Classification Of Psychiatric Disorders In Children And Adolescent Mona Reda

Classification systems DSM : Diagnostic and Statistical Measurement ICD : International Classification of Disorders.

History of classifications Kanner 1935 “ personality difficulties” Guidelines of diagnosis 1957 DSM-I only 4 categories were identified : Chronic brain syndrome associated with bran trauma Schizophrenia reaction Special symptom reaction, LD, enuresis and somnambulism Adjustment reaction

DSM-II. 1968 Hyperkinetic reaction of childhood Withdrawal reaction of childhood Overanxious reaction of childhood Runaway reaction of childhood Unsocialized aggressive reaction of childhood Group delinquent reaction of childhood Over reaction of childhood

DSM-III. 1980 Mental retardation Attention deficit with or without hyperactivity Conduct disorder Anxiety disorder Other disorders of infancy and childhood Eating disorders Stereotypic movement disorder Other disorders with physical manifestations Pervasive developmental disorders

DSM-III R. 1987 Axis II Mental retardation Pervasive developmental disorders Specific developmental disorders Axis II

DSM-IV. 1994 DSM-IV TR. 2000 The provision of a separate section for disorders that are usually first diagnosed in infancy , childhood, or adolescent is for convenience only and is not meant to suggest that there is any clear distinction between childhood and adult disorders for most ( but not all) DSM-IV disorder, a single criteria set is provided that applies to children and adults .

Modifications in DSM Dynamic Diagnostic symptoms Duration of illness Age of onset Spectrum Dynamic

Value Of Classification Communication: Facilitate communication among physicians Reliability will be greater if system is based on clearly defined observable phenomena rather than features Reliability affected by structure of the system Knowledge of the diagnosis should allow the professional to make inferences about Etiology Natural history Expected response to treatment Other associated conditions

Heuristic System is expressed in operational and reproducible form to promote discovery of knowledge ( new diagnosis)

Public health and treatment Ability to develop diagnosis based quality control criteria such as expected form and duration of treatment Useful for planning and quality control as well as evidence based education.

Problems In Diagnostic Issues Misdiagnosis and labeling Comorbidity: Presence of similar criteria in different disorders Presence of one disorder lead to the second. Etiological relationship between the two disorders Common environmental or biological antecedents Diagnostic definition error, disorders commonly occur together Revisions Allow debate and data, with each revision new findings emerge that have direct implications on the existing diagnosis

Approaches to Classification Categorical system An individual will either meet the criteria and carry the diagnosis or will not and will be cleared free of the disorder It represents the way that both the clinician and patient think of a disorder However, Disorders do not always represent them selves in full criteria Disorders differ in their potential to cause impairment Symptoms and signs will differ in different age and sex of the patient

Approaches to Classification Dimensional system Starts with the collection of a large inventory of symptoms from both clinician and community samples Main groups ( internalized and externalized behaviors) Common in studies of child psychopathology.

Disadvantage: A case is a deviation from normal rather than impairment in function Items in inventory are written in simple way Factor structure differs across different age and sex groups, make it difficult to compare. Information collected on single instrument. Greater accuracy in reflecting nature, less predictive of outcome.

Approaches to Classification Multi-axial approach: Axis I: clinical syndrome Axis II: personality disorder & mental retardation Axis III: general medical diagnosis Axis IV: psycho-social and environmental problems Axis V: degree of impairment that resulted from psychiatric disorder

Approaches to Classification Multi-axial approach: Axis I: clinical syndrom,personality disorder & mental retardation ,general medical diagnosis Axis II: psycho-social and environmental problems Axis III: degree of impairment that resulted from psychiatric disorder

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

Thank You