Mental Health Care Plan Template Page 2
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2DSM-IV™ Multi-axial System
Psychiatric Diagnoses are classified by the
Diagnostic and Statistical Manual of Mental Disorders, 4th.
Edition. Better
known as the DSM-IV, the manual is published by the American Psychiatric Association and covers all mental health
disorders for both children and adults. For each condition, it lists the diagnostic criteria, associated features, prevalence,
course, familial patterns and differential diagnosis. Mental Health Professionals use this manual when working with
patients in order to clarify and standardize diagnosis using a biopsychosocial perspective. Much of the information from
the Psychiatric Disorders pages is summarized from the pages of this text. Should any questions arise concerning
incongruence or inaccurate information, you should always default to the DSM as the ultimate guide to mental disorders.
The DSM uses a multi-axial or multidimensional approach to classifying a patient’s mental disorder in order to help the
clinician make a comprehensive and systematic evaluation. It helps organize and communicate clinical information and
capture the complexity and individuality of a patient’s condition. It assesses five dimensions as described below:
Axis I Clinical Disorders
This is what we typically think of as the diagnosis (e.g., major depressive disorder, schizophrenia, social phobia).
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It includes all the DSM diagnoses except Personality Disorders and Mental Retardation
Axis II Personality Disorders and Mental Retardation
Axis II can also be used to indicate prominent maladaptive personality features and maladaptive defense
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mechanisms
Personality disorders are enduring, inflexible patterns of inner experience and behaviour (thinking, experiencing
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emotion, relationships, impulse control) that deviate markedly from the expectations of the person’s culture and
lead to impairment in functioning. They include Paranoid, Antisocial, and Borderline Personality Disorders.
Axis III: General Medical Conditions
Relevant as they may play a role in the development, continuance, or exacerbation of Axis I and II Disorders
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Axis IV: Psychosocial and Environmental Problems
Can affect the diagnosis, treatment, and prognosis of mental disorders
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Examples are: stressful events in a person’s life such as death of a loved one, change in employment, family
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problems, economic difficulties and legal problems. These events are both listed and rated for this axis.
Axis V: Global Assessment of Functioning
On the final axis, the clinician rates the person's level of psychological, social and occupational functioning in a
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given time period (current or highest in the past year). This is useful for tracking clinical progress as well as
measuring the overall impact of the mental disorder. Scale is 0-100 and usually recorded in a 10-digit range e.g.
51-60.
ICD9 Psychiatric (DSM IV) Codes Commonly Used in General Practice:
290
Senile And Presenile Organic Psychotic Conditions (Dementia)
291
Alcoholic Psychoses
292
Drug Psychoses
293
Transient Organic Psychotic Conditions (Delirium)
294
Other Organic Psychotic Conditions
295
Schizophrenia
296
Affective Psychoses (Bipolar disorder)
297
Paranoid States
298
Other Nonorganic Psychoses
299
Psychoses With Origin Specific To Childhood (Autism)
300
Neurotic Disorders (Anxiety, Phobia, OCD, neurotic depression)
303
Alcohol Dependence Syndrome
304
Drug Dependence
305
Nondependent Abuse Of Drugs
306
Physiological Malfunction Arising From Mental Factors
307
Special Symptoms Or Syndromes Not Elsewhere Classified
308
Acute Reaction To Stress
309
Adjustment Reaction
Specific Nonpsychotic Mental Disorders Following Organic Brain
310
Damage
311
Depressive Disorder, Not Elsewhere Classified
312
Disturbance of Conduct, Not Elsewhere Classified
313
Disturbance Of Emotions Specific To Childhood And Adolescence
314
Hyperkinetic Syndrome Of Childhood (ADHD)
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