False: Karl Jaspers (1883–1969) is associated with descriptive psychopathology. He took a systemized approach to phenomenology and psychopathology. He described his approach to nosology as empirical, descriptive and free from theoretical explanations (Sadock & Sadock 2002, p. 275).

False: They are not operationally defined. They are a list of symptoms with no specific rules of application to make a diagnosis (Gelder et al 2006, p. 273; Johnstone et al 2004, p. 247).

False: Eysenck & Eysenck proposed a dimensional classification of personality. The dimensions are introversion–extroversion, neuroticism and psychoticism. Dimensional classification does not use discrete entities and instead assigns a position along one or more axes. It is a more flexible approach. It is often used in psychology (Gelder et al 2006, p. 28; Johnstone et al 2004, pp. 111, 254).

True: Kraepelin described six mixed affective states based on the level of mood, psychic activity and motor activity:

False: Categorical classification often implies a hierarchical use of diagnoses. The principle of co-morbidity avoids hierarchy by lending equal weight to the diagnoses (Gelder et al 2000, p. 111).

False: Categorical (Gelder et al 2006, p. 28).

True: An adequate classification should include separate and mutually exclusive categories and be wholly exhaustive. However, many psychiatric disorders do not neatly fall within the boundaries of one category and there is some overlap (Gelder et al 2006, p. 21; Johnstone et al 2004, p. 254).

False: An adequate classification should be valid, reliable, mutually exclusive and wholly exhaustive. It can be dimensional (rejects use of separate categories) or categorical (uses discrete groups). Each approach has advantages and disadvantages (Gelder et al 2006, p. 21; Johnstone et al 2004, p. 254).

True: Removing aetiology from definitions of psychiatric disorders improves diagnostic reliability, but impoverishes the diagnoses by removing information which would have explained why the patient fell ill at that particular time with that particular symptom. Multiaxial systems allow assessments on several axes, each of which refers to a different domain of information. They promote consideration of all relevant aspects of clinical situations and help plan treatment and predict outcome (DSM-IV 1994, p. 25; Gelder et al 2000, p. 112; Gelder et al 2006, p. 28; Stein & Wilkinson 1998, p. 1246).

False: Syndromal classification is based predominantly on groups of symptoms and signs that together make up a recognizable condition, e.g. schizophrenia and myxoedema. Classification may also be based on alternatives such as aetiology, e.g. delirium tremens and hypothyroidism, or pathophysiology, e.g. cancer, response to treatment or prognosis (Johnstone et al 2004, p. 244; Sadock & Sadock 2002, p. 275).

True: There are three ways to improve reliability:

True: The term ‘disorder’ in ICD-10 refers to ‘the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions’. ICD-10 acknowledges that disorder is not an exact term but is used throughout as defined above (ICD-10 1992, p. 5).

True: Disability is any restriction or lack (resulting from an impairment) of ability to perform an activity in a manner or within the range considered normal for a human being. It is now also called activity limitation (World Health Organisation 2001).

True: There are different versions of ICD-10 for different purposes. These include clinical descriptions and diagnostic guidelines, diagnostic criteria for research, a primary care version, and a multiaspect (axial) version. In the multiaxial version, Axis I covers psychiatric disorders (F1-5), personality disorders (F6) and mental retardation (F7). Axis II is for disability. Axis III covers psychosocial and other problems (Gelder et al 2000, p. 112; Gelder et al 2006, pp. 28, 32).

True: Caseness refers to the way in which the presence of disease is operationalized for the purpose of definition and identification in epidemiological research. However, the extent to which caseness is synonymous with disease will depend on the validity of the instrument used. With instruments with high presumptive validity (e.g. the DSM and the NINCDS-ADRDA), caseness and disease are truly synonymous because there is little further clarification possible from a clinical perspective. With instruments used for screening (e.g. the GHQ or the MDQ), sensitivity is usually high and positive predictive value is usually low; in consequence, caseness is not synonymous with disease, and cases screened positive require to be further interviewed or tested for disease. In contemporary epidemiological research, quality standards demand that instruments of high validity are used; as a result, caseness tends to be correctly identified with disease (Gelder et al 2000, p. 1527; Wright et al 2005, p. 117).

True: According to ICD-10, the IQ ranges are 50–69 for mild learning disability, 35–49 for moderate learning disability, 20–34 for severe learning disability and below 20 for profound learning disability. Thus, 49/50 is the cut-off between mild (F70) and moderate learning disability (F71) (ICD-10 1992).

True: Neurasthenia (F48.0) is classified under ‘Other neurotic disorders’ (F48) and includes fatigue syndrome.

True: Emotionally unstable personality disorder Impulsive subtype (ICD-10 1992, F60.30) includes the categories of explosive and aggressive personality types. Explosive personality disorder was originally described in ICD-9.

False: The ICD-10 classification of mental and behavioural disorders is just Chapter V (F) of the tenth revision of the International Classification of Diseases and Related Health Problems (Gelder et al 2000, p. 111; Johnstone et al 2004, p. 250).

True: Operational definitions are rules of application, i.e. specific criteria that must be met before a diagnosis can be made. They act as diagnostic aids specifying the appropriate diagnosis for every possible combination of symptoms. Operationalized diagnoses are reached by considering characteristic and discriminatory symptoms, their hierarchy and inclusion and exclusion statements. Most categories in ICD-10 have flexible diagnostic guidelines for everyday use and strict diagnostic criteria for research, which uses specific operational criteria in a very similar style to DSM-IV (Gelder et al 2000, p. 111; Gelder et al 2006, p. 31; Johnstone et al 2004, p. 247).

False: The term ‘hysteria’ is not used in the title for any mental disorder in ICD-10. The ICD-10 recommends avoiding the term ‘hysteria’ as far as possible in view of its many and varied meanings. However, hysteria, conversion hysteria and hysterical psychosis are inclusion terms for F44, Dissociative (conversion) disorders and anxiety hysteria are included under F41.8, Other specified anxiety disorders.

True: For a diagnosis of dependence according to ICD-10, 3 or more out of 6 features should have been present together in the previous year. According to DSM-IV, 3 or more of 7 features should have been present in the same 12-month period.

True: Trance and possession disorders (F44.3) are included under Dissociative (conversion) disorders (F44).

False: In DSM-IV ‘Disorders usually diagnosed in infancy, childhood or adolescence’ include more separate categories (52-76) than ICD-10 ‘Disorders of childhood and adolescence’ (F90-98). Mental retardation and disorders of psychological development are listed separately in ICD-10, whereas in DSM-IV they form part of this chapter.

False: Text Revision. DSM-IV was revised to correspond more closely to ICD-10. It lists 365 disorders in 17 sections. In addition, some diagnostic criteria proposed for further study are included in the appendix (DSM-IV-TR 2000; Sadock & Sadock 2002, p. 288; Sadock & Sadock, 2005, p. 1013).