Mental and Behavioral Disorders Introduction

Three principles are central to assessing mental impairment:

1. Diagnosis is among the factors to be considered in assessing the severity and possible duration of the impairment, but it is by no means the sole criterion.

2. Motivation for improvement may be a key factor in the outcome of impairment.

3. A complete assessment requires a longitudinal history of the impairment, its treatment, and attempts at rehabilitation.

Diagnosis And Impairment The Diagnostic and Statistical Manual of Mental Disorders (3rd. ed., revised in 1987), commonly known as DSM (current edition), is a widely accepted classification system for mental disorders. It is similar to another system, the International Classification of Diseases (lCD), also in widespread use.

The criteria for mental disorders include a wide range of signs, symptoms and impairments. Most mental disorders are characterized by one or more impairments. An individual may have a mental or behavioral impairment, however, without meeting the criteria for one of the mental disorders specified in the DSM (current edition) or the lCD.

DSM (current edition) calls for a multiaxial evaluation. Each of five axes refers to a different class of information. The first three constitute the official diagnostic evaluation, including the clinical syndromes and conditions that are the focus of treatment (Axis I), personality and developmental disorders (Axis II), and physical disorders and conditions that may be relevant to understanding and managing the care of the individual (Axis III). Axis IV (specifying and rating psychosocial stressors) and Axis V (rating adaptive functioning) may be particularly important for assessing severity of impairment.

Specific impairments: The degree of impairment may vary considerably among patients, and the severity of the impairment is not necessarily related to the diagnosis. Indeed, diagnosis alone is of limited relevance to the objective assess ment of psychiatric impairment because it does not permit sufficient insight into the nature of the impairment.