Klasifikasi Gangguan Jiwa

MENTAL DISORDER CLASSIFICATION & MULTIAXIAL EVALUATION
Modified of Dr. Gitayanti Hadisukanto, SpKJ(K)s
Mentally Healthy?
Mentally Healthy
a. Feeling healthy and happily b. Facing the life challenges c. Acceptance to others d. Positive attitude toward their life and others
Mental Disorder or Mentally Ill?
Mentally Ill or Mental Disorder Clinically significantly disturbance in mind, feeling, or behaviour Making distress and dysfunction-disability
for the person and the environment
MENTAL DISORDER
December2009 irmiakusumadewi@yahoo.com
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 .
MENTAL DISORDER CLASSIFICATION
PPDGJ-III
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)
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Grouped in 10 blocks: Blocks F0
December2009
F9
irmiakusumadewi@yahoo.com
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
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THE GROUPINGS OF MENTAL DISORDERS BASED ARE:

F0 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 10 disturbances and physical factors
December2009
F6
December2009
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
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December2009
F0 Organic, incl. symptomatic, mental disorders due to physiological changes in the brain
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F00 Dementia in Alzheimers 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
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December2009
F1 Mental and behavioral disorders due to psychoactive substance use
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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
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F1 :MENTAL AND BEHAVIORAL DISORDERS DUE TO

December2009
PSYCHOACTIVE SUBSTANCE USE
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
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December2009
F2
Schizophrenia, schizotypal and delusional disorders (incl. acute and transient psychotic disorders)
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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
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December2009
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
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F2 :SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL DISORDERS ( AND OTHER PSYCHOTIC DISORDERS) F21 Schizotypal disorder F22 Persistent delusional disorders F23 Acute and transient psychotic disorders F24 Induced delusional disorder F25 Schizoaffective disorders F28 Other nonorganic psychotic disorders
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F3
Mood (affective) disorders
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F3 MOOD ( AFFECTIVE ) DISORDERS

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
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F3 MOOD (AFFECTIVE) DISORDERS 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
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December2009
F4
Neurotic, stress related and somatoform disorders
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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.
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F4 : NEUROTIC, STRESS RELATED AND SOMATOFORM

DISORDERS
December2009
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
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December2009
F5 Behavioral syndromes associated with physiological disturbances and physical factors
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F5: BEHAVIORAL SYNDROMES ASSOCIATED WITH

PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS
December2009
F50 F51 F52 F53 F54
F55
F59
Eating disorders Non organic sleep disorders Sexual dysfunction, not caused by organic disorder or disease Mental and behavioral disorders associated with puerpuerium, not elsewhere classified Psychological and behavioral factors associated with disorders or diseases classified elsewhere Abuse of non-dependence producing substances Unspecified behavioral syndromes associated with physiological disturbances and physical factors
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December2009
F6 Disorders of adult personality and behavior
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F6 : DISORDERS OF ADULT PERSONALITY AND BEHAVIOR

Includes a variety of clinically significant conditions and behavior patterns which tend to be persistent and are the expression of an individuals 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.
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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 31 a human identity, just like heterosexuality and any other human identities (race, skin color , religion, etc.)
irmiakusumadewi@yahoo.com December2009
F7 MENTAL RETARDATION
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
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F7 MENTAL RETARDATION
December2009
F70 Mild mental retardation (IQ 5069) F71 Moderate mental retardation (IQ 3549) F72 Severe mental retardation (IQ 20 -34) F73 Profound mental retardation (IQ under 20) F78 Other mental retardation F79 Unspecified mental retardation
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F8: DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
Disorders in this block have the following features in common: (a) An onset that is invariably during infancy or childhood (b) An impairment or delay in the development of functions that are strongly related to biological maturation of the central nervous system (c) A steady course that does not involve the remissions and relapses that tend to be characteristic of many 34 mental disorders
December2009
F8 DISORDERS OF PSYCHOLOGICAL DEVELOPMENT

December2009
F80
F81
F82
F83 F84 F88

F89
Specific developmental disorders of speech and language Specific developmental disorders of scholastic skills Specific developmental disorders of motor function Mixed specific developmental disorders Pervasive developmental disorders Other disorders of psychological development Unspecified disorder of psychological development
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F9 BEHAVIORAL AND EMOTIONAL DISORDERS WITH ONSET USUALLY

OCCURRING IN CHILDHOOD OR ADOLESCENCE
December2009
F90 F91 F92 F93
Hyperkinetic disorders Conduct disorders Mixed disorders of conduct and emotions 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
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MULTIAXIAL EVALUATION
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
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MULTIAXIAL EVALUATION
December2009
Axis I
Axis II
Axis III Axis IV Axis V
:Clinical Disorder (Block F0F9) Other conditiona that may be a focus of clinical attention :Personality Disorder Mental Retardation :General Medical Condition :Psychosocial & Enviromental Problems :Global Assessment of Functioning (GAF)
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THE AIM OF MULTIAXIAL EVALUATION

To understand patients comprehensively
December2009
all the patients 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
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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
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AXIS I - CONT
Z code
December2009
Life problems which are not fulfill diagnostic criterias but make a person seek for help or medical conditions that need attention or therapy.
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AXIS II
Consist of
December2009
personality disorders and mental retardation
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AXIS III
Physical disorder or general medical
December2009
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
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AXIS III - CONT

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
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AXIS IV
To code the
psychosocial & enviromental problems of of stressor:
December2009
that contribute significantly to the development or exacerbation of the current disorder Based on a clinicians assessment oh the stress that an average person with similar sociocutural values & circumstances would experience from the psychosocial stressor
The evaluation
Stressor:
Positve: e.g job promotion Negative: loss of a love one
To formulate

a treament plan:
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Attempt to remove psychosicial stressor Help the patient cope with them
AXIS IV - CONT
Psychosocial & enviromental problems:
December2009
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
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AXIS V
Global assessment of functioning (GAF)
December2009
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
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AXIS V - CONT
The GAF scale:
December2009
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
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MENTAL DISORDER CLASSIFICATION & MULTIAXIAL EVALUATION

Modified of Dr. Gitayanti Hadisukanto, SpKJ(K)s

Mental Disorder or Mentally Ill?

MENTAL DISORDER CLASSIFICATION

Gangguan Jiwa di Indonesia III

Grouped in 10 blocks: Blocks F0

THE GROUPINGS OF MENTAL DISORDERS BASED ARE:

Disorders of adult personality and behavior

F1 Mental and behavioral disorders due to psychoactive substance use

F1 :MENTAL & BEHAVIORAL DISORDERS DUE TO

F1 :MENTAL AND BEHAVIORAL DISORDERS DUE TO

PSYCHOACTIVE SUBSTANCE USE

F2 SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL DISORDERS ( AND OTHER PSYCHOTIC DISORDERS

Mood (affective) disorders

F3 MOOD ( AFFECTIVE ) DISORDERS

Neurotic, stress related and somatoform disorders

F4 :NEUROTIC, STRESS-RELATED & SOMATOFORM

Mental disorders in this block have a common

F4 : NEUROTIC, STRESS RELATED AND SOMATOFORM

F5 Behavioral syndromes associated with physiological disturbances and physical factors

F5: BEHAVIORAL SYNDROMES ASSOCIATED WITH

F50 F51 F52 F53 F54

F6 Disorders of adult personality and behavior

F6 : DISORDERS OF ADULT PERSONALITY AND BEHAVIOR

F6 DISORDERS OF ADULT PERSONALITY AND BEHAVIOR

F8: DISORDERS OF PSYCHOLOGICAL DEVELOPMENT

F8 DISORDERS OF PSYCHOLOGICAL DEVELOPMENT

F83 F84 F88

F9 BEHAVIORAL AND EMOTIONAL DISORDERS WITH ONSET USUALLY

F90 F91 F92 F93

Axis III Axis IV Axis V

THE AIM OF MULTIAXIAL EVALUATION

could also be planned comprehensively

Consist of Clinical Disorders & other conditions that

personality disorders and mental retardation

AXIS III - CONT

psychosocial & enviromental problems of of stressor:

Positve: e.g job promotion Negative: loss of a love one

3 major area of functioning:

The information of GAF:

Is useful in planning treatment, measuring its impact & predicting outcome

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