Classification, psychiatric

The issues that, according to these authors, should be included in research conducted in order to reach an understanding of the holistic nature of culture-bound syndromes are as follows identifying the nature of the phenomenon, situating the syndrome within the social context, the relation between the syndrome and the psychiatric disorders included in current classifications, and the social and psychiatric history of the syndrome. By following these steps it will be possible to correctly identify the phenomenology and subtypes of the syndrome, the social characteristics of the people who suffer from it and the risk factors, as well as to study the relation with other psychiatric disorders and even other syndromes that are specific to other cultures. 

DSM-IV The fourth edition of the American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorders which along with the tenth edition of the World Health Organisation s International Classification of Diseases (ICD-10) are widely used for psychiatric evaluation, especially in clinical pharmacology. 

The process of classification is typically based on systematically arranging entities on the basis of their similarities and differences. A bowl of fruit can be systematically arranged to have apples on one side and bananas on the other. Chemical elements can be systematically arranged into distinct families on the basis of their atomic structures. Classification of this sort is relatively easy and can be grounded on any number of relatively distinctive parameters or combinations of parameters, including color, size, shape, structure, taste, and so forth. We have already noted that psychiatric disorders are best characterized as open concepts. In open psychiatric concepts, overt, objective, and distinctive parameters are often less apparent, making their classification considerably more difficult. 

Evaluation of diagnostic endeavors reveals two principal and interrelated functions of a classification system. First, diagnostic systems are used to determine what constitutes a disorder (psychiatric condition or not) second, diagnostic systems are used to discriminate among the identified psychiatric conditions. Therefore, in discussing classification, we must first ask what a mental disorder is (i.e., should x be considered a psychiatric condition ). If we answer affirmatively, we must then consider whether this disorder is unique from other disorders within the classification system. We briefly consider each of these issues next. 

There are also differences in categorical classification methods. Prototypic classification is a method that suggests the indicators for inclusion and exclusion from a category are fallible rather than perfect. In a psychiatric classification system, the patient s assignment to a category is based on the similarity of that patient to the most typical patient for that disor-... 

There has been some suggestion that the DSM may be influenced by the development of other classification systems, most notably by the International Classification of Diseases (ICD-10 World Health Organization, 1992) which is a widely used international diagnostic system. There are certainly examples in the DSM-III-R and DSM-IV (American Psychiatric Association, 1987, 1994) that clearly indicate that the DSM was changed simply to make it more compatible with an ICD diagnosis. For example, the DSM-IV added a new diagnosis termed Acute Stress Disorder for compatibility with the ICD-10 (American Psychiatric Association, 1994, p. 783). 

Children s Diagnostic Classification. Children s Diagnostic Classification (CDC) test may be used instead of the Children s Psychiatric Rating Scale (CPRS) to arrive at a diagnosis. This differs from the CPRS in that it is highly directed and leads the observer to a diagnosis. It rates the current status of the child and may be used at pretreatment and/or the termination of the clinical trial. 

In the 1970s, Murray Jarvik and others, postdated that the powerful reinforcing effects of tobacco for humans were most likely explained by substances in addition to nicotine in the tobacco and smoke (Jarvik 1977 Russell 1979). Addiction to tobacco has been designated by the nomenclature as nicotine dependence and nicotine withdrawal by the American Psychiatric Association since 1987 because of the presence of nicotine (American Psychiatric Association 1994, 1987 Stratton et al. 2001). In fact, tobacco products are complex chemical cocktails, with the modem commercial cigarette representing perhaps the most complex of all. Therefore, there is also strong merit in the approach of the WHO in its International Classification of Diseases to use the terms tobacco dependence and tobacco withdrawal. ... 

The term "bipolar disorder" originally referred to manic-depressive illnesses characterized by both manic and depressive episodes. In recent years, the concept of bipolar disorder has been broadened to include subtypes with similar clinical courses, phenomenology, family histories and treatment responses. These subtypes are thought to form a continuum of disorders that, while differing in severity, are related. Readers are referred to the Diagnostic and Statisticial Manual of Mental Disorders of the American Psychiatric Association (DSM-IV) for details of this classification. 

The part of the international classification of diseases (ICD 10) concerning psychiatric disorders identifies over 500 different diagnoses or classification terms, divided into 10 main chapters and 100 categories, including classification and diagnostic criteria. These ten main chapters will not all be covered here, because clinical trials and approval data usually do not allow such discrimination. Additionally, some of these categories, such as dementia (code FOO-09) can be covered more appropriately under neurological diseases rather than in a chapter on psychiatric diseases. 

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Several widely used diagnostic classifications currently include sections on tic disorders. These include both the classification system published by the American Psychiatric Association (1994) and the criteria by the World Health Organization (1996). A third classification system, the Classification of Tic Disorders (CTD), has been offered by the Tourette Syndrome Classification Study Group (1993). Although clear differences exist comparing these classification schemes, they are broadly congruent. 

A comprehensive psychiatric history and psychiatric diagnosis according to a major classification system such as the Diagnostic and Statistical Manual, 4th ed. (DSM-IV) or International Classification of Diseases, 10th ed. (ICD-10) is needed for all patients. A structured diagnostic interview may be helpful for some cases. The mortality rate associated with ECT in adults is approximately the same as that for anesthesia alone, about 1 death per 10,000 patients treated (or per 40,000 ECT treatments). 

The Global Assessment of Function (GAF) is Axis 5 in DSM-IV multi-axial classification (American Psychiatric Association, 1994). It is similar to the Global Assessment Scale (GAS), which has separate adult and child (C-GAS Shaffer et ah, 1983) versions. The GAF has anchors with examples for both adults and children... 

The publication of DSM-IV in 1994 (American Psychiatric Association 1994), ICD-10 (clinical guidelines) in 1992 (World Health Organization, 1992) and ICD-10 (research criteria) in 1993 (World Health Organization, 1993) led to a greater convergence between the DSM and ICD classification systems (for details see Hollis, 2001 Remschmidt, 2001). 

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