Classification Of Classification Of Psychiatric Psychiatric

Disorders In Disorders In Children And Children And AdolescentAdolescentMona RedaMona Reda

Classification systemsClassification systems

DSM : Diagnostic and Statistical DSM : Diagnostic and Statistical Measurement Measurement

ICD : International Classification of ICD : International Classification of Disorders.Disorders.

History of classificationsHistory of classifications

Kanner 1935 “ personality difficulties”Kanner 1935 “ personality difficulties” Guidelines of diagnosis 1957Guidelines of diagnosis 1957 DSM-I only 4 categories were DSM-I only 4 categories were

identified :identified : Chronic brain syndrome associated with Chronic brain syndrome associated with

bran traumabran trauma Schizophrenia reaction Schizophrenia reaction Special symptom reaction, LD, enuresis Special symptom reaction, LD, enuresis

and somnambulism and somnambulism Adjustment reactionAdjustment reaction

DSM-II. 1968DSM-II. 1968

Hyperkinetic reaction of childhoodHyperkinetic reaction of childhood Withdrawal reaction of childhoodWithdrawal reaction of childhood Overanxious reaction of childhoodOveranxious reaction of childhood Runaway reaction of childhoodRunaway reaction of childhood Unsocialized aggressive reaction of Unsocialized aggressive reaction of

childhoodchildhood Group delinquent reaction of childhood Group delinquent reaction of childhood Over reaction of childhoodOver reaction of childhood

DSM-III. 1980DSM-III. 1980 Mental retardationMental retardation Attention deficit with or without Attention deficit with or without

hyperactivityhyperactivity Conduct disorderConduct disorder Anxiety disorderAnxiety disorder Other disorders of infancy and childhoodOther disorders of infancy and childhood Eating disordersEating disorders Stereotypic movement disorderStereotypic movement disorder Other disorders with physical Other disorders with physical

manifestationsmanifestations Pervasive developmental disordersPervasive developmental disorders

DSM-III R. 1987DSM-III R. 1987

Mental retardation Mental retardation Pervasive developmental disordersPervasive developmental disorders Specific developmental disordersSpecific developmental disorders

DSM-IV. 1994DSM-IV. 1994DSM-IV TR. 2000DSM-IV TR. 2000

The provision of a separate section The provision of a separate section for disorders that are usually first for disorders that are usually first diagnosed in infancy , childhood, or diagnosed in infancy , childhood, or adolescent is for convenience only adolescent is for convenience only and is not meant to suggest that and is not meant to suggest that there is any clear distinction between there is any clear distinction between childhood and adult disorders for childhood and adult disorders for most ( but not all) DSM-IV disorder, most ( but not all) DSM-IV disorder, a single criteria set is provided that a single criteria set is provided that applies to children and adults .applies to children and adults .

Modifications in DSM Modifications in DSM

Diagnostic symptomsDiagnostic symptoms Duration of illnessDuration of illness Age of onsetAge of onset Spectrum Spectrum

Value Of ClassificationValue Of Classification

CommunicationCommunication: : Facilitate communication among physiciansFacilitate communication among physicians Reliability will be greater if system is based Reliability will be greater if system is based

on clearly defined observable phenomena on clearly defined observable phenomena rather than featuresrather than features

Reliability affected by structure of the systemReliability affected by structure of the system Knowledge of the diagnosis should allow the Knowledge of the diagnosis should allow the

professional to make inferences about professional to make inferences about Etiology Etiology Natural history Natural history Expected response to treatmentExpected response to treatment Other associated conditionsOther associated conditions

HeuristicHeuristic System is expressed in operational System is expressed in operational

and reproducible form to promote and reproducible form to promote discovery of knowledge ( new discovery of knowledge ( new diagnosis) diagnosis)

Public health and treatmentPublic health and treatment Ability to develop diagnosis based Ability to develop diagnosis based

quality control criteria such as quality control criteria such as expected form and duration of expected form and duration of treatmenttreatment

Useful for planning and quality Useful for planning and quality control as well as evidence based control as well as evidence based education.education.

Problems In Diagnostic IssuesProblems In Diagnostic Issues

Misdiagnosis and labelingMisdiagnosis and labeling ComorbidityComorbidity: :

Presence of similar criteria in different disordersPresence of similar criteria in different disorders Presence of one disorder lead to the second.Presence of one disorder lead to the second. Etiological relationship between the two disordersEtiological relationship between the two disorders Common environmental or biological antecedentsCommon environmental or biological antecedents Diagnostic definition error, disorders commonly occur Diagnostic definition error, disorders commonly occur

togethertogether

RevisionsRevisionsAllow debate and data, with each revision new Allow debate and data, with each revision new

findings emerge that have direct implications findings emerge that have direct implications on the existing diagnosis on the existing diagnosis

Approaches to Approaches to Classification Classification

Categorical systemCategorical system An individual will either meet the criteria and An individual will either meet the criteria and

carry the diagnosis or will not and will be cleared carry the diagnosis or will not and will be cleared free of the disorderfree of the disorder

It represents the way that both the clinician and It represents the way that both the clinician and patient think of a disorderpatient think of a disorder

However, However, Disorders do not always represent them selves in Disorders do not always represent them selves in

full criteriafull criteria Disorders differ in their potential to cause Disorders differ in their potential to cause

impairment impairment Symptoms and signs will differ in different age Symptoms and signs will differ in different age

and sex of the patientand sex of the patient

Approaches to Approaches to ClassificationClassification

Dimensional systemDimensional system Starts with the collection of a large Starts with the collection of a large

inventory of symptoms from both inventory of symptoms from both clinician and community samples clinician and community samples

Main groups ( internalized and Main groups ( internalized and externalized behaviors)externalized behaviors)

Common in studies of child Common in studies of child psychopathology.psychopathology.

Disadvantage:Disadvantage: A case is a deviation from normal rather than A case is a deviation from normal rather than

impairment in functionimpairment in function Items in inventory are written in simple wayItems in inventory are written in simple way Factor structure differs across different age Factor structure differs across different age

and sex groups, make it difficult to compare.and sex groups, make it difficult to compare. Information collected on single instrument.Information collected on single instrument. Greater accuracy in reflecting nature, less Greater accuracy in reflecting nature, less

predictive of outcome.predictive of outcome.

Approaches to Approaches to ClassificationClassification

Multi-axial approach:Multi-axial approach: Axis I: clinical syndromeAxis I: clinical syndrome Axis II: personality disorder & mental Axis II: personality disorder & mental

retardation retardation Axis III: general medical diagnosisAxis III: general medical diagnosis Axis IV: psycho-social and environmental Axis IV: psycho-social and environmental

problemsproblems Axis V: degree of impairment that Axis V: degree of impairment that

resulted from psychiatric disorderresulted from psychiatric disorder

Approaches to Approaches to ClassificationClassification

Multi-axial approach:Multi-axial approach: Axis I: clinical syndrom,personality Axis I: clinical syndrom,personality

disorder & mental retardation ,general disorder & mental retardation ,general medical diagnosismedical diagnosis

Axis II: psycho-social and environmental Axis II: psycho-social and environmental problemsproblems

Axis III: degree of impairment that Axis III: degree of impairment that resulted from psychiatric disorderresulted from psychiatric disorder

To conclude:To conclude:

Diagnosis of psychiatric disorder is Diagnosis of psychiatric disorder is made using a classification system in made using a classification system in order to facilitate communication order to facilitate communication and stability of data base to and stability of data base to encourage new diagnosis encourage new diagnosis identification, and better evidence identification, and better evidence based quality of service.based quality of service.

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