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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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)

9. 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

10. 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

11. HOW ARE NEUROPSYCHIATRY DISORDERS CLASSIFIED?
The DSM was introduced in 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Thank you
Introduction to Neuropsychiatric disorders
8/25/2019