2.+Classification

=Unit 4.=

Dot Point 2.
• Systems of classification of mental conditions and disorders: underlying principles of classification; strengths and limitations of discrete categorical (DSM-IV and ICD-10) and dimensional (graded and transitional) approaches to classification of mental disorders ** Underlying Principles of Classification ** Classification Systems allow clinicians and researchers to: ** Strengths and limitations of discrete categorical (DSM-IV and ICD-10) approaches to classification of mental disorders ** Categorical approaches to classifying mental disorders are those that place common symptoms in categories or groups. Examples of categorical approaches are the Diagnostic and Statistical Manual of Mental Disorders – IV, text Revision (DSM-IV-TR) and the International Classification of Diseases-10 (ICD 10). ** Strengths: ** ** Limitations: ** ** DSM-IV-TR ** Prepared by the APA and regularly revised, the DSM-IV-TR provides a classification of 365 mental disorders in 16 categories. It also provides criteria sets to help guide the process of differential diagnosis, descriptions of how frequently the disorder occurs in the general population and numerical codes for each disorder for medical record keeping. It does not detail the causes of conditions. It includes a system of 5 axes or dimensions (Multiaxial System) for assessing all aspects of a patient’s metal and emotional health. ** ICD-10 ** The major international system for the classification of mental disorders – prepared by the World Health Organisation (WHO). Chapter 5 covers 300 ‘mental and behavioural disorders’. The ICD-10 has more general categories using a broad etiology. Both systems list categories of disorder that provide standardised operational criteria that aim to make diagnosis more reliable and valid by laying down rules for the inclusion or exclusion of cases. For each disorder there is a specified list of symptoms, with the varying numbers of symptoms that need to present for a specified time, and the personal and social consequences of the disorder. ** The American Psychiatric Associations Criteria for determining when a particular syndrome represents a mental Disorder: ** ** Strengths and Limitations of dimensional (graded and transitional) approaches to classification of mental disorders ** ** Eg. MMPI: Minnesota Multiphasic Personality Inventory: ** The dimensional approach is a method of categorising mental illness where an individual has a profile of scores on different continuums of diagnoses and symptoms. Clinicians **grade** or rate the severity of the symptoms or disorder by allocating a score or grade on specified //dimensions.// ** Strengths ** ** Limitations **
 * Standardise the description and interpretation of mental disorders – provides clarity and eliminates ambiguity
 * Provide vocabulary and a clinical shorthand to facilitate communication between professionals
 * Predict a conditions prognosis (future course)
 * Consider appropriate treatment
 * Encourage research into their etiology (cause or origin)
 * Encompass all known types (of mental disorders).
 * Serve as an educational tool for teaching psychopathology
 * A major advantage of classification systems for mental disorders is that inappropriate behaviours can be distinguished from functional ones.
 * A range of mental disorders are arranged, organised and described in a particular manner and order. Psychologists and other mental health practitioners use these manuals as they provide a common language for therapists, researchers, social agencies and health workers worldwide. This aids diagnosis, selection of appropriate treatments / therapies for the given conditions.
 * It allows for consistent diagnoses and treatments from hospital to hospital, clinic to clinic, all over the world.
 * The DSM-IV-TR does not explain the causes of the various psychological disorders.
 * This approach ‘boxes people into one of the available categories, sometimes inappropriately, and it does not accommodate the unique nature of the human condition.
 * These classifications do not account for people who have ‘atypical’ symptoms or those that do not clearly follow the ‘script.
 * Critics claim that categorical systems reduce humans to one-dimensional sources of data rather than encouraging practitioners to treat the whole person.
 * Critics also see these systems as tools for social control – giving mental health professionals control over people’s lives.
 * ** MULTIAXIAL SYSTEM ** || ** DESCRIPTION ** || ** EXAMPLE ** ||
 * ** AXIS I ** || * Mental disorder/s that have been diagnosed. A person can suffer from more than one.
 * Includes all of the mental health conditions except personality disorders and mental retardation || * Bipolar disorder
 * Pathological Gambling ||
 * ** AXIS II ** || * Personality disorders or mental retardation (intellectual disability) || * Borderline personality disorder
 * Moderate mental retardation ||
 * ** AXIS III ** || * General medical conditions || * High Blood Pressure
 * Asthma ||
 * ** AXIS IV ** || * Psychological and environmental factors || * Death of a friend
 * Educational problems
 * Housing problems
 * Economic problems
 * Work difficulties ||
 * ** AXIS V ** || * Global Assessment of functioning
 * Based on psychological wellness || * A score of 1-10 indicates that someone is severely unwell
 * A score of 91-100 indicates someone has superior functioning ||
 * 1) The syndrome ( pattern of symptoms) must involve distress and / or impaired functioning serious enough to warrant professional treatment
 * 2) The source of the distress lies within the person, not the environment (such as poverty, prejudice or other social forces that may lead a person to behave contrary to social norms).
 * 3) The syndrome does not represent a deliberate, voluntary decision to behave in a certain way.
 * Dimensional classification does not attempt to place people into discrete, diagnostic categories. Instead, key characteristics are identified upon which all persons can be placed, recognising that mental disorders lie on a continuum with mildly disturbed and normal behaviour, rather than being qualitatively distinct.
 * The dimensional approach is better able to capture many of the subtleties and complexities of person’s life that are missed within the categorical systems.
 * The dimensional approach evaluates symptoms not only on their presence, but also on their severity or degree.
 * The distinction between normal and abnormal is not absolute, but rather a zone where there can be a varying degree of the symptom or characteristic.
 * Dimensional approach is more nuanced and provides an accurate reflection of the state of a given characteristic or symptom in a person.
 * It allows sufferers to see improvement in their condition more readily and help to identify which factors have the largest impact on their well-being.
 * In making a diagnosis using the dimensional approach there is much scope for variable judgements on the part of the clinician evaluating or rating the symptom or characteristic – much more inconsistency in its use.
 * The dimensional approach increases the complexity of the communication of the disorder to fellow professionals and the public.
 * Most theorists cannot agree on how many dimensions are required; some say one dimension is enough, while others have identified as many as 33 dimensions.

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