MENTAL DISORDER CLASSIFICATION & MULTIAXIAL EVALUATION

1. MENTAL DISORDER CLASSIFICATION&MULTIAXIAL EVALUATION Modified of Dr. Gitayanti Hadisukanto, SpKJ(K)’s

2. Mentally Healthy?

3. Mentally Healthy a. Feeling healthy and happily b. Facing the life challenges c. Acceptance to others d. Positive attitude toward their life and others

4. Mental Disorder or Mentally Ill?

5. Mentally Ill or Mental Disorder • Clinically significantly disturbance in mind, feeling, or behaviour • Making distress and dysfunction-disability • for the person and the environment

6. Mental Disorder Note: The concept of “normality” is strongly associated with human values and cultures, which is vary. What is considered “normal” in one culture could be considered “abnormal” in another . irmiakusumadewi@yahoo.com

7. MENTAL DISORDER CLASSIFICATION

8. 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) irmiakusumadewi@yahoo.com

9. Grouped in 10 blocks: • Blocks F0 – F9 • Blocks F0 –F5 are based on hierarchy • Vertical arrangement of group based on rank. • A group on a higher rank / hierarchy have more attributes than the one on the lower irmiakusumadewi@yahoo.com

10. The groupings of Mental Disorders based are: • 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 irmiakusumadewi@yahoo.com

11. 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 irmiakusumadewi@yahoo.com

12. F0Organic, incl. symptomatic, mental disorders due to physiological changes in the brain irmiakusumadewi@yahoo.com

13. F00 Dementia in Alzheimer’s Disease F01 Vascular Dementia F02 Dementia in other disease classified elsewhere F03 Unspecified dementia F04 Organic amnesic syndrome, not induced by alcohol and other psychoactive substances F05 Delirium, not induced by alcohol and other psychoactive substances F06 Other mental disorders due to brain damage and dysfunction and to physical disease F07 Personality and behavioral disorders due to brain disease, damage and dysfunction F09 Unspecified organic orsymptomatic mental disorder irmiakusumadewi@yahoo.com

14. December2009 F1 Mental and behavioral disorders due to psychoactive substance use irmiakusumadewi@yahoo.com 14

15. F1 :Mental & behavioral disorders due to psychoactive substance use F10.- Mental and behavioral disorders due to use of alcohol and other substances F11.- due to use of opioids F12.- due to use of cannabinoids F13.- due to use of sedatives or hypnotics F14.- due to use of cocaine F15.- due to use of other stimulants incl.caffeine F16.- due to use of hallucinogens F17.- due to use of tobacco F18.- due to use of volatile solvents F19.- due to multiple drug use and use of other psychoactive substances irmiakusumadewi@yahoo.com

16. F1 :Mental and behavioral disorders due to psychoactive substance use F1x.0 Acute intoxication F1x.1 Harmful use/ Substance abuse F1x.2 Dependence syndrome F1x.3 Withdrawal state F1x.4 Withdrawal state with delirium F1x.5 Psychotic disorder F1x.6 Amnesic syndrome / Amnesic disorder F1x.7 Residual and late-onset psychotic disorder F1x.8 Other mental and behavioral disorders F1x.9 Unspecified mental and behavioral disorder irmiakusumadewi@yahoo.com

17. December2009 F2 Schizophrenia, schizotypal and delusional disorders (incl. acute and transient psychotic disorders) irmiakusumadewi@yahoo.com 17

18. F2Schizophrenia, schizotypal and delusional disorders ( and other psychotic disorders The mental disorders in this block (except Schizotypal disorder) have a common feature: psychotic symptoms, e.g. having hallucinations, delusions and gross behavioral disturbances with poor insight to the psychopathology irmiakusumadewi@yahoo.com

19. 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 schizophrenia • F20.8 Other schizophrenia • F20.9 Schizophrenia, unspecified irmiakusumadewi@yahoo.com

20. F2 :Schizophrenia, schizotypal and delusional disorders ( and other psychotic disorders) F21 Schizotypal disorder F22 Persistent delusional disorders F23 Acute and transient psychotic disorders F24 Induced delusional disorder F25 Schizoaffective disorders F28 Other nonorganic psychotic disorders irmiakusumadewi@yahoo.com

21. December2009 F3 Mood (affective) disorders irmiakusumadewi@yahoo.com 21

22. F3Mood ( affective ) disorders Changes in mood or affect, usually to depression or elation. The mood changes is usually accompanied by changes in the overall level of activity Most of the disorders tend to be recurrent, and the onset of individual episodes is often related to stressful events or situations irmiakusumadewi@yahoo.com

23. F3Mood (affective) disorders F30 Manic episode F31 Bipolar affective disorder F32 Depressive episode F33 Recurrent depressive disorder F34 Persistent mood (affective disorder) F38 Other mood (affective) disorder F39 Unspecified mood (affective) disorder irmiakusumadewi@yahoo.com

24. December2009 F4 Neurotic, stress related and somatoform disorders irmiakusumadewi@yahoo.com 24

25. F4 :Neurotic, stress-related & somatoform disorders • Mental disorders in this block have a common similarity by not having clinically identifiable physical disease as etiology, neither any psychotic symptoms nor mood disorder as a predominant feature, • In some cases there could be a mixture of symptoms (coexistent depression and anxiety being by far the most frequent) • A substantial proportion of the mental disorders in this block have a substantial (although uncertain ) association with psychological causation. irmiakusumadewi@yahoo.com

26. F4 : Neurotic, stress related and somatoform disorders F40 Phobic anxiety disorders F41 Other Anxiety disorders F42 Obsessive-compulsive disorder F43 Reaction to severe stress, and adjustment disorders F44 Dissociative (conversion) disorders F45 Somatoform disorders F48 Other neurotic disorders irmiakusumadewi@yahoo.com

27. December2009 F5 Behavioral syndromes associated with physiological disturbances and physical factors irmiakusumadewi@yahoo.com 27

28. F5: Behavioral syndromes associated with physiological disturbances and physical factors F50 Eating disorders F51 Non organic sleep disorders F52 Sexual dysfunction, not caused by organic disorder or disease F53 Mental and behavioral disorders associated with puerpuerium, not elsewhere classified F54 Psychological and behavioral factors associated with disorders or diseases classified elsewhere F55 Abuse of non-dependence producing substances F59 Unspecified behavioral syndromes associated with physiological disturbances and physical factors irmiakusumadewi@yahoo.com

29. December2009 F6 Disorders of adult personality and behavior irmiakusumadewi@yahoo.com 29

30. F6 : Disorders of adult personality and behavior Includes a variety of clinically significant conditions and behavior patterns which tend to be persistent and are the expression of an individual‘s characteristic lifestyle and mode of relating to self and others. Some of the these conditions and patterns of behavior emerge early in the course of individual development, as a result of both constitutional factors and social experience, while others are acquired later in life. irmiakusumadewi@yahoo.com

31. F6Disorders of adult personality and behavior F60 Specific personality disorders F61 Mixed and other personality disorders F62 Enduring personality changes, not attributable to brain damage and disease F63 Habit and impulse disorders F64 Gender identity disorders F65 Disorders of sexual preference F66 Psychological and behavioral disorders associated with sexual development and orientation F68 Other disorders of adult personality and behavior F69 Unspecified disorder of adult personality and behavior PS. Homosexuality is not categorized as a mental disorder, it is now identified as a human identity, just like heterosexuality and any other human identities (race, skin color , religion, etc.) irmiakusumadewi@yahoo.com

32. F7Mental retardation Mental retardation is a condition of arrested or incomplete development of the mind, which is especially characterized by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence, i.e. cognitive, language, motor, and social abilities (IQ under 70) Adaptive behavior is always impaired Retardation can occur with or without any other mental or physical disorder irmiakusumadewi@yahoo.com

33. F7Mental retardation F70 Mild mental retardation (IQ 50–69) F71 Moderate mental retardation (IQ 35–49) F72 Severe mental retardation (IQ 20 -34) F73 Profound mental retardation (IQ under 20) F78 Other mental retardation F79 Unspecified mental retardation irmiakusumadewi@yahoo.com

34. F8: Disorders of psychological development Disorders in this block have the following features in common: • An onset that is invariably during infancy or childhood • An impairment or delay in the development of functions that are strongly related to biological maturation of the central nervous system • A steady course that does not involve the remissions and relapses that tend to becharacteristic of many mental disorders irmiakusumadewi@yahoo.com

35. F8Disorders of psychological development F80 Specific developmental disorders of speech and language F81 Specific developmental disorders of scholastic skills F82 Specific developmental disorders of motor function F83 Mixed specific developmental disorders F84 Pervasive developmental disorders F88 Other disorders of psychological development F89 Unspecified disorder of psychological development irmiakusumadewi@yahoo.com

36. F9Behavioral and emotional disorders with onset usually occurring in childhood or adolescence F90 Hyperkinetic disorders F91 Conduct disorders F92 Mixed disorders of conduct and emotions F93 Emotional disorders with onset specific to childhood F94 Disorders of social functioning with onset specific to childhood and adolescence F95 Tic disorders F98 Other behavioral and emotional disorders with onset usually occurring in childhood and adolescence F99 Unspecified mental disorder irmiakusumadewi@yahoo.com

37. MULTIAXIAL EVALUATION

38. 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 irmiakusumadewi@yahoo.com

39. MULTIAXIAL EVALUATION • Axis I :Clinical Disorder (Block F0–F9) Other conditiona that may be a focus of clinical attention • Axis II :Personality Disorder Mental Retardation • Axis III :General Medical Condition • Axis IV :Psychosocial & Enviromental Problems • Axis V :Global Assessment of Functioning (GAF) irmiakusumadewi@yahoo.com

40. 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 • The therapy could also be planned comprehensively irmiakusumadewi@yahoo.com

41. 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 which its onset start during childhood or adolescent • It can be found in adult if the condition continues during the adult years • Block F0-F6 can be manifested in children & adolescent too, if the diagnostic criteria is fulfill irmiakusumadewi@yahoo.com

42. AXIS I - cont • Z code • Life problems which are not fulfill diagnostic criterias but make a person seek for help • or medical conditions that need attention or therapy. irmiakusumadewi@yahoo.com

43. AXIS II • Consist of • personality disorders and • mental retardation irmiakusumadewi@yahoo.com

44. AXIS III • Physical disorder or general medical condition that is present in addition to the mental disorder • The physical condition may be • Causative: e.g kidney failure causing delirium • The result of a mental disorder: e.g alcohol gastritis secondary to alcohol dependence • Unrelated to the mental disorder irmiakusumadewi@yahoo.com

45. AXIS III - cont • When a medical cond is causative or causually related to a mental dis  a mental dis due to a general medical cond is listed on Axis I & the general med cond is listed on both Axis I and Axis III irmiakusumadewi@yahoo.com

46. AXIS IV • To code the psychosocial & 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 a treament plan: • Attempt to remove psychosicial stressor • Help the patient cope with them irmiakusumadewi@yahoo.com

47. 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 irmiakusumadewi@yahoo.com

48. 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 least a few months during the past year • 3 major area of functioning: • Social func • Occupational func • Psychological func irmiakusumadewi@yahoo.com

49. 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 • The information of GAF: • Is useful in planning treatment, measuring its impact & predicting outcome irmiakusumadewi@yahoo.com