Critically analyse the use of ICD10 and DSM-4 in relation to Anxiety - Essay Example

?Introduction Anxiety disorder is a term used by mental health professionals to ify mental health problems whereby the two widely used systems to categorize these disorders are the DSM-IV and the ICD-10 (Aiyegbusi and Kelly 2012, p.209). The DSM-IV is a classification system that was developed by the American Psychiatric Association (APA) for the proper diagnosis of different mental health problems while the ICD-10 is a classification system developed by the World Health Organization (WHO) to diagnose the same. However, these two systems differ in the manner they differentiate the anxiety disorders in adulthood and childhood in that the classification under the ICD-10 argues that emotional disorders in childhood differ from those in adulthood. Cognitive theorists argue that anxiety disorders occur owing to distorted beliefs about how dangerous a situation is believed to be; however, studies show that various stimuli also affects patients suffering from anxiety disorders. Anxiety disorders can be classified under the DSM IV and the ICD-10, which though appear quite similar there are differences in the four aspects of diagnosis especially in typology, identification criteria, inclusion and exclusion criteria (Slade and Watson 2006, p.1593). Studies reveal that the linkage between the current classifications can be improved if the criterion for uncontrollability inherent in the DSM IV and the increased focus on the symptoms that come due to hyper vigilance. Both the DSM IV and ICD-10 use the exclusion criteria to reduce concordance that demonstrates that each of the classification system is composed of different sets of interdependent diagnoses that must be considered as a whole especially in substance use diagnosis (Sunderland et al 2008, p.898). Anxiety disorders usually entail excess or inappropriate arousal of the feelings or moods of a person that may exhibit itself through apprehension, fear or increased levels of anxiety as often triggered by an internal threat or danger. It paralyses the individual to withdraw or be inactive from the daily occurrences or how he usually feels and can persist while at the same time an appropriate response to the threat is resolved and the threat done away with. The anxiety disorders are classified under both the DSM IV and the ICD-10 depending on how severe it is as well as how long the symptoms and the behaviour is shown or exhibited by the person. The disorders that are classified as anxiety disorders are classified according to the severity and duration of their symptoms and specific behavioral characteristics and may be caused by a mixture of psychological, physical and genetic factors that may have a direct influence on the life and anatomy of a human being. Aetiology of Anxiety disorders Anxiety disorders are triggered by several factors such as life experiences, increased stress, inadequate coping mechanisms and psychological traits (Dutton 2012, p.351) while several studies have indicated that there is a close link between anxiety disorders and specific areas of the brain. This is because imbalances in certain neurotransmitters in the brain play an integral role in the regulation of anxiety; for example, the noradrenaline, serotonin and Gamma-amino butyric acid. The forebrain is the most affected area by people with anxiety disorders, while the limbic system plays an important role in keeping memories and generating feelings and in the handling of information associated to anxiety. The locus coeruleus and the dorsal raphe go through the septohippocampal circuit that in turn pierces through the other sections of the limbic system of the body that control anxiety in a person with anxiety disorders. The hippocampus and the amygdale are equally important as they are interconnected and project to subcortical and the cortical nuclei and play a significant role in anxiety disorders. Other structures of the brain that control emotions include the hypothalamus which is involved in the pathogenesis of anxiety disorders, while people with obsessive-compulsive disorder (OCD) have an increased activity at the basal nuclei mostly at the striatum and the front lobes found at the forebrain. The serotoninergic system is also actively involved in the control of anxiety and form part of the pathogenesis of anxiety disorders (Boer and Sitsen 2003, p.465). The fact that anxiety may be present in many medical conditions means that any medical practitioner must find out the underlying issues that may hide any form of anxiety on the part of the patient. This can be achieved by looking at the personal and medical history of the patient as well as looking at other factors such as excessive drinking, substance abuse, or other psychological or mood states that might contribute to, or result from, the anxiety disorder. Diagnostic and Statistical Manual of Mental Disorders (DSM) IV The DSM IV is the method used for grouping of psychological complaints that healthcare specialists and providers in the anxiety disorder diagnosis and treatment use in the United States and it is used in anxiety treatment and diagnosis. It may either be biological contexts, cognitive and behavioural contexts as well as psychodynamic and interpersonal context. The DSM IV is designed to be put to use in all settings such as outpatient, in-patient, partial hospitalization, consultations or private practice or primary care and may be used by different healthcare professionals such as psychiatrists, psychologists, occupational and rehabilitation therapists among other healthcare professionals. The DSM has also been used as an essential tool for collecting and communicating the most accurate statistics touching on the healthcare of the public. It is important to note that the DSM has three components that are integral in the management of anxiety disorders, which include the diagnostic classification, which are standards sets and an expressive text. This classification lists the anxiety disorders that form the DSM system that requires in making any DSM diagnosis, there must be a proper selection of the disorder in question from the classification and choosing whether it best reflects the symptoms and signs that are present in the individual being diagnosed. Disorders listed in the DSM have a set of diagnostic criteria that has a statement on the symptoms present and the length of time they have been present in a person. The diagnostic criteria may be one of the inclusion whereby it addresses the symptoms present or exclusion addressing the symptoms that must not be present in order to qualify a particular person with a corresponding diagnosis. The DSM diagnostic criteria are useful in the sense that they provide a comprehensive description of the disorder being evaluated and the fact that the diagnosis criteria offer much reliability to the healthcare providers. The third part of the DSM-IV gives the descriptive text that gives a brief description or explanation of a particular disorder under subheadings. This may include the features present in the diagnosis, specifiers and/or subtypes, the procedures for recording, the associated features and disorders, features of the person in terms of culture, age and gender, the prevalence of the disorder, its course, patterns in the family and differential diagnosis. The DSM-IV adopts a five multi-axial dimension in the diagnosis of persons as in most instances; other factors in the life of another person also affect his mental health. The first axis known as Axis I indicates the clinical syndromes that are the core of the diagnosis for example depression, social phobia or schizophrenia. Axis II concerns itself with Developmental and Personality Disorders that may include autism, mental retardation or those disorders that are usually evident in childhood or early life. The personality disorders discussed in Axis II are the clinical syndromes that possess symptoms that last for long and entails how the person interacts with the surrounding such as Paranoia, and other Disorders. Axis III involves the physical conditions that have an integral role in the development, prolonging or making worse the disorders in Axis I and II and may include physical injuries to the brain or HIV/AIDS that can have a direct bearing on the mental illness of a person. Axis IV is concerned with how severe the psychosocial stressors are as they define the events or occurrences in the life of the person, for example the death of a loved one or unemployment may affect the disorders in Axis I and II. Lastly is the Axis V, which is the highest level of functioning as, measured under the Global Assessment of Relational Functioning (GARF) Scale whereby the healthcare specialist rates the person’s level of functioning at the time of diagnosis and the highest level within the preceding twelve months. This is important as it enables the healthcare specialist to have a proper understanding on how Axis I-IV affect the person and what changes could be anticipated. Psycho-Diagnostic Features of the DSM-IV The DSM IV provides that anxiety disorders are psychological and behavioural syndromes that can be proven clinically that occur in a person and can be associated with distress (Dorland 2013, p.551). A painful syndrome or the impairment in one or more important facets of human functioning characterizes this and the syndrome is deemed not to be an acceptable response to a particular evident (American Psychiatric Association, 2007). This system may be problematic to understand especially for those with limited expertise in clinically interpreting it and those who have had personal awareness with mental disarrays, but easy for counsellors who have been specially trained to go use it for diagnosis of mental disorders. DSM-IV has fifteen categories of mental disorders classified under different criteria and level. The first involves those disorders that are usually first diagnosed in infancy, earliest stages of childhood or adolescence, they mainly focus on the developmental disorders, and other difficulties associated with childhood. The second category includes Delirium Dementia, Amnestic and other Cognitive Disorders such as conditions consistent with Alzheimer and Vascular Dementia. The third category brings together mental disorders occasioned by general medical conditions that include anxiety and difficulties in controlling moods as well as changes in personality that may be caused by physical complications. The fourth category entails those with substance related disorders such as those with drug and alcohol abuse and dependence while the fifth involves those with Schizophrenia and other Psychotic Disorders that is a range of difficulties consistent with lack of contact with reality and includes Delusional Disorders. The sixth category involves those with mood and anxiety disorders that may include diagnosis showing major Depression and Posttraumatic Stress Disorder. When diagnosing anxiety disorder induced by use or abuse of a substance using the DSM-IV , it is important that the healthcare specialist determines whether there is a relationship between the use and abuse of the substance, which is related to the psychiatric symptoms presented by the person. He must also consider whether the likelihood that the particular pattern of the substance use or abuse can result into psychiatric symptoms that can be observed and whether or not there is a better alternative explanation to it. The DSM-IV criteria for substance-induced substances point to the fact that psychiatric symptoms can be attributed to the use of substances if they are evident within a month of stopping severe intoxication, withdrawal from the substance abuse or use of medication. The Third Step is ruling out whether the disorder has been caused by a general medical condition, as some psychiatric conditions are always because of psychological effects attributable to a medical condition suffered by a person. It is important that the clinician explore whether the general medical condition is the direct cause of the psychiatric symptom that is due to a direct physiological effect on the brain and whether it causes a psychiatric symptom through a psychological mechanism. The clinician must also determine whether the medication taken for the medical condition that has a psychiatric symptom as well as whether the psychiatric symptom affects the general medical condition of the person and whether their occurrence is coincidental. When ruling out medical conditions, it is important to consider whether there is a temporal relationship that is the onset, severity and disappearance of the psychiatric symptoms as related to the medical condition. Moreover, as well as whether the psychiatric presentation is a typical in terms of the pattern of the symptoms or age at the onset of psychiatric symptoms. The Fourth Step is determination of the specific primary disorder through the decision trees in the DSM-IV together with the diagnostic Criteria Charts. International Statistical Classification of Diseases and Related Health Problems (ICD-10) This system adopts a broader category of neurotic, stress-related, and somatoform disorders that includes all the conditions specified under the DSM-IV as well as other disorders that are not considered as anxiety disorders under the DSM-IV. Under this classification, there is the phobic anxiety disorders that include Agoraphobia that may be either without panic or with panic, social phobia and specific or isolated phobias. These phobias may be phobic anxiety disorders or phobic anxiety disorders that are unspecified, while the other anxiety disorders include the panic disorders known as episodic paroxysmal anxiety and general anxiety disorder. The ICD-10 also classifies anxiety disorders into disorders that include; mixed anxiety and depressive disorders, other mixed anxiety disorders and other specified anxiety disorders, as well as Anxiety disorder, though unspecified. It also includes obsessive-compulsive disorder that may either be predominantly obsessional thoughts or ruminations or predominantly compulsive acts that are obsessional rituals. The categorization by International Statistical Classification of Diseases and Related Health Problems (ICD-10) has within its arm bits mixed obsessional thoughts and acts, other obsessive-compulsive disorders and obsessive-compulsive disorder, unspecified. Further, the ICD-10 also classifies anxiety disorders into either severe stress and adjustment disorders, which may be acute, post-traumatic or adjustment in nature. Under the adjustment disorders, there is the depressive reaction that may be brief, prolonged, mixed or depressive which predominantly causes a disturbance in emotions. The categorization under the ICD-10 also includes anxiety disorders with predominant disturbance of conduct, dissociative (conversion) disorders and the Somatoform disorders which are further classified into categories that show how specific the somatoform exhibits the anxiety. Chemical Interventions in Treatment of Anxiety Disorders The most common approach in the treatment of anxiety disorders is through the cognitive therapies and chemical medication through the antidepressants such as the serotonin-norepinephrine reuptake inhibitor (SNRI) while venlafaxine may be used as an alternative. It is also recommended that patients who do not respond to the aforementioned drugs use the tricyclic antidepressants while Benzodiazepines may also be recommended for patients who are not helped by antidepressants but they need faster help (Baldwin et al 2011, p.1199). Medical interventions such as Selective Serotonin Reuptake Inhibitors (SSRIs) are useful in the management of Axis I and Axis II disorders such as OCD (Zohar 2012, p.338). There are also other medications that works in different ways are equally important in the treating of anxiety disorders such as desipramine and bupoprion, which are antidepressants, which contain serotonin and are effective the same way as SSRIs. Similarly, 30 mg of dextroamphetamine was found to have an effect on OCD symptoms while other research suggests that intoxicants such as marijuana may have a temporary relief from persons suffering the symptoms of OCD. Valproic acid and gabapentin have also been found to work on GABAdenergic receptors while carbamazepine and lamotrigine inhibits the Na+ have an effect on the effects of anxiety disorders. Lithium also affects the G proteins exerting a push, pulls effect on the neurotransmitters glutamate, and alters the transportation of sodium in the nerve and muscle cells affecting the shift towards the intraneuronal metabolism of catecholamines. It is important to note that while SSRIs and bupropion act in almost equal measure in terms to their antidepressant efficacy, bipropion cats in a different manner due to the effect on dopamine and little effect on norepinephrine due to the activating rather than the relaxing effect. Bupropion has been used clinically in depression especially when anergia and anhedonia has been detected in order to avoid anxiety in a person. However, it is not used in panic disorders as an anti-depressant due to the edgy feelings that it can bring, which may lead to a setup of panic attacks. Benzodiazepine is used in the treatment of anxiety disorders and its abuse may lead to dependence or addiction, which may bring substance abuse problems. Pharmacological dependence on it may result into withdrawal symptoms but it may be controlled through medication switching or dose tapering. They may also be used in low doses to treat addiction in persons with anxiety disorders (O'Brien 2005, pp.28-33). Strengths and Weaknesses of DSM IV and ICD-10 The advantage of DSM IV is that it allows researchers and medical practitioners to bring together a group of patients who meet a particular criterion for a given disorder enabling them to try different treatment and compare the results. However, as a method or system for diagnosis that is merely based on operational definitions rather than the etiological understanding, it brings with it numerous weaknesses. It also ignores the psychodynamic psychiatry and the contributions it can make in the understanding of pathology and the fact that the treatment is based not only on the diagnosis and the symptoms specified under the DSM IV but on the psychological factors. Through the DSM-IV-TR, there has been the development of a uniform mode of discussing and diagnosing anxiety disorders leading to increased research on behaviour and overall psychopathology. The knowledge of proper diagnosis is integral for the therapists, as through this they provide accurate diagnosis to clients as well as informing them whether their disorders or conditions will be covered by a medical insurance or a medical scheme. The DSM-IV helps in assisting with accountability, proper keeping and management of records, easier communication with other relevant healthcare professionals and positive identification of clients requiring special attention or those whose issues outstretch the expertise offered at any given time. Conversely, therapists often face difficulty or are uncomfortable in assigning a diagnosis to a client due to the disadvantages that are associated with the mechanistic approach in assessment of mental disorders using the DSM-IV. Ordinary persons often have the wrong and false impression that the understanding and the diagnosis of a mental disorder is such an advanced phenomenon only within the reach of professionals contrary to the reality. There is therefore much focus and study on the symptoms and signs exhibited by persons suffering from mental disorders as opposed to having a proper understanding of the problems faced by the client including the development of human beings. References Aiyegbusi, A., & Kelly, G. 2012. Professional and therapeutic boundaries in forensic mental health practice. London, Jessica Kingsley Publishers. American Psychiatric Association, & American Psychiatric Association. 2007. Diagnostic and statistical manual of mental disorders: DSM-IV-TRtm. Washington, D.C: American Psychiatric Association. Baldwin D, Woods R, Lawson R, Taylor D. 2011. Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis. BMJ. 11; 342: d1199. Dorland, W. A. N. 2013. Dorland's illustrated medical dictionary. Philadelphia, Pa, Saunders/Elsevier. http://www.credoreference.com/book/ehsdorland. Dutton, M. 2012. Physical therapist assistant exam review guide. Sudbury, MA, Jones & Bartlett Learning. Sunderland M, Slade T, Anderson Tm, & Peters L. 2008. Impact of substance-induced and general medical condition exclusion criteria on the prevalence of common mental disorders as defined by the CIDI. The Australian and New Zealand Journal of Psychiatry. 42, 898-904. O'Brien, C.P. 2005. Benzodiazepine Use, Abuse, and Dependence. Journal of Clinical Psychiatry, Vol 66 (Suppl 2), 28-33. Slade, T, Watson D. 2006. The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population Psychological Medicine 36: 11. 1593-600 Zohar, J. 2012. Obsessive-compulsive disorder current science and clinical practice. Chichester, John Wiley & Sons. Boer, J. A. D., & Sitsen, J. M. A. 2003. Handbook of depression and anxiety: a biological approach. 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