Chihiro Matsumoto

Disorders specifically associated with stress: A case-controlled field study for ICD-11 mental and behavioural disorders

As part of the development of the Eleventh Revision of International Classification of Diseases and Related Health Problems (ICD-11), the World Health Organization Department of Mental Health and Substance Abuse is conducting a series of case-controlled field studies using a new and powerful method to test the application by clinicians of the proposed ICD-11 diagnostic guidelines for mental and behavioural disorders. This article describes the case-controlled field study for Disorders Specifically Associated with Stress. Using a vignette-based experimental methodology, 1,738 international mental health professionals diagnosed standardized cases designed to test key differences between the proposed diagnostic guidelines for ICD-11 and corresponding guidelines for ICD-10. Across eight comparisons, several proposed changes for ICD-11, including the addition of Complex PTSD and Prolonged Grief Disorder, produced significantly improved diagnostic decisions and clearer application of diagnostic guidelines compared to ICD-10. However, several key areas were also identified, such as the description of the diagnostic requirement of re-experiencing in PTSD, in which the guidelines were not consistently applied as intended. These results informed specific revisions to improve the clarity of the proposed ICD-11 diagnostic guidelines. The next step will be to further test these guidelines in clinic-based studies using real patients in relevant settings.

Categories That Should Be Removed From Mental Disorders Classifications: Perspectives and Rationales of Clinicians From Eight Countries

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 WHOs ICD-11 are discussed.

Should schizophrenia still be named so

9. If you answered “Yes” to No. 6, please mark when it should be changed. a) As soon as possible 5 – b) By the publication of ICD-11 12 – c) Later 3 – d) Did not answer “Yes” to Q.6 1 – 10. If you answered “Yes” to No. 6, what term do you think is more appropriate than the current term, i.e., “schizophrenia”? Please provide your suggestions below. (Space was provided for suggestions.) 11. Should the new name convey an acceptable scientific concept or concepts? 27 4

The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries.

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.

Clinical utility of ICD-11 diagnostic guidelines for high-burden mental disorders: results from mental health settings in 13 countries: Clinical utility of ICD-11 diagnostic guidelines for high-burden mental disorders: results from mental health settings in 13 countries

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.

Global Collaborative Team Performance for the Revision of the International Classification of Diseases: A Case Study of the World Health Organization Field Studies Coordination Group

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 teams 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.

ICD-11 Beta Draft Survey in Japan.

T HE INTERNATIONAL CLASSIFICATION of Diseases and Related Health Problems is being revised and its 11th revision (ICD-11) is scheduled to arrive in 2018. Japan uses the ICD as a framework for health information and reporting just as other WHO member countries do, and the revision of the ICD is expected to have a great impact on clinical practice. Thus, there has been a high level of interest in the revision process among psychiatrists in Japan. With the Beta Draft version of the ICD-11 now available online, the Japanese Society of Psychiatry and Neurology conducted a web-based survey about its members’ perspectives on the new classification. The survey was made accessible during the period of 30 November through 28 December 2015, and 464 members responded. It covered various areas that seemed of particular interest to the members, including dementia, behavioral addiction, conversion disorder and gender identity disorder. Described below is a highlight of what we found. The ICD-11 contains not only a chapter on mental and behavioral disorders (MBD), but it also addresses diseases and conditions of all medical areas. Dementia, or today more broadly conceptualized as neurocognitive disorders, has been classified in the MBD according to the ICD-10, but now is expected to be primarily classified in the chapter on diseases of the nervous system (DNS) in the ICD-11. Of note, customarily, patients with this condition have been seen in psychiatric care in Japan. Asked about how to classify dementia, 63.8% of survey respondents felt that dementia should be primarily classified in the DNS, and classification in the MBD was either not necessary at all (7.1%) or might be only secondary (56.7%); in the meantime, 32.7% of respondents expressed that dementia should be primarily classified in the MBD, and listing in the DNS was either not necessary (4.3%) or might be secondary (28.4%). Internet addiction, a condition often seen as a form of behavioral addiction, was also included as another topic. Asked whether this should be included as an independent diagnostic entity, 69.7% of the respondents felt that it should, while 26.1% either felt against it or had reservations about it. Those who would approve it cited its impact on the patients and their family, its resemblance to other forms of addiction, and needs for commonly usable guidelines; those who would not, in contrast, cited insufficient evidence to regard it as a diagnostic category, doubting the needs to have it recognized as a mental disorder. Pathological gambling, a condition classified as an impulse-control disorder according to the ICD11 Beta Draft, is considered as a non-substancerelated addictive disorder according to the DSM-5. Asked about an appropriate placement for this condition, 55.0% said that a classification as an addictive disorder would be appropriate, while 39.9% felt that it should belong to impulse-control disorders. Conversion disorder has been a particularly debatable category in diagnostic classification: In the DSM-5, it is also noted as ‘functional neurological symptom disorder’ and is classified under somatic symptom and related disorders, whereas in the ICD11 Beta Draft, the term ‘conversion’ does not appear in disorder labels and, instead, its equivalent appears under a parent grouping of dissociative disorders. Asked about classification of conversion disorder, 66.2% expressed that it should be classified as part of dissociative disorders, while 25.9% supported a classification according to its somatic nature (i.e. in a grouping that features bodily symptoms and distress). The vast majority, however, seemed to agree that the concept is still useful in modern psychiatry: only 3.0% said that the concept is unnecessary. Gender identity disorder (GID) has gained awareness over the past several years in Japan. It has been classified as a mental disorder in the ICD-10, but in the ICD-11, which is expected to contain a new chapter, ‘Conditions Related to Sexual Health,’ it has been proposed that GID, or ‘gender incongruence,’ according to the ICD-11 proposal, belongs there. First, asked about where to classify GID, 54.9% expressed that the new chapter is appropriate; 19.2% felt that it should be classified in the MBD,