Mental Disorders & Multi-Axial Assessment

Diagnosis involves accumulation, interpretation & categorization of data. The main aim of this is to enable the clinician to use the most effective treatments available for that condition and to allow them to make accurate assessment of prognosis.

The Importance of diagnosis:

Allows inter-professional communication

Allows us to select appropriate treatments for patients

Allows assessment of prognosis

Allows scientific research to be preformed

However psychiatric diagnoses have been criticized because:

They provide little information about aetiology

They can carry pejorative connotation (negative labeling)

Patients don't always fall into neat categories. Some may have some but not all of the characteristic features of one or more different diagnostic categories (hence the terms schizoaffective & borderline personality)

The uniqueness of an individual patient is lost when labels are applied; one cannot fully convey a patient's predicament with a single label

Historically psychiatric diagnosis has low reliability & Validity (in general psychotic conditions have high reliability and neurotic conditions low reliability)

Both current diagnosis in psychiatry are categorical and can be monothetic (i.e. all criteria must be present e.g. Hypochodriasis) or Polythetic (some must be present e.g. Borderline personality disorders).

The International Classification of Diseases (ICD-10) 1992

Mental disorders are described within chapter V (F) of the ICD 10. There are 10 categories within this chapter & each is further subdivided into further 10.

Categories are denoted by the letter F (for mental disorders chapter), followed by a number for the main group (e.g. F3 for Mood Disorders), followed by a further number for the category within the group (e.g. F32 for depressive episode). A fourth character (or third no) is used if it is necessary to subdivide further (e.g. F32.2 for severe depressive episode without psychotic symptoms)

In Schizophrenia, a fifth character is used to specify the course of the disorder (e.g. F20.01 for paranoid schizophrenia, episodic with progressive deficit).

Different versions of the ICD 10 are available & it is therefore flexible and acceptable to a variety of users for a variety of purposes:

1. Clinical descriptions & diagnostic guidelines: for general clinical, educational & service use.

2. Diagnostic criteria for research

3. Primary care version.

4. Multiaxial version.

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