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

2. Mentally Healthy?

3. 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

4. Mental Disorder or Mentally Ill?

5. Mentally Ill or Mental Disorder
Clinically significantly disturbance in mind, feeling, or behaviour
Making distress and dysfunction-disability
for the person and the environment

6. 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
Psikiatri tidak mengenal normal dengan abnormal

7. MENTAL DISORDER CLASSIFICATION

8. 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)

9. 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
Mengapa penyakit organik didahulukan?
Karena lebih berbahaya
Boleh punya gejala yang ada dibawahnya
Kalau diterapi  gejala akan hilang

10. 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

11. 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

12. due to physiological changes in the brain
December2009
F0 Organic, incl. symptomatic, mental disorders
due to physiological changes in the brain

13. 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
Gangguan mental  terjadi di otak

14. Mental and behavioral disorders due to psychoactive substance use
December2009 F1
Mental and behavioral disorders due to psychoactive substance use
Stimulan
depresan 14 14

15. 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

16. 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

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

18. 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

19. 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

20. 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

21. Mood (affective) disorders
December2009 F3
Mood (affective) disorders
Suasana perasaan 21 21

22. 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 x

23. 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

24. Neurotic, stress related and somatoform disorders
December2009 F4
Neurotic, stress related and somatoform disorders 24 24

25. 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.

26. 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

27. December2009 F5
Behavioral syndromes associated with physiological disturbances and physical factors 27 27

28. 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

29. Disorders of adult personality and behavior
December2009 F6
Disorders of adult personality and behavior 29 29

30. 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.

31. 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

32. 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

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

34. 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

35. 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

36. 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

37. MULTIAXIAL EVALUATION

38. 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

39. 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)

40. 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

41. 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

42. 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.

43. Consist of AXIS II personality disorders and mental retardation
December2009
Consist of
personality disorders and
mental retardation

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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