A computer-assisted 6-axis research prototype for structured documentation and coding of psychiatric diagnostic reasoning. It integrates DSM-5-TR, ICD-11, and ICF within a single expert-system-style interface.
⚠️ Kein Medizinprodukt / Not a Medical DeviceDas multiaxial-diagnostic-system ist kein Medizinprodukt im Sinne der MDR (EU) 2017/745, nicht klinisch validiert, nicht durch BfArM oder eine Benannte Stelle geprüft, nicht zertifiziert. Es ist ein Softwareentwurf zur Erforschung von strukturierter Dokumentation und Kodierung diagnostischer Prozesse (6-Achsen-Modell, DSM-5-TR / ICD-11 / ICF-Integration) zu Lehr-, Forschungs- und Softwareentwicklungszwecken.
- Keine Diagnose. Ausgaben sind strukturierte Kodierungsvorschläge, keine klinischen Diagnosen.
- Keine Therapieempfehlung.
- Keine klinische Entscheidungsunterstützung im Sinne der MDR-Zweckbestimmung.
Diagnose und Behandlungsentscheidung bleiben qualifizierten Fachleuten vorbehalten (Ärztinnen/Ärzte, Psychotherapeutinnen/Psychotherapeuten).
Unentgeltliche Open-Source-Schenkung. Haftung auf Vorsatz und grobe Fahrlässigkeit beschränkt (§ 521 BGB). Nutzung auf eigenes Risiko.
The multiaxial-diagnostic-system is not a medical device within the meaning of the EU MDR 2017/745, not clinically validated, not reviewed or certified by BfArM or any Notified Body. It is a software prototype for teaching, research, and software-engineering purposes exploring the structured documentation and coding of diagnostic reasoning. Outputs are structured coding proposals, not diagnoses, therapy recommendations, or clinical decision support in the regulatory sense. Diagnosis and treatment decisions remain reserved for qualified professionals.
For qualified mental health professionals only. This tool supports but does not replace clinical judgment. See the full legal notice in
NOTICEand section Legal Notice below.
This system addresses the structural gap left by the abolition of the multiaxial system in DSM-5 (2013). It provides a comprehensive, multi-professional diagnostic framework with innovations that go beyond any previous classification system.
| Axis | Name | Sub-axes | Primary Profession |
|---|---|---|---|
| I | Mental Health Profiles | Ia-Ij (10 sub-axes) | Psychologist / Psychiatrist |
| II | Biography & Development | Personality (PID-5), Education, IQ | Psychologist |
| III | Medical Synopsis | IIIa-IIIm (13 sub-axes, symmetric to Axis I) | Physician |
| IV | Environment & Functioning | ICF, WHODAS 2.0, GAF, GdB, CFI | Social Worker |
| V | Integrated Condition Model | 3P/4P Case Formulation | Interdisciplinary Team |
| VI | Evidence Collection & Data-Integrity Layer | Evidence Matrix, CAVE pattern notifications, Symptom Timeline | All Professions |
- Formal Coverage Analysis (Ii/IIIi): Set-based metric C(S) = |explained| / |total symptoms| plus percentage-based symptom-diagnosis matrix identifying unexplained symptoms
- Symmetric Axis I/III Architecture: Identical structural tools for psychologists and physicians
- PRO/CONTRA Evidence Evaluation: Structured evidence for/against each diagnosis with confidence estimation
- CAVE pattern-based notifications: Cross-axis rule-based notifications (drug-interaction patterns, lab artifacts, contraindication patterns) — no automated clinical risk assessment
- Prioritized Investigation Plan: 3-tier system (Urgent / Important / Monitoring)
- Longitudinal Symptom Timeline: Tracking onset, status, and therapy response over time
- HiTOP Spectra: Automatically computed from Cross-Cutting screening results
- 6-Step Gatekeeper Logic: Implementing First's (2024) gold-standard differential diagnosis sequence
- 11 Disorder Modules: Complete screening-to-diagnosis coverage via hierarchical state machine
The theoretical foundation and clinical rationale for this system are described in the accompanying preprint:
Geiger, L. (2026). An Integrated Multiaxial Model for Computer-Assisted Psychiatric Diagnosis: Synthesis of DSM-5-TR, ICD-11, and ICF in a 6-Axis Expert System. Zenodo. https://doi.org/10.5281/zenodo.18736725
The preprint is available in English, German, and a combined bilingual edition:
paper/Review_Multiaxiale_Diagnostik_v2_en.pdf-- Englishpaper/Review_Multiaxiale_Diagnostik_v2_ger.pdf-- German
- XSS Protection: All user-supplied data HTML-escaped before rendering
- GAF Deprecation Notice: DSM-5 replaced GAF with WHODAS 2.0; system shows deprecation warning
- Professional-Use Disclaimer: Sidebar warning for qualified personnel only
- Robust Input Parsing: Likert scale extraction with fallback handling
- Full Bilingual Coverage: All UI strings (584 keys DE/EN) via
translations.json, no hardcoded strings
A standalone web application for digital administration of all 16 validated screening instruments referenced in the paper. Supports both remote client assessment (link sharing) and pen & paper (print-friendly PDFs).
- 16 validated instruments (PHQ-9, GAD-7, PCL-5, ITQ, AUDIT, C-SSRS, PQ-16, ASRS, AQ-10, OCI-R, SSS-8, DES-II, SCOFF, ISI, PID-5-BF, WHODAS 2.0) -- all freely available, bilingual (DE/EN)
- Automatic scoring with severity classification, color-coded thresholds, and clinical action guides
- Test batteries: Send multiple tests as a package -- client receives one link and works through all tests sequentially with progress tracking
- Link sharing: Clinician creates session → generates token URL → sends to client → client fills out remotely → clinician views results
- Print-friendly output: Single tests or bundles as printable HTML (pen & paper), with patient header, scoring tables, and references
- Critical item alerts: Suicidality screening (PHQ-9 Item 9, C-SSRS) triggers immediate warnings with emergency resources
- REST API: Full JSON API for programmatic integration (
/api/tests,/api/results/<token>,/api/score) - Integration with main system: Cross-Cutting screening in the Streamlit app (Gate 5) links directly to the Testcenter for recommended Level-2 instruments
cd _data/testcenter
pip install flask
python app.py
# → http://localhost:5050| Instrument | Items | Domain | Axis | Scoring |
|---|---|---|---|---|
| PHQ-9 | 9 | Depression | I | Sum (0-27), cutoff ≥10 |
| GAD-7 | 7 | Anxiety | I | Sum (0-21), cutoff ≥10 |
| PCL-5 | 20 | PTSD (DSM-5) | I | Sum + DSM-5 clusters |
| ITQ | 16 | PTSD/CPTSD (ICD-11) | I | Diagnostic algorithm |
| PQ-16 | 16 | Psychosis risk | I | Endorsement + distress |
| ASRS v1.1 | 6 | ADHD | I | Threshold count |
| AQ-10 | 10 | Autism spectrum | I | Directional sum |
| AUDIT | 10 | Alcohol use | I | Sum (0-40), 3 subscales |
| C-SSRS | 6 | Suicidality | I | Risk classification |
| OCI-R | 18 | OCD | I | Sum + 6 subscales |
| SSS-8 | 8 | Somatic symptoms | I | Sum (0-32) |
| DES-II | 28 | Dissociation | I | Mean (0-100%) |
| SCOFF | 5 | Eating disorders | I | Sum (0-5) |
| ISI | 7 | Insomnia | I | Sum (0-28) |
| PID-5-BF | 25 | Personality traits | II | 5 domains → HiTOP |
| WHODAS 2.0 | 12 | Functioning | IV | 6 ICF domains |
- Diagnostic System UI: Streamlit
- Testcenter UI: Flask + Bootstrap 5 + Jinja2
- Decision Engine:
transitions(Hierarchical State Machine) - Visualization: Plotly (PID-5 + HiTOP radar charts)
- Data Storage: SQLite (diagnostic codes + test sessions)
- Internationalization: Bilingual (German/English) via
translations.json(661 keys per language)
# Main diagnostic system
pip install streamlit plotly pandas transitions anytree
# Testcenter (separate)
pip install flask# Main diagnostic system (clinician interface)
streamlit run _data/multiaxial_diagnostic_system.py
# Testcenter (patient-facing + clinician admin)
python _data/testcenter/app.pypaper/ # Scientific preprint (EN + DE + .bib)
_data/multiaxial_diagnostic_system.py # Main application (V10, ~2850 lines)
_data/translations.json # Bilingual i18n (661 keys DE/EN)
_data/build_code_database.py # Diagnostic code database builder
_data/diagnostic_codes.db # Pre-built code database (ICD-11/DSM-5-TR/ICF)
_data/requirements.txt # Python dependencies
_data/testcenter/ # Diagnostic Testcenter (Flask web app)
app.py # Main application
scoring.py # Scoring engine (9 methods)
config.py # Configuration
tests/ # 16 test definitions (JSON, bilingual)
templates/ # HTML templates (Bootstrap 5)
static/ # CSS + JavaScript
_results/Konzept_Dimensionale_Integration.md # Dimensional integration concept (DE)
_results/Ausbauplan_Prototyp_V9.md # Development roadmap (DE)
See Ausbauplan_Prototyp_V9.md for the full roadmap.
Completed (Sprint 1 / V9 + V9.1):
- Ii/Ij swap (coverage before investigation)
- HiTOP spectra from Cross-Cutting data
- Symmetric Axis III (13 sub-axes)
- PRO/CONTRA evidence evaluation with confidence
- Formal + quantitative coverage analysis with metrics
- Prioritized investigation plan (3-tier)
- CAVE pattern-based notifications
- Longitudinal symptom timeline
- Extended medication form (IIIm)
- Full JSON export
- XSS protection (html escaping)
- WHODAS 2.0 domain score persistence
- GAF deprecation notice
- Professional-use disclaimer
- Full i18n coverage (no hardcoded strings)
- Robust Likert scale parsing
Completed (Sprint 2 / V10):
- Axis V P1-P4 structured coding (source axis + evidence level per factor)
- Pathophysiological causal model (genetic-neurobiological / psychological-developmental / environmental-situational)
- Therapy resistance tracking (treatment attempts, response rates, switch reasons)
- CGI-S / CGI-I outcome parameters with longitudinal tracking
- Session auto-save / data persistence (JSON-based save & load)
Completed (Sprint 3 / V10.1 -- Testcenter):
- Diagnostic Testcenter: standalone Flask web app with 16 validated instruments
- Bilingual test definitions (DE/EN) with complete item content and scoring
- Test batteries: multiple tests as a single client link
- Print-friendly output for pen & paper administration
- Automatic scoring with 9 scoring methods (sum, mean, algorithm, classification, etc.)
- REST API for programmatic integration
- Cross-Cutting → Testcenter integration (Gate 5 links to recommended instruments)
- Session management with token-based link sharing and deletion
Next (Sprint 4):
- Multi-professional role model (login/role-based axis access)
- Automated coverage analysis (cross-cutting to diagnosis mapping)
- Comorbidity rules (automated warnings)
- HSM disorder modules (11 structured modules)
If you use this system in your research, please cite:
@article{geiger2026multiaxial,
title={An Integrated Multiaxial Model for Computer-Assisted Psychiatric Diagnosis},
author={Geiger, Lukas},
year={2026},
doi={10.5281/zenodo.18736725},
publisher={Zenodo}
}- Software (code, templates, scoring engine): MIT License
- Scientific papers (
paper/): CC-BY 4.0 - Test instruments (
_data/testcenter/tests/): Each instrument under its original license (Public Domain, WHO, APA, etc.) -- see_data/testcenter/NOTICE.md
Lukas Geiger -- Independent Researcher, Bernau im Schwarzwald, Germany
AI-assisted development: Claude Opus 4.6 (Anthropic), Gemini (Google DeepMind), Copilot (Microsoft)
⚠️ Rechtlicher Hinweis / Legal NoticeDieses Projekt ist kein Medizinprodukt im Sinne der MDR (EU) 2017/745 / IVDR (EU) 2017/746. Es ist nicht klinisch validiert, nicht durch BfArM oder eine Benannte Stelle geprüft, nicht zertifiziert. Es verarbeitet Daten ausschließlich zu Forschungs- und Softwareentwicklungszwecken. Eine klinische oder diagnostische Nutzung ist ausdrücklich nicht die Zweckbestimmung. Entscheidungen über Diagnose und Therapie bleiben qualifizierten Fachpersonen vorbehalten.
This project is not a medical device within the meaning of MDR (EU) 2017/745 / IVDR (EU) 2017/746. It is not clinically validated, not approved by BfArM or any Notified Body, not certified. Data is processed exclusively for research and software development purposes. Clinical or diagnostic use is explicitly not the intended purpose. Decisions about diagnosis and therapy remain reserved for qualified professionals.
Unentgeltliche Open-Source-Schenkung (§§ 516 ff. BGB). Haftung auf Vorsatz und grobe Fahrlässigkeit beschränkt (§ 521 BGB). Nutzung auf eigenes Risiko. / Unpaid open-source donation. Liability limited to intent and gross negligence. Use at own risk.