Limitations in the current classification systems for dementia

2005 ◽  
Vol 17 (s1) ◽  
pp. S17-S26 ◽  
Author(s):  
Edmond Chiu
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Disorders ◽  
Classification Systems ◽  
Current Classification ◽  
Two Systems ◽  
Icd 10 ◽  
Dsm Iv

A brief review of classification in psychiatry from Kraepelin to ICD-10 and DSM-IV reveals that the categorical paradigm inherent in these nosological systems has certain inadequacies when applied to dementia specifically and cognitive impairment in general. There are “outcasts” from these two systems that, with the rapid advances in an understanding of cognitive disorders, expose significant limitations in them. As and when they are revised, serious consideration of a different view, accepting a dimensional paradigm, would contribute to a more inclusive and clinically relevant nosology for dementia and cognitive disorders.

scholarly journals Classification in psychiatry: ICD–10 v. DSM–IV

1999 ◽  
Vol 175 (3) ◽  
pp. 205-209 ◽  
Author(s):  
Michael B. First ◽  
Harold Alan Pincus
Keyword(s):  
Mental Disorders ◽  
American Psychiatric Association ◽  
Classification Systems ◽  
Diagnostic Classification ◽  
Two Systems ◽  
Icd 10 ◽  
Harmful Use ◽  
Dsm Iv

The editorial by Andrews et al (1999) usefully calls attention to issues of compatibility between diagnostic classification systems but we believe that the editorial greatly overstates the compatibility problem as well as its implications. The article begins with the suggestion that the DSM–IV authors' position is to downplay the differences between DSM–IV and ICD–10. After stating that the American Psychiatric Association “felt sufficiently confident to publish a DSM–IV International Version in which the DSM–IV criteria are listed against the ICD–10 codes”, the authors go on to report concordances between the classifications for the main mental disorders as ranging from a low of 33% (for substance harmful use or abuse) to 87% (for dysthymia), with an overall concordance of only 68%. The authors conclude that if this “unnecessary dissonance between the classification systems continues, patients, researchers and clinicians will be all the poorer”. Although we acknowledge that there are a number of differences between the two systems, the authors fail to assess fully the sources, significance and solutions for this compatibility problem.

scholarly journals Harmonisation of ICD–11 and DSM–V: opportunities and challenges

2009 ◽  
Vol 195 (5) ◽  
pp. 382-390 ◽  
Author(s):  
Michael B. First
Keyword(s):  
Diagnostic Criteria ◽  
Development Process ◽  
Prior Experience ◽  
International Communication ◽  
Tic Disorder ◽  
Parallel Development ◽  
Dsm V ◽  
Two Systems ◽  
Icd 10 ◽  
Dsm Iv

BackgroundDifferences in the ICD–10 and DSM–IV definitions for the same disorder impede international communication and research efforts. The forthcoming parallel development of DSM–V and ICD–11 offers an opportunity to harmonise the two classifications.AimsThis paper aims to facilitate the harmonisation process by identifying diagnostic differences between the two systems.MethodDSM–IV–TR criteria sets and the ICD–10 Diagnostic Criteria for Research were compared and categorised into those with identical definitions, those with conceptually based differences and those in which differences are not conceptually based and appear to be unintentional.ResultsOf the 176 criteria sets in both systems, only one, transient tic disorder, is identical. Twenty-one per cent had conceptually based differences and 78% had non-conceptually based differences.ConclusionsHarmonisation of criteria sets, especially those with non-conceptually based differences, should be prioritised in the DSM–V and ICD–11 development process. Prior experience with the DSM–IV and ICD–10 harmonisation effort suggests that for the process to be successful steps should be taken as early as possible.

Reconciling hospital-acquired complications and CHADx+ in Victorian coded hospital data

2018 ◽  
Vol 48 (2) ◽  
pp. 76-86 ◽  
Author(s):  
Jennie Shepheard ◽  
Elsa Lapiz ◽  
Carla Read ◽  
Terri J Jackson
Keyword(s):  
Quality Improvement ◽  
Adverse Events ◽  
Classification Systems ◽  
Hospital Inpatient ◽  
Hospital Data ◽  
Two Systems ◽  
Icd 10 ◽  
Definition Of ◽  
Hospital Acquired ◽  
Coded Hospital Data

Background: The Council of Australian Governments has focused the attention of health service managers and state health departments on a list of hospital-acquired complications (HACs) proposed as the basis of funding adjustments for poor quality of hospital inpatient care. These were devised for the Australian Commission on Safety and Quality in Health Care as a subset of their earlier classification of hospital-acquired complications (CHADx) and designed to be used by health services to monitor safety performance for their admitted patients. Objective: To improve uptake of both classification systems by clarifying their purposes and by reconciling the ICD-10-AM code sets used in HACs and the Victorian revisions to the CHADx system (CHADx+). Method: Frequency analysis of individual clinical codes with condition onset flag (COF 1) included in both classification systems using the Victorian Admitted Episodes Dataset for 2014/2015 ( n = 2,623,275 separations). Narrative description of the resulting differences in definition of “adverse events” embodied in the two systems. Results: As expected, a high proportion of ICD-10-AM codes used in the HACs also appear in CHADx+, and given the wider scope of CHADx+, it uses a higher proportion of all COF 1 diagnoses than HACs (82% vs. 10%). This leads to differing estimates of rates of adverse events: 2.12% of cases for HACs and 11.13% for CHADx+. Most CHADx classes (70%) are not covered by the HAC system; discrepancies result from the exclusion from HACs of several major CHADx+ groups and from a narrower definition of detailed HAC classes compared with CHADx+. Case exclusion criteria in HACs (primarily mental health admissions) resulted in a very small proportion of discrepancies (0.13%) between systems. Discussion: Issues of purpose and focus of these two Australian systems, HACs for clinical governance and CHADx+ for local quality improvement, explain many of the differences between them, and their approach to preventability, and risk stratification. Conclusion: A clearer delineation between these two systems using routinely coded hospital data will assist funders, clinicians, quality improvement professionals and health information managers to understand discrepancies in case identification between them and support their different information needs.

scholarly journals Psychopathy in childhood: is it a meaningful diagnosis?

2012 ◽  
Vol 200 (3) ◽  
pp. 175-176 ◽  
Author(s):  
Michael Rutter
Keyword(s):  
Antisocial Behaviour ◽  
Classification Systems ◽  
Icd 10 ◽  
Dsm Iv

SummaryPsychopathy is not included in either of the main classification systems (ICD-10 or DSM-IV). Research has now extended the concept of psychopathy to childhood and has produced evidence that it is meaningfully distinct from antisocial behaviour. It is proposed that psychopathy should be accepted as a meaningful diagnosis in childhood.

Neurocognitive disorders: Cluster 1 of the proposed meta-structure for DSM-V and ICD-11

2009 ◽  
Vol 39 (12) ◽  
pp. 2001-2012 ◽  
Author(s):  
P. Sachdev ◽  
G. Andrews ◽  
M. J. Hobbs ◽  
M. Sunderland ◽  
T. M. Anderson
Keyword(s):  
Mental Disorders ◽  
Task Force ◽  
Cognitive Disorders ◽  
Neurocognitive Disorders ◽  
Study Group ◽  
Normal Brain ◽  
Dsm V ◽  
Co Morbidity ◽  
Icd 10 ◽  
Dsm Iv

BackgroundIn an effort to group mental disorders on the basis of aetiology, five clusters have been proposed. In this paper, we consider the validity of the first cluster, neurocognitive disorders, within this proposal. These disorders are categorized as ‘Dementia, Delirium, and Amnestic and Other Cognitive Disorders’ in DSM-IV and ‘Organic, including Symptomatic Mental Disorders’ in ICD-10.MethodWe reviewed the literature in relation to 11 validating criteria proposed by a Study Group of the DSM-V Task Force as applied to the cluster of neurocognitive disorders.Results‘Neurocognitive’ replaces the previous terms ‘cognitive’ and ‘organic’ used in DSM-IV and ICD-10 respectively as the descriptor for disorders in this cluster. Although cognitive/organic problems are present in other disorders, this cluster distinguishes itself by the demonstrable neural substrate abnormalities and the salience of cognitive symptoms and deficits. Shared biomarkers, co-morbidity and course offer less persuasive evidence for a valid cluster of neurocognitive disorders. The occurrence of these disorders subsequent to normal brain development sets this cluster apart from neurodevelopmental disorders. The aetiology of the disorders is varied, but the neurobiological underpinnings are better understood than for mental disorders in any other cluster.ConclusionsNeurocognitive disorders meet some of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster. Further developments in the aetiopathogenesis of these disorders will enhance the clinical utility of this cluster.

MINI-ADDENBROOKE'S COGNITIVE EXAMINATION (M-ACE): PRAGMATIC STUDY

2015 ◽  
Vol 86 (11) ◽  
pp. e4.139-e4
Author(s):  
Andrew Larner
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Disorders ◽  
Net Benefit ◽  
Dementia Diagnosis ◽  
Female Age ◽  
Diagnosis Of Dementia ◽  
Dsm Iv ◽  
Age Range ◽  
Addenbrooke’S Cognitive Examination ◽  
Pragmatic Study

ObjectiveTo test diagnostic accuracy of the mini-Addenbrooke's Cognitive Examination (m-ACE) compared to the MMSE for the diagnosis of dementia and MCI in consecutive referrals to a dedicated cognitive disorders clinic.Results: Of 135 consecutive new outpatients seen over 6 months (June–November 2014) administered the mini-ACE (F:M=64:71, 47% female; age range 18–88 years, median 60), 24 were diagnosed with dementia (DSM–IV–TR criteria) and 39 had MCI (Petersen criteria). Using the cutoffs defined in the index paper (≤25/30 and ≤21/30), m-ACE was sensitive (1.00, 0.92) but not specific (0.28, 0.61) for dementia diagnosis; it also proved useful for MCI diagnosis (sensitivities 1.00, 0.77; specificities 0.43, 0.82). Area under the ROC curve was 0.86. Effect size (Cohen's d) for m-ACE for dementia vs. no dementia was 1.53 (large) and for MCI vs no cognitive impairment was 1.59 (large); for MMSE the corresponding figures were 1.56 and 1.26. Weighted comparison suggested a small net loss for m-ACE vs MMSE for dementia diagnosis (–0.13) but a large net benefit for MCI diagnosis (0.38).Conclusions: In this pragmatic study, m-ACE proved quick, easy to use, and acceptable to patients, with metrics comparable to MMSE for dementia diagnosis and better for MCI diagnosis.

Considerations on classification of alcohol induced mental disorders

2011 ◽  
Vol 26 (S2) ◽  
pp. 90-90
Author(s):  
I. Pajević ◽  
M. Hasanović
Keyword(s):  
Mental Disorders ◽  
Delirium Tremens ◽  
Alcohol Withdrawal Syndrome ◽  
Classification Systems ◽  
Dimensional Structure ◽  
Clinical Samples ◽  
Dsm V ◽  
Icd 10 ◽  
Dsm Iv ◽  
Substance Related Disorders

IntroductionCurrent valid classification systems (ICD-10 and DSM-IV) of the alcohol-induced disorders include: acute intoxication, pathological intoxication, alcohol withdrawal syndrome, psychotic disorder with delusions or hallucinations, delirium tremens, amnesic syndrome, mood disorders and anxiety disorders caused by alcohol consumption (only in DSM-IV) and sexual dysfunction.AimTo consider adequacy of existing classifications of alcohol dependency and to offer more adequate suggestion for ICD-11 and DSM-V.MethodologyAuthors compared and analyzed the diagnostic criteria that are offered in the current classifications for these disorders.ResultsThere are many similarities and many differences between existing diagnostic criteria's. The former name of the DSM-IV (Substance related disorders, which include Alcohol related disorders) is inappropriate since it excludes other related disorders. Another important issue that is currently a subject of extensive discussions in the process of finalizing the DSM-V refers to the current distinction terms abuse and alcohol dependence. Scientific documents about the criteria of abuse and dependence in clinical samples and samples from the general population suggest that the DSM-IV criteria for abuse and dependence can be considered as part of a one-dimensional structure, thus for DSM-V it could be combined into a single disorder, with two criteria to make a diagnosis.ConclusionIt is expected that the principles adopted by the WHO during the preparation for ICD-11, which includes bridging the differences between ICD and DSM and the introduction of the person centered integrative diagnosis (PID) will be an important step forward in understanding and distinction among alcohol induced mental disorders.

The Nature of Psychiatric Classification: Issues Beyond ICD-10 and DSM-IV

1999 ◽  
Vol 33 (2) ◽  
pp. 137-144 ◽  
Author(s):  
Assen Jablensky
Keyword(s):  
Cultural Context ◽  
Goodness Of Fit ◽  
Synergistic Effects ◽  
Classification Systems ◽  
Major Step ◽  
Psychiatric Classification ◽  
Economic Forces ◽  
Icd 10 ◽  
Dsm Iv ◽  
The Impact

Objective: The aim of this paper is to provide an overview of the methodological underpinnings of current classification systems in psychiatry, their impact on clinical and social practices, and likely scenarios for future development, as an introduction to a series of related articles in this issue. Method: The method involved a selective literature review. Results: The role and significance of psychiatric classifications is placed in a broader social and cultural context; the ‘goodness of fit’ between ICD-10 and DSMIV on one hand, and clinical reality on the other hand, is examined; the nature of psy chiatric classification, compared to biological classifications, is discussed; and questions related to the impact of advances in neuroscience and genetics on psychiatric classification are raised for further discussion. Conclusions: The introduction of explicit diagnostic criteria and rule-based classification, a major step for psychiatry, took place concurrently with the ascent to dominance of a biomedical paradigm and the synergistic effects of social and economic forces. This creates certain risks of conceptual closure of clinical psychiatry if phenomenology, intersubjectivity and the inherent historicism of key concepts about mental illness are ignored in practice, education and research.

scholarly journals Delirium: the role of psychiatry

2001 ◽  
Vol 7 (6) ◽  
pp. 433-442 ◽  
Author(s):  
David Meagher
Keyword(s):  
Medical Literature ◽  
Classification Systems ◽  
World Health ◽  
Clinical Settings ◽  
Mental Disturbance ◽  
Psychotropic Agents ◽  
Icd 10 ◽  
Dsm Iv ◽  
Health Organization

Acute mental disturbance associated with physical illness is well described in early medical literature, but it was not until 1 AD that Celsus coined the term ‘delirium’ (Lindesay, 1999). Although delirium has many synonyms that are applied in particular clinical settings (Box 1), all acute disturbances of global cognitive functioning are now recognised as ‘delirium’, a consensus supported by both ICD–10 (World Health Organization, 1992) and DSM–IV (American Psychiatric Association, 1994) classification systems. Delirium is a complex neuropsychiatric syndrome that typically involves a plethora of cognitive and non-cognitive symptoms, resulting in a broad differential diagnosis dominated by mental disorders. Psychiatrists' skills in assessing cognitive function and psychopathology, coupled with their knowledge of psychotropic agents, make them well suited to improving detection, coordinating management and facilitating research into this understudied disorder.

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