ICD-10 Categories Research Articles

Social anxiety in children

Orphanhood is one of the major problems in Russia. According to 2010 data there are about 700 thousand orphaned children in Russia (Rudov, Mityasova, & Katyushkina, 2011). majority of them live in various kinds of orphanages. This experience has a negative influence on children's development. emotional sphere is the first to suffer in children living in orphanages (Avdeeva, 2009; Bowlby, 2004; Chuprova, 2007; Lisina, 2009). For a long time it was thought that psychological disorders identified in orphans were connected with bad social conditions (such as insufficient medical care or a limited-information environment). These factors are of course important to the development of a child; however the main reason for psychological problems in orphans is not the quality of their living conditions. J. Bowlby and R. A. Spitz showed the importance of maternal care for the child's development. Based on their work it was possible to establish the importance of a close emotional connection with the mother (or the significant adult figure) (Bowlby, 2004; Spitz, 2001). If this connection is missing, maternal deprivation occurs. This is one of the factors that lead to the development of emotional disorders. Orphans have difficulty identifying and understanding emotions and expressing their own emotions; they are characterized by lack of a clearly formed self-image and low self-esteem (Avdeeva, 2009; Chuprova, 2007; Prihozhan & Tolstyh, 2007; Zalysina & Smirnova, 1985). Living outside a family and having a deficit in communication with significant adult figures lead to scarceness of communication skills, difficulties in social-role identification, problems in gender-identity formation, and distorted images of parent-child relationships (Chuprova, 2007; Prihozhan & Tolstyh, 2007; Romanovskiy, 2009; Zalysina & Smirnova, 1985). Many researchers have identified a deficit in creative activities and cognitive motivation (Bozhovich, 2008; Prihozhan & Tolstyh, 2007).Thus, living in orphanages decreases the ability of orphans to adapt to and interact with the world and other people. A deficit of behavior strategies that help adaptation may lead to social anxiety in orphaned children. Studying the characteristics of emotional development of orphaned children and teenagers -- for example, the display of social anxiety -- will allow us to find ways of adapting them to society.Social anxietyUp to the present time the social-anxiety phenomenon has rarely been studied in Russia. Among studies dedicated to this topic one can highlight the research of I.V. Nikitina and A.B. Kholmogorova (Nikitina & Kholmogorova, 2010) and of V.V. Krasnova (Krasnova & Kholmogorova, 2011). The term social anxiety is understood as a type of anxiety which is triggered by various kinds of situations involving social interactions (Nikitina & Kholmogorova, 2010, 80). When people with a high level of social anxiety connect with other people, they experience emotional discomfort and feel anxious about the impression they are making and about how they look in the eyes of others. mildest form of social anxiety is shyness (Zimbardo, 1991). most severe form of social anxiety is social phobia, which is identified as a separate diagnostic category in DSM-IV and ICD-10.Research has shown that social anxiety in teenagers and adults may be connected to suicidal ideation, substance abuse aimed at alleviating the psychological state, and depressive states (Beidel & Turner, 1998, in Nikitina & Kholmogorova, 2011, 82.). A tendency to decrease the frequency of social contacts may lead to a decrease in educational and professional activities and to the deterioration of the quality of interpersonal relationships, sometimes even to social isolation. Research done by Zimbardo (1991) shows that shy children and students are less likely than children and students who are not shy to initiate a conversation, more likely to experience difficulties in ambiguous social situations (where there are no regulations, instructions, or rules), and more likely to be unable to ask for help. …

German approach of coding rare diseases with ICD-10-GM and Orpha numbers in routine settings

In Germany all physicians are compelled to code according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification (ICD-10-GM), according to the Statutory Health Insurance. The classification is in use since 2004 in the same Version for inpatient and outpatient care. Special coding guidelines are to be used for inpatient care. DIMDI provides an Index to the ICD-10-GM, which contains approx. 80.000 terms. For electronic use the index is published with a unique identifier (so called Alpha-ID). This enables electronic communication of diagnosis on a more granular level than the broad categories of ICD-10. In the German project “Coding of Rare diseases” (July 2013 – June 2016) all rare diseases from Orphanet will be coded according to ICD-10-GM and missing terms will be added to the ICD-10-GM-Index-Database. On a regular basis an Alpha-ID file with all indexed diagnostic terms together with the relevant codes from both systems will be published. Coders in Rare diseases Centers in Germany will be encouraged to use the two coding systems by implementing the file in their IT-systems. An evaluation of possible additional use of the file in existing IT-systems will be performed at the end of the project. The file could e.g. help to enable easy access to Orphanet for Users at the time of diagnosis, treatment, or when advising patient/family or coding from routine IT-applications in all kinds of healthcare settings. Two main goals are targeted with the project. First of all it is important to standardize coding of rare diseases in Germany by providing electronic files for easy implementation, which will result in standardized code pairs from the two systems. Selecting codes manually from the two different systems is a potential for errors in patient documentation and might lead to incorrect statistical evaluation of rare disease cases. Secondly the aim of DIMDI is to reduce the administrative burden on the health care system in Germany whenever possible. By providing two coding systems in one file the coder will have to perform the coding just once, a significant reduction of time.

A study of visual expression on ulinastatin usage

To comprehensively understand the situation of research of the use of ulinastatin in clinical treatment, and to display the results with visual images. The keywords of Bikunin, Ulinastatin, Urinastatin, urinary trypsin inhibitor in association with disease, treatment, therapy were searched with search engine from several academic websites with June 30th, 2012 (for English literature) or January 31st, 2013 (for Chinese literature) as the deadline. Bibexcel extracting keywords of diseases and that involving pathophysiology and biology accompanying the diseases and treatment mechanism of the diseases were used. Diseases were classified by ICD10, and the keywords of treatment mechanism were classified according to researchers' understanding and therapist suggestion. Word co-occurrence matrix of diseases and treatment mechanism words were constructed, and were expressed more accurately and intuitively by analyzing multidimensional scaling (MDS). Data were analyzed and charts were produced respectively using UCINET, SPSS 20.0 and Excel 2013 software. A total of 3 660 articles were included for the analysis, including 1 428 in English and 2 232 in Chinese. In English literature, 97 diseases with 796 times were analyzed and 17 disease categories distributed in ICD10. In Chinese literature, 220 diseases with 2 153 times were analyzed and 14 disease categories distributed in ICD10. Seventy-four and 33 words involving treatment mechanism were respectively from English and Chinese literature, respectively, which could be roughly divided into three categories: immunity/inflammation, coagulation and genetic/metabolic. The word co-occurrence matrix analysis and MDS showed that the key word for mechanism of treatment appeared widely in different diseases, and a single disease might be expressed with different terms, while different diseases might have common foundation for ulinastatin treatment, though the foci of indication were also different. All data were found to be able to form visual images according to the aim of investigation. According to the data retrieved in this study, the field of ulinastatin treatment was quite widespread, involving hundreds of diseases, which were distributed in more than 10 categories of ICD10, and almost 100 keywords involving treatment mechanism were found. Although those diseases were varied, they have a common therapeutic foundation based on the word co-occurrence matrix analysis. All the present data were successfully transformed into visual image expression to achieve the goal of this study. On the other hand, the resolving methods and problems used in this study will be helpful for further similar studies.

Welche Fehler machen Hausärzte? Daten der Gutachter-Kommission der Landesärztekammer Baden-Württemberg

In Germany, medical error reporting systems are well established. They collect information reported principally by physicians. Systematic data collection concerning medical errors is also performed by expert arbitration and advisory boards of the German State Medical Associations. Data base MERS (Medical Error Reporting System); cases from the Expert Arbitration and Advisory Board of the State Baden-Württemberg from the years 2004-2011 (8,042 cases) were evaluated as follows: extraction of the cases from general practitioners (n=307, 4%); categorisation of the type of error and degree of severity; classification according to ICD-10 (International Classification of Diseases); overview of confirmed cases including commentaries of the above board; logistic regression analysis of factors potentially associated with confirmed cases. In 26% (n=80) the board confirmed medical errors. 55% of the errors were assigned to the category "diagnosis" (n=44), 21% to "general therapy" (n=17), 8% to "operative therapy" ("minor surgical operations") (n=6) and 10% to "injections" (n=8). 29% of cases (n=23) were associated with permanent damage or death. The majority of cases could be assigned to ICD-10 categories "I" (cardiovascular system, n=20) and "S-T" or "V-Y" (consequences of external causes or external causes of morbidity and mortality, n=34). No significant associations were found by logistic regression analysis. The rate of confirmed cases corresponds with the rate of all medical disciplines. The presented overview is illustrative and may be of help to avoid errors by using it for continuing medical education.

Variations in incidence and age of onset of acute and transient psychotic disorders

To determine incidence and age of onset of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs) characterised by subtypes with polymorphic, schizophrenic and predominantly delusional symptoms, pointing out differences from schizophrenia (SZ) and bipolar affective disorder (BD). We identified all subjects aged 15-64years who were listed for the first time in the Danish Psychiatric Register with a diagnosis of ATPDs (n=3,350), SZ (n=4,576) and BD (n=3,200) in 1995-2008. Incidence rates and rate ratios (IRR; 95% confidence interval) by gender and age were calculated. The incidence of ATPDs was 6.7 per 100,000 person-years, similarly high for both genders (IRR 1.0; 0.9-1.1). Among the ATPD subtypes, polymorphic psychotic disorder was more common in females (IRR 1.4; 1.2-1.6) as opposed to those featuring schizophrenic symptoms, which tended to occur in younger males (IRR 1.4; 1.2-1.7). No significant gender difference was found for acute predominantly delusional disorder (IRR 1.0; 0.9-1.2), which had a later onset than any ATPD subtypes. SZ had an incidence twice as high in males (IRR 2.0; 1.9-2.2), and an earlier age of onset than ATPDs. A different pattern was observed for BD in terms of a slightly greater incidence in females (IRR 1.1; 1.0-1.1), and a later age of onset than both ATPDs and SZ. These findings are likely to reflect the heterogeneity of the clinical features encompassed by ATPDs, and contribute to building a case for their revision in ICD-11.

WPA contribution to the development of the chapter on mental disorders of the ICD-11: An update.

The WPA is partnering with the World Health Organization (WHO) in the development of the chapter on mental disorders of the 11th edition of the International Classification of Diseases (ICD), whose publication is expected in the year 2015. WPA Member Societies participated in the WPA-WHO Global Survey on Psychiatrists' Attitudes Towards Mental Disorders Classification 1, which will guide the WHO in improving the clinical utility of the ICD classification of mental disorders. Almost 5,000 psychiatrists worldwide provided their feedback about their use of diagnostic systems in clinical practice, and the desirable characteristics of a classification of mental disorders. Participants expressed preference for a simpler system with 100 or fewer categories. Over two-thirds preferred flexible guidance to a strict criteria-based approach. Significant minorities of psychiatrists in Latin America and Asia reported problems with the cross-cultural applicability of existing classifications. Overall, ratings of ease of use and goodness of fit for specific ICD-10 categories were fairly high, but several categories were described as having poor utility in clinical practice. This is being an important focus for the ICD revision. Several WPA Member Societies and experts are being or will be involved in ICD-11 field trials and in the various translations/adaptations of the diagnostic system. The WPA is actively contributing to the process of harmonization between the ICD-11 and the DSM-5. The WPA Past-President, M. Maj, who chairs the ICD-11 Working Group on Mood and Anxiety Disorders, recently reported 2 about the expected convergences and divergences in the ICD-11 and DSM-5 approaches to the classification of mood disorders. Among the convergences, both systems are likely to include increased activation/energy as a defining symptom for mania, and to acknowledge that a manic/hypomanic syndrome emerging during antidepressant treatment, and persisting beyond the physiological effect of that treatment, qualifies for the diagnosis of manic/hypomanic episode. Furthermore, both systems are going to provide the clinician with the opportunity to acknowledge the occurrence of subsyndromal anxiety symptoms in a patient with a major depressive episode, by using a specifier (“with prominent anxiety symptoms” in ICD-11, “with anxious distress” in DSM-5). In ICD-11, bipolar II disorder is expected to be recognized as a distinct diagnostic entity, while in ICD-10 it is just mentioned among “other bipolar affective disorders”. Expected divergences between the ICD-11 and the DSM-5 will include a different characterization of mixed states and schizoaffective disorders. The ICD-10 bereavement exclusion in the diagnosis of depressive episode will be eliminated in the DSM-5, but two notes introduced in the text should attenuate the divergence from ICD-11, which is going to exclude from the diagnosis of depressive episode, in line with ICD-10, “normal bereavement reactions appropriate to the culture of the individual concerned”. The Chairman of the WPA Section on Schizophrenia, W. Gaebel, who chairs the ICD-11 Working Group on Psychotic Disorders, recently reported 3 about the expected convergences and divergences in the ICD-11 and DSM-5 approaches to the classification of psychotic disorders. Among the convergences, both systems are going to de-emphasize Schneider's first-rank symptoms in the diagnostic criteria for schizophrenia and to omit subtypes of the disorder. These subtypes are going to be replaced by six symptom specifiers (positive symptoms, negative symptoms, depressive symptoms, manic symptoms, psychomotor symptoms, cognitive impairment) in the ICD-11 and by corresponding dimensional assessments in the DSM-5. Among the divergences, the ICD-11 is expected to keep the one month duration criterion for the diagnosis of schizophrenia, and not to include functional impairment as a mandatory criterion. World Psychiatry is one of the main channels through which the international psychiatric community is being updated about the ICD-11 development. A Special Article authored by the ICD-11 International Advisory Group, summarizing the philosophy of the entire process, has been published in the journal 4, as well as the first report of the Working Group on Intellectual Disabilities 5 and a review of evidence and proposals for the ICD-11 classification of feeding and eating disorders 6. Several papers produced by the Working Group on Mood and Anxiety Disorders have been collected in a special supplement to the journal 7. Many relevant contributions have appeared in recent issues of the journal 8–27. All these articles are available on the WPA website (http://www.wpanet.org).

Family psychiatric morbidity of acute and transient psychotic disorders and their relationship to schizophrenia and bipolar disorder

Although transient psychotic disorders are currently classified as a category separate from schizophrenia (SZ) and affective disorders, their distinctive features remain uncertain. This study examines the family psychiatric morbidity of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs), pointing out differences from SZ and bipolar disorder (BD). From a cohort of 2.5 million persons, we identified all patients enrolled in the Danish Psychiatric Register who were ever admitted with ATPDs (n=2537), SZ (n = 10639) and BD disorder (n=5292) between 1996 and 2008. The relative risk (RR) of ATPDs, SZ and BD associated with psychiatric morbidity in first-degree relatives (FDRs) was calculated as the incidence rate ratio using Poisson regression. The RR of ATPDs [1.93, 95% confidence interval (CI) 1.76-2.11] was higher if patients with ATPDs had at least one FDR admitted with any mental disorder than patients without family psychiatric antecedents. An additional risk arose if they had FDRs admitted not only with ATPDs (RR 1.60, 95% CI 1.33-1.92) but also with SZ (RR 2.06, 95% CI 1.70-2.50) and/or BD (RR 1.55, 95% CI 1.23-1.96). Despite some overlap, the risk of SZ (RR 2.80, 95% CI 2.58-3.04) and BD (RR 3.68, 95% CI 3.29-4.12) was markedly higher if patients with SZ and BD had FDRs admitted with the same condition. These findings suggest that family psychiatric predisposition has a relatively modest impact on ATPDs and argue against a sharp differentiation of ATPDs from SZ and BD.

Comorbidities in ADHD children treated with methylphenidate: a database study

BackgroundMethylphenidate (MPH) is the most common drug treatment of attention deficit / hyperactivity disorder (ADHD) in children. Treatment with MPH is contraindicated in the presence of certain psychiatric, cerebro- and cardiovascular conditions. We assessed MPH treatment prevalence and incidence and the frequency of comorbid conditions related to these contraindications in new MPH users compared to a control group without ADHD and ADHD medication.MethodsWe used health care data for the years 2004 to 2006 from the German Pharmacoepidemiological Research Database (GePaRD) which includes about 18% of the German population. MPH treatment prevalence and incidence was assessed based on at least one MPH prescription in the given year. In MPH users, the prevalence of psychiatric and other comorbidities was assessed in the quarter of the first MPH prescription and the three preceding quarters, whereas in controls it was assessed in the earliest four quarters of continuous insurance time starting at 01.01.2004 or the start of insurance if this was later. Differences in the presence of comorbid diagnoses between MPH users and controls were tested by logistic regression.ResultsIn 2005, 1.5% of all children and adolescents aged 3 to 17 years (2.3% of males and 0.6% of females) received MPH in Germany. The proportion of children with a record of a psychiatric comorbidity in any of the nine ICD categories of diagnoses was substantially higher in new MPH users (83%) compared to controls (20%). Cerebro- and cardiovascular comorbidities were rare in general. Still, among new MPH users, 2% of males and females had a diagnosis of a pre-existing cardiovascular disorder but only 1.2% of controls.ConclusionsBesides MPH treatment prevalence we first publish age-specific incidence rates for Germany. A high proportion of children who were started on MPH had a record of a psychiatric comorbidity preceding the first prescription. Cerebro- and cardiovascular conditions were rare in the studied age range, but still higher among children who received MPH than in the control group. Results show that in a substantial subgroup of patients, comorbidities require a thorough weighting of possible risks of MPH medication against the risks of untreated ADHD.

Concordance Rates of Birth Defects After Assisted Reproductive Technology Among 17 258 Japanese Twin Pregnancies: A Nationwide Survey, 2004^|^ndash;2009

BackgroundMost twins after assisted reproductive technology (ART) are dizygotic. Analysis of dizygotic twin pairs is useful in assessing familial aggregation in the development of birth defects.MethodsUsing nationwide post-ART data from the Japan Society of Obstetrics and Gynecology, recurrence risk ratios (RRRs)—defined as probandwise concordance rates of birth defects in twins divided by the prevalence of birth defects in the general population—were calculated as indicators of familial aggregation. Birth defects were then reclassified according to the ICD-10 categories corresponding to codes Q00–Q99. From 2004 to 2009, there were 17 258 twin pregnancies.ResultsAt least 1 birth defect was noted in 236 twin pairs: 11 concordant and 225 discordant pairs. Regarding major organ systems, high probandwise concordance rates were observed for congenital malformations of eye, ear, face, and neck (11.8%), cleft lip and cleft palate (10.5%), congenital malformations of the nervous system (9.8%), and other congenital malformations of the digestive system (9.5%). High RRRs were observed for congenital malformations of eye, ear, face, and neck (RRR = 233), specifically other congenital malformations of the ear (RRR = 449); congenital malformations of the great arteries (RRR = 235), specifically those of the patent ductus arteriosus (RRR = 530); and for cleft lip and cleft palate (RRR = 208), specifically cleft palate with cleft lip (RRR = 609). The probandwise concordance rate of any birth defect (8.9%) was nearly identical to the approximated recurrence risk of sib-pairs (8.8%), which assumed multifactorial inheritance.ConclusionsThe present findings suggest that familial aggregation is a factor in some birth defects.

Using Semantic Web technology to support icd-11 textual definitions authoring

The beta phase of the 11th revision of International Classification of Diseases (ICD-11) intends to accept public input through a distributed model of authoring. One of the core use cases is to create textual definitions for the ICD categories. The objective of the present study is to design, develop, and evaluate approaches to support ICD-11 textual definitions authoring using Semantic Web technology. We investigated a number of heterogeneous resources related to the definitions of diseases, including the linked open data (LOD) from DBpedia, the textual definitions from the Unified Medical Language System (UMLS) and the formal definitions of the Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT). We integrated them in a Semantic Web framework (i.e., the Linked Data in a Resource Description Framework [RDF] triple store), which is being proposed as a backend in a prototype platform for collaborative authoring of ICD-11 beta. We performed a preliminary evaluation on the usefulness of our approaches and discussed the potential challenges from both technical and clinical perspectives.

Physical co-morbidity among treatment resistant vs. treatment responsive patients with major depressive disorder

Co-morbid physical illness has been suggested to play an important role among the factors contributing to treatment resistance in patients with major depressive disorder. In the current study we compared the rate of physical co-morbidity, defined by ICD-10, among a large multicenter sample of 702 patients with major depressive disorder. A total of 356 of the participants were defined as treatment resistant depression (TRD) patients—having failed two or more adequate antidepressant trials. No significant difference was found between TRD and non-TRD participants in the prevalence of any ICD-10 category. This finding suggests that although physical conditions such as diabetes, thyroid dysfunction, hypertension, ischemic heart disease, and peptic diseases are often accompanied by co-morbid MDD, they do not necessarily have an impact on the course of MDD or the likelihood to respond to treatment. Marginally higher rates of co-morbid breast cancer, migraine and glaucoma were found among TRD participants. Possible explanations for these findings and their possible relation to TRD are discussed.

Health Care Burden and Cost Associated with Fetal Alcohol Syndrome: Based on Official Canadian Data

BackgroundFetal Alcohol Spectrum Disorder (FASD) is a group of disorders caused by prenatal alcohol exposure. From this group, Fetal Alcohol Syndrome (FAS) is the only disorder coded in the International Classification of Diseases, version 10 (ICD-10). This coding was used to gain an understanding on the health care utilization and the mortality rate for individuals diagnosed with FAS, as well as to estimate the associated health care costs in Canada for the most recent available fiscal year (2008–2009).MethodsHealth care utilization data associated with a diagnosis of FAS were directly obtained from the Canadian Institute for Health Information (CIHI). Mortality data associated with a diagnosis of FAS were obtained from Statistics Canada.ResultsThe total direct health care cost of acute care, psychiatric care, day surgery, and emergency department services associated with FAS in Canada in 2008–2009, based on the official CIHI data, was about $6.7 million. The vast majority of the most responsible diagnoses, which account for the majority of a patient’s length of stay in hospital, fall within the ICD-10 category Mental and Behavioural Disorders (F00–F99). It was evident that the burden and cost of acute care hospitalizations due to FAS is increasing −1.6 times greater in 2008–2009, compared to 2002–2003. The mortality data due to FAS, obtained from Statistics Canada (2000–2008), may be underreported, and are likely invalid.DiscussionThe official data on the utilization of health care services by individuals diagnosed with FAS are likely to be underreported and therefore, the reported cost figures are most likely underestimated. The quantification of the health care costs associated with FAS is crucial for policy developers and decision makers alike, of the impact of prenatal alcohol exposure, with the ultimate goal of initiating preventive interventions to address FASD.

Base Rates of Postconcussion Syndrome by Method of Symptom Report

This study compared the base rate of postconcussion syndrome (PCS) symptoms using three different assessment methods in a nonclinical sample. Seventy-three university students with no history of brain injury or neurological disease reported symptoms experienced during the previous 2 weeks in response to an open-ended question, a structured interview (simulated), and the British Columbia Postconcussion Symptom Inventory (BC-PSI). Statistically significant differences (all p < .001, d = 1.80–3.93, large effect sizes) were found between the number of symptoms reported on all assessment methods, such that participants reported the most PCS symptoms on the BC-PSI (M = 9.45, SD = 2.52), followed by the structured interview (M = 5.58, SD = 2.02), and the open-ended question (M = 1.86, SD = 1.00). Further, 100%, 92.1%, and 25.4% of the sample reported three or more ICD-10 Category C PCS symptoms on the BC-PSI, structured interview, and open-ended question, respectively. Findings suggest that method of assessment influences PCS base rates, such that symptom elicitation decreases relative to the reduction in prompting associated with each assessment method. Therefore, different diagnostic conclusions may be drawn depending on method of assessment used. Clinicians need to consider how their chosen assessment method may be influencing the symptoms reported by their patients.

Substanzbezogene Störungen

Alcohol and substance use disorders (ASUD) are considered to be among the most frequent comorbidities in schizophrenic and affective psychoses and have a significant negative influence on their course and prognosis. In the present study patients with diagnosis from the ICD-10 category F2 or F3 were examined regarding a substance use disorder in a multicentre cross-section evaluation at nine psychiatric hospitals in Baden-Württemberg. The aim of this study is to discuss the current research on substance use disorders and psychosis comorbidity regarding the theoretical models by means of collected data. The examination of 50 consecutive admissions per centre is based on a shortened version of the European Severity Index (Europ ASI). An initial urine drug screening was carried out with all patients after admission. Statistical assessment was based on percentage distributions, mean values, standard deviations and suitable correlation analysis. The representative sample included 448 patients. A proportion of 169 patients (37.7%) had a dual diagnosis F2 and F1 and a proportion of 144 patients (32.1%) had a dual diagnosis F3 and F1; 64 patients (14.3%) had an F2 diagnosis and 71 patients (15.8%) had an F3 diagnosis without ASUD. Apart from lifetime use of alcohol (n = 268) and tobacco (n = 325) hypnotics/tranquilizers (n = 214), cannabis (n = 156), opioids (n = 71), stimulants (n = 96) and hallucinogens (n = 36) were consumed. The most frequent combination and long-term intake consisted of tobacco, alcohol, hypnotics/tranquilizer, cannabis and psychostimulants especially in men with schizophrenic disorders. Regarding motivation before first substance use general psychological adjustment disorders (51%), peer impact (42%) and unspecific affective symptoms were predominant. Altogether the present study clearly demonstrates that patients suffering from schizophrenia, affective disorders and ASUD have significantly higher rates of more severe substance use disorders in their psychosocial environment and more suicidal behaviour than patients without substance misuse. The high rate in the cross-sectional prevalence of tobacco, alcohol, cannabis and psychostimulant use calls for more effective drug prevention.

Mental health of young offenders in Switzerland: Recognizing psychiatric symptoms during detention

We reviewed the medical records of the 118 adolescent detainees which had at least one consultation by a psychiatrist at the prison health facility during 2007. General practitioners used the International Classification of Primary Care (ICPC-2) for recording health problems. Psychiatrists used the International Classification of Diseases (ICD-10) for making psychiatric diagnoses. The concordance between the mental health assessment done by general practitioners using the ICPC-2 and the diagnoses proposed by psychiatrists was globally satisfying. The five most frequent ICD categories (conduct disorder, drug abuse, alcohol abuse, personality disorder, adjustment disorder) encompassed the most frequently reported ICPC-2 psychological symptoms. Several associations between psychological symptoms and socio-demographic characteristics were observed. Apart from providing a description of the mental health of adolescent detainees in one of Switzerland’s largest detention centre for minors, results suggest that general practitioners can adequately identify frequent mental disorders in such contexts.

Comparing ICD-9 and ICD-10: The impact on intentional and unintentional injury mortality statistics in Italy and Norway

BackgroundThe international classification of diseases (ICD) provides guidelines for the collection, classification and dissemination of official cause-of-death statistics. New revisions of the ICD can potentially disrupt time trends of cause-of-death statistics and affect between-country comparisons. The aim of this study was to measure how switching from ICD-9 to ICD-10 affected mortality statistics for external causes of death, i.e. intentional and unintentional injuries, in Italy and Norway. MethodsA sample of death certificates (N=454,897) were selected in Italy from the first year the ICD-10 was implemented (2003) and reclassified from ICD-10 to ICD-9 by the Italian National Institute of Statistics. A sample of death certificates was also selected in Norway (N=10,706) from the last year the ICD-9 was used (1995) and reclassified according to ICD-10 by Statistics Norway. The reclassification (double-coding) was performed by special trained personal in governmental offices responsible for official mortality statistics. Although the reclassification covered all causes of death (diseases and injuries) in the sample, our analysis focused on just one ICD chapter XX. This was external causes of mortality (injury deaths), and covered 15 selected categories of injuries. ResultsThe switch from ICD-9 to ICD-10 had a significant net impact on 8 of the 15 selected categories. In Italy, accidental falls decreased by 76%; traffic accidents decreased by 9%; suicide by hanging decreased by 3%; events of undetermined intent decreased by 69%; and overall injury deaths decreased by 4%. These net decreases reflect the moving of death records from injury categories in ICD-9 to other injury or disease categories in ICD-10. In Norway, the number of records in three categories decreased significantly: transport accidents, 9%; traffic accidents, 13%; and suicide by self-poisoning, 18%. No statistically significant differences (net changes) were observed in the total number of accidents, suicides and homicides in either country. ConclusionsSwitching to ICD-10 did not change the overall trends for accidents, homicides and suicides in either country. However, the number of records in some injury subcategories e.g. accidental falls and traffic accidents, decreased. Changing classification can thus affect the ranking of causes of injury mortality, with consequences for public health policy.

P-1064 - Cycloid psychoses: Leonhard's descriptions revisited

Cycloid psychoses (CP) as described by Leonhard comprise the subtypes anxiety-happiness, confusion and motility psychoses. CP presents with an acute onset and have a favourable prognosis. The operational criteria by Perris and Brockington (P&B, 1981) are partly incorporated in ICD-10 as acute polymorphic psychosis (APP). The DSM-IV category Brief Psychotic Disorder (BPD) includes all psychoses with short duration. Establishing concordance of Leonhard's CP with DSM-IV and ICD-10 categories. This study was aimed to investigate the clinical characteristics of CP and to determine the prevalence of CP in patients with psychotic disorders. 80 patients with psychotic disorders were assessed by means of CASH, PANSS and CGI at baseline and after six weeks of treatment. CP's were identified according to Leonhard's descriptions. Furthermore, patients were classified using DSM-IV, ICD-10 and P&B criteria. A diagnosis of Leonhard's CP was present in 12 patients. Overlap between Leonhard's and P&B-CP was modest. ICD-10 and DSM-IV classification showed considerable heterogeneity. Diagnoses of ICD-APP and DSM-BPD were mostly assigned to CP patients. Concordance between Leonhard's CP and these categorical diagnoses was small. Leonhard CP patients showed, compared to non-CP patients, more atypical symptoms like perplexity, pananxiety and psychomotor disturbances. The estimated prevalence of CP in patients with psychotic disorders is 15 percent. Although identification of CP is of heuristic value, this is not warranted by current classification systems or operational criteria. Thorough clinical evaluation of psychotic disorders is required, especially in patients presenting with perplexity, psychomotor disturbances or severe anxieties.

An exploratory study of nutraceutical prescription pattern among psychiatric patients in an out-patient setting

Background: Nutraceuticals are increasingly being used in psychiatric practice. However the literature continues to be limited for most of these agents. Prescription of nutraceuticals to psychiatric patients has not been systematically studied in Indian setting. The current study is aimed at assessment of prescription pattern of nutraceuticals in psychiatry out-patient setting in a tertiary care center. Materials and Methods: The study was carried out at the out-patient department of a tertiary care hospital. The sample frame was constituted by all the prescriptions from the out-patient psychiatry department. The information was collected for the socio-demographic variables using a semi-structured proforma. The patients were diagnosed based on the ICD-10 and the diagnoses were grouped as per the 10 categories of ICD-10. The prescriptions were screened for the nutraceuticals. The data were analyzed using SPSS ver 14.0. Results: A total of 174 consecutive prescriptions from the consenting patients were included in the study. Highest proportion of the study subjects (36.8%) belonged to the 'mood disorder' category (F 30-39), followed by 'schizophrenia, schizotypal and delusional disorders' category (F 20-29) (24.1%). Majority of the prescriptions at first visit (75.9%) did not include a nutraceutical. 63.2% of the last prescriptions did not include any nutraceutical. The different diagnostic categories did not differ significantly with regards to prescription of nutraceutical at the first visit. However there was a significant difference between the different diagnostic categories with regards to nutraceutical in the last prescription. Conclusions: Of all the diagnostic categories, prescriptions of individuals diagnosed with 'mood (affective) disorders' and 'neurotic, stress related and somatoform disorders' demonstrated significant increase in prescription of nutraceutical at the last prescription as compared to the first prescription.

An audit of first prescription of new patients attending a psychiatry walk-in-clinic in north India

Background:Although almost all psychotropic medications available worldwide are readily available in India, there is meager data in this country on the prescription patterns of psychiatrists.Aim:To study the first prescription handed over to patients attending the psychiatry outpatient clinic of a tertiary care hospital.Materials and Methods:Data of all patients (for the period of January 1, 2009 to November 30, 2010; diagnosed with an ICD-10 diagnosis of F2-F4) were extracted from the computer-based registry and analyzed.Results:Ten thousand two hundred and fourteen (10 214) patients were diagnosed to have a diagnosis of F2-F4 ICD-10 category. In all diagnostic groups, olanzapine was the most commonly prescribed antipsychotic followed by risperidone. Very few patients (8%) received typical antipsychotic medication. In all diagnostic groups, escitalopram was the most commonly prescribed antidepressant; other frequently prescribed antidepressants were sertraline, paroxetine, and venlafaxine. Among the mood stabilizers, valproate was preferred over lithium. In all the groups, more than half of the patients were prescribed benzodiazepines, clonazepam being the most commonly prescribed agent, followed by lorazepam. The mean number of psychotropic medications was highest in the bipolar disorder group. Very few patients received the combination of same group of drugs.Conclusions:Olanzapine, escitalopram, and clonazepam are the most commonly prescribed antipsychotic, antidepressants, and benzodiazepines, respectively. Valproate was preferred over lithium as a mood stabilizer. In general, the prescription trends were in accordance to the recommendations of various treatment guidelines, except for the use of benzodiazepines, which was higher.

Mental Disorders Among Frequent Attenders in Primary Care

Frequent attenders account for a large proportion of primary care (PC) contacts, referrals, and prescriptions. Psychosocial and emotional distress is related to the high use of health services. Few studies have focused on the association between mental disorders assessed using structured interviews and frequent use of PC services.The aim of this study was to determine the factors associated with frequent attendance at primary healthcare units, focusing specifically on mental disorders. A two-phase screening epidemiological study comparing frequent attenders and routine attenders in five primary health care units was designed. Three hundred eighteen frequent attenders and 203 patients who attended the same units on a routine basis were compared. Sociodemographic and clinical data were obtained from statistical records and medical charts. Patients with a total score equal or higher than 7 points on the General Health Questionnaire-28 (GHQ-28) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. All the scores obtained on the GHQ were statistically different in the two populations. Frequency of mental disorders also differed significantly between both groups, with somatoform and affective disorders being the most prevalent ICD-10 categories among frequent attenders. The presence of depressive disorders and somatoform disorders is the most powerful predictive factor for frequent attendance. High comorbidity was found among frequent attenders with somatoform disorder. Frequent attendance at primary healthcare units is associated with depressive and somatoform disorders. Psychiatric comorbidity could be a confounder, particularly because affective and somatoform disorders often overlap in PC patients.