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CLASSIFICATION IN
PSYCHIATRYCHAIR PERSON : DR. B. N.
GANGADHAR,
PRESENTER: DR. NITHIN
KONDAPURAM.
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OUTLINE
CONCEPTS IN DIAGNOSIS & CLASSIFICATION
PROS AND CONS OF DIAGNOSIS
HISTORY OF CLASSIFICATION IN PSYCHIATRY
CURRENT CLASSIFICATION SYSTEMS
FUTURE PERSPECTIVES
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INTRODUCTION
CLASSIFICATIONclassifcation !"l#s$%'(
"#$s)%n* n.
+A s,st-.atic a//an0-.-nt into class-s o/ 0/o12s3
+T)- s,st-.atic 0/o12in0 o' o/0anis.s into cat-0o/i-son t)- 4asis o'
-5ol1tiona/, o/ st/1ct1/al /-lations)i2s 4-t6--n t)-.7
*Stedman's Medical Dictionary,29th
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8
Dia0nosis an9 classifcation a/- a .-ans
o' 5i-6in0 t)- 6o/l9:
Sa/to/i1s N
;S,st-. o' cat-0o/i-s to 6)ic) .o/4i9-ntiti-s a/- assi0n-9 acco/9in0 to
-sta4lis)-9 c/it-/ia=P ?@
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WHY DO WE NEED TO CLASSIFY?
TO PLAN
SERVICES
CLASSIFICATION
TO UNDERSTANDDISEASES
TO DETERMINETREATMENT
COMMUNICATION
CONTROL
TO STATEPROGNOSIS
TO PERMITRESEARCH
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T)- 1lti.at- 21/2os- o' classifcation is to i.2/o5-
t/-at.-nt an9 2/-5-ntion
Diso/9-/s can 4- t/-at-9 6it)o1t "no6l-90- o'
-tiolo0, 41t co.2/-)-nsion is 9-si/-9 as it 1s1all,
l-a9s to .o/- -B-cti5- t/-at.-nt an9 2/-5-ntion
Dalal P Si5a"1.a/ T3 Mo5in0 to6a/9s ICD?? an9 DSMV Conc-2t an9 -5ol1tion o'2s,c)iat/ic classifcation3 In9ian = Ps,c)iat/, @7??@
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ssifcation can 4- 2-/'o/.-9 in s-5-/al 6a,s
BY MEDICAL PSYCHIATRIC
CLINICALSYNDROME
MIGRANE SCHIZOPHRENIA
PATHOLOGICALPROCESS
ULCERATIVECOLITIS
ALZHEIMERSDEMENTIA
DEVIATION FROMNORM
HYPERTENSION PERSONALITYDISORDER
HYPOTHETICAL
PROCESS
- DISSOCIATIVE
DISORDER
ETIOLOGY TUBERCULOSIS PTSD
Dalal P Si5a"1.a/ T3 Mo5in0 to6a/9s ICD?? an9 DSMV Conc-2t an9 -5ol1tion o'2s,c)iat/ic classifcation3 In9ian = Ps,c)iat/, @7??@
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REUIREMENTS OF AN INTERNATIONALCLASSIFICATION
!.C"#$%&'&()*+&
.W&-&/(&
0.A11&$234&
5.R&*34&
6.C"()&%+32*+&
7.C"#$32*4& 8*2'
$%&+*"9) 13))*/132*"()
13))*/132*"( " "2'&% )&12"%) ;)"1*3*()9%3(1&
M&&2*(= 2'& (&&) " +3%*"9) 9)&%)
=a4l-ns", A -n9-ll RE3 C/it-/ia 'o/ ass-ssin0 a classifcation in 2s,c)iat/,3 In Ma M-9ito/3 Ps,c)iat/ic 9ia0nosis an9 classifcation3 -st S1ss-Q =o)n il-, an9 sons Lt97 3 223 ?K
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APPROACHES TO PSYCHIATRICCLASSIFICATION
TIOLOGICAL VS DESCRIPTIVE
SYNDROME VS SYMPTOM
CATEGORICAL VS DIMENSION
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HISTORY OF PSYCHIATRIC CLASSIFICATION
>C ;S,n9/o.- S-nil- D-.-ntia< E0,2tP/inc- Pta) Hot-2
J >C S1.-/ian & E0,2t /-'-/-nc- toM-lanc)olia an9 H,st-/ia
?8 >C Hin91 A,1/5-9a on- o' ;Astan0a< 6as>)1ta Vi9,a7 6it)o1t 2),sicalca1sation
8J >C K Hi22oc/at-s J con9itions an9 8t-.2-/a.-nts ?
CENTURIES
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HISTORY OF PSYCHIATRIC CLASSIFICATION
EMIL RAEPELIN !?J?@J*
ADOLF MEYER !?JJ?@*
PAUL EUGEN >LEULER!??@@*
SIGMUND FREUD !?J?@@*
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DEVELOPMENT OF NEUROSIS
E5ol1tion o' t)- conc-2t o' sc)io2)/-nia3 !F/o. Tan9on R Nas/alla) HA -s)a5an MS3 Sc)io2)/-nia ;1st t)-'acts3< 8 Clinical '-at1/-s an9 conc-2t1aliation3 Sc)io2)/ R-s @7???K
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EMIL RAEPELINMANIC DEPRESSIVE
INSANITY
LEONHARDCOINED THE TERM
>IPOLAR
ANGST AND PERRISUNIPOLAR VS >IPOLAR
DEPRESSION
EVOLUTION OF CLASSIFICATION OFBIPOLAR AFFECTIVE DISORDER
?@?@ ?@ ?@JJ ?@
THE NAME >IPOLARDISORDER AS
ADOPTED IN DSM III
)tt2WW6663/c2s,c)3ac31"Wfl-sWsa.2l-c)a2t-/W4i2ol
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EVOLUTION OF CLASSIFICATION OFNEUROSIS
EARLY ?8SSCRUPULOS
!"#
? INSTITUTIONALIA
TION =3E3D Es1i/ol
?8SOREN IEREGAARD
EARLY THCENTURYFREUD
THEORIES
?s?sDESCRIPTION OF
VARIOUS O>SESSIONS
ANXIETY >Y PHYSICIANS
LATE ?Js CLERGYMEN
>ATTISTA SCARAMELLI SHAESPEARES MAC>ETH
END OF ?@THCENTURYCONSESUS A>OUT
NEUROSIS
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?@PIERRE =ANET
?@?JSIGMUND
FRUED
DISORDEROFRELARD
DISO
RDER
OFC
ONTRO
L
DSM ?
CATEGORIES
ICD J
CATEGORIE
S
OPIUMMORPHINE
ARSENIC
COGNITIVE>EHAVIORAPPROACH
EVOLUTION OF CLASSIFICATION OFNEUROSIS ANXIETY
DISORDERS
O>SESSIVECOMPULSIV
E ANDRELATED
DISORDERS
DS
MH
8CATEGOR
IES
JSU>
CATEG
ORIESLi.4ic
F/otost/iatal
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EVOLUTION OF CLASSIFICATION OFSUBSTANCE USE
Alcohol and drug abuse
under Sociopathic
ersonality
!isturbances
first to recognize substance
abuse "including drug abuse#
and substance dependence as
conditions separate from
substance abuse alone
psychoacti$e
substance
abuse
DSM?
DSMIII
DSMIIIR
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HISTORY OF PRESENT PSYCHIATRICCLASSIFICATION?@ Int-/national list o' ca1s- o' 9-at)
?@? APA Dia0nostic s,st-. 6it) @ illn-ss
?@8 o/l9 6a/ II littl- 1s- o' APA 9ia0nostics
?@8@ Int-/national Classifcation o' Dis-as-sJ
SECTION ON MENTAL DISORDERS WAS A&
FIRST TIME
?@ DRAFT OF T)- D*3=(")2*1 3( S232*)2*13
M3(93o' M-ntal Diso/9-/s !DSM*?@ T)- D*3=(")2*1 3( S232*)2*13 M3(93o'
M-ntal Diso/9-/s I
?@ Int-/national Classifcation o' Dis-as-s
https://www.google.co.in/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CBwQFjAA&url=http://www.who.int/whosis/icd10/&ei=AZz3U4POF9bm8AXJpIK4BA&usg=AFQjCNHjUcoeAdI617cQ6L18Os1nKCU8pw&bvm=bv.73612305,d.dGc -
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?@J T)- Dia0nostic an9 Statistical Man1al o' M-ntal
Diso/9-/s II?@ Int-/national Classifcation o' Dis-as-s @
?@ T)- Dia0nostic an9 Statistical Man1al o' M-ntal
Diso/9-/s III?@ T)- Dia0nostic an9 Statistical Man1al o' M-ntal
Diso/9-/s III R-5is-9
?@@ Int-/national Classifcation o' Dis-as-s ?
?@@8 T)- Dia0nostic an9 Statistical Man1al o' M-ntal
Diso/9-/s IV
T)- Dia0nostic & Statistical Man1al o' M-ntal
HISTORY PRESENT OF PSYCHIATRICCLASSIFICATION
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COMMON CLASSIFICATORY SYSTEMS INPSYCHIATRY
I(2&%(32*"(3 C3))*/132*"( " D*)&3)&)
D*3=(")2*1 @ S232*)2*13 M3(93o' M-ntalDiso/9-/s !DSM*
R&)&3%1' D*3=(")2*1 C%*2&%*3
FEIGHNERS
SPITZERS
D*&%&(2 (32*"(3 13))*/132*"()
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INTERNATIONAL CLASSIFICATION OF DISEASES
!60 Fi/st Int-/national Statistical Con'-/-nc-
!0 A9o2tion o' t)- Int-/national Statistical Classifcation o'
Ca1s-s o' D-at)
!0 R-5ision o' List o' Ca1s-s o' D-at) !ICD*Cat3 83
M-ntal 9is-as-s an9 9-fci-nc,
3. M&(23 &/1*&(1>
4. S1'*"$'%&(*3
1. M3(*1 &$%&))*+& $)>1'")*)
. O2'&% #&(23 *)&3)&)
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INTERNATIONAL CLASSIFICATION OF DISEASES
!57 HO is -nt/1st-9 6it) tas" to 2/-2a/- 72'
/-5ision an9 to -sta4lis) an Int-/national List o' Ca1s-s
o' Mo/4i9it,
!5 F*%)2 W"% H&32' A))>:
A"$2*"( " M3(93 " 2'& I(2&%(32*"(3
S232*)2*13 C3))*/132*"( " D*)&3)&), I(9%*&), @
C39)&) " D&32' ;ICD-71li.ia n-/5osa >o9, 9,s.o/2)ic D3
83E.otionall, 1nsta4l- 2-/sonalit, D3
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SHORTCOMINGS OF CLASSIFICATORY SYSTEM
R-s1lts '/o. t6in st19i-s )a5- "ontra'i"te't)- ass1.2tion
t$at se!arate s(n'romes $ave a 'i*erent un'erl(in%
%eneti" basis.-0 GAD Mao/ 9-2/-ssi5- 9iso/9-/ s)a/-
0-n-tic /is" 'acto/3!-n9l-/?@J*
A9o2tion o' t)- "ate%ori"al 'e#nition.i0)t )a5- $in'ere'
resear"$in t)- -tiolo0, o' t)- 2s,c)iat/ic 9iso/9-/s3 DSM V
cat-0o/i-s i' consi9-/-9 -1i5al-nt to 9is-as-s is .o/- li"-l, to
o4sc1/- t)an to -l1ci9at- /-s-a/c) fn9in0s3
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REGROUPING DIAGNOSIS
DSMIVWICD? G/o12in0s 4as-9 2/i.a/il, on
co..on 2/-s-ntin0 s,.2to.
-303 anQi-t, 9iso/9-/
DSMWICD?? G/o12in0s 4as-9 as .1c) as 2ossi4l-
on co..on 1n9-/l,in0 -tiolo0ical 'acto/s
-303 O4s-ssi5-Co.21lsi5- an9 /-lat-9 9iso/9-/s
2/-s1.-9 1n9-/l,in0 co..on n-1/o4iolo0ical 'acto/s
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REGROUPING DIAGNOSIS
S122o/t-9 c/-ation o' a 9ia0nostic 0/o12in0 4as-9
on -tiolo0icall, associat-9 6it) st/-ss'1l li'-
ci/c1.stanc-s
Gi5-n t)at ot)-/ ICD?? 9iso/9-/s .a, 4- associat-9
6it) st/-sso/s !-303 .ao/ 9-2/-ssion* t)-s- a/-
9iB-/-ntiat-9 4, 4-in0 9-fnitionall, associat-9 6it)
st/-ss3
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EPECTATIONS IN ICD !!
CODE
Eac) ;c)a/act-/< /-2/-s-nts a l-5-l in t)- )i-/a/c),7
-303 f/st ICD? c)a/act-/ is c)a2t-/7 al2)a4-tic
nat1/- allo6s 'o/ J 4asic 9i5isions o/ c)a2t-/s N1.-/ic 9-ci.al nat1/- o' ot)-/ c)a/act-/s li.its
-ac) l-5-l to ? 9i5isions
Di5ision o' .-ntal 9iso/9-/s into ? 4loc"s c/-at-9s14o2ti.al 0/o12in0s !-3033 F8 N-1/otic St/-ss
/-lat-9 an9 so.ato'o/. 9iso/9-/s*
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ICD?? 6ill no lon0-/ /-st/ict c)a/act-/ 2lac-s to?7 inst-a9 6ill 4- al2)a4-tic o/ -ls- t6o 9i0it 2-/
c)a/act-/ Cons-1-ntl, 8 4loc" 9i5isions -Q2-ct-9
!-303 Fo/.-/ F 9iso/9-/s >-)a5io/al s,n9/o.-sassociat-9 6it) 2),siolo0ical 9ist1/4anc-s an9
2),sical 'acto/s 6ill -ac) 0-t t)-i/ o6n 4loc" -303
-atin0 9iso/9-/s sl--2 9iso/9-/s s-Q1al 9,s'1nctions-tc3*
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ICD !! CODES
A NEURODEVELOPMENTAL DISORDERS
> SCHIOPHRENIA SPECTRUM AND PRIMARY
PSYCHOTIC DISORDERS
C >IPOLAR AND RELATED DISORDERS
D DEPRESSIVE DISORDERS
E ANXIETY AND FEAR RELATED DISORDERS
F DISORDERS SPECIFICALLY ASSOCIATED ITH
STRESS
G DISSOCIATIVE DISORDERS
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H >ODILY DISTRESS AND PSYCHOLOGICAL AND
>EHAVIORAL FACTORS ASSOCIATED ITH DISEASES
CLASSIFIED ELSEHERE
I O>SESSIVE COMPULSIVE AND RELATED
DISORDERS
= FEEDING AND EATING DISORDERS
ELIMINATION DISORDERS
L SLEEP DISORDERS
M SEXUAL DYSFUNCTIONS AND COMPULSIVE
SEXUAL >EHAVIOR DISORDER
N ACUTE SU>STANCE INTOXICATION
O HARMFUL USE OF SU>STANCES
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P SU>STANCE DEPENDENCE
SU>STANCE ITHDRAAL SYNDROME
R SU>STANCEINDUCED MENTAL DISORDERS T DISRUPTIVE >EHAVIOR AND DISSOCIAL
DISORDERS
U DISORDERS OF PERSONALITY V PARAPHILIC DISORDERS
FACTITIOUS DISORDERS
X NEUROCOGNITIVE DISRODERS
Y MENTAL AND >EHAVIORAL DISORDERS
ATTRI>UTA>LE TO DISORDERS OR DISEASES
CLASSIFIED ELSEHERE
ALTERNATE WAYS OF CLASSIFICATION
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ALTERNATE WAYS OF CLASSIFICATION
?3 >as-9 on!s("$o'(nami" 'e&ense me"$anisms +sta%es o& libi'inal 'evelo!ment3 !Ps,c)oanal,sts*
3 >as-9 on sco/-s on 4att-/i-s o' "o%nitive +
!ro,e"tive tests3 !Ps,c)olo0ists*3
3 >as-9 on co.2/-)-nsi5- anal,sis o' t)- total
be$avioral re!ertoire3
83 >as-9 on treatment res!onse.
3 >as-9 on "ourse + out"omeo' illn-ss-s3
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FUTURE SCENARIOS
ONE CLASSIFICATION
A CLASSIFICATORY SYSTEM >ASED ON
NEUROSCIENCES
NEUROANATOMY
NEUROPHYSIOLOGICAL NEUROPATHOLOGICAL
NEUROCHEMISTRY
NEUROPSYCHOLOGICALGENETIC RESEARCH
CATEGORICAL ITH DIMENSIONAL
OUTLINE OF THE POSSIBLE FUTURE
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OUTLINE OF THE POSSIBLE FUTURECLASSIFICATION SYSTEM
AJ*) I: Genot(!e.
AJ*) II:Neurobiolo%i"al 2)-not,2-3
AJ*) III:1e$avioral2)-not,2-3
AJ*) VI:2nvironmental.o9if-/sW2/-ci2itants3
AJ*) V:T$era!euti"sta/0-ts & /-s2ons-s3
!12'-/ D= *
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