Diagnostic Issues

Older classifications of psychiatric disorder divided diseases into 'psychoses' and 'neuroses'. The term 'psychosis' is still widely used to describe a severe mental illness with the presence of hallucinations, delusions or extreme abnormalities of behaviour including marked overactivity, retardation and catatonia, usually accompanied by a lack of insight. Psychotic disorders therefore include schizophrenia, severe forms of depression and mania. Psychosis may also be due to illicit substances or organic conditions. Clinical features of schizophrenia may be subdivided into 'positive symptoms', which include hallucinations, delusions and thought disorder and 'negative symptoms' such as apathy, flattening of affect and poverty of speech.

Disorders that would formerly have been grouped under 'neuroses' include depression in the absence of psychotic symptoms, anxiety disorders (e.g. panic disorder, generalised anxiety disorder, obsessive-compulsive disorder, phobias and post-traumatic stress disorder), eating disorders (e.g. anorexia nervosa and bulimia nervosa) and sleep disorders.

Also falling within the scope of modern psychiatric diagnostic systems are organic mental disorders (e.g. dementia in Alzheimer's disease), disorders due to substance misuse (e.g. alcohol and opiate dependence—see Chapter 10), personality disorders, disorders of childhood and adolescence (e.g. attention deficit/hyperactivity disorder, Tourette's syndrome) and mental retardation (learning disabilities).

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