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Diagnosis (Psychiatric/General-Medical):

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Discussed with the rest of the Multidisciplinary Treatment Team (in the case of relevant direct clinical notes vs. HPI/collateral information, the name of the clinician, whether doctor, psychiatrist or psychotherapist, is also reported) it maintains the DSM-IV-TR Multi-axial system even after the 2013 changes of the DSM-V:

 Axis I: All psychological diagnostic categories except intellectual disability and personality disorder

 Axis II: Personality disorders and intellectual disability

 Axis III: General medical condition; acute medical conditions and physical disorders

 Axis IV: Psychosocial and environmental factors contributing to the disorder

 Axis V: Global Assessment of Functioning

Axis IV and V are further described in a separate clinical narrative, which includes:

 Current Activities of Daily/Weekly Living

 Job/Vocational Activities

 Special Interests/Leisure/Recreation

 Volunteer Activity

Mind-Body Medicine in Inpatient Psychiatry

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