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Correspondence between Stephen Ralph and Dr Charles Shepherd

Posted by meagenda on November 6, 2009

Correspondence between Stephen Ralph and Dr Charles Shepherd

WordPress Shortlink: http://wp.me/p5foE-2jm

The opinion piece below, which includes extracts from recent correspondence with Dr Charles Shepherd is authored and published by Stephen Ralph; the views and opinions expressed are the views and opinions of Mr Ralph and any comments or queries resulting out of this opinion piece should be addressed to Mr Ralph and not to ME agenda.

Stephen Ralph maintains a website at  www.meactionuk.org.uk 

Dr Charles Shepherd is an Honorary Medical Advisor and a Trustee/Director of the ME Association http://www.meassociation.org.uk/

A copy of the statement which Stephen Ralph quotes from is here:

 XMRV and ME/CFS: WHAT DO WE KNOW SO FAR? AND WHAT DON’T WE KNOW? (VERSION 3) (04.11.09)  http://wp.me/p5foE-2kq

—————–

By Stephen Ralph  ME Action UK

Permission to Repost

06 November 2009

Like many of you, I was alarmed when I read the recent MEA XMRV Statement No.3 particularly because of one telling sentence.

I decided to ask Dr Shepherd a series of questions and although I had several answers, I had no answer at all to one important question that I asked several times.

I asked Dr Shepherd about this statement.

“Demonstrating a link between a retrovirus and ME/CFS does not, by itself, resolve the physical vs psychological debate.

Research studies have demonstrated links between retroviruses and diseases as diverse as autoimmune disorders (which could be relevant to ME/CFS), immunodeficiency diseases, multiple sclerosis, tumours, anaemias and even schizophrenia.”

In reply I got the following from Dr Shepherd.

“I don’t think this comment will have any effect whatsoever on psychiatry.

Psychiatrists already know that viruses and psychiatric illness can sometimes be linked.

I put this info into version 3 because some people are wrongly assuming that having a viral link in an illness means that it must be physical rather than psychological. And that the physical vs psychological battle in ME/CFS is now almost over. I only wish…..

Retroviruses may be involved in schizophrenia and it is being said the up to 40% of people with autism have XMRV.”

I then asked Dr Shepherd what he would do if he found he was XMRV negative and how this might impact on his judgment.

In reply I had the following from Dr Shepherd…

“I don’t know my XMRV status. I obviously could have access to XMRV testing facilities. But as knowing my XMRV result isn’t going to affect either my diagnosis of ME or the management of my illness at this stage I don’t see any point in being tested.”

Lastly, I asked Dr Shepherd if he did or did not support the views of Professors Simon Wessely, Michael Sharpe and Peter White.

I asked this question twice for the sake of clarification.

Dr Shepherd has decided not to answer that question.

I asked the question because on numerous occasions the MEA have released hedge betting, sitting-on-the-fence statements or cheek turning Statements that effectively support the agenda of Somatoform Psychiatry or completely ignore the agenda of Somatoform Psychiatry.

The statement regarding XMRV not ending the debate on mental v physical is for my eyes indicating that yet again the MEA and Dr Shepherd are entertaining the possibility that Wessely White and Sharpe are right.

Dr Shepherd – you should be actively ending the involvement of Professors Wessely, White and Sharpe and you should be representing the total “State of Science” from across the Atlantic as is the case with the ESME – see their website for example…

http://esme-eu.com/news/category7.html

…instead of selectively picking what you want to feed your members and back peddling on the profound implications of XMRV and what was said at the CFSAC last week.

As we all know, the liaison faction of psychiatry firmly and militantly assert that CFS is a functional psychosomatic syndrome and that ME does not exist at all.

We know that the likes of Wessely, White and Sharpe are trying to get CFS into the next edition of the DSM – DSM-V and reclassified in ICD-11.

Both Action for ME and the ME Association are doing nothing to stop this agenda.

I asked Dr Shepherd some time ago if he or the MEA were going to do anything about the CSSID DSM-V ICD-11 agenda and Dr Shepherd said he was too busy and it wasn’t on his list of things to do.

In my view, the ME Association is not a lot more than the Public Relations arm of Action for ME.

Yes they seem approachable and yes they seem to press all the buttons that please some of their members.

But as soon as you ask anything considered “controversial” or important – then Dr Shepherd and/or the MEA goes silent and refuses to answer the question as is the case by default with Action for ME.

It seems to me that here in the UK and for many years, the ME population are being held hostage by the mental health movement who seem to have castrated both Action for ME and the ME Association who between them dominate the arena yet lay silent and do nothing to counter the mental health agenda…

So it seems to me that neither charity actually give a damn about the concerns of the ME community unless those views accord with their agenda that they will not discuss when challenged in ANY detail.

They say the devil is in the detail but we do not know what the detail is because when we ask we get nothing back.

Under these circumstances we need those over in the USA and those in the UK with Independence of mind and purposes such as ME Research UK, the 25% ME Group and Invest in ME – to come to the rescue of the UK ME patient population.

If people are not happy with this e-mail I have written and you think I am being unfair then you should ask Dr Shepherd and the MEA yourselves and get the answers he would not give to me or the many others who have asked similar questions over the years that never get answered.

Why does the MEA turn the other cheek and choose not to robustly challenge the views of Professor Wessely and his colleagues and instead state that “they already know” so that these individuals are therefore beyond challenging…

How exactly does liaison psychiatry “already know” that retro-viruses cause mental illness and does the MEA believe that XMRV potentially causes functional mental illness in people with ME? If not then why stay silent – creating a space for the opposition to occupy.

Why does the MEA put out neutered statements that reflect the views of liaison psychiatry instead of using all the evidence available to robustly and technically challenge those views?

Why is the ME Association calling for the use of the CDC Fukuda Criteria in UK XMRV research when the Fukuda criteria has been and is still being exploited by Wessely et al due to its well known ability to produce a heterogeneous patient group and therefore research results that are by default inconclusive and “mixed” and challengeable by those with a mental health agenda?

Why does the ME Association not firmly call for the use the Canadian criteria or use both Fukuda and the Canadian criteria in parallel research to make the research outcomes more meaningful and less open to exploitative deconstruction when the ME Association at one time adopted the Canadian Criteria by a democratic vote and then quietly swept that democratic vote under their carpet?

This is all about accountability. We should be given full answers to all of the above questions.

What is wrong in asking?  Why does that make us bad?

Yours sincerely,

Stephen Ralph

www.meactionuk.org.uk

Posted in AfME, Action for M.E., CBT/GET, CFS Clinics, CFS Research, CFS in the media, CFSAC, CISSD Project, Canadian Criteria, Criticism of DSM-V, ICD revision process, ICD-11, Institute of Psychiatry, ME Association, ME Research, ME in journals, ME in the media, Professor Peter White, Simon Wessely, WHO (World Health Organization), XMRV, XMRV Retrovirus | Comments Off

Action for M.E. and Facebook; CISSD Final Report finally published

Posted by meagenda on October 30, 2009

Action for M.E. and Facebook; CISSD Final Report finally published

WordPress Shortlink: http://wp.me/p5foE-2gi

Action for M.E. maintains a Facebook site at: http://www.facebook.com/actionforme

Over the past few weeks, questions and criticism around Action for M.E.’s governance, the way in which it relates to its membership, its policies and operation and its relationship with government have been raised by various users on its Facebook “Wall”.

Action for M.E. has chosen not to respond to these questions individually, on the Wall, itself, but by issuing a set of responses in a PDF document. The first document was this one: Facebook responses 20.10.09

A second, updated, set of responses was issued yesterday. It’s not clear whether these responses have been compiled by Action for M.E.’s new Policy Manager or by another member of staff, as the document is unsigned, but it’s interesting to see how the organisation has fielded these questions and concerns.

[To clarify - none of the questions for which responses were provided had been raised by me. I prefer to liaise directly with organisations for information, documents or for policy and position statements or, where applicable, obtain information via the Freedom of Information Act.]

Action for M.E. is becoming rather discomforted that its Facebook site is being used by some as a vehicle for raising political issues but you cannot take the politics out of ME. Users are already asking how the organisation intends to define “political”.

Those of us who were members, in 2003, of the joint charities’ message board “MEssage-UK” will recall how rapidly first Action for M.E., then AYME pulled out of this venture when faced with too many awkward questions; how the message board was then set for pre-moderation by the ME Association; how the moderator, Tony Britton, vetoed posts of a “political nature” without ever setting out how he was going to define what came under the heading of “political” and what did not; how the archives were sifted through for “contentious” messages by senior ME Association staff and then quietly excised without the authors being informed; how the board was closed down suddenly just days before the critical December 03 AGM in which Dr Shepherd was standing as a candidate in the Trustee elections…

When will our patient organisations learn that if they are going to place themselves on public platforms they first need to develop policies for the fielding of questions?

This latest set of responses can be opened in PDF format here:

PDF file: ONGOING FB Q and A document. 29.10.09

Answers to questions raised on the Action for M.E. facebook page, October 2009. Updated

or from Action for M.E’s website, here: http://tinyurl.com/ongoingFB-responses291009

—————-

One of the responses is for a question raised (note, not by me) around the CISSD Project, for which Action for M.E. had acted as principal administrators throughout the project’s life (2003 to 2007).

In response to this question, on Page 23:

Question: “What was your involvement in the CISSD project Conceptual Issues in Somatoform and Similar Disorders for which you received a grant of 67k and why was this project kept so secretive from your members? Only information about it was released when freedom of information act requests were made that pushed you in to a corner where you had to confirm you were involved in it. Was this CISSD project set up with the purpose as suggested by other sources with the intent to look at changing the ME/CFS ICD-10 coding* to that of a Somatoform disorder?”

Action for M.E prefaces its reply with, “As a charity, Action for M.E. is not obliged to answer questions under the Freedom of Information Act but provides information of its free will, as resources allow.”

I should like to clarify that the Freedom of Information requests submitted by me in relation to the CISSD Project had been submitted to the Institute of Psychiatry. Information resulting out of these requests under the FOIA is available here: http://meagenda.wordpress.com/dsm-v-directory/information-obtained-under-foi-act/

One of my requests to the Institute of Psychiatry had been for a copy of the December 2007 “CISSD Final Report” from Dr Richard Sykes to Action for M.E. I had suggested to the Institute of Psychiatry’s Legal Compliance Office that the report ought to be provided with a erratum note, by Dr Sykes, addressing a number of errors he had made in the document that had come to light in June 09, when an unauthorised copy of the text had been placed in the public domain.

Unfortunately, what the Institute of Psychiatry were provided with by Dr Sykes, in order to fulfil the request, is evidently an earlier draft of the December 2007 text. It is missing the Contents page, and there are other disparities between the text that I was provided with and the Final version. No erratum note had been attached, either.

However, as part of its response to the Facebook question, Action for M.E. has now elected to publish two files. The first is a copy of the December 2007 CISSD “Final Report” to Action for M.E., the second, a copy of the “Co-ordinator’s Report”, with a covering letter and summary.

Action for M.E. has finally put these documents in the public domain!

Open PDF files here:

CISSD project report 1

The CISSD Project and CFS/ME Report on the CISSD Project for Action for ME 

Conceptual Issues in Somatoform and Similar Disorders

Report to be read in conjunction with Co-ordinator’s Final Report

Richard Sykes December 2007

CISSD project report 2

Covering letter

The CISSD Project 2003-2007

(Conceptual Issues in Somatoform and Similar Disorders)

Summary

FINAL REPORT OF CO-ORDINATOR   Richard Sykes PhD, CQSW

or from Action for M.E’s website, here:

http://www.afme.org.uk/res/img/resources/CISSD%20project%20report%201.pdf
http://www.afme.org.uk/res/img/resources/CISSD%20project%20report%202.pdf

 

In August, Action for M.E. had published an article titled “Classification conundrum” on pages 16 and 17 of Issue 69 of its membership magazine, InterAction.

You can read a copy of the article here, in an ME agenda posting dated 25 August 2009:

“Action for M.E. stuffs the elephant back into the cupboard”

Note that although the Project had been initiated by Dr Richard Sykes, Dr Sykes does not appear to have contributed to this article – basically an apologia piece authored by Dr Derek Pheby.

In fact, Dr Sykes and his role as instigator and co-ordinator of the Project is not mentioned in the article at all. Nor is the Project’s source of funding – the charitable Trust run by Dr Sykes’ brother, Sir Hugh Sykes, a non-executive director of A4e, the largest European provider of Welfare to Work programmes. 

The December 2007 “Final Report” document has historical significance.  It also contains material (including an entire Appendix) which was omitted from the “CISSD Summary Report” that the ME Association published in June, this year, having negotiated with Dr Sykes for an article. (But having trumped Action for M.E., the MEA has made no comment whatsoever on the implications of the CISSD Project nor provided its membership with an analysis of the various papers and documents that came out of it.  Nor has the MEA made any comment or published any information on the progress of the ICD-10 and DSM revision processes for which the CISSD Project was initiated and has fed into.)

The document sets out Dr Sykes’ views, opinions and perceptions (and misperceptions) that had not previously been publicly available. It would have been appropriate for Action for M.E. to have negotiated with Dr Sykes for this document to have been published in 2007.  Instead, it kept the lid on this project –  a project that had been chaired by Professors Michael Sharpe and Kurt Kroenke and had involved many influential, international researchers and clinicians from the field of liaison psychiatry and psychosomatics – several of whom are now directly involved in the revision of the American Psychiatric Association’s DSM-IV.

In August, I called publicly on Action for M.E. to publish a copy of the CISSD “Final Report” on its website and to preface it with an erratum note addressing both the errors of coding within “Appendix B” of the document and also Dr Sykes’ misconception that “Chronic fatigue syndrome” does not appear in ICD-10.

Chronic fatigue syndrome is listed in the International Statistical Classification of Diseases and Related Health Problems: 10th Revision Version for 2006, Volume 3, the Alphabetical Index (ICD-10 Volume 3).

For the entry in question, see page 528, top right hand column:

http://www.scribd.com/doc/7350978/ICD10-2006-Alphabetical-Index-Volume-3

Since no erratum note has been published with these documents please be aware that where Dr Sykes has written “G33.3″ and “G33.4″ on Pages 12 and 13 of document:

http://www.afme.org.uk/res/img/resources/CISSD%20project%20report%201.pdf

this should read “G93.3″ and “G93.4″.

Why has Action for M.E. published these documents without negotiating with Dr Sykes for an Erratum?

Why did Action for M.E. not publish these documents in August to accompany the article in InterAction?

 

*There is no coding for “ME/CFS” in ICD-10. 
Postviral fatigue syndrome is classified in Chapter VI of ICD-10 Volume 1: The Tabular List at G93.3.
(Benign) myalgic encephalomyelitis is classified in Chapter VI of ICD-10 Volume 1: The Tabular List at G93.3.
Chronic fatigue syndrome is listed in ICD-10 Volume 3: The Alphabetical Index under G93.3.

—————–

Text version of December 2007 CISSD “Final Report” here: CISSD Final Report to AfME 2007

Text version of December 2007 CISSD “Co-ordinator’s Report” here: CISSD PROJECT Coordinators Final Report

June 2009 Summary Report on CISSD as published by the ME Association

The Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by DSM-V Work Group members, Joel Dimsdale and Francis Creed was published in the June issue of the Journal of Psychosomatic Research:

Free access to both text and PDF versions of this Editorial at: http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext

For detailed information on the proposed structure of ICD-11, the Content Model and operation of iCAT, the collaborative authoring platform through which the WHO will be revising ICD-10, please scrutinise key documents on the ICD-11 Revision Google site:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

For information around the DSM and ICD revision processes see DSM-V and ICD-11 Directory page: http://meagenda.wordpress.com/dsm-v-directory/

Posted in A4e, AfME, Action for M.E., CISSD Project, DSM revision process, Elephant Series DSM-V, Freedom of Information, ICD revision process, ICD-11, MUPSS Project, NICE Judicial Review, PACE Trials, Professor Peter White, WHO (World Health Organization), WHO Collaborating Centre, WHO Somatisation Project, XMRV Retrovirus | Comments Off

Journal of Psychosomatic Research: In Press: Is there a better term than “Medically unexplained symptoms”?

Posted by meagenda on October 24, 2009

elephant3

Image | belgianchocolate | Creative Commons

Keywords

APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

The Elephant in the Room Series Three:

Journal of Psychosomatic Research In Press: Is there a better term than “Medically unexplained symptoms”?

WordPress Shortlink for this posting: http://wp.me/p5foE-2d6

24 October 2009

 

An In Press version of the Editorial: Is there a better term than “Medically unexplained symptoms”?, to be published in a forthcoming issue of the Journal of Psychosomatic Research, is already available online (purchase required). The Editorial needs to be read in conjunction with a white paper from:

The European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) http://www.eaclpp.org/

A white paper of the EACLPP Medically Unexplained Symptoms study group

Patients with medically unexplained symptoms and somatisation – a challenge for European health care systems  (Gillian.D.Dunkerley@manchester.ac.uk )

The White Paper can be downloaded from the EACLPP site here: http://www.eaclpp.org/working_groups.html

The document is approx 76 pages long, including tables and charts.  I had considerable difficulty opening this document, in May, due to a corrupted table and I note that the file on the EACLPP site is still glitchy. A copy of the document was therefore obtained directly from the EACLPP and can be opened by clicking the link below.  Note that there may have been revisions to the document as supplied on 19 May, but it will serve as reference for those who might also experience difficulties opening the file from the EACLPP website. If you would like a copy of the file sent to you as a Word.doc, email ME agenda with “EACLPP MUS DOC” in the subject line and I will forward a copy [600 KB].  The tables and charts are slow to load.

Draft – prepared by: Peter Henningsen and Francis Creed January 2009

EACLPP Working group on MUS version 16 Jan 2009

The current issue of the Journal of Psychosomatic Research is Volume 67, Issue 5, Pages A1-A4, 367-466 (November 2009)  http://www.sciencedirect.com/science/journal/00223999

Journal of Psychosomatic Research

In Press

Editorial
Is there a better term than “Medically unexplained symptoms”?

Abstract: http://tinyurl.com/jpsychoresMUS

doi:10.1016/j.jpsychores.2009.09.004

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Editorial

Francis Creed a, Elspeth Guthrie a, Per Fink b, Peter Henningsen c, Winfried Rief d, Michael Sharpe e and Peter White f

a University of Manchester, Manchester, UK 
b University Hospital Aarhus, Denmark
c Technical University, Munich Germany
d University of Marburg, Germany
e University of Edinburgh, UK
f Queen Mary University of London, UK

Received 24 August 2009; revised 24 August 2009; accepted 7 September 2009. Available online 17 October 2009.

Article Outline

Introduction

“Medically unexplained symptoms” – one advantage, but many reasons to discontinue use of the term

Criteria to judge the value of alternative terms for “medically unexplained symptoms”

Terms suggested as alternatives for “medically unexplained symptoms”

Implications for treatment

Implications for DSM-V and ICD-11

Conclusion

References

Note:

Francis Creed is Co-Editor of the Journal of Psychosomatic Research.

Francis Creed, Per Fink, Peter Henningsen and Winfried Rief were all members of the international CISSD Project, (Principal Administrators: Action for M.E.; Co-ordinator: Dr Richard Sykes. Dr Sykes is now engaged in the “London MUPSS Project” in association with the Institute of Psychiatry).

Michael Sharpe was UK Chair for the CISSD Project.

Michael Sharpe and Francis Creed have been members of the APA’s DSM-V Somatic Distress Disorders Work Group since 2007.

Francis Creed (UK), Peter Henningsen (Germany) and Per Fink (Denmark) are the co-ordinators of European EACLPP MUS Work Group.

Francis Creed and Peter Henningsen were the authors of “A white paper of the EACLPP Medically Unexplained Symptoms study group – Patients with medically unexplained symptoms and somatisation – a challenge for European health care systems”, January 2009.

Draft white paper here: http://www.eaclpp.org/working_groups.html

Per Fink is a member of the Danish Working Group on Chronic Fatigue Syndrome, established in August 2008 and expected to complete its work in spring 2009.

 

An Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by DSM-V Work Group members, Joel Dimsdale and Francis Creed on behalf of the DSM-V Workgroup on Somatic Symptom Disorders was published in the June 2009 issue of the Journal of Psychosomatic Research.

Full text of the June 2009 DSM-V SSD Work Group preliminary report can be accessed here:

http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext

See section: Psychological factor affecting general medical condition 

“…The conceptual framework that we propose will allow a diagnosis of somatic symptom disorder in addition to a general medical condition, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome…”

No updates or reports have been published on the APA’s website by DSM-V Task Force or Work Groups since brief reports issued in April 2009. DSM-V is anticipated to be finalised in May 2012 with field trials expected to start this October. No detailed Timeline for DSM-V is available.

Previous DSM Task Force chairs, Robert L Spitzer and Allen Frances, have been two of the most vocal critics of the current Task Force’s oversight of the revision process. Read their joint letter to the APA Board of Trustees here:  Letter to APA Board of Trustees July 09. In Dr Frances Responds to Dr Carpenter: A Sharp Difference of Opinion, Psychiatric Times, 9 July, Frances called for the posting of all the suggested wordings for DSM-V criteria sets well before considering field trials.

 

Javier Escobar, co-author of the Special Report: Unexplained Physical Symptoms: What’s a Psychiatrist to Do? Psychiatric Times, Aug 2008, was also a member of the Work Group for the “Conceptual Issues in Somatoform and Similar Disorders (CISSD) Project.

Javier Escobar is a member of the DSM-V Task Force, serves as a Task Force liaison to the Somatic Symptom Disorders Work Group and said to work closely with this work group.

http://www.psychiatrictimes.com/display/article/10168/1171223

01 August 2008
Psychiatric Times. Vol. 25 No. 9
Special Report

PSYCHIATRY AND MEDICAL ILLNESS
Unexplained Physical Symptoms What’s a Psychiatrist to Do?

Humberto Marin, MD and Javier I. Escobar, MD

According to Escobar and Marin:

“The list of somatoform disorders kept expanding with the addition of vague categories, such as “undifferentiated somatoform disorder” or “somatoform disorder NOS [not otherwise specified],” which, unfortunately, are the most common diagnoses within the somatoform genre. These terms failed to transcend specialty boundaries. Perhaps as a corollary of turf issues, general medicine and medical specialties started carving these syndromes with their own tools. The resulting list of “medicalized,” specialty-driven labels that continues to expand includes fibromyalgia, chronic fatigue syndome, multiple chemical sensitivity, and many others (Table 1).

Table 1

Functional somatic syndromes

Irritable bowel syndrome
Chronic fatigue syndrome
Fibromyalgia
Multiple chemical sensitivity
Nonspecific chest pain
Premenstrual disorder
Non-ulcer dyspepsia
Repetitive strain injury
Tension headache
Temporomandibular joint disorder
Atypical facial pain
Hyperventilation syndrome
Globus syndrome
Sick building syndrome
Chronic pelvic pain
Chronic whiplash syndrome
Chronic Lyme disease
Silicone breast implant effects
Candidiasis hypersensivity
Food allergy
Gulf War syndrome
Mitral valve prolapse
Hypoglycemia
Chronic low back pain
Dizziness
Interstitial cystitis
Tinnitus
Pseudoseizures
Insomnia
Systemic yeast infection
Total allergy syndrome”

These labels fall under the general category of functional somatic syndromes and seem more acceptable to patients because they may be perceived as less stigmatizing than psychiatric ones. However, using DSM criteria, virtually all these functional syndromes would fall into the somatoform disorders category given their phenomenology, unknown physical causes, absence of reliable markers, and the frequent coexistence of somatic and psychiatric symptoms.”

DSM-V and ICD-11 have committed as far as possible “to facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria” with the objective that “the WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.”

The International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders most recent meeting took place on 28 – 29 September. It is anticipated that a Summary Report of the meeting will be available in late November/December.

For detailed information on the proposed structure of ICD-11, the Content Model and operation of iCAT, the collaborative authoring platform through which the WHO will be revising ICD-10, please scrutinise key documents on the ICD-11 Revision Google site:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

For information around the DSM and ICD revision processes see DSM-V and ICD-11 Directory page: http://meagenda.wordpress.com/dsm-v-directory/

Posted in CBT, CBT/GET, CISSD Project, Criticism of DSM-V, DSM revision process, Elephant Series DSM-V, ICD revision process, ICD-11, Institute of Psychiatry, MUPSS Project, MUS, Professor Peter White, WHO (World Health Organization), WHO Collaborating Centre, WHO Somatisation Project | Comments Off

ICD Revision Advisory Groups: Mental and Behavioural Disorders and TAG Neurology

Posted by meagenda on October 2, 2009

Information on the new International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and the Topic Advisory Group (TAG) for Neurology

WordPress Shortlink for this posting: http://wp.me/p5foE-25M

The text below has been compiled using information provided by the Senior Project Officer, Department of Mental Health and Substance Abuse, WHO, Geneva, and is published with permission. The text may be reposted provided it is published unedited, in full and http://meagenda.wordpress.com is credited as the source.  

The International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders was constituted by the WHO for a period of two years (2007 – 2008) with the primary task of advising the WHO on all steps leading to the revision of the mental and behavioural disorders classification in ICD-10, in line with the overall ICD revision process.

The initial period of operation has now expired and the group has been reconstituted and reappointed for the next two year period. The appointment of the Harmonization Group and other working groups reporting to the Advisory Group has also now expired, and new working groups will be appointed based on the current needs of the revision.

The Advisory Group is co-ordinated by Senior Project Officer, Dr Geoffrey M Reed, PhD, who is seconded to the Department of Mental Health and Substance Abuse, WHO, Geneva, through the IUPsyS (International Union for Psychological Science). The Department of Mental Health and Substance Abuse will also be managing the technical part of the revision of Diseases of the Nervous System (currently Chapter VI), as it is doing for Chapter V.

The new Advisory Group expands and makes some changes to its composition in order to obtain better geographical representation and also based on the nature of the tasks of the next period of the revision process.

The members of the new International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders are:

Steven Hyman (Chair), Harvard University, Cambridge, Massachusetts, USA
José Luís Ayuso-Mateos, Universidad Autónoma de Madrid, Madrid, Spain
Alan Flisher, University of Cape Town, Rondebosch, South Africa
Wolfgang Gaebel, Heinrich-Heine University, Düsseldorf, Germany
Oye Gureje, University College Hospital, Ibadan, Nigeria
Assen Jablensky, University of Western Australia, Crawley, Australia
Brigitte Khoury, American University of Beirut Medical Center, Beirut, Lebanon
Anne Lovell, Institute National de la Santé et de la Recherche Médicale, Paris, France
Maria Elena Medina-Mora, Instituto Nacional de Psiquiatria Ramon de la Fuente, México, D.F., Mexico.
Afarin Rahimi, Tehran University of Medical Sciences, Tehran, Iran
Norman Sartorius, Geneva, Switzerland
Pratap Sharan, All India Institute of Medical Sciences, New Delhi, India
Pichet Udomratn, Prince Songkha University, Hat Yai, Thailand
Xiao Zeping, Shanghai Mental Health Center, Shanghai, China

The professional and scientific organisations that have been asked to appoint representatives to the International Advisory Group for Mental and Behavioural Disorders, and the names of their representatives, are:

International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP):
Per-anders Rydelius, Karolinska Institutet, Stockholm, Sweden

International Council of Nurses (ICN):
Tesfamicael Ghebrehiwet, International Council of Nurses, Geneva, Switzerland

International Federation of Social Workers (IFSW):
Dr Sabine Bährer- Kohler, Psychiatric University Clinic, Basel, Switzerland

International Union of Psychological Science (IUPsyS):
Ann D. Watts, Entabeni Hospital, Durban, South Africa

World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA):
Michael Klinkman, University of Michigan, Ann Arbor, Michigan, USA

World Psychiatric Association (WPA):
Mario Maj, University of Naples, Naples, Italy

All of these organisations were also represented on the previous Advisory Group with the exception of IACAPAP.

The first meeting of the reconstituted Advisory Group took place on 28 – 29 September 2009, in Geneva. There have been no other meetings since the December 2008 meeting of the former group. It is anticipated that a Summary Report of the meeting held last month, 28 – 29 September will be available within two months.

The report of the meeting held on 1 – 2 December 2008 can be read here: http://www.who.int/mental_health/evidence/icd_advisory_group_december_08_summary.pdf

—————–

Topic Advisory Group for Neurology

Lead WHO Secretariat for TAG Neurology is Dr Tarun Dua, Management of Mental and Brain Disorders, Department of Mental Health and Substance Abuse, WHO. Email: duat@who.int.

Dr Dua, a neurologist, co-ordinated the Atlas Multiple Sclerosis Resources in the World 2008, a collaboration between the World Health Organization and the Multiple Sclerosis International Federation and was a co-author of the World Health Organization publication, Neurological Disorders: Public Health Challenges, 2006 or download by chapters in PDF format at: http://www.who.int/mental_health/neurology/neurodiso/en/index.html

The members of the Topic Advisory Group (TAG) for Neurology are:

Raad Shakir (Chair), Imperial College London, London, UK
Donna Bergen, Rush University Medical Center, Chicago, Illinois, USA
Pierre Bill, Inkosi Ambert Luthuli Central Hospital, Durban, South Africa
Mandaville Gourie-Devi, Institute of Human Behaviour and Allied Sciences, New Delhi, India
Mitsuru Kawamua, School of Medicine, Showa University, Tokyo, Japan
Marco Medina, National Autonomos University of Honduras, Tegucigalpa, Honduras
Mohamad Mikati, American University of Beirut Medical Center, Beirut, Lebanon

The professional and scientific organisations that have been asked to appoint representatives to the Topic Advisory Group for Neurology, and the names of their representatives, are:

Alzheimer’s Disease International:
Murat Emre, Istanbul Faculty of Medicine, Istanbul, Turkey

International Brain Research Organization:
Krister Kristensson, Karolinska Institutet, Stockholm, Sweden

International Child Neurology Association
Marc Patterson, Mayo Clinic, Rochester, Minnesota, USA

International Headache Society:
Jes Olesen, University of Copenhagen, Copenhagen, Denmark

International League Against Epilepsy:
Ettore Beghi, Istituto “Mario Negri”, Milan, Italy

International Neuropsychological Society:
Andreas Monsch, University Hospital Basel, Basel, Switzerland

Movement Disorders Society:
Kapil D Sethi, Medical College of Georgia, Augusta, Georgia, USA

Multiple Sclerosis International Federation:
Alan J. Thompson, Director, National Hospital for Neurology & Neurosurgery, London, UK

World Federation of Neurosurgical Societies:
Marc Levivier, Centre Romand de Neurochirurgie, Lausanne, Switzerland

World Federation of Neurology:
Johan Aarli, University of Bergen, Bergen, Norway

World Stroke Organization:
Bo Norrving, Lund University, Lund, Sweden

1 October 2009

—————————–

Daily iCAMP YouTubes on the WHOICD11 Channel: http://www.youtube.com/user/WHOICD11

Transcripts of YouTube narrations on the ICD11 blog: http://whoicd11.blogspot.com/

For further information on the proposed structure of ICD-11, the Content Model and iCAT, the collaborative authoring platform the WHO will be using to revise ICD-10:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

Agenda for the 22 September – 2 October iCAMP Alpha Draft Training Meeting [MS Word]

Content Model Style Guide document [MS Word]

Morbidity Reference Group Discussion papers:
        ICD-11 rules, conventions and structure [MS Word]
        Revision topics for topic advisory groups [MS Word]

Content Model Blank document [Excel]

Content Model Myocardial infarction example document [Excel]

Content Model Hypertension Category example document [Excel]

ICD 11 Alpha Draft presentation by Dr B. Ustun [MS pptx slides]

Start-Up List presentation by Dr R. Jakob [MS pptx slides]

Myocardial infarction Content Model presentation [MS ppt slides]

[Note that some of these documents are "works in progress" and subject to ongoing review and revision.]

Posted in CISSD Project, DSM revision process, Elephant Series DSM-V, ICD revision process, ICD-11, WHO (World Health Organization), WHO Collaborating Centre, WHO Somatisation Project | Comments Off

The Elephant in the Room Series Three: Who’s watching the WHO?

Posted by meagenda on September 30, 2009

elephant3

Image | belgianchocolate | Creative Commons

Keywords

APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

The Elephant in the Room Series Three:

Who’s watching the WHO?

WordPress Shortlink for this posting: http://wp.me/p5foE-25h

30 September 2009

It’s now Week Two of the Geneva iCAMP Meeting to test iCAT – the multi-layered, wiki-like collaborative authoring platform that the WHO will be using to revise ICD-10. Are you watching the video reports?

The most important difference between ICD-10 and ICD-11 will be the Content Model:

“Population of the Content Model and the subsequent review process will serve as the foundation for the creation of the ICD-11. The Content Model identifies the basic characteristics needed to define any ICD category through use of multiple parameters (e.g. Body Systems, Body Parts, Signs and Symptoms, Diagnostic Findings, Causal Agents, Mechanisms, Temporal Patterns, Severity, Functional Impact, Treatment interventions, Diagnostic Rules).”

For the next edition of ICD, we’re unlikely to be looking at just a couple of lines in Chapter VI*, or whatever…

Daily iCAMP YouTubes are being posted on the WHOICD11 Channel. They’re all less than five minutes long and you can watch Days 1 to 6 here: http://www.youtube.com/user/WHOICD11 or on ME agenda here and here

For those with connections too slow for YouTube, transcripts of the narrations that intersperse the footage are being posted on the ICD11 blog, here: http://whoicd11.blogspot.com/

There are three more YouTube reports to come before iCAMP disperses.

The videos will give a feel for the potential extent of the Content Model and how the iCAT platform is intended to function as a multi-user, web-based authoring and review tool, through which alpha and beta drafts will be developed.

But for better understanding of the proposed structure of ICD-11 and the potential implications for the population of content, you really need to go here:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

Here you will find:

Minutes of the 3 – 7 August 2009 iCAMP Meeting, Geneva [MS Word]

Provisional List of Participants for 22 September – 2 October 2009 iCAMP Meeting [MS Word]

Participants’ CVs [MS Word]

Agenda for the 22 September – 2 October iCAMP Alpha Draft Training Meeting [MS Word]

Content Model Style Guide document [MS Word]

Morbidity Reference Group Discussion papers:
ICD-11 rules, conventions and structure [MS Word]
Revision topics for topic advisory groups [MS Word]

ICD11 Model Representation Comparison document [MHTML]

Content Model Blank document [Excel]

Content Model Myocardial infarction example document [Excel]

Content Model Urticaria example document [Excel]

Content Model Hypertension Category example document [Excel]

ICD 11 Alpha Draft presentation by Dr B. Ustun [MS pptx slides]

Start-Up List presentation by Dr R. Jakob [MS pptx slides]

iCAT Tool presentation by T. Tudorache [MS ppt slides]

Myocardial infarction Content Model presentation [MS ppt slides]

Workflow document [pdf]

and ancillary material.

[Note that some of these documents are "works in progress" and subject to ongoing review and revision, so you will need to monitor the site from time to time for revised and updated versions, which is why I've not given the file paths.]

[Note also, that those with Office 2003 installed may not be able to open the slides of two presentations produced using the more recent PowerPoint file format "pptx" and will need to download the free MS Office 2007 PowerPoint Viewer (pptx viewer) or in my case, in order to view the Robert Jakob Start-Up List presentation, the MS Office Compatibility Pack for Word, Excel, and PowerPoint 2007 File Formats.]

The ICD-11 alpha draft is planned for May 2010, the beta draft for May 2011 and the final draft expected to be submitted to WHA by 2014, for implementation in 2015.

The additional dimension of the concurrent DSM-V development process towards its own alpha draft, the ICD-DSM commitment to congruency and “harmonization” between the two systems and the involvement of DSM Task Force members in the Advisory Group for Mental and Behavioural Disorders needs to be borne in mind. The APA plans to publish DSM-V in May 2012, several years ahead of ICD-11.

We don’t have an ETA, yet, for the launch of iCAT.

“The starting point for the ICD-11 alpha draft will be the “Start-Up List” of categories which has been drafted by WHO/HQ to initiate the editing process. This list includes all the proposals received to revise the existing ICD as well as the input from ICD national modifications. During alpha drafting, detailed structured definitions will be added to these ICD categories according to a common model…”    Agenda, ICD-11 Alpha Draft Training Meeting

It’s not yet known whether other proposals that have relevance to the ME community have already been submitted for review, over and above those proposals evident from the ICD Update and Revision Platform; or what input coming from ICD national modifications, WHO affiliates or other sources may have significance for us. That is, we do not know what will be the starting point for the reviewing of those sections relevant to our patient community.

“The ICD-11 will be a collaboratively authored project, and many people will be submitting proposals for content, much like wikipedia. Unlike Wiki, however, the ICD will be peer reviewed with the TAGs serving as the editorial boards. The Managing Editor for each TAG…will collect, synthesize, and present the information for each proposal, and they are responsible for ensuring that the correct team of reviewers is selected…”

“The beauty of a collaborative authoring tool like the iCAT is that it allows the creation of the ICD-11 to draw on the expertise of anyone at anytime, anywhere in the world. After a proposal is created, the Managing Editor will serve as “postmaster”, ensuring that each proposal is complete and correctly formatted, as well as thoroughly supported, before forwarding the content proposal on to the specifically chosen team of independent peer reviewers. It is also the job of the Managing Editor to filter out or address those proposals which do not fulfill the necessary criteria.

“Those content proposals which receive the appropriate percentage of approvals by the peer reviewers will be passed along to the Topic Advisory Group for further review. The TAG is responsible for further evaluation of the content proposal and the supporting information provided. Each content proposal which reaches this stage may also require the review of other, parallel, TAGs, if the content of the proposal overlaps between multiple TAG areas. Each proposal which meets the exacting requirements of the TAG or TAGs will be passed along for further evaluation by the Revision Steering Group…”

The Summary of the December 2008 Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders reported that the Advisory Group for the Revision of Diseases of the Nervous System (that is TAG Neurology and Chapter VI) had been approved and its members appointed and that the WHO Department of Mental Health and Substance Abuse would be managing the technical part of the revision of Chapter VI, as it is doing for Chapter V.

The 5th Meeting of the now reconstituted Advisory Group for the Revision of Mental and Behavioural Disorders was scheduled to take place this week, on 28 – 29 September.

Following this meeting, I hope to be in a position to provide information about the appropriate channels of communication with TAG Neurology and TAG Mental Health, the process through which stakeholders will be able to submit proposals and what will be required of them.

In the meantime, I recommend familiarising yourselves with the documentation and processes evolving at:
https://sites.google.com/site/icd11revision/home/documents

There’s a lot of material here, but we need to be informing ourselves around these processes, now.

*According to a discussion paper on ICD-11 rules, conventions and structure, it is proposed that Arabic should replace roman numerals throughout the classification (eg chapter numbering), except where they are the standard for a disease concept.  So for ICD-11, we might anticipate Chapter 5, Chapter 6 etc. rather than Chapter V, Chapter VI.

Suzy Chapman
30 September 2009

Posted in CISSD Project, Criticism of DSM-V, DSM revision process, Elephant Series DSM-V, ICD revision process, ICD-11, MUPSS Project, MUS, WHO (World Health Organization), WHO Collaborating Centre, WHO Somatisation Project | Comments Off

ICD-11 iCAMP on YouTube: Week Two

Posted by meagenda on September 29, 2009

ICD-11 iCAMP on YouTube: Week Two

Week Two of the Geneva iCamp Meeting to test the iCAT collaborative authoring tool that the WHO will be using to revise ICD-10.

iCamp YouTube videos at:  WHO ICD11 Channel

Follow WHO ICD-11 on Twitter: http://twitter.com/WHOICD11

Follow WHO ICD-11 on Blogspot: http://whoicd11.blogspot.com

Follow WHO ICD-11 on Facebook: http://www.facebook.com/ICD11

ICD-11 Revision on Google Sites: https://sites.google.com/site/icd11revision

—————

YouTubes Days 1, 2, 3 and 4 can also be viewed at: http://wp.me/p5foE-23l

——————-

WHO ICD Revision: iCAMP daily YouTubes:

Day 5 | 28 September 2009 |  4.28 mins

Fifth day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.

 
Day 6 | 29 September 2009 | 4.16 mins

Sixth day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.


 

Day 7 | 30 September 2009 | 3.47 mins

Seventh day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.

Day 8 | 01 October 2009 | 2.44 mins

Eighth day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.

Day 9 | 02 October 2009 | 5.50 mins

Ninth and final day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.

YouTubes Days 1, 2, 3 and 4: http://wp.me/p5foE-23l

Posted in CISSD Project, DSM revision process, Elephant Series DSM-V, ICD revision process, ICD-11, WHO (World Health Organization), WHO Collaborating Centre, WHO Somatisation Project | Comments Off

ICD-11 iCAMP on YouTube

Posted by meagenda on September 23, 2009

ICD-11 iCAMP on YouTube (Days 1, 2, 3and 4 now available below)

22 September saw the start of the Geneva iCamp Meeting to test the iCAT collaborative authoring tool that the WHO will be using to revise ICD-10. Follow WHOICD11 on Twitter: http://twitter.com/WHOICD11

According to ICD Revision on Facebook

i-CAMP

The training meeting for the ICD-11 alpha draft will test the collaborative authoring tool (iCAT) and further develop the joint authoring tools and procedures. Aims of the iCAMP: Shared Learning Process: – Learn the tooling environment – Learn …how to populate the content model and make structural changes – Learn the overall workflows for the revision process – Revise the overall tooling and organization of alpha-drafting Simulating the “Managing Editor” tasks for alpha-drafting – Managing the input from different sources into the ICD categories – Identifying the reviewers – Managing Workflows Observing the interactions amongst the participants to develop ideas for social networking for the ICD-11 Beta Drafting Phase.

The starting point for the ICD-11 alpha draft will be the “Start-Up List” of categories which has been drafted by WHO/HQ to initiate the editing process. This list includes all the proposals received to revise the existing ICD-10 as well as the input from ICD national modifications. During alpha drafting, detailed structured definitions will be added to these ICD categories according to a common model. In the iCAMP, participants will review the proposed classification structure, and start filling in the content model: i.e. they will define the diseases according to a common template which identifies the parameters and corresponding values for each of these parameters. Discussions will clarify and improve the content model, value sets, workflows and the overall revision process. During this structured exercise, the iCAT will be pilot tested mainly by the TAG Managing Editors and classification experts.

TAG Managing Editors will assume three different roles: (a) proposal generator, (b) reviewer, and (c) managing editor. Thus, they will be learning-by-doing the details of different contributor roles and testing whether the collaborative platform is fit for the intended purposes of the revision process. Classification Experts will examine the start up list for its completeness, accuracy, conformance with national adaptations and specialty adaptations as well as its relevance for intended use cases. They will also start working on the compilation of the coding rules and instructions (Volume II) and index (Volume III). Informatics experts will assist in tooling and workflows to ensure effective interactions between the proposal generators, managing editors and Topic Advisory Groups as well as other experts. They will also work on the multilingual aspects of the tooling and the products.

ICD Revision is posting iCamp YouTube videos on WHO ICD11 Channel

 

WHO ICD Revision: iCAMP Day 1

Day 1 | 22 September 2009 | 5.23 mins

“First day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.”

 
WHO ICD Revision: iCAMP Day 2

Day 2 | 23 September 2009 | 4.39 mins

“Second day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.”

 
WHO ICD Revision: iCAMP Day 3

Day 3 | 24 September 2009 | 3.46 mins

“Third day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.”

 
WHO ICD Revision: iCAMP Day 4

Day 4 | 25 September 2009 | 3.57 mins

“Fourth day of the World Health Organization’s International Classification of Diseases (ICD) Revision iCamp Meeting. This meeting will discuss the Collaborative Authoring Tool (iCAT) that will be used to revise the ICD towards its 11th Edition.”

Week Two videos at: ICD-11 iCAMP on YouTube: Week Two

—————————

—————————

Related material:

June 2009 PowerPoint presentation

Robert Jakob, Medical Officer, Classifications and Terminologies, WHO Geneva
Slides only, no audio [PDF format 1.3 MB]: Overview of ICD Revision towards ICD-11, includes Timelines for overall revision process and Alpha Draft Calendar; illustrates sample textual definition

April 2008 PowerPoint presentation

Christopher Chute, MD, Mayo Clinic bioinformatics specialist and ICD Revision Steering Group Chair
Audio and slides [31 mins plus question session]: ICD-11 Revision Update, Overview for the NCBO (National Center for Biomedical Ontology) of development process towards ICD-11 using wiki-like collaborative authoring tools (iCAT)

http://www.who.int/mental_health/evidence/icd_advisory_group_december_08_summary.pdf

Summary Report: 4th Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders (1-2 December 2008)

Posted in CISSD Project, DSM revision process, Elephant Series DSM-V, ICD revision process, ICD-11, WHO (World Health Organization), WHO Collaborating Centre, WHO Somatisation Project | Comments Off

Reference to Psychological Medicine manuscripts in Summary of 4th meeting of Advisory Group for Revision of ICD-10 Chapter V

Posted by meagenda on September 20, 2009

Elephant70

Image | belgianchocolate | Creative Commons

Keywords

APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

————

The Elephant in the Room Series Three:

Reference to Psychological Medicine manuscripts in the Summary of the 4th meeting of the Advisory Group for Revision of ICD-10 Chapter V (Mental and Behavioural Disorders)

WordPress shortlink for this posting:  http://wp.me/p5foE-22o

On 18 September, I posted a copy of the Summary Report of the 4th Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders held on 1-2 December 2008, which has only just been published by the WHO.

When reading the Advisory Group’s latest report, bear in mind that it is a summary of a meeting held nine months ago. It has not yet been established when the Advisory Group anticipates publishing a summary of its next meeting which is scheduled for the end of this month (28-29 September).

Since the December 2008 meeting took place, the DSM-V “Somatic Symptom Disorders” Work Group has published an Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by DSM-V Work Group members, Joel Dimsdale (Chair) and Francis Creed. The report, published in the June 2009 issue of the Journal of Psychosomatic Research, expands on proposals in the very brief DSM-V Work Group update, published on the APA’s website, in April.

Page 1 of the Summary of the 4th Meeting of the International Advisory Group reports:

2. Update on proposal for large groupings of mental and behavioural disorders: Overview of Psychological Medicine articles

Presenter: Dr. David Goldberg

“Dr. Goldberg described key changes and additional specifications in the proposal for large groupings of mental disorders discussed at the AG meeting in March, 2008. Manuscripts based on this proposal are now in press in Psychological Medicine. The current version of the proposals includes five clusters of disorders. Each of these clusters meets some, though not all, of the validation criteria as modified from Robins and Guze by Hyman and colleagues. Similarities within the proposed clusters make it reasonable to view the different disorders within the cluster as variations on a single theme rather than separate and ‘comorbid’ disorders. The AG emphasized that decisions about an overarching architecture of categories will need to be made within the next year, keeping in mind WHO’s emphasis on clinical utility in a broad range of settings and countries…”

and goes on to discuss the relevance of large groupings to ICD revision and the testing of clinical utility in various contexts.

The “Cluster” manuscripts referred to as “in Press in Psychological Medicine” are listed on the APA’s recently published webpage:

“Peer-Reviewed Publications from DSM-V Development”

http://www.psychiatry.org/MainMenu/Research/DSMIV/DSMV/DSMRevisionActivities/DSMV-Publications.aspx

“As part of the efforts to make information about DSM-V development as widely disseminated as possible, the American Psychiatric Institute for Research and Education is maintaining an ongoing list of peer-reviewed journal publications arising from the DSM-V planning conference series (2002-08) and from DSM-V Task Force and Work Group discussions (e.g., empirical literature reviews, secondary data analyses). This list will be continually updated.”

[...]

“119. Andrews G, Goldberg DP, Krueger RF, Carpenter Jr WT, Hyman SE, Sachdev P & Pine DS. Exploring the Feasibility of a Meta-Structure for DSM-V and ICD-11: Could It Improve Utility and Validity? Psychological Medicine; in press.

120. Sachdev P, Andrews G, Hobbs MJ, Sunderland M & Anderson TM. Neurocognitive Disorders: Cluster 1 of the Proposed Meta-Structure for DSM-V and ICD-11. Psychological Medicine; in press.

121. Andrews G, Pine DS, Hobbs MJ, Anderson TM & Sunderland M. Neurodevelopmental Disorders: Cluster 2 of the Proposed Meta-Structure for DSM- V and ICD-11. Psychological Medicine; in press.

122. Carpenter Jr WT, Bustillo JR, Thaker GK, van Os J, Krueger RF & Green MJ. Psychoses: Cluster 3 of the Proposed Meta-Structure for DSM-V and ICD-11. Psychological Medicine; in press.

123. Goldberg DP, Krueger RF, Andrews G & Hobbs MJ. Emotional Disorders: Cluster 4 of the Proposed Meta Structure for DSM-V and ICD-11. Psychological Medicine; in press.

124. Krueger RF & South SC. Externalizing Disorders: Cluster 5 of the Proposed Meta-Structure for DSM-V and ICD 11. Psychological Medicine; in press.

125. Goldberg DP, Andrews G & Hobbs MJ. Where Should Bipolar Appear in the Meta-Structure? Psychological Medicine; in press.”

Gavin Andrews, MD, is a member of the DSM-V Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group.

Sir David Goldberg, MD, is a member of the DSM-V Mood Disorders Work Group

Robert Krueger, PhD, is a member of the DSM-V Personality and Personality Disorders Work Group

William T Carpenter, Jr., MD, chairs the DSM-V Psychotic Disorders Work Group and is a member of the DSM-V Task Force

Steven E Hyman, MD, is a member of the DSM-V Task Force and chairs the International Advisory Group for the Revision of ICD Mental and Behavioural Disorders

Perminder Sachdev MD, PhD, FRAZCP, is a member of the DSM-V Neurocognitive Disorders Work Group

Daniel S. Pine, MD, chairs the DSM-V Disorders in Childhood and Adolescence Work Group and is a member of the DSM-V Task Force

Juan R. Bustillo, MD, is a member of the DSM-V Psychotic Disorders Work Group

————

The June 2009 Journal of Psychosomatic Research Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by Joel Dimsdale and Francis Creed was published as free access.

It is not yet known which issue of Psychological Medicine these manuscripts are to be published in or whether they will be freely available to non subscribers to the journal.

Given that the DSM-V Task Force insists that its oversight of the DSM revision is a transparent process, one assumes that these manuscripts are going to be made freely accessible to all stakeholders irrespective of whether the proposals contained within them still stand or are now superseded by alternative proposals.

See also: Summary Report of 3rd Meeting International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders 11 – 12 March 2008, Geneva

See also: Pages 3 and 4 Diagnostic Issues Symposium programme

————

Psychological Medicine is published by Cambridge Journals

http://journals.cambridge.org/action/displayJournal?jid=PSM

The Editors of Psychological Medicine are:

Kenneth S. Kendler
Psychiatric Genetics Research Program
Dept of Psychiatry
P O Box 980710
Richmond, VA 23298-0710 USA

and

Robin M. Murray
Institute of Psychiatry
de Crespigny Park
Denmark Hill
London SE5 8AF

The Editorial Board for Psychological Medicine includes:

Sir David Goldberg*
Institute of Psychiatry, London, UK

Professor Matthew Hotopf
Institute of Psychiatry, UK

Dr James Levenson*
Virginia Commonwealth University, USA

and

Professor S. C. Wessely
King’s College London, UK

———————–

*Dr James Levenson, MD, is a member of the DSM-V Somatic Symptoms Disorders Work Group and had been a member of the CISSD Project.

*Professor Sir David Goldberg, MD, Professor (Emeritus) Institute of Psychiatry, has been a member of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and is a member of the APA’s DSM-V Work Group for Mood Disorders.

Professor Goldberg was a member of the UK National Editorial Team and UK National Consensus Group for the WHO “Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version”.

For archived correspondence between Connie Nelson, the WHO, Geneva, and the WHO Collaborating Centre, Institute of Psychiatry, from 2001, concerning the issue of the WHO Collaborating Centre’s flexible use of terminology around chronic fatigue, fatigue syndrome and neurasthenia, and chronic fatigue syndrome and ME see:

http://www.meactionuk.org.uk/whomisc.htm

I will update when these manuscripts have been published.

————

On the DSM-V Peer-Reviewed Publications from DSM-V Development page under “Somatoform Disorders” is listed the paper: 

88. Kanaan RAA, Lepine JP, & Wessely SC. The association or otherwise of the functional somatic syndromes. Psychosomatic Medicine, 2007; 69:855-859.

This paper can be accessed via Google Books “Preview”, published as Chapter 2 of:

“Somatic Presentations of Mental Disorders: Refining the Research Agenda for DSM-V”

Monograph published by the American Psychiatric Association, in 2009, summarising the proceedings of the September 2006 APA/WHO Beijing Symposium: Somatic presentations of mental disorders

See Chapter 2: Pages 9-18   http://tinyurl.com/somaticpresentationsDSM-V

————

For latest “Elephant in the Room” series report (compiled before the release of the Advisory Group’s 4th meeting Summary Report)

see: DSM, ICD: transparency and timelines 03 September 2009.

Posted in AfME, Action for M.E., CISSD Project, Criticism of DSM-V, Elephant Series DSM-V, ICD revision process, ICD-11, Institute of Psychiatry, MUPSS Project, MUS, Simon Wessely, WHO (World Health Organization), WHO Collaborating Centre, WHO Somatisation Project | Comments Off

Summary Report: 4th Meeting of International Advisory Group for Revision of ICD-10 Mental and Behavioural Disorders

Posted by meagenda on September 18, 2009

Elephant70

Image | belgianchocolate | Creative Commons

Keywords

APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

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WordPress shortlink for this posting:  http://wp.me/p5foE-21S

18 September 2009

The International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders (Chapter V) was constituted by the WHO in 2007 with the primary task of advising WHO on all steps leading to the revision of mental and behavioural disorders classifications in ICD-10 in line with the overall revision process.

Timelines for the revision process towards ICD-11 are set out here:  http://wp.me/p5foE-1Yh

A 4th meeting of the Advisory Group was held in Geneva on 1 – 2 December 2008.

I am advised by the WHO that no meetings have taken place since this December 2008 meeting and that a 5th meeting is scheduled this month, for 28 – 29 September.

Since late March, I have been liaising with the Advisory Group Senior Project Officer and the ICD-11 Revision Steering Group Chair for a copy of the summary report for the Advisory Group’s last meeting (December 2008).

A summary report has been released today and is published on the WHO website in PDF format. A list of participants has been provided in an Annex and both documents are appended.

It is unfortunate that this important summary of a meeting held over nine months ago has been published less than two weeks before the Advisory Group’s next meeting.

The Advisory Group (AG) and all its working groups (including the ICD-DSM Harmonization Group) were appointed in 2007 for a period of two years, this has now expired. A new Advisory Group has been appointed for the next two year period.

The names of the members of the reconstituted Advisory Group and the professional and scientific organizations that have been asked to appoint representatives to it have been provided to me.

I have also been provided with the names of the members of the Topic Advisory Group (TAG) for Neurology and a list of the professional and scientific societies and their appointed representatives associated with this TAG.

I intend to circulate these when clearance has been obtained for the publication of information not currently available on the WHO website or the ICD Update and Revision Platform.

The WHO maintains an ICD Revision Facebook presence at: http://www.facebook.com/ICD11

When reading this document please bear in mind that it is a summary of a meeting held nine months ago. It is not yet established when the Advisory Group anticipates publishing a summary of the meeting scheduled for the end of this month. Since the December 08 meeting took place, the DSM-V “Somatic Symptom Disorders” Work Group has published an Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by DSM-V Work Group members, Joel Dimsdale (Chair) and Francis Creed. This was published in the June issue of the Journal of Psychosomatic Research and expands on the proposals in the brief DSM-V April 2009 Work Group update (links for both these documents at the end of this posting).

PDF icon l

ICD Advisory Group Meeting Summary December 08

 

Text:

Summary Report: 4th Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders

http://www.who.int/mental_health/evidence/en/

http://www.who.int/mental_health/evidence/icd_advisory_group_december_08_summary.pdf

PDF Page 1

World Health Organization
Department of Mental Health and Substance Abuse
Geneva, Switzerland

Meeting of the International Advisory Group
for the Revision of ICD-10 Mental and Behavioural Disorders
1 – 2 December 2008, Geneva, Switzerland

Meeting Summary Report

The fourth meeting of the International Advisory Group (AG) for the Revision of ICD-10 Mental and Behavioural Disorders was held in Geneva during 1 – 2 December 2008. A list of participants is provided in the Annex. The AG was constituted by WHO for a period of 2 years (2007 – 2008) with the primary task of advising WHO on all steps leading to the revision of the mental and behavioural disorders classification in ICD-10 in line with the overall revision process.

This Summary Report provides a summary of the conclusions reached during the meeting

1. Opening Remarks

The meeting was opened by Dr. Benedetto Saraceno, Director, Department of Mental Health and Substance Abuse, WHO. Dr. Mario Maj was introduced as the new representative of the World Psychiatric Association (WPA) on the AG, and Dr. Ann Watts as the new representative of the International Union of Psychological Science (IUPsyS). Dr. Saraceno announced that the International Advisory Group for the Revision of ICD-10 Diseases of the Nervous System (Chapter VI) has been approved and members appointed. The Department of Mental Health and Substance Abuse will manage the technical part of the revision of Chapter VI, as it is doing for Chapter V. Dr. Saraceno reminded the AG that this would be the final meeting of this group in its current composition. As noted, the AG was appointed in January, 2007 for a 2-year period.

Dr. Steven Hyman, AG Chair, discussed the growing public awareness and concern about conflict of interest issues as they relate to the development and revision of systems for mental and behavioural disorders classification. It is very important that any potential or apparent conflict of interest be clearly disclosed as required by WHO policy, but also that the AG be fully aware of all such issues so that it can manage them appropriately and transparently. Dr. Hyman suggested that it is also important to be transparent about AG members’ involvement in the American Psychiatric Association’s revision of its Diagnostic and Statistical Manual of Mental Disorders (DSM), in the light of discussions about harmonization and copyright issues that may have financial implications.

Regarding the formation of a new AG, the AG was aware of the importance of appropriate representation by region, gender, and profession. In addition, the AG agreed that it would be useful to select AG members who have an institutional base that will facilitate their implementation of the types of testing programmes in multiple settings, countries, and cultures.

2. Update on proposal for large groupings of mental and behavioural disorders: Overview of Psychological Medicine articles

Presenter: Dr. David Goldberg

Dr. Goldberg described key changes and additional specifications in the proposal for large groupings of mental disorders discussed at the AG meeting in March, 2008. Manuscripts based on this proposal are now in press in Psychological Medicine. The current version of the proposals includes five clusters of disorders. Each of these clusters meets some, though not all, of the validation criteria as modified from Robins and Guze by Hyman and colleagues. Similarities

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within the proposed clusters make it reasonable to view the different disorders within the cluster as variations on a single theme rather than separate and ‘comorbid’ disorders. The AG emphasized that decisions about an overarching architecture of categories will need to be made within the next year, keeping in mind WHO’s emphasis on clinical utility in a broad range of settings and countries.

3. Relevance of large groupings to ICD revision: Testing clinical utility of large groupings in low and middle-income countries

Presenters: Dr. Rangaswamy Thara, Dr. Oye Gureje, Dr. Maria Elena Medina-Mora, and Dr. Khalid Saeed

Based on their experience in a variety of institutional settings in low and middle-income countries, Drs. Thara, Gureje, Medina-Mora, and Saeed were asked to describe briefly the major issues and challenges related to assessing the utility of the proposed large groups of mental disorders in those countries and settings. Dr. Thara emphasized that behavioral and functional descriptions would be more helpful in community settings than lists of criteria. Dr. Gureje pointed out that treatment of mental disorders in primary care and the need for a simpler, user friendly system are not just issues for low and middle-income countries. Dr. Medina-Mora described possibilities for a range of demonstration projects, particularly in Latin America, that would provide useful information about the proposed groupings. The primary goal of these projects would be to examine clinical utility within specific cultural and economic contexts, and the types of additional support that may be needed to improve identification and treatment of mental disorders. Dr. Saeed suggested that may be little correspondence between public health needs in mental health and the issues that would be addressed by a re conceptualization of mental disorders categories along the lines of the proposed meta-structure.

4. Relevance of large groupings to ICD revision: Testing clinical utility in other contexts

Presenters: Dr. Michael Klinkman, Dr. Mario Maj, Dr. Norman Sartorius, Dr. Graham Mellsop, and Dr. Toshimasa Maruta

The next series of presentations focused on the potential utility of the proposed large groups of mental disorders and possibilities for testing their clinical utility in a variety of other contexts, including professional societies and national or regional networks. Dr. Klinkman discussed the potential utility of the proposed large groupings in primary care. WONCA’s International Classification of Primary Care (ICPCP) provides a limited number of categorical mental disorders diagnoses (e.g., depressive disorder), as well as a variety of commonly presented symptoms and a list of social problems. Dr. Maj suggested that the proposed large groupings may be no simpler and no less confusing to the average clinician than existing clusters, and may not represent the natural world any better. Dr. Sartorius discussed the possible role of the Global Scientific Partnership Network in testing the global applicability of the proposals. Dr. Mellsop pointed out that even if the evidence for the proposed clusters is mixed if examined in relationship to the Hyman validation criteria, it may compare favorably to an evaluation of the current nine groupings against the same validation criteria. Dr. Maruta decribed efforts underway in Japan to prepare for field trials, and identified several questions that should be addressed.

Conclusions, Items 2 – 4

The AG emphasized that in considering these and other proposals for the ICD, it is important to make a distinction between validity and utility. This distinction is useful even though they can be considered as overlapping constructs. Utility must always be considered with respect to a particular purpose (e.g., clinical, public health, communication, education, research). From a research perspective, the AG considered the large groupings proposal to be useful as a hypothesis. From a clinical perspective, grouping disorders for which the same interventions are effective (e.g., most of the emotional disorders) will likely be helpful; groupings that do not inform assessment and treatment will be less clinically useful. While WHO views validity as an important priority for the

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classification, the goal of increasing the utility of the classification for identifying and treating mental disorders and reducing associated disease burden also provides a compelling basis for making changes. The development of methods and specific plans for testing questions related to clinical utility in relevant settings should be among the priorities for work during the next year.

5. Epidemiological evidence coordination group: Available datasets, information needs, and work plan

Presenters: Dr. Ronald Kessler and Dr. Somnath Chatterji

The purpose of this presentation was to inform the Advisory Group of the work conducted and planned by the Epidemiological Evidence Coordination Group, specifically including the assessment of available databases for relevant epidemiological analyses, a description of analyses in process and potential future analyses, and examples of results. Activities of the group include conducting secondary analyses of the World Mental Health Survey data, designing and soliciting new data collections, and collaborating with existing networks of researchers focused on particular disorders or disorder clusters.

6. Secondary data analyses for DSM-V

Presenter: Dr Darrel Regier

Dr Regier described strategies and methods for secondary analyses of epidemiological data that are being used in the DSM revision process. To date, secondary data analyses have focused on:

a) the developmental expression of disorders across the lifespan; b) differences in expression of disorders by gender and culture; c) disorder spectra; and d) the interface between mental and general medical disorders. Longitudinal data sets are being used to conduct analyses on the developmental expression of disorders. The AG requested that the results of epidemiological and secondary data analyses conducted in the context of the DSM and ICD revisions be made available to both groups.

7. Global Scientific Partnership Network and Coordinating Group

Presenter: Dr. Norman Sartorius

Dr. Sartorius described the current composition of the Global Scientific Partnership Network (GSPN) and highlighted the need for additional representation from particular geographic regions – most particularly Latin America and Southeast Asia – and with specific types of experience and expertise, including experts with professional backgrounds other than psychiatry. AG members and professional societies will make recommendations for additional members for the GSPN. The WHO Secretariat will work with Dr. Sartorius to improve representation.

8. Broadening revision inputs

a) Summary of comments received from ICD Update and Revision Platform

Presenter: Dr. Geoffrey Reed

Dr. Reed reported that the Update and Revision Platform is easy to use and works extremely well, and again commended members of the Classifications, Standards, and Terminology group for their work on it. He provided a summary of comments received to date, which have generally been highly specific proposals in areas of particular professional or personal interest to the commenter.

b) Soliciting input from international professional societies

Presenters: Dr. Mario Maj (WPA), Dr. Ann Watts (IUPsyS), Dr. Nicholas Hardiker (ICN), Dr. Michael Klinkman (WONCA), and Mr. Rolf Blickle-Ritter (IFSW)

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Dr. Maj described how World Psychiatric Association (WPA) member societies could provide a cross-cultural perspective in the several important areas related to the revision. Dr. Watts described how the International Union of Psychological Science (IUPsyS) could help to expand revision input by identifying and nominating global experts, providing comments through a global, electronically-based network of national and regional members, and affiliates; and participating in field trials. Dr. Hardiker described how the International Council of Nurses (ICN) can provide access to nurses’ experience with classification in the delivery of mental health services. Dr. Klinkman described how the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) can contribute to the revision effort, for example by helping the Advisory Group to re-conceptualize somatoform presentations and risk factors for mental illness, and clarifying which aspects of psychosocial factors need to be revised. Mr. Blickle-Ritter indicated that the International Federation of Social Workers (IFSW) can collect information relevant to the ICD revision from social workers across countries. As the need arises, the AG or the WHO Secretariat will direct specific, targeted question to the professional societies, and may also want to ask for background literature or scientific information. However, professional organizations are also encouraged to initiate input regarding the direction, method, and content of the revision process based on the perspectives of their membership and the aims of their organizations.

9. ICD/DSM Harmonization Group

Presenters: Dr. Darrel Regier and Dr. David Kupfer (APA); Dr. Benedetto Saraceno and Dr.Shekhar Saxena (WHO).

Dr. Hyman began this discussion by raising the issue of how the international community might best be involved in the DSM process. To the extent that ICD and DSM diverge, this may create unintentional divergence in treatment, research, and epidemiology. It is often clear that the two systems agree about the nature of the phenomenon that categories represent, but approach them in slightly different ways. This challenge is elevated when groups begin to revise individual criteria sets, as research has demonstrated that relatively minor differences in criteria can have a large impact on prevalence estimates.

Speaking for the APA side of the harmonization agenda, Dr. Regier placed the current situation in a historical context. While there had been early collaboration between ICD and DSM for DSM-I and DSM-II, DSM-III made a major break and as a result was substantially different from ICD-9. In retrospect, this represented a failure to communicate and collaborate. At the same time, it is possible that DSM-III was so different from ICD that it would have been very difficult for WHO to obtain the necessary agreement to make so dramatic a change in any case. Dr. Regier indicated that APA had made a major effort to make the DSM process as collaborative as possible beginning in 1999, and characterized the DSM process as cross-cultural and interdisciplinary. He described the DSM process as a very transparent one; the proceedings from all of the working conferences have been published or are in process. He emphasized the importance of an advisory review process that can help to make sure that DSM-V will fit the needs of the world, crossculturally, and to make sure that it can be integrated with other components of the ICD. Dr. Regier suggested that a unique contribution that WHO can make is to facilitate an international consensus that avoids some of the risks of independent national classifications.

Dr. Kupfer, also speaking from the APA side of the harmonization issue, emphasized that he saw communication between APA and WHO as having been very successful, with open conversations, active involvement, and observer status at one another’s meetings. There continues to be discussion about larger clusters as a part of the DSM process, which is a theme that came out of the WHO/APIRE Public Health conference. A joint discussion about the issue of impairment is now becoming more prominent. The DSM effort is now looking into adopting or creating measures of impairment that are relatively independent of each diagnosis. This should

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help tremendously, particularly with co-morbidity. It is important that such instrumentation efforts not be undertaken separately, but as a part of a collaborative work plan.

Dr. Saraceno, speaking from the WHO side of the harmonization issue, raised a number of concerns related to harmonization. As Director of the WHO Department of Mental Health and Substance Abuse, he routinely receives communications from global leaders in the field. In recent months, the topic of the ICD revision has been prominent, and the issue of harmonization with the DSM has been raised frequently. The importance of harmonization is widely endorsed, but many have emphasized that the two processes should be parallel and independent and that WHO’s development of ICD should not be substantially influenced by the DSM process. Some have specifically criticized APA’s and WHO’s attendance at one another’s revision meetings, pointing out that other classification groups – Chinese, Cuban, etc. – are not treated equivalently. There has also been criticism of cross-membership on DSM and ICD working groups. These issues regarding the interaction of the ICD and DSM processes will need to take into account, both in terms of their substance and in terms of perception, even in the overall context of harmonization as a general goal.

Dr. Saxena, also speaking on behalf of WHO, acknowledged a history of successful collaboration between WHO and APA, including the recent conferences, but also noted significant challenges. The mandates, organizational requirements, and interests of WHO and APA do not overlap entirely and cannot be put aside. The constitutional responsibility of WHO for ICD is a unique and serious one. As the ICD process goes forward, there will be a demand for increasing specificity, which will create more difficulties if uniformity is seen as the most important goal. There are also issues related to copyright and publication revenues. There was a Memorandum of Understanding between APA and WHO in 1990 regarding ICD-10 and DSM-IV, which seems to have worked well. However, changes in organizational priorities, global health care, and technology suggest that it may not be a simple matter to achieve a similarly workable agreement in the current context. Commercial issues may become more prominent the greater the degree of harmonization achieved.

10. Functional Status, Disability, and Diagnosis

Presenters: Dr. Geoffrey Reed and Dr. Somnath Chatterji

The purpose of this session was to articulate the implications for the ICD revision of the model of functioning and disability provided by the International Classification of Functioning, Disability,and Health (ICF). In particular, this was considered in relation to the AG’s expressed goal of separating diagnosis and functional status. In examining the differences between ICD and DSM, the ‘clinical significance’ criterion – most often operationalized in terms of functional status – is one of the most important source of differences between the two systems, and there is evidence that this is largely responsible for difference in prevalence estimates using the two systems. A major source of confusion in this discussion is that there is no agreement about the meaning and use of terms – e.g., functional status, impairment, disability – so that the degree of consensus about these issues is difficult to evaluate.

Signs and symptoms of most diseases or health conditions involve impairments in body functions or body structures (e.g., insulin deficiency, spinal cord injury, high blood pressure, loss of vision, impaired reuptake of serotonin). Therefore, impairments in body functions and structures – even though the ICF includes these in its conceptualization of disability – must be allowable as diagnostic criteria. Moreover, there are some important symptoms of mental disorders that in the ICF would be considered to be part of Activities and Participation. Examples include disturbances in social-emotional functioning in autism, ‘persistent refusal to accept medical advice’ in somatization disorder, and such behaviours as lying, breaking the law, putting one’s job at risk, and acquiring debts in pathological gambling. In some cases, these may be defining features of a disorder that are assumed to correspond to some underlying brain process that cannot be directly observed. In other cases, these may be considered observable manifestations of a

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disorder in a particular environment. And in still others, these may in fact be best conceptualized as consequences of a disorder.

The AG noted that there are at least two separable projects related to the interaction of mental disorder and disability. The first is the question of how disability related to mental disorders should be assessed as a separate construct. The second is an evaluation of the extent to which disability is already embedded in mental disorder criteria and a consideration of whether at the criteria level disorder and disability can be teased apart. A part of this second project concerns the separation of disability and disorder severity, and whether this would be the same for all disorders. The AG affirmed that it was important to continue to work on issues related to the relationship of diagnosis, functioning, and disability. Where possible, it will be helpful to do this collaboration with the DSM revision given the relative importance of this issue among the differences between ICD and DSM. However, the AG made a distinction between the discussion of how criteria are defined in relationship to disability, which is of direct concern to the ICD revision effort, and the instrumentation of disability within the DSM as a more general issue. This second area is not as directly relevant to the ICD mental and behavioural disorders revision effort.

11. Closing Remarks

Dr. Saraceno described his view of the needs for the reconstituted AG that will be appointed in 2009. For the first 2 years, the AG has really focused on conceptual discussions and decisions about the overall direction of the ICD revision. This phase of the work is over. The next stage will require more concrete and specific decisions about the shape and content of the classification. While there are specific needs for regional and gender representation that WHO must satisfy, there is also a great need to consider representation of expertise in relation to the tasks that will be required over the next 2 years. There must be an ability to consult more effectively and efficiently with external people who can provide specific and needed inputs without having to be members of a continuing advisory structure. There will also be a need for smaller, technical groups to conduct specific, targeted pieces of work. A more flexible model will be required, as well as people who will actually be able to assist with implementation and be accountable for those tasks. Dr. Saraceno extended WHO’s sincere thanks to the group and to the Chair for their work over the past two years.

[Ends]

Annex: LIST OF PARTICIPANTS

WORLD HEALTH ORGANIZATION

4th Meeting of the Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders

1 – 2 December 2008 Geneva, SWITZERLAND

Venue: Conference Room M.105 (1st day) and conference room D (2nd day) WHO Main building

LIST OF PARTICIPANTS

1. Gavin Andrews, Clinical Research Unit for Anxiety Disorders, St. Vincent’s Hospital, 299 Forbes Street, Darlinghurst, NSW 2010, Australia. Email: gavina@unsw.edu.au (unable to attend)

2. Rolf Blickle-Ritter, International Federation of Social Workers, Psychiatrizentrum Münsingen, Leitung Sozialdienst, 3110 Münsingen, Switzerland. Email: rolf.blickle@gef.be.ch

3. David Goldberg, Institute of Psychiatry, King’s College, London, United Kingdom. Email: davidpgoldberg@yahoo.com

4. Oye Gureje, Department of Psychiatry, University College Hospital, PMB 5116 Ibadan, Nigeria. Email: ogureje@comui.edu.ng

5. Nicholas Hardiker, International Council of Nurses, Salford Centre for Nursing, Midwifery & Collaborative Research, University of Salford, Greater Manchester, United Kingdom. Email: N.R.Hardiker@salford.ac.uk

6. Steven Hyman (Chairman), Harvard University, Massachusetts Hall, Cambridge, MA 02138, USA. Email: steven_hyman@harvard.edu

7. Michael Klinkman, The World Organisation of Family Doctors (Wonca), University of Michigan Depression Center, 1500 E Medical Center Drive, F6321 MCHC Ann Arbor, MI 48109-0295, USA. Email: mklinkma@med.umich.edu

8. Mario Maj, World Psychiatric Association, Institute of Psychiatry, University of Naples, Largo Madonna Delle Grazie, I-80138 Naples, Italy. Email: majmario@tin.it

9. Maria Elena Medina-Mora, Instituto Nacional de Psiquiatria Ramon de la Fuente, Calzada Mexico-Xochimilco, Col. San Lorenzo Huipulco, México, D.F. 14370, Mexico. Email: medinam@imp.edu.mx

10. Karen Ritchie, Institut National de la Santé et de la Recherche Médicale, E 361 Pathologies of the Nervous System Epidemiological and Clinical Research, Hôpital La Colombière, 34093 Montpellier Cedex 5, France. Email: karen.ritchie@inserm.fr

11. Norman Sartorius, 14 chemin Colladon, 1209 Geneva, Switzerland. Email: sartorius@normansartorius.com

12. Rangaswamy Thara, Schizophrenia Research Foundation (SCARF), R/7A, North Main Road, West Anna Nagar Extension, Chennai- 600 101, India. Email: scarf@vsnl.com

13. Ann D. Watts, International Union of Psychological Science, Entabeni Hospital, Medical Centre West, 148 South Ridge Road, Durban 4001, South Africa. Email: anndwatts@iafrica.com

14. Xin Yu, Institute of Mental Health, Peking University, Huayuanbeilu 51, Haidian District, 100083, Beijing, China. Email: yuxin@bjmu.edu.cn (unable to attend)

SPECIAL INVITEES:

15. Ronald C. Kessler, Ph.D., Professor, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Suite 215, Boston, MA 02115, USA. Email: kessler@hcp.med.harvard.edu

16. Toshimasa Maruta, Department of Psychiatry, Tokyo Medical University,6-7-1 Nishi-Shinjuku, Shinjuku-Ku, Tokyo 160-0023, Japan. E-mail: maruta@tokyo-med.ac.jp / t-maruta@bd5.so-net.ne.jp (Representative of the Government of Japan)

17. Graham Mellsop, University of Auckland, P O Box 128469, Remuera, Auckland New Zealand Email: Mellsopg@waikatodhb.govt.nz (Representative of the Government of New Zealand)

18. Kimmo Kuoppasalmi, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. Email: kimmo.kuoppasalmi@ktl.fi (Representative of the Government of Finland) (unable to attend)

OBSERVERS:

19. David Kupfer, Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute & Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213-2593, USA. Email: kupferdj@upmc.edu

20. Darrel Regier, American Psychiatric Association, 1000 Arlington Blvd, Suite 1825, Arlington, VA 22209-390, USA. Email: dregier@psych.org

WHO SECRETARIAT:

21. Somnath Chatterji, Country Health Information, Department of Measurement and Health Information Systems, WHO. Email: chatterjis@who.int

22. Tarun Dua, Evidence, Research and Action on Mental and Brain Disorders, Department of Mental Health and Substance Abuse, WHO. Email: duat@who.int

23. Robert Jakob, Classifications and Terminology, Department of Measurement and Health Information Systems, WHO. Email: jakobr@who.int

24. Vladimir Poznyak, Management of Substance Abuse, Department of Mental Health and Substance Abuse, WHO. Email: poznyakv@who.int

25. Geoffrey Reed, Evidence, Research and Action on Mental and Brain Disorders, Department of Mental Health and Substance Abuse, WHO. Email: reedg@who.int

26. Khaled Saeed, WHO Regional office for the Eastern Mediterranean, Cairo, Egypt. WHO Email: Saeedk@emro.who.int

27. Benedetto Saraceno, Director, Department of Mental Health and Substance Abuse, WHO. Email: saracenob@who.int

28. Shekhar Saxena, Evidence, Research and Action on Mental and Brain Disorders, Department of Mental Health and Substance Abuse, WHO. Email: saxenas@who.int

29. Bedirhan Ustun, Classifications and Terminology, Department of Measurement and Health Information Systems, WHO. Email: ustunb@who.int

30. Rosemary Westermeyer, Evidence, Research and Action on Mental and Brain Disorders, Department of Mental Health and Substance Abuse, WHO. Email: westermeyerr@who.int

[Ends]

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Summaries of the first three meetings of the Advisory Group can be found here:

http://www.who.int/mental_health/evidence/en/

Summary Report of the 1st Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders 11 – 12 January 2007, Geneva
http://www.who.int/mental_health/evidence/icd_advisory_group_meeting_jan_%202007_summary.pdf

Summary Report of the 2nd Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders 24 – 25 September 2007, Geneva
http://www.who.int/mental_health/evidence/icd_summary_report_sept_2007.pdf

Summary Report of the 3rd Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders 11 – 12 March 2008, Geneva
http://www.who.int/mental_health/evidence/icd_summary_report_march_2008.pdf

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The April 2009 report of the APA DSM-V Somatic Distress Disorders Work Group (also known as the Somatic Symptom Disorders Work Group) can be read here: http://tinyurl.com/DSMSDDWGApril09

The Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by DSM-V Work Group members, Joel Dimsdale and Francis Creed, published in the June issue of the Journal of Psychosomatic Research expands on the proposals in the April 2009 update.

Free access to both text and PDF versions of the Editorial here:

http://download.journals.elsevierhealth.com/pdfs/journals/0022-3999/PIIS0022399909000889.pdf

http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext

ME agenda DSM-V and ICD-11 Directory page:  http://meagenda.wordpress.com/dsm-v-directory/ 

Latest “Elephant in the Room Series”: DSM, ICD: transparency and timelines:  http://wp.me/p5foE-1Yh

Suzy Chapman
18 September 2009

Posted in AfME, Action for M.E., CISSD Project, DSM revision process, Elephant Series DSM-V, ICD revision process, ICD-11, MUPSS Project, MUS, WHO (World Health Organization), WHO Collaborating Centre | Comments Off

The Elephant in the Room Series Three: DSM, ICD: transparency and timelines

Posted by meagenda on September 3, 2009

Elephant70

Image | belgianchocolate | Creative Commons

Keywords

APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

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The Elephant in the Room Series Three: DSM, ICD: transparency and timelines

WordPress shortlink for this posting:  http://wp.me/p5foE-1Yh

(See also update: 18 September 2009:  Summary Report: 4th Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders )

Psychiatric Times online maintains a resource for the current edition of the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) – the so-called “Psychiatrists’ Bible” – with articles, updates and commentary on the revision process towards the next edition of DSM (DSM-V) at DSM-V Topic Centre.

Over the past couple of months, the journal has published a series of commentaries around the revision process, including controversial critiques from some of those who had been involved in the development of previous editions of DSM, provoking caustic responses from the DSM-V Task Force.

These exchanges have previously been highlighted here and here on ME agenda and you can catch up on more recent commentaries and responses here:

http://www.psychiatrictimes.com/display/article/10168/1431322

31 July 2009, Psychiatric Times. Vol. 26 No. 8 EDITORIAL: The Great DSM Debate, Susan Kweskin, Group Editorial Director, Psychiatric Times

http://www.psychiatrictimes.com/display/article/10168/1431333

07 August 2009, Psychiatric Times. Vol. 26 No. 8 COMMENTARY: A Response to the Charge of Financial Motivation, Allen Frances, MD

http://www.psychiatrictimes.com/display/article/10168/1444633

26 August 2009, PsychiatricTimes.com. COMMENTARY: Advice To DSM V. . .Change Deadlines And Text, Keep Criteria Stable, Allen Frances, MD

http://www.psychiatrictimes.com/display/article/10168/1448330

01 September 2009, PsychiatricTimes.com. CLINICAL: Advice to DSM-V: Integrate with ICD-11, Allen Frances, MD

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Additional commentary from various authors on Psychiatric Times blog and on several other blogs, here:

http://www.mindhacks.com/blog/2009/07/of_manuals_and_madne.html

22 July 2009, Of manuals and madness, the fight rolls on

http://www.nature.com/news/2009/090722/full/460445a.html

22 July 2009 | Nature 460, 445 (2009) | doi:10.1038/460445a | published online

News: Psychiatry manual revisions spark row, US psychiatrists divided by claims of secrecy and scientific overreach, Heidi Ledford (To read this story in full you will need to login or make a payment)

http://carlatpsychiatry.blogspot.com/2009/08/dsm-v-transparency-case-study.html

04 August 2009, DSM-V Transparency: A Case Study

and here (commenting briefly on his contribution to the recent BBC R4 broadcast):

http://carlatpsychiatry.blogspot.com/2009/08/new-bbc-program-rewriting-psychiatrists.html

06 August 6 2009, New BBC Program: Rewriting the Psychiatrist’s Bible

(Broadcast no longer available on BBC iPlayer)

http://psychcentral.com/blog/archives/2009/06/25/transparency-kupfer-and-the-dsm-v/

25 June 2009, Transparency, Kupfer and the DSM-V, John M Grohol, PsyD

http://psychcentral.com/blog/archives/2009/08/07/dsm-v-update-and-transparency

07 August 2009, PsychCentral: DSM V Update and Transparency, John M Grohol, PsyD

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Previous DSM Task Force chairs, Robert L Spitzer and Allen Frances, have been two of the most vocal critics of the current Task Force’s oversight of the revision process. Read their joint letter to the APA Board of Trustees here:  Letter to APA Board of Trustees July 09

In “Advice To DSM V. . .Change Deadlines And Text, Keep Criteria Stable” (Psychiatric Times, 26 August) Allen Frances, who had chaired the DSM-IV Task Force, writes:

“The official publication date for DSM-V is May 2012. That date was picked to be consistent with an earlier, no longer correct, expectation that ICD-11 would be published in that same year. It now seems obvious that this looming deadline is neither necessary nor feasible, and that a later or a flexible deadline should instead be substituted. Why is 2012 no longer a necessary deadline? It recently became known that delays in the preparation of the ICD-11 will postpone its publication at least until 2014.”

But it has been known for some time that the timeline for dissemination of ICD-11 has slipped by a couple of years.

Exhibit 3, Page 14 of this American Psychological Association document (note this is not the American Psychiatric Association, publishers of DSM, who also use the acronym “APA”) confirms that the WHO’s original goal had been to complete the revision and release of ICD-11 by 2012. (For those interested in the relationships between the WHO, the IUPsyS, the American Psychological Association and the American Psychiatric Association, this document is worth a skim):

http://www.apa.org/international/s08agenda25WHOIUPsyS.pdf

COMMITTEE ON INTERNATIONAL RELATIONS ACTION, March 28–30, 2008

Agenda Item No. 25 Revision of the International Classification of Diseases (ICD-10) and Involvement of Psychology

Issue

The World Health Organization (WHO) is undertaking a revision of the International Classification of Diseases and Related Health Problems (ICD) and psychology has been offered an unprecedented opportunity to provide significant leadership in this effort. The purpose of this item is to request guidance and support for an APA commitment to provide sustained resources during the ICD revision process.

Background

The World Health Organization (WHO) is undertaking a revision of the International Classification of Diseases and Related Health Problems (ICD) and psychology has been offered an opportunity to provide significant leadership in this effort. In gathering partners for the revision, WHO engages directly only with international non-governmental organizations (NGOs). For psychology, this partner is the International Union of Psychological Science (IUPsyS), an umbrella organization of 70 national psychology associations (or coalitions of organizations) that represents organized psychology. IUPsyS has been granted status as an accredited NGO with WHO and has been asked to support the core involvement of a psychologist in the revision process. IUPsyS, in turn, has asked APA to support this effort by funding the services of an APA member in this work. WHO has specifically requested that former APA Practice Directorate Assistant Executive Director Dr. Geoffrey Reed serve in the consultant role. APA has collaborated with IUPsyS on a range of projects in the past.

This is an important opportunity that has arisen in large part because psychology (through IUPsyS and prior work of APA and Dr. Reed on related WHO activities) has engaged in a focused, sustained effort of activities and contributions to ongoing work with WHO. Although historically, the ICD process was dominated by psychiatric and medical models (the only WHO partner for mental health has been the World Psychiatric Organization, with whom the American Psychiatric Association partners), the present invitation has, for the first time, included psychology to assume one of two senior roles as part of the core revision team…

The formal request from WHO to IUPsyS is attached. The request indicates WHO’s intention that Dr. Reed join the core revision team as the primary coordinating person for the work of the Advisory Group (a role he has already begun to take on, as noted above), and that he be integrally involved in the drafting and redrafting of categories and criteria and in the development and implementation of field trials. The importance of this opportunity cannot be understated. Until now, such a role would have been reserved for psychiatry, which will be the default position if psychology is not able to meet WHO’s request…

[...]

Full document here

Appended to this document (in a separate PDF) is a letter signed by WHO Secretariat, Dr Shekhar Saxena, dated 8 August 2007, listed as “Exhibit 1 Correspondence”, the purpose of which was to formally request that the IUPsyS (International Union of Psychological Science) broker the funding to enable the WHO to extend the role that Dr Geoffrey Reed was already undertaking and retain him as full-time, primary co-ordinator of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders (ICD-10 Chapter V).

PDF EXHIBIT 1:  http://www.apa.org/international/s08agenda25-Exhibit1.pdf

Page 1 states that “The revision of ICD [...] is scheduled to be completed by 2012″. Page 4 includes a “Revision of ICD-10 Mental and Behavioural Disorders Provisional Activity Plan and Resource Needs” table which sets out the tasks for “Completion of the second draft; Harmonization with other classifications (e.g. ICF DSM); Final review; Translation; Dissemination” during year 2011.

The first meeting of the Advisory Group (which had taken place in January 2007, predating the letter requesting procurement of funding for the continued secondment of Dr Reed) had already noted a dissemination date of 2014, “consistent with the overall ICD-10 revision process”. It is unclear, then, why the WHO were including in their request for funding a timeline for the revision of Chapter V that, according to the summary report of the group’s first meeting, had already slipped by some two years.

Summary Report: first Meeting of the Advisory Group January 2007  [pdf 62kb]

[...]

The Advisory Group agreed with the following tentative timelines that are consistent with the overall ICD-10 revision process:

• An alpha draft version of the ICD-11 mental and behavioural disorders chapter should be completed for review by the Advisory Group by the end of 2008.

• A broad and international review and comment process on the alpha draft should be conducted during 2009.

• Based on comments received, a beta draft should be prepared during 2010. Field testing of the beta draft should be conducted during 2011.

• Based on the results of field trials, a final proposed version should be prepared during 2012 and made available for public review.

It is hoped that the full ICD-11 will be ready for approval by the World Health Assembly in 2014.

These timelines will be reviewed and revised as the work progresses.

By March 2008 (at the time of writing, the last Advisory Group meeting for which a summary has been published) the timeline for completion of alpha and beta drafts had slipped even further:

Summary Report: third Meeting of the Advisory Group March 2008  [pdf 257kb]

[...]

The timeline for the revision process is as follows:

the Alpha draft version of ICD-11 should be completed in 2010, followed by 1 year for commentary and consultation.

The Beta draft version should be completed in 2011, followed by field trials, analysis of field trial data, and revision during the subsequent 2 years.

The final version for public viewing should be completed in 2013, with approval by the World Health Assembly in 2014.

So although Dr Frances writes “It recently became known that delays in the preparation of the ICD-11 will postpone its publication at least until 2014″ it has been publicly reported since at least the publication of the summary of the January 2007 Advisory Group meeting that the anticipated dissemination of ICD-11 had slipped significantly, with the result that it was already lagging at least two years behind the planned publication date of DSM-V (currently May 2012).

A June 2009 PowerPoint presentation by Robert Jakob (Medical Officer, Classifications and Terminologies, WHO Geneva) sets out timelines for ICD-11 and can be download here: ICD Revision Process [PDF format 1.33 MB]

ICD Revision Process
ICD-11 June 2009

Presentation: Robert Jakob / Bedirhan Üstün

See Slide 9 for “Tentative Timeline” (for overall revision process)

Tentative Timeline

2010 : Alpha version ( ICD 10+ → ICD 11 draft)
– +1 YR : Commentaries and consultations
2011 : Beta version & Field Trials Version
– +2 YR : Field trials
2013 : Final version for public viewing
– 2014 : WHA Approval
2015+ : Implementation

See Slide 38 for “ICD-11 Alpha Drafting Timeline” (to May 2010)

See Slide 39 for “ICD-11 Alpha Draft Calendar” (to May 2010)

Alpha Draft Calendar

Preparations will finish before 31 August 2009
Overall Drafting Period: 14 September 2009 – 15 April 2010
Phase 1: 14 Sept – 11 Dec 2009 (10 WORKING WEEKS)
Provisional Interim Review: 15 Dec – 15 Jan
Phase 2: 18 Jan – 16 April 2010 (10 WORKING WEEKS)
Prefinal Review by WHOFIC: 15 April – Council
Submission for Systematic ALPHA TESTS: May 2010

According to “ICD Revision” on Facebook:

http://www.facebook.com/pages/ICD-Revision/117942832025

ICD-11 alpha draft will be ready by 10 May 2010
ICD-11 beta draft will be ready by 10 May 2011
ICD final draft will be submitted to WHA by 2014

————

It is reported that the APA plans to launch some field trials for DSM-V in October, with all field trials scheduled for completion by the end of 2010 for an anticipated publication date of May 2012.

See:  DSM-V Field Trials Set to Begin, Elsevier Global Medical News, 27 August, 2009

In Advice To DSM V. . .Change Deadlines And Text, Keep Criteria Stable , (Psychiatric Times, 26 August), Frances goes on to raise the issue of non parallel timelines and the forthcoming shift from ICD-9-CM to ICD-10-CM in the US – a transition now scheduled for October 2013:

Frances writes:

“Under normal circumstances, it would make sense to continue the tradition of publishing DSM-V and ICD-11 simultaneously, whenever ICD-11 is ready—probably in 2014. But there is also a problem with a 2014 deadline caused by a coding change that will go into effect before then. ICD-9-CM is now the official method of diagnostic coding used to specify all medical encounters in the United States. It will be replaced in October 2013 by a completely revamped ICD-10-CM. Publishing DSM-V much before October 2013 would result in great confusion and force a choice between 2 equally undesirable options: publish DSM-V in 2012 with the current ICD-9-CM codes, which would be usable only for 18 months; or else, publish DSM-V with the new ICD-10-CM codes even though DSM users would still have to use the ICD-9-CM codes for the next 18 months. Only by delaying publication of DSM-V until just before October 2013 would this problem be solved.”

I have been unable to find any public statements from the DSM Task Force addressing this issue.

For commentary around ICD timelines and the implications for the shift from ICD-9-CM to ICD-10-CM from Dr Christopher Chute, MD, Mayo Clinic bioinformatics specialist and Chair of the ICD Revision Steering Group, see video of PowerPoint presentation, 29 April 08 at http://www.bioontology.org/ICD11-2  (31.55 mins in from start, slides 54, 55, 56).

The APA participates with the WHO in an ICD-DSM Harmonization Coordination Group. The task of this group is “to facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria” with the objective that “the WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.”

The DSM-V Somatic Symptom Disorders Work Group published its latest proposals for the redefining of the classification of “Somatoform Disorders” in a brief April 09 update on the APA’s website, and also as a preliminary report in the June 09 issue of the Journal of Psychosomatic Research, in an Editorial by DSM Work Group members, Francis Creed and Joel Dimsdale (Chair). These latest proposals have not been presented in any great detail and may be subject to further revision prior to forthcoming field trials and issue of alpha drafts. No further DSM-V Work Group updates have been published since April and it’s not known whether the APA intends to publish interim updates before commencing its field trials. 

On 09 July, in Dr Frances Responds to Dr Carpenter: A Sharp Difference of Opinion, Frances called for the posting of all the suggested wordings for DSM-V criteria sets well before considering field trials:

“Will [Dr William Carpenter, MD] seems to think that his presentations at professional meetings in front of relatively small audiences provide a sufficiently open DSM-V process…We, the field, still know almost nothing about the content of what is being considered for DSM-V or how the options still in play are justified by the literature reviews and data reanalyses…We should have every wording of every proposed criteria set or dimension. Why not post these now to allow for the widest review well before field trials are started? I cannot imagine going to the trouble and expense of field testing before there is confidence that the diagnostic concepts make sense and that they are appropriately worded. Equally puzzling is the lack of posting of the literature reviews and of the methods of the proposed field trials. The DSM-V leadership has made the truly bizarre claim that they have provided the “most open process” of all the previous DSM revisions, but they have not posted any explicit or detailed indication of what they are doing and why…If the real reason for not posting is that the material is not yet in a presentable form, admit this and postpone the field trials until everything can be posted and fully vetted.”

Currently we have no information about what changes the WHO might be proposing for its corresponding Chapter V: F45 – F48 codes, how closely the WHO and DSM have been collaborating on the revision of their respective “Somatoform Disorders” sections or to what extent the WHO intends that any changes to this specific section of Chapter V will mirror Task Force proposals for DSM-V, whatever these might be.

————

In “Advice to DSM-V: Integrate with ICD-11″ (Psychiatric Times, 01 September), Allen Frances suggests a radical and provocative “solution” to the various obstacles he perceives – the postponement of the publication date for DSM-V and the integration of DSM-V and ICD-11 into one system.

Frances writes:

“…We would be better off having had only 1 system, either DSM-IV or ICD-10, than we are having both.

What, if anything, can be done to bring DSM-V and ICD-11 into a more harmonious relationship? The best solution would be a clear division of labor. The DSM criteria sets have become the de facto international standard for research use. ICD-10, on the other hand, is often used outside the United States by mental health professionals and primary care clinicians. DSM-V could continue to provide its detailed criteria sets for clinical and research use. ICD-11 would provide brief prototypal narratives adapted from these criteria sets that would be much easier to use in those clinical settings where simplicity is a priority. DSM-V would give up on having its own primary care version, which is no great loss since the one developed for DSM-IV is not much used. ICD-11 would give up its research version, which is also not widely used. Neither system would lose anything essential and the world would be spared the current confusion. The DSM-V criteria sets and the ICD-11 prototypic descriptions would be at different levels of detail-nested and without conflict.

Is this possible? The signs to date do not encourage optimism that integration of the 2 systems will occur. Thus far, this has not been a priority for the DSM-V leadership, and there has been no concerted effort at harmonization. The original publication date for both DSM-V and ICD-11 in 2012 would have meant that the clock had probably run out.

It is possible, however, that a new opportunity for integration may now open up. ICD-11 has been postponed until at least 2014. Although the DSM-V Task Force may not fully realize it yet, its planned publication deadline in May, 2012 appears impossible to meet and is also remarkably inconvenient given a coding change required in October 2013.2 If, as seems necessary, the DSM-V publication date is postponed for a year or more, there will be sufficient time to join the systems in a nested alignment. This would be the most welcome and enduring legacy of both DSM-V and ICD-11…”

These suggestions are likely to provoke further responses on Psychiatric Times online in the coming weeks.

————

In September 2008, Robert Spitzer, MD, (who had chaired the DSM-III Task Force and has also contributed to these exchanges) compared the transparency of the WHO with that of the current DSM revision Task Force. In Psychiatrists Revise Diagnostic Manual – In Secret Spitzer wrote:

“It should be noted that in contrast to this new APA confidentiality policy, which discourages DSM-V members from providing information about the ongoing revision process, the World Health Organization has adopted the opposite policy with regard to its development of ICD-11. Minutes of all ICD-11 meetings are posted on the WHO website without any restrictions on who can have access…”

But contrary to Spitzer’s vision of an open and transparent ICD revision process, the WHO does not appear to be publishing minutes of all ICD-11 meetings on its website other than having posted summary reports of the first three meetings of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. A fourth meeting took place 1-2 December 2008 (with a fifth meeting scheduled for late September) but the WHO has yet to publish a summary report of the Advisory Group’s last meeting, held in Geneva, over nine months ago.

With the exception of Rare Diseases, which has its own internet platform and does publish minutes, progress being made by other Topic Advisory Groups (TAGs), to date, remains obscure, so I cannot agree with Dr Spitzer’s perceptions.

ICD Revision Steering Group chair, Dr Christopher Chute, has been asked to clarify when a summary of the proceedings of this December 2008 meeting will be published and to provide a list of members of the ICD-DSM Harmonization Group, since this information has not been made available on the WHO website nor via the website of the APA.

Dr Chute has also been asked whether a Topic Advisory Group for Neurology is operative and to provide a list of the names of its chair and members; to identify chairs and members of any work group(s) that have already been set up under the Neurology TAG and to clarify what is (or will be) the channel of communication for interest groups wishing to communicate with, or submit proposals to the TAG for Neurology – again, this information is not available from the WHO website, nor is any information on the more recently formed TAGs to be found on the WHO website or on the WHO ICD Update and Revision Platform intranet.

I hope to be in a position to provide an update, shortly.

(See update: 18 September 2009:  Summary Report: 4th Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders )

Latest proposals from the Somatic Symptom Disorders Work Group:

The April 2009 report of the APA DSM-V Somatic Distress Disorders Work Group (also known as the Somatic Symptom Disorders Work Group) can be read here: http://tinyurl.com/DSMSDDWGApril09

The Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary reportby DSM-V Work Group members, Joel Dimsdale and Francis Creed, published in the June issue of the Journal of Psychosomatic Research expands on the proposals in the April 2009 update.

Free access to both text and PDF versions of the Editorial here:

http://download.journals.elsevierhealth.com/pdfs/journals/0022-3999/PIIS0022399909000889.pdf

http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext

ME agenda DSM-V and ICD-11 Directory page:  http://meagenda.wordpress.com/dsm-v-directory/

Posted in CISSD Project, Consultations, Criticism of DSM-V, DSM revision process, Elephant Series DSM-V, ICD revision process, ICD-11, WHO (World Health Organization), WHO Somatisation Project | Comments Off