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