Introduction to Neuropsychiatric disorders Dr. Johnson Alex College of Medicine, DAU Introduction to Neuropsychiatric disorders 8/25/2019

Objectives At the end of the class students should be able to Define neuropsychiatric disorders Describe the classification of neuropsychiatric disorders Introduction to Neuropsychiatric disorders 8/25/2019

Introduction A mental disorder is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (a painful symptom) or disability (impairment in one or more areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. Syndrome- a group of clinical observations or symptoms that tend to co-occur. Prevalence of neuropsychiatric disorders -28% (lifetime prevalence in US population) and 50% depression in global Introduction to Neuropsychiatric disorders 8/25/2019

What is Neuropsychiatry disorders (Abnormal)? Four D’s – Deviance, Distress, Dysfunctional & Danger Deviance from or violation of a society’s ideas about proper function. Norms- a society’s explicit and implicit rules for proper conduct. Culture- a society’s shared rules that govern the behavior of its members, common history, values, beliefs, habits, skills, technology, and arts. Includes a valuational aspect which varies from culture to culture. Introduction to Neuropsychiatric disorders 8/25/2019

What is Neuropsychiatry disorders (Abnormal)? Distress: Pain or discomfort Dysfunctional or Maladaptive Behavior It interferes with daily functioning. Danger Behavior that becomes dangerous to self or others. Note: Abnormal behavior is to some degree arbitrary and culturally determined Medical Model vs. Bio-psychosocial Model Introduction to Neuropsychiatric disorders 8/25/2019

Classification of Neuropsychiatry Disorders Physical conditions are classified based on etiology (e.g. viral pneumonia), structural pathology (e.g. bronchopneumonia), symptoms (e.g. migraine) Neuropsychiatric disorders are based on symptoms, but, few are based on etiology (e.g. Alzheimer's) Three models of classification in Neuropsychiatry 1. Categorical 2. Dimensional 3. Prototypal

Three Models of Classification Categorical Approach Human behavior can be divided into two categories (health or unhealthy). The unhealthy category consists of discrete, non overlapping, classes or types. Dimensional Approach Bx= product of different dimensions (eg. anxiousness, extroversion) People differ in profile or configuration of these dimensional traits. Normal or abnormal is determined by looking at any particular dimension and making a determination usually based on a normative percentage.

Three Models of Classification Prototypal Approach Assumes the existence of conceptual entities (prototypes) depicting idealized combinations of characteristics, ones that more or less regularly occur together. Multiaxial classification (Axis I, II, III, IV, V) DSM IV-TR Axis I-Based on disorder, Axis II- Personality disorders and mental retardation, Axis III- Medical conditions, Axis IV- Psychosocial and environmental factors affecting the person, Axis V- Global Assessment Functioning. 10 (persistent danger) – 100 (No symptom)

The Purpose 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. Introduction to Neuropsychiatric disorders 8/25/2019

Psychiatric Disorders Organic Non-Organic 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 Suicide

HOW ARE NEUROPSYCHIATRY DISORDERS CLASSIFIED? The DSM was introduced in 1952. The latest version, published in 2013, is the DSM-5. Another common system of classification, published by the World Health Organization, is used mainly for compiling statistics on the worldwide occurrence of disorders: the International Statistical Classification of Diseases and Related Health Problems (ICD), which is now in its tenth revision (the ICD-10). The DSM-V is compatible with the ICD, so that DSM diagnoses could be coded in the ICD system as well. Introduction to Neuropsychiatric disorders 8/25/2019

DSM Classification of Mental Disorders Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM – American Psychiatry Association (APA) Moving from a subjective to operational definition. Diagnosis is based on signs and symptoms Signs- objective observations of a patients physical or mental disorder by a diagnostician. Symptoms- patient’s subjective description of a physical or mental disorder. Introduction to Neuropsychiatric disorders 8/25/2019

DSM Classification Neurodevelopmental disorders Schizophrenia spectrum and other psychotic disorders Bipolar and related disorders Depressive disorders Anxiety disorders Obsessive –Compulsive and related disorders Trauma and Stress related disorders Dissociative disorders Somatic Symptoms and related disorders Feeding and Eating disorders Elimination disorders Introduction to Neuropsychiatric disorders 8/25/2019

DSM Classification Sleep-Wake disorders Sexual dysfunctions Gender dysphoria Disruptive, Impulse control and conduct disorders Substance related and addictive disorders Neurocognitive disorders Personality disorders Other mental disorders Medication-induced movement disorders and adverse effects of medication Introduction to Neuropsychiatric disorders 8/25/2019

ICD-10 Classification System Developed by WHO, it has 21 chapter 10th revision is known as ICD-10 Psychiatric disorders are described in chapter V & Coding use alpha numeric system, e.g. Fxx: (F20- Schizophrenia) Its classification over 300 mental and behavioral disorders ICD-10 Classification available for both clinical and research Introduction to Neuropsychiatric disorders 8/25/2019

ICD-10 Classification System F00-F09 Organic, including symptomatic, mental disorders F10-F19 Mental and behavioral disorders due to psychoactive substance use F20-F29 Schizophrenia, schizotypal and delusional disorders F30-F39 Mood disorders F40-F49 Neurotic, stress-related and somatoform disorders F50-F59 Behavioural syndrome associated with physiological disturbance and physical factors F60-F69 Disorders of adult personality and behaviour F70-F79 Mental retardation F80-F89 Disorders of psychological development F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence Introduction to Neuropsychiatric disorders 8/25/2019

Mental Disorder’s Qualifying Terms Comorbidity-existence of two or more disorders Acute- describes a disorder of sudden onset, usually with intense symptoms Chronic- describes a long-standing or frequently recurring disorder, often of progressing seriousness Mild/Moderate/Severe- describes a disorder of a low order of severity, intermediate order of severity, and a high degree of seriousness. Episodic Disorder- describes a disorder that tends to decrease and to reappear Recurrent- describes a disorder pattern that tends to come and go. Introduction to Neuropsychiatric disorders 8/25/2019

Culture-Bound Syndromes Culture-bound syndromes - Patterns of abnormal behavior found within only one or a few cultures. Culture-bound syndromes may reflect exaggerated forms of common folk superstitions and belief patterns within a particular culture. Culture-bound syndromes in the United States include anorexia nervosa and dissociative identity disorder (formerly called multiple personality disorder). Example: Zar (possession of spirit and sudden changes in consciousness) North Africa and Middle East Introduction to Neuropsychiatric disorders 8/25/2019

Thank you Introduction to Neuropsychiatric disorders 8/25/2019