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Published on January 15, 2008

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Using the ICD-10-AM Mental Health Manual A guide to an integrated classification and diagnostic tool for community-based mental health services First Edition - 1 July 2002:  Using the ICD-10-AM Mental Health Manual A guide to an integrated classification and diagnostic tool for community-based mental health services First Edition - 1 July 2002 National Centre for Classification in Health Slide2:  © Copyright Commonwealth of Australia 2002 Published by the National Centre for Classification in Health (Sydney), Faculty of Health Sciences, University of Sydney, NSW 1825 Australia Whilst every reasonable care has been taken to ensure information accuracy within this publication, the National Centre for Classification in Health and its staff make no warranty or guarantee that the information presented here is error-free and will bear no responsibility for the results or consequences for the use of this material. This work is copyright. It may be reproduced in part for study and training purposes subject to the inclusion of an acknowledgment of the source and no commercial usage or resale. Reproduction for other purposes than those stated above requires the written permission of the National Centre for Classification in Health, PO Box 170, Lidcombe NSW 1825 Australia. Acknowledgments:  Acknowledgments For assistance with educational material, the NCCH wishes to thank: Professor Aleksandar Janca - Director, WHO Collaborating Centre and Professor of Psychiatry, University of WA Danny Rock - Acting Deputy Director, Centre for Clinical Research in Neuropsychiatry, WA Kay Bonello - Health Information Manager, Northpark Private Hospital and Lecturer, La Trobe University, VIC Acknowledgments:  Acknowledgments Educational strategy was also influenced by the: Mental Health Manual Working Group Victorian Mental Health Special Interest Group of Health Information Management Association of Australia State and Territory health authorities About NCCH:  About NCCH Australian centre of expertise in health classification theory Creates classifications and standards which uniformly describe diseases, injuries, other health conditions and interventions Developers of ICD-10-AM (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) Funded by Commonwealth Department of Health and Ageing, Australian Institute of Health & Welfare, Australian Bureau of Statistics, Queensland University of Technology Contact us:  Contact us Public submissions for modifications to the Mental Health Manual can be directed to our Classification Support and Development Manager Guidelines for making a public submission can be found on our website Introducing the ICD-10-AM Mental Health Manual:  Introducing the ICD-10-AM Mental Health Manual The ICD-10-AM Mental Health Manual:  The ICD-10-AM Mental Health Manual The ICD-10-AM Mental Health Manual is: a composite diagnostic, classification and assessment tool for use in community-based mental health services a subset of ICD-10-AM Third Edition adapted from World Health Organization mental health publications endorsed by Information Strategy Committee and National Health Information Management Group for National Minimum Data Set - Community Mental Health Care Implementation July 1, 2002 Background:  Background 1998: Victorian Mental Health Coding Special Interest Group of HIMAA identified need for portable ICD-10-AM subset because of coding differences Vic Dept Human Services approached - national potential seen - Commonwealth Dept Health and Aged Care approached for funding Information Strategy Committee concurs with need for simplified ICD-10-AM mental health subset for community sector Background:  DHAC (now Dept of Health & Ageing) contracts NCCH to produce ICD-10-AM subset and training March 2002: Release of Mental Health Manual May 2002: Commencement of education program Background Working Group:  Working Group Psychiatrists Clinical psychologists Nurses Social workers Occupational therapists Health information managers Epidemiologists and researchers (incl. DHA & AIHW) The National Mental Health Information Strategy Committee (ISC) Primary Objective:  Primary Objective To provide a useful diagnostic and ICD-10-AM coding tool for community-based mental health professionals Aims:  Aims Produce an adaptation of the ICD-10 classification acceptable to the Australian community-based mental health services sector Develop a portable, accessible subset of the ICD-10-AM Third Edition Produce a diagnostic and coding tool that will create a common language between acute and community sectors in collecting morbidity data What is clinical coding?:  What is clinical coding? The translation of diseases, injuries, related health problems and procedural concepts from text to alpha/numeric codes Essential to understand characteristics, terminology and conventions of the classification system Facilitates data collection, retrieval and reporting for compilation of statistical information Where do codes go?:  Where do codes go? This morbidity data, along with other establishment and client level data, is submitted by acute and certain non-acute health facilities to their State/Territory health authority and other bodies (eg. cancer registries, perinatal/maternal health collections) State/Territory health authority then submits the data to AIHW, ABS and DHA Refer handout: Flow chart of coded morbidity data Where do codes go?:  Where do codes go? Community mental health sector NMDS - Community Mental Health Establishments establishment-level data comprises bulk of data submitted by this sector NMDS - Community Mental Health Care client-level data ‘Principal diagnosis’ required in ICD-10-AM being extended to increase alignment with acute sector Uses of coded data:  Uses of coded data Research Education Administration Payment of acute health services (DRGs / casemix) Utilisation patterns Evaluation of appropriateness of health care costs Epidemiological studies Quality of health care Health care planning Summary:  Summary The ICD-10-AM Mental Health Manual: a useful composite diagnostic and coding tool for community and other mental health professionals aims to improve the quality and consistency of data between sectors endorsed by ISC and NHIMG for use in recording and coding ‘Principal diagnosis’ for the NMDS - Community Mental Health Care aids establishment of a common language in health vital to electronic health record initiative Structure of the Manual:  Structure of the Manual Overview:  Overview ICD-10-AM provides for a wide variety of signs, symptoms, abnormal findings, complaints and social circumstances, not just diseases and injuries Structured in a manner that facilitates the classification of data recorded under various headings, eg. diagnosis - principal, provisional, working, additional reason for admission or consultation conditions treated Conventions of the Manual:  Conventions of the Manual Inclusion terms (guide to contents) Instructional terms Excludes: (condition is classified elswhere) Use additional code, if desired… (to fully describe cond’n) NOS (not otherwise specified = unspecified/unqualified) …not elsewhere classified (variants elsewhere) ‘AND’ in titles Conventions common to all Chapters Conventions of the Manual:  Conventions of the Manual Point-dash (eg. B90.- = optional specificity) Annotations ( = Australian code) Text boxes black reverse (further 4th char) grey reverse (further 5th char) outline (no further spec) Conventions specific to Chapters One, Two and Three Conventions of the Manual:  Conventions of the Manual Instructional terms Includes: (further defines contents) Note: (explanation/clarification) Conventions specific to Chapter Four Text boxes black reverse = block of interventions (cannot be assigned) Conventions of the Manual:  Conventions of the Manual Structure (main terms bolded, wide indentation) Code numbers Modifiers essential (impact on code, eg. ‘Personality -unstable’) non-essential (bracketed, eg. ‘…-unstable (emotional)’) NEC (not elsewhere classified = non-specific) Conventions to the Index Chapter One: Mental and behavioural disorders:  Chapter One: Mental and behavioural disorders Based on Chapter V of ICD-10-AM Third Edition Codes F00-F99 Provides glossary descriptions and diagnostic guidelines for each disorder Developed using ICD-10 Vol I and ICD-10 classification of mental and behavioural disorders - clinical descriptions and diagnostic guidelines (CDDG) (WHO) Prefaced by complete list of F00-F99 categories Chapter One: Mental and behavioural disorders:  Chapter One: Mental and behavioural disorders Glossary descriptions Provide brief definitions of disorders List inclusion and exclusion terms and conditions Chapter One: Mental and behavioural disorders:  Diagnostic guidelines Provide main and associated clinical features of disorders Indicate the number and balance of symptoms usually required before a confident diagnosis can be made Chapter One: Mental and behavioural disorders Chapter One: Mental and behavioural disorders:  Example: Code and title F44.1 Dissociative fugue Glossary description Dissociative fugue has all the features of dissociative amnesia, plus purposeful travel beyond the usual everyday range. (etc.) Diagnostic guidelines For a definite diagnosis there should be: (a) the features of dissociative amnesia (F44.0); (etc.) Chapter One: Mental and behavioural disorders Slide29:  A list of physical disorders and conditions found in other chapters of ICD-10-AM Third Edition, often associated with mental and behavioural disorders in Chapter One Selected from code range A00-Y98, except F category Based on the Annex of the ICD-10 classification of mental and behavioural disorders - clinical descriptions and diagnostic guidelines (CDDG) (WHO) Chapter Two: Other (medical) conditions Slide30:  For clinicians to record associated diagnoses not inherent in a Chapter One diagnosis Mostly three character level codes Examples: E66.- Obesity (note ‘point-dash’ convention) X45 Accidental poisoning by and exposure to alcohol Four and five character codes for selected diagnoses Examples: B23.0 Acute HIV infection syndrome E10.11 Type 1 diabetes mellitus with ketoacidosis, without coma Chapter Two: Other (medical) conditions Slide31:  Contains selected codes from ICD-10-AM Third Edition, Volume 1, Chapter XXI Factors influencing health status and contact with health services From code range Z00-Z99 Includes brief definitions, based on those in the Multiaxial presentation of the ICD-10 for use in adult psychiatry - Axis Three (WHO) Chapter Three: Contextual factors Slide32:  For clinician to assess and record contextual factors that: contribute significantly to the occurrence, presentation, course, outcome or treatment of the present mental and physical disorders recorded from Chapters One and Two; or are of clear relevance for the clinical care of the present illness episode Chapter Three: Contextual factors Slide33:  Example 1: Z56.2 Threat of job loss Definition: Events or situations which are threatening for the continuation of gainful employment. Chapter Three: Contextual factors Slide34:  Example 2: Z61.3 Events resulting in loss of self-esteem in childhood Definition: Events resulting in a negative self-reappraisal by the child such as failure in tasks with high personal investment; disclosure or discovery of a shameful or stigmatising personal or family event; and other severely humiliating experiences. Chapter Three: Contextual factors Chapter Four: Mental health interventions:  Contains certain codes from ACHI: ICD-10-AM Third Edition, Vol 3, Chapter XIX Non-invasive, cognitive and other interventions, not elsewhere classified Describes diagnostic, therapeutic and client support interventions provided in community-based mental health services Chapter Four: Mental health interventions Chapter Four: Mental health interventions:  Based on the Commonwealth Medicare Benefits Schedule (MBS), plus two-digit extension ( - ## ) Brief definitions for most codes Code numbers provided within ‘blocks’, according to intervention subtype Chapter Four: Mental health interventions Chapter Four: Mental health interventions:  Diagnostic interventions: Assessment, consultation, interview, examination, evaluation Diagnostic tests, measures or investigations - nervous system Therapeutic interventions: Counselling, education Interventions involving assistive or adaptive devices, aids or equipment Nutritional support interventions (cont’d) Chapter Four: Mental health interventions Chapter Four: Mental health interventions:  Chapter Four: Mental health interventions Therapeutic interventions (cont’d) Mental, behavioural or psychosocial therapies, skills training Therapies using agents, not elsewhere classified Immunisation, injections, perfusion Therapeutic interventions - cardiovascular system Other therapeutic interventions Client support interventions: Assistance Other client support interventions Chapter Four: Mental health interventions:  Example 1: THERAPEUTIC INTERVENTIONS - COUNSELLING, EDUCATION Block 1867 - Counselling or education relating to personal care and other activities of daily/independent living 96073-00 Substance addiction counselling or education Note: Counselling and/or education activities in response to substance abuse and associated needs and issues. Includes alcohol and prescribed/self-selected drug abuse as well as illicit drug use. Excludes: preventative counselling or education (96066-00 [1867]) Chapter Four: Mental health interventions Chapter Four: Mental health interventions:  Chapter Four: Mental health interventions Example 2: THERAPEUTIC INTERVENTIONS - MENTAL, BEHAVIOURAL OR PSYCHOSOCIAL THERAPIES, SKILLS TRAINING Block 1873 - Psychological/psychosocial therapies 96001-00 Psychological skills training Skills training in: • activity scheduling • anger management • (etc.) Excludes: interpersonal psychotherapy (96177-00 [1873]) that as a technique of: behaviour therapy (96176-00 [1873]) cognitive behaviour therapy (96101-00 [1873]) psychodynamic therapy (96100-00 [1873]) Appendix One: WHO Short Disability Assessment Schedule (WHO DAS-S):  Appendix One: WHO Short Disability Assessment Schedule (WHO DAS-S) WHO DAS-S = short version of the WHO Disability Assessment Schedule (WHO DAS) Based on principles in the International Classification of Impairments, Disabilities and Handicaps (ICIDH) Intended for clinician’s assessment of disabilities caused by mental and physical disorders (rates 4 areas of functioning) User guidelines provided Appendix Two: ICD-10-AM Symptom Checklist for Mental Disorders:  Appendix Two: ICD-10-AM Symptom Checklist for Mental Disorders Intended for clinician’s assessment of selected psychiatric symptoms and syndromes in categories F00-F69 of Chapter One An adaptation of WHO ICD-10 Symptom Checklist for Mental Disorders v1.1 Consists of face sheet, screener and four modules representing categories F00-F69 User guidelines provided Appendix Three: ICD-10-AM Multiaxial Diagnostic Formulation Form:  The ICD-10-AM adaptation of ICD-10 Multiaxial Diagnostic Formulation Form, from WHO’s Multiaxial presentation of the ICD-10 for use in adult psychiatry A comprehensive and multiaspect diagnostic procedure intended to provide biopsychosocial portrayal of patient’s clinical condition One administrative section and three clinical axes (structured specifically for use with the Manual) User guidelines provided Appendix Three: ICD-10-AM Multiaxial Diagnostic Formulation Form Appendices One to Three:  Appendices One to Three Copies of forms for these assessment tools are available to download from the NCCH website Coding in ICD-10-AM:  Coding in ICD-10-AM Basic coding steps:  Basic coding steps 1. Identify the type of statement to be coded and refer to the index 2. Locate the lead term 3. Read and be guided by any note that appears under the lead term Basic coding steps:  4. Read any terms enclosed in parentheses after the lead term (non-essential modifiers), as well as any terms indented under the lead term (essential modifiers), until all the words in the clinical expression have been accounted for 5. Follow carefully any cross-references (‘see’ and ‘see also’) found in the index Basic coding steps Basic coding steps:  6. Refer to the tabular list of the relevant Chapter to verify the suitability of the code number selected 7. Be guided by any inclusion or exclusion notes under the selected code or under the chapter, block or category heading 8. Assign the code Basic coding steps Clinical Application of the Manual:  Clinical Application of the Manual Diagnostic and recording principles specific to the Manual: Chapter One (Mental and behavioural disorders):  Record as many Chapter One diagnoses as are necessary to describe the clinical picture Give one precedence over the others by specifying it as the principal diagnosis 1. Recording multiple diagnoses from Chapter One Diagnostic and recording principles specific to the Manual: Chapter One (Mental and behavioural disorders) Diagnostic and recording principles specific to the Manual: Chapter One:  ‘Disorder’ used rather than ‘disease’ or ‘illness’ implies the existence of a clinically recognisable set of symptoms or behaviour associated in most cases with personal distress and interference with social functioning Diagnostic and recording principles specific to the Manual: Chapter One 2. Terminology issues Diagnostic and recording principles specific to the Manual: Chapter One:  Terminology issues (cont’d) ‘Organic’ means that the syndrome so classified can be attributed to an independently diagnosable cerebral or systemic disease or disorder does not imply that conditions elsewhere classified are ‘non-organic’, ie. have no cerebral substrate Diagnostic and recording principles specific to the Manual: Chapter One Diagnostic and recording principles specific to the Manual: Chapter One:  Terminology issues (cont’d) ‘Impairment’, ‘disability’ and ‘handicap’ Used according to the International classification of impairments, disabilities and handicaps (ICIDH) Being revised by WHO in line with International Classification of Functioning, Disability and Health (ICF) Diagnostic and recording principles specific to the Manual: Chapter One Diagnostic and recording principles specific to the Manual: Chapter One:  Terminology issues (cont’d) Impairment: reduction or loss of a normal physical or psychological function Disability: interference (reduction or loss) with performance of purposeful activities due to impaired functional capacity Handicap: social and environmental consequences of having impairment and disability (social disadvantage) Organ Person Social Level Diagnostic and recording principles specific to the Manual: Chapter One Diagnostic and recording principles specific to the Manual: Chapter One:  It is a principle of ICD-10 that there should not be different classifications for different age groups Child and adolescent mental and behavioural disorders cover only those disorders that are specific for childhood and adolescence and are included in two diagnostic category sections of ICD-10-AM Diagnostic and recording principles specific to the Manual: Chapter One 3. Children and adolescents Diagnostic and recording principles specific to the Manual: Chapter One:  Children and adolescents (cont’d) These diagnostic category sections are: F80-F89 Disorders of psychological development F90-98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence Diagnostic and recording principles specific to the Manual: Chapter One Diagnostic and recording principles specific to the Manual: Chapter One:  Children and adolescents (cont’d) A number of disorders placed in other ‘F’ categories can occur in persons of almost any age, and should be used for children and adolescents when required Examples: F50 Eating disorders F51 Nonorganic sleeping disorders F64 Gender identity disorders Diagnostic and recording principles specific to the Manual: Chapter One Diagnostic and recording principles specific to the Manual: Chapter One:  Chapter One diagnostic categories classified according to phenomenology, with no assumption of aetiology However, some exceptions to this principle: F00-F09 Organic, including symptomatic, mental disorders F43 Reaction to severe stress, and adjustment disorders Diagnostic and recording principles specific to the Manual: Chapter One 4. Aetiology Diagnostic and recording principles specific to the Manual: Chapter Two (Other [medical] conditions):  Conditions other than mental or behavioural disorders should be recorded only if present with Chapter One diagnosis Examples: G40 Epilepsy K70.- Alcoholic liver disease Diagnostic and recording principles specific to the Manual: Chapter Two (Other [medical] conditions) Diagnostic and recording principles specific to the Manual: Chapter Two:  Record as many conditions as relevant, in order of severity and influence on Chapter One diagnosis Time frame of other (medical) conditions: depends on clinical judgement if judged relevant to present illness, record them - irrespective of time of appearance Diagnostic and recording principles specific to the Manual: Chapter Two Diagnostic and recording principles specific to the Manual: Chapter Two:  Signs and symptoms fulfilling the criteria of a Chapter One disorder should not be coded in Chapter Two, as these signs or symptoms are inherent in the Chapter One diagnosis Example: R45.81 Suicidal ideation Excludes: suicidal ideation constituting part of a mental disorder (F00-F99) Diagnostic and recording principles specific to the Manual: Chapter Two Diagnostic and recording principles specific to the Manual: Chapter Three (Contextual factors):  Environmental, psychosocial and lifestyle factors and situations Record contextual factor(s) only if: of such severity and duration that it has significantly influenced present condition; or relevant to clinical care of present illness Diagnostic and recording principles specific to the Manual: Chapter Three (Contextual factors) Diagnostic and recording principles specific to the Manual: Chapter Three:  Record as many contextual factors as relevant, in order of severity and influence on present Chapter one diagnosis Time frame of contextual factors: depends on clinical judgement if judged relevant to present illness, record as present - irrespective of time of appearance also record factors of a lasting nature if important to current condition Diagnostic and recording principles specific to the Manual: Chapter Three Diagnostic and recording principles specific to the Manual: Chapter Three:  Contextual factors fulfilling the criteria of a Chapter One disorder should not be coded in Chapter Three, as these factors are inherent in the Chapter One diagnosis Diagnostic and recording principles specific to the Manual: Chapter Three Example: Contextual factor Z72.1 Alcohol use (Chapter Three) should be coded as F10.1 Harmful use (Chapter One), if the patient fulfils criteria for the latter Diagnostic and recording principles specific to the Manual: Chapter Four (Mental health interventions):  Diagnostic, therapeutic and client support interventions involved in direct care to client/patient Record as many Chapter Four interventions as necessary to cover all procedures involved in process of care Diagnostic and recording principles specific to the Manual: Chapter Four (Mental health interventions) Diagnostic and recording principles specific to the Manual: Chapter Four:  Give consideration to selecting a code that captures the ‘intent’ of the intervention, rather than assigning codes for each individual component of an intervention Diagnostic and recording principles specific to the Manual: Chapter Four Example: 96095-00 [1871] Therapeutic diet support (includes assessment or review of client’s progress - additional assessment code not required) Diagnostic criteria:  Diagnostic criteria Inclusion criteria list of symptoms, signs and other diagnostic features necessary to be present for a positive diagnosis specification of the required number of symptoms and signs and sometimes of their clustering, onset, recency, frequency and duration Diagnostic criteria:  Diagnostic criteria Inclusion criteria (cont’d) Example: F51 Nonorganic sleep disorders The following are essential clinical features for a definite diagnosis: - the complaint is either of difficulty falling asleep or maintaining sleep, or of poor quality of sleep; - the sleep disturbance has occurred at least three times per week for at least 1 month; (etc.) Diagnostic criteria:  Diagnostic criteria Exclusion criteria list of diagnostic features and requirements that should not be present if a particular diagnosis is to be made Example: - the disorder does not meet criteria (b), (c) and (d) for acute polymorphic psychotic disorder (F23.0) - the total duration of the disorder does not exceed 1 month Assessment tools WHO Short Disability Assessment Schedule (WHO DAS-S):  An instrument for recording clinician’s assessment of disabilities caused by mental and physical disorders Assessment tools WHO Short Disability Assessment Schedule (WHO DAS-S) Assessment tools: WHO DAS-S:  WHO DAS-S is a disability rating schedule Base ratings on information obtained from: patient key informants (eg. family members) case notes and other written records patient observation Assessment tools: WHO DAS-S User guidelines Assessment tools: WHO DAS-S:  Assessment tools: WHO DAS-S User guidelines (cont’d) Ask appropriate questions in order to assess related disabilities Refer to guiding questions In rating, take into account both severity and duration of disability: severe but brief ) rate at less severe but of longer duration ) same level Assessment tools: WHO DAS-S:  Assessment tools: WHO DAS-S User guidelines (cont’d) Evaluate disability against person of: presumed ‘average’ or ‘normal’ functioning same sex comparable age comparable sociocultural background Assessment tools: WHO DAS-S:  Administration steps 1. Determine rating period (section 1) Before assessment, decide on time period of rating: current last month last year other (specify) Assessment tools: WHO DAS-S Assessment tools: WHO DAS-S:  2. Assess disability (section 2) Assess and rate disability in the following areas of functioning: A. Personal care B. Occupation C. Family and household D. Broader social context Assessment tools: WHO DAS-S Steps (cont’d) Assessment tools: WHO DAS-S:  A. Personal care activity guided by social norms and conventions refers to personal hygiene, dressing, feeding, etc. when rating, consider patient’s: maintenance of personal hygiene/health eating habits maintenance of personal belongings and living space Assessment tools: WHO DAS-S Steps: 2. Assess disability (cont’d) Assessment tools: WHO DAS-S:  B. Occupation expected functioning in paid activities, studying, homemaking, etc. when rating, consider patient’s: conformity quality of performance motivation Assessment tools: WHO DAS-S Steps: 2. Assess disability (cont’d) Assessment tools: WHO DAS-S:  C. Family and household participation in: family life (marital and parental roles) household activities when rating, apply specific sociocultural context Assessment tools: WHO DAS-S Steps: 2. Assess disability (cont’d) Assessment tools: WHO DAS-S:  For marital role: consider patient’s: communication with spouse ability to show affection and concern spouse’s perception of patient as support source determine severity of dysfunction, considering if: reduced communication between patient and spouse reduced mutual affection and support threat to viability of marriage, etc. Assessment tools: WHO DAS-S Steps: 2. Assess disability - C. Family and household (cont’d) Assessment tools: WHO DAS-S:  Assessment tools: WHO DAS-S For parental role: consider: basic tasks and activities undertaken to ensure health and security of children closeness of relationship, depth of affection and interest shown in children’s well-being and future any abuse of parental role or possibility of adverse effects Steps: 2. Assess disability - C. Family and household (cont’d) Assessment tools: WHO DAS-S:  Assessment tools: WHO DAS-S determine severity of dysfunction, considering patient’s: performance in childcare-related tasks involvement in upbringing and childrens’ lives competence in approaching and relating to their children Steps: 2. Assess disability - C. Family and household - parental role (cont’d) Assessment tools: WHO DAS-S:  Assessment tools: WHO DAS-S For participation in household activities: consider patient’s: functions and duties in maintaining family as viable social group manner in which his/her family roles carried out (e.g. spouse, father, etc.) Steps: 2. Assess disability - C. Family and household (cont’d) Assessment tools: WHO DAS-S:  D. Functioning in a broader social context expected performance of patient in relation to: community members participation in leisure participation in other social activities Assessment tools: WHO DAS-S Steps: 2. Assess disability (cont’d) Assessment tools: WHO DAS-S:  outside household, consider patient’s: adaptation to others interaction with people response to questions, requests, demands manner with those disliked quality and amount of contact with friends/others engagement in outside leisure activities Assessment tools: WHO DAS-S Steps: 2. Assess disability - D. Functioning in a broader social context (cont’d) Assessment tools: WHO DAS-S:  determine severity of dysfunction, considering evidence of: lack of cooperation in social situations adverse consequences for social functioning (i.e. restricted social integration) Assessment tools: WHO DAS-S Steps: 2. Assess disability - D. Functioning in a broader social context (cont’d) Assessment tools: WHO DAS-S:  For each area of functioning, rate disability: 0 = no disability at any time 1 = deviation from norms (one or more expected tasks) 2 = deviation from norms (conspicuous): slightly disabled most of the time or moderately disabled some of the time 3 = deviation from norms (most tasks) 4 = deviation from norms (all tasks) 5 = severely disabled all the time Assessment tools: WHO DAS-S Steps: 2. Assess disability (cont’d) Assessment tools: WHO DAS-S:  If in doubt, select the lower numeric If patient performed because supported: rate actual disability level tick ‘functioning with assistance’ box Assessment tools: WHO DAS-S Steps: 2. Assess disability (cont’d) Assessment tools: WHO DAS-S:  Less than one year One year or more Unknown Assessment tools: WHO DAS-S Steps (cont’d) 3. Note duration of disability (section 3) Assessment tools: WHO DAS-S:  Abilities which are important for: management planning rehabilitation process Such assets may be: skilful handling of a musical instrument particularly good looks physical strength ease in social situations Assessment tools: WHO DAS-S Steps (cont’d) 4. Note specific abilities (section 4) Assessment tools ICD-10-AM Symptom Checklist for Mental Disorders:  Assessment tools ICD-10-AM Symptom Checklist for Mental Disorders A semi-structured instrument for clinician’s assessment of psychiatric symptoms and syndromes in categories F00-F69 of Chapter One Assessment tools: Symptom Checklist:  Be familiar with diagnostic guidelines in Chapter One Instrument consists of: face sheet screener four modules representing categories: F00-F19 Organic mental and psychoactive substance use syndromes F20-F39 Psychotic and affective disorders F40-F59 Neurotic and behavioural disorders F60-F69 Personality disorders Assessment tools: Symptom Checklist User guidelines Assessment tools: Symptom Checklist:  Face sheet: Administrative items - institutional and patient Principal and additional ICD-10-AM diagnoses from ‘F’ category Diagnostic confidence (high, moderate, low) Clinician’s notes Assessment tools: Symptom Checklist User guidelines (cont’d) Assessment tools: Symptom Checklist:  Screener: Tick symptoms and thus be guided to relevant module for diagnosis Sections: Psychiatric case identification Organic mental and psychoactive substance use syndromes (directs user to F00-F19 module) Psychotic and affective syndromes (to F20-F39) Neurotic and behavioural syndromes (to F40-F59) Personality disorders (to F60-F69) Assessment tools: Symptom Checklist User guidelines (cont’d) Assessment tools: Symptom Checklist:  Modules: Each consists of symptom list Accompanied by instructions to help user consider other possible syndromes or modules in checklist Can also record for syndromes the onset, severity, duration and no. of episodes List of states which should be excluded or could be associated with the syndrome Assessment tools: Symptom Checklist User guidelines (cont’d) Assessment tools: Symptom Checklist:  (Screener) 1. Check positive symptoms listed in the Screener (mark with tick or cross) 2. Be guided to relevant Module Assessment tools: Symptom Checklist Administration steps Assessment tools: Symptom Checklist:  (Modules) 3. Use only those Modules for which the patient is screened positive 4. Check positive symptoms in the Modules used (mark with tick or cross) Assessment tools: Symptom Checklist Steps (cont’d) Assessment tools: Symptom Checklist:  5. For duration of syndrome and number of episodes, enter appropriate number in the box (eg. 03) 6. Consider differential diagnoses or syndromes as instructed in the Modules. If necessary, refer to other Modules Assessment tools: Symptom Checklist Steps: Modules (cont’d) Assessment tools: Symptom Checklist:  (Face Sheet) 7. Record/code positive diagnoses on the Face Sheet using ‘F’ code categories (eg. F41.0) Where indicated by a ‘dash’, eg. F1-.1 or F50.-, users should refer to the appropriate category in Chapter One of the Manual to obtain the third or fourth character Assessment tools: Symptom Checklist Steps (cont’d) Assessment tools: Symptom Checklist:  8. Record diagnostic confidence (high, moderate or low) on the Face Sheet 9. Record any relevant clinical notes on the Face Sheet Assessment tools: Symptom Checklist Steps: Face Sheet (cont’d) Assessment tools The ICD-10 Multiaxial Diagnostic Formulation Form - adapted for ICD-10-AM Mental Health Manual:  Assessment tools The ICD-10 Multiaxial Diagnostic Formulation Form - adapted for ICD-10-AM Mental Health Manual A comprehensive diagnostic procedure intended to provide a biopsychosocial portrayal of the patient’s clinical condition Assessment tools: Multiaxial Diagnostic Formulation Form:  One administrative section Three clinical axes: Axis 1 Clinical diagnoses Axis 2 Disabilities: A. Personal Care C. Family and household B. Occupation D. Broader social context Axis 3 Contextual factors Assessment tools: Multiaxial Diagnostic Formulation Form User guidelines Assessment tools: Multiaxial Diagnostic Formulation Form:  Axis 1 - Clinical diagnoses (from Chapters 1 & 2) For listing positive ICD-10-AM diagnoses of mental and physical disorders and conditions Axis 2 - Disabilities (from Appendix 1) For transferring ‘disability’ ratings 0-5 made in the WHO DAS-S Axis 3 - Contextual factors (from Chapter 3) For listing ICD-10-AM contextual ‘Z’ codes Assessment tools: Multiaxial Diagnostic Formulation Form User guidelines (cont’d) Assessment tools: Multiaxial Diagnostic Formulation Form:  Base evaluation and multiaxial formulation on all available information: results of the clinical examination (psychiatric and physical) data obtained from relatives and other informants review of medical records, laboratory/other diagnostic tests results of psychological testing social worker reports and data from other sources such as school or work reports Assessment tools: Multiaxial Diagnostic Formulation Form User guidelines (cont’d) Assessment tools: Multiaxial Diagnostic Formulation Form:  1. Prior to administration, decide on assessment period and indicate on form: current last month last year other (specify) 2. Complete other administrative items, eg. enter ID code, age, etc. Assessment tools: Multiaxial Diagnostic Formulation Form Administration steps Assessment tools: Multiaxial Diagnostic Formulation Form:  3. In Axis 1, list all positive ICD-10-AM diagnoses (as many as required), from Chapters One and Two: Mental (including personality) and behavioural conditions - Chapter One Physical disorders / conditions - Chapter Two (if condition not found, refer complete ICD-10-AM) Assessment tools: Multiaxial Diagnostic Formulation Form Steps (cont’d) Assessment tools: Multiaxial Diagnostic Formulation Form:  4. In Axis 2, transfer the following from WHO DAS-S: disability ratings (0-5) in specific areas of functioning (A-D) all appropriate areas A-D in which the patient functions with assistance specific abilities 5. In Axis 3, list all contextual factors from Chapter Three (‘Z’ codes) Assessment tools: Multiaxial Diagnostic Formulation Form Steps (cont’d)

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