Icd 10 Keswa

MENTAL DISORDER
CLASSIFICATION
&
MULTIAXIAL EVALUATION
Dr. Hervita Diatri, Sp.KJ(K)

Modified of
Dr. Gitayanti Hadisukanto, SpKJ(K)
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
December2009
Note:
The concept of “normality” is strongly
associated with human values and
irmiakusumadewi@yahoo.com
cultures, which is vary.
What is considered “normal” in one culture
could be considered “abnormal” in another
.
6
MENTAL DISORDER CLASSIFICATION
PPDGJ-III
December2009
 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:
December2009
 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:
December2009
 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
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disturbances and physical factors
 F6
December2009
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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December2009
F0
Organic, incl. symptomatic, mental disorders
due to physiological changes in the brain
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F00 Dementia in Alzheimer’s Disease
December2009
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
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disorder
December2009
F1
Mental and behavioral disorders due to
psychoactive substance use
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F1 :MENTAL & BEHAVIORAL DISORDERS DUE TO
PSYCHOACTIVE SUBSTANCE USE
December2009
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
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F19.- due to multiple drug use and use of other
psychoactive substances
F1 :MENTAL AND BEHAVIORAL DISORDERS DUE TO
December2009
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
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F1x.9 Unspecified mental and behavioral disorder
December2009
F2
Schizophrenia, schizotypal and delusional
disorders (incl. acute and transient psychotic
disorders)
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F2
SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL
December2009
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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December2009
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)
December2009
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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December2009 irmiakusumadewi@yahoo.com
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Mood (affective) disorders
F3
F3
MOOD ( AFFECTIVE ) DISORDERS
December2009
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
December2009
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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December2009
F4
Neurotic, stress related and somatoform
disorders
24
F4 :NEUROTIC, STRESS-RELATED & SOMATOFORM
DISORDERS
December2009
 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.
25
F4 : NEUROTIC, STRESS RELATED AND SOMATOFORM
DISORDERS
December2009
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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December2009
F5
Behavioral syndromes associated with
physiological disturbances and physical factors
27
F5: BEHAVIORAL SYNDROMES ASSOCIATED WITH
PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS
December2009
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
28
with physiological disturbances and physical
factors
December2009
F6
Disorders of adult personality and behavior
29
F6 : DISORDERS OF ADULT PERSONALITY AND BEHAVIOR
December2009
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.
30
F6
DISORDERS OF ADULT PERSONALITY AND BEHAVIOR
December2009
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
31
a human identity, just like heterosexuality and any other human identities
(race, skin color , religion, etc.)
F7
MENTAL RETARDATION
December2009
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 32
F7
MENTAL RETARDATION
December2009
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 retardation
33
F79 Unspecified mental retardation
F8: DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
December2009
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
34
mental disorders
F8
DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
December2009
F80 Specific developmental disorders of
speech and language
scholastic skills
motor function
F83 Mixed specific developmental disorders
F84 Pervasive developmental disorders
F88 Other disorders of psychological
development
F89 Unspecified disorder of psychological
development 35
F9
BEHAVIORAL AND EMOTIONAL DISORDERS WITH ONSET USUALLY
December2009
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 36
F99 Unspecified mental disorder
MULTIAXIAL
EVALUATION
MULTIAXIAL SYSTEM
December2009
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
December2009
 Axis I :Clinical Disorder (Block F0–F9)
Other condition 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)
39
THE AIM OF MULTIAXIAL EVALUATION
December2009
 To understand patients comprehensively
 all the patient’s 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 40
comprehensively
AXIS I
December2009
 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
December2009
 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
December2009
 Consist of
 personality disorders and
 mental retardation
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AXIS III
December2009
 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
44
AXIS III - CONT
December2009
 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
45
AXIS IV
December2009
 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
December2009
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
47
AXIS V
December2009
 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
December2009
 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
49
December2009 irmiakusumadewi@yahoo.com
THANK YOU
50

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MENTAL DISORDER

Dr. Hervita Diatri, Sp.KJ(K)

a. Feeling healthy and happily

b. Facing the life challenges

d. Positive attitude toward their life and others

• Clinically significantly disturbance in

• Making distress and dysfunction-

• for the person and the environment

 Based on ‘ICD-10 Classification of Mental

Disorders of psychological development

Behavioral and emotional disorders with onset

F1x.0 Acute intoxication

Most of the disorders tend to be recurrent, and the

Some of the these conditions and patterns of

Adaptive behavior is always impaired

Retardation can occur with or without any other

 The information of GAF:

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