Mental disorder classification multiaxial evaluation
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MENTAL DISORDER CLASSIFICATION & MULTIAXIAL EVALUATION. Modified of Dr. Gitayanti Hadisukanto, SpKJ(K)’s. Mentally Healthy?. Mentally Healthy. a. Feeling healthy and happily b. Facing the life challenges c. Acceptance to others d. Positive attitude toward their life and others.

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MENTAL DISORDER CLASSIFICATION & MULTIAXIAL EVALUATION

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Mental disorder classification multiaxial evaluation

MENTAL DISORDER CLASSIFICATION&MULTIAXIAL EVALUATION

Modified of

Dr. Gitayanti Hadisukanto, SpKJ(K)’s


Mentally healthy

Mentally Healthy?


Mental disorder classification multiaxial evaluation

Mentally Healthy

a. Feeling healthy and happily

b. Facing the life challenges

c. Acceptance to others

d. Positive attitude toward their life and others


Mental disorder or mentally ill

Mental Disorder or Mentally Ill?


Mental disorder classification multiaxial evaluation

Mentally Ill or Mental Disorder

  • Clinically significantly disturbance in mind, feeling, or behaviour

  • Making distress and dysfunction-disability

  • for the person and the environment


Mental disorder

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 .

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Mental disorder classification

MENTAL DISORDER CLASSIFICATION


Ppdgj iii

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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Mental disorder classification multiaxial evaluation

  • 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

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The groupings of mental disorders based are

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

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Mental disorder classification multiaxial evaluation

  • 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

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Mental disorder classification multiaxial evaluation

F0Organic, incl. symptomatic, mental disorders

due to physiological changes in the brain

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Mental disorder classification multiaxial evaluation

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

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Mental disorder classification multiaxial evaluation

December2009

F1

Mental and behavioral disorders due to psychoactive substance use

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14


F1 mental behavioral disorders due to psychoactive substance use

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

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F1 mental and behavioral disorders due to psychoactive substance use

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

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Mental disorder classification multiaxial evaluation

December2009

F2

Schizophrenia, schizotypal and delusional disorders (incl. acute and transient psychotic disorders)

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17


F2 schizophrenia schizotypal and delusional disorders and other psychotic disorders

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

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Mental disorder classification multiaxial evaluation

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

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F2 schizophrenia schizotypal and delusional disorders and other psychotic disorders1

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

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Mental disorder classification multiaxial evaluation

December2009

F3

Mood (affective) disorders

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21


F3 mood affective disorders

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

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F3 mood affective disorders1

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

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Mental disorder classification multiaxial evaluation

December2009

F4

Neurotic, stress related and somatoform disorders

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24


F4 neurotic stress related somatoform disorders

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.

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F4 neurotic stress related and somatoform disorders

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

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Mental disorder classification multiaxial evaluation

December2009

F5

Behavioral syndromes associated with physiological disturbances and physical factors

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27


F5 behavioral syndromes associated with physiological disturbances and physical factors

F5: Behavioral syndromes associated with physiological disturbances and physical factors

F50Eating disorders

F51Non organic sleep disorders

F52Sexual dysfunction, not caused by organic

disorder or disease

F53Mental and behavioral disorders associated

with puerpuerium, not elsewhere classified

F54Psychological and behavioral factors

associated with disorders or diseases classified

elsewhere

F55Abuse of non-dependence producing

substances

F59Unspecified behavioral syndromes associated

with physiological disturbances and physical

factors

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Mental disorder classification multiaxial evaluation

December2009

F6

Disorders of adult personality and behavior

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F6 disorders of adult personality and behavior

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.

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F6 disorders of adult personality and behavior1

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.)

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F7 mental retardation

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

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F7 mental retardation1

F7Mental retardation

F70Mild mental retardation (IQ 50–69)

F71Moderate mental retardation

(IQ 35–49)

F72Severe mental retardation

(IQ 20 -34)

F73Profound mental retardation

(IQ under 20)

F78Other mental retardation

F79Unspecified mental retardation

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F8 disorders of psychological development

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

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F8 disorders of psychological development1

F8Disorders of psychological development

F80Specific developmental disorders of

speech and language

F81Specific developmental disorders of

scholastic skills

F82Specific developmental disorders of

motor function

F83Mixed specific developmental disorders

F84Pervasive developmental disorders

F88Other disorders of psychological

development

F89Unspecified disorder of psychological

development

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F9 behavioral and emotional disorders with onset usually occurring in childhood or adolescence

F9Behavioral and emotional disorders with onset usually occurring in childhood or adolescence

F90Hyperkinetic disorders

F91Conduct disorders

F92Mixed disorders of conduct and emotions

F93Emotional disorders with onset specific to

childhood

F94Disorders of social functioning with onset

specific to childhood and adolescence

F95Tic disorders

F98Other behavioral and emotional disorders with

onset usually occurring in childhood and

adolescence

F99 Unspecified mental disorder

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Multiaxial evaluation

MULTIAXIAL EVALUATION


Multiaxial system

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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Multiaxial evaluation1

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)

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The aim of multiaxial evaluation

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

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Axis i

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

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Axis i cont

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.

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Axis ii

AXIS II

  • Consist of

    • personality disorders and

    • mental retardation

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Axis iii

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

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Axis iii cont

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

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Axis iv

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

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Axis iv cont

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

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

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Axis v cont

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

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