Psychiatric disorders classification

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. 

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. 

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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The third edition of the American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorders (DSM-III) marked the beginning of a new era in the classification of mental disorders in the United States (1). The emphasis on phenomenology in DSM-III and its revision, the DSM-lll-R, was a significant departure from the impressionistic, theoretically based schema of its predecessors, the DSM-I (1952) and the DSM-II (1968) ( 2, 3 and 4). The DSM-IV continues to emphasize the role of empirical findings as the basis for diagnosing psychiatric disorders, as well as strive for compatibility with the tenth revision of the International Classification of Diseases (ICD-10), whenever feasible ( 5, 6). 

Insomnia is a complaint, not a disease. The causes of insomnia are classified both in the DSM-IV for psychiatrists and in the International Classification of Sleep Disorders for sleep experts (Table 8—3). Insomnia can be a primary problem, or it can be secondary to medical or psychiatric disorders or to medications. Insomnia can also be due psychophysiological factors such as stress or to circadian rhythm distur-... 

Primary insomnia includes a number of insomnia diagnoses according to the International Classification of Sleep Disorders, including psychophysiological insomnia and idiopathic insomnia [11]. Psychophysiological insomnia most closely resembles primary insomnia. Individuals with idiopathic or childhood-onset insomnia show a lifelong inability to obtain adequate sleep there is no evidence of medical or psychiatric disorders that could account for the sleep disturbance. In sleep disor-... 

What is required now is the clear demonstration that these findings are relevant for the diagnostic classification of schizophrenia. If psychiatric disorders other than schizophrenia are also associated with... 

Although neuroticism is not a disease per se, it predisposes individuals to anxiety disorders (12, 13). Neuroticism is a vulnerability factor for all forms of anxiety (14-16). A system established by the Diagnostic and Statistical Manual for Psychiatric Disorders in the United States, currently in its 4th edition (DSM-IV) text revision (TR) (American Psychiatric Association, 2000), sets the boundary at which a particular level of behavior becomes an anxiety disorder—a level often based on the number and the duration of symptoms. DSM is a categorical system based on the qualitative separation of disease states from the state of well-being. The DSM-IVTR category of anxiety disorders currently includes generalized anxiety disorder (GAD), simple phobia, posttraumatic stress disorder (PTSD), panic disorder, social phobia, and obsessive compulsive disorder (OCD) as discrete anxiety disorders. The International Classification of Diseases-10 (IC-10) is a similar system, but it is less frequently used in research (17). 

Older classifications of psychiatric disorder divided diseases into psychoses and neuroses. The term psychosis is still widely used to describe a severe mental illness with the presence of hallucinations, delusions or extreme abnormalities of behaviour including marked overactivity, retardation and catatonia, usually accompanied by a lack of insight. Psychotic disorders therefore include schizophrenia, severe forms of depression and mania. Psychosis may also be due to illicit substances or organic conditions. Clinical features of schizophrenia may be subdivided into positive symptoms, which include hallucinations, delusions and thought disorder and negative symptoms such as apathy, flattening of affect and poverty of speech. 

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. 

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 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). 

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. 

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. 

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