Byline: Abid. Choudry, Saeed. Farooq
The two main classification systems, International Classification of disease (ICD) and diagnostic and statistical manual (DSM) have recently been revised. The revision of DSM-IV by the American Psychiatric Association is complete and DSM-5 has already arrived. The draft ICD-11 diagnostic guidelines for mental disorders are nearly complete and will soon be published as ICD-11. In this article we will briefly discuss the challenges in classifying psychotic disorders, the revised classification of these disorders in ICD-11 and how this differs from ICD-10 and DSM-5. Several changes to the classification of schizophrenia and other psychotic disorders have been made to increase the reliability, clinical use and validity of the diagnostic classification which are considered here.
The two main classification systems, i.e., international classification of disease (ICD) and diagnostic and statistical manual (DSM) have recently been revised. The DSM-5 has already arrived, while the draft ICD-11 diagnostic guidelines for mental disorders are nearly complete. In this article, we will briefly discuss the challenges in classifying psychotic disorders, the revised classification of these disorders in ICD-11, and how this differs from ICD-10 and DSM-5.
There are number of challenges in the classification of psychiatric disorders, and classifying psychosis epitomizes these challenges. The nomenclature of the core category of schizophrenia is itself not universally acceptable. The Japanese classification has already renamed schizophrenia as 'integration disorder.' Translation of the word 'schizophrenia' to Japanese 'seishin-bunretsu-byo' means 'mind-split-disease.' The new term to replace schizophrenia 'togo shitchosho,' which means 'integration disorder,' is considered more positive for users and carers. Whether changing the name of a diagnostic concept will have any effect on the stigma remains to be seen, but it highlights the challenges associated with the classification of psychiatric disorders.
Psychosis is a clinical syndrome, not a nosological entity. The term 'psychosis' has been used for about 170 years and still seems to serve a useful function as it is retained in the draft ICD-11 as well as DSM-5. The clinical syndrome is characterized by several 'psychotic' symptoms such as delusions and hallucinations and lack of insight; however, a clearly operationalized definition of the term 'psychosis' is still lacking.
Issues Regarding Psychosis and Related Disorders in International Classification of Disease-10
The current construct of schizophrenia is derived from Kraepelin's formulation of dementia praecox in the late 19th century. Definitions of schizophrenia included in ICD-10 and DSM-IV are based on the Kraepelinian dichotomy focusing on its chronic course. Gradually, pathophysiological and etiological factors relevant to schizophrenia have become clearer.,
The classical subtypes of schizophrenia provided a poor description of its heterogeneity with only the paranoid and undifferentiated subtypes being used more frequently, in clinical practice; further, their longitudinal stability was found to be low. Moreover, the ICD-10 construct of schizophrenia was criticized for not adequately describing major psychopathological dimensions of the condition. The DSM-5 as well as draft ICD-11 have replaced subtypes of schizophrenia with dimensional classification.
In ICD-10, the boundaries between schizophrenia, schizoaffective disorder, and mood disorder were not clearly differentiated. This could...