Specifying the disorders Diagnostic categories

The epidemiology of mental disorders could have made no real progress without methods for specifying the disorders to be investigated, then measuring these, so that research on, say, depression or schizophrenia can be comparable between sites, within and between countries. Whether the study is at the level of the community, primary healthcare or mental health services, it is essential to specify which symptoms or which diagnoses are to be studied. Having consistency in diagnosis has been made much easier through the development of the diagnostic criteria now in wide international use.

The first of these is the International Classification of Diseases (10th Revision) (ICD-10) with its Classification of Mental and Behavioural Disorders. This comes in two mutually complementary presentations: the Clinical Descriptions and Diagnostic Guidelines,(20) and the Diagnostic Criteria for Research.(21> These sets of diagnostic criteria have been prepared after wide consultation with expert psychiatrists in some 40 countries. They therefore represent an international consensus. Furthermore, the Diagnostic Criteria for Research have been used as the basis for diagnostic instruments that have computer algorithms to apply these criteria, precisely and invariably, to the information obtained at interview (see below).

Another system is the Diagnostic and Statistical Manual, 4th edition (DSM-IV) of the American Psychiatric Association.(22) This is a national system that is used throughout the United States and quite widely elsewhere. Through a process of extensive consultation between the World Health Organization and the architects of DSM-IV, it is closely similar to ICD-10. These two sets of diagnostic criteria have brought a common language to clinical practice and to research. When authors now submit a paper to a reputable scientific journal, it is virtually mandatory that the disorders investigated be according to one or both systems.

These classifications are described further in ChapteLLll

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