ICD-11 symposia at the World Congress of Psychiatry.

Abstract

Within the 16th World Congress of Psychiatry, held in Madrid from 14 to 18 September 2014, a series of symposia took place, providing information on the ongoing development of the chapter on mental disorders of the ICD-11. The symposia summarized the proposals for the various sections of the chapter, which are being produced by the fourteen working groups appointed by the World Health Organization (WHO) in consultation with relevant stakeholders, including WHO's member countries, several professional groups, and users of mental health services and their families. A list of scientific papers presenting and discussing these proposals, and of other relevant publications, is provided at the end of this article (1–99). The symposia also presented the field studies for the development of the ICD-11 chapter on mental disorders, which can be subdivided into three groups: formative field studies, Internet-based field studies, and clinic-based field studies. Formative field studies aimed to guide decisions about the basic structure and content of the classification, exploring clinicians' conceptualizations of the interrelationships among categories of mental disorders. In the first study (100), 1,371 psychiatrists and psychologists from 64 countries rated the similarity between mental disorders presented as paired comparisons. The results indicated that the participants' mapping of mental disorders was remarkably consistent across professions, languages and WHO regions. The degree of similarity between clinicians' views and the structures provided by the DSM-IV and ICD-10 was moderate (kappa + .42). The proposed structure for ICD-11 was found to more closely align with clinicians' understanding of the relationships among disorders (kappa + .51). In the second study (101), 517 mental health professionals recruited by field study centres in eight countries were asked to sort a set of 60 cards containing the names of mental disorders, based on their own clinical experience, and then to form a hierarchical structure by aggregating and disaggregating these groupings. The hierarchical organizations produced by clinicians were remarkably consistent across countries, diagnostic systems currently used and professions. Clinicians' consensus classification structure was different from ICD-10 and DSM-IV and in several respects consistent with proposals for ICD-11. Internet-based field studies are being implemented through the Global Clinical Practice Network, which currently includes about 12,000 practitioners from all regions of the world. Physicians, primarily psychiatrists, represent 59% of the Network, and psychologists 30%. All other mental health disciplines (e.g., nursing, social work and occupational therapy) are also represented. One third of the members are from Asia, one third from Europe, and 20% from the Americas, equally divided between Latin and North America. About 41% come from low- or middle-income countries. Members have registered through nine languages (Arabic, Chinese, English, French, German, Japanese, Portuguese, Spanish and Russian). These Internet-based studies are using vignette methodologies to examine clinical decision-making in relationship to the proposed ICD-11 diagnostic categories and guidelines. Data collection has been completed for the first study, dealing with disorders specifically associated with stress, which has been conducted in English, Japanese and Spanish with the participation of 1,738 Network registrants. Clinic-based studies will assess the clinical utility of proposed ICD-11 diagnostic guidelines in real-life settings, with a special focus on low- and middle-income countries. More specifically, the studies will assess: the ability of the diagnostic categories to aid clinicians' understanding of the person's condition; how well the guidelines fit the presentation of actual clinical cases; the feasibility of using the guidelines in regular clinical interactions; and the adequacy of the guidelines for assessing individuals' conditions. A major multi-country study has also been conducted concerning the utility and reliability of key changes being recommended for the primary health care version of the ICD-11 chapter on mental disorders. This study focused on the most common mental disorders seen in primary care settings (in particular, depression, anxiety and somatic symptoms).