19 February 2012
Extracts from:
http://www.rcpsych.ac.uk/pdf/IPv8n1.pdf=20
Journal of International Psychiatry
Volume 8 Number 1 February 2011
ISSN 1749-3676
?
Journal affiliated to International Psychiatry: African Journal of =
Psychiatry
(Editorial Board includes Rachel Jenkins, UK WHO Collaboration Centre, =
IoP)
Page 1 Guest Editorial=20
A revised mental health classification for use in general medical =
settings: the ICD11-PHC
David Goldberg
Chairman, WHO Advisory Group for Classification in Primary Care
A revised mental health classification for use in general medical =
settings: the ICD11-PHC 1
David Goldberg
[...]
"...However, some of the ICD10-PHC disorders were equivalent to existing =
categories in the parent classification, and did not take into account =
developments in diagnostic thinking. An interesting example of this =
concerns 'medically unexplained symptoms', which appear to have fallen =
out of favour with our GP colleagues, who have taken the view that even =
some medically explained symptoms can be abnormally prolonged and =
accentuated. Psychiatrists have taken a similar view: the new concept of =
'complex somatic symptom disorder' being field tested for DSM-V also =
draws attention not to whether somatic symptoms can be explained, but to =
the cognitive components that may accompany them, whether they are part =
of a known physical disease or not.
[...]
Box 2 The 28 disorders to be field tested for ICD11-PHC
Childhood disorders
1 Intellectual development disorder (was mental retardation)=20
2 Autism spectrum disorder (new)=20
3 Specific learning disability (new)=20
4 Attention-deficit hyperactivity disorder (ADHD)=20
5 Conduct disorder=20
6 Enuresis, encopresis
Psychotic disorders=20
7 Acute psychosis=20
8 Chronic psychosis=20
9 Bipolar disorder
Dysphoric disorders
10 Anxious depression (new)
11 Depressive disorder
12 Anxiety disorder
13 Distress disorder (replaces F42.2, F43, F48)
14 Post-traumatic stress disorder (PTSD) (new)
15 Panic/agoraphobia (was panic disorder)
Body distress disorders
16 Bodily distress syndrome (new - was unexplained somatic complaints)
17 Health preoccupation (new)
18 Conversion disorder (was dissociative disorder)
Bodily function disorders
19 Sexual function disorder, male
20 Sexual function disorder, female
21 Sleep disorder
22 Eating disorder
Substance use disorders
23 Alcohol use disorders
24 Drug use disorders
25 Tobacco use disorders
Personality disorder
26 Borderline personality (new)
Acquired neurocognitive disorders
27 Dementia
28 Delirium
[...]
A new category called bodily distress disorders will include conversion =
disorder (fairly common in some lower-income countries), health =
preoccupation (a new disorder similar to hypochondriasis) and the less =
severe 'bodily distress syndrome'. In the syndrome, the patient is both =
distressed and concerned and has three or more somatic symptoms in one =
bodily system. This is diagnosed only if the patient does not have one =
of the three dysphoric disorders.=20
[...]
These proposals are radical indeed, and by no means all of the proposed =
disorders will survive the field tests. Each proposed category will be =
commented upon by experts who are not part of the group, as well as by =
the main advisory group responsible for ICD-11. Final amendments will be =
made by the primary care group before the revised classification is =
released for field tests. The field tests are likely to be quite =
extensive, and to involve studies in both high-income and low- and =
middle-income countries. A second set of revisions will be made after =
the field tests.=20
In our early discussions, many of the disorders in ICD10-PHC are =
recommended to be retained - often with suitable amendments - but there =
have been several interesting new disorders suggested, as well as =
several disorders proposed for removal. Perhaps the most radical =
proposal is to abandon the distinction between anxiety disorders and =
mood disorders, and to gather them all under the single umbrella of =
'dysphoric disorders'. Within this important group, two innovations are =
proposed. First, some simple operational criteria will be tested in =
field trials to assess whether clinicians in the field find them useful; =
if they do not, we could return to diagnosis by descriptions of clinical =
prototypes. Even if they do like the operational criteria, we will need =
to recalibrate the point on the scale equivalent to what was previously =
described as MADD. The simple scales will allow a clinician to diagnose =
depression and anxiety on their own, or the combination of both - to be =
called 'anxious depression'. Second, where any of these three disorders =
achieve the severity required for a 'case', any somatic symptoms not =
part of a known physical disorder will be assumed to be related to the =
dysphoric disorder. Those whose symptoms fall short of the requirements =
for any of these three diagnoses, but who are distressed and disabled by =
their current symptoms (whether dysphoric or somatic), are to be given =
the residual diagnosis of 'distress disorder'. Distress disorder =
replaces a motley collection of minor disorders, including neurasthenia =
(or chronic fatigue) and adjustment disorder..."=20
This document is over a year old, now, and the criteria suggested above =
may have since been modified in response to the field trials and may not =
necessarily reflect the criteria for the apparent proposals for Chapter =
5 of ICD-11 for three levels of "Bodily Distress Disorder."
Note that for DSM-5, the proposal for "Conversion Disorder" is to rename =
it to "Functional Neurological Disorder", though this name is still =
under discussion, and to possibly locate it not under "Somatic Symptom =
Disorders" but under "Dissociative Disorders," where it currently sits =
in ICD.
It's like the Pic 'n Mix counter at Woolworths.=20
Suzy Chapman
_____________________
http://dxrevisionwatch.wordpress.com=20
http://meagenda.wordpress.com
http://www.facebook.com/MEagenda
http://twitter.com/MEagenda
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