Version 1

Document Sample
Version 1 Powered By Docstoc
					DSM Directory | Document 2
APA DSM DSM-IV DSM-V WHO ICD ICD-10 ICD-11 American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders World Health Organization Classifications DSM Revision Process DSM-ICD Harmonization Coordination Group International Advisory Group Global Scientific Partnership Coordination Group for Revision of ICD Mental and Behavioural Disorders ICD Update and Revision Platform WHO Collaborating Centre DSM-V Task Force DSM-V Somatic Distress Disorders Work Group CISSD Project Somatoform Somatisation Somatization Functional Somatic Syndromes Myalgic encephalomyelitis ME Chronic fatigue syndrome CFS Fibromyalgia FM CS CI MUS http://tinyurl.com/dsm-vdirectory

Document 2 Ref: ICD-10 Chapter V http://www.who.int/classifications/apps/icd/icd10online/index.htm?gF40.htm+F454 Mental and behavioural disorders (F00-F99) Neurotic, stress-related and somatoform disorders (F40-F48)

WHO ICD Update and Revision Platform Topical Advisory Group - Mental Health (TAGMH) https://extranet.who.int/icdrevision/GroupPage.aspx?gcode=104 18 Proposals submitted by Dr Richard Sykes, Co-ordinator CISSD Project Dated 3 March 2008, 5 March 2008

F45.4 R 1299 Deletion of Persistent Somatoform Pain Disorder Sykes Richard The CISSD Project Working Group recommends that the category be deleted. The specific type of pain condition or conditions, e.g. low back pain, headache, fibromyalgia, noncardiac chest pain, should be classified outside Ch V. If psychological factors are also present, these should be given an additional coding from Ch V, either as a discrete disorder, e.g. Major Depression, Panic Disorder, or as F54 Psychological and behavioural factors associated with disorders or diseases classified elsewhere (Psychological Factors Affecting Medical Condition in DSM-IV). Rationale 1. There is extensive literature showing comorbidity between chronic pain and depression, their bidirectional dependency and central nervous system linkages.
Directory: APA DSM WHO ICD Revision Process http://meagenda.wordpress.com

1

2. The category has been infrequently researched as a discrete diagnosis 3. Pain experts do not use the category 4. Assigning a Chapter V diagnosis to a small subset of chronic pain patients is highly arbitrary 5. Assigning a Chapter V diagnosis to a small subset of chronic pain patients presumes, or may be understood to presume, that there is a whole class of chronic pain patients for whom physiological factors are irrelevant.

F45.1 R 1300 Deletion of Category of Undifferentiated Somatoform Disorder Sykes Richard The CISSD Project Working Group recommends that the category of Undifferentiated Somatoform Disorder be deleted. Some of the conditions now placed in this category should be classified outside Chapter V (i.e. not as one of the “Mental or Behavioural Disorders”). Others might be placed in the category of Somatization Disorder, if a more inclusive definition of Somatization Disorder is adopted. (The CISSD Project Working Group recommends that, if a category of Somatization Disorder is retained, a broader definition of it is adopted,) Rationale 1. A psychiatric diagnosis should not be made solely on the basis that symptoms are medically unexplained. Positive “psychological” criteria are also needed. 2. The category is too broad and heterogeneous. 3. The category is not well validated. 4. The category is not widely used.

F45.2 R 1301 Updating of criteria for Hypochondriacal Disorder Sykes Richard The CISSD Project Working Group recommends that the criteria be revised and updated. Rationale 1. There have been several recent evidence-based reviews which should be taken into account. 2. The ineffectiveness of medical reassurance has been shown to be an unreliable criterion.

F45.2 R 1302 Hypochondriacal Disorder to be renamed Health Anxiety Sykes Richard The CISSD Project Working Group recommends that Hypochondriacal Disorder be renamed “Health Anxiety”. Rationale “Health Anxiety” is less stigmatizing and more acceptable to patients. Unnecessary aggravation of patients is to be avoided

F45.0 R 1303 Broader Concept for Somatization Disorder Sykes Richard The CISSD Project Working Group recommends that if a category of Somatization Disorder is retained, the criteria should include positive “psychological” criteria.

Directory: APA DSM WHO ICD Revision Process http://meagenda.wordpress.com

2

Rationale 1. The present criteria for Somatoform Disorder are very restrictive and pick out a strictly limited number of patients. 2. A broader category would be more useful in practice.

F45.0 R 1304 Positive Psychological Criteria for Somatization Disorder Sykes Richard The CISSD Project Working Group recommends that if a category of Somatization Disorder is retained, the criteria should include positive “psychological” criteria. Rationale A psychiatric diagnosis should not be made solely on the basis that symptoms are medically unexplained. Positive “psychological” criteria are also needed.

Ch05 R 1305 ICD-11 and DSM-V to be made compatible Sykes Richard The CISSD Project Working Group recommends that the APA and the WHO should work together to make ICD-11 and DSM-V compatible with respect to categories, disorders and criteria for mental disorders. Rationale A single universally agreed classification would have substantial benefits for international communication and research. Differences between the classifications introduce unnecessary difficulties.

F45 R 1306 Positive Psychological Criteria for Somatoform Disorder Sykes Richard The CISSD Project Working Group recommends that if the category of Somatoform Disorder is retained, positive psychological criteria should be included in addition to the symptoms being unexplained. Rationale Being unexplained does not, on its own, justify a psychiatric diagnosis. Positive psychological criteria are also needed.

F45.3 R 1307 Deletion of Somatoform Autonomic Dysfunction Sykes Richard The CISSD Project Working Group recommends that the category of Somatoform Autonomic Dysfunction be deleted. Rationale 1. Its deletion would increase compatibility between ICD and DSM. 2. Some of the disorders listed here, e.g, irritable bowel syndrome, are listed elsewhere in ICD, outside Ch V. Is it confusing for a disorder to have alternative classifications?

Directory: APA DSM WHO ICD Revision Process http://meagenda.wordpress.com

3

F48.0 R 1308 Deletion of Neurasthenia Sykes Richard The CISSD Project Working Group recommends that the category of Neurasthenia be deleted. Rationale 1. The diagnosis is increasingly rarely used. 2. Its elimination would increase compatibility between ICD and DSM F45 R 1309 Whether views of non-psychiatric clinicians and of patients be taken into account Sykes Richard The CISSD Project Working Group recommends that if the category of Somatoform Disorder is retained, the following be considered as a key issue: To what extent should the views of nonpsychiatric clinicians and of patients be taken into consideration in the process of revising the classifications? Rationale 1. Patients with unexplained symptoms that meet criteria for a somatoform disorder are mostly seen in primary care as well as in medical and surgical subspecialty settings, where somatoform diagnoses are seldom used. 2. Patients often resist having somatic problems labelled as a psychiatric disorder, with the consequent stigma and negative financial implications. F45 R 1310 Key Issue - Whether some terms and concepts in the Somatoform Category be abolished Sykes Richard The CISSD Project Working Group recommends that if the category of Somatoform Disorder is retained, the following be considered as a key issue: Should some terms and concepts such as “somatization”, “somatoform”, “psychosomatic”, “functional”, “pseudo-neurological” be abolished? Rationale These terms can be unsatisfying or stigmatizing for some patients. Language which is more acceptable to patients is likely to lead to improved communication and treatment result

F45 R 1311 Key Issue - Whether functional syndromes should have a unique classification Sykes Richard The CISSD Project Working Group recommends that if the category of Somatoform Disorder is retained, the following be considered as a key issue: Should “functional syndromes”, e.g. irritable bowel syndrome, have a unique classification? Rationale At present some “functional” syndromes have alternative classifications. They are included in Ch V, although they also have a place outside Ch V. Irritable Bowel Syndrome, for example, is given an alternative classification in Ch V as F45.32, a somatoform autonomic dysfunction disorder, one of the somatoform disorders, although it also has a place outside Ch V as K58, an intestinal disease. It would appear inconsistent, however, if a patient with the same symptoms is classified differently in Psychiatry and in Primary Care – if, when seen by a psychiatrist, he
Directory: APA DSM WHO ICD Revision Process http://meagenda.wordpress.com

4

is diagnosed with a somatoform disorder in chapter V, but when seen in primary care is placed outside

F45 R 1312 Key Issue - Whether conditions defined by somatic symptoms alone should be classified outside Ch V Sykes Richard The CISSD Project Working Group recommends that if the category of Somatoform Disorder is retained, the following be considered as a key issue: Should conditions defined by somatic symptoms be considered “medical” rather than “psychiatric” and be placed outside Chapter V? Rationale At present, some conditions defined by somatic symptoms alone, e.g. Undifferentiated Somatoform Disorders, are classified in Ch V. However 1. Medical practitioners outside Mental Health regard such conditions as “medical”. 2. Patients do not want to be stigmatised by the diagnosis of a Mental Disorder

F45 R 1313 Key Issue - whether being not fully explained should remain a criterion for Somatoform Disorders Sykes Richard The CISSD Project Working Group recommends that if the category of Somatoform Disorder is retained, the following be considered as a key issue: Should “explanation” remain a core construct in defining Somatoform Disorders? Rationale At present a key feature of the definition of Somatoform Disorders is that they are not medically explained or not fully medically explained. However 1 Determining what is “not fully explained” can be difficult, particularly when there are comorbid medical conditions. 2. All psychiatric conditions are considered to have a biopsychosocial development. 3. Total symptom count (including explained as well as unexplained symptoms) may be as good a marker for outcomes.

Ch05 R 1316 Key Issue - Whether substitutes be found for terms and concepts that may give offence to patients Sykes Richard The CISSD Project Working Group recommends that the following be considered as a key issue: Should substitutes be found for terms and concepts which may give offence to patients? Such terms and concepts may include several in the Somatoform Disorder category, e.g. “somatization”, “somatoform”, “psychosomatic”, “functional”, “pseudo-neurological”. Rationale 1. Some terms can be unsatisfying or stigmatizing for some patients. 2. Language which is more acceptable to patients is likely to lead to improved communication and improved treatment results.

Directory: APA DSM WHO ICD Revision Process http://meagenda.wordpress.com

5

Ch05 R 1317 Key Issue - whether all disorders should have a unique classification Sykes Richard The CISSD Project Working Group recommends that the following be considered as a key issue: Should all disorders have a unique classification? Rationale At present some “functional” syndromes have alternative classifications. They are included in Ch V, although they also have a place outside Ch V. Irritable Bowel Syndrome, for example, is given an alternative classification in Ch V as F45.32, a somatoform autonomic dysfunction disorder, one of the somatoform disorders, although it also has a place outside Ch V as K58, an intestinal disease. It would appear inconsistent, however, if a patient with the same symptoms is classified differently in Psychiatry and in Primary Care – if, when seen by a psychiatrist, he is diagnosed with a somatoform disorder in chapter V, but when seen in primary care is placed outside chapter V. F45.0 R 1319 Key Issue - whether symptom checklists be used in defining Somatization Disorder Sykes Richard The CISSD Project Working Group recommends that if a category of Somatization Disorder is retained, the following be considered as a key issue: Should symptom checklists be used in the criteria for Somatization Disorder? Rationale 1. They may have operational value 2. Although symptom checklist results may be more difficult to interpret in multi-system diseases, such diseases are not commonly misdiagnosed as somatoform disorders.

Directory: APA DSM WHO ICD Revision Process http://meagenda.wordpress.com

6


				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:4
posted:11/16/2009
language:English
pages:6