CLASSIFICATION of

MENTAL and BEHAVIOURAL DISORDER

( from ICD-10 = International
Classification of Disease )
LECTURE OF PSYCHIATRY - UPH
By: dr.Engelberta Pardamean,Sp.KJ

This teaching material is copyrighted.

No part of this work may be reproduced, including photocopied, without written permission of UPH.
PEDOMAN
PENGGOLONGAN
DIAGNOSIS
GANGGUAN JIWA
di INDONESIA-III

( PPDGJ-III )
 List Categories in ICD-10
• F00-09 Organic, including symptomatic, mental disorders
• F10-19 Mental & behavioral disorders due to psychoactive
substance use
• F20-29 Schizophrenia, schizotypal & delusional disorders
• F30-39 Mood (affective) disorder
• F40-49 Neurotic, stress related & somatoform disorders
• F50-59 Behavioral syndromes associated with physiological
disturbance & physical factors
• F60-69 Disorders of adult personality & behavior
( personality disorders and gender identity sexual
preference )
• F70-79 Mental retardation
• F80-89 Disorders of psychological development
• F90-98 Behavioral & emotional disorders with onset usually
occurring in childhood or adolescence
F99 Unspecified mental disorder
 Evaluation Multiaxial Diagnosis
• 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 of
mental health-illness, on a scale 0-100.
 Axis I:
( Psychiatric diagnosis )

• All psychiatric diagnoses are listed on Axis I

(except for the personality disorders and mental
retardation, which are reported on Axis II).
• If there is more than one diagnosis, the primary
diagnosis is mentioned first and then the
subsequent comorbid diagnoses.
 List of Axis I diagnosis
• 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-F48 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-F98 Behavioural and emotional disorders with onset usually
occurring in childhood and adolescence
• F99 Unspecified mental disorder
• Z 03.2 : None
• R 69 : Delayed diagnosis
 Axis II:
Developmental diagnoses and
diagnoses first diagnosed in infancy or
• Axis II may also be used to note prominent
childhood
maladaptive personality features and defence
mechanisms

• An Axis II diagnosis should not be made while

the patient is suffering from an Axis I diagnosis.
 List of Axis II diagnosis

• F60-F69 : Disorders of adult personality

and behaviour
• F70-F79 : Mental Retardation
• Z 03.2 : None
• R 46.8 : Delayed
 Axis III:
Physical diseases

• All physical diseases are mentioned here, whether the

disease symptoms are related to the psychiatric
disorders or not.
• When a mental disorder is judged to be a direct
physiological consequence of the general medical
condition it should be diagnosed on Axis I and the
general medical condition should be recorded on both
Axis I and Axis III.
• Some general medical conditions may not be directly
related to the mental disorder but have important
prognostic or treatment implications.
• A00-B99 Certain infectious and parasitic diseases
• C00-D48 Neoplasms
• D50-D89 Diseases of the blood and blood-forming organs and certain disorders involving
the immune mechanism
• E00-E90 Endocrine, nutritional and metabolic diseases
• G00-G99 Diseases of the nervous system
• H00-H59 Diseases of the eye and adnexa
• H60-H95 Diseases of the ear and mastoid process
• I00-I99 Diseases of the circulatory system
• J00-J99 Diseases of the respiratory system
• K00-K93 Diseases of the digestive system
• L00-L99 Diseases of the skin and subcutaneous tissue
• M00-M99 Diseases of the musculoskeletal system and connective tissue
• N00-N99 Diseases of the genitourinary system
• O00-O99 Pregnancy, childbirth and the puerperium
• P00-P96 Certain conditions originating in the perinatal period
• Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities
• R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere
classified
• 00-T98 Injury, poisoning and certain other consequences of external causes
• V01-Y98 External causes of morbidity and mortality
• Z00-Z99 Factors influencing health status and contact with health services
 Axis IV:
Psychological stress factors affecting the patient

• This includes all stressors, past and present,

which have an influence on the patient at the
time of the evaluation. These factors may
include situations dating from childhood up to
the present day.
 Axis V:
Global functioning of the patient

• The Global Assessment of Functioning (GAF)

scale can be used to quantify this level of
functioning.
The GAF scale was developed specifically to rate
psychological, social and occupational
functioning
 GAF score
• 91 - 100 Superior functioning in a wide range of activities, life's problems
never seem to get out of hand, is sought out by others because of his or
her many positive qualities. No symptoms.
• 81 - 90 Absent or minimal symptoms (e.g., mild anxiety before an exam),
good functioning in all areas, interested and involved in a wide range of
activities, socially effective, generally satisfied with life, no more than
everyday problems or concerns (e.g., an occasional argument with family
members).
• 71 - 80 If symptoms are present, they are transient and expectable
reactions to psychosocial stressors (e.g., difficulty concentrating after
family argument); no more than slight impairment in social, occupational,
or school functioning (e.g., temporarily falling behind in schoolwork).
• 61 - 70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR
some difficulty in social, occupational, or school functioning (e.g.,
occasional truancy, or theft within the household), but generally
functioning pretty well, has some meaningful interpersonal relationships.
• 51 - 60 Moderate symptoms (e.g., flat affect and circumstantial speech,
occasional panic attacks) OR moderate difficulty in social, occupational, or
school functioning (e.g., few friends, conflicts with peers or co-workers).
 GAF score
• 41 - 50 Serious symptoms (e.g., suicidal ideation, severe obsessional
rituals, frequent shoplifting) OR any serious impairment in social,
occupational, or school functioning (e.g., no friends, unable to keep a job).
• 31 - 40 Some impairment in reality testing or communication (e.g., speech
is at times illogical, obscure, or irrelevant) OR major impairment in several
areas, such as work or school, family relations, judgment, thinking, or
mood (e.g., depressed man avoids friends, neglects family, and is unable to
work; child frequently beats up younger children, is defiant at home, and is
failing at school).
• 21 - 30 Behavior is considerably influenced by delusions or hallucinations
OR serious impairment, in communication or judgment (e.g., sometimes
incoherent, acts grossly inappropriately, suicidal preoccupation) OR
inability to function in almost all areas (e.g., stays in bed all day, no job,
home, or friends)
• 11 - 20 Some danger of hurting self or others (e.g., suicide attempts
without clear expectation of death; frequently violent; manic excitement)
OR occasionally fails to maintain minimal personal hygiene (e.g., smears
feces) OR gross impairment in communication (e.g., largely incoherent or
mute).
• 1 - 10 Persistent danger of severely hurting self or others (e.g., recurrent
violence) OR persistent inability to maintain minimal personal hygiene OR
serious suicidal act with clear expectation of death.
 Examples

• Axis I : F20.0 Schizophrenia paranoid

• Axis II : Z 03.2 None
• Axis III : E11.9 Adult onset non-insulin
dependent diabetes mellitus
without complications
• Axis IV : Z63.4 Disappearance and death
of family member
• Axis V : 55
 Examples

• Axis I : F20.00 Mild Depressive

disorder without psychotic
symptoms
• Axis II : F60.6 Avoidant personality
disorder
• Axis III : None
• Axis IV : Z56.0 Unemployment
• Axis V : 85
 Examples

• Axis I :
– F30.1 Mania without psychotic symptoms
– E05.0 Thyrotoxicosis with diffuse goitre
• Axis II : Z 03.2 None
• Axis III : E05.0 Thyrotoxicosis with
diffuse goitre
• Axis IV : None
• Axis V : 88