Dementia and the International Classification of Diseases-11 (Beta Version)
| Autor: | K. S. Jacob, GPrasad Rao, Mukesh Jagiwala, TS Sathyanarayana Rao, AjitV Bhide, M. S. V. K. Raju, Gautam Saha, KS Shaji |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Neurology Population Coding (therapy) medicine.disease Mental health 03 medical and health sciences Psychiatry and Mental health 0302 clinical medicine Etiology medicine Dementia Delirium 030212 general & internal medicine Editorial 1 medicine.symptom Psychology education Psychiatry 030217 neurology & neurosurgery Reimbursement Clinical psychology |
| Zdroj: | Indian Journal of Psychiatry |
| ISSN: | 0019-5545 |
| Popis: | Byline: T. Sathyanarayana Rao, K. Jacob, K. Shaji, M. S. V. K. Raju, Ajit. Bhide, G. Rao, Gautam. Saha, Mukesh. Jagiwala The World Health Organization (WHO) recently uploaded the International Classification of Diseases-11 (ICD-11)(beta version) on its website.[sup][1] The draft had a major shock for the mental health and psychiatric community. The ICD-11 version has moved the syndromal diagnosis of dementia from the chapter on mental and behavioral disorders to the chapter on diseases of the nervous systems. The sudden and unexpected change in the WHO's position on diagnosis and coding was a clear departure from its previously stated position on the subject and its previous classifications. The new scheme is a sharp deviation from the long-standing consensus and approach employed by the WHO and international psychiatry. Many national and international psychiatric associations, including the Indian Psychiatric Society, have sent their serious concerns and arguments against the move. This editorial highlights the arguments and position of the Indian Psychiatric Society. The earlier beta versions of the ICD-11 and that of the ICD-10[sup][2] and the Diagnostic and Statistical Manual-5[sup][3] included syndromal codes for dementia and its associated behavioral and psychological symptoms under the chapter on mental and behavioral disorders with diagnosis of dementia with specific neurological etiologies included in the chapter on diseases of the nervous system. The current approach suggested in the latest beta version of ICD-11 is problematic for psychiatrists, particularly for those working in low-resource settings in India and low- and middle-income countries (LMICs) for the following reasons: The general population in many LMICs often consider cognitive impairment and decline in older people as part of normal aging.[sup][4],[5] Consequently, the majority of people who are brought to medical attention have behavioral psychological symptoms of dementia and consult psychiatrists and mental health workers, only when their relatives have behavioral and psychological problems associated with dementia. The removal of syndromal codes for dementia and its associated behavioral and psychological symptoms is problematic as psychiatrists and mental health professional play a crucial role in the management of majority of people with dementia in LMICs.[sup][6] The suggested system is clearly disadvantages for clinical care. The shortage of neurology specialists and their limited expertise in managing behavioral and psychological symptoms does not help. The neurologists could always use specific codes for dementia in the ICD-10, and a similar system can be continued in the ICD-11. The diagnostic facilities and resources in LMICs may not always allow for elucidating specific etiologic diagnosis/categories of dementia, and so the syndromal approach is useful and should be retained in the chapter of mental and behavioral disorder, while specific dementias are listed in the chapter on diseases of the nervous system. This new approach is inconsistent with the fact that behavioral disorders secondary to general medical conditions are included in the chapter on mental and behavioral disorders in the beta version of ICD-11.[sup][1] Behavioral disorders secondary to endocrine, cardiovascular, infectious disease, and a diagnosis of delirium have codes in the chapter on mental and behavioral disorders. For example, delusional, psychotic, and depressive disorders secondary to general medical conditions continue to have codes in the chapter on mental and behavioral disorders. The current beta version goes against the explicit aims of the WHO and the American Psychiatric Association's Diagnostic and Statistical Manual-5's attempt harmonization of the two approaches. The new approach will also create problems related to insurance reimbursement for psychiatrists working in LMICs as insurance companies may insist on a neurologist's assessment, if syndromal codes for dementia are exclusively in the chapter on diseases of the nervous system. … |
| Databáze: | OpenAIRE |
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