Psychiatric Nursing: A Guide to DSM-IV-TR Multiaxial System Essay

Custom Student Mr. Teacher ENG 1001-04 16 February 2017

Psychiatric Nursing: A Guide to DSM-IV-TR Multiaxial System

Introduction

            The heart of the DSM-IV-TR system is the multiaxial format that uses five levels or areas to perform a thorough diagnosis. This system recognizes the complexity of diagnosis and the interrelatedness of many factors that are components of a mental disorder diagnosis. The multiaxial system generally takes into account psychological, physical, internal, external, developmental, and social factors. The five axes that make up the system are as follows:

            Axis I: Clinical Disorders – other conditions that may be a focus of clinical attention

            Axis II: Personality Disorders – Mental retardation

            Axis III: General Medical Conditions

            Axis IV: Psychosocial and Environmental Problems

            Axis V: Global Assessment of Functioning

Axis I: Clinical Disorders and Axis II: Personality Disorders and Mental Retardation

            Axis I and Axis II are the key components of the multiaxial system and are used o record the 340 disorders in the classification system. The distinction between the two axes has a historical basis. Axis I is used to record what in the past were viewed as neuroses and psychoses, and Axis II is used to record what were referred to as character disorders. Neuroses were considered deficiencies and limitations that could impair, but not chronically alter, almost al areas of functioning and could be effectively relieved with intervention.

Character disorders were viewed as long-standing defects ingrained in the developmental process of childhood that caused major, lifelong dysfunction in most aspects of life and were not generally amenable to treatment. This is most likely why payers consistently reimburse clinicians for Axis I disorders and not Axis II disorders, since Axis I disorders can be changed through intervention, whereas Axis II disorders are unalterable, and paying for treatment of intractable disorders is an inefficient use of funds.

            In the existing system, Axis I is used to trace clinical disorders in the foremost section of DSM-IV-TR, in addition to other situations that may be a focus of clinical awareness. Axis II is used for reporting personality disorders and mental retardation. A separate axis is included for personality disorders and mental retardation to ensure that they are not overlooked, since Axis I disorders are more evident during an assessment. Axis II can also be utilized to record maladaptive character features and protection methods. Personality features and defense mechanisms are recorded without codes.

Axis III: General Medical Conditions

            Axis III is used to record coexisting physical disorders that may be associated with a mental disorder or may be independent of the mental disorder but related to its treatment. These conditions are classified outside the “Mental Disorders”.

            Universal medical circumstances can be related to mental disorders in a diversity of traditions. Sometimes, it is obvious that the broad medical situation is frankly etiological to the expansion or deterioration of mental indications and that the method for this outcome is physiological. In cases of a mental illness that is diagnosed to be an outright physiological outcome of the overall medical circumstance, a Mental Disorder Due to a General Medical Condition must be identified on Axis I and the overall medical state must be documented on both Axis I and Axis III.

            Such situations in which the etiological correlation involving the universal medical state and the mental signs is inadequately comprehensible to demand an Axis I finding of Mental Disorder Due to a General Medical Condition, the suitable mental illness should be recorded and coded on Axis I; the overall medical state must be only be coded on Axis III.

            In a case where a person has over one clinically pertinent Axis III finding, all must be documented. If no Axis III abnormality is there, this must be designated by the information “Axis III: None.” If an Axis III diagnosis is postponed, in the course of the gathering of supplementary information, this must be designated by the information “Axis III: Deferred.”

Axis IV: Psychosocial and Environmental Problems

            Axis IV is for documenting psychosocial and environmental troubles that may have an effect on the judgment management, and prediction of mental disorders (Axes I and II). Any life events can trigger, worsen, or perpetuate mental disorders. Axis IV encourages clinicians to consider factors that may be critical in the overall management of the patient.

            Typically, the stressors are restricted to those that have occurred in the past year. However, long-standing, chronic, or severe problems that occurred many years in the past that still have an enduring influence are also recorded. Psychosocial and environmental problems that become the primary focus of clinical attention (usually in the absence of another psychiatric diagnosis) are recorded on Axis I.

Axis V: Global Assessment of Functioning

            Axis V allows you to judge how well your patient has been able to function at work, in social relations, and during leisure time. This assessment is doe by using the Global Assessment of Functioning (GAF) to rate your patient’s level of functioning at the time of the evaluation, and you may also want to rate his or her highest level of functioning for at least a few months during the past year.

The patient’s current level of functioning will generally reflect his or her need for treatment, and the highest level of functioning in the past year is likely to have some prognostic significance, because patients often return to their previous levels of functioning after an episode of illness.

            You will want to consult DSM-IV to determine how to evaluate your patients’ situations with respect to psychosocial stressors (Axis IV) and global assessment of functioning (Axis V). In many health care facilities, the use of Axis IV and Axis V is optional.

References:

McDonald, J. J., & Kulick, F. B. (2002). Mental and Emotional Injuries in Employment Litigation (2nd ed.). Washington DC: BNA Books.

Munson, C. E. (2001). The Mental Health Diagnostic Desk Reference: Visual Guides and More for Learning to Use the Diagnostic and Statistical Manual (DSM-IV-TR) (2nd ed.). New York: Haworth Press.

 

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