Psychiatry - H.T. Sonyk 2003

Classification and Types of Course of Mental Disorders

The clinical manifestations of mental disorders are diverse. Through Classification, psychiatric theorists and practitioners strive to ensure the planning of appropriate Treatment and the prediction of disease progression. Without denying every patient's need for an individualized therapeutic and preventive approach, it should be noted that assigning a pathological condition to a specific classification category is practical for planning medical, psychological, and social care. This helps establish a common understanding among physicians when discussing The Nature of patients' suffering, comparing clinical research findings, and ensuring a guaranteed standard of medical care. Furthermore, comparing individual observations against classification criteria disciplines a clinician's thinking and fosters professional growth.

Historically, several stages can be identified in the development and refinement of psychiatric classifications. In The First stage, original classifications were formulated by world-renowned psychiatrists, emerging from the 19th to the early 20th century. During this period, The most significant contributions to the systematics of mental disorders were made by E. Kraepelin, M. Bleuler, and A. Meyer. Among domestic scientists, prominent figures included S.S. Korsakov, P.O. Butkovsky, V.P. Osipov, V.A. Gilyarovsky, and others. Subsequently, professional psychiatric associations in several countries developed national classifications. Notably, the systematics of the American Psychiatric Association gained worldwide recognition, first published in 1952 and subsequently revised multiple times. In its current form, it exists as the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), with future editions currently in preparation. These preceding efforts enabled the pooling of international psychiatric expertise; thus, to enhance and facilitate global collaboration, a dedicated chapter on mental disorders—The ICD classification of mental and behavioral disorders—was incorporated into the International Classification of Diseases (ICD). This section is developed and regularly updated by the World Health Organization.

The latest tenth edition of this classification (ICD-10) incorporates proposals from researchers and clinicians across nearly 40 countries (represented by 110 institutions). It was officially adopted for clinical practice in Ukraine in 1998, and work on ICD-11 is currently underway.

These systems encompass the following main classification categories:

- intellectual disability: persistent underdevelopment of mental and, above all, cognitive Functions originating in early childhood.

- personality disorders: abnormal patterns of behavior manifested persistently from childhood.

- mental disorder: abnormal behavior or distressing psychological experiences arising after a period of normal functioning.

- adjustment disorders: disturbances triggered by stressful situations, typically less severe than those in the preceding category.

- other disorders: conditions that cannot be classified under previous categories (such as substance dependence, atypical sexual preferences, 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-specific disturbances of attention, activity, behavior, emotions, social functioning, motor skills, feeding, speech, as well as tics, enuresis, and encopresis.

The section on nosological psychiatry in this textbook follows traditional domestic clinical-nosological systematics. It includes the following principal forms of mental disorders:

✵ infectious disorders;

✵ mental disturbances associated with traumatic Brain injury;

✵ alcoholism, drug addiction, and substance abuse;

✵ Epilepsy;

✵ Schizophrenia;

✵ affective psychoses;

✵ mental disturbances associated with somatic diseases;

✵ Psychogenic Disorders (reactive states, neuroses);

✵ presenile and senile disorders;

✵ oligophrenia and developmental delays;

✵ psychopathies (personality disorders) and character accentuations.

In accordance with traditional systematics, a comprehensive Diagnosis takes into account nosological categorization, Primary and secondary Psychopathological Syndromes, Clinical presentation, and patterns of disease progression. This enables the administration of appropriate treatment and supportive social interventions.

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

- F0 - organic, including symptomatic, mental disorders;

- F1 - mental and behavioural disorders due to psychoactive substance use;

- F2 - schizophrenia, schizotypal and delusional disorders;

- F3 - mood [affective] disorders;

- F4 - Neurotic, stress-related and somatoform disorders;

- F5 - behavioural syndromes associated with physiological disturbances and physical factors;

- F6 - disorders of adult personality and behaviour;

- F7 - mental retardation;

- F8 - disorders of psychological development;

- F9 - behavioural and emotional disorders with onset usually occurring in childhood and adolescence.

ICD-10 borrows heavily from the DSM, particularly regarding METABOLISM/2.html">THE CONCEPT OF systematization and Structure. During The Development of DSM-IV, many of the core categories were adopted from ICD-10. Both classifications provide a similar description of symptom groups, forms, and variants of mental disorders.

The DSM-IV features the following main categories:

✵ disorders of infancy, childhood, and adolescence;

✵ delirium and dementia due to general medical or neurological conditions not previously 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 classifications examined include A number of broad categories, namely: age-related variations, organic mental disorders, psychoactive substance-induced disorders, mood disorders, and others.

In clinical practice, a physician 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. Afterward, an initial attempt is made to compare the generalized, interrelated symptoms with the psychopathological syndromes outlined in the classification. Most syndromes are ruled out based on the premise that they are non-discriminant for a particular patient (i.e., observed in a given syndrome but rarely in another). Considering the initially selected symptoms from both cross-sectional and longitudinal Perspectives helps to isolate the leading syndrome and assign it to a specific diagnostic category. A cross-sectional approach involves analyzing symptom dynamics over the past few weeks. For example, a rapid (within several days) reduction of newly emerged psychotic 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 diagnostic categories, and the long-term course of the illness. Thus, a direct, clear connection between the onset of symptoms and a psychotraumatic situation also Supports the hypothesis of a reactive state. Conversely, the appearance of delusions against the Background of chronic alcohol consumption, a torpid course, and identical themes of delusional ideas even during exacerbations triggered by stressful situations, will tilt the diagnosis toward an «alcoholic psychosis» category. This latter judgment is reinforced by the presence of alcohol-induced personality degradation (cross-sectional perspective) and past episodes of alcoholic psychosis.

The correct execution of logical operations during the verification of a patient's mental disorders is facilitated by the Practical Application of the so-called principles of consistency. According to these principles, considerable importance in diagnosis should be attributed to the correlation: 1) between the patient's objective condition and their medical history, disease duration, and symptom development patterns; 2) between features that most typically reflect the core of the illness and its additional manifestations; 3) between clinical psychopathological, somatoneurological, and laboratory findings; and 4) between psychopathological syndromes and the course type of the mental illness.

MAIN TYPES OF Mental Illness Courses

1. Progredient (processual): a gradual deepening of psychopathology accompanied by the development of a personality defect. This type of course is characteristic of schizophrenia, epilepsy, alcoholism, Pick's disease, Alzheimer's disease, etc.

2. Phasic (circular or intermittent): the regular occurrence of attacks or phases of an illness state, interspersed with periods of relative health. Examples include manic-depressive or bipolar psychosis, and occasionally schizophrenia, etc.

3. Reactive: the onset of the disorder is directly linked to The impact of traumatic life events. The clinical picture

reflects these psychotraumatic circumstances. The signs of the mental disorder subside once the traumatizing situation normalizes (Jaspers' triad), which is typical of reactive states or reactive psychogenic psychoses.

4. Development: a gradual accumulation of psychopathological symptoms (without The formation of a personality defect). Under an unfavorable combination of predisposing circumstances, social maladjustment may occur, such as in neurotic or psychopathic disorders.

5. Episode: a mental disturbance triggered by a specific pathological factor that abruptly comes into play. The pathological state does not assume a systematic character, remaining merely a discrete episode in the person's life, such as hepatic or hypoglycemic coma, etc.