Diagnosis multiaksial

1. Diagnosis multiaksial Psikologi abnormal

2. DIAGNOSIS MULTIAKSIAL • DSM (Diagnostic and Statistical Manual of Mental Disorder) published by American Psychiatric Association (APA) • In Indonesia, mental disorder diagnosis classify in PPDGJ (Pedoman Penggolongan dan Diagnostik Gangguan Jiwa)  based on DSM and ICD (International Classification of Diseases) published by WHO

3. Diagnosis Multiaxial • DSM pertama kali diperkenalkan di tahun 1952. • DSM diterbitkan oleh APA (American Psychiatric Association) • Classification in DSM - IV (1994) are description, atheoretical, and multiaxial more comprehensif (Millon & Davis, 2000)  DSM IV - TR • DSM-IV-TR includes five axes = multiaxial classification system, by requiring judgements on each of the five axes, forces the diagnostician to consider a broad range of information

4. Pada tahun 1939, WHO (World Health Organization) memasukkan gangguan jiwa ke dalam ICD (International List of Causes of Death)

5. 5 Axes in DSM-IV-TR • Axes I: • Clinical Disorder • Other conditions that may be a focus of clinical attention • Axes II: • Personality Disorder • Mental Retardation • Axes III: General Medical Condition • Axes IV: Psychosocial and environmental problems • Axes V: Global Assesment of Functioning (GAF) Scale

6. 5 Axes in DSM-IV-TR • Axes I: • Clinical Disorder • Other conditions that may be a focus of clinical attention • Axes II: • Personality Disorder • Mental Retardation • Axes III: General Medical Condition • Axes IV: Psychosocial and environmental problems • Axes V: Global Assesment of Functioning (GAF) Scale

7. Tujuan Pembedaan Aksis I, II, III: 1. encourage thoroughness in evaluation 2. enhance communication among health professionals • Tidak mengimplikasikan bahwa ada perbedaan fundamental dalam konseptualisasinya  tidak ingin mengatakan bhw. Ggn mental tidak berhubungan dengan proses atau faktor fisik, biologis atau psikososial

8. Aksis I dan II: • Isi mata kuliah Psikologi Abnormal (kecuali mental retardation)

9. Aksis III: General Medical Condition (GMC) • Current general medical conditions that are potentially relevant to the understanding or management of the individual’s mental disorder.

10. GMC can be related to mental disorders in several ways: • Bila GMC merupakan etiologi perkembangan atau memburuknya simtom mental  efek fisiologis, mis. Hypothyroidism penyebab simtom depresi Aksis I: mood disorder due to hypothyroidism with depressive features Aksis III: hypothyroidism • Hub antara GMC mgkn ada, tp tdk jelas Aksis I: dituliskan simtom mentalnya apa Aksis III: GMC nya apa

11. GMC dicatat pada Aksis III, meskipun tak berhubungan langsung dengan ggn mental, krn penting untuk memahami keseluruhan treatment individu. Mis. Individu yang depresi karena diagnosis kanker payudara Aksis I: Adjustment disorder with depressed mood Aksis III: kanker payudara • GMC dicatat untuk tujuan pharmacotherapy (supaya tidak overlap dalam pemberian obat)

12. Aksis IV: Psychosocial and Environmental Problems • Psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders: - negative life events - environmental difficulties or deficiencies - familial or other interpersonal stress - inadequacy of social support or personal resources - positive stressors (mis. Promosi, pernikahan) yang menyebabkan stress.

13. Cara menulis pada Aksis IV: • Problems with primary support group (e.g. death of a family, remarriage of parent) • Problems related to the social environment (e.g. inadequate social support, living alone, retirement) • Educational problems (e.g. academic, discord with teachers) • Occupational problems (unemployment, job dissatisfaction)

14. Housing problems (e.g. homelessness, inadequate housing) • Economic problems (e.g. extreme poverty) • Problems with access to health care service (e.g.transport unavailable) • Problems related to interaction with the legal system/crime (e.g. arrest) • Other psychosocial and environmental problems (e.g. exposure to disasters, wars)

15. Catatan: - note only those psychosocial and environmental problems that have been present during the year preceeding the current evaluation - bila masalah terjadi lebih dari 1 tahun  catat bila jelas memberi kontribusi, atau telah menjadi fokus treatment

16. Aksis 5: Global Assessment of Functioning (GAF) Scale • Berdasarkan pertimbangan berfungsinya secara psikologis, sosial & okupasional, pada suatu kontinum hipotesis dari kesehatan-gangguan mental. • Jangan memasukkan hendaya dalam berfungsi yang berhubungan dengan keterbatasan fisik atau lingkungan.

17. GAF Scale Consider psychological, social, and occupational functioning on a hypothetical continuum of mental heal/illness. Do not include impairment in functioning due to physical (or environment) limitations. 0 : Inadequate information 1-10 : Persistent danger of severely hurting self or others/ persistent inability to maintain minimal personal hygiene 51-60 : moderate symptoms/moderate difficulty in social, occupational, or school functioning 91-100: No symptoms, superior functioning in a wide range of activities

18. Contoh Penulisan Diagnosis Multiaksial Aksis I : (296.23) Gangguan depresi berat, tanpa ciri psikotik Aksis II : (301.6) Gangguan kepribadiandependen, sering menggunakan mekanisme defense denial Aksis III : tidak ada Aksis IV : ancaman kehilangan pekerjaan Aksis V : GAF=35 (current)

19. Diagnosis Multiaxial Axes I : (296.23) Severe major depression, without psychotic feature Axes II : (301.6) Personality disorder, defence mechanism denial Axes III : none Axess IV : Occupational Problem Axes V : GAF=35 (current)

20. Current issues related to DSM-V • Disorder that might be included in DSM-V • Behavioral Addiction • Definition: excessive use sex, shopping, or computers may signal addiction. These behavior can be taken to such extremes that they easily mimic the behaviors of drug addicts. • Binge Eating Disorder • Definition: individuals who binge are unable to control periods of overeating and feel guilty or disgusted with themselves. They often become obese. Some eat alone to avoid feelings of shame.

21. Current issues related to DSM-V • Complicated Grief • Definition: after the death of someone close, grief and sadness normally begin to dissipate within six months. But some people continue to mourn for much longer.

22. Current issues related to DSM-V • Disorder that might be excluded in DSM-V • The Paraphilia: Intense sexual urges involving animals, children, nonconsensual sex, suffering, or humiliation are classified as paraphilias – a term that was thought to be relatively non judgmental when it replaced “perversions” in 1980. • Gender Identity Disorder: Since the DSM-III appeared in 1980, individual who wish to be of the opposite sex-and who are uncomfortable with their own-have been diagnosed with Gender Identity Disorder.