06. klasifikasi gangguan jiwa
DESCRIPTION
gangguan jiwaTRANSCRIPT
MENTAL DISORDER CLASSIFICATION&MULTIAXIAL EVALUATION
Modified ofDr. 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
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 .
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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 – F9
Blocks F0 –F5 are based on hierarchyVertical 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:
F0Organic, incl. symptomatic mental disorders
F1Mental and behavioral disorders due to psychoactive substance use
F2Schizophrenia, schizotypal and delusional disorders (incl. acute and transient psychotic disorders)
F3Mood (affective) disorders
F4Neurotic, stress related and somatoform disorders
F5Behavioral syndromes associated with physiological disturbances and physical factors
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F6Disorders of adult personality and behavior
F7Mental Retardation
F8Disorders of psychological development
F9Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
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F0Organic, incl. symptomatic, mental disorders
due to physiological changes in the brain
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F00 Dementia in Alzheimer’s DiseaseF01 Vascular DementiaF02 Dementia in other disease classified elsewhereF03 Unspecified dementiaF04 Organic amnesic syndrome, not induced by
alcohol and other psychoactive substancesF05 Delirium, not induced by alcohol and other psychoactive substancesF06 Other mental disorders due to brain damage and dysfunction and to physical diseaseF07 Personality and behavioral disorders due to brain disease, damage and dysfunctionF09 Unspecified organic or symptomatic mental
disorder
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F1Mental and behavioral disorders due to psychoactive substance use
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F1 :MENTAL & BEHAVIORAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE USE
F10.- Mental and behavioral disorders due to use ofalcohol and other substances
F11.- due to use of opioidsF12.- due to use of cannabinoidsF13.- due to use of sedatives or hypnoticsF14.- due to use of cocaineF15.- due to use of other stimulants incl.caffeineF16.- due to use of hallucinogensF17.- due to use of tobaccoF18.- due to use of volatile solventsF19.- due to multiple drug use and use of other
psychoactive substances
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F1 :MENTAL AND BEHAVIORAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE USE
F1x.0 Acute intoxicationF1x.1 Harmful use/ Substance abuseF1x.2 Dependence syndromeF1x.3 Withdrawal stateF1x.4 Withdrawal state with deliriumF1x.5 Psychotic disorderF1x.6 Amnesic syndrome / Amnesic disorderF1x.7 Residual and late-onset psychotic disorderF1x.8 Other mental and behavioral disordersF1x.9 Unspecified mental and behavioral
disorder
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F2Schizophrenia, schizotypal and delusional disorders (incl. acute and transient psychotic disorders)
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F2SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL DISORDERS ( AND OTHER PSYCHOTIC DISORDERS
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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F20 SchizophreniaF20.0 Paranoid schizophreniaF20.1 Hebephrenic schizophreniaF20.2 Catatonic schizophreniaF20.3 Undifferentiated schizophreniaF20.4 Post-schizophrenic depressionF20.5 Residual schizophreniaF20.6 Simple schizophreniaF20.8 Other schizophreniaF20.9 Schizophrenia, unspecified
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F2 :SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL DISORDERS ( AND OTHER PSYCHOTIC DISORDERS)
F21 Schizotypal disorderF22 Persistent delusional disordersF23 Acute and transient psychotic
disordersF24 Induced delusional disorderF25 Schizoaffective disordersF28 Other nonorganic psychotic
disorders
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F3MOOD ( 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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F3MOOD (AFFECTIVE) DISORDERS
F30 Manic episodeF31 Bipolar affective disorderF32 Depressive episodeF33 Recurrent depressive disorderF34 Persistent mood (affective
disorder)F38 Other mood (affective) disorderF39 Unspecified mood (affective)
disorder
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F4Neurotic, stress related and somatoform disorders
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F4 :NEUROTIC, STRESS-RELATED & SOMATOFORM DISORDERS
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
F40 Phobic anxiety disordersF41 Other Anxiety disordersF42 Obsessive-compulsive disorderF43 Reaction to severe stress, and
adjustment disordersF44 Dissociative (conversion)
disordersF45 Somatoform disordersF48 Other neurotic disorders
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F5Behavioral syndromes associated with physiological disturbances and physical factors
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F5: BEHAVIORAL SYNDROMES ASSOCIATED WITH PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS
F50 Eating disordersF51 Non organic sleep disordersF52 Sexual dysfunction, not caused by organic
disorder or diseaseF53 Mental and behavioral disorders associated
with puerpuerium, not elsewhere classifiedF54 Psychological and behavioral factors
associated with disorders or diseases classified
elsewhereF55 Abuse of non-dependence producing
substancesF59 Unspecified behavioral syndromes associated
with physiological disturbances and physicalfactors
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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 individual‘s 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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F6DISORDERS 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 a human identity, just like heterosexuality and any other human identities (race, skin color , religion, etc.)
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F7MENTAL 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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F7MENTAL RETARDATION
F70 Mild mental retardation (IQ 50–69)F71 Moderate mental retardation
(IQ 35–49)F72 Severe mental retardation
(IQ 20 -34)F73 Profound mental retardation
(IQ under 20)F78 Other mental retardationF79 Unspecified mental retardation
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F8: DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
Disorders in this block have the followingfeatures 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 mental disorders
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F8DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
F80 Specific developmental disorders ofspeech and language
F81 Specific developmental disorders ofscholastic skills
F82 Specific developmental disorders ofmotor function
F83 Mixed specific developmental disordersF84 Pervasive developmental disordersF88 Other disorders of psychological
developmentF89 Unspecified disorder of psychological
development
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F9BEHAVIORAL AND EMOTIONAL DISORDERS WITH ONSET USUALLY OCCURRING IN CHILDHOOD OR ADOLESCENCE
F90 Hyperkinetic disordersF91 Conduct disordersF92 Mixed disorders of conduct and emotionsF93 Emotional disorders with onset specific to
childhoodF94 Disorders of social functioning with onset
specific to childhood and adolescenceF95 Tic disordersF98 Other behavioral and emotional disorders with
onset usually occurring in childhood andadolescence
F99 Unspecified mental disorder
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MULTIAXIAL EVALUATION
MULTIAXIAL SYSTEM
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
Axis I :Clinical Disorder (Block F0–F9) Other conditiona that may be a
focus of clinical attention
Axis II :Personality Disorder Mental Retardation
Axis III :General Medical Condition Axis IV :Psychosocial & Enviromental
Problems Axis V :Global Assessment of Functioning
(GAF)
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THE AIM OF MULTIAXIAL EVALUATION
To understand patients comprehensivelyall the patient’s aspects are highlighted,
including his/ her quality of lifeCapturing the complexity of clinical situationDescribing the heterogenity of individuals
presenting with the same diagnosisPromotes the application of biopsychosocial
model in clinical, education & research settingSo 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 yearsBlock F0-F6 can be manifested in children &
adolescent too, if the diagnostic criteria is fulfill
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AXIS I - CONT
Z codeLife 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 ofpersonality disorders andmental retardation
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AXIS III
Physical disorder or general medical condition that is present in addition to the mental disorder
The physical condition may beCausative: e.g kidney failure causing
deliriumThe 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
problemsthat contribute significantly to the development or
exacerbation of the current disorder The evaluation of of stressor:
Based on a clinicians’ assessment oh the stress that an average person with similar sociocutural values & circumstances would experience from the psychosocial stressor
Stressor:Positve: e.g job promotionNegative: loss of a love one
To formulate a treament plan:Attempt to remove psychosicial stressorHelp the patient cope with them
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AXIS IV - CONT
Psychosocial & enviromental problems:Problems with primary support groupProblems related to the social enviromentalEducational problemsOccupational problemsHousing problemsEconomic problemsProblems with access to health care servicesProblems related to interaction with the legal
system/ crimeOther psychosocial & enviromental problems
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AXIS V
Global assessment of functioning (GAF)Scale in which clinicians judge patients’
overall levels of functioning during a particular timeAt the time of the evaluationPatients’ highest level of functioning for at least a few months during the past year
3 major area of functioning:Social funcOccupational funcPsychological func
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AXIS V - CONT
The GAF scale:Based on a continuum of mental health
& mental illnessA 100-point scale100 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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