Classification of Psychiatric Disorders Dr. Khalid Bazaid, MB BS, FRCPC Assistant Professor & Consultant Child & Adolescent Psychiatrist College of Medicine King Saud University

Introduction: Most of physical conditions are classified on the basis of etiology, e.g.: viral pneumonia. Or On the basis of structural pathology, e.g.: Bronchopneumonia. Based on symptoms, e.g. migraine. Psychiatric disorders are diagnosed based mainly on symptoms. Few are based on etiology e.g. Alzheimer’s disease.

Purposes of Classification: To make generally acceptable diagnosis. To facilitate communication between psychiatrists, other doctors and professionals. To make generalizations in treatment response, course & prognosis of individual patients. To make framework for research in psychiatry.

Types of Classification Categorical Classification: - Grouping disorders into separate entities according to symptom – pattern, course and outcome. - It includes hierarchal categories. e.g.: Organic mental disorders then functional psychotic disorders (e.g. Schizophrenia) then neurotic disorder (e.g. generalized anxiety disorder) then personality disorders. - Also it includes in-built hierarchy of significance within the disorders themselves. e.g.: Anxiety symptoms occur commonly with depressive disorder.

2. Dimensional Classification: - Diagnosing individual patients by giving scores on separate dimensions. e.g. Psychoticism, neuroticism, introversion and extroversion

e.g. DSM, ICD 3. Multiaxial Approach: Applied to schemes of classifications in which two or more separate sets of information are coded e.g. DSM, ICD

⇨ ICD10 DSM 4 CLASSIFICATION ……… ......... ……… Multiaxial Organic d. Childhood Childhood d. cognitive d. ……… 1-Psych. Dis. 2- M.R. Personality d. 3- Physical illness 4- Stresses 5-Functioning level

Psychiatric Disorders Organic (Body) Non-Organic (Mind) Acute Delirum Wernicke’s Chronic Dementia Korsakoff Others Alcohol … Head Injury Etc…. Psychoses Schizophrenia Mood disorders Etc…. Neuroses Anxiety disorders Adjustment dis. Dysthymia Dissociative dis. Others Personality dis. Sleep disorder Sex disorder Etc…

Neurosis and Psychosis - unsatisfactory term - refers broadly to severe forms of mental disorders such as: a. organic mental diseases b. schizophrenia c. affective disorders Characteristics: - greater severity - lack of insight - patient’s inability to distinguish between subjective experience and reality e.g. hallucinations, delusions.

Neurosis and Psychosis unsatisfactory term. Refers to mental disorders that are generally less severe than psychosis. Characteristics: - Symptoms are closer to normal experience e.g. anxiety.

Psychosis Neurosis Major mental illness Abnormal in quality e.g. hallucinates Affected Drugs & ECT Minor mental illness Abnormal in quantity e.g. anxiety Preserved Psychological & drugs Severity Features Insight Treatment

NEGATIVE FEATURES Poverty of thoughts & speech. Self-neglect. Lack of ambition interest & initiation. Restricted affect. Self-neglect. Poor self care & hygiene

Features Suggesting of Organic Mental Illness: Disturbed consciousness. Disturbed cognitive functions: a. Attention and concentration b. Orientation: time, place & person c. Memory : immediate, recent and remote Presence of physical illness e.g. DM, HTN Presence of neurological features e.g. dysarthria & ataxia. Old age onset.