The family of documents connected to Chapter V F

Chapter V of ICD-10 is not just a catalogue of disorders for statistical purposes, but is also a clinical manual, a textbook of diagnoses, and an instrument for research for different users. Therefore a group of texts had to be produced to serve the various purposes—the so-called 'family of documents'. (38>

The Short Glossary of ICD-10, Chapter V (F) is part of the basic work known as the International Statistical Classification of Diseases and Related Health Problems.(39) The Short Glossary is part of the first of three volumes, the general systematic classification, and gives short definitions which are useful not only for medical personnel but also for statisticians, health insurance clerks, and others who are not in medical or related professions.

The Clinical Descriptions and Diagnostic Guidelines (CDDG Version), the so-called Blue Book, was developed first and can be regarded as the central part of the psychiatric classification (37> intended for use by psychiatric clinicians in their daily practice. An extensive description of each disorder is followed by criteria for diagnosis together with inclusion and exclusion terms.

The Diagnostic Criteria for Research (DCR), the so-called Green Book, were developed for scientific use. (49 A number of rather restrictive criteria are given for every disorder so as to facilitate the selection of groups of individuals whose symptoms resemble each other. The research criteria should be used together with the diagnostic guidelines. Compared with the Blue Book the symptom criteria are more clearly defined, the time criteria are stricter, and the inclusion and exclusion criteria are more precise. Thus many unclear cases which are unsuitable for research are excluded. However, despite its title, this book is also useful for diagnosticians in clinical practice. Its combination with the Short Glossary, published as the Pocket Gu/'de,(41> is useful.

The multiaxial version of the ICD-10 classification of mental disorders allows different aspects of the patient's health and social situation to be assessed. Several attempts have been made to broaden the diagnostic view by consideration of additional aspects, for example Kretschmer's multidimensional diagnosis (42> or, much later, the multiaxial system of Essen-M6ller(43> who proposed coding the clinical picture and aetiology on different axes. Introduced by Rutter et al.,(44> multiaxial diagnosis has been employed for many years in child and adolescent psychiatry. It contains clinical syndromes, problems of development, intelligence, somatic disorders, and psychosocial problems. In adult psychiatry many attempts were undertaken to initiate a multiaxial system. Some of these are associated with a multiaxial system of ICD-10 (MAS) which was developed independently after the main part of the classification was finished.

To a high degree the multiaxial version of ICD-10 is comparable with that of DSM-IV. However, in DSM-IV, axis I is for psychiatric clinical disorders, axis II is for personality disorders and mental retardation, and axis III is for general medical conditions. In ICD-10, axis I includes all three groups. Thus psychiatric disorders (F1-F5), personality disorders (F6) and mental retardation (F7), and the chapters on somatic comorbidity all use one axis.

Axis II of ICD-10 is for disability. To facilitate its use, WHO developed an instrument, the short disability assessment schedule ( WHO DAS-S), which helps to describe and assess the consequences of axis I disorders.(45) Axis II corresponds to the widely used DSM-IV axis V, Global Assessment of Functioning (GAF). In connection with the disability axis, the International Classification of Impairments, Disabilities and Handicaps ( ICIDH),(46) created by WHO for the whole of rehabilitative medicine, of which psychiatry is only a part, should be mentioned. At the time of writing, a new version of this classification ( ICIDH-II) is being tested in field trials.(47) It uses a more positive approach, replacing disabilities by activities and handicaps by participation.

Axis III of ICD-10 covers psychosocial and other problems and corresponds to DSM-IV axis IV (psychosocial and environmental problems).

The primary health care (PHC) version of the ICD-10 classification of mental disorders (48> was constructed because of the great importance of psychiatric disorders in general practice, for example the high prevalence of depressions, anxiety disorders, and dependence on alcohol and psychotropic drugs. (48) There are 24 syndromes, including dementia, delirium, depression, etc. Each disorder is understood in a rather broad sense, and not subdivided, and the descriptions are simpler than those in the main classification. A flipcard containing symptoms, diagnostic criteria, differential diagnoses, and counselling and treatment of the patient and the family is provided for every syndrome.

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