Psychiatric Diagnosis and Classification - ResearchGate

224 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
Table
9.1. Predicted prevalence of ICD-10 mental disorders among consecutive attenders
in 15 centers, showing proportion recognized by physicians in 4 centers after UÈ stuÈ n
and Sartorius [10])
ICD-10 diagnosis
Predicted prevalence
%) 15 centers)
Proportion detected by
physicians %)
4 centers) a
Current depression 10.4 60.5
Generalized anxiety
7.9 50.1
disorder
Neurasthenia chronic
5.4 61.1
fatigue)
Harmful use of alcohol 3.3 9.6
Alcohol dependence 2.7 66.6
Somatization disorder 2.7 64.4
Dysthymia 2.1 73.5
Agoraphobia 1.5 65.7
Panic disorder 1.1 59.2
Hypochondriasis 0.8 73.1
Proportion with at least one
diagnosis
24.0 58.8
The 15 centers were Ankara, Athens, Bangalore, Berlin, Groningen, Ibadan, Mainz, Manchester,
Nagasaki, Paris, Rio de Janeiro, Santiago de Chile, Seattle, Shanghai and Verona.
a These 4 centers Manchester, Seattle, Verona and Bangalore) had somewhat better detection
rates than all 15.
classification of psychological disorders presenting in primary care. We
focus on symptoms and disorders most commonly encountered in primary
care: anxiety, depression, and unexplained somatic symptoms.
Across different health care systems, primary health providers may range
from physicians with specialist qualifications internists or pediatricians) to
paraprofessionals with quite limited training. Even in developed countries,
physicians may delegate recognition and assessment of psychological disorders
to nurses or other clinical staff. A practical primary care classification
system should be appropriate for use by a wide range of health care
providers. As discussed below, the ICD-10 primary care taxonomy is actually
a family of classifications for use by a range of health care providers
a more complexsystem for physicians and a simplified system for nonprofessional
or paraprofessional providers). Two primary care modifications
of the DSM system also discussed below) have been adapted for use
by primary care nursing staff.
A classification of mental disorders should both consider the realities of
current primary care practice and direct attention toward important shortcomings.
In other words, an appropriate classification system must remain
relevant and accessible to primary care providers while emphasizing areas
of need for more specific diagnosis and management. Like any good educa-