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 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 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.

scholarly journals What's so special about conversion disorder? A problem and a proposal for diagnostic classification

2010 ◽  
Vol 196 (6) ◽  
pp. 427-428 ◽  
Author(s):  
Richard A. Kanaan ◽  
Alan Carson ◽  
Simon C. Wessely ◽  
Timothy R. Nicholson ◽  
Selma Aybek ◽  
...  
Keyword(s):  
Conversion Disorder ◽  
Diagnostic Classification ◽  
Psychiatric Classification ◽  
Icd 10 ◽  
Dsm Iv ◽  
The Right

SummaryConversion disorder presents a problem for the revisions of DSM–IV and ICD–10, for reasons that are informative about the difficulties of psychiatric classification more generally. Giving up criteria based on psychological aetiology may be a painful sacrifice but it is still the right thing to do.

The contribution of epidemiology to the study of diagnosis

1994 ◽  
Vol 9 (1) ◽  
pp. 3-12 ◽  
Author(s):  
H Häfner ◽  
K Maurer
Keyword(s):  
Diagnostic Criteria ◽  
Diagnostic Category ◽  
Field Trials ◽  
Classification Systems ◽  
Epidemiological Methods ◽  
Functional Psychoses ◽  
Operational Diagnosis ◽  
Icd 10 ◽  
The Stability ◽  
The Impact

SummaryPsychiatric diagnoses provide short labels for diseases or discrete symptom clusters. They should designate the same throughout the world, give information about course, outcome and indications for therapy as well as provide an heuristic basis for etiological research. Hence, the core question is how to attain an optimal representation of real morbidity in diagnosis, sets of diagnostic criteria and diagnostic classifications. Clinical observation can be improved considerably by multi-centre field trials, as applied in the preparation of ICD-10 and DSM-IV. But the approach has considerable limitations due to a lack of external measures in many psychiatric disorders and a highly limited representation of many diagnostic groups in clinical populations. Therefore, epidemiological methods are required in validating diagnosis and diagnostic criteria. The simplest way is to supplement clinical multicentre diagnostic studies by general-practice studies, but these, also, cannot fully replace population studies. Operational diagnosis and case criteria can be defined either categorically or dimensionally. Most of the categorical diagnoses in ICD-10 or DSM III also include dimensional characteristics. The impact of various diagnostic criteria, particularly cut-offs of dimensional characteristics, on the assignment of a diagnosis and, thus, on the morbidity figures of a diagnostic category is demonstrated by data from a large representative sample of first-admitted schizophrenics. Attempts at etiological validation by methods of genetic epidemiology provide limited support for Kraepelin's dichotomous model of functional psychoses. Validation by epidemiological course studies has shown that the stability of diagnosis in functional psychoses differs according to the sets of diagnostic criteria of different classification systems.

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.

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.

scholarly journals The Consortium to Investigate Vascular Impairment of Cognition: Methods and First Findings

2003 ◽  
Vol 30 (3) ◽  
pp. 237-243 ◽  
Author(s):  
Kenneth Rockwood ◽  
Heather Davis ◽  
Chris MacKnight ◽  
Robert Vandorpe ◽  
Serge Gauthier ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Case Report ◽  
Diagnostic Criteria ◽  
Clinical Diagnosis ◽  
Vascular Cognitive Impairment ◽  
Case Report Form ◽  
Icd 10 ◽  
Dsm Iv ◽  
The Impact

Background:The Consortium to Investigate Vascular Impairment of Cognition (CIVIC) is a Canadian, multi-centre, clinic-based prospective cohort study of patients with Vascular Cognitive Impairment (VCI). We report its organization and the impact of diagnostic criteria on the study of VCI.Methods:Nine memory disability clinics enrolled patients and recorded their usual investigations and care. A case report form included all vascular dementia (VaD) individual criteria for each of four sets (National Institute of Neurological Disorders and Stroke (NINDS-AIREN), Alzheimer’s Disease Diagnostic Treatment Centers (ADDTC), the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) of consensus-based diagnostic criteria and for the Hachinski Ischemia Score (HIS). Investigators, having completed the case report form, were asked to make a clinical judgement about the cognitive diagnosis based on the best available information, including neuroimaging.Results:Of 1,347 patients (mean age 72 years; 56% women), 846 (63%) were diagnosed with dementia and 324 (24%) were diagnosed with VCI. The proportion of patients diagnosed with VaD by the diagnostic criteria was: 23.9% (n=322) by DSM-IV, 10.2% (n=137) by HIS, 4.3% (n=58) by ICD-10, 3.8% (n=51) by ADTCC, and 3.6% (n=48) by NINDS-AIREN. Judged against a clinical diagnosis of VaD, the sensitivity/specificity of each was: DSM-IV (0.77/0.80); HIS (0.41/0.92); ICD-10 (0.29/0.98); ADTCC (0.24/0.98); NINDS-AIREN (0.42/0.995). Compared with a clinical diagnosis of VCI, sensitivities were lower for the diagnostic criteria, reflecting the exclusion of patients who did not have dementia.Conclusions:Consensus-based criteria for VaD omit patients who do not meet dementia criteria that are modeled on Alzheimer’s disease. Even for patients who do, the proportion identified with VaD varies widely. Criteria based on empirical analyses need to be developed and validated.

scholarly journals Coexisting Depression and Anxiety: Classification and Treatment

2012 ◽  
Vol 12 (2) ◽  
pp. 32-38 ◽  
Author(s):  
T. Kulhan ◽  
I. Ondrejka ◽  
J. Ordaz ◽  
E. Snircova ◽  
G. Nosalova
Keyword(s):  
Clinical Practice ◽  
Classification Systems ◽  
Depression And Anxiety ◽  
Therapeutic Approaches ◽  
Anxious Depression ◽  
Icd 10 ◽  
Dsm Iv ◽  
Recommended Guidelines ◽  
Based Medicine ◽  
Classification And Treatment

Coexisting Depression and Anxiety: Classification and TreatmentDespite of the fact, that comorbidity of depression and anxiety is a frequent condition in clinical practice, current psychiatric classification systems (according to WHO-ICD 10 and according to APA-DSM IV-TR) are not taking this reality into account sufficiently. The concept of anxious depression is very important for clinical practice. Recommended guidelines and algorithms of treatment based on evidence based medicine (EBM), established mainly on randomized controlled trials are designed separately for depression and separately for anxious disorders. This presents very often a significant complication in clinical practice. The aim of this article was to bring the concept of anxious depression to closer attention with highlighting of possible therapeutic approaches.

International Psychiatric Classification: ICD-10 and DSM-IV

2001 ◽  
pp. 435-450
Author(s):  
J. van Drimmelen-Krabbe ◽  
A. Bertelsen ◽  
C. Pull
Keyword(s):  
Psychiatric Classification ◽  
Icd 10 ◽  
Dsm Iv

The Classification of Mental Disorders in Primary Care: A Guide through a Difficult Terrain

1998 ◽  
Vol 28 (2) ◽  
pp. 159-176 ◽  
Author(s):  
Henk Lamberts ◽  
Kathryn Magruder ◽  
Roger G. Kathol ◽  
Harold A. Pincus ◽  
Inge Okkes
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Primary Care Physicians ◽  
Common Mental Disorders ◽  
Classification Systems ◽  
Somatization Disorder ◽  
Icd 10 ◽  
Dsm Iv ◽  
Difficult Terrain ◽  
Clinical Comparability

Background: Primary care physicians traditionally have a strong interest in the mental health of their patients. Three classification systems are available for them to diagnose, label, and classify mental disorders: 1) The ICD-10 approach with three options, 2) The DSM-IV approach with two options, and 3) the ICPC approach with two options. This article lists important similarities and differences between the systems to help potential users choose the option that best meets their needs. Methods: Definitions for depressive disorder, anxiety disorder, and somatization disorder are compared on five characteristics of classification: 1. the domain, 2. the scope, 3. the nature of the definitions, 4. focus on episodes of care, and 5. clinical guidelines. Results: Primary care physicians and psychiatrists have different perspectives, reflected in different classifications. Each system has specific possibilities and limitations with regard to the diagnosis of mental disorders. For common mental disorders it is possible, however, to choose codes from one system while maintaining compatibility with the other two. Comparability as to the diagnostic content of the different classes, however, is more difficult to establish. The available classification systems give both primary care physicians and psychiatrists options to diagnose, label, and to classify mental disorders from their own perspective, but once a system has been chosen the clinical comparability of a patient with the same diagnosis in other systems is limited. Conclusion: Compatibility among systems can be optimized by strictly following a number of rules. The conversion between ICPC and ICD-10 (and consequently DSM-IV) allows simultaneous use of ICPC and ICD-10 as a classification and DSM-IV as the standard nomenclature. This is of particular interest for computer based patient records in primary care. The clinical comparability of the same diagnosis in different systems however is limited by the characteristics of the different system.

Sign in / Sign up

Export Citation Format

Share Document