Psychiatric Diagnosis and Classification - ResearchGate
Psychiatric Diagnosis and Classification - ResearchGate
Psychiatric Diagnosis and Classification - ResearchGate
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220 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION<br />
APPROACHES TO CLASSIFICATION OF MENTAL<br />
DISORDERS IN PRIMARY CARE<br />
<strong>Classification</strong>s Produced by General Practitioners<br />
The WONCA System ICHPPC-2)<br />
General practitioners GPs) have produced a simplified version of the<br />
WONCA system, but this has troubles of its own, since the 21 conditions<br />
recognized are sometimes over-inclusive, <strong>and</strong> at other times do not allow<br />
recognition of important syndromes [2]. For example, dementia <strong>and</strong> delirium<br />
are included together as ``organic psychoses'', <strong>and</strong> all childhood disorders<br />
are grouped together; while chronic neurosis, fatigue syndromes,<br />
<strong>and</strong> even chronic psychosis are nowhere to be found.<br />
The designers of ICHPPC-2 were clearly correct to focus their classification<br />
on a couple of dozen disorders that are commonly encountered in<br />
primary care, but it seems likely that the borders between the various<br />
disorders could be drawn in a more useful way, <strong>and</strong> it would be of great<br />
importance to ensure that primary care workers were given assistance in<br />
recognizing disorders for which there are treatments.<br />
The Read Codes<br />
An alternative approach in the United Kingdom is to use the Read codes. This<br />
is a system derived from computerized records in the doctor's office, <strong>and</strong> is<br />
used for central data collection within the National Health Service concerned<br />
with all morbidity, including psychological. Since many consultations in<br />
primary care do not result in a firm diagnosis, it is a classification of: a)<br />
complaints e.g. ``tearful'', ``loss of confidence'', ``worried'', ``tired all the<br />
time''); b) abnormalities noticed by the doctor e.g. ``disoriented'', ``flight of<br />
ideas'', ``poor insight into neurotic condition''); c) circumstances surrounding<br />
the consultation e.g. ``life crisis'', ``marital problems''); d) investigations<br />
e.g. ``depression screen'', ``psychological testing''); e) treatment given or<br />
stopped e.g. ``lithium stopped'', ``grieving counseling''); f) referral decisions<br />
e.g. ``refer to counselor'', ``refer to psychologist'') <strong>and</strong>, finally, g)<br />
diagnosis where one is known e.g. ``alcoholic psychosis'', ``schizophrenic<br />
psychosis'') [3]. The system allows [11] diagnoses corresponding to the ICD-<br />
10, all relating to organic psychoses <strong>and</strong> psychotic illnesses, as well as codes<br />
for non-psychotic conditions e.g. anorexia nervosa, drug dependency) <strong>and</strong><br />
quasi-diagnostic terms e.g. attempted suicide, emotional problem).<br />
With such logical heterogeneity, <strong>and</strong> so little help in deciding which code<br />
to use, it is hardly surprising that there is great variation between practices