Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders.

Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.

Neuropsychology in South Africa: confronting the challenges of specialist practice in a culturally diverse developing country.

OBJECTIVE: This was an invited paper on the history and current status of neuropsychology in South Africa. METHOD: Information was gathered from literature searches, personal communication, and the authors' experiences while occupying relevant professional and academic positions for over 30 years. RESULTS: Since its origins in the 1950s, the development of neuropsychology in South Africa has faced numerous challenges, against a background of extreme sociocultural and socioeconomic disparity in the country that is on-going. The creation of the South African Clinical Neuropsychological Society in the 1980s, a credentialing and training body, gave impetus to the discipline. In the absence of a neuropsychology category within the South African professional framework, university instruction has been ad hoc with vastly different levels of competency depending on the institution involved. The small number of practitioners and/or academics involved in neuropsychology includes mainly masters, and some doctoral level psychologists registered in clinical, counseling or educational categories. A prime emphasis of neuropsychological research has been local norming of psychometric tests to facilitate valid assessment practices in the country. South Africa is on the cusp of achieving a hard-won neuropsychology professional register. It is anticipated that this development will provide impetus to the discipline by promoting training programs, the creation of neuropsychology posts, wider service delivery, and increased research funding. CONCLUSIONS: Despite significant challenges in a culturally diverse, developing country, neuropsychology has evolved sufficiently to warrant the creation of a separate category in the professional framework. This development will facilitate training, research, and services in the country.

Psychologists' perspectives on the diagnostic classification of mental disorders: results from the WHO-IUPsyS Global Survey.

This study examined psychologists' views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD-11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD-10 used most frequently by 51% and DSM-IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD-11 development and dissemination are discussed.