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ICD 10 Training Kit - (in collaboration with WHO)

ICD 10 Training Kit - (in collaboration with WHO)

WORLD HEALTH ORGANIZATION
WORLD PSYCHIATRIC ASSOCIATION

THE INTERNATIONAL CLASSIFICATION OF MENTAL AND BEHAVIOURAL DISORDERS
(ICD-10 Chapter V)
EDUCATIONAL PROGRAMME

Prepared by
Norman Sartorius
Juan J. Lopez-Ibor
Jenny van Drimmelen
Dolores Crespo
PRESENTATION

The appearance of the ICD-10 Classification of Mental and Behavioral Disorders has beenan event of vast importance for psychiatry. The classification is an essential part of thelanguage which will allow national and international communication in the field of mentalhealth and facilitate joint work across cultures and countries.

The challenge now is to familiarize psychiatrists and other mental health workers withthe ICD-10 Classification of Mental and Behavioral Disorders to help them to use it well.

The World Psychiatric Association, the World Health Organization as well as othereducational institutions and Centers have carried out presentations and seminarsconcerning the role of ICD-10 in different countries with great success. This disketteprovides materials that have been developed on the basis of experience gained in suchprocess. It has been prepared to help those who would like to undertake similar training activities.

The production of the ICD-10 Classification of Mental and Behavioural Disorders and thefamily of related materials is the result of a joint effort of many people andinstitutions, worldwide. To them should go the credit for this major contribution to thescience and practice of psychiatry; before them and before the WHO and WPA is now also theduty to ensure the widespread and correct use of these materials of the ICD and relatedinstruments.

A first version of this diskette has been produced by the World Psychiatric Associationand the WHO Division of Mental Health and Prevention of Substance as a courtesy to theparticipants of the 10th. World Congress of Psychiatry.

Prof Jorge Costa e Silva Prof Norman Sartorius
Director of the Division of Mental Health President World Psychiatric Association
and Prevention of Substance Abuse Professor of Psychiatry

World Health Organization University of Geneva

Geneva, Switzerland Geneva, Switzerland

CONTENTS
Preface

Acknowledgements

Section 1 Presentations and workshops

Section 2 Contents of the ICD-10 lectures

Section 3 Listing of materials, useful for training

Section 4 Transparencies

Section 5 Case histories

Appendix 1 - List of references to key books and articles Appendix 2 - Editorial guidelines for the production of case histories

Appendix 3 - Guidelines for the production of videotapes

Appendix 4 - List of WHO Reference and Training Centres on Classification,Diagnosis and Assessment of Mental and Behavioural Disorders

Appendix 5 - Information about computer programmes

Appendix 6 - Form for recording diagnosis

Appendix 7 - Model for evaluation of lecture or workshop

Appendix 8 - Model for certificate for participation in ICD-10 familiarization workshop

Section 1. provides suggestions for the organization of workshops. Section 2. and 3.contain description of the content, as well as suggestions concerning materials to be usedin training.

The text of Section 4. (transparencies) may be used to produce slides or transparentsheets for an overhead projector. For this purpose the files (especially the ASCII files)need adjustments concerning the font, letter sice, etc..

Section 5 (case histories) contains 25 cases, accompanied by a discussion of thediagnosis according to the ICD-10 guidelines and criteria. These cases can be used toilustrate the use of ICD-10 and to provide practice materials for the participants ofworshops or seminars. Teachers may wish to complement this collection with a descriptionof cases linked to the local situation where the participants in the training live andwork.

The text is provided both in Word Perfect 6.0 for Windows (*.wp6) and ASCII (*.asc)text (DOS) and consists of the following files:

Contents
WordPerfect
ASCII
Preface
Acknowledgements
Section 1: Presentation and workshops
Section 2: Contents of ICD-10 lectures
Section 3: Listing of materials, useful for training
intro.wp6
intro.asc
Section 4: Transparencies
trans.wp6
trans.asc
Section 5: Case histories
cases.wp6
cases.asc
Appendices
append.wp6
append.asc

PREFACE

The appearance of the ICD-10 Classification of Mental and Behavioural Disorders in itsvarious versions and many languages has been an event of great importance for psychiatry.For the first time in its history psychiatry has produced a classification based on aconsensus of experts and schools of psychiatry world-wide. The new classification is acornerstone, an essential part of the effort to develop a language which will allownational and international communication in the field of mental health and facilitatejoint work across cultures and countries. The production of the classification and of theassessment instruments which are linked to it was an important first step: the nextchallenge is to familiarise psychiatrists and other mental health workers - as well asothers involved in mental health and general health care - with the principles on whichthe ICD classification of mental disorders is based and to help them to use it well.

The nature of this challenge makes collaboration between governmental andnongovernmental organizations in the conduct of relevant programmes highly desirable.WHO's international network of centres and experts which has helped in the development ofthe classification and other WHO mechanisms facilitating technical cooperation are clearlyof great importance in this effort: it is however obvious that the education ofpsychiatrists and of others dealing with mental illness will be greatly helped if majornon-governmental organizations participate in this activity. Among the latter, the WorldPsychiatric Association is already in a particularly useful position because it bringstogether more than 100 psychiatric associations which count among its members the vastmajority of psychiatrists worldwide. The WPA has collaborated in the formulation of theICD-10 participating in a special committee, chaired by the late Professor E. Strömgren,through the WPA's Section on Classification and Diagnosis and by contributions to thedevelopment of the ICD-10 made by many of WPA's member societies.

In view of the above, the Division of Mental Health and Prevention of Substance Abuseof the World Health Organization and the World Psychiatric Association have agreed tocollaborate in the development of materials that can be used in training on the ICD-10classification of mental disorders and its assessment instruments. These materials weremade available to WHO collaborating centres, to the WPA member societies, to institutionsinvolved in the teaching of psychiatry, to other non-governmental organizations and toministries of health of WHO Member States.

The materials which are included in the present educational programme include:

  1. standard curricula for workshops introducing ICD-10;
  2. sheets to be used for the production of transparencies or slides;
  3. a set of case history exercises;
  4. models that can be used for an evaluation form and for a certificate;
  5. a list of selected references;
  6. other appendices, e.g., listings of training centres, and guidelines for the production of case histories and videotapes.
Further information can be obtained from:

WHO
Prof Jorge Alberto Costa e Siva
Director
Division of Mental Health and Prevetion of Substance Abuse
World Health Organization Tel: +41 (22) 791 3617
1211 Geneva, Switzerland Fax: +41 (22) 791 4160

WPA
Prof N. Sartorius
WPA President
Department of Psychiatry, University of Geneva
Bd. Saint George Tel: +41 (22) 327 7582
105 Geneva, Switzerland Fax: +44 (22) 327 7575

Prof J.J. Lopez-Ibor Jr
WPA President Elect
Clínica Lopez-Ibor
Av. Nueva Zelanda 44 Tel: +34 (1) 373 7361
28035 Madrid, Spain
Fax: +34 (1) 316 2749

Dr. R. Montenegro
WPA Secretary for Education
Juncal 2425 8ºB Tel: +54 (1) 823 8381
1425 Buenos Aires, Argentina
Fax: +54 (1) 821 45 40

Or from the ICD-10 Reference and Training Centres for Classification, Diagnosis andAssessment in the Field of Mental Health

Prof A. Bertelsen
Institute of Psychiatric Demography
Psychiatric Hospital
University of Aarhus Tel: +45 (86) 17 77 77
8240 Risskov, Denmark
Fax: +45 (86) 17 59 77

Prof H. Dilling
Klinik für Psychiatrie der Medizinischen Hochschule
Ratzeburger Allee 160 Tel: +49 (451) 500 2440
23562 Lübeck, Germany
Fax: +49 (451) 500 2603

Dr G. Harrison
Department of Psychiatry, Mapperley Hospital,
Porchester Road, Tel: +44 (115) 952 9406
Nottingham NG3 6AA, UK Fax: +44 (115) 985 6396

Prof J.J. Lopez-Ibor Jr
Servicio de Psiquiatria, Hospital Universitario San Carlos
28040 Madrid, Spain Tel/fax: +34 (1) 330 3574

Dr R.S. Murthy
National Institute of Mental Health and Neurosciences
Department of Psychiatry Tel: +91 (80) 642121
Bangalore 560029, India Fax: +91 (80) 6631 830

Prof Y. Nakane
Department of Neuropsychiatry
Nagasaki University, School of Medicine
7-1 Sakamoto-Machi Tel: +81 (958) 47 21 11
Nagasaki 852, Japan Fax: +81 (958) 49 43 72

Prof A. Okasha
Institute of Psychiatry, Ain Shams University
3 Shawarby Street
Kasr-El-Nil Tel: +20 (2) 3350 233
Cairo, Egypt Fax: +20 (2) 348 1786

Prof Ch. Pull
Service de Neuropsychiatrie
Centre Hospitalier de Luxembourg
4 rue Barblé Tel: +352 4411 2256
1210 Luxembourg Fax: +352 458 762

Dr D. Regier
Director, Division of Epidemiology and Services Research
NIMH, Room 10-105
5600 Fishers Lane Tel: +1 (301) 443 3648
Rockville, MD 20857, USA Fax: +1 (301) 443 4045


ACKNOWLEDGEMENTS

The compilation of these training materials has been made possible by the generoussupport and guidance provided by the experts listed blow. Their contributions areacknowledged with gratitude:

Dr A. Bertelsen, Risskov, Denmark
Dr J.E. Cooper, Nottingham, United Kingdom
Dr H. Dilling, Lübeck, Germany
Dr M. Gelder, Oxford, United Kingdom
Dr G. Harrison, Nottingham, United Kingdom
Dr A. Janca, Geneva, Switzerland
Dr Y. Nakane, Nagasaki, Japan
Dr A. Okasha, Cairo, Egypt
Dr C. Pull, Luxembourg, Luxembourg
Dr B. Üstün, Geneva, Switzerland
SECTION 1
PRESENTATIONS AND WORKSHOPS


Introduction

The materials included in this package can be used in different settings and for thetraining of various audiences. The different options are summarized in the table I,followed by more detailed information on the following pages. Section 3 (page 15 listsmaterials for the trainer and the participants.
The first option is appropriate when time is limited to one to two hours. Thelecture should make participants understand the nature of the ICD-10 Classification ofMental and Behavioural Disorders. The lecture could be given to any qualified audience, inany setting, and for any number of participants. The presentation can be supported by alimited number of transparencies or slides (listed in Section 4). This lecture can be inserted into the one-day training course on the use of the PrimaryCare Version of ICD-10 Mental and Behavioural Disorders (see option 4) or within any othercourse on psychiatric matters.
Option 2 is recommended, when the purpose of the presentation is to familiarizethe audience with the classification to a degree which will enable them to use ICD-10 inclinical practice. This familiarization workshop lasts a minimum of two half days,contains several lectures and offers the participants a possibility of doing somediagnostic exercises. The full set of transparencies and slides, offered in this trainingpackage (Section 4), would be useful for such a workshop: the trainers may, however, wishto select a subset according to the interest of the audience and complement it with other materials.
This familiarization workshop could be combined with training in the use of themultiaxial presentation of Chapter V of ICD-10, for which a separate training package isavailable, or with training in the application of the Diagnostic Criteria for Research(see options 3a and 3b).
Option 2 could also be combined with familiarization or full training courses for theICD-10 related instruments, CIDI, SCAN or IPDE, which are available separately, usuallylasting 5 days.
Future trainers should familiarize themselves with the classification. A workshop forfuture trainers may be composed of option 2 with an extra day for diagnostic exercises and discussion.

Table I: Overview of options for ICD-10 presentations and workshops

Option
Description/purpose Duration Number of lecturers Number of participants Type of audience
1 Lecture: understanding ICD-10 1-2 hours 1 or 2 unlimited mental health workers
2 ICD-10 Ch. V familiarization workshop 2 half days 3 or 4 ca. 50 mental health workers, who will use ICD-10 in clinical work
3a Option 2 plus familiarization multiaxial presentation 3 half days 3 or 4 ca. 50 as in option 2
3b Option 2 plus familiarization diagnostic criteria for research 3 half days 3 or 4 ca. 50 as in option 2
4 Option 1 plus familiarization with primary care version 1 day 2 10-15 health workers in primary care (e.g. general practicioners)

Option 1
Lecture: Understanding ICD-10 Ch. V

Duration: ca. 2 hours

Objective: to present the International Classification of Mental and Behaviouraldisorders (ICD-10 Ch. V) and associated texts and instruments. At the end of the lecturethe participants will be able to understand the basic principles, the structure and thepractical rules of the ICD-10 classification.

Number of participants: unlimited.
Target group: (mental) health workers: psychiatrists, general practitioners,coders.
Number of presentators: 1 or 2.
Material to be used: selected transparencies or slides (see Section 4).
Material to be distributed (optional):

  • paper copies of transparencies that are used during the lecture, with room for personal notes;
  • evaluation form: name and address and a few questions (see appendix 7);
  • pocket reference booklet: "Understanding the ICD-10" by N. Sartorius.
Structure and global time distribution:
(i) General presentation of ICD-10 15 min

(ii) Main differences between ICD-9 and ICD-10
Relationship between ICD-10 and national and speciality classifications, e.g. DSM-IV 10 min

(iii) Chapter V, overview of contents
The ICD-10 family and its members 45 min
  • clinical and diagnostic guidelines
  • diagnostic criteria for research
  • multiaxial presentation
  • version for primary health care
  • conversion tables
  • computer applications
(iv) ICD-10 related assessment instruments 15 min
  • ICD-10 Checklists
  • CIDI, SCAN, and IPDE
(v) Illustration with case history and coding according to ICD-10 15 min
Explanation of some coding rules

(vi) General information on familiarization and training workshops 5 min

(vii) Discussion 15 min

Option 2

ICD-10 Ch. V familiarization workshop

Duration: two half days of 3 hours each

[Note: The duration of the workshop may be lengthened to 1 12 day, which would offertime for more case history exercises, preferably locally prepared, and presentation oflocal experience with use of ICD-10]

Objective: to familiarize participants with the application of the InternationalClassification of Mental and Behavioural Disorders (ICD-10 Ch. V) and its variousversions, and to present the related assessment instruments. At the end of the workshopthe participants will be able to use the ICD-10 classification in their clinical work.

Number of participants: up to 50.

Target group: mental health workers: psychiatrists, psychologists and others.

Number of trainers: 3 or 4.

Material to be used: complete training kit.

Material to be distributed (optional):
  • paper copies of transparencies that are used during the lecture (see appendix 9);
  • forms for recording diagnoses (see appendix 6);

    - evaluation form: name and address and a few questions (see appendix 7);

  • certificate to participants for ICD-10 Ch. V familiarization workshop (see appendix8);
  • pocket reference booklet: "Understanding the ICD-10" by N.Sartorius;
  • written case histories (see Section 5).
Option 2 (cont'ed) Structure and global time distribution
(for detailed description of thepresentations see Contents of the ICD-10 lectures, Section 2 )
First part

(i) General presentation of ICD-10 20 min

(ii) Main differences between ICD-9 and ICD-10
Relationship between ICD-10 and national classifications, e.g. DSM-IV 10 min

(ii) Presentation of Chapter V, features 15 min
  • Description of the ICD-10 family and its members 45 min
  • Contents of Chapter V
  • Coding rules and guidelines
  • Future of ICD-10 60 min
(iii) Illustration with case history presentation
(written, video-taped or life) 15 min

(iv) Discussion 15 min
Second part

(v) 5 case history exercises
Plenary discussion of problems encountered during exercises (see note on case history exercises, above) 120 min

(vi) ICD-10 related assessment instruments 45 min
  • ICD-10 Checklists
  • CIDI
  • SCAN
  • IPDE

(vii) Discussion and closure 15 min

Option 3

ICD-10 Ch. V familiarization workshop in combination withfamiliarization with the multiaxial presentation (3a), or diagnostic criteria for research (3b)

Option 3a. ICD-10 Ch. V familiarization workshop (option 2) in combination with familiarization with the multiaxial presentation

Duration:three half days of 3 hours each. The third period of three hours will beused to familiarize the participants with the multiaxial schema.

Objective: to familiarize participants with the application of the InternationalClassification of Mental and Behavioural Disorders (ICD-10 Ch. V) and its variousversions, to present the related assessment instruments, and to familiarize theparticipants with its multiaxial presentation. At the end of the workshop the participantswill be able to use the ICD-10 classification as well as its multiaxial presentation intheir clinical work.

Number of participants: up to 50.

Target group: mental health workers: psychiatrists, psychologists and others.

Number of trainers: 3 or 4.

Material to be used: complete training set and the Multiaxial Presentation text.

Material to be distributed: see option 2.

  • paper copies of transparencies that are used during the lecture (see appendix 9);
  • forms for recording diagnoses (see appendix 6);
  • evaluation form: name and address and a few questions (see appendix 7);
  • certificate to participants for ICD-10 Ch. V familiarization workshop (see appendix8);
  • pocket reference booklet: "Understanding the ICD-10" by N.Sartorius;
  • copy of the Multiaxial version of ICD-10 chapter V;
  • written case histories (see Section 5).
Option 3b ICD-10 Ch. V familiarization workshop (option 2) in combination with familiarization with the diagnostic criteria for research

Duration: three half days of 3 hours each. The third period of three hours will beused to familiarize the participants with the diagnostic criteria for research.

Objective: to familiarize participants with the application of the InternationalClassification of Mental and Behavioural Disorders (ICD-10 Ch. V) and its variousversions, to present the related assessment instruments, and to familiarize theparticipants with the diagnostic criteria for research. At the end of the workshop theparticipants will be able to use the ICD-10 classification and the research criteria,accompanying Chapter V, in their clinical and research work.

Number of participants: up to 50.

Target group: mental health researchers: psychiatrists, psychologists and others.

Number of trainers: 3 or 4.

Material to be used: complete training set and in addition the Diagnostic Criteriafor Research (Green Book).

Material to be distributed: (optional):
  • paper copies of transparencies that are used during the lecture (see appendix 9);
  • forms for recording diagnoses (see appendix 6);
  • evaluation form: name and address and a few questions (see appendix 7);
  • certificate to participants for ICD-10 Ch. V familiarization workshop (see appendix8);
  • pocket reference booklet: "Understanding the ICD-10" by N.Sartorius;
  • copy of the Diagnostic Criteria for Research version of the ICD-10 chapter V;
  • written case histories (see Section 5).
Option 4 Lecture on ICD-10 Ch. V, in combination with familiarization with thePrimary Care Version

Duration: 1 day

Objective: to present the International Classification of Mental and Behaviouraldisorders (ICD-10 Ch. V) and associated texts and instruments (option 1), and to enablethe participants to use the Primary Care Version of the ICD-10 Chapter V in their dailypractice.

Number of participants: 10-50.

Target group: general practitioners, and others health workers in primary care.

Number of presentators: 1 to 2.

Material to be used: selected transparencies or slides, as in option 1, andtraining materials for the primary care version (available on demand).

Material to be distributed (optional):
  • paper copies of transparencies that are used during the lecture, with room for personal notes;
  • evaluation form (see appendix 7);
  • pocket reference booklet: "Understanding the ICD-10" by Sartorius;
  • copy of the Primary Care Version of the ICD-10 Chapter V.
SECTION 2

CONTENTS OF THE ICD-10 LECTURES

Part 1

General Presentation of ICD-10

Historical development of ICD

Purposes of ICD-10

WHO Family of International Classifications

Specialty-based adaptations of ICD-10
  • Neurological Adaptation
  • Psychiatric version for administrators
Presentation of ICD-10 structure:
  • listing of chapters
  • explanation of ICD-10 codes
  • listing of other related codes (Z codes)
  • Part 2

    Presentation of Chapter V

    Development of common language in psychiatry

    Main differences between the classification of mental and behavioural disorders in ICD-10 and in previous versions, e.g. ICD-9

    Relationships between ICD-10 Chapter V and national and specialty classifications, e.g. the International Classification of Sleep Disorders and DSM-IV

    Features of Chapter V, results of field trials of Chapter V

    Family of Chapter V

    Different versions of the classification

    Short Glossary (contained in ICD-10)

    Clinical Descriptions & Diagnostic Guidelines (Blue book)

    Diagnostic Criteria for Research (Green book)

    ICD-10 Primary Care Version

    Multiaxial Presentation of ICD-10

    Tools

    conversion tables

    lexica

    computer applications

    casebook

    Training materials

Contents of Chapter V
  • organization of chapter
  • overview of content, section by section (F0 - F9)
  • explanation of coding rules and guidelines

Part 3

WHO ICD-10 related assessment instruments
  • Description of instruments
  • principles of application
  • information on training courses
  • sample pages or items
  • how to obtain the instruments
ICD-10 Checklists
CIDI
SCAN
IPDE

Optional

Part 4

Presentation of experiences with ICD-10 in the local context

Presentation of the translation of ICD-10 & related instruments

Specific issues arising when using ICD-10 in the country

Adapting ICD-10 in the specific culture and language group

Local field trials and results

Future work on the ICD-10

SECTION 3

MATERIALS USEFUL FOR TRAINING

Note:
    • Part I and II of this section lists those materials that are included in this training set.

    • Concerning the materials listed in Part III and IV of this section, some are available on request, others are not yet available and again others are to be obtained elsewhere, as indicated in the list.

    • The items marked with * are intended only for the participants of option 2.

    I. Materials to be used by the trainer

    1. Introduction
    2. Curricula: options for presentation of, or familiarization with ICD-10 Chapter V and possibilities of combination with additional courses on members of the "family" of ICD-10 Chapter V
    3. Editorial guidelines for production of "local"case histories (see appendix 2)
    4. Complete set of transparencies, (or slides)
    5. Videotapes (see Guidelines for the production of videotapes, appendix 3)
    6. Additional information on various subjects:
      list of training and reference centers for ICD-10 Chapter V
    II. Materials to be distributed to the participants (optional)

    1. Pocket reference: "Understanding the ICD-10", by N. Sartorius, Sciencepress, 1995
    2. List of key references (see appendix 1)
    3. Set of paper copies of slides or transparencies, used during the lecture, with room for personal notes
    4. Reprints of key articles with background information:
    1. Sartorius N. WHO's work on the epidemiology of mental disorders.Soc Psychiatr Epidemiol (1993) 28: 147-155
    2. Sartorius N. et al. Progress towards achieving a common language in psychiatry: results from the field trails of the clinical guidelines accompanying the WHO Classification of Mental and Behavioural Disorders in ICD-10. Archives of General Psychiatry (1993) 50: 115-124.
    3. Janca A, Üstün TB, Sartorius N. New versions of World Health Organization instruments for the assessment of mental disorders. Acta Psychiatr Scand (1994) 90: 73-83
    1. * 3 sets of 5 case histories, to be used during the diagnostic case historyexercises
    2. * Form for recording of diagnosis (see appendix 6)
    3. * Forms for evaluation of lecture or workshop (see appendix 7)
    4. * Certificate for participation in familiarization workshop of ICD-10 Ch V, SCAN, CIDI or IPDE, to be prepared by local organizer(see appendix 8)
    III. Materials which the trainer should know well

    1. ICD-10, volume 1, 2 and 3
    2. ICD-10 Chapter V Clinical Descriptions and Diagnosic Guidelines version (Blue Book)
    3. ICD-10 Chapter V Diagnostic Criteria for Research version (Green Book)
    4. Checklists
    5. Conversion tables between ICD-8, ICD-9, ICD-9-CM and ICD-10, rev. 1, 1994
    6. Casebook
    7. ICD-10 Chapter V Multiaxial version
    8. Primary care version
    9. Catalogue of WHO assessment instruments
    10. Lexica
    11. Multilingual dictionary
    12. Appendix of DSM-IV with ICD-10 codes

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