Psychiatric Diagnosis and Classification - ResearchGate

MULTIAXIAL DIAGNOSIS IN PSYCHIATRY 169
The multiaxial schema of the Third Cuban Glossary of Psychiatry includes
six axes: Axis IÐClinical disorders; Axis IIÐDisabilities; Axis IIIÐAdverse
environmental and personal factors; Axis IVÐOther environmental and
personal factors; Axis VÐMaladaptive mechanisms; Axis VIÐOther significant
information tests, therapeutic response).
Attempts are under way to evaluate the usefulness of this schema for
clinical care.
REVIEW OF THE USE OF MULTIAXIAL DIAGNOSIS: ITS
VALUE ANDLIMITATIONS
Critical Review of the Literature on Clinical Care, Training,
Research and Administration
When considering the use of a multiaxial approach in daily clinical practice,
the time required for routine use is crucial for its applicability on the
international scene, where there is often a shortage of adequate mental
health services. This concern is particularly pertinent in non-industrialized
areas, where professionals frequently work in primary care settings under
constraints of both limited personnel and resources. To ensure its successful
application, we are faced with the problem of having to strike the right
balance between the wish for richness of information, comprehensiveness of
disease description, simplicity and a manageable system [16].
Despite international surveys reporting that the multiaxial approach is
helpful as well as useful, the use of such systems has not been without
problems. Actual use in daily clinical practice can be seen as a good test for
its value as a professional instrument and here it has to be recognized that
daily use by clinicians of the ``non-nosological'' axes has been limited,
despite an expressed interest in them by the very same clinicians. The
particular value in clinical settings has primarily been linked to the elucidation
of complex clinical cases, and experiences have paid particular attention
to the perceived use in daily clinical practice of the various multiaxial
schemas [12, 31, 32].
With an increasing focus on the management of clinical care, cost reduction
and efficiency of services, a multivariate approach [33] that provides a systematic
scrutiny of clinical information may become increasingly demanded
as a means to understand and predict service utilization and cost.
The transformation of psychiatric services, with its reduction in the
number of psychiatric beds and the increasing emphasis on community
care, has led to careful consideration and need for identification of those
groups that either require special attention or are heavy users of mental