MENTAL DISORDER

CLASSIFICATION
&
MULTIAXIAL EVALUATION
Modified of
Dr. 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 hierarchy
Vertical 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:
F0
Organic, incl. symptomatic mental disorders
F1
Mental and behavioral disorders due to psychoactive
substance use
F2
Schizophrenia, schizotypal and delusional disorders (incl.
acute and transient psychotic disorders)
F3
Mood (affective) disorders
F4
Neurotic, stress related and somatoform disorders
F5
Behavioral syndromes associated with physiological
disturbances and physical factors
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F6
Disorders of adult personality and behavior
F7
Mental Retardation
F8
Disorders of psychological development
F9
Behavioral and emotional disorders with onset
usually occurring in childhood and adolescence
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F0
Organic, incl. symptomatic, mental disorders

due to physiological changes in the brain

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F00 Dementia in Alzheimers Disease
F01 Vascular Dementia
F02 Dementia in other disease classified elsewhere
F03 Unspecified dementia
F04 Organic amnesic syndrome, not induced by
alcohol and other psychoactive substances
F05 Delirium, not induced by alcohol and other
psychoactive substances
F06 Other mental disorders due to brain damage
and dysfunction and to physical disease
F07 Personality and behavioral disorders due to
brain disease, damage and dysfunction
F09 Unspecified organic or symptomatic mental
disorder
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F1
Mental 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 of
alcohol and other substances
F11.- due to use of opioids
F12.- due to use of cannabinoids
F13.- due to use of sedatives or hypnotics
F14.- due to use of cocaine
F15.- due to use of other stimulants incl.caffeine
F16.- due to use of hallucinogens
F17.- due to use of tobacco
F18.- due to use of volatile solvents
F19.- 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 intoxication
F1x.1 Harmful use/ Substance abuse
F1x.2 Dependence syndrome
F1x.3 Withdrawal state
F1x.4 Withdrawal state with delirium
F1x.5 Psychotic disorder
F1x.6 Amnesic syndrome / Amnesic disorder
F1x.7 Residual and late-onset psychotic disorder
F1x.8 Other mental and behavioral disorders
F1x.9 Unspecified mental and behavioral disorder
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F2
Schizophrenia, schizotypal and delusional
disorders (incl. acute and transient psychotic
disorders)




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F2
SCHIZOPHRENIA, 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 Schizophrenia
F20.0 Paranoid schizophrenia
F20.1 Hebephrenic schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.4 Post-schizophrenic depression
F20.5 Residual schizophrenia
F20.6 Simple schizophrenia
F20.8 Other schizophrenia
F20.9 Schizophrenia, unspecified
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F2 :SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL
DISORDERS ( AND OTHER PSYCHOTIC DISORDERS)
F21 Schizotypal disorder
F22 Persistent delusional disorders
F23 Acute and transient psychotic
disorders
F24 Induced delusional disorder
F25 Schizoaffective disorders
F28 Other nonorganic psychotic
disorders
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F3
Mood (affective) disorders


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F3
MOOD ( 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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F3
MOOD (AFFECTIVE) DISORDERS
F30 Manic episode
F31 Bipolar affective disorder
F32 Depressive episode
F33 Recurrent depressive disorder
F34 Persistent mood (affective disorder)
F38 Other mood (affective) disorder
F39 Unspecified mood (affective) disorder
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F4
Neurotic, 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 disorders
F41 Other Anxiety disorders
F42 Obsessive-compulsive disorder
F43 Reaction to severe stress, and
adjustment disorders
F44 Dissociative (conversion) disorders
F45 Somatoform disorders
F48 Other neurotic disorders
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F5
Behavioral syndromes associated with
physiological disturbances and physical factors
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F5: BEHAVIORAL SYNDROMES ASSOCIATED WITH
PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS
F50 Eating disorders
F51 Non organic sleep disorders
F52 Sexual dysfunction, not caused by organic
disorder or disease
F53 Mental and behavioral disorders associated
with puerpuerium, not elsewhere classified
F54 Psychological and behavioral factors
associated with disorders or diseases classified
elsewhere
F55 Abuse of non-dependence producing
substances
F59 Unspecified behavioral syndromes associated
with physiological disturbances and physical
factors
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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
individuals 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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F6
DISORDERS 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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F7
MENTAL 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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F7
MENTAL RETARDATION
F70 Mild mental retardation (IQ 5069)
F71 Moderate mental retardation
(IQ 3549)
F72 Severe mental retardation
(IQ 20 -34)
F73 Profound mental retardation
(IQ under 20)
F78 Other mental retardation
F79 Unspecified mental retardation
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F8: DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
Disorders in this block have the following
features 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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F8
DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
F80 Specific developmental disorders of
speech and language
F81 Specific developmental disorders of
scholastic skills
F82 Specific developmental disorders of
motor function
F83 Mixed specific developmental disorders
F84 Pervasive developmental disorders
F88 Other disorders of psychological
development
F89 Unspecified disorder of psychological
development
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F9
BEHAVIORAL AND EMOTIONAL DISORDERS WITH ONSET USUALLY
OCCURRING IN CHILDHOOD OR ADOLESCENCE
F90 Hyperkinetic disorders
F91 Conduct disorders
F92 Mixed disorders of conduct and emotions
F93 Emotional disorders with onset specific to
childhood
F94 Disorders of social functioning with onset
specific to childhood and adolescence
F95 Tic disorders
F98 Other behavioral and emotional disorders with
onset usually occurring in childhood and
adolescence
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 F0F9)
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 comprehensively
all the patients aspects are highlighted, including his/ her
quality of life
Capturing the complexity of clinical situation
Describing the heterogenity of individuals presenting with
the same diagnosis
Promotes the application of biopsychosocial model in
clinical, education & research setting
So 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 years
Block F0-F6 can be manifested in children & adolescent
too, if the diagnostic criteria is fulfill
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AXIS I - CONT
Z code
Life 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 of
personality disorders and
mental 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 be
Causative: e.g kidney failure causing delirium
The 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 problems
that 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 promotion
Negative: loss of a love one
To formulate a treament plan:
Attempt to remove psychosicial stressor
Help the patient cope with them
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AXIS IV - CONT
Psychosocial & enviromental problems:
Problems with primary support group
Problems related to the social enviromental
Educational problems
Occupational problems
Housing problems
Economic problems
Problems with access to health care services
Problems related to interaction with the legal
system/ crime
Other 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 time
At the time of the evaluation
Patients highest level of functioning for at least a few
months during the past year
3 major area of functioning:
Social func
Occupational func
Psychological func
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AXIS V - CONT
The GAF scale:
Based on a continuum of mental health & mental
illness
A 100-point scale
100 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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