Building a Case for Addressing
the Issue of Mental Health in Rural Tamil Nadu

Nicholas De Vito, Amudha Panneerselvam,
Kavya Vaghul, Juhi Sutaria,
Ravikumar Chockalingam

Classification and diagnosis of mental illness

There are two principal methods used to classify mental illnesses. The Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) is published by the American Psychiatric Association and is the main source of psychiatric diagnosis in the United States as well as many other countries. It covers all mental disorders and includes information about causes of the disorders, gender statistics, age at onset, prognosis, and current research being done. The DSM-IV organizes the diagnosis process in the form of broad Axes, as summarized in Appendix Figure A. Under Axis I, diagnosis, is a list of specific mental disorders, included in Appendix Figure B, along with general summaries of each. The International Classification of Diseases, Version 10 (ICD-10), published by the World Health Organization is a comprehensive classification of disease, with a chapter (Chapter V) devoted to mental and behavioral disorders. Appendix Figure C shows the organization of topics under ICD-10, and the general descriptions of the mental disorders listed in the DSM-IV Appendix Figure B can be applied to the ICD-10 categories as well.

The two systems have many similarities, as well as important differences. They share many similarities in diagnosis of diseases such as depression, dysthymia, substance dependence, and generalized anxiety disorder. However, there are lower concordance levels for a number of other diseases. For example, according to one study by Andrews et al. (1999), the ICD-10 system of diagnosis tended to indicate a larger percentage of social phobias, panic disorder, and post-traumatic stress disorder. The opposite was true for agoraphobia and obsessive-compulsive disorder, for which the DSM-IV indicated a higher prevalence. In general, the ICD-10 was shown to have a lower threshold for diagnosing mental disorder than the DSM-IV (Andrews et al. 1999). There have been arguments that the ICD-10 structure is inflexible, and does not provide the full range of choices for doctors to diagnose certain illnesses. For example, among the F2 disorders listed, the diagnosis is based strongly on duration of symptoms. A diagnosis may change depending on persistence of symptoms, and often the time of remission required can delay a diagnosis, or the change in diagnosis after treatment can cause the patient to stop taking proper medications and relapse (Bertelsen 1998). The Axis structure of the DSM-IV often allows more flexibility in diagnosis, which in some cases makes it a better option. The World Health Organization uses the ICD-10 system for diagnosis. This review will compile data from studies that use both, and will specify which system was used.

Many studies also use more specific surveys or diagnostic methods for research as well. These are questionnaires or criteria specifically tailored to a certain disease. Often, they offer a more in-depth diagnostic criteria or a way to quantify the extent or severity of a certain disease. Common examples in the literature include the Hamilton Rating Scale of Depression, The Panic Disorder Severity Scale, The Positive and Negative Symptoms Scale, The Beck Depression Inventory, and The WHO Quality of Life Assessment (Wiley-Exley 2007, Manjula et al. 2009).

The term Common Mental Disorders (CMDs) is commonly used by mental health professionals. CMD was a term coined by Goldberg and Huxley (1992) to describe “disorders which are commonly encountered in community settings, and whose occurrence signals a breakdown in normal functioning” (Patel et al., 1999). Depressive and anxiety disorders are classified as separate diagnostic categories in the ICD 10. The concept of CMDs, which are basically depressive and anxiety disorders, is valid in community settings because of the high degree of comorbidity between these categories and the similarity in their epidemiological profiles and treatment responsiveness (Patel et al., 2006).

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