CLASSIFICATION IN

PSYCHIATRY

ANESCO, Carlo G.
ANGELES, Maria Veronica R.
ANTENOR, Armary Ruth C.
ASISTORES, Marie Aileen C.
ASUNCION, Reynaldo Raul N.
BARDELOSA, Justine Grace M.
BESANA, Mark Anthony B.
BONDOC, Angelo James F.
BUCAG, Arcelie T.
BUMANLAG, Exene Keisha G.

Section 3C

Dr. Ruben Manapat

PURPOSE OF CLASSIFICATION
  To distinguish one psychiatric diagnosis from another
 To provide a common language among health care professionals
 To explore the still unknown causes of many mental disorders

HISTORY

 Hippocrates - introduced the terms mania and hysteria  as forms of mental illness in the
fifth century BC
 1869 - first US classification was introduced at the annual meeting of the American
Medico-Psychological Association
 1952 - the American Psychiatric Association’s Committee on Nomenclature and
Statistics published the first edition of the Diagnostic and Statistical Manual of Mental
Disorders - I (DSM - I)

Two most important psychiatric classifications:

 Diagnostic and Statistical Manual of Mental Disorders (DSM)

 International Classification of Diseases (ICD)

DSM-5 CLASSIFICATION
 Lists 22 major categories of mental disorders, comprising more than 150 discrete
illnesses
 developed by the American Psychiatric Association in collaboration with other groups of
mental health professionals
 official psychiatric coding system used in United States
 was designed to correspond to the 10th revision of ICD-10, first developed in 1992

ICD-10
 developed by the World Health Organization
 official classification system used in Europe and many other parts of the world

All categories used in DSM-5 are found in ICD-10 but not all ICD-10 categories are in
DSM-5.

DSM-5 BASIC FEATURES

1. Descriptive Approach
 DSM-5 attempts to describe the manifestations of the mental disorders and only rarely
attempts to account for how disturbances come about

2. Diagnostic Criteria
  specified diagnostic criteria are provided for each specific mental disorder
 These criteria include a list of features that must be present for the diagnosis to be made
 increase the reliability of the diagnostic process

3. Systematic Description

- DSM-5 systematically describes each disorder in terms of its associated features:

 specific age, culture and gender-related features

 prevalence, incidence, risk
 course
 complications
 predisposing factors
 familial pattern
 differential diagnosis

- Laboratory findings and associated physical examination signs and symptoms are also
described when they are relevant

DSM-5 Classification

 To assist trained clinicians in the diagnosis of their patients' mental disorders as part
of a case formulation assessment that leads to a fully informed treatment plan for
each individual.

1. Neurodevelopmental Disorders

2. Schizophrenia Spectrum and Other Psychotic Disorders

3. Bipolar and Related Disorders

4. Depressive Disorders

5. Anxiety Disorders

6. Obsessive-Compulsive and Related Disorders

7. Trauma- or Stress-Related Disorder

8. Dissociative Disorders

9. Somatic Symptom and Related Disorders

 10. Feeding and Eating Disorders

11. Elimination Disorders

12. Sleep-Wake Disorders

13. Sexual Dysfunctions

14. Gender Dysphoria

15. Disruptive, Impulse-Control, and Conduct Disorders

16. Substance-Related Disorders

17. Neurocongnitive Disorders

18. Personality Disorders

19. Paraphilic Disorders and Paraphilia

20. Medication-Induced Movement Disorders and Other Adverse Effects of Medication

1. NEURODEVELOPMENTAL

- The disorders typically manifest early in development, often before the child enters
grade school, and are characterized by developmental deficits that produce impairments of
personal, social, academic, or occupational functioning.

● Intellectual disability

● Communication disorder

● Autism spectrum disorder

● ADHD

● Neurodevelopmental motor disorder

● Specific learning disorder

2. SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS

 - signs and symptoms are variable and includes changes in perception, emotion,
cognition, thinking and behavior.

● Delusions

● Hallucinations

● Disorganized speech (incoherence)

● Grossly disorganized or abnormal motor behavior (including catatonia)

● Negative symptoms (avolition)

3. BIPOLAR AND RELATED DISORDERS

- A bridge between the two diagnostic classes (schizo and depressive) in terms of
symptomatology, family history, and genetics. Patients with both manic and depressive
episodes or manic episode alone.

● Bipolar I disorder

● Bipolar II disorder

● Cyclothymic disorder

● Substance/medication-induced

4. DEPRESSIVE DISORDERS

- The common feature of all of these disorders is the presence of sad, empty, or irritable
mood, accompanied by somatic and cognitive changes that significantly affect the
individual's capacity to function.

- What differs among them are issues of duration, timing, or presumed etiology.

5. ANXIETY DISORDERS

- disorders that share features of excessive fear and anxiety and related behavioral
disturbances.

a. FEAR
 - emotional response to real or perceived imminent threat

- more often associated with surges of autonomic arousal necessary for fight or flight,
thoughts of immediate danger, and escape behaviors

b. ANXIETY

- more often associated with muscle tension and vigilance in preparation for future
danger and cautious or avoidant behaviors; anticipation of future threat

c. PANIC ATTACKS

- feature prominently within the anxiety disorders as a particular type of fear

response; not limited to anxiety disorders but rather can be seen in other mental
disorders as well.

6. OBSESSIVE – COMPULSIVE AND RELATED DISORDERS

a. OBSESSIONS

- recurrent and persistent thoughts, urges, or images that are experienced as intrusive
and unwanted

b. COMPULSIONS

- repetitive behaviors or mental acts that an individual feels driven to perform in

response to an obsession or according to rules that must be applied rigidly.

7. TRAUMA AND STRESSOR – RELATED DISORDERS

- Stressor is the prime causative factor in the development of PTSD. It involves an intense
fear or horror. The most prominent clinical characteristics are:

● Anhedonic and dysphoric symptoms,

● Externalizing angry and aggressive symptoms

● Dissociative symptoms.

● Reactive attachment disorder

● Disinhibited social engagement disorder

 ● Posttraumatic stress disorder (PTSD)

● Acute stress disorder

● Adjustment disorders

8. DISSOCIATIVE DISORDERS

- Characterized by a disruption of and/or discontinuity in the normal integration of

consciousness, memory, identity, emotion, perception, body representation, motor control, and
behavior. Signs and symptoms are often caused by a psychological trauma.

● Dissociative identity disorder

● Dissociative amnesia

● Depersonalization/Derealization disorder

9. SOMATIC SYMPTOM AND RELATED DISORDERS

- Individuals with medical complaints that have no physical cause. “All in your head”

● 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 DISORDER

- Persistent disturbance of eating or eating-related behavior that results in the altered

consumption or absorption of food and that significantly impairs physical health or
psychosocial functioning.

● Pica
 ● Rumination disorder

● Anorexia nervosa

● Bulimia nervosa

● Binge-eating disorder

11. ELIMINATION DISORDER

- Involve the inappropriate elimination of urine or feces and are usually first diagnosed in
childhood or adolescence.

a. Enuresis

- repeated voiding of urine into inappropriate places

b. Encopresis

- repeated passage of feces into inappropriate places.

12. SLEEP WAKE DISORDERS

● Insomnia disorder

● Hypersomnolence disorder

● Narcolepsy

● Breathing-related sleep disorders

○ Obstructive Sleep Apnea Hypopnea

○ Central Sleep Apnea

○ Sleep-related Hypoventilation

13. HUMAN SEXUALITY AND 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/early ejaculation

● Substance/medication induced sexual dysfunction

14. GENDER DYSPHORIA/GENDER IDENTITY DISORDER

- Incongruence between one's experienced or expressed gender and one's assigned

gender.

15. DISRUPTIVE IMPULSE CONTROL AND CONDUCT DISORDERS

- These problems are manifested in behaviors that violate the rights of others (e.g.,
aggression, destruction of property) and/or that bring the individual into significant conflict with
societal norms or authority figures.

- More common in males than in females

● Oppositional defiant disorder

● Intermittent explosive disorder

● Conduct disorder

● Antisocial personality disorder

● Pyromania

● Kleptomania

16. SUBSTANCE RELATED AND ADDICTIVE DISORDERS - They produce such an intense
activation of the reward system that normal activities may be neglected.
● Alcohol

● Caffeine

● Cannabis

● Hallucinogens

● Inhalants

● Opioids

● Sedatives

● Hypnotics

● Anxiolytics

● Stimulants (amphetamine-type substances, cocaine, and other stimulants)

● Tobacco

17. NEUROCOGNITIVE DISORDERS

● Dementia

● Delirium

● Amnestic

18. PERSONALITY DISORDERS

- An enduring pattern of inner experience and behavior that deviates markedly from
the expectations of the individual's culture, is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over time, and leads to distress or impairment.

19. PARAPHILIC DISORDERS

a. Voyeuristic disorder

- spying on others in private activities

 b. Exhibitionistic disorder

- exposing the genitals

c. Frotteuristic disorder

- touching or rubbing against a nonconsenting individual

d. Sexual masochism disorder

- undergoing humiliation, bondage, or suffering

e. Sexual sadism disorder

- inflicting humiliation, bondage, or suffering

f. Pedophilic disorder

- sexual focus on children

g. Fetishistic disorder

- using nonliving objects or having a highly specific focus on nongenital body parts

h. Transvestic disorder

- engaging in sexually arousing cross-dressing

ICD-10 (International Classification of Diseases 10th Revision)

- a diagnostic coding system developed by the World Health Organization in 1993 to

replace ICD-9-CM.

- It consist of diagnosis codes and will be used in all settings by all providers.

- The codes report diagnoses, signs, and/or symptoms documented in a patient’s

chart or medical record.

ICD-9-CM Codes

- Codes up to 5 characters long

 - Most codes are numeric

- Valid codes may be 3, 4 or 5 characters long

- Approximately 17,000 codes

ICD-10-CM Codes

- Up to 7 characters long

- All codes have both alpha and numeric characters

- 1st character is always alpha (any letter but U)

- 2nd character is always numeric

- 3rd through 7th characters can be mix of alpha and numeric

- Valid codes may be 3, 4, 5, 6, or 7 characters long

- Approximately 141,000 codes

- Allows for higher specificity such as location

Clinical Descriptions and Diagnostic Guidelines

F00-F09

- Organic, including symptomatic, mental disorders

- This block comprises a range of mental disorders grouped on the basis of their common,
demonstrable etiology in CEREBRAL DISEASE, BRAIN INJURY, or insult leading to
CEREBRAL DYSFUNCTION.

F10-F19

- Mental and behavioural disorders due to psychoactive substance use

- This block contains a wide variety of disorders that differ in severity, but that are all
attributable to the use of one or more psychoactive substances (which may or may not
have been medically prescribed).

F20-F29

- Schizophrenia, Schizotypal and delusional disorder

- This block forms a heterogenous and poorly understood collection of disorders, which
can conveniently be divided according to their typical duration into a group of persistent
delusional disorders and a larger group of acute and transient psychotic disorders.

F30-F39

- Mood (affective) Disorders

- In these disorders, the fundamental disturbance is a change in mood or affect, usually to

depression or to elation.

F40-F48

- Neurotic, stress-related and somatoform disorders

- Brought together because of their historical association with the concept of neurosis and
of a substantial proportion of these disorders with psychological causation.