ICD 11 electronic version. WHO publishes new international classification of diseases
World Psychiatry
WPA
OFFICIAL JOURNAL OF THE WORLD PSYCHIATRIC ASSOCIATION (WPA)
Volume 15, Number 3
October 2016
FROM THE EDITOR
Bridging the gap between ICD/DSM and constructs
RDoC: possible steps and nuances
Mario Maj
193
SPECIAL ARTICLE
Traditional marijuana, high-potency hemp
and synthetic cannabinoids: increased risk of psychosis
Robin M. Murray, Harriet Quigley, Diego Quattrone,
Amir Englund, Marta Di Forti
195
Sexuality-related disorders
and gender in ICD-11: a revision
ICD-10 classification based on the latest
scientific evidence, clinical experience
and legal considerations
Geoffrey M. Reed, Jack Drescher, Richard B. Krueger,
Elham Atalla, Susan D. Cochran, Michael B. First,
Peggy T. Cohen-Kettenis, Ivan Arango-de Montis,
Sharon J. Parish, Sara Cottler, Peer Briken,
Shekhar Saxena
PROSPECTS
Improvement of research
domain criteria
Charles A. Sanislow
Possibility of using the “continuous” model
improvements for revisions
DSM in the future
Michael B. First
Prescription of treatment according to diagnosis:
how is psychiatry different?
David Taylor
Rising suicide rate: underestimated
role of the internet?
Elias Aboujaoude
FORUM – TRANSITION TO PRECISION MEDICINE
IN PHARMACOTHERAPY OF DEPRESSION:
CHALLENGES AND FUTURE STRATEGY
Refusal of a personalized approach
for the sake of precision in the pharmacotherapy of depression
Roy H.Perlis
COMMENTS
Discard the “masks” of depression
before moving to personalized
and evidence-based medicine
Koen Demyttenaere
Is it acceptable to “dismember” depression?
Allan H. Young, Alessandro Colasanti
Practical treatment options needed
depression and anxiety disorders
Gavin Andrews, Megan J. Hobbs
Towards precision medicine for depression:
admitting ignorance and focusing on failure
A. John Rush
Can we at least learn faster
lose?
Gregory E. Simon
RESEARCH REPORT
How effective is cognitive behavioral therapy?
therapy in the treatment of major depressive disorder
disorders and anxiety disorders?
Current meta-analysis of data
Pim Cuijpers, IoanaA. Cristea, Eirini Karyotaki,
Mirjam Reijnders,
Ultra-high risk status and presentation
psychosis in 22Q11.2 deletion syndrome
Maude Schneider, Marco Armando, Maria Pontillo,
Stefano Vicari, Martin Debban, Frauke Schultze-Lutter,
Stephan Eliez
257
"Prolonged grief reaction" and "persistent
complicated loss reaction" are one
and the same diagnostic unit, not including
into a “complicated grief reaction”: data analysis
Yale Bereavement Study
Paul K. Maciejewski, Andreas Maercker, Paul A. Boelen,
Holly G. Prigerson
263
REVALUATION
Mental health around the world: the current state
and development prospects
Graham Thornicroft, Tanya Deb, Claire Henderson
A VIEW FROM INSIDE
Four main components of psychoanalytic
technology and other psychoanalytic
psychotherapies
Otto F. Kernberg
282
Functional rehabilitation for bipolar disorder:
from remission to recovery
Eduard Vieta, Carla Torrent
Meditative-cognitive psychotherapy
to prevent relapses in disorders
mood
Zindel V. Segal, Le-Anh Dinh-Williams
Somatic distress syndrome in ICD-11:
problems and prospects
Oye Gureje, Geoffrey M. Reed
LETTERS TO THE EDITOR
WPA NEWS
Correct choice of method, timing and patient
in the treatment of depression: biosignatures
and precision therapy
Madhukar H. Trivedi
Individually Focused Therapy
measurement-based depression
clinical indicators
Rudolf Uher
New impact factor 20.205
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problems in structural mechanics. Int J Num Math
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London: Wiley, 1964.
3. Fraeijs de Veubeke B. Displacement and equilibrium
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O. C., Hollister G. S. (eds). Stress analysis. London: Wiley,
1965:145-97.
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FROM THE EDITOR
Bridging the ICD/DSM gap
and RDoC designs: possible steps and nuances
Mario Maj
Department of Psychiatry, University of Naples SUN, Naples, Italy
Translation: Filippov D.S.
Editing: Ph.D. Severova E.A.
(World Psychiatry 2016; 15: 193-194)
These need to be taken into account, because not all
assumptions underlying the RDoC design may
be accepted by us at this stage of our development
scientific discipline.
The first possible step that we, clinicians and
specialists in psychopathology, we can take
in order to bridge the above gap -
it is the redefinition and analysis of certain complex symptoms.
Indeed, if the characteristics of mental
syndromes have been repeatedly specified over the past forty
years, the characteristics of symptoms and signs remained more or less unchanged, resulting in
descriptions of several symptoms, especially compound ones
and heterogeneous (for example, delusions, hallucinations,
anhedonia), in the DSM-5 seem outdated and unsuitable for study by neuroscientists.
A second possible step is to identify empirical intermediate phenotypes that may be
added to phenotypes, mainly behavioral,
included in the RDoC. Primary psychotic experiences - for example, aberrant delusions that are partly correlated with a delusional atmosphere
Jaspers – may be more suitable and meaningful
object for neuroscientists than, say, delusional
ideas. Of course, these primary psychotic experiences must be characterized clearly and
reliably, as, for example, is done in the Assessment of Abnormal Self-Experiences (EASE) (4), an instrument developed by J. Parnas and other European specialists.
The third possible step is to clarify the identified
the current boundaries of mental disorders and
establishing correspondences during the transition between these
boundaries and constructs of RDoC. This goal was set by P. Wang and D. Clarke, whose work with APA
(5), was presented at the mentioned symposium in
Atlanta.
The fourth possible step is a more accurate and detailed description of broad groups of pathological disorders, such as endogenous and exogenous disorders, as well as neurotic ones. A good example of how
It is possible to productively pursue such a strategy, shows research presented at the Atlanta symposium by R. Krueger's group on these disorders and their neurobiological correlates, and
their recent attempt to explore the likely relationships between these groups and RDoC constructs
(6).
The fifth possible step is to improve approaches to determining the stages of development of mental
disorders, especially psychoses (7). Some
of these stages, especially the early ones, may be better
studied by neuroscientists than the full-blown syndromes described in the ICD and DSM.
The sixth step is an in-depth study of the dynamics of symptoms. Recent research in this area suggests that there may be interactions between the symptoms of a mental disorder in which
an adverse event may cause one or
several symptoms, which in turn activate other symptoms that change the severity
previous symptoms (8). This dynamic can
be relevant to neurobiological research.
Of course, this is a very approximate list,
which can be improved and expanded.
Let's move on to the conceptual comments that
stem from the rich literature on
philosophy of psychiatry. By the way, as T said.
Kuhn (9), “recourse to philosophy and
discussion of fundamental provisions" is
symptom of "transition from normal examination to
extraordinary", which corresponds to the change
paradigms in a scientific discipline. There is no doubt that this
exactly what is observed in the current phase of development
psychiatry.
First note. Mental phenomena can be observed and explained at different levels, and there is no reason to believe that any of these levels is more
fundamental than others (10). Of course, abnormal experiences and abnormal behavior are realized through neural networks, but this does not mean that
It will be most useful and effective to consider these anomalies at the level of neural networks. On
At what level observation and explanation are most useful depends on your goals. If we are developing new
psychotropic drugs, then the study is at the level
neural networks will be the most effective, but
if our goal is to develop a new psychotherapeutic technique or a new approach to psychosocial interventions, then more useful and
other levels of observation will be effective and
explanations.
Second, related, but more radical remark
is as follows: although all abnormal mental phenomena are realized through neural networks, this does not mean that these networks are “broken” and
they need to be “fixed.” Some types of mental
dysfunctions associated with learning during the learning process
maladaptive skills (11), which may be accompanied by
change in the configuration of neural activity, not
being “pathological”, although different
from the usual scheme. In other words, the level of pathology may be higher than the level of neural networks, and intervention at the level of neural networks will not be an adequate response to dysfunction.
The third complexity has already been mentioned by Jaspers a hundred
years ago: “The living mosaic method – i.e. idea about
that the disease consists of mosaic structures,
composed of identical and original elements - turns psychopathological research
and diagnostics into something purely mechanical and leads
any data revealed during the analysis process leads to a hopelessly frozen state” (1). In other words,
it is still necessary to prove whether it is possible to decompose the identified mental disorders into “pieces” (variables or dimensions), for which the
The same properties and neurobiological correlates. In the case of different psychopathological groups, the meanings and pathogenetic background of a certain
symptoms may vary.
The fourth point is this. The problem of instrumental (test) and inter-expert
reliability in psychopathology research is often
has been discussed in recent years. Obviously the problem
test instruments and laboratory reliability of neurobiological studies in psychiatry
is not treated equally. It's a problem
which must be taken into account if the purpose of the work is
development of measures for use in routine clinical practice.
What approximate conclusions can be drawn regarding clinical practice and scientific progress?
based on the above?
In clinical practice, experience will show whether the description of individual patient cases using neurobiological and behavioral
terms to add something to the existing characteristics of mental illness (or, as originally
the RDoC project was supposed to completely replace
them) with the goal that remains main for us - to effectively predict the outcome of treatment.
It’s one thing to promise and make statements, but another thing
– facts and data. Today we are very
This is exactly what is needed: strong empirical evidence, clinically relevant and replicated at scale. History of biological psychiatry
didn't start yesterday. We have seen how many biological discoveries were forgotten after a few years, not
having received confirmation or refutation and not finding
application in medical practice.
Regarding the development of science, clinicians and researchers of mental disorders on the one hand and
neuroscientists on the other
New international classification of diseases (ICD-11). It contains approximately 55,000 unique injury, disease, and cause of death codes. This classification forms a common language for physicians around the world.
“ICD is a special source of pride for WHO. It allows us to better understand the causes of disease and death, and to take action to prevent suffering and save lives,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
ICD-11 has been in development for over ten years. Its updated version contains significant improvements compared to previous versions. For the first time, it is presented entirely electronically and has a much more convenient format. Many healthcare workers took part in its development and presented their proposals at conferences. In total, the ICD group at WHO headquarters received more than 10,000 proposals for revision of certain provisions.
ICD-11 will be presented to the World Health Assembly in May 2019 for adoption by WHO Member States and will come into force on 1 January 2022. This version is being published for preview purposes to enable participating countries to formulate their plans for its use, prepare translations of it, and train health professionals throughout the country.
ICD is also used by insurance companies, since the amount of compensation depends on its codes. In addition, the ICD is used by national health program managers; data scientists; and those who track progress in global health and determine the allocation of resources for the health system.
The new version (ICD-11) also reflects progress in medicine and scientific achievements. For example, codes related to antimicrobial resistance are more consistent with the Global Antimicrobial Resistance Surveillance System (GLASS).
ICD-11 will also help to better collect data on safety in healthcare, meaning that some of the factors that influence health outcomes, such as some potentially hazardous hospital practices, can be identified and reduced.
The new ICD also includes new chapters on traditional medicine: despite the fact that millions of people around the world use traditional medicine, it has not yet been classified in this system. Another new chapter, on sexual health, brings together disorders that were previously classified in other ways (for example, gender nonconformity was previously considered a mental disorder) or were described differently. Gambling disorder has been added to the section on addictive disorders.
“A key principle in revising the codes was to simplify the coding structure and electronic toolkit, which will make it easier for health professionals to record disorders,” said Dr Robert Jakob, head of the WHO Terminology and Classification Standards Group.
Dr Lubna Alansari, WHO assistant director-general for health system measurement, says the ICD is the cornerstone of health information and ICD-11 will provide an updated version of disease understanding.
Frequently asked questions about ICD-11
What is the International Classification of Diseases (ICD)?
The International Classification of Diseases (ICD) is the global standard methodology for collecting data on mortality and morbidity. It organizes and encodes health information used for statistics and epidemiology, health management, resource allocation, monitoring and evaluation, research, primary health care, prevention and treatment. It provides insight into the overall health situation of countries and populations.
The 11th version of the ICD is currently being developed through an innovative, collaborative process. For the first time, WHO is calling on experts and users to participate in the revision process on an online platform. This will allow the classification to be developed based on user input and taking into account their needs.
Who uses the ICD?
Users include physicians, nurses, other health care providers, academic researchers, health information managers and coders, health information technology workers, policy makers, insurance companies, and patient organizations.
All Member States use the ICD, which has been translated into 43 languages. Most countries (117) use this system to report mortality, a key indicator of health status.
All Member States are expected to use the latest version of the ICD to report mortality and morbidity statistics (in accordance with the WHO Nomenclature Rules adopted by the World Health Assembly in 1967).
Why is the ICD so important?
The ICD is important because it provides a common language for reporting and monitoring diseases. It allows data to be collated and shared globally in a consistent and standardized way – across hospitals, areas and countries and over defined periods of time. It simplifies the collection and storage of information for analysis and evidence-based decision making.
Why is the ICD being revised?
The ICD is being revised to better reflect scientific progress in health care and medical practice. With advances in information technology, ICD-11 will be available for use in e-health devices and information systems.
What are the features of this revision process?
- The ICD-11 revision process allows for web-based collaborative editing with the participation of all stakeholders. To ensure quality, incoming information will be reviewed for accuracy and relevance.
- The revision will be free to download online for personal use (and available in printed form for a fee).
- Information about the revision process will be available in many languages.
- Definitions, signs and symptoms, and other disease-related content will be defined in a structured manner to more accurately record them.
- The revision is compatible with e-health devices and information systems.
How can I participate in the ICD-11 revision?
Experts and interested parties are invited to provide comments and suggestions, and to participate in field testing of the revised classification. Participants will have the opportunity to make structured contributions that will be peer-reviewed by experts in the field. WHO welcomes the active participation of academic researchers, health information system managers, health care providers and other parties interested in the classification.
Guidance on how to participate in the review process is available on the online review platform.
Why is my contribution important?
Because different views on healthcare and knowledge coming from every corner of the world will contribute to creating a better classification that takes into account the needs of users. The consistency, comparability and usefulness of the classification will be improved through input from multiple parties.
The overall process will lead to global consensus on the definition and recording of diseases and health-related problems. This is an opportunity to engage in international collaboration that will ensure more consistent and systematic collection of health information.
Where to start?
To get started, register for counting on the web portal. The web portal will be open for comments for the next three years and adopted changes will be published immediately.
After registration you will be able to do the following:
- make comments regarding the structure and content of the classification and its implementation;
- make proposals for changing ICD categories;
- propose definitions of diseases;
- participate in on-site testing;
- contribute to translation into different languages.
Center for Primary Immunodeficiencies in Adults
Primary immunodeficiencies (PIDs) are genetically determined diseases that lead to disruption of one or more parts of the immune system. Despite the fact that these diseases are associated with “breakage” of genes, not all of them appear in childhood. There are forms of primary immunodeficiencies, the onset of which occurs over the age of 18 years.
The immune system takes part in the implementation of the work of many organs and systems, so the symptoms of PID are diverse. For adults, the most common manifestations are repeated severe infections of the upper and lower respiratory tract, abscesses of the skin and internal organs, persistent diarrhea, especially with loss of body weight, an increase in the size of lymphoid organs (lymph nodes and spleen), etc. Due to low awareness of how patients and doctors about this pathology, the diagnosis is established very late, when complications lead to irreversible changes in organs, reducing the quality and life expectancy of patients. While timely diagnosis and adequate therapy allows you to have a good quality of life, maintain working capacity and have healthy offspring.
PID is not AIDS; the disease is a birth defect and is not dangerous to others.
When should you consider having a PID? If you or your relative have 2 or more warning signs of PID, you should contact an immunologist to rule out this disease.
Warning signs of PID in adults:
- 1. Two or more otitis media per year
- 2. Two or more sinusitis per year
- 3. Two pneumonias in 1 year or 1 pneumonia over 2 or more consecutive years
- 4. Chronic diarrhea with weight loss
- 5. Recurrent viral infections (herpes, herpes zoster, condylomas, warts)
- 6. The need for repeated courses of parenteral antibiotics to achieve infection control
- 7. Antibiotic therapy for 2 or more months with insufficient effect
- 8. Recurrent deep abscesses of the skin and internal organs
- 9. Persistent fungal infection of the skin and mucous membranes
- 10. Infection normally caused by non-pathogenic mycobacteria
- 11. Two or more episodes of severe generalized infection (meningitis, sepsis)
- 12. Presence of PID in relatives
“ICD is a product of which WHO is rightly proud,” said the WHO Director-General
Dr. Tedros Adhanom Ghebreyesus. “It enables us to understand the variety of reasons why people get sick and die, and to take action to prevent suffering and save lives.”
ICD-11, whose preparation lasted over ten years, differs from previous versions in a number of important improvements. For the first time, it is published in completely electronic form and has a much more reader-friendly format. It also received input from an unprecedented number of health professionals who participated in joint meetings and made suggestions. The ICD Group at WHO headquarters received more than 10,000 proposals for changes to the Classification.
ICD-11 will be presented for adoption by Member States at the World Health Assembly in May 2019 and will enter into force on 1 January 2022. This release is preliminary and exploratory in nature and will enable countries to develop plans for the use of the new version, prepare translations and conduct nationwide training for health professionals.
The ICD is also used by health insurance companies, which use ICD codes to determine compensation payments; managers of national health programs; data collection specialists; and all those who monitor trends in global health and make decisions about the allocation of resources in this area.
The new ICD-11 reflects progress in medicine and the achievements of scientific thought. Thus, codes related to antimicrobial resistance are now more consistent with the criteria of the Global Antimicrobial Resistance Surveillance System (GLASS). ICD-11 also allows for more effective recording of data related to health safety and, accordingly, the identification and prevention of unwanted events that may cause harm to health, such as unsafe practices in hospitals.
The new ICD also includes new chapters, in particular on folk (traditional) medicine: although traditional medicine is used by millions of people around the world, it has not yet been included in this classification system. Another new chapter on sexual health brings together disorders that were previously classified in other categories (for example, gender nonconformity was listed under mental disorders) or described differently. Gaming disorder has been added to the addictive disorders section.
“A key principle of this revision was to simplify the code structure and electronic tools so that health professionals can more easily and comprehensively record different diseases,” says Dr Robert Jakob, WHO Group Leader for Classifications, Terminology and Standards .
According to Dr. Lubna A. Al-Ansary, Assistant Director General for Metrics and Measurement, “ICD is the cornerstone of health information and ICD-11 will provide an updated view of disease typology.” .