Multiaxial Diagnostic System

The DSM-IV diagnoses are made on a multiaxial system in which each axis refers to a different domain of information. This system aids in making a comprehensive assessment, organizing complex clinical information, and communicating between professionals. Axis I disorders comprise the clinical syndromes of mental disorders. Conditions listed on Axis II are the personality disorders and developmental disorders, including mental retardation, which may underlie the more florid Axis I syndrome. Axis III notes general medical conditions. Axes IV and V record psychosocial stressors and adaptive functioning. It is generally unnecessary for the emergency physician to make a complete multiaxial diagnosis, but knowledge of this system may facilitate an understanding of medical records and psychiatric consultants' notes. For instance, a patient with previous medical records containing DSM-IV diagnoses of Axis I: alcohol intoxication; Axis II: antisocial personality disorder; and Axis III: scalp laceration, should be recognized as likely to display features of the Axis II personality disorder, although the patient's chief complaint may be a new problem.

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