MENTAL DISORDER CLASSIFICATION & MULTIAXIAL EVALUATION Klasifikasi  utk menyamakan definisi Modified of Dr. Gitayanti Hadisukanto, SpKJ(K)’s

Mentally Healthy?

a. Feeling healthy and happily b. Facing the life challenges 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?

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 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 . December2009 irmiakusumadewi@yahoo.com Psikiatri tidak mengenal normal dengan abnormal

MENTAL DISORDER CLASSIFICATION

Pedoman Penggolongan dan Diagnosis Gangguan Jiwa di Indonesia III PPDGJ-III December2009 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) irmiakusumadewi@yahoo.com

Blocks F0 –F5 are based on hierarchy 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 December2009 irmiakusumadewi@yahoo.com Mengapa penyakit organik didahulukan? Karena lebih berbahaya Boleh punya gejala yang ada dibawahnya Kalau diterapi  gejala akan hilang

The groupings of Mental Disorders based are: 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 December2009 irmiakusumadewi@yahoo.com

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 December2009 irmiakusumadewi@yahoo.com

due to physiological changes in the brain December2009 F0 Organic, incl. symptomatic, mental disorders due to physiological changes in the brain irmiakusumadewi@yahoo.com

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 or symptomatic mental disorder December2009 irmiakusumadewi@yahoo.com Gangguan mental  terjadi di otak

Mental and behavioral disorders due to psychoactive substance use December2009 F1 Mental and behavioral disorders due to psychoactive substance use irmiakusumadewi@yahoo.com Stimulan depresan 14 14

F1 :Mental & behavioral disorders due to psychoactive substance use December2009 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 irmiakusumadewi@yahoo.com

F1 :Mental and behavioral disorders due to psychoactive substance use December2009 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 irmiakusumadewi@yahoo.com

December2009 F2 Schizophrenia, schizotypal and delusional disorders (incl. acute and transient psychotic disorders) irmiakusumadewi@yahoo.com Tidak bisa membedakan mana yang real dan tidak real Tidak pernah merasa dirinya takut 17 17

F2 Schizophrenia, schizotypal and delusional disorders ( and other psychotic disorders December2009 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 irmiakusumadewi@yahoo.com

F20.0 Paranoid schizophrenia F20.1 Hebephrenic schizophrenia 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 December2009 irmiakusumadewi@yahoo.com

F2 :Schizophrenia, schizotypal and delusional disorders ( and other psychotic disorders) December2009 F21 Schizotypal disorder F22 Persistent delusional disorders F23 Acute and transient psychotic disorders F24 Induced delusional disorder F25 Schizoaffective disorders F28 Other nonorganic psychotic irmiakusumadewi@yahoo.com

Mood (affective) disorders December2009 F3 Mood (affective) disorders irmiakusumadewi@yahoo.com Suasana perasaan 21 21

F3 Mood ( affective ) disorders December2009 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 irmiakusumadewi@yahoo.com x

F3 Mood (affective) disorders December2009 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 irmiakusumadewi@yahoo.com

Neurotic, stress related and somatoform disorders December2009 F4 Neurotic, stress related and somatoform disorders irmiakusumadewi@yahoo.com 24 24

F4 :Neurotic, stress-related & somatoform disorders December2009 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. irmiakusumadewi@yahoo.com

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 December2009 irmiakusumadewi@yahoo.com

December2009 F5 Behavioral syndromes associated with physiological disturbances and physical factors irmiakusumadewi@yahoo.com 27 27

F5: Behavioral syndromes associated with physiological disturbances and physical factors December2009 F50 Eating disorders F51 Non organic sleep disorders F52 Sexual dysfunction, not caused by organic disorder or disease F53 Mental and behavioral disorders associated with puerpuerium, not elsewhere classified F54 Psychological and behavioral factors associated with disorders or diseases classified elsewhere F55 Abuse of non-dependence producing substances F59 Unspecified behavioral syndromes associated with physiological disturbances and physical factors irmiakusumadewi@yahoo.com

Disorders of adult personality and behavior December2009 F6 Disorders of adult personality and behavior irmiakusumadewi@yahoo.com 29 29

F6 : Disorders of adult personality and behavior December2009 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. irmiakusumadewi@yahoo.com

F6 Disorders 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.) December2009 irmiakusumadewi@yahoo.com

F7 Mental retardation Adaptive behavior is always impaired December2009 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 irmiakusumadewi@yahoo.com

F7 Mental retardation December2009 F70 Mild mental retardation (IQ 50–69) F71 Moderate mental retardation (IQ 35–49) F72 Severe mental retardation (IQ 20 -34) F73 Profound mental retardation (IQ under 20) F78 Other mental retardation F79 Unspecified mental retardation irmiakusumadewi@yahoo.com

F8: Disorders of psychological development December2009 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 be characteristic of many mental disorders irmiakusumadewi@yahoo.com

F8 Disorders of psychological development F80 Specific developmental disorders of speech and language F81 Specific developmental disorders of scholastic skills F82 Specific developmental disorders of motor function F83 Mixed specific developmental disorders F84 Pervasive developmental disorders F88 Other disorders of psychological development F89 Unspecified disorder of psychological December2009 irmiakusumadewi@yahoo.com

F9 Behavioral and emotional disorders with onset usually occurring in childhood or adolescence December2009 F90 Hyperkinetic disorders F91 Conduct disorders F92 Mixed disorders of conduct and emotions F93 Emotional disorders with onset specific to childhood F94 Disorders of social functioning with onset specific to childhood and adolescence F95 Tic disorders F98 Other behavioral and emotional disorders with onset usually occurring in childhood and adolescence F99 Unspecified mental disorder irmiakusumadewi@yahoo.com

MULTIAXIAL EVALUATION

MULTIAXIAL SYSTEM December2009 Involves an assessment on several axes which refers to a different domain of information that may help the clinician plan treatment & predict outcome irmiakusumadewi@yahoo.com

MULTIAXIAL EVALUATION December2009 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) irmiakusumadewi@yahoo.com

The aim of multiaxial evaluation December2009 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 irmiakusumadewi@yahoo.com

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 December2009 irmiakusumadewi@yahoo.com

AXIS I - cont December2009 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. irmiakusumadewi@yahoo.com

Consist of AXIS II personality disorders and mental retardation December2009 Consist of personality disorders and mental retardation irmiakusumadewi@yahoo.com

The physical condition may be AXIS III December2009 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 irmiakusumadewi@yahoo.com

AXIS III - cont December2009 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 irmiakusumadewi@yahoo.com

AXIS IV To code the psychosocial & enviromental problems December2009 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 irmiakusumadewi@yahoo.com

AXIS IV - cont Psychosocial & enviromental problems: December2009 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 irmiakusumadewi@yahoo.com

Global assessment of functioning (GAF) AXIS V December2009 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 irmiakusumadewi@yahoo.com

The information of GAF: AXIS V - cont December2009 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 irmiakusumadewi@yahoo.com