Psychiatry - O. K. Napreyenko 2001

Propaedeutics of Psychiatry
Classification and Types of Course of Mental Disorders

The clinical manifestations of mental disorders are remarkably diverse. Through Classification and the identification of patient groups with clinically similar psychopathological features, psychiatric theorists and practitioners strive to plan effective Treatment and forecast disease progression, including its terminal stages. While fully recognizing that every patient requires an individualized diagnostic and therapeutic approach, categorizing their condition within a specific taxonomic rubric is essential for planning medical, psychological, and social care in accordance with established standards. These standards help foster mutual understanding among clinicians when discussing The Nature of a patient's suffering, facilitate the comparison of clinical research findings, and ensure a guaranteed standard of care. Furthermore, comparing individual observations against standardized classification criteria sharpens a clinician's critical thinking, fosters professional growth, and enhances communication when exchanging experience with colleagues.

Historically, several key stages can be identified in the development and refinement of psychiatric classifications. The initial phase saw the creation of pioneering taxonomies by world-renowned psychiatrists during the 19th and early 20th centuries. The most substantial contributions to Modern views on psychiatric systematics during this period were made by such prominent figures as E. Kraepelin, M. Bleuler, and A. Meyer, alongside notable domestic scholars including S. S. Korsakov, P. O. Butkovsky, V. P. Osipov, and V. A. Gilyarovsky. Subsequently, professional psychiatric associations in various countries developed their own national classifications. Among these, the Taxonomy established by the American Psychiatric Association—first published in 1952 and repeatedly revised since—achieved worldwide recognition. Today, it is known as the Diagnostic and Statistical Manual of Mental Disorders (DSM), with subsequent editions continuously in development. These collective milestones have united the efforts of psychiatrists globally; to enhance and streamline international cooperation, a dedicated chapter on mental disorders was incorporated into the International Classification of Diseases (ICD), which is developed and regularly updated by the World Health Organization.

The latest tenth revision of this classification (ICD-10) incorporates proposals from researchers and clinicians across nearly 40 countries (WHO collaborating institutions). It was officially adopted for practical use in Ukraine in 1998, and work is currently underway on ICD-11.

These classification systems comprise the following primary categories:

Mental retardation — persistent impairment of mental and, predominantly, intellectual functioning originating in early childhood.

Personality disorders — abnormal behavioral patterns manifested persistently from childhood onwards.

Mental disorders — abnormal behavior or pathological psychological distress of a certain severity that emerge following a period of normal functioning.

Adjustment disorders — conditions triggered by stressful life events, typically less severe than those in the preceding category.

Other disorders — conditions that do not fit into the previous categories (such as substance dependence, paraphilias, eating disorders, and Sleep disturbances).

Developmental disorders — persistent impairments in speech, visuospatial skills, motor coordination, and other Functions originating in childhood and associated with biological immaturity of the Central Nervous system.

Other disorders specific to childhood and adolescence — age-related difficulties involving attention, activity, behavior, emotions, social functioning, motor skills, feeding, speech, tics, enuresis, and encopresis.

The section on special psychiatry in this textbook is structured into chapters that align with traditional domestic clinical and nosological systematics.

This symptomatology encompasses the following principal forms of mental disorders:

✵ infectious;

✵ cerebrotraumatic;

✵ alcoholism and substance dependence;

✵ Epilepsy;

✵ Schizophrenia;

✵ affective psychoses (manic-depressive illness, cyclothymia);

✵ psychogenias (reactive states, neuroses);

✵ presenile and senile disorders;

✵ oligophrenia and developmental delay;

✵ psychopathies (personality disorders) and character accentuations.

In light of contemporary challenges, special emphasis is placed on mental disorders arising from adverse environmental factors ("environmental psychiatry" and "Psychosomatic and Somatopsychic Disorders").

In accordance with traditional systematics, a comprehensive Diagnosis accounts for nosological affiliation, Primary and secondary Psychopathological Syndromes, Clinical presentation, and the course of the disease. This ensures the Structure/175.html">Implementation of targeted treatment and appropriate social interventions.

The final diagnosis involves multiaxial coding in accordance with Chapter V (F) — "Mental and Behavioural Disorders" — of the International Classification of Diseases. Depending on this, the following ICD-10 categories are distinguished:

F 0 organic, including symptomatic, mental disorders;

F 1 mental and behavioural disorders due to psychoactive substance use;

F 2 schizophrenia, schizotypal and delusional disorders;

F 3 affective mood disorders;

F 4 Neurotic, stress-related and somatoform disorders;

F 5 behavioural and emotional disorders associated with physiological disturbances and physical factors;

F 6 disorders of adult personality and behaviour;

F 7 mental retardation;

F 8 disorders of psychological development;

F 9 behavioural and emotional disorders with onset usually occurring in childhood and adolescence.

ICD-10 borrows heavily from the DSM, particularly regarding the systemisation concept and its structural framework. During The Development of the DSM-IV revision, many core categories were adopted from ICD-10. Both classifications provide similar descriptions of syndrome groups, forms, and variants of mental disorders.

The DSM-IV outlines the following main categories:

✵ disorders usually first diagnosed in infancy, childhood, or adolescence;

✵ delirium, dementia, and amnestic and other cognitive disorders due to a general medical condition not elsewhere classified;

✵ substance-related disorders;

✵ schizophrenia and other psychotic disorders;

✵ mood disorders;

✵ anxiety disorders;

✵ somatoform disorders;

✵ factitious disorders;

✵ dissociative disorders;

✵ sexual and gender identity disorders;

✵ eating disorders;

✵ sleep disorders;

✵ impulse-control disorders not elsewhere classified;

✵ adjustment disorders;

✵ personality disorders;

✵ other conditions that may be a focus of clinical attention.

The reviewed classifications encompass A number of general categories,

Namely: the differentiation of age-related differences, organic mental disorders, those associated with psychoactive substance use, mood disorders, and others. Therefore, the third part of this textbook, alongside traditional domestic names of pathological conditions, also provides the corresponding category lists from ICD-10 and DSM-IV.

In practice, a clinician begins the classification of an identified mental disorder by summarizing the symptoms reported by the patient or others, as well as the signs detected during a direct mental status examination. Following this, an initial attempt is made to compare these generalized, interrelated symptoms with the psychopathological syndromes listed in the classification. Most syndromes are ruled out based on the fact that they are not discriminating for the specific patient (i.e., observed in a given syndrome but rarely in another). Selecting the leading syndrome and assigning it to a specific diagnostic category is facilitated by examining the initially selected syndromes in both cross-sectional and longitudinal cuts. A cross-sectional cut involves an analysis of symptom dynamics over the past few weeks. For instance, the rapid (within a few days) reduction of recently emerged delusional symptoms is characteristic of reactive psychoses. In a longitudinal analysis, attention is paid to the Water/144.html">Origin of the disorder, comparative age-related differences across various diagnostic categories, and the prolonged course of the illness. Thus, a direct, clear connection between the onset of symptoms and a psychotraumatic situation will also support the hypothesis of a reactive state. Conversely, The Emergence of delusions against the Background of prolonged alcohol consumption and a chronic, torpid course—even during exacerbations triggered by psychotraumatic situations sharing the same delusional theme—will tip the scale toward the "alcohol psychosis" category. The latter judgment is corroborated by the presence of alcoholic personality degradation (cross-sectional cut) and past history of alcoholic psychotic episodes.

The correct construction of logical operations in The process of verifying a patient's mental disorders is facilitated by the Practical Application of the so-called principles of correspondence developed by Ya. P. Frumkin and I. Ya. Zaviliansky (1964). According to these principles, great importance in diagnosis should be attached to the ratio: 1) between the patient's objective condition and their Anamnesis, duration of illness, and features of symptom development; 2) between the signs that most typically reflect The Essence of the disease and its additional manifestations; 3) between clinical psychopathological, somatoneurological, and laboratory features; 4) between psychopathological syndromes and the course type of the mental illness.

MAIN TYPES OF the Course of Mental Illnesses

1. Progressing (process) course: a gradual deepening of psychopathology resulting in The formation of a personality defect. Schizophrenia, epilepsy, alcoholism, Pick's disease, Alzheimer's disease, and others follow this type of course.

2. Phasic, circular, or intermittent course: the predictable occurrence of attacks or phases of a pathological condition, with intervals during which the person is relatively healthy. Examples include manic-depressive or bipolar psychosis, and occasionally schizophrenia, among others.

3. Reactive course: the onset of the disorder is directly linked to The impact of psychotraumatic life circumstances, which are reflected in the clinical picture of the illness. The signs of the mental disorder subside after the normalization of the trauma-inducing situation (Jaspers' triad)—constituting reactive states or reactive psychogenic psychoses.

4. Developmental course: a gradual buildup of psychopathological symptoms (without the formation of a personality defect). Under an unfavorable combination of circumstances favoring the Development of the illness, social maladaptation may occur—such as neurotic or psychopathic disorders.

5. Episodic course: a mental disorder triggered by a specific pathological factor that suddenly begins to act. The pathological condition does not acquire a systematized character, remaining merely a discrete episode in a person's life. Examples include hepatic or hypoglycemic coma, etc.

Review Questions

1. Historical stages in the development of mental illness classifications.

2. Main categories of the modern classification of mental disorders.

3. List of mental illnesses According to the traditional domestic classification.

4. Main categories (rubrics) of ICD-10.

5. Main categories (rubrics) of DSM-IV.

6. Types of the course of mental illnesses.