Classification systems: The ICD

Question 1

What is the ICD and what does it provide?

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Answer 1

• A classification that describes mental/behavioural disorders/symptoms (WHO)
• Common language, data collected in diff countries can be usefully compared
• Revised a nb of times

Question 2

Who uses the ICD-10?

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Answer 2

• Clinicians
• Researchers
• Policy makers
• Client organisations

Question 3

How are the disorders listed and how many sections?

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Answer 3

• Listed consecutively

- 11 sections

Question 4

Why does each section have leftover codes?

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Answer 4

• Allows new disorders to be added, without having to recode other disorders

Question 5

What are the codes used for?

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Answer 5

• Indexing medical records, easier in research to find examples of people w specific conditions

Question 6

How do you diagnose using ICD-10?

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Answer 6

• Clinician selects key words from interview w a client that relate to their symptoms
• Clinician looks up these symptoms in alphabetical index or go straight to obvious section (schizo)
• Uses other symptoms = locate sub category

Question 7

What is the main problem of ICD-10 and the consequence of this?
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Answer 7

• Presentation of symptoms shaped by language and culture norms (culture bias)
• Clients in 1 culture diff diagnoses from clients in another, despite similar symptoms

Question 8

What improvements were made to ICD-10 as a result of research programme?
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Answer 8

• Available in many languages and appropriate cultural forms

- Revealed inconsistencies, overlaps in disorders so removed

Question 9

What did the research programme do?

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Answer 9

• Reviewed diff in diagnostic practice and diff use of diagnostic tech across world

Question 10

Evaluate reliability of ICD-10

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Answer 10

^Test-retest reliability. Ponizovsky et al. (longitudinal study) found PPV scores ^by 26% for schizo. ^Nb of disorders from ICD-9 to 10 hasn’t detracted from reliability of diagnoses

^Inter rater reliability. Galeazzi et al. arranged 2 interviewers to conduct joint interview to assess 100 consecutive clients for psychosomatic symp. Kappa values = 0.69-0.97 (v good).

Question 11

Evaluate validity of ICD-10

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Answer 11

> predictive validity. Gurland et al. showed psychiatrists in New York = ^diagnose clients w schizo than affective disorders compared w psychiatrists from London. Diff in cultural background, training of clinician affect interpretation of symptoms

Question 12

How have both systems developed over time?

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Answer 12

ICD = 1893 international list of causes of deaths, DSM = 1952 system to identify disorders in WW2 soldiers. Both ^revised

Question 13

What is the subcategory of schizophrenia?

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Answer 13

• F20

Question 14

What is schizophrenia, schizotypal and delusional disorders grouped as?
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Answer 14

• F20-F29