Future development in international classification

The development of the new global aspect of diagnosis, an expansion of many of the special sections, and the production of more diagnostic instruments can be envisaged. The descriptive diagnoses now established do not consider some traditional psychiatric and psychotherapeutic models such as the endogenous concept or the theories of neurosis. Nevertheless the influence of this type of diagnosis is increasing, even in psychodynamic psychiatry in which operationalized diagnosis would have seemed impossible some years ago. The 'reduction of psychoanalytic negligence in diagnosis and the adherence to accepted and communicable standards' has been proposed/71,' Also, a behaviour therapeutic classification of neurotic disorders has been developed and the new ICIDH-II is currently being tested in a large WHO field study. The multiaxial system may also be revised; for example, instead of axis III of ICD-10, a more comprehensive graded psychosocial diagnosis could be established.

It is to be hoped that in future a single system of classification will be used in psychiatry rather than the two current classifications. ICD-10 is used more in practice and DSM-IV more in science, a disadvantage for both!

Classification will also be developed in general practice. Diagnosis cannot be as sophisticated as that in specialist practice and many minor psychiatric disorders are treated. For these kinds of disorders general practitioners need the diagnostic help and advice on therapy which is currently offered in the primary health care version of ICD-10 (see Chapter, 7.8).

However carefully the rules and criteria for the use of operationalized diagnosis are applied, some cases cannot be coded. In these cases the diagnostician needs to judge individually and to describe the patient. In any case the physician should consider the totality of the patient's suffering and his or her individuality. Diagnosis should be supplemented by an extensive biographical history of the patient.

Aetiology, diagnosis, and therapy should be interrelated. Although most current diagnoses are descriptive, it is possible that nosology may eventually have a stronger basis in aetiology. It is likely that the aetiology of the psychoses will be better understood in the future, especially if an attempt is made to study subgroups of these conditions, relating them as far as possible to somatic abnormalities. This may be achieved with bipolar affective disorders and seasonal depressions, and also with special types of schizophrena such as periodic catatonia with its high genetic load, as described by Kleist and Leonhard. (2!> Future work on both psychotic and non-psychotic disorders should focus on developing a new nosology and overcoming the currently popular atheoretical approach to diagnosis.

We can expect diagnosis and classification to change faster in the next century than in the last hundred years. In the eyes of the diagnostician, the world of psychiatry will hold many surprises.

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