Diagnostic Classifications in the 21st Century: how can we capture developmental details

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Brain Development; Functional development; Life Span; ICD; DSM; ICD11; DSM5; children; adolescence; youth; RDoC; ICD Field Trials;

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<ul><li>1.Diagnostic Classifications in the 21st Century: developmental dimension T. Bedirhan stn, MD World Health Organization Classifications, Terminologies, Standards Geneva, Switzerland</li></ul> <p>2. Outline ICD &amp; DSM Integration of developmental concepts Paradgms across the 20th century RDoCICD Revision Reviews - proposals Field Trials 3. A period of Miraculous Growth 4. Transitions in Life 5. Transitions in Life 6. Transitions in Life 7. Transitions in Life 8. Transitions in Life 9. A Developmental Brain Model For Schizophrenia 10. World Mental Health Surveys: 12 month prevalence of MOOD disorders Kessler &amp; stn, 2008 CUP United States Ukraine France Netherlands Colombia Lebanon Belgium Spain Mexico Italy Germany Japan PRC Beijing PRC Shanghai Nigeria0%2%4%6% Prevalence8%10%12% 11. World Mental Health Surveys: Age of Onset 12. 1952 DSM I 1968 DSM-II 1980 DSM-III 1987 DSM-III-R 1994 DSM-IV 2000 DSM-IV-TR 2013 DSM 5ICD-6 ICD-8 ICD-9 ICD-10 ICD-11 13. "Psychiatrists of Europe! Protect your sanctified diagnoses! Cartoon by Emil Kraepelin, "Bierzeitung", Heidelberg 1896 14. Death of the authorBirth of the reader ? 15. Am J Psychiatry 119:210-216, September 1962 doi: 10.1176/appi.ajp.119.3.210 1962RELIABILITY OF PSYCHIATRIC DIAGNOSES : 1. A CRITIQUE OF SYSTEMATIC STUDIES AARON T. BECK M.D.1 1Dept. of Psychiatry, University of Pennsylvania and the Philadelphia General Hospital. Pertinent systematic studies of the reliability of psychiatric diagnosis were critically examined. It was pointed out that each of these studies presented certain methodological problems which made their findings inconclusive. An experimental design was presented to meet these problems and thus yield a more informative index of reliability. By systematically varying the important variables, such as the level of experience of the psychiatrists, the time interval between interviews, the use of ancillary information, and the degree of refinement of the nosological categories, it will be possible to determine their effects on reliability. 16. On the origins of BOGSAT Roger Peele and Paul Luisada, in Washington, D.C., wrote a paper on hysterical psychoses Spitzer went to meet them: During a forty-minute conversation, hysterical psychoses was divided into two disorders: Short episodes of delusion and hallucination would be labelled brief reactive psychosis, The tendency to show up in an emergency room without authentic cause would be called factitious disorderThen Bob asked for a typewriter, and banged out criteria sets for factitious disorder and for brief reactive psychosis 17. ICD DSM Common Language ? Pseudoconsensus ? Communication: Research &amp; Science: Mutual data exchange Confusion Common framework StraitjacketClinical utility: Reliable assessment ReductionismPublic Health: Human Rights: Guides decision making Conformism Protection Discrimination and stigma 18. DSM5 disorder groups 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.Neurodevelopmental disorders Schizophrenia spectrum and other psychotic disorders Bipolar and related disorders Depressive disorders Anxiety disorders Obsessive-compulsive and related disorders Trauma- and stressor-related disorders Dissociative disorders Somatic symptom and related disorders Feeding and eating disorders Elimination disorders Sleep-wake disorders Sexual dysfunctions Gender dysphoria Disruptive, impulse-control, and conduct disorders Substance-related and addictive disorders Neurocognitive disorders Personality disorders Paraphilic disorders Other mental disorders 19. Welcome to the Real World DSM5 Field Trials Regier et al 2013 20. Test-Retest Reliability of Target DSM-5 Diagnoses at the Child/Pediatric Field Trial Sites 21. DSM-5 Child/Pediatric Field Trials Unsuccessful in Obtaining Accurate Estimates of Kappa 22. DSM-5 Child/Pediatric Field Trials 1 0.9Excellent0.8KAPPA0.7Very good0.6 0.5Good0.4 0.3Questionable0.2 0.1 0Unacceptable 23. NIMH will be re-orienting its research away from DSM categories and toward RDoC.Search: Insel transforming diagnosis23 24. Research Domain Criteria NIMH Dimensions of Observable neurobiological measuresUnits of analysis Genes Molecules Cells Neural Circuits Physiology Behaviours Self Reports (Paradigms) 25. RDoC Constructs 26. Brain Disorders: Scale &amp; Scope 27. Disorders of the Human Connectome 28. Schizophrenia as a brain diseaseSource: Thompson et al. 2001 29. 0.8Somatic Diseases0.6Heritability0.40.20Breast CancerHypertensionIschemic Heart DiseaseRheumatoid Arthritis 30. Mental Disorders 0.8Heritability0.60.40.20 DepressionADHDSchizophreniaAutismBipolar 31. The Meaning of the Human Genome Project for Neuropsychiatric Disorders Steven E. Hyman Provost, Harvard University and Professor of Neurobiology, Harvard Medical School Boston, MA, USA 32. Gene - Behaviour Pathway (Ustun, 2005)G1P1 B1N1 G2 G3P2N2P3N3G4 GeneticGenotypesB2 B3P4 NeurophysiologicalPsychologicalEndophenotypesBehaviouralPhenotypes 33. Lieberman, Insel Issue Joint Statement About DSM-5 and RDoC 14 May 2013 .. they acknowledged that along with the International Classification of Diseases, DSM "represents the best information currently available for clinical diagnosis of mental disorders" and that the two publications "remain the contemporary consensus standard to how mental disorders are diagnosed and treated." mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior," which is the focus of the RDoC initiative 34. Development 35. What is New ? ICD-10 Mental Retardation Autism, Aspergers Scholastic Development Hyperkinetic Disorder Speech Articulation Gender Identity DisorderICD-11 Intellectual Development Autism Spectrum Disorder Learning ADHD Speech Sound Disorder Social Communication Disorder Gender Ingconruence out 36. ICD11 eta http://www.who.int/classifications/icd/revisionBeta Browser &amp; Print 10 look &amp; feel + descriptions code structure !eta ICD-11 Beta draft is NOT FINAL updated on a daily basis NOT TO BE USED for CODING except for agreed FIELD TRIALS 37. ICD-11 Features Internet Based PlatformInput from all StakeholdersContent ModelDefinitionsField Trials for Use CasesElectronic Health Record ReadyMulti Lingual RepresentationsArabic Chinese English English Franais French Russian Espaol SpanishDeutsch PortugusGerman Portuguese 38. ICD11 Field Trials Basic aims To test the fitness of ICD-11 for multiple purposes Mortality coding Morbidity coding Quality &amp; Safety Other use casesTo ensure the comparability between ICD-10 and ICD-11 To increase consistency, identify improvement paths, and reduce errors .Key Assessments: Applicability feasibility easy to useReliability - consistency gives same results in the hands of allUtility - added value renders useful information 39. Core Studies Study One: Feasibility and Reliability for live Cases and Case Summaries coding with ICD-10 an 11Study Two: Basic Questions 40. Inter-rater reliability The Case information live medical recordCoded using ICD11 by at least two different people Agreement rates measured 41. Incentives for Participants 42. ICD-11Comments Proposals Field Trials Review Mechanism </p>