Applying Diagnostic Classification System in Mental Health

APPLYING DIAGNOSTIC CLASSIFICATION SYSTEM IN MENTAL HEALTH By Gary Wong Senior Clinical Associate Tung Wah College ICD-10, ICD-11 DSM-5 WHAT IS “TAXONOMY”? - Noun The science or technique of classification. A classification into ordered (meaningful) categories. In Biology, the scie...

APPLYING DIAGNOSTIC CLASSIFICATION SYSTEM IN MENTAL HEALTH By Gary Wong Senior Clinical Associate Tung Wah College ICD-10, ICD-11 DSM-5 WHAT IS “TAXONOMY”? - Noun The science or technique of classification. A classification into ordered (meaningful) categories. In Biology, the science dealing with the description, identification, naming, and classification of organism. From Dictionary.com retrieved on 13 Sep 2017 CLASS ACTIVITY! PURPOSE - ICD It’s not about explaining. International Classification of Diseases. (n.d.). Retrieved September 13, 2017, from http://www.who.int/classifications/icd/en/ PURPOSE - DSM To improve communication about the types of patients cared for in US mental hospitals. Used as a component of the full U.S. census in recording the frequency of “idiocy/ insanity”. Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington: American Psychiatric Publishing. DEFINE VS EXPLAIN “DEFINE” “EXPLAIN” To determine or fix the boundaries To make clear the cause or or extent of somethings reason of somethings To make clear the outline or form To account for somethings of somethings Classification and diagnostic system is used to define mental disorders, not to explain them. DEFINING MENTAL DISORDER How to define mental disorder? Please discuss among your classmates nearby. DEFINING MENTAL DISORDER HOW TO DEFINE MENTAL DISORDER? Through statistical method? People with anatomical or physiological defect/ Deviants in the society? abnormalities (in the brain)? People who demonstrate People who have functional disruptive behaviors? difficulties/ disabilities? People who experience distress? People with “maladaptive” behaviors?  DEFINING MENTAL DISORDER “An account of what an illness is, is an opinion of the patient himself and the language of norms in a give culture. “Psychiatrist can adopt the empirical approach, i.e. define illness as ‘statistical deviation’ from the average. “Psychiatrist should also consider patient’s attitude and experience of Karl Jaspers (1883 – 1969) being ‘sick’ in determining an illness” Psychiatrist and Philosopher in Phenomenology “……no definition adequately specifies precise boundaries for the concept of ‘mental illness’. The concept of mental disorder, like many other concepts in medicine and science, lacks a consistent operational definition that covers all situations.” Diagnostic and statistical manual of mental disorders: DSM-IV. (2000). Washington, DC: American Psychiatric Assoc.  1844 Predecessor of DSM By Frederick H. Wines 7 Categories of Mental Disorders 1968 1974 DSM-II DSM-II 1980 (Revised) 1987 2018 DSM-III DSM-III-R 1994 2000 ICD-11 DSM-IV DSM-IV-TR 1949 ICD-6 1952 1968 DSM-I 1975 ICD-8 ICD-9 1992 1952 ICD-10 DSM-5 SIGNIFICANT ADVANCEMENT In DSM-III In DSM-IV Atheoretical formulation and Avoid untenable distinction operationalized definition between brain and mind psychiatrists from different E.g. Obsoleted “Organic mental theoretical backgrounds can syndromes” agree on the diagnostic criteria Emphasis on social and Multi-axial diagnoses occupational function Each individual is too complex to Added descriptions in criteria, be diagnosed with one single such as “causes clinically mental disorder significant distress or impairment A biopsychosocial model requires in social, occupational or other diagnosis on different levels (multi- important areas of functioning”. axial) SIGNIFICANT ADVANCEMENT DSM-5 Proactively harmonize with ICD-11 Propose new organization of categories 11 indicators for new grouping Shared neural substrates Family traits Genetic risk factors Specific environmental risk factors Biomarkers, Temperamental antecedents Abnormalities of emotional or cognitive processing Symptom similarity Course of illness High comorbidity Shared treatment responses DSM-IV-TR DSM-5 Disorders usually first diagnosed in infancy, Neurodevelopmental Disorder childhood, or adolescence Schizophrenia Spectrum and Other Psychotic Disorders Delirium, dementia, and amnestic and other Bipolar and Related Disorders cognitive disorders Depressive Disorders Mental disorders due to a general medical Anxiety Disorders condition Obsessive-compulsive and related Disorders Substance-related disorders Trauma- and Stress-Related Disorders Schizophrenia and other psychotic disorders Dissociative Disorders Mood disorders Somatic Symptom and Related Disorders Anxiety disorders Feeding and Eating Disorders Somatoform disorders Elimination Disorders Factitious disorders Sleep-Wake Disorders Dissociative disorders Sexual Dysfunctions Sexual and gender identity disorders Gender Dysphoria Eating disorders Disruptive, Impulse-Control, and Conduct Disorders Sleep disorders Substance-related and Addictive Disorders Impulse-control disorders not elsewhere Neurocognitive Disorders classified Personality Disorders Adjustment disorders Paraphilic Disorders Personality disorders Medication-Induced Movement Disorders and other Other conditions that may be a focus of clinical Adverse Effects of Medication attention Other conditions that may be a focus of clinical attention  COVERED IN RSS2006 Neurodevelopmental Disorder Sleep-Wake Disorders Severe Schizophrenia Spectrum and Other Sexual Dysfunctions Mental Psychotic Disorders Gender Dysphoria Illness (SMI) Bipolar and Related Disorders Disruptive, Impulse-Control, and Depressive Disorders Conduct Disorders Anxiety Disorders Substance-related and Addictive Obsessive-compulsive and related Disorders Common Mental Disorders Neurocognitive Disorders Disorder Trauma- and Stress-Related Disorders Personality Disorders Dissociative Disorders Paraphilic Disorders Somatic Symptom and Related Medication-Induced Movement Disorders Disorders and other Adverse Effects Feeding and Eating Disorders of Medication Elimination Disorders Other conditions that mayPharmacological be a focus of clinical attention Treatment and Side- effects HOW TO APPLY? Morally and legitimately, only a professionally trained psychiatrist, and some of the psychologists, can determine whether a person is suffered from a mental disorder or not. Three types of clinical diagnoses: Primary diagnosis – The mental condition directly leads to current consultation or visit to mental health facilities. Provisional diagnosis – The current manifestation only “partially” matches with the set of diagnostic criteria and the mental condition will be verified along with the reveal of essential information in the short coming future. Differential diagnosis – The mental condition shares a similar presentation with patient’s current manifestations of signs and symptoms. It can be made through hypothetical deduction. WHY OT APPLYING DSM / ICD ? SIDE-PRODUCTS OF DSM/ ICD Labeling Effect Sick Role Self-identity or behaviors The person “declared” to be determine/ influence by the sick is sanctioned to a role with “label” used to describe the certain rights and responsibilities person. Rights: To be exempt from “normal” Stigmatization social roles or expectations The disapproval, and sometimes To be not responsible for their discontent, of a person or a illness/ condition group based on the socially Responsibilities: deviated characteristics Have to try to be better Have to seek help from professional others, e.g. medical professionals. WHAT IS OT ACTUALLY TREATING? WHAT IS OT ACTUALLY TREATING? What OT theories Say? PEOP Model? MOHO? International Classification of Functioning, Disability and Health (ICF) The Suggested Thinking Process…… What is the Diagnosis? How to determine the diagnosis? History of present illness Signs and Symptoms Manifestation Patient’s subjective complaints Complaints from significant others What is/are the aim(s) of OT referral? Are they OT’s domain of concern? Can OT really make a different? Are you really competent to answer the referral? What are the presenting problems? Cause-oriented Reasoning Outcome-oriented Reasoning WHAT SHOULD AN OT DO? WITHIN OT OUTSIDE OT Be familiar with diagnostic criteria Communicate well with other mental health professionals Be sensitive in differentiating the diagnosis of the patient Demonstrate your professional Holistic approach in judgement as an “OT” understanding the patient and the illness Be competent with OT “legitimate tools” Make reference from OT theories Make sure your patient, and their Formulate treatment plan in OT relatives, know what an OT can perspectives help Q&A