BACKGROUND: We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. METHODS: 1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of eleven pairs of case vignettes. RESULTS: Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories. LIMITATIONS: Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients. CONCLUSIONS: Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.
Bipolar Disorder , International Classification of Diseases , Bipolar Disorder/diagnosis , Humans , Judgment , Mood Disorders/diagnosis , Russia
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.
The movement towards renaming of schizophrenia in Japan started in 1993 upon receipt of a letter by The National Federation of Families with Mentally Ill in Japan addressed to the board of Japanese Society of Psychiatry of Neurology (JSPN), requesting to rename schizophrenia as the then-official term for the condition, Seishin-Bunretsu-Byo, or 'mind-splitting disease', was humiliating. A committee was established within JSPN to address the issue, public comments were collected, a new name 'Togo-Shitcho-Sho' ('disintegration disorder') was approved in 2002, and in 2005, the new name was adopted in the Revised Mental Health and Welfare Act. This paper describes the process of renaming, and also the current situation in Korea, Taiwan, China, Hong Kong and Malaysia, where Chinese characters are used. Also, it presents alternative names for schizophrenia that have been suggested in the process of two research projects conducted by the authors and also additional candidates suggested by others.
Schizophrenia/classification , Terminology as Topic , Asia , Humans , Social Stigma
Background/Objective: Collaborative teamwork in global mental health presents unique challenges, including the formation and management of international teams composed of multicultural and multilingual professionals with different backgrounds in terms of their training, scientific expertise, and life experience. The purpose of the study was to analyze the performance of the World Health Organization (WHO) Field Studies Coordination Group (FSCG) using an input-processes-output (IPO) team science model to better understand the team's challenges, limitations, and successes in developing the eleventh revision of the International Classification of Diseases (ICD). Method: We thematically analyzed a collection of written texts, including FSCG documents and open-ended qualitative questionnaires, according to the conceptualization of the input-processes-output model of team performance. Results: The FSCG leadership and its members experienced and overcame numerous barriers to become an effective international team and to successfully achieve the goals set forth by WHO. Conclusions: Research is necessary regarding global mental health collaboration to understand and facilitate international collaborations with the goal of contributing to a deeper understanding of mental health and to reduce the global burden of mental disorders around the world
Antecedentes/Objetivo: El trabajo de equipo colaborativo en salud mental global presenta retos particulares, incluyendo la formación y el control de grupos internacionales integrados por profesionales multilingües y multiculturales con diferentes antecedentes en términos de entrenamiento, competencias científicas y experiencias vitales. El propósito del estudio fue analizar el funcionamiento del Grupo de Coordinación de Estudios de Campo (GCEC) de la Organización Mundial de la Salud (OMS) utilizando un modelo científico de entrada-proceso-salida (EPS) para mejorar la comprensión de los retos, limitaciones y logros del equipo en el desarrollo de la onceava revisión de la Clasificación Internacional de Enfermedades (CIE). Método: Se llevó a cabo un análisis temático de una colección de textos, incluyendo documentos del GCEC y cuestionarios cualitativos de preguntas abiertas, acordes con la conceptualización del modelo de rendimiento de equipos de entrada-proceso-salida. Resultados: El liderazgo y los miembros del GCEC experimentaron y superaron numerosas barreras para convertirse en un grupo internacional efectivo y lograr exitosamente los objetivos establecidos por la OMS. Conclusiones: Se requiere de investigación sobre la colaboración en salud mental global a fin de entender y facilitar las colaboraciones internacionales dirigidas a comprender a profundidad la salud mental y reducir la carga de los trastornos mentales en el mundo
Humans , World Health Organization , International Classification of Diseases , Mental Disorders/classification , International Cooperation , 25783 , Global Health
Background/Objective: Collaborative teamwork in global mental health presents unique challenges, including the formation and management of international teams composed of multicultural and multilingual professionals with different backgrounds in terms of their training, scientific expertise, and life experience. The purpose of the study was to analyze the performance of the World Health Organization (WHO) Field Studies Coordination Group (FSCG) using an input-processes-output (IPO) team science model to better understand the team's challenges, limitations, and successes in developing the eleventh revision of the International Classification of Diseases (ICD). Method: We thematically analyzed a collection of written texts, including FSCG documents and open-ended qualitative questionnaires, according to the conceptualization of the input-processes-output model of team performance. Results: The FSCG leadership and its members experienced and overcame numerous barriers to become an effective international team and to successfully achieve the goals set forth by WHO. Conclusions: Research is necessary regarding global mental health collaboration to understand and facilitate international collaborations with the goal of contributing to a deeper understanding of mental health and to reduce the global burden of mental disorders around the world.
Antecedentes/Objetivo: El trabajo de equipo colaborativo en salud mental global presenta retos particulares, incluyendo la formación y el control de grupos internacionales integrados por profesionales multilingües y multiculturales con diferentes antecedentes en términos de entrenamiento, competencias científicas y experiencias vitales. El propósito del estudio fue analizar el funcionamiento del Grupo de Coordinación de Estudios de Campo (GCEC) de la Organización Mundial de la Salud (OMS) utilizando un modelo científico de entrada-proceso-salida (EPS) para mejorar la comprensión de los retos, limitaciones y logros del equipo en el desarrollo de la onceava revisión de la Clasificación Internacional de Enfermedades (CIE). Método: Se llevó a cabo un análisis temático de una colección de textos, incluyendo documentos del GCEC y cuestionarios cualitativos de preguntas abiertas, acordes con la conceptualización del modelo de rendimiento de equipos de entrada-proceso-salida. Resultados: El liderazgo y los miembros del GCEC experimentaron y superaron numerosas barreras para convertirse en un grupo internacional efectivo y lograr exitosamente los objetivos establecidos por la OMS. Conclusiones: Se requiere de investigación sobre la colaboración en salud mental global a fin de entender y facilitar las colaboraciones internacionales dirigidas a comprender a profundidad la salud mental y reducir la carga de los trastornos mentales en el mundo.
In this paper we report the clinical utility of the diagnostic guidelines for ICD-11 mental, behavioural and neurodevelopmental disorders as assessed by 339 clinicians in 1,806 patients in 28 mental health settings in 13 countries. Clinician raters applied the guidelines for schizophrenia and other primary psychotic disorders, mood disorders (depressive and bipolar disorders), anxiety and fear-related disorders, and disorders specifically associated with stress. Clinician ratings of the clinical utility of the proposed ICD-11 diagnostic guidelines were very positive overall. The guidelines were perceived as easy to use, corresponding accurately to patients' presentations (i.e., goodness of fit), clear and understandable, providing an appropriate level of detail, taking about the same or less time than clinicians' usual practice, and providing useful guidance about distinguishing disorder from normality and from other disorders. Clinicians evaluated the guidelines as less useful for treatment selection and assessing prognosis than for communicating with other health professionals, though the former ratings were still positive overall. Field studies that assess perceived clinical utility of the proposed ICD-11 diagnostic guidelines among their intended users have very important implications. Classification is the interface between health encounters and health information; if clinicians do not find that a new diagnostic system provides clinically useful information, they are unlikely to apply it consistently and faithfully. This would have a major impact on the validity of aggregated health encounter data used for health policy and decision making. Overall, the results of this study provide considerable reason to be optimistic about the perceived clinical utility of the ICD-11 among global clinicians.
Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization - schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear-related disorders, and disorders specifically associated with stress - among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint-rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD-11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines. These data provide support for the suitability of the ICD-11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD-11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD-11 by WHO member states.
OBJECTIVE: To explore the rationales of mental health professionals (mainly psychiatrists and psychologists) from 8 countries for removing specific diagnostic categories from mental disorders classification systems. METHOD: As part of a larger study, 505 participants indicated which of 60 major disorders should be omitted from mental disorders classification systems and provided rationales. Rationale statements were analyzed using inductive content analysis. RESULTS: The majority of clinicians (60.4%) indicated that 1 or more disorders should be removed. The most common rationales were (a) problematic boundaries between normal and psychopathological conditions (45.9% of total removal recommendations), (b) problematic boundaries among mental disorders (25.4%), and (c) problematic boundaries between mental and physical disorders (24.0%). The categories most frequently recommended for deletion were gender identity disorder, sexual dysfunction, and paraphilias, usually because clinicians viewed these categories as being based on stigmatization of a way of being and behaving. A range of neurocognitive disorders were described as better conceptualized as nonpsychiatric medical conditions. Results were analyzed by country and country income level. Although gender identity disorder was the category most frequently recommended for removal overall, clinicians from Spain, India, and Mexico were most likely to do so and clinicians from Nigeria and Japan least likely, probably because of social and systemic factors that vary by country. Systematic differences in removal rationales by country income level may be related to the development, structure, and functioning of health systems. CONCLUSION: Implications for development and dissemination of the classification of mental and behavioral disorders in WHO's ICD-11 are discussed.
Attitude of Health Personnel , Diagnostic and Statistical Manual of Mental Disorders , Health Personnel/psychology , International Classification of Diseases , Mental Disorders/classification , Mental Disorders/psychology , Brazil , China , Developing Countries/economics , Gender Identity , Humans , India , Japan , Mexico , Nigeria , Psychiatry , Psychology , Spain , Stereotyping , United States , World Health Organization
I overviewed the draft of the linear structure (22nd May, 2013) of the International Statistical Classification of Diseases and Related Health Problems, Eleventh Revision. In this draft, sleep and sexual disorders were not included in mental and behavioural disorders. The World Health Organization decided not to regard them as mental disorders. The primary classification of neurocognitive disorders was also not included in mental and behavioural disorders. In the draft of the linear structure, 25 major categories were classified: neurodevelopmental disorders, disorders of speech and language, schizophrenia and other primary psychotic disorders, catatonia, bipolar and related disorders, depressive disorders, anxiety and fear-related disorders, obsessive-compulsive and related disorders, disorders specifically associated with stress, dissociative disorders, bodily distress disorders, and behavioural factors associated with disorders or diseases classified elsewhere, feeding and eating disorders, elimination disorders, substance intoxication, harmful use of substances, substance dependence, substance withdrawal syndrome, substance-induced mental and behavioural disorders, impulse control disorders, disruptive behaviour and dissocial disorders, disorders of personality, paraphilic disorders, factitious disorders, neurocognitive disorders, and mental and behavioural disorders associated with disorders or diseases classified elsewhere. I also introduced the Global Clinical Practice Network (GCPN), which is now being organized by the WHO to carry out field studies for the ICD-11. Over 700 members of the Japanese Society for Psychiatry and Neurology (JSPN) have registered in the GCPN. The ICD-11 committee of the JSPN is very actively building the GCPN and revising the ICD.
Mental Disorders/diagnosis , Humans , Japan , Linear Models , Mental Disorders/classification , Psychiatric Status Rating Scales , World Health Organization
OBJECTIVE: To examine the conceptualizations held by psychiatrists and psychologists around the world of the relationships among mental disorders in order to inform decisions about the structure of the classification of mental and behavioral disorders in World Health Organization's International Classification of Diseases and Related Health Problems 11th Revision (ICD-11). METHOD: 517 mental health professionals in 8 countries sorted 60 cards containing the names of mental disorders into groups of similar disorders, and then formed a hierarchical structure by aggregating and disaggregating these groupings. Distance matrices were created from the sorting data and used in cluster and correlation analyses. RESULTS: Clinicians' taxonomies were rational, interpretable, and extremely stable across countries, diagnostic system used, and profession. Clinicians' consensus classification structure was different from ICD-10 and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV), but in many respects consistent with ICD-11 proposals. CONCLUSIONS: The clinical utility of the ICD-11 may be improved by making its structure more compatible with the common conceptual organization of mental disorders observed across diverse global clinicians.
Diagnostic and Statistical Manual of Mental Disorders , International Classification of Diseases , Mental Disorders/classification , Adult , Cross-Cultural Comparison , Female , Health Personnel , Humans , Male , Middle Aged
The ICD-11 is being developed for publication in 2015, while another important diagnostic classification system, the DSM-5, is being finalized and prepared for publication in 2013. This paper provided an overview of the revision process and also the current status of the drafts of both systems. In addition, the Global Clinical Practice Network, an online network created by the WHO for clinicians throughout the world to participate in the revision efforts for the ICD-11 by reviewing the proposals, providing feedback on them, and participating in field trials, is introduced.
International Classification of Diseases/standards , Mental Disorders/diagnosis , Practice Guidelines as Topic , Psychiatric Status Rating Scales/standards , Humans , Mental Disorders/classification , World Health Organization
Enhancing clinical utility is an emphasis of the World Health Organization's development of the mental and behavioural disorders chapter of the next International Classification of Diseases (ICD-11). Understanding how clinicians conceptualize the structure of mental disorders can enable a more clinically intuitive classification architecture that will help professionals find the categories they need more efficiently. This study examined clinicians' conceptualizations of the relationships among mental disorders and the dimensions they use in making these judgements. Psychiatrists and psychologists from 64 countries (n = 1,371), participating in English or Spanish, rated the similarity of mental and behavioural disorders presented as paired comparisons. Data were analysed by multidimensional scaling procedures (INDSCAL) and by analyses of consistency. Participants used three distinctive dimensions to evaluate the similarity among disorders: internalizing versus externalizing, developmental versus adult onset, and functional versus organic. Clinicians' conceptual map of mental disorders was rational and highly stable across profession, language, and country income level. The proposed ICD-11 structure is a moderately better fit with clinicians' conceptual model than either ICD-10 or DSM-IV. Clinician judgements can be used to improve clinical utility of the ICD-11 without sacrificing validity based on a scientific approach to enhancing a logically organized classification meta-structure.
International Classification of Diseases/standards , Mental Disorders/classification , Psychiatry/statistics & numerical data , Data Collection , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , International Classification of Diseases/organization & administration , Male , Mental Disorders/diagnosis , Middle Aged , Psychology, Clinical/statistics & numerical data , Quality Improvement
Some psychiatric diagnoses are stigmatic. In August of 2002, at the annual congress of the Japanese Society of Psychiatry and Neurology, the Society decided to change the name of schizophrenia in Japanese from seishinbunretsu-byo ('split mind disease') to togoshitcho-sho ('loss of coordination disorder'). In 2006 a survey was carried out among the 80 members of the Section on Classification, Diagnostic Assessment and Nomenclature of the World Psychiatric Association. Of the 21 responding, nine (45%) did not think that 'schizophrenia' was an appropriate term for the disease and half thought that the term 'schizophrenia' had a stigmatic meaning.
Schizophrenia , Stereotyping , Terminology as Topic , Data Collection , Humans , Psychiatry/trends , Surveys and Questionnaires
Burnout of nurses at university hospitals was analyzed in relation to their personality characteristics and coping behaviors. A self-administered questionnaire regarding burnout (the Copenhagen Burnout Inventory), work-related stressors (the Nursing Job Stressor Scale), personality characteristics (Short-Form Eysenck Personality Questionnaire-Revised), and coping behaviors (the short Japanese version of Brief COPE) was used. We obtained answers from 778 nurses (response rate: 94.9%), and analyzed 707 female registered nurses. Multiple regression analysis showed that neuroticism was more closely related to personal, work-related, and client-related burnout than extroversion. Covariate structure analysis revealed that among the nurses with high neuroticism and low extroversion, client-related burnout was found to be correlated with stressors in relation to conflict with patients and with positive coping behaviors. Among the nurses with low neuroticism and high extroversion, client-related burnout correlated with the coping behavior of behavioral disengagement and conflict with patients. In both groups, an increase in quantitative workload was associated with a higher score for stressors arising from conflict with patients, leading to client-related burnout. These results suggest that acquisition of skills to cultivate appropriate coping behaviors might be useful for reducing client-related burnout in relation to nurses' personality characteristics. These findings need to be further endorsed by intervention studies.
Adaptation, Psychological , Burnout, Professional/psychology , Nursing Staff, Hospital/psychology , Personality , Adult , Female , Hospitals, University , Humans , Stress, Psychological/physiopathology , Surveys and Questionnaires
