Psychiatric Diagnosis and Classification - ResearchGate

228 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
to medical illness or prescribed medication. Such an ``either±or'' view can
lead primary care physicians to overlook important opportunities for treatment.
In some primary care surveys, presence of a chronic medical illness
has been associated with decreased likelihood that anxiety or depressive
disorders will be recognized.
ADAPTING PSYCHIATRISTS' CLASSIFICATIONS TO THE
NEEDS OF PRIMARY CARE
The Special Version of the Mental Disorders Section of
ICD-10 for Use in Primary Care ICD-10-PHC)
The tenth revision of the ICD has some important differences from its
predecessor where mental disorders are concerned. The traditional dichotomy
between ``psychosis'' and ``neurosis'' is no longer recognized; the user
is provided with clear diagnostic criteria for use in research projects; and
special versions of the classification are available for use in specialized
settings.
The ICD-10-PHC classification [22] is unusual in a number of important
respects. It is user-friendly, consisting of about 26 rather than 440 different
disorders; it gives clear advice about probable presenting complaints and
the differential diagnosis of such complaints; and, most important of all, it
gives clear advice about the management of each disorder. The set of
disorders found useful in one country may well be different from that
found useful in another, and each country is allowed to make its own
selection of disorders to be adopted. It may not be necessary to include
eating disorders in India, or conversion hysteria in Scandinavia. However,
most of the disorders will be common to all countries, and the categories
will correspond broadly to those recognized by the more detailed ICD-10
used by psychiatrists [23]. The ICD-10-PHC classification is not simply a
condensed version of the larger classification system for specialists. It is a
separate system created for primary care, but designed to be compatible
with the classification system used by specialists.
The classification is accompanied by a choice of other supporting materials:
a glossary giving definitions of all technical terms used; advice on the
way in which psychological inquiries should be fitted into the course of the
usual medical consultation, and the circumstances which should act as
``triggers'' for the GP to focus upon psychological adjustment; and a diagnostic
flow chart showing how the various diagnoses logically relate to
one another. The conditions which have been suggested for inclusion in
ICD-10-PHC are shown in Table 9.2.