Important Questions for IGNOU PGDCFT MSCCFT MCFT002 Exam with Main Points for Answer - Unit 3

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Unit 3 Classification and Assessment of Mental Disorders

1. How can a classificatory system help you in your chosen profession?

Classificatory system can help in following ways:

i) It helps to decide about patient or client problem management, as standardised management strategies are known for many diagnosis;

ii) It helps to predict the course and outcome of the client’s problems;

iii) It helps in communicating efficiently with other professionals, as they follow the same, standardized classificatory system; and

iv) It helps to group and analyse individuals with similar set of problems.

2. How are most mental disorders different from other medical illnesses?

The diagnosis of most mental disorders is based on a set of signs and symptoms, as there is no known aetiology. However, in other medical illness, a definitive diagnosis can be made by carrying out investigations to establish the diagnosis.

3. Name some eminent persons associated with the development of psychiatric classification.

Some eminent persons associated with the development of psychiatric classification are Hippocrates, Aurelianus, Sydenham, Pinel, Kahlbaum, Griesinger, Pinel, Kahlbaum and Kraepelin.

4. What was Kraepelin’s approach to the classification of mental illnesses?

Kraepelin used three criteria for the classification of mental illnesses, that are:

i) Clinical description,

ii) Course of the illness, and

iii) Outcome of the illness.

5. When was ICD-10 published?

1992

6. Mental disorders are given the following code in ICD-10:

7. How many major classes of mental disorders exist in ICD-10?

8. When was DSM-IV published?

1994

9. How many major classes of mental illness exist in DSM-IV?

10. What does the class F50 – F59 denote?

Class F50 – 59 denotes: eating disorders, sleep disorders, sexual disorders and abuse of non-dependence producing substances

11. Describe the psychosis – neurosis classification in mental illness.

Psychosis is characterised by symptoms such as hallucinations, delusions and bizarre behaviour, loss of insight and severe illness. Neurosis is characterised by the predominant presence of anxiety, presence of insight and milder severity of illness.

12. What are the axes used in DSM-IV classification?

The multi-axial approach used in DSM-IV comprises:

i) Axis I: All clinical diagnosis, except for personality disorders and mental retardation.

ii) Axis II: Personality disorders, mental retardation and defence mechanism.

iii) Axis III: General medical conditions that may be relevant to understanding or managing the patient’s psychiatric disorder.

iv) Axis IV: Psychosocial and environmental problems relevant to diagnosis, treatment and prognosis of the patient’s disorder.

v) Axis V: Global assessment of functioning based on the clinician’s judgement.

13. What is the difference between the various classes of childhood psychiatric disorders?

The mental disorder under class F70–79 is characterised by a decreased intellectual functioning; F80–89 is characterised by deficits in certain areas of intellectual functioning or deviation in intellectual functioning; F90–99 is characterised by disordered behaviour and emotional aspects of childhood.

14. What are the various benefits of an assessment?

Benefits of assessment are:

i) Establishing a diagnosis as it helps to understand the nature of problem,

ii) Planning the treatment as steps in managing the problem can be planned according to priority basis,

iii) Referral to a specialist for further management if required, and

iv) It helps in establishing rapport and in making the client comfortable.

15. What are the various components of an assessment?

The various components of psychiatric assessment are:

a) Eliciting history,

b) Mental status examination,

c) Physical examination,

d) Physical investigations, and

e) Psychological assessment.

16. What do you assess in the ‘General appearance and behaviour’ section of the mental status examination?

The areas assessed in the ‘General appearance and behaviour’ section of the mental status examination are build and nutrition status, gait, posture, manner of approaching and greeting the counsellor, clothing, behaviour towards the counsellor as well as others in the room, movement of the client, gestures, facial expression, etc. In addition, appropriateness of these in the given sociocultural milieu is also assessed.

17. What are the various types of cognitive functions assessed in the mental status examination?

Following are the cognitive functions assessed in the mental status examination section:

i) Orientation,

ii) Attention and concentration,

iii) Memory,

iv) Judgement, and

v) Insight

18. Why should one perform physical examination as part of assessment?

Physical examination is done because:

i) Some mental illnesses may have physical manifestations,

ii) Some mental symptoms may be the result of physical illness, and

iii) Some medications given for mental illness have significant side effects.

19. What are the various types of psychological tests used?

The various psychological tests used can be divided into the following domains:

i) Neuropsychological tests,

ii) Personality tests, and

iii) Projective tests.

20. List some scales used for rating mental illness.

Some examples of tools used in rating of mental illness are:

i) Schizophrenia: Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), Positive and Negative Symptom Scale (PANSS), Brief Psychiatric Rating Scale (BPRS),

ii) Mania: Young Mania Rating Scale (YMRS), Manic State Rating Scale (MSRS),

iii) Depression: Hamilton Depression Rating Scale (HDRS), Zung Depression Scale, Montgomery Asberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI),

iv) Anxiety: Hamilton Anxiety Rating Scale (HARS), Yale Brown Obsessive Compulsive Scale (YBOCS) for OCD, and

v) General health / quality of life: General Health Questionnaire (GHQ), World Health Organisation Quality of Life Scale (WHOQOL), Global Assessment of Functioning (GAF).

21. List some assessment schedules used for diagnosing mental illness.

Examples of assessment schedules used for diagnosing mental illness are:

i) Schedule for Clinical Assessment in Neuropsychiatry (SCAN),

ii) Present Status Examination (PSE),

iii) Composite International Diagnostic Interview (CIDI),

iv) Diagnostic Interview Schedule (DIS),

v) Structured Clinical Interview for DSM-IV (SCID), and

vi) Schedule for Affective Disorders and Schizophrenia (SADS).

22. What is the difference between classification and assessment?

Classification uses established systems, like the ICD and DSM, to organise mental disorders based on shared traits and symptoms. This helps with communication between professionals, diagnosis, treatment and research. However, the sources note difficulties arise because mental disorders are diagnosed using subjective data.

Assessment, a broader process, gathers comprehensive information about an individual's mental health to understand their experiences, going beyond diagnostic labels. This involves history taking, mental status examination, physical examinations and investigations, and psychological assessments to establish a diagnosis, plan treatment and build rapport.

23. How did classificatory system come into existence?

From a long time, philosophers and researchers alike have tried to classify mental illness into various categories. Noted among them were Hippocrates, Aurelianus, Sydenham, Pinel, Kahlbaum, Griesinger, etc. Initially, mental illness was believed to be due to disturbance of the humoral balance, or a disturbance in the tension of the solid tissues. However, later researchers such as Phillip Pinel linked the occurrence of mental illness to disordered functioning of the nervous system.

Subsequently, many researchers unsuccessfully tried to link specific mental illnesses to specific lesions in the nervous system. Finally, Karl Ludwig Kahlbaum introduced the concept of diagnoses based on symptom complexes (sets of signs and symptoms), distinction between organic (psychiatric disorders with known causes) and non-organic (psychiatric disorders without known causes) disorders, and the consideration of age of onset as the basis of classificatory systems.

In the last two decades of the 19th century, Kraepelin used three criteria – clinical description, course of the illness and outcome of the illness to distinguish between the major mental disorders.

24. What do you mean by the term ‘ICD’. Please mention the categories given by ICD-10.

International Classification of Diseases

F00 – F09 Organic, including symptomatic, mental disorders
F10 – F19 Mental and behavioural disorders due to psychoactive substance use
F20 – F29 Schizophrenia, Schizotypal and delusional disorders
F30 – F39 Mood (affective) disorders
F40 – F49 Neurotic, stress related and somatoform disorders
F50 – F59 Behavioural syndromes associated with physiological disturbances and physical factors
F60 – F69 Disorders of adult personality and behaviour
F70 – F79 Mental retardation
F80 – F89 Disorders of psychological development
F90 – F99 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence

25. Explain the steps of assessment.

The assessment is carried out in the following steps:

1) Eliciting history,

2) Mental status examination,

3) Physical examination,

4) Physical investigations,

5) Psychological assessment, and

6) Assessment Schedules and Rating Scales

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