Classification of Mental Disorders & Multi-Axial Assessment (DSM IV-TR & ICD 10)

Classification of Mental Disorders & Multi-Axial Assessment (DSM IV-TR & ICD 10) Diagnosis involves accumulation, interpretation & categorization of data. The main aim of this is to enable the clinician to use the most effective treatments available for that condition and to allow them to make accurate assessment of prognosis. The Importance of diagnosis: Allows … Continue reading “Classification of Mental Disorders & Multi-Axial Assessment (DSM IV-TR & ICD 10)”

Classification of Mental Disorders &

Multi-Axial Assessment

(DSM IV-TR & ICD 10)

Diagnosis involves accumulation, interpretation & categorization of data. The main aim of this is to enable the clinician to use the most effective treatments available for that condition and to allow them to make accurate assessment of prognosis.

The Importance of diagnosis:

  • Allows inter-professional communication
  • Allows us to select appropriate treatments for patients
  • Allows assessment of prognosis
  • Allows scientific research to be preformed

However psychiatric diagnoses have been criticized because:

  • They provide little information about aetiology
  • They can carry pejorative connotation (negative labeling)
  • Patients don’t always fall into neat categories. Some may have some but not all of the characteristic features of one or more different diagnostic categories (hence the terms schizoaffective & borderline personality)
  • The uniqueness of an individual patient is lost when labels are applied; one cannot fully convey a patient’s predicament with a single label
  • Historically psychiatric diagnosis has low reliability & Validity (in general psychotic conditions have high reliability and neurotic  conditions low reliability)

Both current diagnosis in psychiatry are categorical and can be monothetic (i.e. all criteria must be present e.g. Hypochodriasis) or Polythetic (some must be present e.g. Borderline personality disorders).

The International Classification of Diseases (ICD-10) 1992

Mental disorders are described within chapter V (F) of the ICD 10. There are 10 categories within this chapter & each is further subdivided into further 10.

Categories are denoted by the letter F (for mental disorders chapter), followed by a number for the main group (e.g. F3 for Mood Disorders), followed by a further number for the category within the group (e.g. F32 for depressive episode). A fourth character (or third no) is used if it is necessary to subdivide further (e.g. F32.2 for severe depressive episode without psychotic symptoms)

In Schizophrenia, a fifth character is used to specify the course of the disorder (e.g. F20.01 for paranoid schizophrenia, episodic with progressive deficit).

Different versions of the ICD 10 are available & it is therefore flexible and acceptable to a variety of users for a variety of purposes:

1. Clinical descriptions & diagnostic guidelines: for general clinical, educational & service use.

2. Diagnostic criteria for research

3. Primary care version.

4. Multiaxial version.

Main categories in ICD-10

F0  Organic, including symptomatic, mental disorders (e.g. dementia)

F1 Mental & behavioral disorders due to psychoactive substance use

F2 Schizophrenia, schizotypal & delusional disorders

F3 Mood (affective) disorder

F4 Neurotic, stress related & somatoform disorders (anxiety disorders, OCD)

F5 Behavioral syndromes associated with physiological disturbance & physical factors (e.g. eating disorders, sexual dysfunction)

F6 Disorders of adult personality & behavior (personality disorders and gender identity sexual preference.

F7 Mental retardation

F8 Disorders of psychological development (language and speech disorders)

F9 Behavioral & emotional disorders with onset usually occurring in childhood or adolescence (e.g. conduct disorders and hyperactivity)

Diagnostic & Statistical Manual of mental disorder (DSM) IV-TR (revised):

Published by the American Psychiatric Association (APA), it is a multi-axial classification. An assessment on several axes, each of which refers to a different domain of information that may help the clinician plan treatment & predict outcome:

  • Provide more information about the patient than does a single category
  • Facilitate comprehensive & systemic evaluation
  • Provide a format for organizing & communicating clinical information & for reflecting the complexity of clinical situations
  • Promotes the application of the biopsychosocial model

However, multiaxial system increase the time involved in making the diagnosis, are therefore not easy to apply in everyday clinical practice. Axes IV & V offer rather crude measurement of dubious reliability & validity.

Axis I  Clinical Disorders (may be >1)

Axis II  Personality disorder, Mental retardation

Axis III  General Medical Condition (potentially relevant to the mental disorder)

Axis IV  Psychosocial & Environmental Problems (which may affect the diagnosis, treatment or prognosis of the mental disorder)

Axis V  Global Assessment of Functioning (GAF): Psychological, social & occupational functioning on a hypothetical continuum of mental health-illness, on a scale 0-100.

State whether GAF is for the current period, at discharge or admission. Exclude impairment due to physical or environmental limitations.



1. Stevens L, Rodin I, Psychiatry: An illustrated colour text, Churchill Livingstone 2001

2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

3. World Health Organisation (WHO): ICD10 Classification of Mental and Behavioural Disorders (1992)

4. American Psychiatric Association. The Diagnostic and statistical Manual of Mental Disorders (DSM-IV).1994


Pancreatic Cancer Causes, Diagnosis, Treatment and Prognosis

Pancreatic cancer begins in the tissues of your pancreas, a large organ that lies horizontally behind the lower part of the stomach. Pancreatic cancer occurs most commonly in men between the ages of 35 and 70, it is the fourth most common cause of cancer mortality (behind lung cancer, colorectal cancer and breast cancer). Pancreatic cancer is usually an adenocarcinoma and it usually arises from the pancreatic duct cells which make up the major part of the pancreas.

Cause of pancreatic cancer
Pancreatic cancer is caused by damage to genes, but it is not known exactly why this damage happens. Evidence suggests that it is linked to exposure to carcinogens such as; cigarettes, food high in fat and protein and food additives. Possible predisposing factors are chronic pancreatitis, diabetes mellitus and chronic alcohol abuse.

There is some evidence that people who don’t eat many fresh vegetables and fruits are more at risk from pancreatic cancer. Being overweight may cause a small increase in the risk of pancreatic cancer. Some industrial chemicals called chlorinated hydrocarbon solvents have been linked to pancreatic cancer, although they are unlikely to be a major factor. Other chemicals and exposures that have been linked to an increased risk of pancreatic cancer in some studies include pesticides, radiation, nickel, chromium and iron.

The average age of onset of pancreatic cancer is between 70 to 80 but heavy smokers and heavy drinkers present with pancreatic cancer an average of seven to 10 years earlier than the rest of the population.

Signs and symptoms of pancreatic cancer
The most common are weight loss, abdominal or low back pain, jaundice and diarrhea.
Other more general effects include; fever, skin lesions, depression, anxiety and a premonition of impending death. Ascites ( fluid retention in the abdomen ) can be a sign of pancreatic tumors.

It is very difficult to diagnose pancreatic cancer as the pancreas is so deep within the body and symptoms vary depending on the exact location of the tumor in the pancreas and which cells or function of the pancreas is affected by the tumour or cancer. Unfortunately the symptoms of pancreatic cancer can also be quite vague and non specific and may be caused by many other more common and less serious conditions.

Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages, which is a major reason why it is a leading cause of cancer death. Pancreatic cancer specialists believe that anyone over 50 who develops diabetes and has unexplained weight loss should be investigated for other pancreatic disease. Courvoisier sign defines the presence of jaundice and a painlessly distended gallbladder as strongly indicative of pancreatic cancer and may be used to distinguish pancreatic cancer from gallstones.

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences. The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn’t an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm. Pancreatic cancer is relatively resistant to medical treatment and the only potentially curative treatment is surgery. Radiation therapy for pancreatic cancer can palliate pain but does not affect the patients survival.

Gemcitabine was approved by the US FDA in 1998 after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer. Management of pain and other symptoms is an important part of the treatment of advanced pancreatic cancer.

Pancreatic cancer often has a poor prognosis, even when diagnosed early and the median survival period from the time of diagnosis until demise is arguably the worst of any of the cancers. The best predictors of long term survival after surgery are a tumor diameter of less than 3 cm, no nodal involvement, negative resection margins, and diploid tumor DNA content.

Due to difficulties in diagnosis, the aggressive nature of pancreatic cancer and the limited systemic treatments available, the five-year survival rate for patients who have pancreatic adenocarcinoma is only about 5%. For pancreatic cancer that cannot be removed completely with surgery, or cancer that has spread beyond the pancreas, cure is not currently possible and the average survival is usually less than 1 year.

Neuritis – Causes, Symptoms and Treatment

Neuritis is a complex process involving inflammation of the nerves, resulting in irritation that interferes with normal nerve function and the areas served. Specifically, it affects the peripheral nerves (those outside the brain, spinal cord, or central nervous system), blocking sensory and motor functions, with pronounced symptoms.

Patients with acute brachial plexus neuritis are often misdiagnosed as having cervical radiculopathy. Acute brachial plexus neuritis is an uncommon disorder characterized by severe shoulder and upper arm pain followed by marked upper arm weakness. The temporal profile of pain preceding weakness is important in establishing a prompt diagnosis and differentiating acute brachial plexus neuritis from cervical radiculopathy.


The cause of optic neuritis is unknown. Sudden inflammation of the optic nerve (the nerve connecting the eye and the brain) leads to swelling and destruction of its outer shell, called the myelin sheath. The inflammation may occasionally be the result of a viral infection, or it may be caused by autoimmune diseases such as multiple sclerosis. Risk factors are related to the possible causes.


The main symptoms of neuritis are a tingling and burning sensation, and stabbing pains in the affected nerves. In severe cases, there may be numbness, loss of sensation, and paralysis of the nearby muscles. Thus temporary paralysis, of the face muscles may result from changes in the facial nerve on the affected side. During the acute stage of this condition, the patient may not be able to close his eyes due to a loss of normal tune and strength of the muscles on the affected side of the face.

Optic neuritis is suspected in patients with characteristic pain and vision loss. Neuroimaging, preferably with gadolinium-enhanced MRI, may show an enlarged, enhancing, optic nerve. MRI may also help diagnose multiple sclerosis. Fluid attenuating inversion recovery (FLAIR) MRI sequences may show typical demyelinating lesions in a periventricular location if optic neuritis is related to demyelination.

Visual loss. The extent of visual loss associated with optic neuritis varies. Some people experience severe difficulty seeing, while others might not notice any changes in their vision. Vision loss, should it occur, usually develops over a day to a week and may be worsened by heat or exercise. Vision loss is usually temporary, but in some cases, it may be permanent.

Vestibular neuritis – in most cases, vestibular neuritis is a self-limiting condition that only occurs once in a person’s lifetime. However, some mild dizziness when moving the head may continue for several years following the infection. For the remaining five per cent or so of cases, the symptoms recur. The condition is then considered to be another type of balance disorder, such as Meniere’s syndrome or benign paroxysmal positional vertigo (BPPV).


Since the Optic Neuritis Treatment Trial (ONTT), doctors have discovered that treating patients with intravenous steroid medication (but not oral steroids) reduces the risk of developing MS later on. This finding is very significant since approximately 50% of those who experience an initial occurrence of optic neuritis will develop MS. While this treatment has little if any impact on vision, it is important for overall health.

The Causes, Diagnosis, And Treatment Of Ovarian Cysts

The first step to correctly diagnosing and treating ovarian cysts is to locate the cause of the cysts. Ovarian cyst can be triggered by a variety of factors. It’s important to understand these different factors in order to seek appropriate treatment.

Primary factors that cause ovarian cysts

There are many factors, which can lead to ovarian cysts. These factors should not be isolated however, as sometimes the combination of these factors can together lead to the causes of ovarian cysts.

    1) Genetic predisposition: Genetic predisposition is often considered the leading cause of ovarian cysts. Research has shown that the genetic pattern of women who suffer from this chronic condition is different as compared to women who never get ovarian cysts or PCOS. However, this shouldn’t be a death warrant as many times the genetic characteristics can be modified with the help of environmental factors and proper lifestyle related changes.
    2) Poor dietary choices: Eating poorly can cause hormonal imbalance that can weaken your immune system making you more vulnerable to ovarian cysts. Avoiding foods that are rich in carbohydrates and sugar are important to fighting ovarian cysts. Making sure you’re getting enough fresh fruits, vetegtables and essential nutrients each and everyday to help your body flush out toxins that can aggravate ovarian cysts problem.
    3) Weak immune system: Like I just mentioned a weak immune system can be trouble, as it’s not able to put up a natural fight against ovarian cyst triggers. Many factors including dietary factors and sleep deprivation can lead to weakened immune system.
    4) Insulin resistance: High level of insulin can stimulate ovarian androgen production, which leads to the production of male hormones. This reduces the serum sex-hormone binding globulin or SHGB. The SHBG can in turn aggravate the ovarian cyst condition to quite an extent.
    5) Failed ovulation process: Sometimes, the ovaries fail to release egg on a monthly basis. This fails to produce progesterone and brings about hormonal imbalance. This can then lead to the formation of ovarian cysts.

Besides the above primary factors, toxins in liver and even environmental toxins can aggravate and cause ovarian cysts. Hence, ovarian cyst condition is not a simple to understand or treat.

Diagnosis of Ovarian Cysts

Once you recognize the symptoms and causes of ovarian cysts it’s important to get a professional medical diagnosis to determine the seriousness of your ovarian cysts.

Diagnosis Tests

A healthcare provider may perform the following tests to determine if a woman has an ovarian cyst or to help characterize the type of cyst that is present:

    1) Endovaginal ultrasound: This is a special imaging test developed to examine the pelvic organs and is the best test for diagnosing an ovarian cyst. An endovaginal ultrasound is a painless procedure that resembles a pelvic exam. This type of ultrasound produces the best image because rather than a scan through the abdominal wall a small probe is inserted in the vigina and can be positioned closer to the ovaries.    
    – Other imaging:
    CT scanning aids in assessing the extent of the condition. MRI scanning may also be used to clarify results of an ultrasound.
    2) Laparoscopic surgery: A procedure when a surgeon fills a woman’s abdomen with a gas and makes small incisions through which a thin scope (laparoscope) can pass into the abdomen. The surgeon identifies the cyst through the scope and may remove the cyst.
    3) Serum CA-125 assay: This is a blood test that checks for a substance called CA-125, which is associated with ovarian cancer (the CA stands for cancer antigen). This test is used in the assessment of epithelial ovarian cancer and may help determine if an ovarian mass is harmless or cancerous. However, sometimes non-harmful conditions may result in the elevated levels of CA-125 in the blood, so the test does not positively establish the diagnosis of ovarian cancer.

    4) Hormone levels: A blood test to check LH, FSH, estradiol, and testosterone levels. Checking these levels are used to indicate potential problems concerning those hormone levels.

    5) Pregnancy testing: The treatment of ovarian cysts is different for a pregnant woman than it’s for a non-pregnant woman. An ectopic pregnancy (pregnancy outside the uterus) must be ruled out because some of the symptoms of ectopic pregnancy may be similar to those of ovarian cysts.

    6) Culdocentesis: This test involves taking a fluid sample from the pelvis with a needle inserted through the vaginal wall behind the uterine cervix.

 Once you received a medical diagnosis you can properly treat your ovarian cysts. Conventional ovarian cysts treatments are the most commonly used treatment but this strategy has been proven over and over again to only mask symptoms and in some cases make the condition worse. Conventional wisdom blinded by out-of-date forms of treatment cannot treat and cure ovarian cysts. To treat ovarian cysts, a multidimensional holistic approach is needed.

 Natural Holistic Treatment Vs Conventional Treatment

Ovarian cyst disease is a chronic condition that can really take a toll on the physical, mental and emotional well being of a woman. Conventional ovarian cysts methods don’t take this into account and don’t help prevent this emotional stress but in some cases make it worse. Conventional treatments only use two methods to treat ovarian cysts. These two methods are birth control pills and surgery.

    – Birth control pills have shown to only mask the symptoms by helping to reduce the size of the cysts but not fully curing the condition. Birth control pills can also cause harm to a womens reproductive organs and can cause her to become infertile even after treatment is over.
    Surgery has it’s own health risk too. Although, surgery is necessary in extreme cases it can cause the most harm. It has been proven that even after surgery women are still likely to get ovarian cysts and sometimes make conditions worse.

Holistic approach is a multidimensional approach to treatment. When using holistic as a treatment you work to find the root causes of ovarian cysts. You’re not just focusing on a stereotypical symptom and using the same treatment in every individual case. The holistic approach is used to investigate the proper method to treat this condition and recognizes the body as a unified whole. The holistic approach adjusts to the individual differences in people and never sets standard rules for treatment. Therefore, a woman can get the best form of treatment for her individual self that can promote healing at physical, mental and emotional levels.

More Reason To Why Holistic Treatment Is Better Than Conventional Treatment

1) Side effects of conventional medication:

    Conventional medical treatment can cause many side effects. Women who have to have surgery and lose their ovaries often experience change in their personality due to hormonal imbalance. Also, oral contraceptives, which are used prominently to treat ovarian cysts, can affect fertility of a woman. Pregnant women cannot use conventional medication, without having to endure significant risks of miscarriage and premature delivery.
    – Natural remedies have no side effects. Some forms of natural treatment also put emphasis on strengthening the mental and emotional state.

2) Inefficiency of conventional medication:

    Conventional medicine only provides temporary relief from the symptoms of ovarian cysts. The ovarian cysts often reoccur after the treatment is discarded. Even after surgery, the patient is not immune to ovarian cysts. In fact research has shown that the growth of ovarian cysts after surgery is a side effect of this harsh treatment option.
    – Natural treatment provides long-term relief from the condition since it tackles the root cause of ovarian cysts and is therefore more effective.

3) Impersonal approach:

    – Conventional medication works according to rule of thumb without paying attention to individual differences. Hence, conventional treatment of ovarian cysts fails to treat certain conditions, as it lays emphasis on the disease and not the patient.
    – Natural treatment is a personalized treatment approach. Each and every course of treatment varies from one person to another. This is the reason why it has such an astounding success rate.

4) Expensive conventional treatment:

    Conventional treatment for ovarian cysts is very expensive. Besides expensive surgery, you will have to pay for hospitalization, tests, prescription drugs and more.
    – Natural remedies are comparatively cost effective and therefore women on a shoestring budget can also take advantage of them.

Spleen Disorders – Causes, Symptoms and Treatment

Spleen is a vital organ found in the left upper quadrant of the human body which plays a central role in the immune system. Not only is it a reservoir of blood reserve, which the body keeps in case of an emergency such as bleeding or hemorrhage. It performs the vital function of removing old red blood cells, but it also works like a factory for antibodies which can help maintain the defense mechanism of the body against various health threats.

There are two major spleen disorders:

· Splenomegaly

· Asplenia


This is a disorder in which the spleen is enlarged. The normal spleen size is up to 12 cm, and anything larger than that is classified as Splenomegaly. Splenomegaly could be moderate, within a range of 11 to 20 cm, or severe, more than 20 cm. The condition should not be confused with Hypersplenism, which is the over-activity of the spleen.


The symptoms of Splenomegaly include chest pain, back pain and abdominal pain. When the spleen grows considerably in size, an apparent mass in the upper left quadrant of the back can be felt on physical examination. The symptoms of anemia could be observed if the condition also accompanies cytopenia.


A number of conditions can cause that pathology. Mostly, this condition is caused by a number of other underlying diseases. The diseases that could possibly cause Splenomegaly include removal of defective RBC, various types of anemia, immune hyperplasia, bacterial or fungal infections, organ failure and metabolic disease are among other such factors.


In many cases, Splenomegaly is accompanied with other diseases, so the treatment is administered in relation to that. However, as the condition involves a great risk of bacterial infections, antibiotics are administered except in the case of the formation of an abscess in the spleen. Chemotherapy is a preferable treatment, but surgery could be required for its treatment as well. Medicines administered in this condition help avoid deaths and complications.


Asplenia, meaning “absence of spleen”, is a serious spleen disorder, in which either the organ is absent or fails to perform its vital functions. This leads to reduced immunity and increased risk of infection. It should not be confused with another condition Hyposplenia, which is the reduced function of the spleen.


Digestive tract disorders like malrotation of intestines. Complications in the shape and location of the heart, the occurrence of three lobes in the liver instead of two could also be among the symptoms.


The causes of Asplenia could either be genetic or acquired. However, the cases of its occurrence due to genetic reasons are very rare. Trauma causing damage to the spleen can cause this condition. Furthermore, sometimes a preexisting condition causes the spleen to lose its functionality. Diseases like sickle cell anemia can lead to Asplenia, for example. Sometimes, the spleen loses its functionality despite of its apparently healthy presence in the body as well, a condition known as Functional Asplenia. Furthermore, the condition obviously occurs in the case of splenectomy, which is the partial or complete surgical removal of the spleen. This surgical procedure is sometimes performed when the presence of a spleen is actually making a particular medical condition worse and when physicians are left with little choice but to go for its removal.


One of the treatment methods that are prescribed instantly on diagnosis for Asplenia is Antibiotic Prophylaxis. Antibiotics such as penicillin and erythromycin are used to prevent infections. The prolonged intake of antibiotics is particularly recommended in case of children undergoing splenectomy, for at least a year, with some physicians recommending it up to all the way into adulthood in the most complicated cases.

Asplenia is a major risk factor of splenectomy, so physicians keep in mind all the precautions to minimize the dangers. But first of all, surgeons try to ensure partial splenectomy as much as possible depending on the case and try to preserve its function. They administer preoperative vaccination to help restoring the function of the spleen as well.

The patients with symptoms of Asplenia should be checked for bacterial infections and measures are taken to immunize the patient through vaccines. Bacterial infection is a major complication risk for Asplenia victims.