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The Elephant in the Room Series Two: DSM-V Directory
Revision of the American Psychiatric Association (APA) Diagnostic and Statistical Manual for Mental Disorders Fourth Edition (DSM-IV) has been underway since 1999. The approved version of the next edition, DSM-V, is anticipated to be finalised in May 2012.
Planning for this fifth revision began in 1999 with a collaboration between the APA and the US National Institute of Mental Health (NIMH). The revision process is headed up by former NIMH staff and funded by NIMH grants. In 2000, Darrel A Regier, MD, was recruited from the NIMH to serve as research director for the APA and co-ordinator for the development of DSM-V.
DSM-V work groups, composed of more than 120 scientific researchers and clinicians, have been meeting since late 2007. 13 groups are working towards proposals for the revision of existing disorder criteria, the inclusion of new disorders, or no changes to a disorder or its criteria. Work groups may also commission literature reviews and develop research plans for field trials. Individual work groups build on recommendations resulting out of 13 conferences held internationally between 2004 and 2008, conducted by the APA’s American Psychiatric Institute for Research and Education (APIRE) and funded by US National Institute of Health (NIH) grants.
The progress of the work group we need to monitor is the DSM-V Work Group for “Somatic Distress Disorders”. This is the group responsible for making recommendations and proposals for the revision of “Somatoform Disorders” which includes the so-called “Functional somatic syndromes” - the umbrella term under which many psychiatrists and psychologists place “chronic fatigue syndrome”, CFS, CFS/ME, ME, fibromyalgia and IBS.
The DSM revision has been a complex and controversial process: it has been criticised in the US by members of the medical profession, medical writers and advocacy groups around perceived lack of transparency over its development, the potential for conflicts of interest in its advisers and those appointed to its task force, work groups and study groups, and around potential inclusions of new and controversial “disorders”.
In November 2008, in an opinion piece for the Los Angeles Times, Christopher Lane, Professor of English, Northwestern University, Illinois wrote:
“Not only do mental health professionals use it routinely when treating patients, but the DSM is also a bible of sorts for insurance companies deciding what disorders to cover, as well as for clinicians, courts, prisons, pharmaceutical companies and agencies that regulate drugs. Because large numbers of countries, including the United States, treat the DSM as gospel, it’s no exaggeration to say that minor changes and additions have powerful ripple effects on mental health diagnoses around the world.” [1]
Meanwhile, the WHO is revising the classification of mental and behavioural disorders as a part of its overall revision of ICD-10. This process has been underway since April 2007. The Alpha draft version of ICD-11 is expected to be completed in 2010, followed by a year for commentary and consultation. The Beta draft version is expected to be completed in 2011, followed by field trials, analysis of field trial data, and revision during the subsequent 2 years. The final version for public viewing is expected be completed in 2013, with approval by the World Health Assembly in 2014. [2]
The APA participates with the WHO in a DSM-ICD Harmonization Coordination Group.
The task of this group is “to facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria.” with the objective that “the WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.” [2]
For the purpose of revision of ICD-10 Mental and Behavioural Disorders, the following groups have been established:
International Advisory Group (AG) for the Revision of ICD-10 Mental and Behavioural Disorders
Global Scientific Partnership Coordination Group
Stakeholder Input and Partnership Coordination Group
Global Health Practice Network (GHPN)
DSM-ICD Harmonization Coordination Group
Prof David Goldberg, Institute of Psychiatry, King’s College London is a participant in Advisory Group meetings and a member of the Global Scientific Partnership Coordination Group.
Dr Steven Hyman, Harvard University, Cambridge, MA, a former Director of the NIMH and an APA DSM-V Task Force member, chairs the meetings of the Advisory Group. As chair of the Topic Advisory Group for Mental Health (TAGMH), Dr Hyman is also a member of the ICD-11 Revision Steering Group.
Another key member of the WHO revision team is psychologist, Dr Geoffrey Reed, PhD, the American Psychological Association’s principal representative to WHO’s International Classification of Functioning, Disability and Health system since 1995. [NB: do not confuse the American Psychological Association with the American Psychiatric Association who use the same acronym - APA.]
According to document [3], in August 2007, the WHO submitted a request for funding for the revision of ICD-10 Mental and Behavioural Disorders which was met by the American Psychological Association.
Page 5 of the Fall/Winter edition of The Amplifier [4], a publication of the American Psychological Association, reports:
“The Council approved funding for the sustained contribution of psychology to the World Health Organization’s revision of the mental health chapter of the current International Classification of Diseases and Related Disorders (ICD-10). APA will support the effort through a contract with the International Union of Psychological Science (IUPsyS), which will retain a psychologist consultant to work on the core revision team at WHO. The IUPsyS consultant will be Geoffrey Reed, PhD, former APA Practice Directorate assistant executive director…”
This article goes on to state:
“Dr. Reed is already at work in Geneva with WHO assuring that the ICD-11 will have more psychological and less biological underpinnings to the mental health chapter than the American Psychiatric Association’s DSM-V.”
There are significant concerns over the implications for potential revisions to DSM-ICD of specific categories like “Somatoform Disorders” and the so-called “Functional somatic syndromes” amongst the UK and US CFS, ME, FM, IBS, GWS, CI, CS and SBS patient communities.
Are UK and international ME patient organisations, ME medical researchers and physicians scrutinising these complex revision and congruency processes? Are they monitoring the work of the DSM-V Somatic Distress Disorders Work Group whose remit has the most relevance for the ME community?
Despite having acted as administrators for the CISSD (Conceptual Issues in Somatoform and Similar Disorders) Project, UK patient organisation, Action for M.E., has yet to publish anything meaningful on the aims, objectives and outcomes of the CISSD Project and who comprised its Work Group, nor has this organisation informed its members about the DSM-V and ICD-11 revision and “Harmonization” process. The UK patient organisation, the ME Association, has likewise published nothing to date.
In order to assist the ME community and other interested parties in navigating these harmonization and revision processes, I have compiled a DSM-V and ICD-11 “Directory”. This 20 page document collates links for key documents and notes around the APA DSM-V and WHO ICD-11 revision processes and also around the CISSD Project. This international project, undertaken between 2003 and 2007 was co-ordinated by Dr Richard Sykes, PhD, former Director of Westcare UK. The proceedings of three Workshops, convened by CISSD Project Chairs, Prof Kurt Kroenke and Prof Michael Sharpe, has informed both the DSM and ICD development processes. Five members of the CISSD Project Work Group participated in the APA Beijing planning conference and four members also sit on the DSM-V Somatic Distress Disorders group.
Over the last four years, the DSM-V revision process has spawned dozens of papers around the so-called “Somatoform Disorders” and “Functional somatic syndromes”. The Directory also lists selected journal papers, reviews and commentaries, including papers resulting out of the CISSD Project and the APA’s 2006 Beijing research planning Symposium “Somatic Presentations of Mental Disorders”. The Directory will be updated as new information becomes available.
The DSM-V Directory can be downloaded in MS Word format from the DSM-V Directory Tab
[1] http://www.latimes.com/news/opinion/commen...0,5678764.story
[2] http://www.who.int/entity/mental_health/ev..._march_2008.pdf
[3] http://www.apa.org/international/s08agenda25-Exhibit1.pdf
[4] http://www.apa.org/divisions/div46/AmpFall...ter08_final.pdf
********************************************************************************************************
Ecco la traduzione delle tre notizie fondamentali cioè quelle in grassetto:
Il progresso del gruppo di lavoro che noi abbiamo bisogno di esaminare è il Gruppo di Lavoro del DSM-V per “Disturbi ansia e somatici.” Questo è il gruppo responsabile per attuare raccomandazioni e suggerimenti, per la revisione dei “Disturbi somatoformi” che include le cosìdette “sindromi somatiche e Funzionali” - sotto il termine di ombrello che molti psichiatri e psicologi applicano “sindrome da fatica cronica”, CFS, CFS/ME, io, fibromialgia ed IBS.
Nel frattempo, il WHO sta revisionando la classificazione dei disordini mentale e comportamentali come una parte della revisione complessiva di ICD-10. Questo processo è in preparazione dall' aprile 2007. La versione bozza Alfa di cambio Alfabetico all' ICD-11 attende di essere completata nel 2010, seguita da un anno relativo ai commenti e alle consultazioni. La versione bozza Beta di cambio attende di essere completata nel 2011, seguita da percorsi di prova , analisi dei dati di prova e revisione durante i 2 anni susseguenti. La versione finale da rendere nota all l''osservazione pubblica ci si aspetta sia completata nel 2013, con L'approvazione dell assemblea mondilale sulla salute nel 2014.
“Il Dott. Reed che è già al lavoro a Ginevra con WHO assicura che gli ICD-11 avranno supporti di sostegno più psicologici e meno biologici al capitolo di salute mentale che non il DSM-V dell'Associazione Psichiatrica americana.”
Tra le comunità di pazienti CFS, ME, FM, IBS, GWS, CI, CS SBS nel Regno Unito e negli Stati Uniti vi sono notevoli preoccupazioni per le potenziali implicazioni della revisione di categorie specifiche del DSM-ICD come per es. "Disordini Somatoformi”e le cosiddette "sindromi somatiche funzionali".
Della serie......di male in peggio, grave....molto grave, senza parole.. -
uonderuoman.
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Apocalypse23.
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Summary Report of the 3rd Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders1
source meagenda.wordpress.com
World Health Organization
Department of Mental Health and Substance Abuse
Geneva, Switzerland
Meeting of the International Advisory Group
for the Revision of ICD/10 Mental and Behavioural Disorders
11 /12 March, 2008, Geneva SWITZERLAND
Meeting Summary Report
The third meeting of the International Advisory Group (AG) for the Revision of ICD/10 Mental and
Behavioural Disorders was held in Geneva during 11 /12 March 2008. The AG was constituted by
WHO with the primary task of advising WHO on all steps leading to the revision of the mental and
behavioural disorders classification in ICD-10 in line with the overall revision process. A list of
participants in this meeting is provided in the Annex.
This Summary Report provides a summary of the conclusions reached during the meeting.
1. Opening Remarks
The meeting was opened by Dr. Ala Alwan, Assistant Director General, Noncommunicable Diseases
and Mental Health. Dr. Alwan emphasized the importance of the revised ICD Mental and
Behavioural Disorders classification as a tool for improving services for people with mental disorders
and to encourage accountability among governments for their efforts to reduce the substantial disease
burden associated with them.
2. Large groups of diagnoses and entities and spectra
Introduced by Dr. Gavin Andrews
Presentations by Dr. Robert Krueger, Dr. William Carpenter, Dr. David Goldberg, and
Dr. Gavin Andrews
The purpose of this series of presentations was to introduce a proposed re-conceptualization of the
large groups of mental disorders currently found in ICD/10. This re-conceptualization relates to how
disorders are grouped together into classes and not to the criteria for individual diagnoses. This
conceptual schema was offered as a basis for discussion by the AG, and not as a completed project.
The proposed grouping is based on several factors, including symptom presentation, risk factors,
treatment response, and other biological, cognitive, and emotional characteristics. Based on the
available information, four large clusters of disorders were proposed, which were the focus of the
subsequent presentations. It is important to note that the names used in this report to refer to these
clusters are simply for the purpose of clarity, and with the AG’s awareness that a more complete
discussion of terminology would be needed.
Dr. Krueger reviewed evidence from a variety of studies indicating that common mental disorders
separate into two correlated clusters, which have been labelled Internalizing and Externalizing. He
also presented data suggesting that the Internalizing Disorders cluster further separates in to Distress
(e.g., depression, dysthymia, generalized anxiety disorder) and Fear (e.g., phobias, panic disorder).
The evidence for the coherence of the Externalizing cluster includes genetic effects, course in early
adulthood, and neural correlates, in addition to phenomenological similarities. Prototypic examples of
disorders in the Externalizing cluster are those related to alcohol and substance use, conduct disorder,
adult antisocial personality disorder, and possibly the hyperactivity component of ADHD.
Dr. Carpenter argued that the current classificatory structure for psychotic disorder fails to define
similarities and differences among disorders that result in specific and discrete classification. The
Summary Report of the 3rd Meeting of the International Advisory Group for the Revision of ICD/10 Mental and Behavioural Disorders
2
current over-specification and arbitrary grouping of disorders has contributed to problems in both
research and practice. The conceptualization of treatments at a cluster level and the identification of
key similarities and differences among disorders within clusters would help to refine the research and
therapeutic issues. Evidence for the coherence of the Psychotic Disorders cluster comes from research
on biomarkers, environmental and genetic influences on psychotic disorders, family studies of
schizophrenia spectrum, neural substrates, cognitive and emotional factors, co-morbidity, and
treatment response. The disorders in this cluster include those that are currently classified as psychotic
disorders, as well as bipolar disorder and some forms of personality disorder.
Dr. Goldberg presented evidence for common features within the cluster of Internalizing Disorders.
These disorders are characterized by distress experienced inwardly, and related to the emotions of
anxiety, depression and fear. Although diagnostic criteria are specific to each disorder, many
symptoms are shared so that a wide range of common disorders may be identified by superficial
screening. As symptom severity increases, the symptoms that differentiate among the disorders
appear. Disorders in this cluster share common environmental risk factors and substantial similarities
in cognitive and emotional processes (e.g., high negative affectivity or “neuroticism”). Available
treatments are generally effective across disorders within the cluster (e.g., SSRIs, cognitive behaviour
therapy). Internalizing disorders include generalized anxiety, panic disorder, specific phobias, social
phobias, obsessional states, dysthymic disorders, neurasthenia, somatoform disorders, post-traumatic
stress disorder, and non-psychotic forms of depression.
Dr. Andrews presented findings relevant to a cluster of disorders characterized by neurocognitive
deficit, usually associated with permanent neural loss. Dr. Andrews argued that clustering these
disorders together can help to facilitate diagnosis, improve treatment processes, improve prognosis by
facilitating early identification and treatment, and inform research. Disorders in this cluster share
some genetic and environmental risk factors. Treatments that are effective for disorders within this
cluster are not disorder-specific, and also typically effective for other disorders within the cluster
(e.g., anticholine esterase inhibitors, antipsychotic medications, cognitive behaviour therapy). At the
same time, this cluster was recognized as the most disparate of the four presented.
The AG acknowledged that this approach would represent a major change in classification, but
viewed the proposed approach as a potential basis for the development of a more clinically useful
system, both for multidisciplinary mental health professionals and in primary care settings. The
approach is intuitively appealing, easily understandable, roughly corresponds to the way in which
mental health care is often organized, and provides a useful correction to the over-specification that
characterizes current classification systems. At the same time, the AG noted several limitations and
reservations about the proposed approach, in particular regarding the coherence of a single cluster of
neurocognitive disorders. The AG discussed the idea of a separate cluster for disorders that can be
considered under the rubric of developmental disorders. There was also considerable discussion about
the names for the clusters.
Based on the AG’s discussion, Drs. Andrews and Goldberg were asked to prepare a more complete
“straw man” grouping as a basis for further discussion. This second iteration, presented on the second
day, included the notable addition of a category for Bodily Disorders (e.g., eating disorders, sleep
disorders, sexual disorders) and the separation of developmental disorders and mental retardation
from neurocognitive disorders such as delirium and depression. A number of additional issues were
raised regarding the revised proposal, but there was not sufficient time for the AG to discuss them
thoroughly. Further development of the proposal will be reported at the AG’s next meeting.
3. Progress in the overall ICD revision
Introduced by Dr. Bedirhan Üstün and Mr. Can Celik
Dr. Üstün reminded the AG that the goals of the revision are to develop a multi-purpose and coherent
classification with logical linkages to available health-related terminologies and ontologies. ICD/11
should function seamlessly in an electronic health records environment and serve as an international
Summary Report of the 3rd Meeting of the International Advisory Group for the Revision of ICD/10 Mental and Behavioural Disorders
3
and multilingual reference standard for scientific comparability and communication purposes.
Specific challenges for this revision include: to achieve comparable and consistent data across health
information systems; to managing the transition from legacy systems; and to involve multiple
stakeholders on a large scale to capture and synthesize information.
Web-based tools are available for enhanced communication among individuals involved in the
revision process, via three primary methods:
1) The ICD Update and Revision Platform is a web-based application that allows any user to
post proposals or comments and to review other proposals and comment on them.
2) The ICD/11 draft will be a WIKI-like joint authoring tool, designed for use by ICD/11
Technical Advisory Group (TAG) and WHO editors in the specification of taxonomic rules,
definitions and diagnostic criteria.
3) The ICD terminology provides the basis of the information model linking between ICD and
SNOWMED-CT, other ontology and terminologies, and clinical interface algorithms.
The timeline for the revision process is as follows: the Alpha draft version of ICD/11 should be
completed in 2010, followed by 1 year for commentary and consultation. The Beta draft version
should be completed in 2011, followed by field trials, analysis of field trial data, and revision during
the subsequent 2 years. The final version for public viewing should be completed in 2013, with
approval by the World Health Assembly in 2014.
4. Progress on Coordinating Groups
Reports from three Coordinating Groups established by the AG were presented and discussed. The
AG noted that these groups had been appointed for the 2-year period of 2007 / 2008.
A. Global Scientific Partnership Coordination Group
Introduced by Dr. Norman Sartorius
The Global Scientific Partnership Coordination Group was established to assist the AG in ensuring
continued involvement of and input from scientists around the world during the revision process. The
group has created a Global Scientific Partnership Network that is intended as an important scientific
resource for the AG. This network will facilitate identification and use of key scientific papers,
particularly from countries mainly using languages other than English. Its tasks also include
identification and evaluation of country-level or regional adaptation of ICD Mental and Behavioural
Disorders. The AG commended Dr. Sartorius for the group’s progress and plans, and expects that Dr.
Sartorius will be in close communication with the AG Chair and the Secretariat as the group’s work
proceeds.
B. Stakeholder Input and Partnership Coordination Group
Introduced by Dr. Juan Mezzich and Dr. Benedetto Saraceno
The purpose of this group was to stimulate input, collaboration, and commitment to implementation
among the three primary groups of WHO constituents: 1) users/consumers of mental health services
and their families; 2) multidisciplinary mental health professionals and other relevant health
professionals; and 3) governments of WHO member states.
The AG recognized the important and valuable resources represented by World Psychiatric
Association (WPA), its Section on Classification and Diagnostic Assessment, and the WPA Global
Network of Classification and Diagnostic Groups. The AG also believes that it is important to
develop relationships with other groups of relevant professional associations, beginning with those
represented on the AG. These organizations should be encouraged to develop infrastructures to
enable participation, such as WPA has done. In terms of service users and family members, the WHO
Secretariat will identify groups who may be in a position to participate constructively in the revision
process and a plan for communicating with them about the revision. In relation to governments, the
Secretariat has already initiated communication with a number of member states, as evidenced by the
participation of their representatives at AG meetings. In view of the current nature and range of tasks
related to stakeholder coordination and input, the Terms of Reference and composition of this group
will be reviewed at the Fall AG meeting.
C. ICD/DSM Harmonization Group
Introduced by Dr. Shekhar Saxena
The task of this group is to facilitate the achievement of the highest possible extent of uniformity and
harmonization between ICD/11 mental and behavioural disorders and DSM-V disorders and their
diagnostic criteria. Dr. Saxena emphasized the genuine desire of both organizations to achieve
harmonization of the two systems. He described a variety of specific issues related to differences
between the DSM and the ICD/10 that are important areas of discussion by the Harmonization Group.
The AG endorsed the following statement intended to guide the WHO representatives in their
activities as part of the ICD/DSM Harmonization Group: “WHO and APA should make all attempts
to ensure that in their core versions, the category names, glossary descriptions and criteria are
identical for ICD and DSM. Adaptations of the ICD should be directly translatable into the core
version.”
5. Contributions of epidemiology: Report from the ad-hoc group
Introduced by Dr. Somnath Chatterji
At its September, 2007 meeting, the AG appointed Dr. Oye Gureje, Dr. Maria Elena Medina-Mora,
Dr. Andrews, and Dr. Goldberg to work with Dr. Chatterji to consider the needs to epidemiological
data and analyses as a part of the AG’s work. Dr. Chatterji provided a discussion of ways in which
epidemiological data would make an important contribution to decisions about the classification
system. For example, using available epidemiological datasets, from the World Mental Health
Survey as well as other studies, the effects on or proposed changes on parameters such as case
identification and prevalence. The AG was in full agreement regarding the relevance and importance
of epidemiological data in the revision process. The AG recommended that an open call be issued for
epidemiological information relevant to series of specific questions based on the information
presented by Dr. Chatterji. This may help to distribute the resource demands of time-intensive reanalyses
of epidemiological datasets. The AG recommended formalization of this ad-hoc group as a
Coordinating Group reporting to the AG.
6. Report on progress and plans on public health aspects of diagnoses and classification
Introduced by Dr. Norman Sartorius
The WHO/APIRE Conference on Public Health Aspects of Diagnosis and Classification of Mental
Disorders was held during 26/ 27 September, 2007, immediately following the most recent AG
meeting. As Co-Chair of that conference, Dr. Sartorius provided a summary to the AG. The
conference produced the following outcomes: 1) Ten background papers regarding the public health
implications of diagnosis and classification of mental disorders were developed; 2) A series of
recommendations from a public health perspective regarding the revision of mental disorders
diagnosis and classification systems; and 3) Summary recommendations from the previous
conferences in the APIRE series on diagnosis, reviewed and revised in order to best serve public
health needs. The background papers developed for the conference will be finalized for publication as
part of a joint WHO/APIRE publication, and the recommendations considered as they relate to both
DSM and ICD.
Summary Report of the 3rd Meeting of the International Advisory Group for the Revision of ICD/10 Mental and Behavioural Disorders
5
7. Research versus clinical diagnoses
Introduced by Dr. Shekhar Saxena and Dr. Norman Sartorius
Dr. Saxena provided a brief overview of the history of the development of the different versions of
the ICD/10 Chapter V and the DSM-IV. In the case of ICD/10, the Clinical Descriptions and
Diagnostic Guidelines for mental and behavioural disorders were developed first, and the Diagnostic
Criteria for Research were published a year later.
The AG decided to devote more of its time to discussion of the “large groups” or categories of
disorders, so the series of presentations that had been planned for this item was truncated. The AG has
already established its intention to develop a comprehensive ICD/11 that can be viewed at different
levels of detail for different purposes. These “views” would be developed simultaneously and in
integrated form, rather than being based on different conceptualizations. The question of how the
disorders are aggregated in large groups is a fundamental part of this process.
The AG placed a priority on the development of a user-friendly classification system for clinical
applications, including for use in primary care. It would also be important to develop a version with
more specific criteria to meet the requirements of researchers, in close collaboration with the DSM
group. The AG will need to have additional discussion of the need for different versions as the
revision process proceeds.
8. Reports from representatives of federations/associations
A. WONCA
Comments by Dr. Michael Klinkman
Dr. Klinkman provided a discussion of relationship between ICD/10 and mental health concepts
included in the International Classification of Primary Care (ICPC), which has been accepted by
WHO as a related classification. A revision of the ICPC is currently underway, with its completion
planned within two and a half year.
B. International Council of Nurses
Comments by Dr Amy Coenen
Dr Coenen presented an overview about the International Council of Nurses (ICN). Members of the
ICN include 129 national associations of nurses, each representing one country. The ICN’s mission is
“to represent nursing worldwide, advancing the profession and influencing health policy.” The pillars
of ICN programmatic activity are professional practice, social and economic welfare of nurses, and
nursing regulation. Dr Coenen also described the International Classification of Nursing Practice
(ICNP), which is a standard ontology that includes nursing diagnoses, nursing interventions, and
outcomes of nursing care. Dr Coenen recommended that the ICD revision be examined for
compatibility with the ICNP, in addition to other structured terminologies.
C. International Union of Psychological Science
Comments by Dr. Geoffrey Reed
Dr. Reed presented an overview of the International Union of Psychological Science (IUPsyS), which
is an umbrella organization of national or regional associations representing psychologists in more
than 70 countries. IUPsyS’s mission is to support “the development of psychological science,
whether biological or social, normal or abnormal, pure or applied”. In characterizing psychological
practice as it relates to the ICD revision, a challenge is presented by the major international
differences in professional requirements. The authorization of psychologists to make diagnoses, and
therefore their use of a diagnostic classification system and capacity to participate in the ICD revision
process will differ from country to country in relation to the standard of training for practice. Dr.
Reed suggested that there is a need for more involvement of multidisciplinary mental health
Summary Report of the 3rd Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders
6
professionals in specifying use requirements, establishing the development process, and conducting
field trials. To accomplish this, international associations of health professionals must develop an
infrastructure that enables such participation.
D. World Psychiatric Association
Comments by Dr. Juan Mezzich
Dr. Mezzich presented the perspective of the World Psychiatric Association (WPA) on the ICD
revision. WPA is committed to full collaboration with the WHO in developing the ICD-11 and
related classifications. WPA will engage its Section on Classification and Diagnostic Assessment,
other scientific sections, member societies, and members of the WPA Global Network of
Classification and Diagnosis Groups in this process. Dr. Mezzich presented recent publications and
additional contributions of WPA that are relevant to the ICD revision, such as the organization of
symposia on international classification and diagnostic systems and the WPA Institutional Program
on Psychiatry for the Person.
E. International Federation of Social Workers
Comments by Mr. Rolf Blickle-Ritter
Mr. Blickle-Ritter described the perspective of the International Federation of Social Workers (IFSW)
related to the ICD revision process. The profession of social work defines itself on the basis of acting
for and with the person, emphasizing the characteristics of the person instead of the diagnosis,
including strengths as well as deficits, and viewing the person within his or her social context. The
Federation is establishing a reference group in relation to the ICD revision process in order to raise
awareness and to solicit input on the questions of relevance to the AG. The Federation believes that
the revision process should emphasize the public health purposes of diagnosis, helping to improve
access to treatment all over the world, to educate the public about mental disorders, and to involve
more people in the treatment and recovery process. The Federation believes that a version of the
ICD/11 for use in primary care would be more attractive to social workers, and therefore result in
wider training, dissemination, and implementation of the system.
The AG requested that the representatives of professional organizations to the AG develop methods
for soliciting comments from their groups regarding the issues that are under discussion.
Representatives should provide summary feedback from these comment processes to the AG, with
specific and individual comments submitted through the ICD Update and Revision Platform.
Professional association representatives were asked to disseminate information about the platform to
their members and to obtain as much input as possible over the next year. This will increase the
active involvement of the organizations, but also help to ensure input from a range of mental health
professionals.
9. Future plans for coordinating and working groups
Introduced by Benedetto Saraceno
As noted, the existing coordinating and working groups of the AG were established at the beginning
of 2007 and intended to have a life of two years. At its Fall 2008 meeting, the AG will review the
need for, Terms of Reference, and composition of existing groups, and propose changes it views as
necessary at that time. The AG itself was also appointed for a 2-year period through the end of 2008,
and the Chair and Secretariat will review its composition in relationship to the ongoing needs of the
revision effort. It would be helpful for more member states to designate representatives and support
their participation. The AG recommended that two new working groups be established with
immediate effect: A working group on epidemiology and one on the “large groups” to provide input
to the AG and to inform the work of the ICD/DSM Harmonization Group.
Annex: Report of the 3rd Meeting of the International Advisory Group for the Revision of ICD/10 Mental and Behavioural Disorders
3rd Meeting of the Advisory Group
for the Revision of ICD/10
Mental and Behavioural Disorders
WORLD HEALTH
ORGANIZATION
11 - 12 March 2008 Geneva, SWITZERLAND
Venue: Conference Room B, 3rd floor, WHO Main building
LIST OF PARTICIPANTS
1. Gavin Andrews, Clinical Research Unit for Anxiety Disorders, St. Vincent's Hospital, 299 Forbes
Street, Darlinghurst, NSW 2010, Australia. Email: [email protected]
2. Rolf Blickle-Ritter, International Federation of Social Workers, Psychiatrizentrum Münsingen, Leitung
Sozialdienst, 3110 Münsingen, Switzerland. Email: [email protected]
3. Amy Coenen, International Council of Nurses, University of Wisconsin - Milwaukee, College of
Nursing, PO Box 413, Milwaukee WI 53201-0413, USA. Email: [email protected]
4. David Goldberg, Institute of Psychiatry, King's College, London, United Kingdom. Email:
[email protected]
5. Oye Gureje, Department of Psychiatry, University College Hospital, PMB 5116 Ibadan, Nigeria. Email:
[email protected]
6. Steven Hyman (Chairman), Harvard University, Massachusetts Hall, Cambridge, MA 02138, USA. Email:
[email protected]
7. Michael Klinkman, The World Organisation of Family Doctors (Wonca), University of Michigan
Depression Center, 1500 E Medical Center Drive, F6321 MCHC Ann Arbor, MI 48109-0295, USA.
Email: [email protected]
8. Maria Elena Medina-Mora, Instituto Nacional de Psiquiatria Ramon de la Fuente, Calzada Mexico-
Xochimilco, Col. San Lorenzo Huipulco, México, D.F. 14370, Mexico. Email: [email protected]
9. Juan Mezzich, World Psychiatric Association, International Center for Mental Health, Mount Sinai
School of Medicine of New York University, Fifth Avenue & 100th Street, Box 1093 New York, NY
10029-6574, USA. Email: [email protected]
10. Geoffrey Reed, International Union of Psychological Science, Glorieta de Bilbao, 5, 4º 428004
Madrid, Spain. Email: [email protected]
11. Karen Ritchie, Institut National de la Santé et de la Recherche Médicale, E 361 Pathologies of the
Nervous System Epidemiological and Clinical Research, Hôpital La Colombière, 34093 Montpellier
Cedex 5, France. Email: [email protected]
12. Khaled Saeed, H. No: B-18, St: 02, Rawalpindi Medical College Staff Colony, Rawal Road, B-18, St.
02, Rawalpindi, Pakistan. Email: [email protected]
13. Norman Sartorius, 14 chemin Colladon, 1209 Geneva, Switzerland. Email:
[email protected]
14. Rangaswamy Thara, Schizophrenia Research Foundation (SCARF), R/7A, North Main Road, West
Anna Nagar Extension, Chennai- 600 101, India. Email: [email protected]
15. Xin Yu, Institute of Mental Health, Peking University, Huayuanbeilu 51, Haidian District, 100083,
Beijing, China. Email: [email protected]
World Health Organization
- 2 -
SPECIAL INVITEES:
16. William Carpenter, University of Maryland School of Medicine, Maryland Psychiatric Research
Center,
Baltimore, USA. Email: [email protected]
17. Toshimasa Maruta, Department of Psychiatry, Tokyo Medical University,6-7-1 Nishi-Shinjuku,
Shinjuku-Ku, Tokyo 160-0023, Japan. E-mail: [email protected]/ [email protected]
(Representative of the Government of Japan)
18. Graham Mellsop, University of Auckland, P O Box 128469, Remuera, Auckland New Zealand Email:
[email protected] (Representative of the Government of New Zealand)
19. Robert Krueger, Department of Psychology, University of Minnesota,75 E. River Rd.,Minneapolis, MN
55455, USA. Email: [email protected]
20. Kimmo Kuoppasalmi, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland.
Email: [email protected] (Representative of the Government of Finland)
OBSERVERS:
21. David Kupfer, Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute &
Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213-2593, USA. Email: [email protected]
22. Darrel Regier, American Psychiatric Association, 1000 Arlington Blvd, Suite 1825, Arlington, VA
22209-390, USA. Email: [email protected]
WHO SECRETARIAT:
23. Can Celik, Classifications and Terminology, Department of Measurement and Health Information
Systems, WHO. Email: [email protected]
24. Somnath Chatterji, Country Health Information, Department of Measurement and Health Information
Systems, WHO. Email: [email protected]
25. Tarun Dua, Management of Mental and Brain Disorders, Department of Mental Health and
Substance Abuse, WHO. Email: [email protected]
26. Samy Egli, Mental Health: Evidence and Research, Department of Mental Health and Substance
Abuse, WHO. Email: [email protected]
27. Robert Jakob, Classifications and Terminology, Department of Measurement and Health Information
Systems, WHO. Email: [email protected]
28. Vladimir Poznyak, Management of Substance Abuse, Department of Mental Health and Substance
Abuse, WHO. Email: [email protected]
29. Benedetto Saraceno, Director, Department of Mental Health and Substance Abuse, WHO. Email:
[email protected]
30. Shekhar Saxena, Mental Health: Evidence and Research, Department of Mental Health and
Substance Abuse, WHO. Email: [email protected]
31. Bedirhan Ustun, Classifications and Terminology, Department of Measurement and Health
Information Systems, WHO. Email: [email protected]
32. Rosemary Westermeyer, Mental Health: Evidence and Research, Department of Mental Health and
Substance Abuse, WHO. Email: [email protected]
http://pb.rcpsych.org/cgi/content/full/27/12/472
chi è il Dr bendetto Saraceno.
The College
Dr Benedetto Saraceno
(Introduced by Professor Hamid Ghodse)
Dr Benedetto Saraceno is the Director of the Department of Mental Health and Substance Dependence of the World Health Organization (WHO) in Geneva - and, as such, can be said to be responsible for the world’s mental health. Leading up to this elevated position is a career of considerable eminence, of which I can only offer a brief outline now. Benedetto Saraceno graduated as a doctor from the University of Milan and moved swiftly into psychiatric practice, obtaining his post-doctoral degree in psychiatry from the University of Parma. He progressed from strength to strength and soon became Chief of the Psychiatric Unit at the Mario Negri Institute for Pharmacological Research, with a distinguished academic record. But his interest in a broader landscape for his talents was manifest by his gaining a qualification in public health and epidemiology. This led him towards the international stage and during the 1990s he contributed to a number of WHO projects in South and Latin American countries. This in turn led on to his appointment as the Head of the Laboratory of Epidemiology and Social Psychiatry and Director of the WHO Collaborating Centre for Research and Training in Mental Health at the Mario Negri Institute.
Later, in 1996, he moved to Geneva as Programme Manager in the Division of Mental Health and Prevention of Substance Abuse. Yet again, he made his mark and, with the reorganisation of the WHO, he was appointed Director of the Department of Mental Health and Substance Dependence - a post in which he has continued to demonstrate his industry and leadership. For example, he convinced the WHO to designate 2001 as the World Health Organization Mental Health Year and to dedicate the World Health Report of 2001 to mental health. This is the first time that mental health has been accorded such a prominent position in the WHO Programme of Action and, for those of us who work in and are dedicated to services that are often perceived as ‘Cinderella services’, such recognition is very important. It also illustrates the underlying theme of Benedetto Saraceno’s professional life, which has been dedicated to the need of giving voice to the underserved, the excluded and the poor. This topic was a major preoccupation for him as a young psychiatrist working in Italy, when he led the Italian psychiatric reform; it was broadened during his service in Latin America, and was the key issue of his WHO programme ‘Nations for Mental Health’. The same topic is the main axis of the new WHO mental health Global Action Programme.
Dr Saraceno is also committed to the international role of the Royal College of Psychiatrists, with the firm belief that the College has a unique position in training, education and advocacy. His initiative led to a memorandum of understanding between the College and the WHO for research training fellowships and, with his persuasive encouragement, the WHO is firmly committed to closer collaboration with the College.
In summary, Dr Saraceno, with his distinguished academic and clinical background, is a psychiatrist of significant stature. He can be singled out as an individual who has made, and continues to make, a major contribution to global mental health, by his sustained and vigorous efforts for the advancement of psychiatry and mental health around the world, and particularly for those who are least able to speak for themselves. As such, he is eminently worthy of the highest honour that the College can bestow - an Honorary Fellowship. For us, the presence among us, of a person of such high international esteem, emphasises the importance of mental health as a global issue. It is therefore a great pleasure for me to present Dr Benedetto Saraceno to you as an Honorary Fellow of this College.
The Vote of Thanks on behalf of the Honorary Fellows for 2003 was given by Mr John Bowis, OBE, MEP.
*************************************************************************
I commenti e i riassunti prossimamente.sono cotta. ma insomma anche la neuroastenia è inclusa nella lista il grande capo è il medico di cui sopra. non vi metto la trad auto perchè non si capirebbe nulla troppo lavoro .......ma nessuno che possa dare un aiutino nelle traduz?
. -
Apocalypse23.
User deleted
ICD 10 ICD 11 update 11/05/2010.
11/05/2010 --L’Associazione Americana di Psichiatria (APA) ha deliberato e praticamente concluso in materia di trasformazione da ICD 10 a ICD 11 ed ha varato i nuovi criteri diagnostici, per le categorie appartenenti alle sopracitate voci, contenute nel DMS 5 ossia "Diagnostic and Statistical Manual of Mental Disorders”, "Manuale Diagnostico e Statistico dei Disturbi Mentali" edizione N°5.
Dal sito originale, orginal Link:
www.psych.org/MainMenu/Newsroom/New...-for-DSM-5.aspx
Tradotto per voi da : https://empa.forumcommunity.net
....."L'obiettivo del DSM-5 è quello di creare un manuale basato su prove scientifiche che sia di aiuto ai medici specialisti e che rappresenti il meglio della scienza attualmente disponibile,” lo ha dichiarato il presidente in carica dell’unità operativa del DSM 5 Dr David J. Kupfer-
"I criteri che abbiamo adottato hanno fornito al gruppo di lavoro ulteriori informazioni e valutazioni assicurando che abbiamo pienamente considerato l’eventuale impatto che le modifiche avrebbero sulla pratica clinica e sulla prevalenza delle malattie, così come altre effettive implicazioni reali a livello globale per quanto riguarda i criteri revisionati”
La maggior parte dei criteri che sono stati presentati sono riguardo a diagnosi-specifiche , mentre quasi un quarto sono stati a livello generale. La ripartizione dei criteri variava a seconda dei 13 gruppi di lavoro. I gruppi di lavoro con
il maggior numero di criteri che sono stati presentati includono :
• Gruppo di lavoro Disturbi dello sviluppo neurologico lavoro di gruppo (23% dei criteri)
• Gruppo di lavoro Disturbi d'Ansia (15% dei criteri )
• Gruppo di lavoro Disturbi della Psicosi (11% dei criteri)
• Gruppo di lavoro Disturbi Sessuali dell'Identità di Genere (10% dei commenti)
A seguito di una revisione di tutti i criteri osservativi presentati ed eventuali revisioni al progetto criteri, l’ APA inizierà una serie di esperimenti sul campo per testare alcuni dei criteri diagnostici proposti nelle indicazioni cliniche.
I criteri proposti continueranno ad essere revisionati e perfezionati nel corso dei prossimi due anni.
La pubblicazione finale del DSM-5 è prevista per il mese di maggio 2013.
Leggi di più , please read more here:
www.dsm5.org/Pages/Default.aspx
www.psych.org/MainMenu/Newsroom/New...-for-DSM-5.aspx
Edited by Apocalypse23 - 11/5/2010, 14:48. -
Apocalypse23.
User deleted
Submission – to the American Psychiatric Association on DSM-V
http://www.investinme.org/Article-420%20AP...0Submission.htm
Invest in ME is an independent UK charity campaigning for bio-medical research into Myalgic Encephalomyelitis (ME or ME/CFS), as defined by WHO-ICD-10-G93.3 – (also referred to as Chronic Fatigue Syndrome (CFS) – although in this letter we shall use the term ME/CFS).
Even though we are not mental health professionals or represent people with mental health disorders we feel it important to comment on the draft proposal of DSM-V.
This response should be seen against the backdrop of the devastation caused by some psychiatrists in the UK regarding their treatment of people with ME/CFS and their promotion of false perceptions about the disease to the public, healthcare authorities and government.
When a generation of patients have been adversely affected by misinformation promoted by a section of psychiatrists in the UK and when the field of psychiatry has been brought into disrepute by these same psychiatrists then it is of paramount importance that the American Psychiatric Association are aware of the dangers inherent in establishing incorrect categories of disorders which are based on poor science, vested interests or which do not serve the patients for whom they must surely be priority in all healthcare provision.
We are especially concerned about the criteria described in the new category of Complex Somatic Symptom Disorder which seems to lump together many illnesses. It cannot be helpful for clinicians or researchers to have such a variety of patients under one category especially when very little is known of the pathophysiology of these conditions placed in this category.
In the CSSD Criteria B there are terms used which are subjective and not measurable – such as “health concerns” and “catastrophising”.
Based on our experience with the treatment of an organic illness such as ME/CFS our concern is that there is a great danger of mis- or missed diagnoses when looking at this category and its diagnostic criteria.
Not all physical illnesses can be easily determined without extensive investigations and this category may allow clinicians to miss brain tumours, rare cancers and other illnesses which are difficult to diagnose.
The criteria are very vague and allow too much subjectivity.
In fact, ME/CFS could mistakenly be placed in this category if one were to ignore the huge volume of biomedical research and evidence which shows it to be an organic illness and if one were to use only the broad CSSD criteria to diagnose.
Such an action would be a major and costly mistake.
The patients we are concerned with suffer from Myalgic Encephalomyelitis which is a neurological disease but all too often these patients are being treated as if they had a somatoform illness.
Parents of children with ME are restricted in visiting their severely ill children in hospital or worse still the children are taken away from their families as the healthcare professional believes it is the family that is keeping the child ill.
Severely ill grown ups with this disease are denied usual medical care and threatened with sectioning if they are too ill to care for themselves and ask for help.
This not only sets patient against healthcare professional but also is a waste of resources and of lives. In the UK the profession of psychiatry also suffers as psychiatrists are often derided as uncaring, unscientific and unprofessional. The possibility of litigation ensuing against psychiatrists who cause such damage should also not be forgotten.
A broad unspecific category such as the proposed Complex Somatic Symptom Disorder does not help patients who need an honest and clear diagnosis. Any illness lacking a diagnostic test is in danger of being put into this non specific category which helps no one.
We are at least thankful that the APA has not attempted to repeat the major mistake being made by prominent UK psychiatrists in attempting to classify Myalgic Encephalomyelitis in amongst Complex Somatic Symptom Disorders.
Such a course of action would create another source of conflict between patients and the field of psychiatry and lead to unnecessary loss of health, potential loss of life and possible legal actions being taken against those professional organizations and/or individuals who use incorrect guidance for their diagnoses,
Yours Sincerely,
Kathleen McCall
Chairman Invest in ME
Charity Nr 1114035
Invest in ME
PO Box 561
Eastleigh SO50 0GQ
Hampshire
England
segue la traduzione automatica:
non è come quella umana ma rende.
Presentazione - l'Associazione psichiatrica americana sul DSM-V
Invest in ME è un'organizzazione indipendente campagna beneficenza del Regno Unito per la ricerca biomedica in Encefalomielite mialgica (ME o ME / CFS), come definito dalla OMS-ICD-10-G93.3 - (noto anche come sindrome da affaticamento cronico (CFS) - anche se in questa lettera useremo il termine ME / CFS).
Anche se non siamo professionisti della salute mentale o che rappresentano le persone con disturbi mentali riteniamo che sia importante commentare la proposta del DSM-V.
Questa risposta va visto sullo sfondo della devastazione causata da alcuni psichiatri nel Regno Unito per quanto riguarda il trattamento delle persone con ME / CFS e la loro promozione di idee sbagliate sulla malattia al pubblico, la sanità e le autorità di governo.
Quando una generazione di pazienti sono stati colpiti dalla disinformazione promossa da una sezione di psichiatri nel Regno Unito e quando il campo della psichiatria è stato portato in discredito da questi psichiatri stessi, allora è fondamentale che l'American Psychiatric Association sono consapevoli della pericoli insiti nella creazione di categorie non corretta dei disordini che si basano sulla scienza poveri, gli interessi acquisiti o che non servono i pazienti per i quali deve sicuramente essere la priorità in tutte le fornitura di assistenza sanitaria.
Siamo particolarmente preoccupati per i criteri descritti nella nuova categoria di Complex somatica Sintomo disordine che sembra grumo insieme molte malattie. Non può essere utile per i medici o ricercatori di avere una tale varietà di pazienti al di sotto di una categoria in particolare quando si conosce molto poco della fisiopatologia di queste condizioni in questa categoria.
Nel CSSD criteri B vi sono termini usati che sono soggettivi e non misurabili - come "preoccupazione per la salute" e "catastrophising".
Sulla base della nostra esperienza con il trattamento di una malattia organica, come ME / CFS la nostra preoccupazione è che c'è un grande pericolo di mis-diagnosi o perdere, quando guardando questa categoria ed i suoi criteri diagnostici.
Non tutte le malattie fisiche possono essere facilmente determinato senza approfondite indagini e di questa categoria può consentire ai medici di perdere tumori cerebrali, tumori ed altre malattie rare che sono difficili da diagnosticare.
I criteri sono molto vaghi e permettono soggettività troppo.
In realtà, ME / CFS potrebbe erroneamente essere inserito in questa categoria se si dovesse ignorare il volume enorme di ricerca biomedica e di prove che dimostra di essere una malattia organica, e se si dovesse usare solo i criteri generali Cssd da diagnosticare.
Tale azione sarebbe un errore grande e costoso.
I pazienti ci occupiamo soffrono di Encefalomielite mialgica che è una malattia neurologica ma troppo spesso questi pazienti vengono trattati come se avessero una malattia somatoformi.
I genitori dei bambini con me sono limitato a visitare i loro bambini gravemente malati in ospedale o peggio ancora i bambini sono portati via dalle loro famiglie, il personale sanitario ritiene che sia la famiglia che sta tenendo il bambino malato.
Gravemente malato cresciuto ups con questa malattia si vedono negare le cure mediche abituali e minacciato di sezionamento se sono troppo malato per la cura per se stessi e chiedere aiuto.
Ciò non si limita a fissare paziente contro operatore sanitario, ma è anche uno spreco di risorse e di vite. Nel Regno Unito la professione della psichiatria soffre anche come psichiatri sono spesso derisi come indifferente, non scientifica e non professionale. La possibilità di contenzioso conseguente contro psichiatri che provocare tali danni non deve essere dimenticato.
Una vasta categoria aspecifici come la proposta Complesso Somatic Sintomo Disturbo non aiutare i pazienti che hanno bisogno di una diagnosi onesta e chiara. Qualsiasi malattia priva di un test diagnostico è in pericolo di essere messo in questa categoria non specifici che non aiuta nessuno.
Ci sono almeno grati che l'APA non ha cercato di ripetere l'errore più consistente da parte di primo piano psichiatri del Regno Unito nel tentativo di classificare Encefalomielite mialgica in mezzo Complex somatica Disturbi sintomo.
Tale corso d'azione creerebbe un'ulteriore fonte di conflitto tra i pazienti e il campo della psichiatria e portare a inutili perdite di salute, la perdita potenziale di vita e di possibili azioni legali intraprese contro le organizzazioni professionali e / o persone che fanno uso di indicazioni inesatte di loro diagnosi,
Cordiali saluti,
Kathleen McCall
Presidente Invest in ME
Carità Nr 1114035
Invest in ME
PO Box 561
Eastleigh SO50 0GQ
Hampshire
Inghilterra
.
REVISIONE WHO ICD 10/11ME,CFS, FM IBS GWS etc.. |