ICD Classification Systems Research Articles

МІЖДИСЦИПЛІНАРНІ АСПЕКТИ СИСТЕМ КЛАСИФІКАЦІЇ ПСИХІЧНИХ РОЗЛАДІВ

B a c k g r o u n d . The article demonstrates the development and influence of the main diagnostic systems in psychiatry, such as the DSM and the ICD, on the concept of psychiatric diseases. The problem of classification of psychiatric disorders is one of the main topics that is the field of study of the philosophy of psychiatry. The correct diagnosis within a particular diagnostic system directly affects the choice of appropriate drug treatment, psychotherapy and social support for people suffering from mental disorders. Misdiagnosis has not only negative medical but also social consequences, leading to stigmatization and avoidance of people suffering from mental disorders. M e t h o d s . The research uses an integrated approach to the analysis of psychiatric diagnostic systems, including historical, comparative and interdisciplinary methods. The application of the historical method contributed to a detailed study of the evolution of psychiatric diagnostic systems and changes in approaches to the classification of mental disorders. A comparative analysis of the main diagnostic systems was carried out, considering their structure, diagnostic criteria and interaction. The interdisciplinary method involves the integration of knowledge from psychiatry, philosophy, medical history, cultural studies, and psychology, providing a deep understanding of the medical, philosophical, social, and cultural aspects of mental disorders. R e s u l t s . The article analyzes the historical development of ideas and methodology for the classification of mental disorders from ancient Greece to the present. From Hippocrates and Plato to Sydenham, Kabanis, Pinel, and Eskierol, the authors trace the evolution of understanding of mental disorders, emphasizing the shift in emphasis from etiological theories to more descriptive and categorical models. The authors describe the current state of the DSM and ICD classification systems, which play a dominant role in psychiatric science and subsequent social support and welfare for people suffering from mental disorders. Changes that have occurred in these systems and their impact on psychiatric practice and research are discussed. Considerable emphasis is placed on the history of the diagnosis of post-traumatic stress disorder (PTSD), which becomes a symbolic indicator of the complexities and challenges associated with the modern classification of mental illness. The authors consider the phenomenological method as a tool for a deeper understanding of PTSD, especially in the context of the constant psychotraumatic factors of war, the consequences of which generate new challenges for Ukrainian psychiatric practice. The authors present a case study using the phenomenological approach to diagnose PTSD, which demonstrates the need for a detailed analysis of patients' internal experience for accurate diagnosis and effective treatment. C o n c l u s i o n s . The conclusions emphasize the importance of integrating philosophical methods into the diagnosis and analysis of mental illness in clinical practice. The authors call for the development of interdisciplinary research involving both philosophers and mental health professionals to develop more detailed and person-centered approaches to the diagnosis and treatment of mental disorders.

Fibromyalgia from a psychiatric point of view

Fibromyalgia is a disorder bordering on rheumatology and psychiatry, which was included in the ICD-10 (M79.7) classification in the 1990s. It is characterised by a triad of symptoms including chronic widespread pain, sleep disturbances, and mental or physical exhaustion. According to various estimates, fibromyalgia affects from 2 to 4% of the population, particularly individuals between 50 and 60 years of age. There is a lack of consistent data in the available literature on the prevalence of the disorder between sexes. Depending on the criteria used, the female/male ratio is reported to be 13.7:1, 4.8:1 or 2.3:1. Despite nearly three decades of fibromyalgia presence in the ICD classification system, the nature and treatment of the disease have not been sufficiently recognized and arouse a lively discussion among researchers of various medical specialties. The paper attempts to systematise selected issues related to fibromyalgia which seem particularly important from the point of view of psychiatry. The introduction presents the history of the debate on the concept of fibromyalgia, problems relating to the definition and classification of the condition and, finally, symptomatology. The article focuses on the psychiatric aspect of fibromyalgia and reviews reports of the association of fibromyalgia with mental disorders, as well as issues relating to pathophysiological and therapeutic concepts that may be useful to both psychiatrists and other specialists who may encounter the disorder in their practice.

Clinical Utility and Global Applicability of Prolonged Grief Disorder in the ICD-11 from the Perspective of Chinese and German-Speaking Health Care Professionals

Background: Prolonged grief disorder (PGD) is included in the ICD-11 (11th edition of the International Classification of Diseases). The new PGD criteria reflect the requirements and recommendations of the World Health Organization for improved clinical utility and international applicability. Even though the ICD classification system is globally used, no research has investigated how healthcare professionals (HP) in non-Western countries may adopt this change for their own practice. Objective: The present study explored the extent to which the new PGD criteria were accepted and perceived to meet the standards for clinical utility and international applicability among Chinese and German-speaking HP. Methods: Individual semistructured interviews were conducted in person, by phone, or online (e.g., via Skype), with 24 Chinese (n = 10) and German-speaking (n = 14) HP working with bereaved populations in China and Switzerland, and analyzed using a qualitative framework analysis. Questions included “what items are currently missing from the PGD criteria?”. Results: Across all HP, the majority supported the inclusion of PGD and were generally aligned with the current criteria. HP found that the criteria distinguished between normal and abnormal grief and considered the criteria easy to use if their modifications were considered. Merits included, among others, improved clinical decision making, research promotion, and social acknowledgment. Main concerns included misdiagnosis, pathologization, and a lack of specificity of criteria. The importance of international applicability was emphasized across Chinese and German-speaking HP. Different grief-specific symptoms were identified by German-speaking and Chinese HP. Conclusions: These findings provide evidence for the clinical utility and international applicability of ICD-11 PGD criteria among German-speaking and Chinese HP, as well as cultural similarities and differences in the barriers to implementation of these criteria.

Neuroscience in ICD11

The ICD classification system is a primary function of the WHO, which started long before its establishment in 1948. The initial reporting was on causes of mortality evolved into mortality and morbidity. The aim of the revision was to produce a modern classification to replace ICD10 that was established in the 1980s. Our knowledge in genetics, microbiology, immunology, imaging, therapeutics and management has made revolutionised medical knowledge. There are many highlights in ICD11, which makes it stand out, perhaps the most salient for Neurology is stroke. Since 1955 in ICD7, stroke was classified under the vascular system and hence in all the WHO statistics it was not counted as a brain disease. Stroke is the second cause of death and should be separated from cardiac disease. The neurology topic advisory group with the support of the World Stroke organization, worked for years to disentangle stroke and bring it to the neurology chapter. This was accomplished and in the future brain diseases will receive their rightful recognition as the second cause of death and the first cause of disability. Other conditions, which were not recognised accurately, are Prion disease, which were labelled as ";“slow virus";” infections in ICD10. We still have some issues such as placement of cognitive disorders between Neurology and Psychiatry, similarly functional/dissociative disorders and their accurate placement. ICD11 was discussed at the Executive Board of the WHO and there were some issues raised. It is expected that implementation will start in January 2022

5. RETHINKING THE TAXONOMY, COURSE, AND OUTCOME OF PSYCHOSES: DIMENSIONAL, LATENT TRAJECTORY, AND TRANSDIAGNOSTIC APPROACHES

Overall : Evidence continues to accumulate on heterogeneity in phenomenology, course and outcome of non-affective and affective psychotic disorders. Both DSM and ICD classification systems have evolved to include a large number of categories of psychosis. However, doubt remains about this categorical approach because of high comorbidity, common etiological factors and the absence of zones of relative rarity between categorical diagnoses. Some authors have nevertheless argued that categorical representations of psychosis may still be of clinical utility if used in combination with dimensional indicators.It is now widely accepted that psychotic symptoms partition into several symptom dimensions that would support the heterogeneity of psychotic disorders. However, there is no consensus on the exact number of these dimensions, with previous factor-analytic work pointing towards models with two to twelve specific symptom dimensions. However, recently, there has been evidence for a transdiagnostic dimension underlying affective and non-affective psychotic symptoms in schizophrenia, schizoaffective and bipolar disorder that challenges their classification as distinct diagnostic constructs. There is also considerable heterogeneity in clinical course and outcome of psychotic disorders, but how to best map and model this over time remains to be established. Taken together, this presents significant challenges for the classification of psychotic disorders as separate diagnostic entities.This symposium brings together international researchers at the forefront of research into the phenomenology, course and outcome of psychotic disorders. Roman Kotov will present novel data on symptom dimensions and examines the course of these dimensions in an epidemiologic cohort of 628 first-admission inpatients with psychosis interviewed 6 times over two decades in the Suffolk County Mental Health Project. Craig Morgan will report new findings from the 10-year follow-up of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP-10) study, an epidemiological cohort of 552 patients with a first episode psychosis, using a data driven approach to identify latent trajectory classes to account for heterogeneity in patterns of change in psychotic symptoms over time and characterize these trajectories with the WHO classification, baseline demographic characteristics and diagnoses. Ulrich Reininghaus will present novel data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium to investigate whether there is a transdiagnostic dimension cutting across symptoms of schizophrenia, schizoaffective disorder and psychotic bipolar I disorder. Diego Quattrone will report recent findings from EU-GEI Functional Enviromics Study on genetic and socio-environmental factors associated with transdiagnostic and specific symptom dimensions of non-affective and affective psychosis. Robin Murray will discuss these findings in the context of new challenges in the field and directions for future research.

An overview of ICD medical classification for the information professional

PurposeInformatics work introduces information professionals to taxonomies and other classification systems outside the boundaries of traditional bibliographic systems. This paper aims to provide an overview of the International Statistical Classification of Diseases and Related Health Problems (ICD) for informaticians and information professionals who may not have worked with the system previously.Design/methodology/approachIn this paper, the author reviews the purpose, history, current use and future trends of the ICD classification system.FindingsICD is used globally as a standard vocabulary for medical diagnoses and, in the USA, for medical procedures in hospitals. Understanding the classification system is vital to working with clinical medical data.Originality/valueThe ICD classification system is not commonly used by information professionals. This paper provides a brief overview that will familiarize the information professional with the standard and its uses related to medical practice.

Editorial: Immunogenic Cell Death in Cancer: From Benchside Research to Bedside Reality.

The Editorial on the Research Topic Immunogenic Cell Death in Cancer: From Benchside Research to Bedside Reality Immunogenic cell death (ICD) has emerged as a cornerstone of therapy-induced antitumor immunity (1–3). ICD is distinguished by spatiotemporally defined emission of danger signals or damage-associated molecular patterns (DAMPs) that elevate the immunogenic potential of dying cells [Garg et al.; (4)]. The important role played by DAMPs in immunity, tissue remodeling, and inflammation is discussed in details by Venereau et al. (Marco E. Bianchi lab). Most potent ICD inducers, characterized so far, elicit danger signaling through oxidative-endoplasmic reticulum stress (5). Several ICD inducers have been characterized, e.g., some chemotherapies, some physicochemical therapies (e.g., radiotherapy or photodynamic therapy/PDT), and oncolytic viruses (2, 6). Here, radiotherapy is among the first recognized immunogenic therapies [on account of “abscopal-effect” (7)]. The immunogenic potential of radiotherapy and possibilities for its combination with immune checkpoint blockers is discussed by Derer et al. (Udo S. Gaipl lab). It is noteworthy that ICD can also be achieved by various “smart” combinatorial strategies – an important point for clinically applied non-ICD inducers, discussed in details by Bezu et al. (Guido Kroemer lab). Several lines of experimental evidence have established the validity of ICD. However, the overreliance on usage of prophylactic vaccination in transplantable (heterotopic) tumor models has attracted some criticism (8). While these criticisms are valid, the field is already moving toward tumors produced orthotopically (curative/therapeutic) or in genetically engineered mouse models (GEMM) (at least for few ICD inducers, e.g., hypericin-PDT, Newcastle disease virotherapy and anthracyclines) (9–12). Moreover, the clinical existence of ICD has been proven through retrospective analysis involving cancer patient’s survival/therapy-responsiveness data (13–17). These observations have encouraged the increased usage of ICD-associated DAMPs as predictive/prognostic biomarkers – a point discussed in detail by Fucikova et al. (Radek Spisek lab). The promising results generated by systemically administered ICD inducers have also paved way for application of ICD-based dendritic cell (DC) vaccines (12). This important development has been discussed from the preclinical/clinical vantage points of various solid tumors by Vandenberk et al. (Stefaan W. van Gool lab) and lymphoma by Zappasodi et al. (Massimo Di Nicola lab). In the latter case, it is clear that the field is moving toward chimeric antigen receptor (CAR)-T cell’s application, and it will be interesting to see its combination with ICD in near future. Nevertheless, the insurmountable complexity of cancer makes it inevitable that in certain contexts, ICD may fail. This failure may stem from various factors, e.g., tumor heterogeneity (8), MHC-level heterogeneity (12), pre-established niches enriched in immunosuppressive factors or immune-checkpoints (1), stem cell-based immune-evasion (12), low mutational load, inactivating mutations/polymorphisms in certain immune-receptors (1), general ablation of danger signaling (14), and other genetic or even epigenetic causes. Several of these pro-cancerous immune-evasive mechanisms and immunotherapeutic strategies required for overcoming them are discussed in detail by Kersten et al. (Karin E. de Visser lab). The strategies for targeting epigenetic processes to improve immunotherapy are further discussed by Wachowska et al. (Jakub Golab lab). We believe that the valuable contributions of key researchers/clinicians toward this research topic/special edition have largely fulfilled its primary aim, i.e., to foster a critical discussion on experimental and clinical relevance of ICD. In fact, to further summarize and organize the fields of ICD and DAMPs, we have produced a multi-author consensus paper within this research topic that attempts to classify DAMPs and ICD inducers with an eye on translational potential of ICD (Garg et al.). This classification paper brings together >50 authors from the fields of ICD and DAMPs, and tries to reach a comprehensive accord on various terminologies related to DAMPs/ICD, the historical background of these concepts, ICD classification system (Type I vs. Type II inducers), and the relevant preclinical/clinical criteria crucial for the field(s) (Garg et al.). We hope that this consensus paper will be a useful literature resource for various researchers/clinicians. These contributions, while summarizing the status quo, have also exposed a set of major questions and challenges that still need to be addressed.

The complexity and challenges of the International Classification of Diseases, Ninth Revision, Clinical Modification to International Classification of Diseases, 10th Revision, Clinical Modification transition in EDs

Beginning October 2015, the Center for Medicare and Medicaid Services will require medical providers to use the vastly expanded International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) system. Despite wide availability of information and mapping tools for the next generation of the ICD classification system, some of the challenges associated with transition from ICD-9-CM to ICD-10-CM are not well understood. To quantify the challenges faced by emergency physicians, we analyzed a subset of a 2010 Illinois Medicaid database of emergency department ICD-9-CM codes, seeking to determine the accuracy of existing mapping tools in order to better prepare emergency physicians for the change to the expanded ICD-10-CM system. We found that 27% of 1830 codes represented convoluted multidirectional mappings. We then analyzed the convoluted transitions and found that 8% of total visit encounters (23% of the convoluted transitions) were clinically incorrect. The ambiguity and inaccuracy of these mappings may impact the workflow associated with the translation process and affect the potential mapping between ICD codes and Current Procedural Codes, which determine physician reimbursement.

E-health Information Management according Types of DRGs and ICD Classification Systems: Greek Perspectives and Initiatives

Although efforts for the introduction of ICT in public health care system had begun already in the mid’ of 80s, the results have not yet reached the desired expectations. In order to meet the requirements of the future health care system, in the age of the “smart machine”, the continuous investment in IT without a clear return is unsustainable. Electronic health records are based on the coded data descriptions. Well known data coding schemes e.g. ICD-10, ICPC, GMDN family, have been successfully translated into Greek however less than a third of doctors use these schemes in the clinical IT assessment. Cost continues to be the biggest barrier in IT adoption; some current IT solutions are not usable, particularly for smaller public hospitals in Greece. Therefore, the cost of transforming paper-based data to e-patients’ records does not allow doctors to share valuable information. In the Greek health information platform, a different approach of data exchange, across and outside the public hospitals should be implemented. The hospital should involve the Health Information scientists to assist the doctors in accessing and managing clinical information. The sharing of medical information should ensure that all core patient data conform to the related rules of health information resources management, and are based on international health coding and classification systems. The Health Information management education and training on ICT, must be achieved and maintained. The health information scientists should be educated and prepared for advanced clinical applications, and should use as a tool the evidence-based practice, in order to provide secure access to data to those people that they “need to know”.

Forty years of increasing suicide mortality in Poland: Undercounting amidst a hanging epidemic?

BackgroundSuicide rate trends for Poland, one of the most populous countries in Europe, are not well documented. Moreover, the quality of the official Polish suicide statistics is unknown and requires in-depth investigation.MethodsPopulation and mortality data disaggregated by sex, age, manner, and cause were obtained from the Polish Central Statistics Office for the period 1970-2009. Suicides and deaths categorized as ‘undetermined injury intent,’ ‘unknown causes,’ and ‘unintentional poisonings’ were analyzed to estimate the reliability and sensitivity of suicide certification in Poland over three periods covered by ICD-8, ICD-9 and ICD-10, respectively. Time trends were assessed by the Spearman test for trend.ResultsThe official suicide rate increased by 51.3% in Poland between 1970 and 2009. There was an increasing excess suicide rate for males, culminating in a male-to-female ratio of 7:1. The dominant method, hanging, comprised 90% of all suicides by 2009. Factoring in deaths of undetermined intent only, estimated sensitivity of suicide certification was 77% overall, but lower for females than males. Not increasing linearly with age, the suicide rate peaked at ages 40-54 years.ConclusionThe suicide rate is increasing in Poland, which calls for a national prevention initiative. Hangings are the predominant suicide method based on official registration. However, suicide among females appears grossly underestimated given their lower estimated sensitivity of suicide certification, greater use of “soft” suicide methods, and the very high 7:1 male-to-female rate ratio. Changes in the ICD classification system resulted in a temporary suicide data blackout in 1980-1982, and significant modifications of the death categories of senility and unknown causes, after 1997, suggest the need for data quality surveillance.

Prototype diagnosis of psychiatric syndromes and the ICD-11

Prototype diagnosis of psychiatric syndromes and the ICD-11

The Age at Onset of Attention Deficit Hyperactivity Disorder

Whilst the contemporary concept of attention deficit/hyperactivity disorder (ADHD) is relatively recent, the typical pattern of ADHD symptoms has been described in the literature since the nineteenth century, and these early descriptions all emphasised an onset early in life. ADHD symptoms and impairments are often present during the preschool period. However making a diagnosis during this period is challenging due to the greater variability in normal behaviours during this developmental period. The ADHD construct has been refined over time, and with the introduction of the DSM and ICD classification systems, an age of onset (AOO) criterion was introduced making it a requirement that symptoms, and later on impairment, were present before the age of 7 years. This criterion was challenged as arbitrary and lacking empirical support. In DSM-5 the AOO criterion for ADHD was adjusted such that only some symptoms appearing before the age of 12 years are required to make a diagnosis. ADHD was traditionally thought of as a disorder of childhood, and perhaps adolescence. It is now clear that ADHD often persists into adulthood, either as the full disorder or partially remitted but with continuing impairment. Several recent studies have challenged the notion that ADHD always begins in childhood. Four large community studies have identified a group of adults who did not have ADHD as children but who do meet diagnostic criteria for ADHD as adults. These findings have resulted in considerable debate, and several lines of argument have been put forward to explain the findings.

The Accuracy of the DSM-IV Pain Disorder and the ICD-10 Persistent Somatoform Pain Disorder in Chronic Pain Patients

Objectives. In this investigation we studied the relationships between different psychological relevant subgroups and the presence of different psychosomatic symptoms in a sample of chronic pain patients, testing the accuracy of the DSM- and ICD classification systems. Results. We found no evidence for a “pure” pain syndrome according to the DSM- and ICD systems. On the contrary, we found highly significant evidence of a mixed psychosomatic condition. Conclusion. The results suggest a broad somatoform classification, with subgroups based on personality characteristics taking a stress—coping model into account, including interpersonal attachment behaviour. An alternative model of a diagnostic approach is presented.

Cigarette smoking and the risk of goitre and thyroid nodules amongst parous women

To clarify the mechanisms by which smoking is associated to toxic and nontoxic goitre and thyroid nodules. Cohort study. Sweden. A cohort of 874,507 parous women identified through the Medical Birth Registry, with smoking behaviour assessed through self-reported information at the first pre-natal visit, and follow-up between 1983 and 1997. Hospital diagnoses of toxic and nontoxic goitre and thyroid nodules, identified by record-linkage with the national Inpatient Registry. Cox regression was employed to estimate the hazard ratio (HR) of smokers compared with nonsmokers and the corresponding 95% confidence limits (CL). There was a significantly increased risk of goitre and nodules amongst smokers. The positive association was stronger for toxic (age adjusted HR = 1.94, CL = 1.74-2.16) than for nontoxic goitre and nodules (age-adjusted HR = 1.26; CL = 1.14-1.38). There was generally no clear risk trend with regard to amount smoked (below and above 10 cigarettes per day). Elevated body mass attenuated these associations, whilst being born in Swedish areas of endemic goitre enhanced the association with nontoxic goitre and nodules. Smoking enhances the risk of thyroid goitre and nodules requiring hospital admission. Iodine deficiency and body weight are likely to be important modifiers of the risk of thyroid hyperplastic diseases amongst smokers.

Post-stroke depression: diagnosis and therapy

Depression occurs at least temporarily in up to 30 - 40 % of all patients that have experienced a stroke. In the literature the term of a "Poststroke Depression" (PSD) has already been established. However standardised criteria for this diagnoses do not exist to this day. In most cases the DSM or ICD classification system is applied. Other investigators used various psychiatric rating scales. Even though it is generally acknowledged that there is a high prevalence, the occurrence of depression in combination with a stroke fails in most cases to be diagnosed or is left untreated. The need for treatment is even more pronounced by studies showing that a combination of stroke and depression will result in a less favourable outcome, particularly pertaining to that of functional treatment (motor skills, independent participation in activities of daily life). This difference in impairment between a depressed stroke patient and a not depressed stroke patient could be proven in studies that have been conducted over years. Despite the necessity of treatment that can be concluded from such a finding, the recent literature does not offer consistent information as to the ideal point of time for intervention nor the kind and intensity necessitated. According to singular studies, that have rarely been conducted under controlled conditions, there have been positive outcomes after early treatment. Along with psychostimulants that were most predominantly applied in the USA, as well as conventional tricyclic antidepressants, the group of the "Selective Serotonin Reuptake Inhibitors, SSRIs" have resulted in particularly favourable clinical outcomes.

Reliability of individual diagnostic criterion items for psychoactive substance dependence and the impact on diagnosis.

Reliability of diagnostic criterion items for psychoactive substance dependence and the impact of each on the reliability of the diagnosis were analyzed. As part of a reliability study for a new interview developed for the multisite Collaborative Study on the Genetics of Alcoholism (COGA), data were collected from both within-center and across centers. The impact of each diagnostic item on the reliability of the substance dependence diagnosis was studied by forcing each item to be reliable one at a time and recomputing the kappa statistic for the diagnosis. Findings indicated that the majority of individual diagnostic criterion items were reliable; 87% and 81% were in the fair or better range of reliability for the within- and cross-center studies, respectively. Individual kappa estimates were statistically similar for the two studies. Reliability findings for two classes of substance, alcohol and cocaine, were good, while those for stimulants were less satisfactory. Forcing items one at a time to be reliable did not affect reliability of the overall substance dependence diagnosis, because more than one criterion item changed from Time 1 to Time 2. Because no single item was influential, weighting criteria equally, as is done in the DSM and ICD classification systems, appears to be a reasonable approach.