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   Table of Contents - Current issue
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November 2018
Volume 34 | Issue 5 (Supplement)
Page Nos. 1-90

Online since Tuesday, November 20, 2018

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GUEST EDITORIAL  

Cultural perspectives related to international classification of Diseases-11 p. 1
Pratap Sharan, Jared Keeley
DOI:10.4103/ijsp.ijsp_45_18  
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Core considerations in the development of the world health organization's international classification of diseases, 11th Revision p. 5
Tahilia J Rebello, Geoffrey M Reed, Shekhar Saxena
DOI:10.4103/ijsp.ijsp_43_18  
The World Health Organization (WHO) Department of Mental Health and Substance Abuse is updating the diagnostic guidelines for mental and behavioural disorders intended for inclusion in the International Classification of Diseases, 11th Revision (ICD-11). When ratified and implemented, the ICD-11 will serve as a global standard used across the world for varied purposes ranging from diagnosis, clinical management, health data collection and reporting, research, service and program planning, and policy development. Given the eventual ubiquity of the ICD-11 and its potentially significant impact on clinical practice and public health, WHO has identified three core organizing principles to guide ICD-11 development: 1.) maximizing the clinical utility or usefulness of the guidelines in the clinical context (e.g., ease-of-use, goodness-of-fit, clarity, feasibility of implementation); 2.) assessing the clinical consistency or reliability of the guidelines; and 3.) ensuring the global applicability of the system to clinicians working in diverse settings worldwide. This article provides a review of each of these three core considerations, specifying rationale for their selection and defining the various mechanisms designed by WHO to assess and enhance these key elements of the ICD-11.
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Psychosis and related disorders in international classification of Disease-11 and their relationship to diagnostic and statistical Manual-5 and international classification of Disease-10 p. 11
Abid Choudry, Saeed Farooq
DOI:10.4103/ijsp.ijsp_20_18  
The two main classification systems, International Classification of disease (ICD) and diagnostic and statistical manual (DSM) have recently been revised. The revision of DSM-IV by the American Psychiatric Association is complete and DSM-5 has already arrived. The draft ICD-11 diagnostic guidelines for mental disorders are nearly complete and will soon be published as ICD-11. In this article we will briefly discuss the challenges in classifying psychotic disorders, the revised classification of these disorders in ICD-11 and how this differs from ICD-10 and DSM-5. Several changes to the classification of schizophrenia and other psychotic disorders have been made to increase the reliability, clinical use and validity of the diagnostic classification which are considered here.
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Mood disorders in the international classification of Diseases-11: Similarities and differences with the diagnostic and statistical manual of mental Disorders 5 and the international classification of Diseases-10 p. 17
Subho Chakrabarti
DOI:10.4103/ijsp.ijsp_19_18  
The revision of diagnostic requirements for mood disorders in the forthcoming International Classification of Diseases-11 (ICD-11) classification was governed by the same principles that applied to the rest of the draft. Precedence was given to clinical utility and universal applicability of the classification. Other guiding principles included ensuring scientific validity of the revision and harmonizing it with the Diagnostic and Statistical Manual of Mental Disorders-5. These fundamentals led to considerable reorganization, restructuring, and expansion of the contents of the revision including the section on mood disorders. The mood disorders section now follows a much simpler format than the ICD-10 and is expected to be easier to use. Its simplicity, notwithstanding descriptions of individual diagnostic categories in the revision are more elaborate and precise and in consonance with the current state of knowledge regarding the different mood disorders included in the section. The draft guidelines are undergoing comprehensive field testing on a very large scale across many countries including a majority from the developing world. Results up to now have been encouraging in terms of user acceptability, clinical utility, and global and cross-cultural relevance. However, one has to await the results of further testing and actual use of the final version of the ICD-11 by all stakeholders to determine if the revision indeed meets the high standards it has set for itself.
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Using international classification of Diseases 11 “Mental disorders specifically associated with stress” in developing countries Highly accessed article p. 23
Asma Humayun, Daya Somasundaram
DOI:10.4103/ijsp.ijsp_25_18  
This article summarizes the revised criteria for disorders specifically associated with stress in ICD-11 highlighting major differences from previous classification systems. It also examines the main challenges for implementing these diagnostic guidelines in LMIC countries particularly in South Asia. These challenges are described in the context of socio-cultural, healthcare and humanitarian settings. It also discusses the implications of the revised classification on planning, building capacity, service development and setting up a research agenda for improving mental health care in developing countries.
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Nosological journey of somatoform disorders: From briquet's syndrome to bodily distress disorder p. 29
Geetha Desai, Rajesh Sagar, Santosh K Chaturvedi
DOI:10.4103/ijsp.ijsp_37_18  
Classification of bodily, physical, or somatic symptoms has been a challenge since the classificatory systems have been introduced. The names/labels have undergone a change from hysteria to bodily distress disorder to remove the pejorative terms. The diagnostic criteria have also been modified as there have been significant criticisms of the utility of the categories included under somatoform disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Classification of Disease, Eleventh Edition have addressed some of the concerns that were raised in the previous version of the classifications by renaming the categories and simplifying the diagnostic criteria to improve clinical utility of the diagnostic categories.
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Obsessive-compulsive and related disorders in international classification of Diseases-11 and its relation to international classification of Diseases-10 and diagnostic and statistical manual of mental Disorders-5 p. 34
Y C Janardhan Reddy, HB Simpson, Dan J Stein
DOI:10.4103/ijsp.ijsp_38_18  
The World Health Organization is in the process of publishing the 11th edition of international Classification of Diseases and Related Health Problems (ICD-11). This article discusses the rationale behind the creation of the new “Obsessive-Compulsive and Related Disorders (OCRD)” section in the ICD-11 chapter on Mental and Behavioral Disorders and compares it with the ICD-10 and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new section on OCRD was introduced in ICD-11 after a review of the relevant literature that has accumulated since the publication of ICD-10 in 1990. The proposed OCRD section includes obsessive-compulsive disorder (OCD), body dysmorphic disorder, olfactory reference disorder, hypochondriasis, hoarding disorder, trichotillomania, and skin-picking disorder. Tourette syndrome is also cross-referenced in OCRD. These disorders are grouped together on the basis of considerations of diagnostic validity and clinical utility. The ICD-11 OCRD section is somewhat similar to the DSM-5 OCRD section, reflecting efforts to harmonize the two major classificatory systems. Clustering together disorders related to OCD may encourage clinicians in diverse settings worldwide to identify these disorders early and offer timely interventions.
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Dissociative disorders: Reinvention or reconceptualization of the concept? p. 44
Nidhi Malhotra, Nitin Gupta
DOI:10.4103/ijsp.ijsp_40_18  
“Dissociative disorders” have existed since antiquity, but the concept has undergone major transformations over time. The presence of different theoretical explanations; lack of consensus regarding nosological status; inconclusive evidence with respect to relationship with trauma; and lack of clear evidence of the presence of neurophysiological disturbances are reflections of the fact that there is still lack of clarity with regard to classification of dissociative disorders. Notwithstanding these caveats, there have been significant advances in these areas in recent times, which have contributed to better understanding of dissociative disorders. The current write-up attempts to provide an insight into the evolution of the concept over time, related controversies, and the current nosological debate regarding dissociative disorders.
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Personality disorders: The reformed classification in international classification of Diseases-11 (ICD-11) p. 49
Alireza Farnam, Masumeh Zamanlu
DOI:10.4103/ijsp.ijsp_26_18  
It is of the plain conclusions of education in psychiatry that no psychiatric evaluation is complete, until an understanding of the patient's personality together with its life-long challenges, development, and growth is acquired. However, guides of evaluating personality and diagnosing personality disorders are still on the way to become more and more practical. The current approach for personality disorders is based on syndrome-based classifications, mainly the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases and Related Health Problems (ICD). The previous classification for personality disorders posed certain gaps and inconveniences; therefore, a reclassification of personality disorders was performed in the 11th revision of ICD. The current perspective article discusses the trend of personality disorders since its first introduction in psychiatry until its recent reclassification in ICD-11.
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Substance use and other addictive disorders in international classification of Diseases-11, and their relationship with diagnostic and statistical Manual-5 and international classification of Diseases-10 p. 54
Debasish Basu, Abhishek Ghosh
DOI:10.4103/ijsp.ijsp_83_17  
The beta draft version of the forthcoming eleventh edition of the World Health Organization's medical classificatory system, International Classification of Diseases (ICD-11) is in the public domain, and the final approved version is due for release in 2018. In this beta draft of ICD-11, the section named “disorders due to substance use or addictive behaviours” under chapter 6 (Mental, behavioral, or neurodevelopmental disorders) has recommended some major amendments in terms of both form and content. There are proposed changes in the diagnostic categories, both elimination and addition of new categories. Alterations have also been made in diagnostic criteria and classes of psychoactive drugs. In this perspective paper, we discuss and analyze the proposed changes and their relationship with the American Psychiatric Association's Diagnostic and Statistical Manual 5th edition as well as the current version of ICD. In particular, we also highlight how sociocultural factors may have influenced some of these changes and provide an Asian perspective wherever relevant.
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Childhood disorders in international classification of diseases and related health Problems-11 and their relationship to diagnostic and statistical manual of mental Disorders-5 and international classification of diseases and related health Problems-10 p. 63
Shoba Srinath, Preeti Jacob, Preeti Kandasamy, Sowmya Bhaskaran
DOI:10.4103/ijsp.ijsp_36_18  
Disorders in latest editions of the classificatory systems ICD-11 and DSM-5 have been categorised from a developmental lifespan perspective which is step in the right direction. Other laudatory features include highlighting developmental presentations, grouping neurodevelopmental disorders and including new diagnoses such as Complex PTSD and Prolonged Grief Disorder among others. However, conditions such as Conduct Disorder confined to the family context and Mixed Neurodevelopmental Disorder have been eliminated from the new classificatory system. These changes which have special clinical relevance especially from the Indian context have been reviewed and discussed below.
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Intellectual disability in international classification of Diseases-11: A developmental perspective p. 68
Satish Chandra Girimaji, Arul Jayendra V Pradeep
DOI:10.4103/ijsp.ijsp_35_18  
Historically Intellectual Disability (ID) has been included in the International Classification of Disease and related Health Problems [ICD] and Diagnostic and Statistical manual Of Mental Disorders [DSM] from the beginning. There has been a significant change in the terminology, placement of the condition, classification, and defining features as a result of advances in unraveling the development and functionality of the brain and identifying the etiologic basis of intellectual disability. Current approaches view ID from a developmental perspective and rely on both intellectual abilities and adaptive functioning. This article looks into the salient features of “Disorders of Intellectual Development” as it is termed in ICD-11 in comparison with “Mental Retardation” as it was termed in previous ICD-10 and “Intellectual Developmental Disorder” in latest DSM-5 version, and examines the commonalities and differences.
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International classification of Diseases-11: Primary care perspective p. 75
Bushra Razzaque, Fareed Aslam Minhas
DOI:10.4103/ijsp.ijsp_77_17  
The World Health Organization, Department of Mental Health and Substance Abuse is currently revising the international classification of disease10 (ICD-10) chapter on mental, behavioral, and neurodevelopmental disorders. This revision aims to improve the clinical utility of the ICD-primary health-care (ICD-PHC) classification system in the primary health-care settings, where the presentation of common mental health conditions vary from that of the specialist centers. The salient changes proposed in the ICD-11 PHC version are the category of anxious depression, health anxiety, and bodily stress syndrome. The ICD-11 PHC field trails have positively supported the proposed changes. The changes in the classification will have to be widely disseminated, complemented with training, and supervision for it to be of use to the people suffering from common mental health conditions in the community.
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Will the DSM-5 and ICD-11 “Make-over” really make a difference to women's mental health? p. 79
Soumya Parameshwaran, Prabha S Chandra
DOI:10.4103/ijsp.ijsp_34_18  
The recent modifications to the classificatory systems were expected to enhance the recognition of various psychiatric conditions specific to women. Several researchers and clinicians had made specific recommendations regarding four main conditions; that is, female sexual dysfunction (FSD), perinatal psychiatric disorders (PPDs), and premenstrual dysphoric disorder and eating disorders; to improve the clinical utility of these diagnoses. While FSD has undergone considerable change with its own special place outside of mental health, not all suggestions regarding PPDs were considered. A major advance in both Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) and International Classification of Diseases (ICD11) has been the inclusion of the antenatal period in PPDs, which had hitherto been left out. However, two recommendations related to PPDs-increase in the time frame of the postpartum definition and inclusion of mother–infant interaction disorders were not considered, which we believe are valuable opportunities lost. Substantial changes have been included in the clinical manifestations and course of eating disorders, based on evidence and cross-cultural differences. One condition included in ICD-11 which may help women get better treatment is complex posttraumatic stress disorder. It appears that while there are some changes that are positive, more could have been achieved for women's mental health.
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Classificatory systems and disability p. 86
BS Chavan, Shivangi Mehta
DOI:10.4103/ijsp.ijsp_33_18  
It is generally accepted that disability represents a construct relevant to mental health, with important implications for the categorization of the clinical course and outcome of mental disorders. Thus, it appears that functional impairment should be built into the configuration of an appropriate diagnostic and classification system of mental disorders. The new model of disability adopted in the International Classification of Functioning, Disability and Health (ICF) proved to be valid and cross-culturally applicable. The ICF could be used as a guide for the incorporation of functional impairment in the new classificatory systems. The joint use of the International Classification of Disease and ICF would benefit medicine and health systems toward better health services planning and reimbursement.
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