International Classification of Diseases (ICD) 10
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The International Classification of Diseases
(ICD) is published by the World Health Organization in Geneva, Switzerland. It
included mental health disorders for the first time in 1948, in its sixth
edition. In 1959, following widespread criticism of its classificatory scheme,
the WHO commissioned a global survey of taxonomies of mental health problems,
which was conducted by Stengel. The survey uncovered great disparities and
substantial disagreements as to what constituted mental illness and how it
should be diagnosed (diagnostic criteria and differential diagnoses).
Yet, it was not until 1968 that Stengel's recommendations were implemented in
the eighth edition. The ICD-8 was descriptive and operational and did not commit
itself to any theory of etiology, pathogenesis, or psychological dynamics.
Still, it sported a confusing plethora of categories and allowed for rampant
comorbidity (multiple diagnoses in the same patient).
(continued below)
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The ICD10 was revolutionary. It incorporated the outcomes of
numerous collaborative studies and programmes, both national and international
and included input from the American Psychiatric Association, the publisher of
the Diagnostic and Statistical Manual (DSM), the ICD's equivalent in North
America). Consequently, the ICD and the DSM are now broadly similar.
But, as opposed to the DSM, the ICD provides two sets of diagnostic criteria for
each disorder. One list is useful to the diagnostician and allows for some
latitude and for the practitioner's exercise of judgment. The other set is far
more precise and strict and intended to be used by scholars and researchers in
their studies. Yet a third, simplified classification is applicable to primary
care settings and contains only broad categories (dementia, eating disorder,
psychotic disorder, and so on).
The ICD10 discusses organic, substance use-related, and stress-related disorders
separately. Chapter F, which deals with mental health disorders, is divided into
ten groups and each group, in turn, is again divided into one hundred subunits.
Thus F2 is Schizophrenia, F25 is Schizoaffective Disorder, and F25.1 is
Schizoaffective Disorder, depressive type.
An international study carried out in 112 clinical centers in 39 countries
demonstrated that the ICD10 is not a reliable diagnostic tool as far as
personality disorder go (Sartorius et al. 1993). These findings were not
repeated a year later in the USA and Canada.
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