Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses ...are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup "chronic primary pain." In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as "chronic secondary pain" where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseases will lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.
The ICD-11 classification of Personality Disorders focuses on core personality dysfunction, while allowing the practitioner to classify three levels of severity (Mild Personality Disorder, Moderate ...Personality Disorder, and Severe Personality Disorder) and the option of specifying one or more prominent trait domain qualifiers (Negative Affectivity, Detachment, Disinhibition, Dissociality, and Anankastia). Additionally, the practitioner is also allowed to specify a Borderline Pattern qualifier. This article presents how the ICD-11 Personality Disorder classification may be applied in clinical practice using five brief cases.
(1) a 29-year-old woman with Severe Personality Disorder, Borderline Pattern, and prominent traits of Negative Affectivity, Disinhibition, and Dissociality; (2) a 36-year-old man with Mild Personality Disorder, and prominent traits of Negative Affectivity and Detachment; (3) a 26-year-old man with Severe Personality Disorder, and prominent traits of Dissociality, Disinhibition, and Detachment; (4) a 19-year-old woman with Personality Difficulty, and prominent traits of Negative Affectivity and Anankastia; (5) a 53-year-old man with Moderate Personality Disorder, and prominent traits of Anankastia and Dissociality.
The ICD-11 Personality Disorder classification was applicable to five clinical cases, which were classified according to Personaity Disorder severity and trait domain qualifiers. We propose that the classification of severity may help inform clinical prognosis and intensity of treatment, whereas the coding of trait qualifiers may help inform the focus and style of treatment. Empirical investigation of such important aspects of clinical utility are warranted.
Changes made to the DSM Eating Disorders over the years have aimed to reduce the prevalence of the residual DSM Eating Disorder categories (e.g., Other Specified Eating Disorder). Atypical Anorexia ...Nervosa (AN), included since DSM‐IV as an example of a presentation not meeting criteria for a specific eating disorder, appears to be more prevalent than AN. It is defined as meeting all of the criteria for AN except that, after significant weight loss, weight is at or above normal. As suggested by the Walsh et al. review, lack of definitional precision will likely complicate efforts to determine whether atypical AN is best considered a variant of AN or a distinct category. Problems with the current definition of atypical AN include (1) a lack of precision regarding what constitutes “significant” weight loss; (2) whether the weight loss can occur at any point in the individual's lifetime; and (3) whether there an upper limit to weight being above normal. It is suggested that researchers develop consensus diagnostic criteria and assessment tools to facilitate the collection of empirical data about atypical AN in order to lay the groundwork for future decisions about its nosological status.
The World Health Organization is in the process of preparing the eleventh revision of the International Classification of Diseases (ICD‐11), scheduled for presentation to the World Health Assembly ...for approval in 2017. The International Advisory Group for the Revision of the ICD‐10 Mental and Behavioural Disorders made improvement in clinical utility an organizing priority for the revision. The uneven nature of the diagnostic information included in the ICD‐10 Clinical Descriptions and Diagnostic Guidelines (CDDG), especially with respect to differential diagnosis, is a major shortcoming in terms of its usefulness to clinicians. Consequently, ICD‐11 Working Groups were asked to collate diagnostic information about the disorders under their purview using a standardized template (referred to as a “Content Form”). Using the information provided in the Content Forms as source material, the ICD‐11 CDDG are being developed with a uniform structure. The effectiveness of this format in producing more consistent clinical judgments in ICD‐11 as compared to ICD‐10 is currently being tested in a series of Internet‐based field studies using standardized case material, and will also be tested in clinical settings.
Among the controversies about existing formulations of PTSD are concerns about its overuse in populations exposed to natural or man-made disasters.7,8 One problem has been the application of the ...diagnosis when populations are still being actively exposed to extreme stressors--eg, continuing conflict, uprooting to unsafe locations, or earthquake aftershocks--which makes differentiation between PTSD, adaptive fear reactions, and grief difficult, especially when the definition of PTSD includes non-specific symptoms. ...there is a concern that an overemphasis on PTSD could contribute to clinicians failing to recognise other commonly occurring mental disorders, especially depression.11 Nonetheless, the appropriate use of a clearly defined PTSD category is one aspect of progress in evidence-based mental health care in humanitarian settings.12 The Working Group has recommended a refocus on the diagnosis of PTSD on three core elements, and removal of non-specific symptoms that are also part of other disorders.13,14 The proposed diagnostic guidelines need re-experiencing of the traumatic event, in which the event is not only remembered but experienced as occurring again; avoidance of reminders likely to produce re-experiencing of the traumatic event(s); and a perception of heightened current threat, as indicated by various forms of arousal.15 These elements must have developed after exposure to an event of an extremely threatening or horrific nature, but the diagnosis is mainly based on symptom presentation rather than on determination of whether or not the event constitutes an eligible traumatic stressor. According to the DSM-5 proposal, PTSD is operationalised by 20 symptoms grouped into four clusters, yielding more than 10 000 combinations of symptoms by which a person can meet the minimum criteria for PTSD.
The World Health Organization (WHO) Department of Mental Health and Substance Abuse has developed a systematic program of field studies to evaluate and improve the clinical utility of the proposed ...diagnostic guidelines for mental and behavioral disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11). The clinical utility of a diagnostic classification is critical to its function as the interface between health encounters and health information, and to making the ICD-11 be a more effective tool for helping the WHO's 194 member countries, including the United States, reduce the global disease burden of mental disorders. This article describes the WHO's efforts to develop a science of clinical utility in regard to one of the two major classification systems for mental disorders. We present the rationale and methodologies for an integrated and complementary set of field study strategies, including large international surveys, formative field studies of the structure of clinicians' conceptualization of mental disorders, case-controlled field studies using experimental methodologies to evaluate the impact of proposed changes to the diagnostic guidelines on clinicians' diagnostic decision making, and ecological implementation field studies of clinical utility in the global settings in which the guidelines will ultimately be implemented. The results of these studies have already been used in making decisions about the structure and content of ICD-11. If clinical utility is indeed among the highest aims of diagnostic systems for mental disorders, as their developers routinely claim, future revision efforts should continue to build on these efforts.
Prolonged Grief Disorder and the DSM: A History Zachar, Peter; First, Michael B; Kendler, Kenneth S
The journal of nervous and mental disease,
05/2023, Letnik:
211, Številka:
5
Journal Article
Recenzirano
In the early 1990s, a research group that included Holly Prigerson and Charles Reynolds established that disordered grief overlaps with depression and anxiety but is not the same. They also developed ...a research inventory for studying disordered grief. Subsequently, Prigerson focused on measuring disordered grief using advanced psychometric techniques. Because treatment for grief-related depression reduced symptoms of depression but not grief, Katherine Shear was recruited to develop a more effective therapy. Prigerson came to conceptualize disordered grief as prolonged grief that is associated with negative outcomes. Shear came to conceptualize disordered grief as intense grief that is complicated by features that interfere with adaption to the loss. In 2013 a hybrid disorder composed of criteria from both groups was placed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) appendix. Under the leadership of the DSM Steering Committee, a summit meeting in 2019 helped break an impasse, and a revised prolonged grief disorder became an official DSM diagnosis.
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