1. Classification Of Psychiatric Disorders In Children And Adolescent
Mona Reda

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

3. 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

4. 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

5. 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

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

7. DSM-IV 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 .

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

9. 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

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

11. 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.

12. 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

13. 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

14. 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.

15. 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.

16. 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

17. 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

18. 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.

19. Thank You