In the recent National Mental Health and Well Being report published by the Ministry of Health (Singapore) in 2023, there has been a decline in the state of Mental Wellness among Singaporeans, from 13.4% with some condition in 2020 to 17% in 2022, with youths aged 18 to 29 being the hardest hit.

What exactly constitutes a mental illness, and how do psychiatrists diagnose patients? Although the concept of mental disorder lacks a consistent operational definition that covers all situations, this handbook has managed to classify mental illness based on criteria sets with defining features.

The bulk of this handbook focuses on clinical disorders such as mood, anxiety, sleep, substance-related and psychotic disorders, which could be of interest to both caregivers and healthcare providers, and not just medical students.

Book material worth noting include (i) Decision trees for differential diagnosis (Appendix A), which aid the clinician in understanding the organization structure of DSM-IV classification and (ii) A glossary of technical terms (Appendix C) for reference by lay readers.

I would recommend this valuable handbook to students keen to learn more about the diagnosis of mental disorders, as well as caregivers who wish to gain additional insight into their loved one’s condition. ( )

Biblio Raquel

De vijfde editie van het Amerikaanse handboek voor diagnose en statistiek van psychische stoornissen, DSM, is het resultaat van de bevindingen van een werkgroep die in 2007 een aantal nieuwe classificaties naar voren schoof. Zo horen de schrapping van het aspergersyndroom als aparte classificatie, de invoering van de gokstoornis als nieuwe classificatie en het wegvallen van de exclusie van het rouwproces bij een depressieve periode bij de meest in het oog springende vernieuwingen. Verder zijn het aantal subtypeclassificaties voor verscheidene vormen van schizofrenie afgenomen, werden bepaalde benamingen herzien (genderidentiteitsstoornis wordt genderdysforie) en werd er geopteerd voor een classificatie waarbij symptoomgroepen worden onderverdeeld naargelang de categorie of de stoornis waartoe die behoren. ( )

DSM-IV introduced new diagnoses and a better research base than DSM-III-R. ( )

Most, I'm sure, wouldn't consider reading the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) for pleasure, and I think that's a shame. Because even though the DSM-IV is used primarily in a clincal setting by highly skilled psychiatric professionals for the differential-diagnosing and treatment of mankind's complex plethora of psychopathologies both common and arcane and every run-of-the-mill disorder inbetween, I opine that the DSM-IV, even though it reads as dry as the Sahara Desert of southern Algeria/northern Mauritania, if not in fact drier, nevertheless can be as wildly entertaining an alternative to playing charades or Pictionary at your next dinner or business office party. I recommend taking turns with your co-workers flipping through the DSM-IVs voluminous pages, so that you can self-diagnose one another's leanings -- or predispositions -- toward hundreds of interesting (though dire) mental maladies.

"I think Susie over in HR has a delusional disorder, erotomanic type, coded 297.1, what do you think, Sam?"

"I do not! I heard that. What's the psychiatric code for 'creep', John, because clearly you have a creep disorder!*"

Get the idea? Try it out with friends and family too, or ... on yourself!

However, before one would would ever want to engage in DSM-IV play for fun, one should first have a very clear handle on it's appropriate uses in a professional, and preferably clinical, objective, non-politically intrusive, purely academic, empirically based -- psychiatric -- setting.

The DSM-IV is organized along its five axes. Each axis corresponds to specific subsets of clinical disorders and their diagnostic (and differential-diagnostic) criteria, etiology, behavorial profile of one afflicted with whatever disorder, treatment options, etc. Also, every specific disorder has its own specific code, just like there's specific police codes for every kind of crime or violation.

So, suppose you suffered from "Neuroleptic-Induced Tardive Dyskinesia," you'd be coded 333.82 on all the paperwork which would then hopefully help convince the loophole loving insurance companies to pay your mental health practitioner so you could keep on receiving treatment without paying out of pocket and get better soon.

Axis I of the DSM-IV focuses on "Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention." Simply put, these are the psychopathological (love that word, "psychopathological") biggys: Major Depression, Bipolar Disorder, Schizophrenia, Anxiety Disorder NOS (Not Otherwise Specified), etc.

Axis II is my favorite axis; it covers the Personality Disorders. If people aren't seeking out a therapist for their depression or anxiety, it will undoubtedly be, according to the APA (American Psychiatric Association, which publishes the DSM-IV) for their maladaptive personality types, which can wreak havoc on all levels of their involvement in the social spectrum, most notably, of course, in marriages and in the workplace and at school. There are only eleven Personality Disorders. Let's list each and every one of them, along with their corresponding codes.

1. Paranoid Personality Disorder (301.0). Self explanatory.

2. Schizoid Personality Disorderr (301.20). The loner.

3. Schizotypal Personality Disorder (301.22). People who act bizarre, do bizzare stuff, but don't hear voices and whose symptomatology presents with no clear-cut psychosis. Ergo, they don't make the all out schizophrenia cut.

4. Antisocial Personality Disorder (301.7). Every sociopath who's every lived; every serial killer also, has had this type of PD. It's the primary personality type of most criminals.

5. Borderline Personality Disorder (301.83). These are your stalkers and your "cutters". The teenage girl in White Oleander was on her way to becoming Borderline. Borderlines are miserable, and they're adept at sharing their misery, whether you like sharing it with them or not.

6. Histrionic Personality Disorder (301.50). Think Liza Minelli, Liberace, or any of The Real Housewives of Orange County.

7. Narcissistic Personality Disorder (301.81). I'd argue a lot of actors have this PD. Some doctors or some brain surgeons. It's the God-complex PD of PDs, for those who deem themselves all-powerful, able to control any outcome; they are the center of theirs (and they think, our) universes.

8. Avoidant Personality Disorder (301.82). Closely related to social phobia. Anxiety driven PD. Differentiated from Schizoid PD by concern. Avoidants care about and want to connect with other people, but are shy and inhibited from doing so, while Schizoids, frankly, couldn't give a shit whether they connect with people or not.

9. Dependent Personality Disorder (301.6). If you're 37 and have never left your parent's nest, you probably have Dependent PD. Or the classic spousal abuse scenario in which the person abused refuses to leave her abuser even though she knows down deep she should.

10. Obsessive-Compulsive Personality Disorder (301.4). All too common. Hard to overcome, as they all are. Think Woody Allen. Remember Jack Nicholson in As Good as it Gets?

11. Personality Disorder NOS (301.9).

Axis III covers General Medical Conditions. Perhaps you've got a physical ailment - migraines, say - which negatively affects your mood. Or you suffer from diabetes which can also affect your mood. Any medical conditions that cause psychological problems or contribute to them would be specified on this axis.

Axis IV pertains to Psychosocial and Environmental Problems. Perhaps the most subjective axis for the diagnostician to determine, since they must trust what the patient is telling them; that is, how the patient perceives themselves getting along in the world: in their marriage, relationships, job, education, etc. Are there any outside factors like a flood, say, or a fire resulting in the loss of their home, negatively contributing to their psychological profile?

Axis V: Global Assessment of Functioning. This is where a good clinician can wrap up all the diagnostic criteria and observations and tie a pretty (or not so pretty) bow on the patients overrall psychology, good or bad. There's a GAF scale the clinician uses, as well, to track a patient's progress and provide a numeric figure for a pretty nebulous construct: how well is the patient operating in all the psychologically and behaviorally pertinent areas of their life under inspection?

So that's the DSM-IV (soon to be the DSM-V) in a nutshell.

* searching the literature, I could find no mention of "creep disorder". Creeps, I'd wager (w/out any longitudinal data to support such a hypothesis, of course) are generally your garden variety sufferers of -- and victimizers as a result of -- their narcissistic or antisocial personality disorders. ( )