ABSTRACTS - World Psychiatric Association

services other than health; the question of how best to prevent the
abuse of the classification of mental disorders; and many others. We
present these and other issues and problems and describe what has
been done to resolve them.
US8.2.
TOWARDS MENTAL AND BEHAVIOURAL
DISORDERS IN ICD-11: WHO´S VISION AND PLANS
S. Saxena, G.M. Reed
Department of Mental Health and Substance Abuse,
World Health Organization, Geneva, Switzerland
The World Health Organization (WHO) is revising the International
Statistical Classification of Diseases and Related Health Problems
(ICD-10), accepted by the World Health Assembly in 1990. The inclusion
of mental disorders alongside other diagnostic entities is an
important feature of the ICD, facilitating the search for related mechanisms
of etiology, pathophysiology, and comorbidity, and providing
a basis for parity of mental disorders in clinical, administrative, and
financial policies and functions in health care. Over the past two
decades, research in genetics, neuroscience, epidemiology, and cognitive
and behavioural sciences has made critical advances in understanding
the nature and treatment of mental disorders. The revision of
ICD-10 Chapter V: Mental and Behavioural Disorders must use this
new knowledge to address systemic limitations. At the same time, the
classification must be responsive to WHO’s public health mission and
its three core constituencies: member states, multidisciplinary health
professionals, and users of mental health services. The revision
process is focusing attention on usability and usefulness of the classification
within primary health care settings, where the vast majority of
all care for people with mental disorders is provided. The simultaneous
requirements of scientific validity and clinical utility have led
WHO to establish a multidisciplinary revision process that focuses on
global scientific evidence, worldwide clinical utility, and cross-cultural
applicability. A web-based revision platform for receiving suggestions
is functioning and plans for field trial are being developed. The
ICD revision is also being harmonized with DSM revision being
undertaken simultaneously by the American Psychiatric Association.
US8.3.
ON THE ROAD TO DSM-V AND ICD-11
D.J. Kupfer
Department of Psychiatry, University of Pittsburgh School
of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh,
PA, USA
Many scientific and methodological advances made in the last two
decades could play an important role in the DSM-V and ICD-11. In
order to facilitate their inclusion in the next nomenclature, a research
agenda developed in concert with the American Psychiatric Association,
National Institutes of Health, and World Health Organization is
providing new approaches and stimulating the empirical research
toward that end. The goals of this effort include: a) ensuring greater
clinical utility and relevance; b) utilizing a developmental approach
across the life span; c) incorporating new knowledge from the neurosciences
and the behavioral sciences in elucidating risk factors and
prodromal features of disorders; and 4) adopting methodological
strategies utilizing both dimensional and categorical approaches. We
provide a brief review of the recommendations developed from the
thirteen international planning conferences held between 2003 and
2008. As the Task Force for DSM and specific disorder Workgroups
begin their activities, specific cross-cutting issues are being addressed.
These issues include the following topics: a) life span developmental
approaches; b) diagnostic spectra; c) psychiatric/general medical
interface; and d) gender and cross-cultural expression. Other important
concepts and strategies for alignment with ICD-11 activities will
also be discussed that seek to promote international collaboration
among members of the scientific and clinical communities.
US9.
GENDER-RELATED ISSUES IN PSYCHIATRIC
TREATMENTS
US9.1.
TREATMENT OF DEPRESSION
IN PERIMENOPAUSAL WOMEN
D.E. Stewart
University Health Network, University of Toronto, Canada
Depression is approximately twice as common in women between the
ages of puberty and menopause as in men. Although most epidemiologic
studies do not show a spike in depression rates in women at
midlife, it is now evident that certain women are at greater risk of
depression during perimenopause (the transitional years). Risk factors
for depression in perimenopause include previous depression, premenstrual
dysphoric disorder and possibly postnatal depression and
rapid hormonal changes. The menopausal transitional stages have
been defined by STRAW (Stages of Reproductive Aging in Women).
The associated physical, psychological (including mood and anxiety)
and cognitive symptoms of perimenopause have multifactorial etiologies,
including biological, hormonal and psychosocial cultural factors.
Biologic mechanisms for the symptoms of perimenopause include
ovarian aging and subsequent reductions in estradiol. Theories on the
pathophysiology of thermoregulation and its dysfunction are changing.
The effects of neuromodulators on the hypothalamus and other parts
of the central nervous system play a major role in psychological symptoms.
The effects of estrogen on the serotonergic and noradrenergic
systems and the resulting effects on mood and anxiety during perimenopause
are greater when changes occur rapidly. The socio-cultural
context of the menopausal transition and aging are backdrops of all
biological mechanisms and should not be overlooked. Recommendations
for the assessment and management of depressive symptoms and
depression during perimenopause will be based on recent studies. In
summary, antidepressants and evidence based psychotherapies remain
the treatments of choice, but estradiol supplementation may be efficacious
in perimenopausal women with treatment resistant depression.
US9.2.
TREATING A WOMAN WITH AN UNWANTED
PREGNANCY
N.L. Stotland
Rush Medical Center, Chicago, IL, USA
Helping women making decisions about problem pregnancies
requires therapeutic neutrality and a personal review by the patient of
her values, religion, circumstances, and expectations. The psychiatrist
may have strong personal feelings about the suitability of a patient for
motherhood and must take care not to impose these on the patient.
Mental illness, in and of itself, is not a contraindication to parenting,
but may call for specialized social supports. Should a patient contemplate
terminating the pregnancy, it is important to counter widely
held public misconceptions, and inform her that negative physical
and psychological sequelae of abortion are far less common than
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