Professional Documents
Culture Documents
CLASSIFICATION
&
MULTIAXIAL EVALUATION
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MENTAL DISORDER
CLASSIFICATION
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PPDGJ-III
Pedoman Penggolongan dan
Diagnosis Gangguan Jiwa di
Indonesia III
• Based on ‘ICD-10 Classification of Mental
and Behavioural Disorders’ (International
Classification of Diseases) & DSM-IV
(Diagnosis and Statistical Manual of
Mental Disorder)
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The manifestations of human
behavior is usually manifested in
three aspects:
1. Behavior
2. Thinking
3. Emotion
Note:
• Not all manifestation of the three
aspects that looks different with “normal
behavior” are mental disorders
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Mental Disorder
Is a clinically significant behavior or
psychological syndrome associated with
distress or disability, not just an expected
response to a particular event or limited to
relations between a person and society.
Note:
The term “normal” for human behavior in connotation with the
concept of mental disorder is not used anymore, because the
concept of “normality” is strongly associated with human values
and cultures, which is very diverse. What is considered
“normal” in one culture could be considered “abnormal” in
another culture.
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Mental disorders are grouped in 10 blocks:
Blocks F0 – F9
block F0 – F5 is that
• one cannot diagnose a mental disorder categorized
in a lower hierarchy of F0 – F5, unless mental
disorders with similar features at the higher
hierarchy in block F0 – F5 have been eliminated
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F60: Specific personality disorders
F0
Organic, incl. symptomatic mental disorders
F1
Mental and behavioral disorders due to psychoactive
substance use
F2
Schizophrenia, schizotypal and delusional disorders (incl.
acute and transient psychotic disorders)
F3
Mood (affective) disorders
F4
Neurotic, stress related and somatoform disorders
F5
Behavioral syndromes associated with physiological
disturbances and physical factors 8
F6
Disorders of adult personality and
behavior
F7
Mental Retardation
F8
Disorders of psychological development
F9
Behavioral and emotional disorders with
onset usually occurring in childhood and
adolescence
9
F0
Organic, incl. symptomatic, mental disorders
Note:
this is in contrast with mental
disorders which are the result of a of
psychological impact of knowing about
having a physical disease)
10
F0: Organic, incl. symptomatic, mental disorders
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F2
Schizophrenia, schizotypal and delusional disorders
( and other psychotic disorders)
F20 Schizophrenia
• F20.0 Paranoid schizophrenia
• F20.1 Hebephrenic schizophrenia
• F20.2 Catatonic schizophrenia
• F20.3 Undifferentiated schizophrenia
• F20.4 Post-schizophrenic depression
• F20.5 Residual schizophrenia
• F20.6 Simple schizophenia
• F20.8 Other schizophrenia
• F20.9 Schizophrenia, unspecified 15
F2
Schizophrenia, schizotypal and delusional disorders
( and other psychotic disorders)
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F4
Neurotic, stress-related and somatoform disorders
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F7
Mental retardation
childhood
(b)An impairment or delay in the development of
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MULTIAXIAL SYSTEM
Involves an assessment on several
axes which refers to a different domain
of information that may help the
clinician plan treatment & predict
outcome
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The aim of multiaxial evaluation
To understand patients comprehensively
• all the patient’s aspects are highlighted,
including his/ her quality of life
• Capturing the complexity of clinical situation
• Describing the heterogenity of individuals
presenting with the same diagnosis
• Promotes the application of biopsychosocial
model in clinical, education & research setting
So that
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AXIS I
Consist of Clinical Disorders & other
conditions that may be a focus of clinical
attention
All mental disorders from block F0 to F9,
except F6
F6 is Personality Disorder which is classified
in axis II
Block F7, F8 & F9 are mental disorders
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AXIS II
Consist of
• personality disorders and
• mental retardation
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AXIS III
Physical disorder or general medical
condition that is present in addition
to the mental disorder
The physical condition may be
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AXIS IV
To code the psychosicial & enviromental
problems
• that contribute significantly to the development or
exacerbation of the current disorder
The evaluation of of stressor:
• Based on a clinicians’ assessment oh the stress that an
average person with similar sociocutural values &
circumstances would experience from the psychosocial
stressor
Stressor:
• Positve: e.g job promotion
• Negative: loss of a love one
To formulate e treament plan:
• Attempt to remove psychosicial stressor
• Help the patient cope with them
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AXIS IV - cont
Psychosocial & enviromental problems:
• Problems with primary support group
• Problems related to the social enviromental
• Educational problems
• Occupational problems
• Housing problems
• Economic problems
• Problems with access to health care services
• Problems related to interaction with the legal
system/ crime
• Other psychosocial & enviromental problems
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AXIS V
Global assessment of functioning
(GAF)
• Scale in which clinicians judge patients’
overall levels of functioning during a
particular time
At the time of the evaluation
Patients’ highest level of functioning for at
Psychological func
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AXIS V - cont
The GAF scale:
• Based on a continuum of mental health &
mental illness
• A 100-point scale
• 100 representing the highest level of
functioning in all areas