diagnosis psychiatric disorders. DSM-IV-TR contains diagnostic criteria for 17 major categories of mental disorders (Table 1-1), comprising 375 discrete illnesses. All of those disorders are covered in this book, in separate chapters.
A similar system is used in Europe called the International Statistical Classification of Diseases and Related Health Problems (ICD). Both ICD and DSM-IV-TR use the same numerical codes (which are used in medical reports and insurance forms) for each disorder. All terminology in this book conforms to the official DSM-IV-TR nomenclature, and the diagnostic DSM-IV-TR criteria are contained in the discussion of each disorder.
The DSM-IV-TR classification and code numbers are listed on page 555 of this handbook.
II. Basic Features DSM-IV-TR
A. Diagnostic criteria
The DSM-IV-TR diagnostic system lists diagnostic criteria for each disorder.
If a sufficient number of signs and symptoms are elicited from the patient in the history and mental status (see Chapter 2), the diagnosis can be made.
Specific diagnostic criteria increase reliability (e.g., different observers get the same results).
B. Descriptive approach
DSM-IV-TR only describes mental disorders. It is atheoretical with regard to cause. Etiology and treatment are not covered in DSM.
The descriptive approach increases validity. It measures what it is supposed to measure (e.g., a patient diagnosed with schizophrenia really is schizophrenic).
III. Definition of Mental Disorder
A mental disorder is an illness with psychological or behavioral manifestations associated with significant distress and impaired functioning caused by a biologic, social, psychological, genetic, physical, or chemical disturbance. It is measured in terms of deviation from some normative concept. Each illness has characteristic signs and symptoms.
Table 1-1 Groups of Conditions in DSM-IV-TR* | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
In addition to the DSM-IV-TR classifications, other terms that are used in psychiatry to describe mental illness are as follows:
A. Psychotic.
Loss of reality testing with delusions and hallucinations (e.g., schizophrenia).
B. Neurotic.
No loss of reality testing; based on mainly intrapsychic conflicts or life events that cause anxiety; symptoms include obsession, phobia, and compulsion.
C. Functional.
No known structural damage or clear-cut biological cause to account for impairment.
D. Organic.
Illness caused by a specific agent producing structural change in the brain; usually associated with cognitive impairment, delirium, or dementia (e.g., Pick’s disease). The term organic is not used in DSM-IV-TR because it implies that some mental disorders do not have a biological or chemical component; however, it still remains in common use.
E. Primary.
No known cause; also called idiopathic (similar to functional).
F. Secondary.
Known to be a symptomatic manifestation of a systemic, medical, or cerebral disorder (e.g., delirium resulting from infectious brain disease).
IV. Classification of Disorders in DSM-IV-TR
A. Disorders usually first diagnosed in infancy, childhood, or adolescence
Mental retardation. Below-average intellectual functioning; onset before age 10. Associated with impaired maturation and learning and social maladjustment; classified according to intelligence quotient (IQ) as mild (50–55 to 70), moderate (35–40 to 50–55), severe (20–25 to 35–40), or profound (below 20–25).
Learning disorders. Maturational deficits in development associated with difficulty in acquiring specific skills in mathematics, writing, and reading.
Motor skills disorder. Impairments in the development of motor coordination (developmental coordination disorder). Children with the disorder are often clumsy and uncoordinated.
Communication disorders. Developmental impairment resulting in difficulty in producing age-appropriate sentences (expressive language disorder), difficulty in using and understanding words (mixed receptive–expressive language disorder), difficulty in articulation (phonological disorder), and disturbances in fluency, rate, and rhythm of speech (stuttering).
Pervasive developmental disorders. Characterized by autistic, atypical, and withdrawn behavior; gross immaturity; inadequate development; divided into autistic disorder (stereotyped behavior usually without speech), Rett’s disorder (loss of speech and motor skills with decreased head growth), childhood disintegrative disorder (loss of acquired speech and motor skills before age 10), Asperger’s disorder (stereotyped behavior with some ability to communicate), and a not otherwise specified (NOS) type.
Attention-deficit and disruptive behavior disorders. Characterized by inattention, overaggressiveness, delinquency, destructiveness, hostility, and feelings of rejection, negativism, or impulsiveness. Divided into attention-deficit/hyperactivity disorder (poor attention span, impulsiveness), conduct disorder (delinquency), and oppositional defiant disorder (negativism).
Feeding and eating disorders of infancy or early childhood. Characterized by disturbed or bizarre feeding and eating habits that usually begin in childhood or adolescence and continue into adulthood. Divided into pica (eating nonnutritional substances) and rumination disorder (regurgitation or rechewing).
Tic disorders. Characterized by sudden, involuntary, recurrent, stereotyped movement or vocal sounds. Divided into Tourette’s disorder (vocal tic and coprolalia), chronic motor or vocal tic disorder, and transient tic disorder.
Elimination disorders. Inability to maintain bowel control (encopresis) or bladder control (enuresis) because of physiologic or psychological immaturity.
Other disorders of infancy, childhood, or adolescence. Selective mutism (voluntary refusal to speak), reactive attachment disorder of infancy or early childhood (severe impairment of ability to relate, beginning before age 5), stereotypic movement disorder (thumb sucking, head banging, nail biting, skin picking), and separation anxiety disorder (cannot separate from home, e.g., school refusal, because of anxiety).
B. Delirium, dementia, and amnestic and other cognitive disorders.
Disorders characterized by change in brain structure and function that result in impaired learning, orientation, judgment, memory, and intellectual functions.
Delirium. Marked by short-term confusion and changes in cognition caused by a general medical condition (e.g., infection), substances (e.g., cocaine, opioids, phencyclidine), or multiple etiologies (e.g., head trauma and kidney disease). Delirium NOS may have other causes (e.g., sleep deprivation).
Dementia. Marked by severe impairment in memory, judgment, orientation, and cognition; dementia of the Alzheimer’s typeRelated posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
