ICD-11 Alpha Drafting platform launched 17 May (public version)

May 19, 2011 by

ICD-11 Alpha Drafting platform launched 17 May (public version)

Post #81 Shortlink: http://wp.me/pKrrB-16N

This information does not apply to the forthcoming US specific “Clinical Modification” of ICD-10, called ICD-10-CM, scheduled for implementation in October 2013.

Changes to Alpha Draft since May 17, 2011:

May 19 – 11:02 UTC : Code/sorting label assigned to Parent class “Other disorders of the nervous system” changed from 06N to 06L.

Screenshot from ICD11 Alpha  May 17 – 11.02 UTC    Chapter 6 Diseases of the nervous system: Foundation Tab selected

ICD11 Alpha Chapter 6

    »  http://apps.who.int/classifications/icd11/browse/f/en#/@_@who_3_int_1_icd_2_G93_3_3

Screenshot from ICD11 Alpha  May 19 – 11.02 UTC    Chapter 6: Linearizations Tab > Morbidity selected

    »  http://apps.who.int/classifications/icd11/browse/l-m/en#/@_@who_3_int_1_icd_2_G93_3_3

 

Four new pages were published on the WHO’s main website on 17 May – the revised Timeline for ICD-11, the announcement of an Alpha Draft browser, a Registration form and a Caveat. Yesterday, I posted the revised ICD-11 Revision Timeline.

What can be seen for PVFS, (B)ME and CFS in the public Alpha Draft?

For the Alpha browser, go to this page:

http://www.who.int/classifications/icd/revision/en/index.html

Here it states:

The International Classification of Diseases 11th Revision is due by 2015

ICD is the international standard to measure health & health services

• Mortality statistics
• Morbidity statistics
• Health care costs
• Progress towards the Millenium Development Goals
• Research

– Alpha draft is updated daily as the work progresses
– It is intended to show the new features to stakeholders early
– Commenting will be available in July 2011

The link for the alpha browser is:

http://apps.who.int/classifications/icd11/browse/f/en

This is the link to a page for “Caveats”

“Read more on what to expect in the ICD-11 Alpha Draft”

ICD-11 Alpha Draft Caveats

ICD-11 alpha draft is:

• Incomplete
• May contain errors, omissions or imperfections
• The work in different chapters are at different stages
• The alpha drafting work is going on by the WHO, Revision Steering Group and Topic Advisory Groups
• The alpha draft is going to be updated on a daily basis
• The alpha draft is NOT TO BE USED for CODING at this stage
• The alpha draft has not yet been approved by the Topic Advisory Groups, Revision Steering Group or WHO

Click here to access the public Alpha Draft browser

Poke around and open the Parent and Child categories and the Tabs – you cannot edit or break anything.

This new interface is not as detailed or as easy to navigate as the software version of the iCAT collaborative drafting platform that was in the public domain up until November, last year. Less information is visible, for example, some of the paramenter tabs, including “Definitions”. (Compare with what could be seen in this iCAT screenshot from last June.)

This is a public draft and another platform is being used by ICD Revision for ongoing drafting. The public draft will be updated as the work of the various Topic Advisory Groups and working groups progresses. ICD Revision has not reached its targets for the generation of content and population of “Content Model” fields across all chapters and this draft is not as far forward as ICD Revision had projected for a May 2011 release.

Though viewable now, the Alpha drafting browser is not planned to be open for public comment until July, this year. It’s not yet clear which classes of public stakeholder will be able to participate in the drafting process, come July, or to what extent.

If you are interested in the proposed public comment, interaction and input processes for the Alpha and Beta drafting stages, see this DSM-5 and ICD-11 Watch post for meeting presentation slides.

Summary

First a caveat: It had been anticipated that a Beta drafting platform would be released in May, this year. WHO has cited lack of content and underdeveloped software for delaying the launch of a Beta drafting platform.

This public version of an Alpha drafting platform is a “work in progress”; not all disease and disorder categories may have been entered into the draft and proposed textual content is in the process of being authored and reviewed by the various Topic Advisory Groups, ICD Revision Steering Group and external peer reviewers.

From what can be seen, today, 19 May:

06L00 Chronic fatigue syndrome

is proposed to be coded within Chapter 6 Diseases of the nervous system (the Neurology chapter), as an ICD Title category, under the Parent class, 06L Other disorders of the nervous system.

Benign myalgic encephalomyelitis is specified as an Inclusion to 06L00 Chronic fatigue syndrome.

“Causal mechanisms” for 06L00 Chronic fatigue syndrome are cited as “Virus (organism)”.

The relationship between ICD Title category 06L00 Chronic fatigue syndrome and Inclusion term Benign myalgic encephalomyelitis is not yet specified, ie whether for ICD-11, “Benign myalgic encephalomyelitis” is proposed to be specified as a Synonym , Subclass or other relationship to “06L00 Chronic fatigue syndrome”.

Many categories within the draft are waiting for their Inclusion terms to be specified, not just the three terms of interest to us.

For explanation of Inclusions and other “Content Model” parameter terms, see: iCAT Glossary or the key ICD-11 Content Model document.

6 Inclusions

Details: Inclusion terms appear in the tabular list [Ed: ICD Volume 1] of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.”

 

What is the proposed relationship between PVFS and CFS?

Postviral fatigue syndrome is not accounted for in the “Foundations” or “Linearizations > Morbidity” listings.

In ICD-10, Postviral fatigue syndrome is an ICD Title category under G93 Other disorders of brain. I cannot confirm, but it may be that due to the hierarchy  change, “Postviral fatigue syndrome” is proposed to be subsumed under “06L00 Chronic fatigue syndrome” with “06L00 Chronic fatigue syndrome” becoming the ICD Title category, because “G93.3 Postviral fatigue syndrome” has lost its ICD-10 Parent category.

At the moment, there is not sufficient information displaying to determine what the intention is. Last June, I requested a clarification from Dr Raad Shakir, chair of Topic Advisory Group for Neurology, but no clarification has been forthcoming.

In the iCAT initial drafting platform, last November, where “Postviral fatigue syndrome” was referenced within a “Category Note” and specified as an Exclusion to Chapter 5 and Chapter 18,  it was referenced as:

“G93.3 Postviral fatigue syndrome -> Gj92 Chronic fatigue syndrome”

[“Note: Gj92” is a “Sorting label” assigned for the initial Alpha drafting process, not an eventual ICD-11 code.]

 

“Change history” note from May 2010

In ICD-10, “Postviral fatigue syndrome” is a Title code at G93.3 under Parent category “G93 Other disorders of brain”. “Benign myalgic encephalomyelitis” sits under “G93.3 Postviral fatigue syndrome” (relationship unspecified).

As previously reported, an iCAT “Change history” note, dated 1 May 2010, records a “Change in hierarchy for class: G93.3 Postviral fatigue syndrome because its parent category (G93 Other disorders of brain) is removed.”

This would leaves the existing ICD-10 G93.3 Title category, “Postviral fatigue syndrome” and “Benign myalgic encephalomyelitis” that sits beneath it, and also the G93.3 index entry for Chronic fatigue syndrome with no parent category.

Note that the removal of the parent “G93 Other disorders of brain” affects many other categories also classified under G93 in ICD-10 which have also been assigned new parents under the reorganization of Chapter 6 (VI).

Screenshot of “Change history” Note from May 2010

 

Exclusions

No Exclusions have been specified yet for “06L00 Chronic fatigue syndrome”.

“Postviral fatigue syndrome” is specified as an Exclusion to the following ICD-11 chapters:

Chapter 5 “05E06 Other neurotic disorders > 05E06.00 Neurasthenia”
Chapter 18 “18GF General symptoms and signs > 18F03 Malaise and fatigue.”

(Chapter 18 is the “R code” chapter of ICD-10; ICD-10-CM proposes to retain CFS under R53 Malaise and fatigue at R53.82 Chronic fatigue, unspecified, as “Chronic fatigue syndrome NOS”, with the Exclusion: Postviral fatigue syndrome G93.3.)

Go here for ICD-11 Chapter 5 “Neurotic, stress-related and somatoform disorders” > Somatoform Disorders:

http://apps.who.int/classifications/icd11/browse/f/en#/@_@who_3_int_1_icd_2_F40-F48

Go here for ICD-11 Chapter 18 “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified”:

http://apps.who.int/classifications/icd11/browse/l-m/en#/@_@who_3_int_1_icd_2_XVIII

 

Congruency with DSM-5 proposals for revision of DSM-IV “Somatoform Disorders”

There is no obvious mirroring of the radical proposals currently being put forward by the DSM-5 Somatic Symptom Disorders Work Group to rename “Somatoform Disorders” to “Somatic Symptom Disorders” and combine a number of existing somatoform categories under a new rubric, “Complex Somatic Symptom Disorder”.

 

Registering for involvement

There is a Registration form here

This form appears to be aimed at recruiting medical health professionals for putting their names down to be contacted at some point to “Make comments; Make proposals to change ICD categories; Participate in field trials; Assist in translating“. It’s not clear whether or at what point in the Alpha/Beta drafting processes involvement might be extended to non professional stakeholders.

Register to become involved

ICD-11 Registration

“WHO wants to know if you are interested in being involved in the ICD Revision. We will contact you as certain features are opened to the public.”

[Fields are: Family name*; First name*; Email address*; Organization or Company*; LinkedIn ID; Are you a health care professional?* Yes/No. Continue…]   *Required fields

 

Related information

1] ICD11 Alpha browser

2] ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations

3] Key document: ICD Revision Project Plan version 2.1 9 July 2010

4] Key document: Content Model Reference Guide version January 2011

Filed under ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 revision docs, Somatic Symptom Disorder, Somatoform Disorders, WHO (World Health Organization)

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 3)

May 18, 2011 by

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 3)

Post #80 Shortlink: http://wp.me/pKrrB-15X

Part 1 of this report can be read here in Post #75:

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 1)

Part 2 of this report can be read in Post #77:

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 2)

The second public review of draft proposals for DSM-5 criteria is now open and runs from May to 15th June

Information about registering to submit comment can be read here in Post #78: http://wp.me/pKrrB-15q

In the first part of this report, I addressed some of the queries that have been raised around the second public review of proposals for the revision of DSM categories and diagnostic criteria.

In Part 2, I linked to the latest proposals (dated 14 April 2011) from the DSM-5 Somatic Symptom Disorders Work Group, as published on the DSM-5 Development website, on 4 May.

Stakeholder feedback is being accepted now until 15 June.

       Disorders Description   Key Document One: “Somatic Symptom Disorders

       Rationale Document     Key Document Two: “Justification of Criteria — Somatic Symptoms”

 

Related information:

Submissions by international patient organizations and advocates in February to April 2010 DSM-5 public review can be read here: http://wp.me/PKrrB-AQ

Filed under American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-V, Joel Dimsdale, MSPB (FII), MUS, Somatic Symptom Disorder, Somatoform Disorders

Registering to submit comment in the second DSM-5 public review of draft criteria

May 12, 2011 by

Registering to submit comment in the second DSM-5 public review of draft criteria

Post #78 Shortlink: http://wp.me/pKrrB-15q

Second public review of draft proposals for DSM-5 criteria now open and runs from May to 15th June

 

Under the guise of “eliminating stigma” and eradicating “terminology [that] enforces a dualism between psychiatric and medical conditions” the American Psychiatric Association (APA) appears hell bent on colonising the entire medical field by licensing the application of a mental health diagnosis to all medical diseases and disorders.

If the most recent proposals of the  “Somatic Symptom Disorders” Work Group gain DSM Task Force approval, all medical diseases and disorders, whether “established general medical conditions or disorders” like diabetes or conditions presenting with “somatic symptoms of unclear etiology” will have the potential for a bolt-on diagnosis of “somatic symptom disorder”.

CFS and ME patients, diagnosed or awaiting diagnosis, may be especially vulnerable to highly subjective criteria and difficult to quantify constructs such as “disproportionate distress and disability”, “catastrophising”, “health-related anxiety”, “[appraising] bodily symptoms as unduly threatening, harmful, or troublesome” with “health concerns [that] may assume a central role in the individual’s life, becoming a feature of his/her identity and dominating interpersonal relationships.”

There may be considerable implications for these highly subjective classifications for the diagnoses assigned and the treatments offered to US patients, for the provision of social care and payment of medical and disability insurance.

Who can submit comment?

The APA is inviting all stakeholders to submit comment and feedback on the draft framework for DSM-5 and the latest proposed revisions to diagnostic criteria – patients and families, patient advocates and patient organizations as well as clinicians, researchers, allied health professionals, lawyers and other end users.

It’s important that patients who are able to submit comment do so, but please also encourage patient organizations, informed clinicians, researchers, psychiatrists, psychologists and allied health professionals to submit feedback, too.

Last year, the APA received over 8000 comments from stakeholders across all DSM categories.

Where can I read examples of last year’s submissions?

Copies of last year’s submissions by patient organizations and advocates can be read here: http://tinyurl.com/DSM5submissions

I shall be opening a new page for copies of this year’s patient organization and patient advocate submissions.

How do I register to submit comment?

1. Go to the DSM-5 Development website: http://www.dsm5.org/Pages/Default.aspx

2. Look for the “Participate” box (right hand side of Home Page) and click on “Register Now”. (Log in names and passwords from last year’s public review do appear to have been retained.)

3. Complete the “Register to Make Comments” form: http://www.dsm5.org/Pages/Registration.aspx

Having registered a username, name, email address and country, and entered the “Captcha” code, a confirmation email with a temporary password will be auto generated. The Registration form is also accessible from each of the category Criteria pages, as well as from the Home Page.

You can register in advance, if you wish, then prepare and upload your submission at a later date, but remember the feedback period closes on 15 June.

4. To comment on the proposals of the “Somatic Symptom Disorders” Work Group, Login in and go to this page:

http://www.dsm5.org/proposedrevision/Pages/SomaticSymptomDisorders.aspx

You can submit comment, on that page, for one or more categories, or click on a specific category, for example,

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=368

J 00 Complex Somatic Symptom Disorder

Login in and you will be presented with a WYSIWYG editor.

I would strongly recommend composing your comment in a draft email or word processor first and saving a copy, as last year, there were complaints that Captcha characters were hard to read and the uploading procedure glitchy – so please save a copy first. External links and references can be included but there is no facility for including attachments. There appears to be no maximum word or character length specified. I would also suggest that you head your submission with “For the attention of the Somatic Symptom Disorders Work Group” or similar.

What are the latest proposals for the “Somatic Symptom Disorders” categories?

The latest proposals are set out here, where the two key “Disorder Descriptions” and “Rationale” documents can also be downloaded: http://wp.me/pKrrB-13z 

I’ll be posting extracts from the two key documents in the next post.

More Q and As on and around the public review, here: http://wp.me/pKrrB-12P

 

Related material:

On the subject of the use of the word “somatic” and “somatic symptom” , Angela Kennedy published this note, in June 2009:

I’ve noticed for some time that various people have been using the term ‘somatic’ as if it signified a ‘psychosomatic’ or ‘psychogenic’ condition.

This is incorrect. The OED definition of ‘somatic’ is “of or relating to the body, especially as distinct from the mind” (my italics). The word comes from the Greek ‘soma’ meaning ‘body’.

Even when proponents of ‘psychogenic’ explanations (it’s in your mind, you’re imagining it, misinterpreting it, faking it, caused it by your own beliefs etc. etc. etc.) use the term ‘somatic illness’ they actually do mean an illness of the body. They may then claim this somatic (or bodily illness) is caused by psychological dysfunction, but the word ‘somatic’ does not mean “illness caused by psychological dysfunction”. It merely means illness of a body, or a bodily illness.

It is important that this word is used correctly, especially when people write to the media, government, the medical establishment etc. Otherwise we are in danger of seeing apparent objections published, from advocates, to saying ME/CFS is a bodily illness, purely because someone has used the word ‘somatic’ incorrectly!

Filed under American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-V, Francis Creed, Joel Dimsdale, Somatic Symptom Disorder, Somatoform Disorders

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 2)

May 10, 2011 by

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 2)

Post #77 Shortlink: http://wp.me/pKrrB-13z

Part 1 of this report can be read here in Post #75:

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 1)

In the first part of this report, I addressed some of the queries that have been raised around the second public review of proposals for the revision of DSM categories and diagnostic criteria. Stakeholder feedback is being accepted now until 15 June and I’ll be giving more information on how to submit feedback via the DSM-5 Development website in a forthcoming post.

In this post, I am setting out the latest proposals (dated 14 April 2011) from the DSM-5 Somatic Symptom Disorders Work Group, as published on the DSM-5 Development website, on 4 May. The next post will set out extracts from the two key documents that accompany these revised proposals and why ME and CFS patient representation organizations, patients and advocates need to register their concerns via this second public review.

Criteria proposals and rationales are expanded upon within the two key documents and the devil is in the detail. Patient organizations will need to review both documents, as changes have been made since last year. And if you are able to do so, I recommend that patients, carers and patient advocates read them, too.

At over a dozen pages long, the “Rationale” document (which is titled: “Justification of Criteria — Somatic Symptoms”) looks potentially daunting, but the text is not as long as it appears since five or six pages of references are included at the end. Edits to the documents since the versions published in January, this year, have been highlighted by the Work Group in yellow.

http://www.dsm5.org/ProposedRevision/Pages/SomaticSymptomDisorders.aspx

Somatic Symptom Disorders

Below, I am posting proposal details for categories J 00 thru J 04.

Note that the two key PDF documents, dated 14 April 2011 called: “Disorder Descriptions” (7 pages) and “Rationale” contain full disorder descriptions and rationales for all category proposals in the Somatic Symptom Disorders categories, so you need only download one copy of each PDF.

Open full disorder descriptions here       Disorders Description   Key Document One: “Somatic Symptom Disorders”

Open full rationale document here       Rationale Document   Key Document Two: “Justification of Criteria — Somatic Symptoms”

Related material

Patient organisations, professionals and advocates submitting comments in the DSM-5 draft proposal review process are invited to provide copies of their submissions for this second and current public review for publication on this site.

Read submissions in the last DSM-5 public review, held Feb-April 2010 here:

http://tinyurl.com/DSM5submissions

International patient organisation submissions:

Whittemore Peterson Institute, Steungroep CFS Netherlands, CFS Associazione Italiana, ME Association (endorsing submission by Dr Ellen Goudsmit), Action for M.E., Invest in ME, Mass. CFIDS/ME & FM, The CFIDS Association of America, Vermont CFIDS Association, IACFSME, The 25% ME Group

A number of patient advocate submissions are also published.

Filed under American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-V, Functional Somatic Syndrome (FSS), Javier Escobar, Joel Dimsdale, Somatic Symptom Disorder, Somatoform Disorders

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” and why are they problematic? (Part 1)

May 8, 2011 by

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 1)

Post #75 Shortlink: http://wp.me/pKrrB-12P

DSM stands for Diagnostic and Statistical Manual of Mental Disorders. The DSM is published by the American Psychiatric Association (APA) and contains descriptions, symptoms and criteria for diagnosing mental disorders. It does not include information or guidelines on treatments. DSM is the primary diagnostic system in the US for defining mental disorders and is used to a varying extent in other countries.

As a classification system, DSM does not have quite the significance in the UK as Chapter V: Mental and Behavioural Disorders of the WHO’s ICD-10, which is used more often in Europe for classifying mental health disorders. But the next edition of DSM will shape international research, influence literature in the fields of psychiatry and psychosomatics and inform health care providers and policy makers’ perceptions of patients’ needs for many years to come.

The next edition of DSM, which will be known as DSM-5, is scheduled for publication in May 2013.

Diagnostic criteria defined within the DSM determine what is considered a mental disorder and what is not, what medical treatments individuals receive and which treatments medical insurers will authorise funding for. In addition to use in medical settings, DSM is also used by social services agencies, governments, policy makers, courts, prisons, drug regulation agencies, pharmaceutical companies and in research.

The inclusion or not of a disorder within DSM has revenue implications for pharmaceutical companies seeking licences for new drugs or to expand markets and applications for existing products.

Second public review of proposals for DSM-5

On 4 May, the APA published revised proposals for the 13 Work Groups for the revision of DSM-IV categories and diagnostic criteria on the DSM-5 Development website and issued a news release announcing a second stakeholder review and feedback exercise. According to the DSM-5 Timeline, as it stood in March, this second public review was not expected until August-September.

Q: Is this review and comment process open only to APA members and other professionals?

A: No. All stakeholders are invited to submit comment and feedback on the draft framework and the latest proposed revisions to diagnostic criteria: patients and families, patient advocates and patient representation organizations as well as clinicians, researchers, allied health professionals, lawyers and other end users.

Q: How long will this second review period run for?

A: The DSM-5 Development website is open for commenting now until 15 June.

Q: Is registration required in order to submit feedback?

A: Yes. You will need to register to submit comment to the Work Groups. You can register now on the DSM-5 Development site to participate. Once registered, you can prepare and upload your comment via a WYSIWYG editor anytime until 15 June. More information on registering to submit feedback in Post #78.

Q: Which DSM-5 Work Group proposals have potentially the most implications for CFS and ME patients? 

A: The DSM-5 Work Group which has the most relevance for “Chronic fatigue syndrome”, CFS, “ME”, “CFS/ME”, “ME/CFS”, IBS, Fibromyalgia, Chemical Sensitivity (CS), Chemical Injury (CI), Environmental Illness (EI), GWS and chronic Lyme disease patients is the Somatic Symptom Disorders Work Group (SSD Work Group) which has responsibility for the revision of the categories currently classified in DSM-IV under “Somatoform Disorders”.

Q: Where can I find copies of the comments submitted last year by ME and CFS patient organizations during the first public review?

A: Copies of comments submitted, last year, by international patient organizations to the Work Group for “Somatic Symptom Disorders” are collated here together with some of the feedback submitted by patients and patient advocates: http://tinyurl.com/DSM5submissions

Q: How many submissions did the 13 DSM-5 Work Groups and Task Force receive during the first review?

A: The APA reports having received over 8000 comments across all categories.  After the review period had closed, the Task Force did not publish summaries of key areas of concern brought to its attention by stakeholders and neither has the Task Force nor individual Work Groups published responses to areas of major concern.

Q: How many submissions were received in response to the proposals published last year for the “Somatic Symptom Disorders” categories?

A: The APA did not publish a breakdown of the numbers of responses received by each of the 13 Work Groups.

 

Q: How do the current DSM-IV categories for “Somatoform Disorders” compare with ICD-10?

A: There is a degree of correspondence between the current Somatoform Disorders section in DSM-IV and the equivalent section in ICD-10 Chapter V Mental and behavioural disorders. This simplified table sets out how the two classification systems currently correspond for their respective Somatoform Disorders categories:

Current DSM-IV Codes and Categories for Somatoform Disorders and ICD-10 Equivalents

Source: Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M: Somatoform disorders: time for a new approach in DSM-V. Am J Psychiat. 2005;162:847–855.

Neurasthenia is not categorized in DSM-IV. Neurasthenia is classified in ICD-10 in Chapter V Mental and behavioural disorders, at F48.0, as shown in the table, above.

Chronic fatigue syndrome is not classified in DSM-IV. Chronic fatigue syndrome is indexed in ICD-10 to G93.3, (Chapter VI Diseases of the nervous system – the Neurology chapter), the same code to which PVFS and (Benign) ME are classified.

ICD-10 has “Fatigue syndrome”  [Note: not “postviral”; not “chronic”] coded at F48.0 in Chapter V, which specifically excludes G93.3 Postviral fatigue syndrome.

(Please refer to the “ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines” aka “the Blue Book” and to ICD-10 online for full categories, disorder descriptions, inclusions and exclusions for ICD-10 Somatoform Disorders.) [9] [10]

 

Q: What does “Harmonization” between DSM-IV and the forthcoming ICD-11 mean?

A:  The APA participates with the WHO in an International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and a DSM-ICD Harmonization Coordination Group.

There is already a degree of correspondence between some categories in DSM-IV and their equivalent sections in ICD-10 Chapter V. For their next editions, the APA and the WHO have committed as far as possible:

“To facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria.”

with the objective that

“The WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.”

The WHO acknowledges there may be areas where congruency between the two systems may not be achievable.

Q: Is ICD Revision intending to harmonize its Somatoform Disorders categories with the current proposals for DSM-5?

A: DSM-5 proposals are a “work in progress”. The proposals of the Somatic Symptom Disorders Work Group for the revision of categories within this section represent a radical restructuring of the current DSM-IV Somatoform Disorders; following fields trials, the Work Group will review and potentially revise their proposals. These proposals may be found to be inoperable in the field or otherwise unacceptable to clinicians participating in field trials. The Task Force may require the Work Group to make substantial modifications to the current proposals. A third public review is scheduled for January-February 2011 prior to the finalization of categories and criteria.

It’s not known how closely the DSM-5 Work Group for “Somatic Symptom Disorders” are collaborating with the ICD Revision working group responsible for overseeing the revision of ICD-10’s Somatoform Disorders categories.

There have been no minutes or summaries of meetings of the International Advisory Group for the Revision of ICD-10 Mental and behavioural disorders, in which the APA participates and which is chaired by DSM-5 Task Force member, Steven E Hyman, MD, published since December 2008 (a point raised recently with the WHO’s Dr Bedhiran Üstün) and the ICD Revision Topic Advisory Group for Mental Health does not issue public reports on its progress.

It is not known whether, to what extent or at what stage in the Alpha/Beta drafting process ICD Revision might seek to achieve congruency between category names, glossary descriptions and criteria for ICD-11 Chapter 5 and those being proposed for the restructured DSM “Somatoform Disorders” section. But the classifications under “Somatoform Disorders” for ICD-11 Chapter 5, according to the iCAT Alpha Drafting platform as it stood in November, last year, did not appear to mirror the proposals of the DSM-5 SSD Work Group:

Chapter 5 (V) Somatoform Disorders (the F codes) F45 – F48.0 (as displaying in the iCAT Alpha Drafting platform in November 2010):

(It is understood from ICD documentation that the child categories F45.40 and  F45.41 are proposed new entities for ICD-11.)

From what is understood of ICD taxonomic and ontological principles, the conceptual framework and radical restructuring of the Somatoform Disorders currently proposed by the SSD Work Group, might prove difficult for ICD-11 to assimilate even if ICD Revision were to consider the proposals, per se, to be valid constructs that could be used reliably.

 

Q: What proposals are being put forward for the revision of the DSM-IV categories currently known as “Somatoform Disorders”?

A: The SSD Work Group is recommending renaming the “Somatoform Disorders” disorders section of DSM-IV to “Somatic Symptom Disorders”.

The Work Group proposes combining existing categories – Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC), Factitious Disorder and Factitious Disorder imposed on another (previously known as Factitious Disorder by proxy) into one group entitled “Somatic Symptom Disorders”. Alternatively, Factitious Disorders would be listed under the category “Other Disorders”.

The Work Group’s summary justification is ‘Because the current terminology for somatoform disorders is confusing and because somatoform disorders, psychological factors affecting medical condition, and factitious disorders all involve presentation of physical symptoms and/or concern about medical illness, the work group suggests renaming this group of disorders Somatic Symptom Disorders. In addition, because of the implicit mind-body dualism and the unreliability of assessments of “medically unexplained symptoms,” these symptoms are no longer emphasized as core features of many of these disorders.’

‘…since Somatization Disorder, Hypochondriasis, Undifferentiated Somatoform Disorder, and Pain Disorder share certain common features, namely somatic symptoms and cognitive distortions, the work group is proposing that these disorders be grouped under a common rubric under a new category called “Complex Somatic Symptom Disorder” (CSSD).’

There is a relatively recent additional proposal for a category called “Simple (or abridged) Somatic Symptom Disorder” (SSSD).

These proposals would represent a major change in the diagnostic nomenclature for this section of the DSM.

The Work Group also proposes a category “Illness Anxiety Disorder” (hypochondriasis without somatic symptoms) and recommends the existing Conversion Disorder category be renamed “Functional Neurological Disorder”. (‘Somatic’  means of or relating to the body.)

 

Q: Have there been changes since the publication of the initial proposals, in February 2010?

A: Since the first public review, the Work Group has modified the criteria for “Complex Somatic Symptom Disorder (CSSD), added a new proposal for a category called “Simple Somatic Symptom Disorder” and made revisions to the text of the two key PDF documents. So you will need to review the most recent criteria and the two key documents that accompany these latest proposals if you are intending to submit comment.

I shall be posting the latest proposals for criteria and the two key “Disorder Description” and “Rationale” documents in the next post (Post #77).

 

References

1] APA 4 May 2011  News release No. 11-27  or  http://tinyurl.com/APAnewsrelease4may11

2] “Somatic Symptom Disorders” Work Group Members, Bios and Disclosures

3] Latest proposals for “Somatic Symptom Disorders”

4] Key Somatic Symptom Disorders PDF Document: Disorder Descriptions

5] Key Somatic Symptom Disorders PDF Document: Justification of Criteria

6] Revised DSM-5 Timeline

7] Register on the DSM-5 site to submit stakeholder feedback

8] APA’s FAQ on DSM-5

[9] ICD-10 online (version for 2007) Chapter V: Somatoform Disorders: F45-F48.0 codes”

[10] ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines” (aka “the Blue Book”) PDF format

Filed under American Psychiatric Association (APA), DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-V, Javier Escobar, Joel Dimsdale, MUS, Somatic Symptom Disorder, Somatoform Disorders

APA News Release 4 May 2011: New Framework Proposed for Manual of Mental Disorders

May 6, 2011 by

APA News Release 4 May 2011: New Framework Proposed for Manual of Mental Disorders

Post #74 Shortlink: http://wp.me/pKrrB-12x

http://tinyurl.com/APAnewsrelease4may11

APA News Release 4 May 2011

American Psychiatric Association

News Release

For Information Contact:                                                            Release No. 11-27
Eve Herold 703-907-8640
press@psych.org

Erin Connors 703-907-8562
econnors@psych.org

FOR IMMEDIATE RELEASE

New Framework Proposed for Manual of Mental Disorders
APA Revisions a Key Step in Development of DSM-5

ARLINGTON, Va. (May 4, 2011) The American Psychiatric Association today released the organizational framework proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This restructuring of the DSMs chapters and categories of disorders signals the latest scientific thinking about how various conditions relate to each other and may influence care. The APA is again inviting comment from the public and mental health and other professionals who use the manual for both diagnostic and research purposes.

The revisions reflect the knowledge we have gained since the last DSM was published in 1994, said David Kupfer, M.D., chair of the DSM-5 Task Force. They should facilitate more comprehensive diagnosis and treatment approaches for patients and encourage research across diagnostic criteria.

The changes re-order the existing manuals 16 chapters based on underlying vulnerabilities as well as symptom characteristics, which currently result in many patients being diagnosed with multiple disorders within and across disorder groups. The chapters are arranged by general categories such as neurodevelopmental, emotional and somatic to reflect the potential commonalities in etiology within larger disorder groups.

The sequence of chapters builds on what we have learned about the brain, behavior and genetics over the past two decades, noted Steven Hyman, M.D., former director of the National Institute of Mental Health and a member of the DSM-5 Task Force.

Public comment is invited through June 15 on the draft framework and the latest proposed revisions to diagnostic criteria, both available on http://www.dsm5.org. During an initial public review and comment period last year an unprecedented occurrence in both the field of psychiatry and in medicine the APA received more than 8,000 written responses from clinicians, researchers and family and patient advocates. All of the responses were considered as part of the manuals reorganization.

Todays release marks another stage in the development of DSM-5. Rigorous scientific scrutiny is shaping this 14-year project, with the involvement of nearly 500 experts from the United States and abroad. Publication is scheduled for 2013.

The manuals new organization combines certain disorders under more comprehensive chapter headings while breaking others out from their previous categories. One example is obsessive-compulsive disorder (OCD), long considered to be an anxiety-driven disorder. Recent studies have shown that OCD and several related disorders involve distinct neurocircuits, and so they are now listed as a separate grouping a move that could advance understanding of their root causes.

There are other notable changes. Disorders previously listed under a single rubric of infancy, childhood and adolescence have been integrated into other chapters, in line with the goal of making DSM more developmentally focused. In addition, research findings linking schizophrenia and schizotypal personality disorder into a schizophrenia spectrum will be reflected in this next edition.

The schizophrenia spectrum designation is supported by studies showing how these disorders tend to aggregate within families, said Darrel Regier, M.D., M.P.H., vice chair of the DSM-5 Task Force and executive director of the American Psychiatric Institute for Research and Education. It will help clinicians to correctly diagnose patients by making clear the common features that fall within the spectrum.

To date, reports on the deliberations and progress of the task force and 13 work groups have been presented at international conferences, through more than 100 papers and via the DSM-5 website. After last years public comment period, the work groups continued to amend and refine some categories of disorders.

The first round of field trials is now testing the new diagnostic criteria in real-world settings, including at nearly a dozen larger academic and clinical centers; almost 3,900 mental health professionals in individual practice and smaller settings also will participate before the trials conclude. Another public comment period on the criteria will then follow.

The DSM-5 framework and diagnostic criteria will be determined by 2012 and submitted to the APAs Board of Trustees for review and approval.

At every stage, said Kupfer, DSM-5 is benefiting from a depth of research and a breadth of expertise and diverse opinions that will immeasurably strengthen the final document.

The American Psychiatric Association is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psych.org and www.healthyminds.org.

 

Media coverage, APA’s 4 May DSM-5 announcement

MedPage Today

CNN Blog

 

Related information:

Post: 05.05.11 American Psychiatric Association (APA) announces second public review of DSM-5 draft criteria and structure

Filed under American Psychiatric Association (APA), DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-V, Functional Somatic Syndrome (FSS), Javier Escobar, Joel Dimsdale, Somatic Symptom Disorder, Somatoform Disorders

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