Psychiatric Diagnosis and Classification - ResearchGate

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