ICD 10 Training Kit - (in collaboration with WHO)
SECTION 4 - TRANSPARENCIES
A. Listing of transparencies, for use in the ICD-10 educational programme
1. General information about the ICD
1.1 Why it is necessary to classify mental disorders
1.2 Classification: definitions of key concepts
1.3 Requirements of an international classification
1.4 International Classification of Diseases: History (1)
1.5 International Classification of Diseases: History (2)
1.6 International Statistical Classification of Diseases and Related Health Problems, 10th Revision.
1.7 ICD-10 Composition of chapters (1)
1.8 ICD-10 Composition of chapters (2)
1.9 Examples from Chapter XX
1.10 Examples from Chapter XXI
1.11 ICD-10 family of disease and health-related classifications
1.12 Other health-related classifications
1.13 International nomenclature of diseases
1.14 Structure of an ICD-10 Code
1.14 Administrative version of ICD-10 Chapter V
1.15 Application of ICD-10 to neurology (ICD-NA, second edition): Aims
1.16 ICD-10 NA: contents
1.17 Example of a category in the ICD-10 NA
1.18 ICD-10 Guides, linked to Chapter V and VI of ICD-10, in development
2. Development of the International Classification of Mental and Behavioural Disorders (ICD-10 Ch. V)
2.1 ICD-10 Chapter V: main innovations
2.2 Main innovations (1): Expansion of the provision for categories important for general health care
2.3 Main innovations (2): Bringing together related categories
2.4 Main innovations (3): Conceptual changes for public health reasons
2.5 Calendar of Events
2.6 Development of a Common Language in Psychiatry: 1965-1996 (1)
2.7 Development of a Common Language in Psychiatry: 1965-1996 (2)
2.8 Aims of ICD-10 Chapter V
2.9 Features of ICD-10 Chapter V (1)
2.10 Features of ICD-10 Chapter V (2)
2.11 Features of ICD-10 Chapter V: Based on consensus (1)
2.12 Features of ICD-10 Chapter V: Based on consensus (2)
2.13 Features of ICD-10, Chapter V: Based on field trials (1): Overview of field tests of different versions
2.14 Features of ICD-10, Chapter V: Based on field trials (2): Objectives of field trials
2.15 Features of ICD-10, Chapter V: Based on field trials (3): Results
2.16 Features of ICD-10, Chapter V: Based on field trials (4): Interrater reliablity
2.17 Features of ICD-10 Chapter V: Developed simultaneously in many languages
2.18 Translated in many languages
2.19 Features of ICD-10 Chapter V: Rendered compatible with national classifications and classifications of specialties
2.20 Differences between ICD-10 and a national or specialist classification (1)
2.21 Differences between ICD-10 and a national or specialist classification (2)
2.22 Relationships between ICD-10 and DSM-IV
2.23 Features of ICD-10 Chapter V: Establishment of a network of support centres around the world
3. Family of the international classification of Mental and Behavioural Disorders, Chapter V of ICD-10
3.1 Family of documents related to ICD-10 Chapter V Mental and Behavioural Disorders
3.2 Glossary definition in ICD-10: Example of a short definition
3.3 Clinical descriptions and diagnostic guidelines: Characteristics
3.4 Clinical descriptions and diagnostic guidelines: Example
3.5 Diagnostic criteria for research: Characteristics
3.6 Diagnostic criteria for research: Example
3.7 Diagnostic criteria for research: Example (continued)
3.8 Primary health care version (ICD-10 PHC): Basic features
3.9 Primary health care version (ICD-10 PHC): Selection of categories
3.10 Primary health care version (ICD-10 PHC): List of categories
3.11 Primary health care version (ICD-10 PHC): Components of ICD-10 PHC
3.12 Primary health care version (ICD-10 PHC): Diagnostic guidelines and management guidelines
3.13 Primary health care version (ICD-10 PHC): Example (1): DEMENTIA F00 (presenting complaint)
3.14 Primary health care version (ICD-10 PHC): Example (2): DEMENTIA F00 (diagnostic features)
3.15 Primary health care version (ICD-10 PHC): Example (3): DEMENTIA F00 (differential diagnosis)
3.16 Primary health care version (ICD-10 PHC): Example (4): DEMENTIA F00 (essential information for patient and family)
3.17 Primary health care version (ICD-10 PHC): Example (5): DEMENTIA F00 (specific counselling to patient and family)
3.18 Primary health care version (ICD-10 PHC): Example (6): DEMENTIA F00 (medication and specialist consultation)
3.19 Multiaxial presentation of ID-10: Why do we need axes?
3.20 Multiaxial presentation of ICD-10: Three axes. Contents of axis I
3.21 Multiaxial presentation of ICD-10: Contents of axis II
3.22 Multiaxial presentation of ICD-10: Contents of axis III 3.23 Example of a multiaxial diagnostic formulation
3.24 Conversion tables between ICD-8, ICD-9, ICD-10, and ICD-9-CM: Example of conversion of F50 Eating disorders
3.25 Casebook
3.26 Casebook: Example of case history
3.27 Example of discussion of diagnosis
3.28 Lexica of terms
4. Application of the International Classification of Mental and Behavioural Disorders, Chapter V of ICD-10
4.1 Application of the International Classification of Mental and Behavioural Disorders,Chapter V of ICD-10
4.2 Basic coding rules (1)
4.3 Basic coding rules (2): Main diagnosis
4.4 Basic coding rules (3): Levels of diagnostic confidence
4.5 Basic coding rules (4): Example of the different elements of a diagnosis according to ICD-10
4.6 General conventions on use of terminology (1): Disorder
4.7 General conventions on use of terminology (2): Organic and Symptomatic
4.8 General conventions on use of terminology (3): Psychotic
4.9 General conventions on use of terminology (4): Neurotic
4.10 General conventions on use of terminology (5): Psychogenic
4.11 General conventions on use of terminology (6): Psychosomatic
4.12 General conventions on use of terminology (7): Impairment, Disability and Handicap"
5. Overview of the contents of Chapter V of ICD-10
5.1 Structure of Chapter V
5.2 Section F0: Organic, including symptomatic, mental disorders
5.3 Section F1: Mental and behavioural disorders due to psychoactive substance use
5.4 Section F2: Schizophrenia, schizotypal and delusional disorders
5.5 Section F3 Mood [affective] disorders
5.6 Section F4: Neurotic, stress-related and somatoform disorders
5.7 Section F5: Behavioural syndromes associated with physiological disturbances and physical factors
5.8 Section F6: Disorders of adult personality and behaviour
5.9 Section F7 Mental retardation
5.10 Section F8: Disorders of psychological development
5.11 Section F9: Behavioural and emotional disorders with onset usually
occurring in childhood and adolescence, and Section F99: Unspecified
mental disorder
6. Assessment instruments linked to ICD-10 Chapter V
6.1 Assessment instruments: Purposes
6.2 Assessment instruments: Overview
6.3 ICD-10 checklists
6.4 ICD-10 symptom checklist: Description and example
6.5 ICD-10 symptom glossary: Description and example
6.6 Composite International Diagnostic Interview (CIDI): Purpose and characteristics
6.7 CIDI: How to ask CIDI questions
6.8 Schedules for Clinical Assessment in Neuropsychiatry (SCAN): Purpose and characteristics
6.9 SCAN: Components
6.10 SCAN: Principles of SCAN interview
6.11 SCAN: Sample item from Interview Manual plus glossary definition (overtalkativeness)
6.12 SCAN: sample item from Interview Manual plus glossary definition (distractibility)
6.13 Differences and similarities between CIDI and SCAN
6.11 International Personality Disorder Examination (IPDE): Purpose and characteristics
6.12 IPDE: Description and modules
6.13 IPDE: Sample item (1)
6.14 IPDE: sample item (2)
6.9 WHO Disability Assessment Schedule (DAS): Purpose and characteristics
6.10 WHO Disability Assessment Schedule (DAS): Description
6.11 WHO Disability Assessment Schedule (DAS): Sample item
6.12 WHO Disability Assessment Schedule (DAS): Rating schedule
B. Text for sheets for transparencies
WHY IS IT NECESSARY TO CLASSIFY MENTAL DISORDERS?
- to facilitate reporting about mental disorders and thus allow rational decisions about health care
- to provide a framework for research on the nature of mental disorder
- to simplify and improve communication among health workers and between them and others involved in health care provision and evaluation
CLASSIFICATION: DEFINITIONS OF KEY CONCEPTS
- classification: the activity of placing phenomena or objects into categories according to their characteristics
- classificatory system: a set of categories into which objects or phenomena can be placed
- disorder: is used in ICD-10 to imply the existence of a recognizable set of symptoms and behavioural signs associated in most cases with distress and with interference with personal functions and social roles
- diagnosis: a short statement about a disorder, indicating its origin, cause, probable reaction to treatment, course and outcome
- taxonomy: the study of various strategies of classification
- nosology: the study of disorders according to theories that support the classification of symptoms, signs, syndromes, and disorders
- nosography: the act of assigning names to disorders
- nomenclature: a listing of names of symptoms, disorders and disease
REQUIREMENTS OF AN INTERNATIONAL CLASSIFICATION
It should be:
- comprehensive
- well-defined
- acceptable
- attractive
- reliable
- conservative
- compatible with
- previous classifications
- classification of other sectors (e.g. social insurance)
- monitoring procedures (e.g. epidemiological reports)
INTERNATIONAL CLASSIFICATION OF DISEASES
1853 First International Statistical Conference
1893 Adoption of the International Statistical Classification of Causes of Death
1900, 1910, 1920, 1929
Revisions 1 - 4 of International List of Causes of Death
1938 Revision 5 of List of Causes of Death (ICD-5):
Cat. 84. Mental diseases and deficiency
a. Mental deficiency
b. Schizophrenia
c. Manic depressive psychosis
d. Other mental diseases
1946 WHO is entrusted with task to prepare 6th revision and to establish an International List of Causes of Morbidity
INTERNATIONAL CLASSIFICATION OF DISEASES
1948 First World Health Assembly:
Adoption of Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-6)
1955 ICD-7
Section V: Mental, psychoneurotic and personality disorders contains 26 three-digit categories
1965 ICD-8
Chapter V Mental Disorders (wit glossary definitions)
1974 Publication of Glossary accompanying ICD-8
1975 ICD-9
Chapter 5 cotains 30 three-digit categories
1989 Adoption of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10)
Chapter V Mental and Behavioural Disorders contains 78 three-character categories
1994 Introduction of the ICD-10 into health services as a reporting system by WHO member states
INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASE AND RELATED HEALTH PROBLEMS TENTH REVISION
Geneva, World Health Organization
Vol. 1: Tabular list (1992)
Vol. 2: Instruction manual (1993)
History
Rules and guidance for coding
Vol. 3: Index (1994)
Alphabetical
With synonyms and inclusion terms
ICD-10 COMPOSITION OF CHAPTERS (1)
Chapter number and designation Range of codes
I Certain infectious and parasitic diseases A00-B99
II Neoplasms C00-D48
III Disease of the blood and bloodforming organs and certain disorders involving the immune mechanism D50-D89
IV Endocrine, nutritional and metabolic diseases E00-E90
V Mental and behavioural disorders F00-F99
VI Diseases of the nervous system G00-G99
VII Diseases of the eye and adnexa H00-H59
VIII Diseases of the ear and mastoid process H60-H95
IX Diseases of the circulatory system I00-I99
X Diseases of the respiratory system J00-J99
XI Diseases of the digestive system K00-K93
XII Disease of the skin and subcutaneous tissue L00-L99
XIII Diseases of the musculo-skeletal M00-M99 system and connective tissue
ICD-10 COMPOSITION OF CHAPTERS (2)
Chapter number and designation Range of codes
XIV Disease of the genito-urinary system N00-N99
XV Pregnancy, childbirth and the puerperium O00-O99
XVI Certain conditions originating in the perinatal period P00-P95
XVII Congenital malformations, deformations, and chromosomal abnormalities Q00-Q99
XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified R00-R99
XIX Injury, poisoning and certain other consequences of external causes S00-T98
XX External causes of morbidity and mortality V01-Y98
XXI Factors influencing health status and contact with health services Z00-Z98
EXAMPLES (1)
Chapter XX External causes of morbidity and mortality
Intentional self-harm (X60-X84)
X61 Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified (Includes: barbiturates, tranquillizers, etc.)
X70 Intentional self-harm by hanging, strangulation and suffocation
X80 Intentional self-harm by jumping from a high place
EXAMPLES (2)
Chapter XXI Factors influencing health status and contact with health services
Persons encountering health services for examination and investigation (Z00-Z13)
Z03.2 Observation for suspected mental and behavioural disorders
Z04.6 General psychiatric examination, requested by authority
Persons with potential health hazards related to socioeconomic circumstances (Z55-Z65)
Z55 Problems related to education and literacy
Z55.3 Underachievement in school
Z56 Problems related to employment and unemployment
Z56.2 Threat of job loss
Z60 Problems related to social environment
Z60.3 Acculturation difficulty
Z65 Problems related to other psychosocial circumstances
Z65.4 Victim of crime and terrorism (Includes victim of torture)
FAMILY OF DISEASE AND HEALTH-RELATED CLASSIFICATIONS
INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS
ICD-10
ICD 3-character core
Short tabulation lists
ICD
4-character classification
OTHER HEALTH RELATED CLASSIFICATIONS
Classification of Impairments, Disabilities and Handicaps
Procedures
Reasons for encounter (complaints)
INTERNATIONAL NOMENCLATURE OF DISEASES (IND)
Objectives:
- to provide, for each morbid entity, a single recommended name
- to provide for each disease a definition, as unambiguous and brief as possible
- to provide synonyms for each disorder after each definition
Available:
- Diseases of the lower respiratory tract (WHO, 1979)
- Cardiac and vascular diseases (WHO, 1989)
- Diseases of the digestive system (WHO, 1990)
- Metabolic, nutritional and endocrine disorders (WHO, 1991)
- Diseases of the kidney, the lower urinary tract, and the male genital system (WHO, 1992)
- Diseases of the female genital system (WHO, 1992)
- Infectious diseases (WHO, 1992)
STRUCTURE OF AN ICD-10 CODE
- mental and behavioural disorders
- section on schizophrenia and related disorders
- schizophrenia
- hebephrenic type
- continous course
An extra number may be used as a subdivision for special purposes
ADMINISTRATIVE VERSION OF ICD-10 CHAPTER V
Aims: to provide administrators in psychiatric hospitals and psychiatrists, concerned with coding, with a convenient tool
Contents: ICD-10 chapter V, including glossary definitions
Other conditions, frequently seen in mental health care facilities
Conversion tables between ICD-8, -9, -10 and ICD-9-CM (Clinical Modification)
Index
APPLICATION OF ICD-10 TO NEUROLOGY
(ICD-NA, SECOND EDITION)
Aims:
- To provide a code for each recognized neurological disorder
- To encourage making detailed diagnoses and the recording of all disorders present
- To provide standard recording system for neurological disorders, available in several languages
-
To facilitate national and international epidemiological research for
support of programmes of prevention and control of neurological
disorders
APPLICATION OF ICD-10 TO NEUROLOGY
(ICD-10 NA)
Contents:
Instructions and recommendations for the use of ICD-10 NA
Tabular list of neurological and related disorders
Morphology of neoplasms, numerical list
Acknowledgements
Index, including list of drugs and chemicals
EXAMPLE OF A CATEGORY IN THE ICD-10 NA
G43 Migraine
Use additional external cause code (Ch.XX) if desired to identify drug, if drug-induced
Excludes : headache NOS (R51)
atypical facial pain (G50)
G43.0 Migraine without aura
[common migraine]
G43.1 Migraine with aura [classical migraine]
G43.10 With typical aura
G43.11 With prolonged aura
G43.12 With acute onset aura
Use sixth character, if desired, to identify neurological symptoms:
G43.1x0 Hemianoptic and other visual migraine
G43.1x1 Hemisensory migraine
G43.1x2 Migraine with aphasia
G43.1x3 Basilar migraine
G43.1x4 Migraine aura (all types) without headache
G43.1x5 Familial hemiplegic migraine
G43.1x7 Multiple types of aura
G43.1x8 Other specified migraine with aura
ICD-10 GUIDES IN DEVELOPMENT
- Headaches
- Mental retardation
- Cerebrovascular disorders
- Epilepsy
- Movement disorders
ICD-10 CHAPTER V: MAIN INNOVATIONS
- EXPANSION OF THE PROVISION FOR CATEGORIES IMPORTANT FOR GENERAL HEALTH CARE
- BRINGING TOGETHER RELATED CATEGORIES
- CONCEPTUAL CHANGES FOR PUBLIC HEALTH REASONS
MAIN INNOVATIONS (1)
EXPANSION OF THE PROVISION FOR CATEGORIES IMPORTANT FOR GENERAL HEALTH CARE
- Acute and transient psychotic disorders
- Somatoform disorders
- Stress-related disorders
- ICD-9 rubric "Sexual deviations and disorders" split into three categories: Disorders of sexual preference, gender identity disorders and sexual dysfunctions
- Childhood and developmental disorders
MAIN INNOVATIONS (2):
BRINGING TOGETHER RELATED CATEGORIES
- Organic disorders
- Alcohol and drug-related disorders
- Affective disorders
- Disorders with onset specific to childhood and adolescence
MAIN INNOVATIONS (3):
CONCEPTUAL CHANGES FOR PUBLIC HEALTH REASONS
- Substance abuse section: 3-character code for the substance involved
- "Culture-bound" syndromes to be classified according to predominant psychopathology
ICD-10: CHAPTER V: CALENDAR OF EVENTS
- 1964-1976 "Programme A"
- 1980-1981 Reviews of Literature and Scientific Group Meetings
- 1981 Copenhagen "Strategic" Conference
- 1983-1996 Drafting of texts; technical meetings; circulation of texts & revisions
- 1987 Prefinal draft
- 1987-1990 Field tests of Clinical Guidelines & Research Criteria
- 1992 Publication of Clinical Guidelines
- 1993 Publication of Research Criteria
- 1991-1995 Completion of tests of PHC version, multiaxial version and instruments
- 1996 Publication of PHC version,
- 1997 multiaxial version and instruments (CIDI, SCAN, IPDE)
- 1965-1996: DEVELOPMENT OF A COMMON LANGUAGE IN PSYCHIATRY (1)
- 1965-1974 WHO Programme A
Aims:
- standardization of psychiatric diagnosis, classification and statistics
- development of transculturally applicable and acceptable instruments for reliable assessment of the mentally ill
Resulting inter alia in:
- ICD-8 (1967) with GLOSSARY;
- the Present State Examination (PSE) and other crossculturally applicable instruments
- and a collaborative, global network
1965-1974 Collaborative international research with important implications for diagnosis and classification:
- UK-US Diagnostic study on psychiatric diagnosis
- WHO International pilot study of schizophrenia (IPSS)
1965-1996: DEVELOPMENT OF A COMMON LANGUAGE IN PSYCHIATRY (2)
1972-1975 Diagnostic Criteria for Research (Feighner and Spitzer)
1978-1986 International study on longterm course and outcome of schizophrenia;
International studies on depression and disability
1980 DSM-III
1983-1993 Development of ICD-10 Chapter V: International Classification of Mental and Behavioural Disorders:
AIMS OF ICD-10 CHAPTER V
to facilitate medical practice and public health action by providing a common language to all concerned.
The acceptance of the diagnostic and classification system proposed in the ICD-10 will enable mental health workers, public health decision makers, statisticians and professionals in disciplines relevant to psychiatry:
- to understand one another
- to share results of research
- to improve and unify training strategies
FEATURES OF ICD-10 CHAPTER V (1)
- based on cnsensus
- based on field trials
developed in collaboration between a Governmental Organization (WHO) and non-Governmental Organizations (WPA, WFN, AD, etc.) - developed simultaneously in many languages
- rendered compatible with national classifications
-
developed in collaboration with a network of centres around the world
participating in relevant research, undertaking translation and
providing training and support to users
FEATURES OF ICD-10 CHAPTER V (2)
- composed of a family of documents:
- different versions of the classification:
- short definitions
- guidelines for diagnosis
- criteria for research
- primary health care version
- multiaxial presentation
- tools:
- conversion tables between ICD-10 and previous revisions
- lexicon of psychiatric and mental health terms
- lexicon of alcohol and drug terms
- lexicon of culture-specific terms in mental health
casebook - training materials - linked to assessment instruments
FEATURES OF ICD-10 CHAPTER V (3)
BASED ON CONSENSUS (1)
STEPS:
- Review of evidence by individual experts,
- A series of workshops each devoted to a disease group,
- A summary strategic conference
- Establishment of a special advisory group to help in setting up the framework for the classification
- Selection and invitation of experts to draft definitions, guidelines and criteria for research
- Production of draft texts by some 50 experts from different parts of the world and from different schools of psychiatry
- Circulation of texts to experts organized in panels for the different groups of disorders
FEATURES OF ICD-10 CHAPTER V (4)
BASED ON CONSENSUS (2)
STEPS (continued):
- Circulation of amended drafts to nongovernmental organizations representing psychiatry and other disciplines.
- Circulation of drafts to member societies of the NGO's and meetings with groups preparing national classifications (e.g. DSM IV, French classification of disorders in childhood)
- Presentation of drafts to heads of ICD-10/MH centres for comments and approval from the point of view of translatability
- Finalization of drafts and field trials
- Finalization of texts, taking into account results of field trials
FEATURES OF ICD-10 CHAPTER V (5)
BASED ON FIELD TRIALS (1)
Overview of field trials of different versions
| Version | Countries | Centers | Clinicians | Patients |
| Clinical | 39 | 112 | 711 | 15,302 |
| Research | 32 | 150 | 150 | 13,793 |
| Multiaxial | 35 | 75 | 200 | 4,330 |
| Primary care | 45 | 20 | 564 | 3,123 |
FEATURES OF ICD-10 CHAPTER V (6)
BASED ON FIELD TRIALS (2)
Objectives of field trials of the classification and of the clinical descriptions and diagnostic guidelines (1987 draft):
I. Assessment of ease to understand and to use thenew classification
II. Assessment of goodness of fit in routine clinical practice
III. Assessment of inter-rater reliability of users in different countries and internationally
FEATURES OF ICD-10 CHAPTER V (7)
BASED ON FIELD TRIALS (3)
Results from the Clinical Descriptions and Diagnostic Guidelines version field trials (1)
Clinicians' assessment:
- easy to use 85%
- good fit 82%
- feeling confident in making diagnosis 91%
- reliability: weighted kappas .60 - .100
FEATURES OF ICD-10 CHAPTER V (8)
BASED ON FIELD TRIALS (4)
Results from the Clinical Descriptions and Diagnostic Guidelines version field trials (2)
Interrater reliability for major groups of disorders (kappa coefficients)
F0: 0,78 F5: 0,91
F1: 0,80 F6: 0,51
F2: 0,82 F7: 0,77
F3: 0,77 F8: not enough cases
F4: 0,74 F9: 0,74
overall agreement: at 2 character level: 0,81
at 3 character level: 0,71 at 4 character level: 0,59
FEATURES OF ICD-10 CHAPTER V (9)
DEVELOPED SIMULTANEOUSLY IN MANY LANGUAGES
- ARABIC
- CHINESE
- ENGLISH
- FRENCH
- GERMAN
- JAPANESE
- PORTUGUESE
- RUSSIAN
- SPANISH
OTHER LANGUAGES INTO WHICH ICD-10 CHAPTER V HAS BEEN TRANSLATED
(until march 1996)
- BULGARIAN
- CROATIAN
- CZECH
- DANISH
- DUTCH
- ESTONIAN
- FARSI (IRAN)
- GREEK
- HEBREW
- HUNGARIAN
- INDONESIAN
- ITALIAN
- KOREAN
- LATVIAN
- LITHUANIAN
- NORWEGIAN
- POLISH
- RUMANIAN
- SERBIAN
- SWEDISH
- THAI
- TURKISH
- UKRAINIAN
- VIETNAMESE
FEATURES OF ICD-10 CHAPTER V (10)
RENDERED COMPATIBLE WITH NATIONAL CLASSIFICATIONS AND CLASSIFICATIONS OF SPECIALTIES
DSM-III, DSM-IIIR, DSM-IV
- French INSERM classification
- French classification of childhood mental disorders
- Indonesian official classification of mental disorders
- Nordic countries' classification
- Russian classification
- classification of Alzheimer International Association
- classification of epilepsy
- classification of headaches
- classification of sleep disorders
- and others
DIFFERENCES BETWEEN ICD-10 AND A
NATIONAL OR SPECIALIST CLASSIFICATION (1)
ICD-10 |
National or specialists classifications |
| WHO Member States use ICD-10 for official reporting about disease and death | The use of a national classification does not obviate the need to also report data in ICD-terms, for all official purposes |
| Continuity between revisions of the classification is considered essential | Continuity is desirable;innovations are welcome |
| The general structure of ICD-10 imposes limitations on structure and contents of Chapter V | No limitations concerning structure |
| Chapter V is part of a comprehensive classification of all diseases and disorders, and includes other reasons for contact of health services | It is not part of an overall classification |
| Adopted by national governments and used for reporting by intergovernmental agencies (i.e. WHO) | Approved by national or international professional organizations |
DIFFERENCES BETWEEN ICD-10 AND A
NATIONAL OR SPECIALIST CLASSIFICATION (2)
ICD-10 |
National or specialist classifications |
| Translation into oter languages is an integral part of development | May be translated after it as been developed |
| ICD-10 reflects current usage in psychiatry | Is directive concerning utilization in practice |
| ICD-10 is a uniaxial classification which can be presented in a multiaxial way | Different axes are independent |
| Developed in different versions for different users | Ussually exists in only one version |
| Social criteria are as far as possible avoided | Social criteria are used |
| ICD-10 is a member of a family of classifications | Ussually independent, sometimes with various presentations |
RELATIONSHIPS BETWEEN ICD-10 CHAPTER V AND DSM-IV
COLLABORATION IN DEVELOPMENT
- Experts were involved who worked both on ICD-10 and DSM developments
- Activities undertaken in the framework of the Joint Project of WHO and ADAMHA (USA), from 1982-1995 contributed to the scientific basis of both classifications
- The National Institute of Mental Health (USA) has sponsored special meetings (during 1988-1991) to facilitate harmonious development of ICD-10 and DSM-IV
- Field trials of ICD-10 and DSM-IV were carried out in the US and elsewhere (often in the same centres)
FEATURES OF ICD-10 CHAPTER V (11)
ESTABLISHMENT OF A NETWORK OF SUPPORT CENTRES AROUND THE WORLD:
WHO Training and Reference Centres on Classification, Diagnosis and Assessment of Mental and Behavioural Disorders (ICD-10/MH CENTRES)
coordinating field studies of clinical and research criteria
- AARHUS
- BANGALORE
- BEIJING
- CAIRO
- LUBECK
- LUXEMBOURG
- MADRID
- MOSCOW
- NAGASAKI
- OXFORD
- ROCKVILLE
FAMILY OF DOCUMENTS RELATED TO ICD-10 CHAPTER V
MENTAL AND BEHAVIOURAL DISORDERS
- composed of a family of documents:
- different versions of the classification:
- short definitions
- guidelines for diagnosis
- criteria for research
- primary health care version
- multiaxial presentation
tools:
- conversion tables between ICD-10 and previous revisions
- lexica and glossaries
- casebook
- training materials
linked to assessment instruments
- Composite International Diagnostic Interview (CIDI)
- Schedules for Clinical Assessment in Neuropsychiatry (SCAN)
- International Personality Disorder Examination (IPDE)
GLOSSARY DEFINITIONS IN ICD-10: EXAMPLE
F23.2 Acute schizophrenia-like psychotic disorder
An acute psychotic disorder in which the psychotic symptoms are comparitively stable and justify a diagnosis of schizophrenia, but have lasted for less than about one month. If the schizophrenic symptoms persist the diagnosis should be changed to schizophrenia (F20.-)
Acute (undifferentiated) schizophrenia
Brief schizophreniform disorder or psychosis
Oneirophrenia
Schizophrenic reaction
Excludes: organic delusional [schizophrenia-like disorder (F06.2)
schizophreniform disorder NOS (F20.8)
CLINICAL DESCRIPTIONS AND DIAGNOSTIC GUIDELINES
Characteristics:
- For general clinical and educational use
- Users: psychiatrists and other mental health workers
- Narrative style of description of the main clinical features of each disorder
- Diagnostic guidelines, indicating the number of symptoms usually required for a confident diagnosis
- Allows for a provisional diagnosis, even if not all criteria are fullfilled
CLINICAL DESCRIPTIONS AND DIAGNOSTIC GUIDELINES
Example:
F32.0 Mild depressive episode Diagnostic guidelines
Depressed mood, loss of interest and enjoyment, and increased fatiguability are usually regarded as the most typical symptoms of depression, and at least two of these, plus at least two of a list of other common symptoms (e.g. decreased self-esteem, disturbed sleep) should usually be present for a definite diagnosis. None of the symptoms should be present to an intense degree. Minimum duration of the whole episode is about 2 weeks.
An individual with a mild depressive episode is usually distressed by the symptoms and has some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely.
DIAGNOSTIC CRITERIA FOR RESEACH
Characteristics
- For use in psychiatric research
- Contains precise criteria for diagnoses
- Does not contain descriptions of clinical concepts and must therefore be used in conjunction with the "Clinical Descriptions and Diagnostic Guidelines"
- Criteria are restrictive so as to maximize homogeneity of groups of patients in research
DIAGNOSTIC CRITERIA FOR RESEARCH
Example:
F32 Depressive episode
G1 The depressive episode should last for at least 2 weeks.
G2 There have been no hypomanic or manic symptoms sufficient to meet
the criteria for hypomanic or manic episode (F30.-) at any time in the
individual's life.
G3 Most commonly used exclusion clause: The episode is not attributable
to psychoactive substance use (F10-F19) or to any organic mental
disorder (in the sense of F00-F09).
F32.1 Moderate depressive episode
A. The general criteria for depressive episode (F32) must be met.
B. At least two of the three symptoms listed for F32.0, criterion B
(i.e. depressed mood, loss of interest or pleasure, decreased energy or
increased fatiguability), must be present.
C. Additional symptoms from a list of 7 (e.g. sleep disturbance, change
in appetite)(described in F32.0, criterion C), must be present, to give
a total of at least six.
A fifth character .x0 or .x1 may be used to specify the presence or absence of the "somatic syndrome" (also called "vital" or "melancholic" in other classifications). To qualify for this syndrome 4 from a list of 7 symptoms must be present (e.g. depression worse in the morning).
PRIMARY HEALTH CARE VERSION (ICD-10 PHC)
Basic features:
- reduced number of categories:
- version with 24 categories
- version with 6 categories
- brief definitions
- uses familiar diagnostic terms
- offers guidelines for recognition
- offers guidelines for management
PRIMARY HEALTH CARE VERSION (ICD-10 PHC)
ICD-10 categories which were selected for ICD-10 PHC
- groups of disorders of public health importance
- high prevalence
- associated with significant disablement, morbidity or mortality
- associated with significant burden on family
- health care resources needed to help people with the condition
- for which it is posible to provide effective and acceptable management in PHC setting
List of categories
- F00* Dementia
- F05 Delirium
- F10 Alcohol use disorder
- F11* Drug use disorders
- F17.1 Tobacco use
- F20 Chronic psychotic disorders
- F23* Acute psychotic disorders
- F31 Bipolar disorder
- F32* Depression
- F40* Phobic disorders
- F41.0 Panic disorder
- F41.1 Generalized anxiety disorder
- F41.2 Mixed anxiety and depression
- F43* Adjustment disorders
- (Z63* Bereavement)
- F44* Dissociative disorder
- F45 Unexplained somatic complaints
- F48.0 Neurasthenia
- F50* Eating disorders
- F51* Sleep problems
- F52 Sexual disorders
- F70 Mental retardation
- F90 Hyperkinetic disorder
- F91 Conduct disorder
- F98.0 Enuresis
* An asterisk indicates that more than one ICD-10 code is included (e.g. F00* includes disorders coded in F00-F04)
Components of ICD-10 PHC
listing of categories
- diagnostic and management guidelines for each category
- flow-charts
- symptom index
- supporting material:
- patient leaflets
- medication cards
For each disorder
Diagnostic guidelines
- presenting complaints
- diagnostic features
- differential diagnosis
Management guidelines
- essential information for patient and family
- specific counselling for patient and family
- medication
- need for specialist consultation
Example: DEMENTIA F00 (1)
Presenting complaint
Patients may complain of forgetfulness or feeling depressed, but may be unaware of memory loss. Patients and family may sometimes deny severity of memory loss.
Families ask for help initially because of failing memory, change in personality or behaviour in later stages because of confusion, wandering, or incontinence.
Poor personal hygiene in an older patient may indicate memory loss
Example: DEMENTIA F00 (2)
Diagnostic features
Decline in recent memory, thinking and judgement, orientation, language
Patients often appear apathetic or disinterested, but may appear alert and appropriate despite poor memory.
Decline in everyday functioning (dressing, washing, cooking).
Loss of emotional control - patients may be easily upset, tearful or irritable.
Common in older patients, very rare in youth or middle age.
Tests of memory and thinking include:
- ability to recall names of three common objects immediately and again after three minutes,
- ability to name days of week in reverse order.
Example: DEMENTIA F00 (3)
Differential diagnosis
Examine for other illnesses causing memory loss.
Examples include:
- depression (F32*) anaemia
- urinary infection vitamin B12 or folate
- HIV infection deficiency
- siphilis normal pressure
- subdural haematoma hydrocephalus
- other infectious illnesses
- Prescribed drugs or alcohol may affect memory and concentration.
Sudden increases in confusion may indicate a physical illness (i.e. acute infectious illness) or toxicity from medication. If confusion, wandering attention or agitation are present, see Delirium F05.
Depression may cause memory and concentration problems similar to those of dementia, especially in older patients. If low or sad mood is prominent, see Depression F32*.
Example: DEMENTIA F00 (4)
Management guidelines:
Essential information for patient and family
Dementia is frequent in old age
Memory loss and confusion may cause behaviour problems (e.g. agitation, suspiciousness, emotional outbursts).
Memory loss usually proceeds slowly, but course is quite variable.
Physical illness or mental stress can increase confusion
Provide available information and describe community resources
Example: DEMENTIA F00 (5)
Management guidelines:
Specific counselling to patient and family
Monitor the patient's ability to perform daily tasks
Consider use of memory aids or reminders if memory loss is mild
Avoid placing patient in unfamiliar places or situations
Consider ways to reduse stress on those caring for the patient (e.g. self-help groups). Support from other families caring for relatives with dementia may be helpful
Discuss planning of legal and financial affairs
As appropriate, discuss arrangements for support in the home, community or day care programmes, or residential placement
Uncontrollable agitation may require admission to a hospital or nursing home
Example: DEMENTIA F00 (6)
Management guidelines:
Medication
Use sedative or hypnotic medications (e.g. benzodiazepines) cautiously; they may increase confusion.
Antipsychotic medication in low doses (e. g. haloperidol 0.5 to 1.0 mg once or twice a day) may sometimes be needed to control agitation, psychotic symptoms or aggression. Beware of drug side-effects (Parkinsonian symptoms, anticholinergic effects) and drug interactions.
Example: DEMENTIA F00 (7)
Management guidelines:
Specialist consultation
Consider consultation for
- uncontrollable agitation
- sudden onset or worsening of memory loss
- physical causes of dementia requiring specialist treatment (e.g. syphilis, subdural haematoma)
Consider placement in a hospital or nursing home if intensive care is needed
MULTIAXIAL PRESENTATION OF ICD-10
Why do we need axes1?
To provide a comprehensive description of the patient's condition, which is likely to facilitate:
- appropriate decisions about therapy
- an accurate prognosis
To facilitate the interpretation of statistics from health facilities
To facilitate coordination of interventions by different health professionals (e.g. psychiatrist and social workers)
To allocate health care resources in a efficient way
Axis I Clinical diagnoses
- mental disorders
- physical disorders
- personality disorders
Chapters I to XX of ICD-10
Axis II Disability (following the principles of ICIDH)rating of 4 specific areas of functioning
Axis III Contextual factors (selected ICD-10 Z-codes: Chapter XXI)environmental and life style factors relevant to pathogenesis and course of patient's illness
Axis II Disability1
- personal care
- occupation
- family and household
-
functioning in broader social context rating of specific areas of
functioning on a scale of 6 points, which are defined in operational
terms
Axis III Contextual factors (selected ICD-10 Z-codes: Ch. XXI)
- problems related to negative events in childhood
- problems related to education and literacy
- problems related to primary support group, including family circumstances
- problems related to social environment
- problems related to housing or economic circumstances
- problems related to (un)employment
- problems related to physical environment
- problems related to certain psychosocial circumstances
- problems related to legal circumstances
- problems related to family history of diseases or disabilities
- problems related to life-style and life-management difficulties
Example of a multiaxial diagnostic formulation
Axis I: CLINICAL DIAGNOSES
Somatization disorder F45.0
Axis II: DISABILITIES
ratings (0-5)
A. Personal care . . . 0
B. Occupation . . . 1
C. Family and household . . 1
D. Broader social context . 2
Axis III: CONTEXTUAL FACTORS
Acculturation difficulty Z60.3
CONVERSION TABLES BETWEEN ICD-8, -9, -10 AND ICD-9-CM (CLINICAL MODIFICATION)
example
ICD-10 |
ICD-9 |
ICD-8 |
| F50 Eating disorders | 306.5 Feeding disturbances | |
| F50.0 Anorexia nervosa | 307.1 Anorexia nervosa | |
| F50.1 Atypical anorexia F50.2 Bulimia nervosa F50.3 Atypical bulimia F50.4 Overeating and F50.5 Vomiting associated with other psychological disturbance F50.8 Other eating disorder F50.9 Eating disorder, unspecified |
307.5 Other unspecified disorders of eating |
ICD-10 CASEBOOK
The Many Faces of Mental Disorders-
Adult Case Histories
According to ICD-10
Provides case histories illustrating disorders classified in F0-F6 of Chapter V of ICD-10, accompanied by discussions of the diagnosis
Example of a case history (shortened): Mr X, a 35-year old factory worker, married, with 3 children, was admitted to a general hospital, after having broken his leg by falling of the stairs.
On the third day of his stay, he grew increasingly nervous and started to tremble. During the night he could not sleep, talked incoherently and was obviously very anxious.
According to his wife, Mr X had drunk large quantities of beer each night after he came home until he would fall asleep, for over three years. At the night of admissal, he had slipped on the stairs when he came home, breaking his leg, before having his first beer. During the past year he had missed work several times and had been threatened with dismissal. He had a car accident when drunk two years before, but without any major injury. His father had been a chronic alcoholic and died from liver cirrhosis, when Mr X was 24 years old.
On examination Mr X spoke incoherently. He was disoriented in time, place, and at times also in person. On several occasions he picked at bugs that he could see on his blanket. He trembled and sweated profusely. He tried constantly to get out of bed and seemed unaware that his right leg was in plaster.
Example of discussion of the diagnosis (shortened): Mr X
Mr X had a long history of heavy alcohol use and developed severe withdrawal symptoms when he could not get alcohol. He presented with the characteristic symptoms of a delirium: clouding of consciousness, global disturbance of cognition, psychomotor agitation, disturbance of the sleep-wake cycle, rapid onset and fluctuation of the symptoms. Since there were no convulsions, the diagnosis according to ICD-10 is
F10.40 Alcohol withdrawal state with delirium, without convulsions.
The information provided by his wife gives evidence pointing to an additional diagnosis of alcohol dependence syndrome: continuous heavy use during the last 3 years, difficulties in controlling the drinking and the presence of a withdrawal state. Although this is not enough for a definite diagnosis according to ICD-10, a provisional additional diagnosis may be made:
F10.24 Alcohol dependence syndrome, currently using the substance.
LEXICA OF TERMS
Lexicon of psychiatric and mental health terms, WHO, Geneva, 1989
Provides definitions of over 300 terms that appear in the text of ICD-9 Chapter V.
Lexicon of psychiatric and mental health terms. 2nd edition. WHO, Geneva, 1994
Provides definitions of some 700 terms that appear in the text of ICD-10, Chapter V.
Lexicon of alcohol and drug terms. WHO, Geneva (1994)
Provides definitions of terms related to use, abuse and dependence of psychoactive substances. For each general class of psychoactive drugs the definitions include information on effects, symptomatology, sequelae, and therapeutic indiations. Social as well as health aspects of drug use and problems related to use are covered.
Lexicon of culture-specific terms in mental health. WHO, Geneva (1997)
Facilitates the use of the ICD-10 Classification of Mental and Behavioural Disorders in various cultural settings. It contains definitions of terms, concepts, symptoms and syndromes, that are important for the understanding of human experience in a socio-cultural setting.
APPLICATION OF THE INTERNATIONAL CLASSIFICATION OF MENTAL AND BEHAVIOURAL DISORDERS
1. Basic coding rules
2. General conventions on use of terminology
BASIC CODING RULES (1)
- Use as many diagnoses as are necessary to describe the condition of the patient
- Record main diagnosis first
- Write down both your own diagnosis in words and the ICD-10 category to which it is assigned
BASIC CODING RULES (2)
Main diagnosis precedence should be given to that diagnosis most relevant to the purpose for which the diagnoses are being collected in clinical work the main diagnosis is usually the reason for consultation or contact with health services in case of doubt about what the main diagnosis is, follow the numeric order of ICD-10
BASIC CODING RULES (3)
Levels of diagnostic confidence
Confidence in diagnostic categorization may be expressed as follows:
definite: Criteria are fulfilled for a specific category of ICD-10
provisional: Criteria are not completely fulfilled
More information will probably become available, after which the criteria will most likely be fulfilled probable: Criteria are not fulfilled. More information cannot be obtained, current diagnosis is the most likely under the circumstances
BASIC CODING RULES (4)
Example of the different elements of a diagnosis according to ICD-10
Main diagnosis: F32.2 Severe depressive episode without psychotic symptoms
Other diagnoses: X70 Intentional self-harm by hanging, strangulation and suffocation
F10.2 Alcohol dependence syndrome
F60.7 Dependent personality disorder
K29.2 Alcoholic gastritis
Z56.2 Threat of job loss
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (1)
DISORDER
The term "disorder" is used throughout the classification. Although it is recognized that "disorder" is not an exact term, its use avoids even greater problems inherent in the use of terms such as "disease" and "illness".
The term "disorder" implies the existence of a clinically recognizable set of symptoms or behaviour, associated in most cases with distress and with interference with personal functions.
Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here.
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (2)
ORGANIC and SYMPTOMATIC
The term "organic" is used for those syndromes that can be attributed to an independently diagnosable cerebral or systemic disease or disorder
Use of the term "organic" does not imply that conditions elsewhere in the classification are "nonorganic" in the sense of having no cerebral substrate
The term "symptomatic" is used for those organic mental disorders in which cerebral involvement is secondary to a systemic extracerebral disease of disorder
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (3)
PSYCHOTIC
The term "psychotic" has been retained as a convenient descriptive term, particularly in F23, Acute and transient psychotic disorders
Its use does not involve assumptions about psychodynamic mechanisms
The term "psychotic" is used only to indicate the presence of hallucinations, delusions, or a limited number of severe abnormalities of behaviour (such as abnormal excitement and overactivity, marked psychomotor retardation, and catatonic behaviour)
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (4)
NEUROTIC
The traditional division between neurosis and psychosis, that was evident in ICD-9 is not longer used in ICD-10
However, the term "neurotic" is still retained for occasional use and occurs, for instance, in the heading of section F4 "Neurotic, stress-related and somatoform disorders"
Most of the disorders regarded as neuroses by those who still use the concept (except depressive neurosis) are to be found in block F40 - F48
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (5)
PSYCHOGENIC
The term "psychogenic" has not been used in the titles of categories, in view of its different meanings in different languages and psychiatric traditions
It still occurs occasionally in the text, and should be taken to indicate that the diagnostician regards obvious life events or difficulties as playing an important role in the genesis of the disorder
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (6)
PSYCHOSOMATIC
The term "psychosomatic" has not been used in the titles of categories, in view of its different meanings in different languages and psychiatric traditions, and because use of this term might be taken to imply that psychological factors play no role in the occurrence, course and outcome of other diseases that are not so described
Disorders described as psychosomatic in other classifications can be found in ICD-10 in F45 (Somatoform disorders), F50 (Eating disorders), F52 (Sexual dysfunction), and F54 (Psychological or behavioural factors associated with disorders or diseases classified elsewhere)
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (7)
IMPAIRMENT, DISABILITY, HANDICAP
The terms "impairment, "disability" and "handicap" are used according to the recommendation of WHO (International classification of impairments, disabilities and handicaps, Geneva, WHO, 1980)1*
"Impairment" is defined as: "loss or abnormality . . of structure or function". Many types of psychological impairment have always been recognized as psychiatric symptoms
"Disability" is defined as: "a restriction or lack . . of ability to perform an activity in the manner or within the range considered normal for a human being". Disability at the personal level includes ordinary activities of daily living (such as washing, dressing, eating and excretion), is influenced little, if at all, by culture, and may be used as a criterion for certain psychiatric diagnoses (such as dementia)
"Handicap" is defined as: "the disadvantage for an individual . . that prevents or limits the performance of a role that is normal . . for that individual", and represents the effects of impairments or disabilities in a wide social context that may be heavily influenced by culture. Handicap should not be used as a central component of a diagnosis
STRUCTURE OF ICD-10 CHAPTER V
F0 Organic and symptomatic mental disorders
F1 Mental and behavioural disorders due to psychoactive and other substance use
F2 Schizophrenia, schizotypal and delusional disorders
F3 Mood [affective] disorders
F4 Neurotic, stress-related and somatoform disorders
F5 Behavioural syndromes and mental disorders associated with physiological dysfunction
F6 Disorders of adult personality and behaviour
F7 Mental retardation
F8 Disorders of psychological development
F9 Behavioural and emotional disorders with onset usually occurring in childhood or adolescence
F99 Unspecified mental disorder
F00-F09 ORGANIC, INCLUDING SYMPTOMATIC, MENTAL DISORDERS
F00 Dementia in Alzheimer's disease
F01 Vascular dementia
F02 Dementia in other diseases classified elsewhere
F03 Unspecified dementia
F04 Organic amnesic syndrome, not induced by alcohol and other psychoactive substances
F05 Delirium, not induced by alcohol and other psychoactive substances
F06 Other mental disorders due to brain damage and dysfunction and to physical disease
F07 Personality and behavioural disorders due to brain disease, damage and dysfunction
F09 Unspecified organic or symptomatic mental disorder
F10-F19 MENTAL AND BEHAVIOURAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE USE
F10 Alcohol
F11 Opioids
F12 Cannabinoids
F13 Sedatives and hypnotics
F14 Cocaine
F15 Other stimulants (incl. caffeine)
F16 Hallucinogens
F17 Tobacco
F18 Volatile solvents
F19 Multiple, other and unidentified substances
F20-F29 SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL DISORDERS
F20 Schizophrenia
F21 Schizotypal disorder
F22 Persistent delusional disorders
F23 Acute and transient psychotic disorders
F24 Induced delusional disorder
F25 Schizoaffective disorders
F28 Other nonorganic psychotic disorders
F29 Unspecified nonorganic psychosis
F30-F39 MOOD [AFFECTIVE] DISORDERS
F30 Manic episode
F31 Bipolar affective disorder
F32 Depressive episode
F33 Recurrent depressive disorder
F34 Persistent mood [affective] disorders
F38 Other mood [affective] disorders
F39 Unspecified mood [affective] disorder
F40-F48 NEUROTIC, STRESS-RELATED AND SOMATOFORM DISORDERS
F40 Phobic anxiety disorders
F41 Other anxiety disorders
F42 Obsessive-compulsive disorder
F43 Reaction to severe stress, and adjustment disorder
F44 Dissociative [conversion] disorder
F45 Somatoform disorders
F48 Other neurotic disorders
F50-F59 BEHAVIOURAL SYNDROMES ASSOCIATED WITH PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS
F50 Eating disorders
F51 Nonorganic sleep disorders
F52 Sexual dysfunction, not caused by organic disorder or disease
F53 Mental and behavioural disorders associated with the puerperium, not elsewhere classified
F54 Psychological and behavioural factors associated with disorders or diseases classified elsewhere
F55 Abuse of non-dependence-producing substances
F59 Unspecified behavioural syndromes associated with physiological disturbances and physical factors
F60-F69 DISORDERS OF ADULT PERSONALITY AND BEHAVIOUR
F60 Specific personality disorders
F61 Mixed and other personality disorders
F62 Enduring personality changes, not attributable to brain damage and disease
F63 Habit and impulse disorders
F64 Gender identity disorders
F65 Disorders of sexual preference
F66 Psychological and behavioural disorders associated with sexual development and orientation
F68 Other disorders of adult personality and behaviour
F69 Unspecified disorder of adult personality and behaviour
F70-F79 MENTAL RETARDATION
F70 Mild mental retardation
F71 Moderate mental retardation
F72 Profound mental retardation
F78 Other mental retardation
F79 Unspecified mental retardation
F80-F89 DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
F80 Specific developmental disorders of speech and language
F81 Specific developmental disorders of scholastic skills
F82 Specific developmental disorder of motor function
F83 Mixed specific developmental disorders
F84 Pervasive developmental disorders
F88 Other disorders of psychological development
F89 Unspecified disorder of psychological development
F90-F98 DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
F90 Hyperkinetic disorders
F91 Conduct disorders
F92 Mixed disorders of conduct and emotions
F93 Emotional disorders with onset specific to childhood
F94 Disorders of social functioning with onset specific to childhood and adolescence
F95 Tic disorders
F98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence
F99 NON SPECIFIED MENTAL DISORDER
F99 Mental disorder, not otherwise specified
ASSESSMENT INSTRUMENTS LINKED TO ICD-10 CHAPTER V
Purposes:
- to improve precision of assessment in psychiatry
- to increase reliability of psychiatric assessment and diagnosis
- to standardise data collection so as to
- increase replicability and comparability across
- to facilitate collaboration and communication among resarchers
| Checklists | ICD-10 Checklists | Summary of assessment | Clinicians |
| Composite International | Diagnostic Interview | Epidemiological surveys | Lay interviewers |
| SCAN | Schedules for Clinical Assessment in Neuropsychiatry | Clinical research and practice | Clinicians |
| IPDE | International Personality Disorder Examination | Clinical research | Clinicians |
| DAS | Disability Assessment Schedule | Clinical research and practice | Clinicians and other mental health workers |
| MODULES & MODIFICATIONS |
ICD-10 CHECKLISTS
I. ICD-10 symptom checklist for mental disorders, accompanied by ICD-10 symptom glossary
II. International Diagnostic Checklists for ICD-10, accompanied by manual
ICD-10 SYMPTOM CHECKLIST FOR MENTAL DISORDERS
A semi-structured instrument intended for clinician's assessment of the psychiatric symptoms and syndromes in F0 - F6; accompanied by ICD-10 symptom glossary for mental disorders
Example: F0/F1 Module: Organic mental and psychoactive substance use syndromes
Organic mental disorders
A. Which of the following are present?
1. decline in memory [__]
2. decline in other intellectual abilities [__]
3. deterioration in emotional control, social behaviour or motivation [__]
4. impairment of consciousness and attention [__]
5. disturbances of perception or disorientation [__]
6. psychomotor disturbances [__]
7. disturbance of the sleep-wake cycle [__]
8. rapid onset and diurnal fluctuations of symptoms [__]
ICD-10 SYMPTOM GLOSSARY FOR MENTAL DISORDERS
Provides brief descriptions of the symptoms and terms used in the criteria in the F0 - F6 categories and has been developed as a companion to the checklist
Example:
Decline in memory
A decline in the registration, storage and retrieval of new information. Previously learned and familiar material may also be lost, particularly in the later stages of dementia.
COMPOSITE INTERNATIONAL DIAGNOSTIC INTERVIEW (CIDI)
Purpose Assessment of current and/or life time symptoms of mental disorders for case identification and assessment (e.g. in epidemiological research)
Type of instrument Fully structured diagnostic interview schedule: symptom questions are spelled out positive answers are further explored
computerized data entry and diagnostic programmes
available in different life time and 12 monhs versions
can be supplemented by different modules
User Interviewers without clinical experience as well as clinicians
Training Essential (5 days)
Administration time 75 minutes
More information is available on the Internet:
http://www.unsw.edu.au/clients/crvfad/home.ktm
How to ask CIDI questions:
- all questions should be read as written
- no interpretation of questions and answers by the interviewer (if the respondent does not understand the question or interrupts the interviewer, the question should be read again without additional clarification)
- a rating will be made only when the respondent understands the intent of the question and has responded appropriately
- interviewers should probe and not assume answers
SCHEDULES FOR CLINICAL ASSESSMENT IN NEUROPSYCHIATRY (SCAN)
Purpose Assessment of present state and clinical history for clinical diagnosis
Type of instrument Semi-structured clinical interview schedule with semi-standardized questions
User Psychiatrists or psychologists
Training Essential
Administration time 60 - 90 minutes
Components:
1. Glossary of definitions
2. Assessment manual
- Present State Examination (PSE-10)
- Item Group Checklist (IGC)
- Clinical History Schedule (CHS)
3. Rating record schedules
4. Computer program
Catego-5: - descriptive profiles - ICD-10, DSM-IV diagnoses
5. Version 2.1 (1998) revised with CAPSE for ICD-10 and DSM-IV
Principles of SCAN Interview
- - Based on definitions of items in SCAN glossary
- - Aims at comprehensive assessment of symptoms and signs
- - Clinically semi-structured interview with additional probes, if judged necessary by clinician
- - Ratings based on judgement of clinician
- - Flexible order of administration according to state of patient and judgement of clinician
A sample item from SCAN (Version 2.0, p. 117) (1)
10.005 Overtalkativeness
Have people said that you talked too fast [__][__]
and too much so that they couldn't understand
you? Or do you feel pressure to keep talking?
Use SCALE 1
If > 2 years, consider cyclothymia
Glossary definition
Overtalkativeness:
Respondents may sense a pressure to keep talking but, more often, it is
the others who notice an abnormality. Speech is fluent, rapid and loud.
There may be overcircum-stantiality and shifts of topic, bur
conversation can be conducted with wit. It may be possible to rate this
item from self-description, but respondents may also report the
comments of others at the time which corroborate their account.
A sample item from SCAN (Version 2.0, p. 189)(2)
22.014 Distractibility
Changes behaviour or speech inappropriately [__][__]
though attending to irrelevant noises or events or objects
Use RATING SCALE III
Glossary definition
Distractibility: The respondent's attention is taken up by trivial events occurring while the interview proceeds which usually would not be noticed, let alone interfere with the interview. The respondent is unable to sustain attention for a period required by the task at hand. The subject may remark on the wallpaper instead of replying to a question, or break off to comment on the furniture or the sound of someone walking by. If this is occurring continuously, rate (2). If it occurs quite markedly but not continuously, rate (1).
Write down an example.
COMPARISON BETWEEN CIDI AND SCAN
| CIDI | SCAN |
| Fully structured | Semi-structured |
| Applied by lay-iterviewer | Applied by clinician |
| Probe-flow chart | "Cross-examination" |
| Based on answers of subject (no interviewer’s interpretation) | Ratings reflect interviewer’s interpretation |
| Selection of items based on diagnostic criteria | Aims at comprehensive assessment |
- Computer scoring programme
- Specific training needed
- Coverage of ICD-10 and DSM IV diagnoses
- Available in many languages
- Network of training centers available
INTERNATIONAL PERSONALITY DISORDER EXAMINATION (IPDE)
Purpose to assess the phenomenology and life experiences relevant to the diagnosis of personality disorders in the ICD-10 and DSM-IV classification systems.
Type of instrument Structured clinical interview schedule with semi-standardized probes
- module for ICD-10 diagnoses
- module for DSM-IV diagnoses
- screening questionnaire
User Psychiatrists or psychologists
Training Essential (3 days)
Administration time 1,5 - 3 hours
Description:
152 items arranged under 6 headings:
work
self
interpersonal relationships
affects
reality testing
impulse control
items are introduced by open-ended queries that offer the individual opportunity to discuss topic before answering
answers need to be supplemented by examples
additional questions to determine whether the individual has met frequency, duration and age of onset requirements (duration should be at least 5 years; at least one criterion to be met before age 25)
second scoring column for data from informants
last 6 items to be scored by interviewer based on observation during interview
Sample item from IPDE (1): questions
Preoccupation with details, lists, order, organization, or schedules to the extent that the major point of activity is lost
DSM-III-R Obsessive Compulsive: 2
Preoccupation with details, rules, lists, order, organization or schedule
ICD-10 Anankastic (obsessive compulsive): 2
Are you fussy about little details?
If yes: Do you spend much more time on them than you really have to?
If yes: Does that prevent you from getting much work done as you're expected to do?
If yes: Tell me about it.
Do you spend so much time scheduling and organizing things that you don't have any time left to do the job you're really supposed to do?
If yes: Tell me about it.
Sample item from IPDE (2): commentary
The subject is so concerned with the method or details of accomplishing a task or objective, that they almost become an end in themselves, consuming much more time and effort than is necessary, and thereby preventing the task from being accomplished or markedly prolonging the time required to achieve the objective. The subject need not display all of the features enumerated in the criterion.
2 Convincing evidence supported by examples that the behaviour frequently interferes with reasonable expectations of productivity.
1 Convincing evidence supported by examples that the behaviour occasionally interferes with reasonable expectations of productivity.
0 Denied, rare, or the consequences are insignificant.
WHO DISABILITY ASSESSMENT SCHEDULE (DAS)
Purpose: Evaluation of social functioning, and some of the factors influencing it.
Type of instrument: Semi-structured clinical assessment schedule
User: Psychiatrists, psychologists, sociologists or social workers
Training: Essential (2 days)
Administration time: 30 minutes
Description
97 items, divided in 5 parts:
Part 1: Overall behaviour (including self-care, under-activity, slowness, social withdrawal)
Part 2: Social role performance
Part 3: Functioning in hospital
Part 4: Modifying factors, such as specific assets and specific liabilities, home atmosphere, outside support
Part 5: Global evaluation
Part 6: Summary of ratings and scoring
Sample item
2. Social role performance
2.1 Participation in household activities during past month
Inquire about:
(i) patient's participation in common activities Card of the household, such as having meals together, Column doing domestic chores, going out or visiting together, playing games, watching television, etc.;
(ii) patient's participation in decision-making concerning the household, e.g. decisions about the children, money, etc. For housewives, consider the household jobs that a housewife usually has to do.
Make a rating without regard to whether the patient is asked to participate, left on his/her own or rejected [__] 38 in some way.
RATING SCHEDULE
Rate 8 if information not available and 9 if item not applicable
No dysfunction: patient participates in household 0 -- activities as much as is expected for his/her age, sex, position in the household, and sociocultural context.
Minimum dysfunction: patient participates less than 1 -- would be expected and has little interest in (ii), although such participation would normally be expected for someone in similar circumstances.
Obvious dysfunction: ....... 2 --
Serious dysfunction: ........ 3 --
Very serious dysfunction: ......... 4 --
Maximum dysfunction: patient totally excludes him 5 --
self/herself,
or is excluded, from participation in any common household activities;
disrupts the functioning of the household as a unit.
Chapter number and designation Range of codes
I Certain infectious and parasitic diseases A00-B99
II Neoplasms C00-D48
III Disease of the blood and bloodforming organs and certain disorders involving the immune mechanism D50-D89
IV Endocrine, nutritional and metabolic diseases E00-E90
V Mental and behavioural disorders F00-F99
VI Diseases of the nervous system G00-G99
VII Diseases of the eye and adnexa H00-H59
VIII Diseases of the ear and mastoid process H60-H95
IX Diseases of the circulatory system I00-I99
X Diseases of the respiratory system J00-J99
XI Diseases of the digestive system K00-K93
XII Disease of the skin and subcutaneous tissue L00-L99
XIII Diseases of the musculo-skeletal M00-M99 system and connective tissue
ICD-10 COMPOSITION OF CHAPTERS (2)
Chapter number and designation Range of codes
XIV Disease of the genito-urinary system N00-N99
XV Pregnancy, childbirth and the puerperium O00-O99
XVI Certain conditions originating in the perinatal period P00-P95
XVII Congenital malformations, deformations, and chromosomal abnormalities Q00-Q99
XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified R00-R99
XIX Injury, poisoning and certain other consequences of external causes S00-T98
XX External causes of morbidity and mortality V01-Y98
XXI Factors influencing health status and contact with health services Z00-Z98
EXAMPLES (1)
Chapter XX External causes of morbidity and mortality
Intentional self-harm (X60-X84)
X61 Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified (Includes: barbiturates, tranquillizers, etc.)
X70 Intentional self-harm by hanging, strangulation and suffocation
X80 Intentional self-harm by jumping from a high place
EXAMPLES (2)
Chapter XXI Factors influencing health status and contact with health services
Persons encountering health services for examination and investigation (Z00-Z13)
Z03.2 Observation for suspected mental and behavioural disorders
Z04.6 General psychiatric examination, requested by authority
Persons with potential health hazards related to socioeconomic circumstances (Z55-Z65)
Z55 Problems related to education and literacy
Z55.3 Underachievement in school
Z56 Problems related to employment and unemployment
Z56.2 Threat of job loss
Z60 Problems related to social environment
Z60.3 Acculturation difficulty
Z65 Problems related to other psychosocial circumstances
Z65.4 Victim of crime and terrorism (Includes victim of torture)
FAMILY OF DISEASE AND HEALTH-RELATED CLASSIFICATIONS
INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS
ICD-10
ICD 3-character core
Short tabulation lists
ICD
4-character classification
OTHER HEALTH RELATED CLASSIFICATIONS
Classification of Impairments, Disabilities and Handicaps
Procedures
Reasons for encounter (complaints)
INTERNATIONAL NOMENCLATURE OF DISEASES (IND)
Objectives:
to provide, for each morbid entity, a single recommended name
to provide for each disease a definition, as unambiguous and brief as possible
to provide synonyms for each disorder after each definition
Available:
Diseases of the lower respiratory tract (WHO, 1979)
Cardiac and vascular diseases (WHO, 1989)
Diseases of the digestive system (WHO, 1990)
Metabolic, nutritional and endocrine disorders (WHO, 1991)
Diseases of the kidney, the lower urinary tract, and the male genital system (WHO, 1992)
Diseases of the female genital system (WHO, 1992)
Infectious diseases (WHO, 1992)
STRUCTURE OF AN ICD-10 CODE
mental and behavioural disorders
section on schizophrenia and related disorders
schizophrenia
hebephrenic type
continous course
An extra number may be used as a subdivision for special purposes
ADMINISTRATIVE VERSION OF ICD-10 CHAPTER V
Aims: to provide administrators in psychiatric hospitals and psychiatrists, concerned with coding, with a convenient tool
Contents: ICD-10 chapter V, including glossary definitions
Other conditions, frequently seen in mental health care facilities
Conversion tables between ICD-8, -9, -10 and ICD-9-CM (Clinical Modification)
Index
APPLICATION OF ICD-10 TO NEUROLOGY
(ICD-NA, SECOND EDITION)
Aims:
To provide a code for each recognized neurological disorder
To encourage making detailed diagnoses and the recording of all disorders present
To provide standard recording system for neurological disorders, available in several languages
To facilitate national and international epidemiological research for
support of programmes of prevention and control of neurological
disorders
APPLICATION OF ICD-10 TO NEUROLOGY
(ICD-10 NA)
Contents:
Instructions and recommendations for the use of ICD-10 NA
Tabular list of neurological and related disorders
Morphology of neoplasms, numerical list
Acknowledgements
Index, including list of drugs and chemicals
EXAMPLE OF A CATEGORY IN THE ICD-10 NA
G43 Migraine
Use additional external cause code (Ch.XX) if desired to identify drug, if drug-induced
Excludes : headache NOS (R51)
atypical facial pain (G50)
G43.0 Migraine without aura
[common migraine]
G43.1 Migraine with aura [classical migraine]
G43.10 With typical aura
G43.11 With prolonged aura
G43.12 With acute onset aura
Use sixth character, if desired, to identify neurological symptoms:
G43.1x0 Hemianoptic and other visual migraine
G43.1x1 Hemisensory migraine
G43.1x2 Migraine with aphasia
G43.1x3 Basilar migraine
G43.1x4 Migraine aura (all types) without headache
G43.1x5 Familial hemiplegic migraine
G43.1x7 Multiple types of aura
G43.1x8 Other specified migraine with aura
ICD-10 GUIDES IN DEVELOPMENT
Headaches
Mental retardation
Cerebrovascular disorders
Epilepsy
Movement disorders
ICD-10 CHAPTER V: MAIN INNOVATIONS
EXPANSION OF THE PROVISION FOR CATEGORIES IMPORTANT FOR GENERAL HEALTH CARE
BRINGING TOGETHER RELATED CATEGORIES
CONCEPTUAL CHANGES FOR PUBLIC HEALTH REASONS
MAIN INNOVATIONS (1)
EXPANSION OF THE PROVISION FOR CATEGORIES IMPORTANT FOR GENERAL HEALTH CARE
Acute and transient psychotic disorders
Somatoform disorders
Stress-related disorders
ICD-9 rubric "Sexual deviations and disorders" split into three
categories: Disorders of sexual preference, gender identity disorders
and sexual dysfunctions
Childhood and developmental disorders
MAIN INNOVATIONS (2):
BRINGING TOGETHER RELATED CATEGORIES
Organic disorders
Alcohol and drug-related disorders
Affective disorders
Disorders with onset specific to childhood and adolescence
MAIN INNOVATIONS (3):
CONCEPTUAL CHANGES FOR PUBLIC HEALTH REASONS
Substance abuse section: 3-character code for the substance involved
"Culture-bound" syndromes to be classified according to predominant psychopathology
ICD-10: CHAPTER V: CALENDAR OF EVENTS
1964-1976 "Programme A"
1980-1981 Reviews of Literature and Scientific Group Meetings
1981 Copenhagen "Strategic" Conference
1983-1996 Drafting of texts; technical meetings; circulation of texts & revisions
1987 Prefinal draft
1987-1990 Field tests of Clinical Guidelines & Research Criteria
1992 Publication of Clinical Guidelines
1993 Publication of Research Criteria
1991-1995 Completion of tests of PHC version, multiaxial version and instruments
1996 Publication of PHC version,
1997 multiaxial version and instruments (CIDI, SCAN, IPDE)
1965-1996: DEVELOPMENT OF A COMMON LANGUAGE IN PSYCHIATRY (1)
1965-1974 WHO Programme A
Aims:
standardization of psychiatric diagnosis, classification and statistics
development of transculturally applicable and acceptable instruments for reliable assessment of the mentally ill
Resulting inter alia in:
ICD-8 (1967) with GLOSSARY;
the Present State Examination (PSE) and other crossculturally applicable instruments
and a collaborative, global network
1965-1974 Collaborative international research with important implications for diagnosis and classification:
UK-US Diagnostic study on psychiatric diagnosis
WHO International pilot study of schizophrenia (IPSS)
1965-1996: DEVELOPMENT OF A COMMON LANGUAGE IN PSYCHIATRY (2)
1972-1975 Diagnostic Criteria for Research (Feighner and Spitzer)
1978-1986 International study on longterm course and outcome of schizophrenia;
International studies on depression and disability
1980 DSM-III
1983-1993 Development of ICD-10 Chapter V: International Classification of Mental and Behavioural Disorders:
AIMS OF ICD-10 CHAPTER V
to facilitate medical practice and public health action by providing a common language to all concerned.
The acceptance of the diagnostic and classification system proposed in the ICD-10 will enable mental health workers, public health decision makers, statisticians and professionals in disciplines relevant to psychiatry:
to understand one another
to share results of research
to improve and unify training strategies
FEATURES OF ICD-10 CHAPTER V (1)
based on consensus
based on field trials
developed in collaboration between a Governmental Organization (WHO)
and non-Governmental Organizations (WPA, WFN, AD, etc.)
developed simultaneously in many languages
rendered compatible with national classifications
developed in collaboration with a network of centres around the world
participating in relevant research, undertaking translation and
providing training and support to users
FEATURES OF ICD-10 CHAPTER V (2)
composed of a family of documents:
different versions of the classification:
short definitions
guidelines for diagnosis
criteria for research
primary health care version
multiaxial presentation
tools:
conversion tables between ICD-10 and previous revisions
lexicon of psychiatric and mental health terms
lexicon of alcohol and drug terms
lexicon of culture-specific terms in mental health
casebook
training materials - linked to assessment instruments
FEATURES OF ICD-10 CHAPTER V (3)
BASED ON CONSENSUS (1)
STEPS:
Review of evidence by individual experts,
A series of workshops each devoted to a disease group,
A summary strategic conference
Establishment of a special advisory group to help in setting up the framework for the classification
Selection and invitation of experts to draft definitions, guidelines and criteria for research
Production of draft texts by some 50 experts from different parts of the world and from different schools of psychiatry
Circulation of texts to experts organized in panels for the different groups of disorders
FEATURES OF ICD-10 CHAPTER V (4)
BASED ON CONSENSUS (2)
STEPS (continued):
Circulation of amended drafts to nongovernmental organizations representing psychiatry and other disciplines.
Circulation of drafts to member societies of the NGO's and meetings
with groups preparing national classifications (e.g. DSM IV, French
classification of disorders in childhood)
Presentation of drafts to heads of ICD-10/MH centres for comments and
approval from the point of view of translatability
Finalization of drafts and field trials
Finalization of texts, taking into account results of field trials
FEATURES OF ICD-10 CHAPTER V (5)
BASED ON FIELD TRIALS (1)
Overview of field trials of different versions Version Countries Centers Clinicians Patients
Clinical 39 112 711 15,302
Research 32 150 150 13,793
Multiaxial 35 75 200 4,330
Primary care 45 20 564 3,123
FEATURES OF ICD-10 CHAPTER V (6)
BASED ON FIELD TRIALS (2)
Objectives of field trials of the classification and of the clinical descriptions and diagnostic guidelines (1987 draft):
I. Assessment of ease to understand and to use thenew classification
II. Assessment of goodness of fit in routine clinical practice
III. Assessment of inter-rater reliability of users in different countries and internationally
FEATURES OF ICD-10 CHAPTER V (7)
BASED ON FIELD TRIALS (3)
Results from the Clinical Descriptions and Diagnostic Guidelines version field trials (1)
Clinicians' assessment:
easy to use 85%
good fit 82%
feeling confident in making diagnosis 91%
reliability: weighted kappas .60 - .100
FEATURES OF ICD-10 CHAPTER V (8)
BASED ON FIELD TRIALS (4)
Results from the Clinical Descriptions and Diagnostic Guidelines version field trials (2)
Interrater reliability for major groups of disorders (kappa coefficients)
F0: 0,78 F5: 0,91
F1: 0,80 F6: 0,51
F2: 0,82 F7: 0,77
F3: 0,77 F8: not enough cases
F4: 0,74 F9: 0,74
overall agreement: at 2 character level: 0,81
at 3 character level: 0,71 at 4 character level: 0,59
FEATURES OF ICD-10 CHAPTER V (9)
DEVELOPED SIMULTANEOUSLY IN MANY LANGUAGES
ARABIC
CHINESE
ENGLISH
FRENCH
GERMAN
JAPANESE
PORTUGUESE
RUSSIAN
SPANISH
OTHER LANGUAGES INTO WHICH ICD-10 CHAPTER V HAS BEEN TRANSLATED
(until march 1996)
BULGARIAN
CROATIAN
CZECH
DANISH
DUTCH
ESTONIAN
FARSI (IRAN)
GREEK
HEBREW
HUNGARIAN
INDONESIAN
ITALIAN
KOREAN
LATVIAN
LITHUANIAN
NORWEGIAN
POLISH
RUMANIAN
SERBIAN
SWEDISH
THAI
TURKISH
UKRAINIAN
VIETNAMESE
FEATURES OF ICD-10 CHAPTER V (10)
RENDERED COMPATIBLE WITH NATIONAL CLASSIFICATIONS AND CLASSIFICATIONS OF SPECIALTIES
DSM-III, DSM-IIIR, DSM-IV
French INSERM classification
French classification of childhood mental disorders
Indonesian official classification of mental disorders
Nordic countries' classification
Russian classification
classification of Alzheimer International Association
classification of epilepsy
classification of headaches
classification of sleep disorders
and others
DIFFERENCES BETWEEN ICD-10 AND A
NATIONAL OR SPECIALIST CLASSIFICATION (1)
ICD-10 National or specialists classifications
WHO Member States use ICD-10 for official reporting about disease and
death The use of a national classification does not obviate the need to
also report data in ICD-terms, for all official purposes
Continuity between revisions of the classification is considered
essential Continuity is desirable;innovations are welcome
The general structure of ICD-10 imposes limitations on structure and
contents of Chapter V No limitations concerning structure
Chapter V is part of a comprehensive classification of all diseases and
disorders, and includes other reasons for contact of health services It
is not part of an overall classification
Adopted by national governments and used for reporting by
intergovernmental agencies (i.e. WHO) Approved by national or
international professional organizations
DIFFERENCES BETWEEN ICD-10 AND A
NATIONAL OR SPECIALIST CLASSIFICATION (2)
ICD-10 National or specialist classifications
Translation into oter languages is an integral part of development May be translated after it as been developed
ICD-10 reflects current usage in psychiatry Is directive concerning utilization in practice
ICD-10 is a uniaxial classification which can be presented in a multiaxial way Different axes are independent
Developed in different versions for different users Ussually exists in only one version
Social criteria are as far as possible avoided Social criteria are used
ICD-10 is a member of a family of classifications Ussually independent, sometimes with various presentations
RELATIONSHIPS BETWEEN ICD-10 CHAPTER V AND DSM-IV
COLLABORATION IN DEVELOPMENT
Experts were involved who worked both on ICD-10 and DSM developments
Activities undertaken in the framework of the Joint Project of WHO and
ADAMHA (USA), from 1982-1995 contributed to the scientific basis of
both classifications
The National Institute of Mental Health (USA) has sponsored special
meetings (during 1988-1991) to facilitate harmonious development of
ICD-10 and DSM-IV
Field trials of ICD-10 and DSM-IV were carried out in the US and elsewhere (often in the same centres)
FEATURES OF ICD-10 CHAPTER V (11)
ESTABLISHMENT OF A NETWORK OF SUPPORT CENTRES AROUND THE WORLD:
WHO Training and Reference Centres on Classification, Diagnosis and Assessment of Mental and Behavioural Disorders (ICD-10/MH CENTRES)
coordinating field studies of clinical and research criteria
AARHUS
BANGALORE
BEIJING
CAIRO
LUBECK
LUXEMBOURG
MADRID
MOSCOW
NAGASAKI
OXFORD
ROCKVILLE
FAMILY OF DOCUMENTS RELATED TO ICD-10 CHAPTER V
MENTAL AND BEHAVIOURAL DISORDERS
composed of a family of documents:
different versions of the classification:
short definitions
guidelines for diagnosis
criteria for research
primary health care version
multiaxial presentation
tools:
conversion tables between ICD-10 and previous revisions
lexica and glossaries
casebook
training materials
linked to assessment instruments
Composite International Diagnostic Interview (CIDI)
Schedules for Clinical Assessment in Neuropsychiatry (SCAN)
International Personality Disorder Examination (IPDE)
GLOSSARY DEFINITIONS IN ICD-10: EXAMPLE
F23.2 Acute schizophrenia-like psychotic disorder
An acute psychotic disorder in which the psychotic symptoms are comparitively stable and justify a diagnosis of schizophrenia, but have lasted for less than about one month. If the schizophrenic symptoms persist the diagnosis should be changed to schizophrenia (F20.-)
Acute (undifferentiated) schizophrenia
Brief schizophreniform disorder or psychosis
Oneirophrenia
Schizophrenic reaction
Excludes: organic delusional [schizophrenia-like disorder (F06.2)
schizophreniform disorder NOS (F20.8)
CLINICAL DESCRIPTIONS AND DIAGNOSTIC GUIDELINES
Characteristics:
For general clinical and educational use
Users: psychiatrists and other mental health workers
Narrative style of description of the main clinical features of each disorder
Diagnostic guidelines, indicating the number of symptoms usually required for a confident diagnosis
Allows for a provisional diagnosis, even if not all criteria are fullfilled
CLINICAL DESCRIPTIONS AND DIAGNOSTIC GUIDELINES
Example:
F32.0 Mild depressive episode Diagnostic guidelines
Depressed mood, loss of interest and enjoyment, and increased fatiguability are usually regarded as the most typical symptoms of depression, and at least two of these, plus at least two of a list of other common symptoms (e.g. decreased self-esteem, disturbed sleep) should usually be present for a definite diagnosis. None of the symptoms should be present to an intense degree. Minimum duration of the whole episode is about 2 weeks.
An individual with a mild depressive episode is usually distressed by the symptoms and has some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely.
DIAGNOSTIC CRITERIA FOR RESEACH
Characteristics
For use in psychiatric research
Contains precise criteria for diagnoses
Does not contain descriptions of clinical concepts and must therefore
be used in conjunction with the "Clinical Descriptions and Diagnostic
Guidelines"
Criteria are restrictive so as to maximize homogeneity of groups of patients in research
DIAGNOSTIC CRITERIA FOR RESEARCH
Example:
F32 Depressive episode
G1 The depressive episode should last for at least 2 weeks.
G2 There have been no hypomanic or manic symptoms sufficient to meet
the criteria for hypomanic or manic episode (F30.-) at any time in the
individual's life.
G3 Most commonly used exclusion clause: The episode is not attributable
to psychoactive substance use (F10-F19) or to any organic mental
disorder (in the sense of F00-F09).
F32.1 Moderate depressive episode
A. The general criteria for depressive episode (F32) must be met.
B. At least two of the three symptoms listed for F32.0, criterion B
(i.e. depressed mood, loss of interest or pleasure, decreased energy or
increased fatiguability), must be present.
C. Additional symptoms from a list of 7 (e.g. sleep disturbance, change
in appetite)(described in F32.0, criterion C), must be present, to give
a total of at least six.
A fifth character .x0 or .x1 may be used to specify the presence or absence of the "somatic syndrome" (also called "vital" or "melancholic" in other classifications). To qualify for this syndrome 4 from a list of 7 symptoms must be present (e.g. depression worse in the morning).
PRIMARY HEALTH CARE VERSION (ICD-10 PHC)
Basic features:
- reduced number of categories:
version with 24 categories
version with 6 categories
- brief definitions
- uses familiar diagnostic terms
- offers guidelines for recognition
- offers guidelines for management
PRIMARY HEALTH CARE VERSION (ICD-10 PHC)
ICD-10 categories which were selected for ICD-10 PHC
- groups of disorders of public health importance
- high prevalence
- associated with significant disablement, morbidity or mortality
- associated with significant burden on family
- health care resources needed to help people with the condition
- for which it is posible to provide effective and acceptable management in PHC setting
List of categories
F00* Dementia
F05 Delirium
F10 Alcohol use disorder
F11* Drug use disorders
F17.1 Tobacco use
F20 Chronic psychotic disorders
F23* Acute psychotic disorders
F31 Bipolar disorder
F32* Depression
F40* Phobic disorders
F41.0 Panic disorder
F41.1 Generalized anxiety disorder
F41.2 Mixed anxiety and depression
F43* Adjustment disorders
(Z63* Bereavement)
F44* Dissociative disorder
F45 Unexplained somatic complaints
F48.0 Neurasthenia
F50* Eating disorders
F51* Sleep problems
F52 Sexual disorders
F70 Mental retardation
F90 Hyperkinetic disorder
F91 Conduct disorder
F98.0 Enuresis
* An asterisk indicates that more than one ICD-10 code is included (e.g. F00* includes disorders coded in F00-F04)
Components of ICD-10 PHC
listing of categories
diagnostic and management guidelines for each category
flow-charts
symptom index
supporting material:
patient leaflets
medication cards
For each disorder
Diagnostic guidelines
presenting complaints
diagnostic features
differential diagnosis
Management guidelines
essential information for patient and family
specific counselling for patient and family
medication
need for specialist consultation
Example: DEMENTIA F00 (1)
Presenting complaint
Patients may complain of forgetfulness or feeling depressed, but may be unaware of memory loss. Patients and family may sometimes deny severity of memory loss.
Families ask for help initially because of failing memory, change in personality or behaviour in later stages because of confusion, wandering, or incontinence.
Poor personal hygiene in an older patient may indicate memory loss
Example: DEMENTIA F00 (2)
Diagnostic features
Decline in recent memory, thinking and judgement, orientation, language
Patients often appear apathetic or disinterested, but may appear alert and appropriate despite poor memory.
Decline in everyday functioning (dressing, washing, cooking).
Loss of emotional control - patients may be easily upset, tearful or irritable.
Common in older patients, very rare in youth or middle age.
Tests of memory and thinking include:
- ability to recall names of three common objects immediately and again after three minutes,
- ability to name days of week in reverse order.
Example: DEMENTIA F00 (3)
Differential diagnosis
Examine for other illnesses causing memory loss.
Examples include:
depression (F32*) anaemia
urinary infection vitamin B12 or folate
HIV infection deficiency
siphilis normal pressure
subdural haematoma hydrocephalus
other infectious illnesses
Prescribed drugs or alcohol may affect memory and concentration.
Sudden increases in confusion may indicate a physical illness (i.e. acute infectious illness) or toxicity from medication. If confusion, wandering attention or agitation are present, see Delirium F05.
Depression may cause memory and concentration problems similar to those of dementia, especially in older patients. If low or sad mood is prominent, see Depression F32*.
Example: DEMENTIA F00 (4)
Management guidelines:
Essential information for patient and family
Dementia is frequent in old age
Memory loss and confusion may cause behaviour problems (e.g. agitation, suspiciousness, emotional outbursts).
Memory loss usually proceeds slowly, but course is quite variable.
Physical illness or mental stress can increase confusion
Provide available information and describe community resources
Example: DEMENTIA F00 (5)
Management guidelines:
Specific counselling to patient and family
Monitor the patient's ability to perform daily tasks
Consider use of memory aids or reminders if memory loss is mild
Avoid placing patient in unfamiliar places or situations
Consider ways to reduse stress on those caring for the patient (e.g. self-help groups). Support from other families caring for relatives with dementia may be helpful
Discuss planning of legal and financial affairs
As appropriate, discuss arrangements for support in the home, community or day care programmes, or residential placement
Uncontrollable agitation may require admission to a hospital or nursing home
Example: DEMENTIA F00 (6)
Management guidelines:
Medication
Use sedative or hypnotic medications (e.g. benzodiazepines) cautiously; they may increase confusion.
Antipsychotic medication in low doses (e. g. haloperidol 0.5 to 1.0 mg once or twice a day) may sometimes be needed to control agitation, psychotic symptoms or aggression. Beware of drug side-effects (Parkinsonian symptoms, anticholinergic effects) and drug interactions.
Example: DEMENTIA F00 (7)
Management guidelines:
Specialist consultation
Consider consultation for
uncontrollable agitation
sudden onset or worsening of memory loss
physical causes of dementia requiring specialist treatment (e.g. syphilis, subdural haematoma)
Consider placement in a hospital or nursing home if intensive care is needed
MULTIAXIAL PRESENTATION OF ICD-10
Why do we need axes1?
To provide a comprehensive description of the patient's condition, which is likely to facilitate:
appropriate decisions about therapy
an accurate prognosis
To facilitate the interpretation of statistics from health facilities
To facilitate coordination of interventions by different health professionals (e.g. psychiatrist and social workers)
To allocate health care resources in a efficient way
Axis I Clinical diagnoses
mental disorders
physical disorders
personality disorders
Chapters I to XX of ICD-10
Axis II Disability (following the principles of ICIDH)rating of 4 specific areas of functioning
Axis III Contextual factors (selected ICD-10 Z-codes: Chapter XXI)environmental and life style factors relevant to pathogenesis and course of patient's illness
Axis II Disability1
personal care
occupation
family and household
functioning in broader social context rating of specific areas of
functioning on a scale of 6 points, which are defined in operational
terms
Axis III Contextual factors (selected ICD-10 Z-codes: Ch. XXI)
problems related to negative events in childhood
problems related to education and literacy
problems related to primary support group, including family circumstances
problems related to social environment
problems related to housing or economic circumstances
problems related to (un)employment
problems related to physical environment
problems related to certain psychosocial circumstances
problems related to legal circumstances
problems related to family history of diseases or disabilities
problems related to life-style and life-management difficulties
Example of a multiaxial diagnostic formulation
Axis I: CLINICAL DIAGNOSES
Somatization disorder F45.0
Axis II: DISABILITIES
ratings (0-5)
A. Personal care . . . 0
B. Occupation . . . 1
C. Family and household . . 1
D. Broader social context . 2
Axis III: CONTEXTUAL FACTORS
Acculturation difficulty Z60.3
CONVERSION TABLES BETWEEN ICD-8, -9, -10 AND ICD-9-CM (CLINICAL MODIFICATION)
example
ICD-10 ICD-9 ICD-8
F50 Eating disorders 306.5 Feeding disturbances
F50.0 Anorexia nervosa 307.1 Anorexia nervosa
F50.1 Atypical anorexia
F50.2 Bulimia nervosa
F50.3 Atypical bulimia
F50.4 Overeating and F50.5 Vomiting associated with other psychological disturbance
F50.8 Other eating disorder
F50.9 Eating disorder, unspecified 307.5 Other unspecified disorders of eating
ICD-10 CASEBOOK
The Many Faces of Mental Disorders-
Adult Case Histories
According to ICD-10
Provides case histories illustrating disorders classified in F0-F6 of Chapter V of ICD-10, accompanied by discussions of the diagnosis
Example of a case history (shortened): Mr X, a 35-year old factory worker, married, with 3 children, was admitted to a general hospital, after having broken his leg by falling of the stairs.
On the third day of his stay, he grew increasingly nervous and started to tremble. During the night he could not sleep, talked incoherently and was obviously very anxious.
According to his wife, Mr X had drunk large quantities of beer each night after he came home until he would fall asleep, for over three years. At the night of admissal, he had slipped on the stairs when he came home, breaking his leg, before having his first beer. During the past year he had missed work several times and had been threatened with dismissal. He had a car accident when drunk two years before, but without any major injury. His father had been a chronic alcoholic and died from liver cirrhosis, when Mr X was 24 years old.
On examination Mr X spoke incoherently. He was disoriented in time, place, and at times also in person. On several occasions he picked at bugs that he could see on his blanket. He trembled and sweated profusely. He tried constantly to get out of bed and seemed unaware that his right leg was in plaster.
Example of discussion of the diagnosis (shortened): Mr X
Mr X had a long history of heavy alcohol use and developed severe withdrawal symptoms when he could not get alcohol. He presented with the characteristic symptoms of a delirium: clouding of consciousness, global disturbance of cognition, psychomotor agitation, disturbance of the sleep-wake cycle, rapid onset and fluctuation of the symptoms. Since there were no convulsions, the diagnosis according to ICD-10 is
F10.40 Alcohol withdrawal state with delirium, without convulsions.
The information provided by his wife gives evidence pointing to an additional diagnosis of alcohol dependence syndrome: continuous heavy use during the last 3 years, difficulties in controlling the drinking and the presence of a withdrawal state. Although this is not enough for a definite diagnosis according to ICD-10, a provisional additional diagnosis may be made:
F10.24 Alcohol dependence syndrome, currently using the substance.
LEXICA OF TERMS
Lexicon of psychiatric and mental health terms, WHO, Geneva, 1989
Provides definitions of over 300 terms that appear in the text of ICD-9 Chapter V.
Lexicon of psychiatric and mental health terms. 2nd edition. WHO, Geneva, 1994
Provides definitions of some 700 terms that appear in the text of ICD-10, Chapter V.
Lexicon of alcohol and drug terms. WHO, Geneva (1994)
Provides definitions of terms related to use, abuse and dependence of psychoactive substances. For each general class of psychoactive drugs the definitions include information on effects, symptomatology, sequelae, and therapeutic indiations. Social as well as health aspects of drug use and problems related to use are covered.
Lexicon of culture-specific terms in mental health. WHO, Geneva (1997)
Facilitates the use of the ICD-10 Classification of Mental and Behavioural Disorders in various cultural settings. It contains definitions of terms, concepts, symptoms and syndromes, that are important for the understanding of human experience in a socio-cultural setting.
APPLICATION OF THE INTERNATIONAL CLASSIFICATION OF MENTAL AND BEHAVIOURAL DISORDERS
- Basic coding rules
- General conventions on use of terminology
BASIC CODING RULES (1)
Use as many diagnoses as are necessary to describe the condition of the patient
Record main diagnosis first
Write down both your own diagnosis in words and the ICD-10 category to which it is assigned
BASIC CODING RULES (2)
Main diagnosis precedence should be given to that diagnosis most relevant to the purpose for which the diagnoses are being collected in clinical work the main diagnosis is usually the reason for consultation or contact with health services in case of doubt about what the main diagnosis is, follow the numeric order of ICD-10
BASIC CODING RULES (3)
Levels of diagnostic confidence
Confidence in diagnostic categorization may be expressed as follows:
definite: Criteria are fulfilled for a specific category of ICD-10
provisional: Criteria are not completely fulfilled
More information will probably become available, after which the criteria will most likely be fulfilled probable: Criteria are not fulfilled. More information cannot be obtained, current diagnosis is the most likely under the circumstances
BASIC CODING RULES (4)
Example of the different elements of a diagnosis according to ICD-10
Main diagnosis: F32.2 Severe depressive episode without psychotic symptoms
Other diagnoses: X70 Intentional self-harm by hanging, strangulation and suffocation
F10.2 Alcohol dependence syndrome
F60.7 Dependent personality disorder
K29.2 Alcoholic gastritis
Z56.2 Threat of job loss
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (1)
DISORDER
The term "disorder" is used throughout the classification. Although it is recognized that "disorder" is not an exact term, its use avoids even greater problems inherent in the use of terms such as "disease" and "illness".
The term "disorder" implies the existence of a clinically recognizable set of symptoms or behaviour, associated in most cases with distress and with interference with personal functions.
Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here.
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (2)
ORGANIC and SYMPTOMATIC
The term "organic" is used for those syndromes that can be attributed to an independently diagnosable cerebral or systemic disease or disorder
Use of the term "organic" does not imply that conditions elsewhere in the classification are "nonorganic" in the sense of having no cerebral substrate
The term "symptomatic" is used for those organic mental disorders in which cerebral involvement is secondary to a systemic extracerebral disease of disorder
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (3)
PSYCHOTIC
The term "psychotic" has been retained as a convenient descriptive term, particularly in F23, Acute and transient psychotic disorders
Its use does not involve assumptions about psychodynamic mechanisms
The term "psychotic" is used only to indicate the presence of hallucinations, delusions, or a limited number of severe abnormalities of behaviour (such as abnormal excitement and overactivity, marked psychomotor retardation, and catatonic behaviour)
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (4)
NEUROTIC
The traditional division between neurosis and psychosis, that was evident in ICD-9 is not longer used in ICD-10
However, the term "neurotic" is still retained for occasional use and occurs, for instance, in the heading of section F4 "Neurotic, stress-related and somatoform disorders"
Most of the disorders regarded as neuroses by those who still use the concept (except depressive neurosis) are to be found in block F40 - F48
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (5)
PSYCHOGENIC
The term "psychogenic" has not been used in the titles of categories, in view of its different meanings in different languages and psychiatric traditions
It still occurs occasionally in the text, and should be taken to indicate that the diagnostician regards obvious life events or difficulties as playing an important role in the genesis of the disorder
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (6)
PSYCHOSOMATIC
The term "psychosomatic" has not been used in the titles of categories, in view of its different meanings in different languages and psychiatric traditions, and because use of this term might be taken to imply that psychological factors play no role in the occurrence, course and outcome of other diseases that are not so described
Disorders described as psychosomatic in other classifications can be found in ICD-10 in F45 (Somatoform disorders), F50 (Eating disorders), F52 (Sexual dysfunction), and F54 (Psychological or behavioural factors associated with disorders or diseases classified elsewhere)
GENERAL CONVENTIONS ON USE OF TERMINOLOGY (7)
IMPAIRMENT, DISABILITY, HANDICAP
The terms "impairment, "disability" and "handicap" are used according to the recommendation of WHO (International classification of impairments, disabilities and handicaps, Geneva, WHO, 1980)1*
"Impairment" is defined as: "loss or abnormality . . of structure or function". Many types of psychological impairment have always been recognized as psychiatric symptoms
"Disability" is defined as: "a restriction or lack . . of ability to perform an activity in the manner or within the range considered normal for a human being". Disability at the personal level includes ordinary activities of daily living (such as washing, dressing, eating and excretion), is influenced little, if at all, by culture, and may be used as a criterion for certain psychiatric diagnoses (such as dementia)
"Handicap" is defined as: "the disadvantage for an individual . . that prevents or limits the performance of a role that is normal . . for that individual", and represents the effects of impairments or disabilities in a wide social context that may be heavily influenced by culture. Handicap should not be used as a central component of a diagnosis
STRUCTURE OF ICD-10 CHAPTER V
F0 Organic and symptomatic mental disorders
F1 Mental and behavioural disorders due to psychoactive and other substance use
F2 Schizophrenia, schizotypal and delusional disorders
F3 Mood [affective] disorders
F4 Neurotic, stress-related and somatoform disorders
F5 Behavioural syndromes and mental disorders associated with physiological dysfunction
F6 Disorders of adult personality and behaviour
F7 Mental retardation
F8 Disorders of psychological development
F9 Behavioural and emotional disorders with onset usually occurring in childhood or adolescence
F99 Unspecified mental disorder
F00-F09 ORGANIC, INCLUDING SYMPTOMATIC, MENTAL DISORDERS
F00 Dementia in Alzheimer's disease
F01 Vascular dementia
F02 Dementia in other diseases classified elsewhere
F03 Unspecified dementia
F04 Organic amnesic syndrome, not induced by alcohol and other psychoactive substances
F05 Delirium, not induced by alcohol and other psychoactive substances
F06 Other mental disorders due to brain damage and dysfunction and to physical disease
F07 Personality and behavioural disorders due to brain disease, damage and dysfunction
F09 Unspecified organic or symptomatic mental disorder
F10-F19 MENTAL AND BEHAVIOURAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE USE
F10 Alcohol
F11 Opioids
F12 Cannabinoids
F13 Sedatives and hypnotics
F14 Cocaine
F15 Other stimulants (incl. caffeine)
F16 Hallucinogens
F17 Tobacco
F18 Volatile solvents
F19 Multiple, other and unidentified substances
F20-F29 SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL DISORDERS
F20 Schizophrenia
F21 Schizotypal disorder
F22 Persistent delusional disorders
F23 Acute and transient psychotic disorders
F24 Induced delusional disorder
F25 Schizoaffective disorders
F28 Other nonorganic psychotic disorders
F29 Unspecified nonorganic psychosis
F30-F39 MOOD [AFFECTIVE] DISORDERS
F30 Manic episode
F31 Bipolar affective disorder
F32 Depressive episode
F33 Recurrent depressive disorder
F34 Persistent mood [affective] disorders
F38 Other mood [affective] disorders
F39 Unspecified mood [affective] disorder
F40-F48 NEUROTIC, STRESS-RELATED AND SOMATOFORM DISORDERS
F40 Phobic anxiety disorders
F41 Other anxiety disorders
F42 Obsessive-compulsive disorder
F43 Reaction to severe stress, and adjustment disorder
F44 Dissociative [conversion] disorder
F45 Somatoform disorders
F48 Other neurotic disorders
F50-F59 BEHAVIOURAL SYNDROMES ASSOCIATED WITH PHYSIOLOGICAL DISTURBANCES AND PHYSICAL FACTORS
F50 Eating disorders
F51 Nonorganic sleep disorders
F52 Sexual dysfunction, not caused by organic disorder or disease
F53 Mental and behavioural disorders associated with the puerperium, not elsewhere classified
F54 Psychological and behavioural factors associated with disorders or diseases classified elsewhere
F55 Abuse of non-dependence-producing substances
F59 Unspecified behavioural syndromes associated with physiological disturbances and physical factors
F60-F69 DISORDERS OF ADULT PERSONALITY AND BEHAVIOUR
F60 Specific personality disorders
F61 Mixed and other personality disorders
F62 Enduring personality changes, not attributable to brain damage and disease
F63 Habit and impulse disorders
F64 Gender identity disorders
F65 Disorders of sexual preference
F66 Psychological and behavioural disorders associated with sexual development and orientation
F68 Other disorders of adult personality and behaviour
F69 Unspecified disorder of adult personality and behaviour
F70-F79 MENTAL RETARDATION
F70 Mild mental retardation
F71 Moderate mental retardation
F72 Profound mental retardation
F78 Other mental retardation
F79 Unspecified mental retardation
F80-F89 DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
F80 Specific developmental disorders of speech and language
F81 Specific developmental disorders of scholastic skills
F82 Specific developmental disorder of motor function
F83 Mixed specific developmental disorders
F84 Pervasive developmental disorders
F88 Other disorders of psychological development
F89 Unspecified disorder of psychological development
F90-F98 DISORDERS OF PSYCHOLOGICAL DEVELOPMENT
F90 Hyperkinetic disorders
F91 Conduct disorders
F92 Mixed disorders of conduct and emotions
F93 Emotional disorders with onset specific to childhood
F94 Disorders of social functioning with onset specific to childhood and adolescence
F95 Tic disorders
F98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence
F99 NON SPECIFIED MENTAL DISORDER
F99 Mental disorder, not otherwise specified
ASSESSMENT INSTRUMENTS LINKED TO ICD-10 CHAPTER V
Purposes:
to improve precision of assessment in psychiatry
to increase reliability of psychiatric assessment and diagnosis
to standardise data collection so as to
increase replicability and comparability across
to facilitate collaboration and communication among resarchers
Checklists ICD-10 Checklists Summary of assessment Clinicians
Composite International Diagnostic Interview Epidemiological surveys Lay interviewers
SCAN Schedules for Clinical Assessment in Neuropsychiatry Clinical research and practice Clinicians
IPDE International Personality Disorder Examination Clinical research Clinicians
DAS Disability Assessment Schedule Clinical research and practice Clinicians and other mental health workers
MODULES & MODIFICATIONS
ICD-10 CHECKLISTS
I. ICD-10 symptom checklist for mental disorders, accompanied by ICD-10 symptom glossary
II. International Diagnostic Checklists for ICD-10, accompanied by manual
ICD-10 SYMPTOM CHECKLIST FOR MENTAL DISORDERS
A semi-structured instrument intended for clinician's assessment of the psychiatric symptoms and syndromes in F0 - F6; accompanied by ICD-10 symptom glossary for mental disorders
Example: F0/F1 Module: Organic mental and psychoactive substance use syndromes
Organic mental disorders
A. Which of the following are present?
1. decline in memory [__]
2. decline in other intellectual abilities [__]
3. deterioration in emotional control, social behaviour or motivation [__]
4. impairment of consciousness and attention [__]
5. disturbances of perception or disorientation [__]
6. psychomotor disturbances [__]
7. disturbance of the sleep-wake cycle [__]
8. rapid onset and diurnal fluctuations of symptoms [__]
ICD-10 SYMPTOM GLOSSARY FOR MENTAL DISORDERS
Provides brief descriptions of the symptoms and terms used in the criteria in the F0 - F6 categories and has been developed as a companion to the checklist
Example:
Decline in memory
A decline in the registration, storage and retrieval of new information. Previously learned and familiar material may also be lost, particularly in the later stages of dementia.
COMPOSITE INTERNATIONAL DIAGNOSTIC INTERVIEW (CIDI)
Purpose Assessment of current and/or life time symptoms of mental disorders for case identification and assessment (e.g. in epidemiological research)
Type of instrument Fully structured diagnostic interview schedule: symptom questions are spelled out positive answers are further explored
computerized data entry and diagnostic programmes
available in different life time and 12 monhs versions
can be supplemented by different modules
User Interviewers without clinical experience as well as clinicians
Training Essential (5 days)
Administration time 75 minutes
More information is available on the Internet:
http://www.unsw.edu.au/clients/crvfad/home.ktm
How to ask CIDI questions:
all questions should be read as written
no interpretation of questions and answers by the interviewer (if the
respondent does not understand the question or interrupts the
interviewer, the question should be read again without additional
clarification)
a rating will be made only when the respondent understands the intent of the question and has responded appropriately
interviewers should probe and not assume answers
SCHEDULES FOR CLINICAL ASSESSMENT IN NEUROPSYCHIATRY (SCAN)
Purpose Assessment of present state and clinical history for clinical diagnosis
Type of instrument Semi-structured clinical interview schedule with semi-standardized questions
User Psychiatrists or psychologists
Training Essential
Administration time 60 - 90 minutes
Components:
1. Glossary of definitions
2. Assessment manual
Present State Examination (PSE-10)
Item Group Checklist (IGC)
Clinical History Schedule (CHS)
3. Rating record schedules
4. Computer program
Catego-5: - descriptive profiles - ICD-10, DSM-IV diagnoses
5. Version 2.1 (1998) revised with CAPSE for ICD-10 and DSM-IV
Principles of SCAN Interview
- Based on definitions of items in SCAN glossary
- Aims at comprehensive assessment of symptoms and signs
- Clinically semi-structured interview with additional probes, if judged necessary by clinician
- Ratings based on judgement of clinician
- Flexible order of administration according to state of patient and judgement of clinician
A sample item from SCAN (Version 2.0, p. 117) (1)
10.005 Overtalkativeness
Have people said that you talked too fast [__][__]
and too much so that they couldn't understand
you? Or do you feel pressure to keep talking?
Use SCALE 1
If > 2 years, consider cyclothymia
Glossary definition
Overtalkativeness:
Respondents may sense a pressure to keep talking but, more often, it is
the others who notice an abnormality. Speech is fluent, rapid and loud.
There may be overcircum-stantiality and shifts of topic, bur
conversation can be conducted with wit. It may be possible to rate this
item from self-description, but respondents may also report the
comments of others at the time which corroborate their account.
A sample item from SCAN (Version 2.0, p. 189)(2)
22.014 Distractibility
Changes behaviour or speech inappropriately [__][__]
though attending to irrelevant noises or events or objects
Use RATING SCALE III
Glossary definition
Distractibility: The respondent's attention is taken up by trivial events occurring while the interview proceeds which usually would not be noticed, let alone interfere with the interview. The respondent is unable to sustain attention for a period required by the task at hand. The subject may remark on the wallpaper instead of replying to a question, or break off to comment on the furniture or the sound of someone walking by. If this is occurring continuously, rate (2). If it occurs quite markedly but not continuously, rate (1).
Write down an example.
COMPARISON BETWEEN CIDI AND SCAN
CIDI SCAN
Fully structured Semi-structured
Applied by lay-iterviewer Applied by clinician
Probe-flow chart "Cross-examination"
Based on answers of subject (no interviewer’s interpretation) Ratings reflect interviewer’s interpretation
Selection of items based on diagnostic criteria Aims at comprehensive assessment
Computer scoring programme
Specific training needed
Coverage of ICD-10 and DSM IV diagnoses
Available in many languages
Network of training centers available
INTERNATIONAL PERSONALITY DISORDER EXAMINATION (IPDE)
Purpose to assess the phenomenology and life experiences relevant to the diagnosis of personality disorders in the ICD-10 and DSM-IV classification systems.
Type of instrument Structured clinical interview schedule with semi-standardized probes
module for ICD-10 diagnoses
module for DSM-IV diagnoses
screening questionnaire
User Psychiatrists or psychologists
Training Essential (3 days)
Administration time 1,5 - 3 hours
Description:
152 items arranged under 6 headings:
work
self
interpersonal relationships
affects
reality testing
impulse control
items are introduced by open-ended queries that offer the individual opportunity to discuss topic before answering
answers need to be supplemented by examples
additional questions to determine whether the individual has met frequency, duration and age of onset requirements (duration should be at least 5 years; at least one criterion to be met before age 25)
second scoring column for data from informants
last 6 items to be scored by interviewer based on observation during interview
Sample item from IPDE (1): questions
Preoccupation with details, lists, order, organization, or schedules to the extent that the major point of activity is lost
DSM-III-R Obsessive Compulsive: 2
Preoccupation with details, rules, lists, order, organization or schedule
ICD-10 Anankastic (obsessive compulsive): 2
Are you fussy about little details?
If yes: Do you spend much more time on them than you really have to?
If yes: Does that prevent you from getting much work done as you're expected to do?
If yes: Tell me about it.
Do you spend so much time scheduling and organizing things that you don't have any time left to do the job you're really supposed to do?
If yes: Tell me about it.
Sample item from IPDE (2): commentary
The subject is so concerned with the method or details of accomplishing a task or objective, that they almost become an end in themselves, consuming much more time and effort than is necessary, and thereby preventing the task from being accomplished or markedly prolonging the time required to achieve the objective. The subject need not display all of the features enumerated in the criterion.
2 Convincing evidence supported by examples that the behaviour frequently interferes with reasonable expectations of productivity.
1 Convincing evidence supported by examples that the behaviour occasionally interferes with reasonable expectations of productivity.
0 Denied, rare, or the consequences are insignificant.
WHO DISABILITY ASSESSMENT SCHEDULE (DAS)
Purpose: Evaluation of social functioning, and some of the factors influencing it.
Type of instrument: Semi-structured clinical assessment schedule
User: Psychiatrists, psychologists, sociologists or social workers
Training: Essential (2 days)
Administration time: 30 minutes
Description
97 items, divided in 5 parts:
Part 1: Overall behaviour (including self-care, under-activity, slowness, social withdrawal)
Part 2: Social role performance
Part 3: Functioning in hospital
Part 4: Modifying factors, such as specific assets and specific liabilities, home atmosphere, outside support
Part 5: Global evaluation
Part 6: Summary of ratings and scoring
Sample item
2. Social role performance
2.1 Participation in household activities during past month
Inquire about:
(i) patient's participation in common activities Card of the household, such as having meals together, Column doing domestic chores, going out or visiting together, playing games, watching television, etc.;
(ii) patient's participation in decision-making concerning the household, e.g. decisions about the children, money, etc. For housewives, consider the household jobs that a housewife usually has to do.
Make a rating without regard to whether the patient is asked to participate, left on his/her own or rejected [__] 38 in some way.
RATING SCHEDULE
Rate 8 if information not available and 9 if item not applicable
No dysfunction: patient participates in household 0 -- activities as much as is expected for his/her age, sex, position in the household, and sociocultural context.
Minimum dysfunction: patient participates less than 1 -- would be expected and has little interest in (ii), although such participation would normally be expected for someone in similar circumstances.
Obvious dysfunction: ....... 2 --
Serious dysfunction: ........ 3 --
Very serious dysfunction: ......... 4 --
Maximum dysfunction: patient totally excludes him 5 --
self/herself, or is excluded, from participation in any common household activities; disrupts the functioning of the household as a unit.
