Summary: ICD-11 Alpha Draft and iCAT (PVFS, ME and CFS)

Summary: ICD-11 Alpha Draft and iCAT (PVFS, ME and CFS)

Shortlink: http://wp.me/p5foE-2Ur

Compiled by Suzy Chapman Dx Revision Watch

May be republished if published in full, unedited and with source acknowledged. 

A version of this report was published on Co-Cure on 11 June 2010.

The information in this summary relates to proposals for ICD-11. It does not apply to ICD-10-CM, the forthcoming US “Clinical Modification” of ICD-10, scheduled for implementation in October 2013.

This report provides a summary of the material published on Dx Revision Watch site on 7 June that included screenshots from the iCAT, the wiki-like collaborative authoring platform through which ICD-11 is being drafted.

 

To view proposals as they currently stand, see the 12 screenshots here:

PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform, 7 June 2010, Post # 46: http://wp.me/pKrrB-KK

 

Presentation of an alpha draft to the WHA:

A hard copy “snapshot” of the ICD-11 alpha draft, as it stood at that point, was presented by WHO at the 63rd World Health Assembly meeting, between 17 and 25 May.

According to page 38 of the document “ICD-11 Revision Project Plan”:

“WHO will consider endorsement of the alpha draft, after all concerns of RSG and the Classification TAGs have been duly taken into account. The alpha draft is a frozen state of development of the ICD-11 that will include a large part of the structural changes, and the majority of the definitions. The Alpha draft will be produced in a traditional print and electronic format. The Alpha Draft will also include a Volume 2 containing the traditional sections and including a section about the new features of ICD-11 in line with the style guide. An index for print will be available in format of sample pages. A fully searchable electronic index using some of the ontological features will demonstrate the power of the new ICD” [1].

The date by which WHO anticipates this stage should be reached is unconfirmed.

Caveat

For better understanding, it is important that the brief iCAT Glossary page is read in conjunction with the iCAT screenshots, especially the Glossary entries for ICD-10 Code, ICD Title, Definition, and for the Terms: Synonyms, Inclusions and Exclusions [2].

Read the iCAT Glossary here:
http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html

Secondly, it needs to be understood that the alpha draft is a “work in progress”. Not all content will have been compiled yet and entered into the iCAT and there are many blank fields awaiting population for all chapters and all categories. It also needs to be understood that some text already entered into the various “Details” fields may still be in the process of internal review.

Summary

In ICD-10, there is no textual content for the three terms “Postviral fatigue syndrome”, “Benign myalgic encephalomyelitis” and “Chronic fatigue syndrome” .

There are no definitions and the relationship between the three terms is not specified.

In ICD-11, categories will be defined through the use of multiple parameters: Title & Definition, Terms: Synonyms, Inclusions, Exclusions, Clinical Description, Signs and Symptoms, Diagnostic Criteria and so on, according to a common “Content Model” [3].

The level of detail currently visible in the iCAT isn’t sufficiently specific to enable me to present an unequivocal overview of current proposals for potential changes to hierarchy or for the specification of the relationships between the three terms of interest to us.

Based only on the information visible in the iCAT as it stood at 11 June 2010, it appears that instead of:

ICD-10: Volume 1: The Tabular List (version for 2007)

http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933

Chapter VI (6)

Diseases of the nervous system
(G00-G99)

[…]

Other disorders of the nervous system
(G90-99)

[…]

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis

(with Chronic fatigue syndrome indexed to G93.3 in ICD-10: Volume 3: The Alphabetical Index)

what appears to be being proposed at this point for ICD-11 is that:

The classifications coded between G83.9 thru G99.8 in ICD-10 Chapter VI: Diseases of the nervous system, are being reorganised.

For ICD-11, Chapter 6, codings beyond G83.9 are represented by new parent classes numbered GA thru to GN;

example:

Chapter 6 VI Disorders of the nervous system

[…]
G80-G83 Cerebral palsy and other paralytic syndromes
GA Infections of the nervous system
GB Movement disorders and degenerative disorders
GC Dementias
GD Epilepsy and seizures
[…]
GN Other disorders of the nervous system

“GN Other disorders of the nervous system” is parent to five child classes which have been assigned the “Sorting labels” Gj90-Gj94.

(A Sorting label is a string that can be used to sort the children of a category. This is not the ICD code.)

Four of these five Gj9x classes have a complex hierarchy of child and grandchildren classes.

At Gj92, sits “Chronic fatigue syndrome”

“Gj92 Chronic fatigue syndrome” has no child classes of its own.

Next to “Gj92 Chronic fatigue syndrome” is an icon for “Category Notes and Discussions”.

There is one Category Note for Gj92 which records:

“[Reason for change]: Change in hierarchy for class: G93.3 Postviral fatigue syndrome. Parents added: (Gj90-Gj99 Other disorders of the nervous system). Parents removed: (G93 Other disorders of brain). New hierarchy”

(Note that the removal of the parent category “G93 Other disorders of brain” will affect a large number of categories classified under G93 in ICD-10, not just those at G93.3.)

In the iCAT production server, click on “Gj92 Chronic fatigue syndrome” and “Details for Gj92 Chronic fatigue syndrome” will display on the right of your screen (it may take a few seconds for the text to load). Or you can view the screenshots on my site: http://wp.me/pKrrB-KK

“Gj92 Chronic fatigue syndrome” is an ICD Title term with a Details page, a Definition and an Inclusions term (but with no Synonyms, Exclusions or other fields yet populated).

“Benign myalgic encephalomyelitis” is listed under Inclusions (the relationship is not currently specified, eg “Synonym” or “Subclass” or whatever).

Extract: iCAT Glossary

http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html#inclusions

“Inclusion terms appear in the tabular list of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.”

————-

In the iCAT ICD Categories list, there is no Gj9x Sorting label listing for “Postviral fatigue syndrome” or “Benign myalgic encephalomyelitis” under “GN Other disorders of the nervous system” or under any other parent or child class, and consequently no Category Details display for either term.

(Whether this is because Inclusion terms would appear in the tabular list version but not in the iCAT version or whether this is because of proposed changes to the hierarchy and/or relationship between the three terms, cannot be determined from the information as it stands at 11 June.)

“Postviral fatigue syndrome” is not currently specified under Inclusions in “Details for Gj92 Chronic fatigue syndrome”.

Again, whether this is because “Postviral fatigue syndrome” would be accounted for in the tabular list version or whether this is because it may be being proposed that the term “Postviral fatigue syndrome” (which has lost its parent class “G93 Other disorders of brain”) should be subsumed into “Chronic fatigue syndrome”, with “Chronic fatigue syndrome” as the new ICD category Title, cannot be determined from the information as it currently stands.

Exclusions

If you pull up the iCAT Details for ICD-11 Chapter 5: F48.0 Neurasthenia (or view the screenshots on my site)

“postviral fatigue syndrome” is listed under Exclusions to Neurasthenia and is referenced thus:

“postviral fatigue syndrome”    G93.3 -> Gj92 Chronic fatigue syndrome

In iCAT Chapter 18: R53 Malaise and Fatigue

“fatigue syndrome postviral” [sic] is also listed under Exclusions, referenced

G93.3 -> Gj92 Chronic fatigue syndrome
 

But that in the absence of further information, it is currently unclear what the proposed hierarchical status of Postviral fatigue syndrome will be in relation to Chronic fatigue syndrome.

————-

When you click on the Category Notes icons for some other categories, the Notes are often more explicit, for example, the Category Note for:

GN Other disorders of the nervous system

> Gj90 Disorders of CSF pressure and flow
         > Gj90.0 Increased intracranial pressure disorders

Reads: [Reason for change]: Create class with name: Increased intracranial pressure disorders, parents: Disorders of CSF Pressure and Flow

replaces G93.5, G93.6, and G93.7

The Category Note for “Gj90 Disorders of CSF pressure and flow” records that this class has been created to replace:

G91, G92, G93.0, G93.2, G94.0, G94.1, G94.2, G96.0, G97.0, G97.1, G97.2

(which also gives an idea of the extent to which the structure of ICD-10 classifications between G90 – G99.8 is being reorganised.)

In the absence of an Alpha Draft, I shall be contacting the chair of the Topic Advisory Group for Neurology for further clarification.

**************************************************

So what can be said is that currently in the iCAT for ICD-11 drafting:

That under Chapter 6 (Neurology):

The parent class “G93 Other disorders of brain” is removed.

“Chronic fatigue syndrome” displays as a Title term in the Categories list.

It is a child to parent class “GN Other disorders of the nervous system”.

It has been assigned the “Sorting label” Gj92.

“Gj92 Chronic fatigue syndrome” has a Definition field populated.

It has an External Definitions field populated which includes definitions imported from other classification systems, the text of which includes “Also known as myalgic encephalomyelitis”.

It has “Benign myalgic encephalomyelitis” specified under Inclusions.

It has no Synonyms, Exclusions or other descriptor fields populated yet.

That at this point and as far as the iCAT version is concerned, neither “Postviral fatigue syndrome” nor “Benign myalgic encephalomyelitis” have been listed as ICD Title terms under the parent class “GN Other disorders of the nervous system” or under any other class.

That at this point and as far as the iCAT version is concerned, there is no accounting for “Postviral fatigue syndrome”, other than that “Postviral fatigue syndrome” is specified under Exclusions to Chapter 5 F48.0 Neurasthenia and to Chapter 18 R53 Malaise and fatigue and is referenced as

“postviral fatigue syndrome” G93.3 -> Gj92 Chronic fatigue syndrome

**************************************************

So please read the iCAT Glossary of Terms page, have a look at the screenshots and then have a poke around in the iCAT – you can’t break anything as members of the public have no editing rights [4].

I shall continue to monitor the iCAT production server closely and report on any changes to proposals for Category listings and on the progress of the population of content. (There has been no change since this report was compiled.)

And if you were thinking of getting a G93.3 tattoo done – well it might be best to hang on for a bit…

References:

[1] ICD-11 Revision Project Plan – Draft 2.0 (v March 10)
Describes the ICD revision process as an overall project plan in terms of goals, key streams of work, activities, products, and key participants:
http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

[2] iCAT Glossary
http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html

[3] Content Model Specifications and User Guide (v April 10)
Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters:
http://tinyurl.com/ICD11ContentModelApril10

[4] iCAT production server and Demo and Training iCAT Platform:
https://sites.google.com/site/icd11revision/home/icat
iCAT production server: http://icat.stanford.edu/
Demo and Training iCAT Platform: http://icatdemo.stanford.edu /

Compiled by Suzy Chapman
http://dxrevisionwatch.wordpress.com
https://meagenda.wordpress.com

US “Clinical Modification” ICD-10-CM: Clarification

US “Clinical Modification” ICD-10-CM: Clarification

Shortlink: http://wp.me/p5foE-2Ul

This post is intended to clarify any confusion between ICD-10, ICD-11 and the forthcoming US Clinical Modification of ICD-10 which will be known as ICD-10-CM.

The WHO published ICD-10 in 1992. The current version of ICD-10 (Version for 2007) is used in the UK and in many countries throughout the world.

ICD-10 is under revision and the development of the structure and content of ICD-11 has been underway since 2007. ICD-11 is scheduled for completion in 2014.

 

Clinical Modifications

Several countries are permitted to publish adaptations of the ICD called “Clinical Modifications” (sometimes known as “national modifications”).

Countries using Clinical Modifications of ICD-10 include Canada (ICD-10-CA), Australia (ICD-10-AM) and Germany (ICD-10-GM).

The United States currently uses an adaptation of the WHO’s now retired ICD-9, called ICD-9-CM, and has been slow to move onto ICD-10.

Rather than skip ICD-10 and move straight onto ICD-11 in 2014+, the US has been developing a modification of ICD 10 called ICD-10-CM which will replace ICD-9-CM.

ICD-10-CM is due for implementation in October 2013.

According to one report, the US should not expect to move on to ICD-11 (or a modification of ICD-11) until well after 2020, assuming that the ICD-11 Beta is published around the 2014-2015 projection:

Why move to ICD-10, if ICD-11 is on the horizon?
http://www.healthcarefinancenews.com/news/why-move-icd-10-if-icd-11-horizon

 

What are the proposed classifications and codings for PVFS, (Benign) ME and Chronic fatigue syndrome for ICD-10-CM?

In March 2001, the document:

“A Summary of Chronic Fatigue Syndrome and Its Classification in the International Classification of Diseases Prepared by the Centers for Disease Control and Prevention, National Center for Health Statistics, Office of the Center Director, Data Policy and Standards”

provided a concise “summary of the classification of Chronic Fatigue Syndrome in the International Classification of Diseases (ICD), ninth and tenth revisions, and their clinical modifications.”

That document is archived here: http://www.co-cure.org/ICD_code.pdf

In 2001, the proposal had been:

“In keeping with the placement in the ICD-10, chronic fatigue syndrome (and its synonymous terms) will remain at G93.3 in ICD-10-CM.”

So at that point, it was being proposed for the forthcoming US ICD-10-CM that PVFS, (Benign) ME and Chronic fatigue syndrome would be coded at G93.3, which would have placed all three terms in Chapter VI: Diseases of the nervous system (the Neurological chapter).

But the current proposals for ICD-10-CM propose classifying Chronic fatigue syndrome in Chapter 18, under R53 Malaise and fatigue, at R53.82.

The “R” codes are classified under

CHAPTER 18 (XVIII)
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill defined conditions regarding which no diagnosis classifiable elsewhere is recorded…

Note: this is not the ICD-10-CM Mental and Behavioural chapter, which is:

CHAPTER 5 (V)
Mental and behavioral disorders (F01-F99)
Includes: disorders of psychological development
Excludes2: symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)

which specifically excludes the R00-R99 codes.

So the current proposal for ICD-10-CM separates CFS and Postviral fatigue syndrome into mutually exclusive categories:

“Chronic fatigue, unspecified” and “Chronic fatigue syndrome not otherwise specified” appear in Chapter 18, under R53 Malaise and fatigue, at R53.82.

Whilst “Postviral fatigue syndrome” and “benign myalgic encephalomyelitis” appear in Chapter 6, under G93 Other disorders of brain, at G93.3.

At some point before October 2013, ICD-10-CM revision will be “frozen” for Centers for Medicare and Medicaid Services (CMS) and insurance companies to prepare for the October 1, 2013 implementation.

See Tom Sullivan at ICD10 Watch.com (no connection with my site) here:

CMS, CDC call for ICD-9 and ICD-10 code freeze
http://icd10watch.com/headline/cms-cdc-call-icd-9-and-icd-10-code-freeze

“CMS, the Centers for Medicare and Medicaid Services, along with CDC, the Centers for Disease Control and Prevention, proposed that both ICD-9-CM and ICD-10-CM/PCS code sets be frozen two years before the compliance deadline.

“What that means: As of October 1, 2011, only limited updates would be instituted into the code sets so that providers, payers, clearinghouses, and health IT vendors, will not have to simultaneously keep pace with code updates while also reconfiguring their existing systems for ICD-10-CM/PCS.” ICD10 Watch.com

During the last ten minutes of the CFSAC meeting on Monday, 10 May, Dr Lenny Jason raised his concerns with the committee that the placement of CFS in ICD-10-CM in the Chapter 18 “R” codes could be problematic.

Videocast of full CFSAC meeting here:
http://videocast.nih.gov/Summary.asp?File=15884

In August 2005, CFSAC had submitted the following recommendation to the Secretary:

http://www.hhs.gov/advcomcfs/recommendations/082005.html

“Recommendation 10: We would encourage the classification of CFS as a ‘Nervous System Disease,’ as worded in the ICD-10 G93.3.”

I suggest that US advocates with concerns about current proposals for the placement of CFS within ICD-10-CM keep a close eye on decisions about the date by which ICD-10-CM is to be frozen.

For the most recent ICD-10-CM proposals see:

http://www.cdc.gov/nchs/icd/icd10cm.htm

The 2010 update of ICD-10-CM is now available and replaces the July 2009 version.

The file for the Tabular List is in a Zipped file which is not that easy to locate on the site. A non Zipped PDF can be downloaded from this site:

http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp#TopOfPage
http://www.cms.gov/ICD10/Downloads/6_I10tab2010.pdf

or open the PDF on my Dx Revision Watch site, here
http://dxrevisionwatch.files.wordpress.com/2009/12/i10tab2010.pdf

ICD-10-CM CHAPTER 18

Tabular List of Diseases and Injuries Page 1165 (Update for 2010)

R53 Malaise and fatigue

[…]

R53.8 Other malaise and fatigue

Excludes1: combat exhaustion and fatigue (F43.0)
congenital debility (P96.9)
exhaustion and fatigue due to:
depressive episode (F32.-)
excessive exertion (T73.3)
exposure (T73.2)
heat (T67.-)
pregnancy (O26.8-)
recurrent depressive episode (F33)
senile debility (R54)

R53.81 Other malaise

Chronic debility
Debility NOS
General physical deterioration
Malaise NOS
Nervous debility
Excludes1: age-related physical debility (R54)

R53.82 Chronic fatigue, unspecified

Chronic fatigue syndrome NOS
Excludes1: postviral fatigue syndrome (G93.3)

R53.83 Other fatigue

Fatigue NOS
Lack of energy
Lethargy
Tiredness

 

ICD-10-CM CHAPTER 6 Page 325 (Update for 2010)

Diseases of the nervous system (G00-G99)

Excludes2:

[…]
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

[…]

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome

Benign myalgic encephalomyelitis
Excludes1: chronic fatigue syndrome NOS (R53.82)

For comparison:

German Modification ICD-10-GM
http://www.dimdi.de/static/de/klassi/diagnosen/icd10/htmlgm2010/block-g90-g99.htm

ICD-10-GM Version 2010

Kapitel VI
Krankheiten des Nervensystems
(G00-G99)

G93.- Sonstige Krankheiten des Gehirns

[…]

G93.3 Chronisches Müdigkeitssyndrom

Benigne myalgische Enzephalomyelitis
Chronisches Müdigkeitssyndrom bei Immundysfunktion
Postvirales Müdigkeitssyndrom

For comparison:

Canadian Modification ICD-10-CA

(Version 2009 of ICD-10-CA/CCI replaces version 2006)

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=codingclass_e

Version 2009 ICD-10-CA Tabular List, Volume 1 PDF (4.9MB)
http://secure.cihi.ca/cihiweb/en/downloads/ICD-10-CA_Vol1_2009.pdf

Version 2009 ICD-10-CA Alphabetical Index, Volume 2 PDF (4.3MB)
http://secure.cihi.ca/cihiweb/en/downloads/ICD-10-CA_Vol2_2009.pdf

Chapter VI

Diseases of the nervous system
(G00-G99)

Other disorders of the nervous system
(G90-99)

[…]

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome

Includes: Benign myalgic encephalomyelitis
Chronic fatigue syndrome

Excludes: fatigue syndrome NOS (F48.0)

For comparison with WHO ICD-10:

Current ICD-10 codings for the three terms are set out on my site, here, together with extracts from Chapter V (the “F” codes) and Chapter XVIII (the “R” codes):

http://dxrevisionwatch.wordpress.com/icd-11-me-cfs/

or go here for the full ICD-10 Volume 1: Tabular List

http://apps.who.int/classifications/apps/icd/icd10online/

ICD-10 Version for 2007 online
http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933

Chapter VI

Diseases of the nervous system
(G00-G99)

Other disorders of the nervous system
(G90-99)

[…]

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis

Note that in ICD-10, Chronic fatigue syndrome is not included in Volume 1: The Tabular List, Chapter VI under the parent term:

G93 Other Disorders of brain

but “Chronic fatigue syndrome” does appear in Volume 3: The Alphabetical Index, where it is indexed to G93.3.

In a forthcoming post, I shall be publishing important information about proposals for parent terms, classifications and codings in the ICD-11 Alpha Draft.

 

Related material:

ICD-9-CM

For information on the current codings in ICD-9-CM (US Clinical Modification) see the NAME U.S. page: WHO ICD Codes section

American Psychiatric Association on DSM-5

In a 10 December Press Release, the American Psychiatric Association said:

“Extending the timeline [for DSM-5] will allow more time for public review, field trials and revisions”

and

“The extension will also permit the DSM-5 to better link with the U.S. implementation of the ICD-10-CM codes for all Medicare/Medicaid claims reporting, scheduled for October 1, 2013. Although ICD-10 was published by the WHO in 1990, the “Clinical Modification” version (ICD- 10-CM) authorized by the U.S. Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control (CDC) is not being implemented in the U.S. until 23 years later.

“The ICD-10-CM includes disorder names, logical groupings of disorders and code numbers but not explicit diagnostic criteria. The APA has already worked with CMS and CDC to develop a common structure for the currently in-use DSM-IV and the mental disorders section of the ICD- 10-CM.

“The International Classification of Diseases (ICD) is published by the WHO for all member countries to classify diseases and medical conditions for international health care, public health, and statistical use. The WHO plans to release its next version of the ICD, the ICD-11, in 2014.

“APA will continue to work with the WHO to harmonize the DSM-5 with the mental and behavioral disorders section of the ICD-11. Given the timing of the release of both DSM-5 and ICD-11 in relation to the ICD-10-CM, the APA will also work with the CDC and CMS to propose a structure for the U.S. ICD-10 CM that is reflective of the DSM-5 and ICD-11 harmonization efforts. This will be done prior to the time when the ICD-10-CM revisions are “frozen” for CMS and insurance companies to prepare for the October 1, 2013, adoption.”

ICD-11 Alpha Draft, iCAT Collaborative Authoring Platform and PVFS, ME, CFS

ICD-11 Alpha Draft, iCAT Collaborative Authoring Platform and PVFS, ME, CFS

Shortlink: http://wp.me/p5foE-2Ui

The information in this report relates to proposals for ICD-11. It does not apply to ICD-10-CM, the forthcoming US “Clinical Modification” of ICD-10.

 

Whither the ICD-11 Alpha Draft?

According to documents published by the ICD Revision Steering Group (RSG) and the Agenda for the iCAMP2 and Revision Steering Group meeting on 19-23 April 2010, it was projected that an alpha draft for ICD-11 would be ready by 10 May 2010 [Key document 1a].

The RSG meeting Agenda proposed that the alpha draft should be presented to the World Health Assembly (WHA) between 17-25 May. A proposal for a press launch was also tabled for discussion.

It is understood that the ICD-11 alpha draft is being created for internal users, was not expected to be complete by May 2010, but released as a “work in progress” towards the beta stage. The beta draft for ICD-11 is scheduled for 2011, which will be subjected to systematic field trials and then made available for public comment.

10 May has come and gone, and there has been no public launch of an alpha draft or the iCAT – the wiki-like collaborative authoring platform through which ICD-11 is being drafted.

As the Minutes of the April RSG meeting are not yet available, it remains unclear how on target the alpha draft is or whether the goals for 2010 have had to be revised. (See Page 7, ICD-11 Revision Project Plan – Draft 2.0 for Project milestones and budget, and organizational overview.)

When the RSG does release information on the status of the alpha draft and the operational status of the iCAT, I will post an update.

In the meantime, I have raised a number of queries around the status of the alpha draft, whether the RSG intends to make a draft available for public viewing, at what point, and in what format(s). I have also asked for information about the availability of Topic Advisory Group proposal forms for stakeholder input, up to what stage in the development process timeline these might be used, and which stakeholders are going to be permitted to make use of proposal forms.

 

iCAT production server

In the posting ICD-11 Alpha Draft scheduled to launch between 10 and 17 May, 6 May, I reported that it is already possible to view a “Demo and Training iCAT Platform” and also access the iCAT production server.

I cautioned that until an official ICD-11 Alpha Draft is released, it cannot be determined how far the various Topic Advisory Groups have progressed with revising classifications and populating textual content according to a common “Content Model” for the ICD Chapters and categories of interest to us [Key document 1b].

I noted that the Demo and Training iCAT Platform, at that point, was sparsely populated for content and that the classifications and codings listed within the various chapters appeared to have been imported from ICD-10, with little discernable change – presumably as the starting point for the drafting process.

A revised Demo and Training iCAT Platform is now accessible, the content of which is also viewable on the iCAT production server and it is to these proposed revisions that I want to draw your attention.

Note that anyone can view the Demo and Training iCAT Platform and iCAT production server but only WHO, ICD Revision and IT personnel and the Managers and members of the various Topic Advisory Groups (TAGS)will have editorial access. External reviewers recruited by TAG Managers will also use the iCAT to upload reviews and comment on proposals and content.

I have compiled a series of screenshots and very brief notes on what is viewable at the moment for the chapters and categories of interest to us.

Note: Screenshots are taken from the Demo and Training iCAT Platform and iCAT production server as they stood at 24 May 2010. Alpha drafting is an ongoing process and what currently appears may be subject to revision, refinement and additions before an official Alpha Draft is released. Not all the classification and content work currently undertaken may have been entered into the iCAT.

Note also that when viewing the iCAT in your browser, the left hand side of the screen displays the ICD Categories listings with the category Definition, Term, Clinical Description, Diagnostic Criteria etc displaying on the right of the screen. Because this view is too wide to display on my website template, the screenshots have had to be split in two. On your screen the iCAT will look like this:

 

When you have read this report and familiarised yourself with the way the iCAT functions, I suggest you poke around – you can’t break anything as members of the public have no editing access.

All screenshots as they stood at 24 May 2010

A wiki-like Collaborative Authoring Tool (known as the iCAT)) is being used for the initial authoring of the alpha draft.

The iCAT production server and Demo and Training iCAT Platform can be accessed here:

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

iCAT production server at: http://icat.stanford.edu/

Demo and Training iCAT Platform at: http://icatdemo.stanford.edu/

Load either (they may take a minute or more to load and appear less inclined to hang in Firefox).

One loaded, you will be presented with an Entry Page – this is the My ICD Tab

Welcome to iCAT – the Initial ICD 11 Collaborative Authoring Tool!

Select the ICD Content Tab and ICD Categories by chapter will populate down the left side of the screen.

Scroll down and open up the + next to 06 VI Diseases of the nervous system

ICD Categories:

 

Scroll down and note that ICD-10 codings between G83.9 and G99.8 are being reorganised and have been assigned the labels GA thru GN (some of which, like GN, are parent categories with child and grandchildren categories).

Open up the + next to GN Other disorders of the nervous system

which is a parent to category Gj92 Chronic fatigue syndrome

(Note: Gj92 is known as a “Sorting label”. A Sorting label is a string that can be used to sort the children of a category. This is not the ICD code.)

Note that Postviral fatigue syndrome and Benign myalgic encephalomyelitis are not currently accounted for in the ICD Categories List as children of the parent category GN Other disorders of the nervous system. Only Chronic fatigue syndrome is listed and assigned the Sorting Label “Gj92”. [See Glossary: Inclusions]

 

 

Click on the double speech bubble icon next to Gj92 Chronic fatigue syndrome which will display 1 Category Discussion Note (Click Expand to display the full note. Discussion Notes can also be accessed via the Category Notes and Discussions Tab, from which the screenshot below, orginates).

Discussion Note for Gj92 Chronic fatigue syndrome:

This Discussion Note records a Change in hierarchy for class: G93.3 Postviral fatigue syndrome because its parent category (G93 Other disorders of brain) is removed.

Note that the removal of the parent G93 Other disorders of brain will affect other categories also classified under G93 in ICD-10, not just G93.3. Open up the double speech bubble icons next to other category listings and you can view the Discussion Notes on proposed restructuring for other G8x and G9x categories.

Next, with the ICD Content Tab selected, click on Gj92 Chronic fatigue syndrome and the Details for Gj92 Chronic fatigue syndrome will display on the right side of the screen. Allow a few moments for the text in the boxes to load.

With the Title & Definition Tab selected (the Tab may read Definition only, depending on whether you are viewing the iCAT production server or the Demo iCAT), you can view the

Details for Gj92 Chronic fatigue syndrome

To view a Glossary of Terms page, which defines the terms in the Tabs click on the blue question mark icons which will load the iCAT Glossary.

Content for Gj92 Chronic fatigue syndrome:

[See Glossary: Definition] The full text of External Definitions (imported from affiliate classification publications) which is partly hidden in the screenshot, is appended at end of this post. According to discussion on the iCAT Users Google Group, it is proposed that External Definitions might be given less prominence when displaying in the iCAT.

 

Now click on the Terms Tab.

Terms for Gj92 Chronic fatigue syndrome:

Benign myalagic encephalomyelitis currently appears listed under Inclusions to Gj92 Chronic fatigue syndrome.

Note that Postviral fatigue syndrome is not listed under Inclusions and that Synonyms and Exclusions for Gj92 Chronic fatigue syndrome have yet to be populated. [See Glossary: Synonyms, Inclusions, Exclusions]

Very few of the other Content Tabs have been populated but it is envisaged that they will be in due course.

I provide no screenshots for Benign myalagic encephalomyelitis or Postviral fatigue syndrome because these are not listed in the ICD Categories List. [See Glossary: ICD Title, Synonyms, Inclusions, Exclusions]

Extract from the iCAT Glossary

6. Inclusions

Short definition: Inclusion terms are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy.

Details: Inclusion terms appear in the tabular list of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.

7. Exclusions

Short definition: Exclusion terms help users eliminate entities that should be assigned to a different ICD category because of differences in meaning or terminology.

Details: Exclusion terms help users eliminate entities that should be assigned to a different ICD category because of differences in meaning or terminology.

 

I am including some screenshots of other Chapters which will be of interest.

Chapter 5 (V) Somatoform Disorders at F45 (currently same as or near ICD-10):

 

Neurasthenia remains in Chapter 5 (V) at F48.0:

 

Inclusions and Exclusions for Neurasthenia:

 

Chapter 18 (XVIII) displaying R53 Malaise and fatigue (this is the Chapter under which the US Clinical Modification, ICD-10-CM, proposes classifying Chronic fatigue syndrome, at R53.82):

 

Inclusions and Exclusions for R53 Malaise and fatigue:

 

Here are the two Category discussion Notes that appear directly beneath 06 VI Diseases of the nervous system (no ICD10 concepts from Chapter 06 VI are currently moved into either of these “holding pens”).

1 Discussion Note for: Needing a decision to be made

 

1 Discussion Note for: To be retired

________________________________________________________________________

  

External Definitions: (Imported from affiliate classification publications, these remain the same as my 6 May posting.)

External Definitions for Gj92 Chronic fatigue syndrome

A syndrome of unknown etiology. Chronic fatigue syndrome (CFS) is a clinical diagnosis characterized by an unexplained persistent or relapsing chronic fatigue that is of at least six months duration, is not the result of ongoing exertion, is not substantially alleviated by rest, and results in substantial reduction of previous levels of occupational, educational, social or personal activities. Common concurrent symptoms of at least six months duration include impairment of memory or concentration, diffuse pain, sore throat, tender lymph nodes,headaches of a new type, pattern, or severity, and nonrestorative sleep. The etiology of CFS may be viral or immunologic. Neurasthenia and fibromyalgia may represent related disorders. Also known as myalgic encephalomyeltis.

Ontology ID UMLS/NC12007_05
E

distinctive syndrome characterized by chronic fatigue, mild fever, lymphadenopathy, headache, myalgia, arthralgia, depression, and memory loss: candidate eitiological agents include Epstein-Barr and other herpesviruses.

Ontology ID UMLS/CSP2006

A syndrome characterized by persistent or recurrent fatigue, diffuse musculoskeletal pain, sleep disturbances, and subjective cognitive impairment of 6 months duration or longer. Symptoms are not caused by ongoing exertion; are not relieved by rest; and result in a substantial reduction of previous levels of occupational, educational, social or personal activities. Minor alterations of immune, neuroendocrine, and automatic function may be associated with this syndrome. There is also considerable overlap between this condition and FIBROMYALGIA.
(From Semin Neurol 1998;18(2):237-42: Ann Intern Med 1994 Dec 15;121(12):953-9)

Ontology ID UMLS/MSH2008_2
008_02_04

 

Based only on the information visible in the iCAT as it stood at 24 May 2010, it appears that instead of:

ICD-10 (version for 2007) Tabular List

http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933

Chapter VI (6)

Diseases of the nervous system
(G00-G99)

[…]

Other disorders of the nervous system
(G90-99)

[…]

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis

(with Chronic fatigue syndrome indexed to G93.3 in Volume 3: The Alphabetical Index)

that what may be being proposed at this point is:

that G83.9-G99.8 codes in ICD-10 Chapter VI: Diseases of the nervous system are being restuctured;

that G93 Other disorders of brain is removed as a parent category for G93.x codings;

that GN Other disorders of the nervous system

is now the parent to a large number of categories previously classified between G83.9 and G99.8

that GN Other disorders of the nervous system is the parent to

Gj92 (Sorting label) Chronic fatigue syndrome

that Gj92 Chronic fatigue syndrome is included in ICD-11 Chapter 06 VI Diseases of the nervous system (Neurology chapter) in the ICD Categories list as an ICD Title term;

that there is currently displaying no Gj9x Sorting label (or any other Sorting label) listing for Postviral fatigue syndrome or Benign myalgic encephalomyelitis in ICD Categories list or any Category Details for either term;

(Whether this is because Inclusion terms appear in the tabular list of the traditional print version but not in the iCAT version, or because of proposed hierarchy changes to the relationship between these three terms or because text remains to be entered into the iCAT for these two terms, cannot be determined from the information available at 10 June – please refer to Glossary of Terms which sets out the relationships between an ICD Title and its inclusion in the iCAT Categories list and between an ICD Title and its Synonyms, Inclusions and Exclusions.)

that Gj92 Chronic fatigue syndrome is an ICD Title term with a Details page, a Definition and an Inclusion term (but with no Synonyms or Exclusions or other fields yet populated);

that Benign myalgic encephalomyelitis is listed as an Inclusion to Gj92 Chronic fatigue syndrome

that Chapter 5 V Details for F48.0 Neurasthenia specifies
“postviral fatigue syndrome” as an Exclusion with References

G93.3 -> Gj92 Chronic fatigue syndrome

that Chapter 18 XVIII Details for R53 Malaise and Fatigue specifies
“fatigue syndrome postviral” [sic] as an Exclusion with References

F48.0 -> F48.0 Neurasthenia,
G93.3 -> Gj92 Chronic fatigue syndrome

but that in the absence of further information, it is currently unclear what the proposed hierarchical status of Postviral fatigue syndrome and Benign myalgic encephalomyelitis will be in relation to Chronic fatigue syndrome, and in relation to each other.

I shall continue to monitor the iCAT production server closely and report on any changes to proposals for Category listings and on the progress of the population of content.

 

[1] Key documents:

a) ICD-11 Revision Project Plan – Draft 2.0 (v March 10) [PDF format]
Describes the ICD revision process as an overall project plan in terms of goals, key streams of work, activities, products, and key participants.

b) Content Model Specifications and User Guide (v April 10)
Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.

c) Alpha Drafting Workflow (v 06.10.09)
Sets out lines of responsibility between the various contributors for the alpha drafting phase.

d) Further documents eg Style Guide, ICD-11 Conventions:
ICD Revision Google site

ICD-10-CM codings raised at 10 May CFSAC meeting

ICD-10-CM raised at 10 May CFSAC meeting

Shortlink: http://wp.me/p5foE-2SF

A one day public meeting of the US Chronic Fatigue Syndrome Advisory Committee (CFSAC) was held on Monday, 10 May. Minutes of the previous two day meeting and a Videocast of the proceedings of both days (with subtitles) can be accessed here and here.

The Chronic Fatigue Syndrome Advisory Committee (CFSAC) provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Department of Health and Human Services on issues related to chronic fatigue syndrome (CFS). More information here [PDF].

Towards the end of the Spring meeting, Dr Leonard Jason, PhD, raised concerns in response to current proposals for the placement of CFS within the forthcoming US “Clinical Modification”, ICD-10-CM, due to be implemented in October 2013. (See foot of this Dx Revision Watch page for current ICD-10-CM proposals.)

Agenda for this Spring 2010 meeting here

CFSAC Agenda – May 10, 2010
Chronic Fatigue Syndrome Advisory Committee
US Department of Health and Human Services

Meeting was webcast live at http://videocast.nih.gov

Webcast of entire meeting with subtitles is now available to view here

Chronic Fatigue Syndrome Advisory Committee
Monday, May 10, 2010
HHS Office on Women’s Health (OWH)
Total Running Time: 05:47:57

More information here: http://videocast.nih.gov/Summary.asp?File=15884

Presentations, Public Testimonies and Written Testimonies here

Transcripts are being compiled on a dedicated Facebook site here

YouTubes videos here:

New Hillary Johnson blog post – “Sif-Sac, again.” here

Cort Johnson blog

A very different looking federal advisory committee on CFS (CFSAC) discussed its charter, its recommendations, XMRV and the blood supply, what the CDC program will look and more. Asst Secretary of Health Dr. Koh, Annette Whittemore and Kim McCleary spoke. Check out the goings on at the CFSAC meeting in

‘The CFSAC on Itself, XMRV, the CDC and More’ from the Bringing the Heat blog:

Phoenix Rising forum thread here

CFSAC Agenda – May 10, 2010

May 10, 2010

9:00 am
Call to Order
Opening Remarks

Roll Call, Housekeeping
Dr. Christopher Snell
Chair, CFSAC

Dr. Wanda Jones
Designated Federal Official

9:15 am
Welcome Statement from the Assistant Secretary for Health

New Members Statement on CFSAC Interests/Goals
Dr. Howard K. Koh

CFSAC New Members

10:00 am
Remarks from Dr. Elizabeth Unger
Dr. Elizabeth Unger

10:30 am
Blood Safety Update on XMRV
Dr. Jerry Holmberg

11:00 am
Review/Update of past CFSAC recommendations
Committee Members

12:30 pm
Subcommittee Lunch
Subcommittee Members

1:30 pm
Public Comment
(on CFSAC charter)
Public

2:00 pm
Review and Discussion of CFSAC Charter and ByLaws
Committee Members

4:00 pm
Adjourn

ICD-11 Alpha Draft: launch scheduled 10 – 17 May

ICD-11 Alpha Draft: launch scheduled 10 – 17 May

Shortlink: http://wp.me/p5foE-2Sg

Note that until the ICD-11 Alpha Draft is released, it cannot be determined how far the various Topic Advisory Groups have progressed with proposals for revising ICD-10 classifications or with populating definitions and other content according to the ICD Content Model. Proposals for revision of classifications and textual content may differ from the examples on the Demo and Training iCAT platform as it appeared on the date this report was compiled (accessed 06.05.10).

The ICD-11 Alpha Draft and iCAT (Initial ICD-11 Collaborative Authoring Tool) is anticipated to be launched by the WHO between 10 and 17 May.  See this Dx Revision Watch report

Also note that information in this report applies to the revision of ICD-10 towards ICD-11. Countries using a “Clinical Modification” of ICD, for example, Canada (ICD-10-CA), the USA (implementing ICD-10-CM, in October 2013), Australia (ICD-10 AM) and Germany (ICD-10-GM) should refer to their specific national modification of ICD.

Allen Frances MD on DSM-5 draft proposals and comment: Psychology Today

Allen Frances MD on DSM-5 draft proposals and comment: Psychology Today

Shortlink: http://wp.me/p5foE-2Ry

Over the past 12 months, Allen Francis MD has published a series of often controversial commentaries on the DSM revision process in the media, via Psychiatric Times website and yesterday, on the site of Psychology Today.

Dr Frances had been chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

I have had a comment published, this morning, in response to his latest piece on Psychology Today.

Blogs
DSM5 in Distress

The DSM’s impact on mental health practice and research.
by Allen Frances, MD

DSM5: An Open Process Or Bust
The next steps need help from the field and public.
Published on April 12, 2010

“The first drafts of DSM5 were posted two months ago, allowing the field and the public a first glimpse into what had previously been an inexplicably secretive process. Today is the last day for public comment on these drafts…”

Read full text here

Comments

Public review process

Submitted by Suzy Chapman on April 13, 2010 – 3:24am.

I would like to thank Dr Frances for his commentaries around the DSM revision process. I hope he won’t mind my highlighting that draft proposals are out for review until Tuesday, 20 April – so there is another week during which health professionals, researchers, patient organisations and the lay public can input into the review process.

For some time now, professionals in the field, interest groups and the media have voiced concerns that the broadening of criteria for some DSM-5 categories would bring many more patients under a mental health diagnosis.

But if the draft proposals of the “Somatic Symptom Disorders” Work Group were to be approved there will be medical, social and economic implications to the detriment of all patient populations and especially those bundled by many within the field of liaison psychiatry and psychosomatics under the so-called “Functional Somatic Syndromes” (FSS) and “Medically Unexplained Syndromes” (MUS) umbrellas, under which they include Chronic fatigue syndrome, ME, Fibromyalgia, IBS, chemical injury, chemical sensitivity, chronic Lyme disease, GWS and others [1].

There is considerable concern amongst international patient organisations for the implications of the “Somatic Symptom Disorders” Work Group proposal for combining Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC), and Factitious Disorders under a common rubric called “Somatic Symptom Disorders” and for the creation of a new classification, “Complex Somatic Symptom Disorder” (CSSD).

They are particularly concerned for patients living with conditions characterised by so-called “medically unexplained symptoms” or with medical conditions for which diagnostic tests are currently lacking that provide evidence substantiating the medical seriousness of their symptoms and the need for provision of appropriate medical investigations, treatments, financial and social support, and in the case of children and young people, the putting in place of arrangements for the education of children too sick to attend mainstream school.

According to “Somatic Symptom Disorders” Work Group proposals:

[Criteria superceded by third draft criteria.]

The CFIDS Association of America has submitted: “As drafted, the criteria for CSSD establish a “Catch 22” paradox in which six months or more of a single or multiple somatic symptoms – surely a distressing situation for a previously active individual – is classified as a mental disorder if the individual becomes “excessively” concerned about his or her health. Without establishing what “normal” behavior in response to the sustained loss of physical health and function would be and in the absence of an objective measure of what would constitute excessiveness, the creation of this category poses almost certain risk to patients without providing any offsetting improvement in diagnostic clarity or targeted treatment.” [2]

To date, there has been little public discussion by professionals or the media of the medical, social and economic implications for patients of the application of an additional diagnosis of “Complex Somatic Symptom Disorder”.

With a week to go before this initial public review period closes there is still time and I urge professionals and stakeholders to scrutinise the proposals of the “Somatic Symptom Disorder” Work Group and to submit their concerns to the Task Force.

Suzy Chapman, UK patient advocate

[1] Marin H, Escobar JI: Unexplained Physical Symptoms What’s a Psychiatrist to Do? Psychiatric Times. Aug 2008, Vol. 25 No. 9 http://www.psychiatrictimes.com/display/article/10168/1171223

[2] CFIDS Association of America submission to DSM-5 public review:
http://www.cfids.org/advocacy/2010/dsm5-statement.pdf

—————————

Related material:

PULSE Today

Managing medically unexplained symptoms, 07 Apr 10

—————————

The DSM-5 public review period runs from 10 February to 20 April. Members of the public, patient representation organisations, professionals and other end users can submit responses, online.

Please take this opportunity to register comment and to alert and encourage professionals and international patient organisations to participate.

Proposed Draft Revisions to DSM Disorders and Criteria are published here on the APA’s relaunched DSM5.org website: http://www.dsm5.org/Pages/Default.aspx

Somatoform Disorders:
http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

Proposed new DSM-5 category: Complex Somatic Symptom Disorder
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

Two Key PDF documents are associated with proposals:

 PDF Somatic Symptom Disorders Introduction DRAFT 1/29/10

 PDF Justification of Criteria – Somatic Symptoms DRAFT 1/29/10

The Alpha Draft for ICD-11 is scheduled for May 2010. I shall be posting again shortly around the ICD-11 revision process.

DSM-5 submissions by US, UK and international patient organisations

DSM-5 submissions by US, UK and international patient organisations

Shortlink: http://wp.me/p5foE-2Rk

The DSM-5 public review period closes on 20 April – that’s less than four weeks away.

Patient representation organisations, clinicians, researchers, allied health professionals, patient advocates and other stakeholders can register online at www.dsm5.org to submit responses.

 

US patient organisation submissions:

CFSIDS: The March issue of CFIDSLink-e-News reports that the CFIDS Association of America is seeking input from outside experts into the DSM-5 public review process. Their notice can be read here:
http://www.cfids.org/archives/2006-2010-cfidslink/march-2010.asp#advocacy

WPI: The Whittemore Peterson Institute has announced on its Facebook site that it intends to submit a response:
http://www.facebook.com/pages/Whittemore-Peterson-Institute/154801179671

International patient organisation submissions:

IACFSME: The IACFSME has issued an alert for international CFS and ME clinicians, researchers and professionals and has published a copy of the organisation’s own submission in the DSM-5 public review process. Their notice and submission can be read here: http://www.iacfsme.org/Home/tabid/36/Default.aspx

ESME: ESME (International Society for ME) has stated on its Facebook site that its Think Tank panel members will submit a response which will be posted on ESME’s website and on ESME’s Facebook page:
http://www.facebook.com/pages/ESME-European-Society-for-ME/326113349124

If readers are aware of other US organisations, international organisations or professionals who have stated that they intend to submit responses, please let me know as I am collating these on my site.

 

UK patient organisation submissions:

On 4 March, I contacted senior personnel of seven national UK patient and research organisations. All were sent key links and documents relevant to the DSM-5 Somatic Symptom Disorders Work Group proposals. (These organisations had also been sent selected DSM revision related material during the course of the past twelve months so all will have been aware of the impending release of draft proposals for DSM-5.)

They were all asked if they would clarify whether they intended to submit a response to the DSM-5 draft proposals for revision of DSM-IV categories currently classified under “Somatoform Disorders” and if so, whether they intended to publish their submission.

Those organisations which had not responded by 22 March were contacted again. These are the replies so far to my enquiries:

The Young ME Sufferers Trust: No reply received.

AYME: No reply received.

Invest in ME: Invest in ME has confirmed that it does intend to submit a response and that it will be publishing its response.

ME Research UK: Neil Abbott has said that it is uncertain whether resources will run to producing a response, but if a response is put together on behalf of MERUK, then this would be made publicly available.

Action for M.E.: On 25 March, in a telephone conversation, Action for M.E.’s Policy Officer was unable to confirm what Action for M.E.’s intentions are. The Policy Officer was asked to follow this up with Sir Peter Spencer (CEO) and Heather Walker (Communications Manager) since neither had responded to my email enquiries.

Later in the day, Action for M.E. posted on its Facebook Wall ( http://www.facebook.com/actionforme ) that:

“Action for M.E. will respond to the American consultation exercise before the 20th April.

“We will publish our considered response on our website when it has been submitted to the DSM-5 Task force.

“Action for M.E ‘s position is that M.E./CFS is a long-term and disabling physical illness. We accept the WHO classification in ICD 10 G93.3 that M.E. is a neurological disorder.

“We will oppose any attempt to classify CFS/M.E. as a psychiatric disorder either explicitly or implicitly.”

25% ME Group: The 25% ME Group has published a 12 page “Submission re: DSM-V and ME/CFS”, compiled by Professor Malcolm Hooper and Margaret Williams for submission by The 25% ME Group, dated 20 March 2010:
http://www.25megroup.org/News/DSM-V%20submission.doc

The ME Association: Neil Riley, Chair of the ME Association Board of Trustees, provided me with the following information:

That a response had already been submitted to the DSM-5 on 11 February.
That the response was submitted not by the ME Association but by Dr Ellen Goudsmit, PhD.
That the ME Association endorses Dr Goudsmit’s submission.
That the ME Association “had not thought of publishing it and wanted to see what the final proposals for the revision of the DSM categories will be but [Mr Riley] can confirm that the main argument put forward was that CFS should be an exclusion.”

In response to a request for further clarification, Mr Riley wrote:

“As you are aware the DSM-5 draft proposals relate to proposed psychiatric categories and this is a specialised field for which professional advice was best sought. As you know CFS and ME are not in the current draft for DSM-5. A comment was submitted related to another disorder (CSSD) which may be considered by some clinicians as an additional diagnosis on the axis e.g. affecting outcome of CFS. This was not a response to the text on CFS but challenged the robustness of a proposed psychiatric disorder.”

“The current text in the draft ‘clarifies that a diagnosis of CSSD is inappropriate in the presence of only unexplained medical symptoms. Similarly, in conditions such as irritable bowel syndrome, CSSD should not be coded unless the other criterion (criterion B-attributions, etc) is present.’ Without diagnostic tests to determine whether attributions are correct (cf criterion B), our recommendation is that to avoid confusion, CFS should be an exclusion.”

Mr Riley added:

“If a future draft mentions CFS, a formal response on behalf of the MEA is justified and will be published in full online.”

Other than the comments contained in Mr Riley’s responses to me earlier this month, the ME Association has been silent on the DSM-5 revision process and its position on the proposals of the Somatic Symptom Disorders Work Group and whether it had intended to submit a response, as an organisation, on behalf of its members.

Mr Riley’s response indicates that the ME Association does not plan to publish a copy of the response which it says it is endorsing, in order to fully inform its membership and the wider ME community of its position on the DSM-5 proposals.

If you find this unacceptable, please advise the Board of Trustees.

In June 2009, the ME Association published, on its website only, a “Summary Report” on the CISSD Project* which had been co-ordinated by Dr Richard Sykes, PhD. between 2003 and 2007. This report drew on the content of the December 2007 Final Report on the CISSD Project handed to the project’s Administrators, Action for M.E. on completion of the project.

The ME Association has published no comment or opinion on the aims and objectives of the project, itself, the membership of its workgroup, the content and recommendations contained in the Review paper published by the project’s leads, Kroenke, Sharpe and Sykes in mid 2007, or on the “Summary Report” provided to it by Dr Sykes, either at the time that it placed this document on its website, last June, nor since.

The project’s UK chair was Professor Michael Sharpe.

I will update when I have heard from the remaining three organisations.

If readers are aware of other UK organisations and professionals who are intending to make a submission, please let me know.

 

Related material:

The DSM-5 proposal is that Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC) and Factitious Disorders should be combined under a common rubric entitled “Somatic Symptom Disorders” and for a new disorder – “Complex Somatic Symptom Disorder (CSSD)”.

The DSM-5 public review period runs from 10 February to 20 April. Members of the public, patient representation organisations, professionals and other end users can submit responses, online.

Please take this opportunity to comment and to alert and encourage professionals and international patient organisations to participate.

Proposed Draft Revisions to DSM Disorders and Criteria are published here on the APA’s relaunched DSM5.org website: http://www.dsm5.org/Pages/Default.aspx

Somatoform Disorders:
http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

Proposed new DSM-5 category: Complex Somatic Symptom Disorder:
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

Two Key PDF documents are associated with proposals:

PDF A] Somatic Symptom Disorders Introduction DRAFT 1/29/10
http://www.dsm5.org/Documents/Somatic/APA%20Somatic%20Symptom%20Disorders%20description%20January29%202010.pdf

PDF B] Justification of Criteria – Somatic Symptoms DRAFT 1/29/10
http://www.dsm5.org/Documents/Somatic/APA%20DSM%20Validity%20Propositions%201-29-2010.pdf

*Review paper: CISSD Project leads Kroenke K, Sharpe M, Sykes R: Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations. Psychosomatics 2007 Jul Aug;48(4):277-85. FREE Full Text: http://psy.psychiatryonline.org/cgi/content/full/48/4/277

18 Proposals submitted by Dr Richard Sykes to WHO ICD Update and Revision Platform, Topical Advisory Group – Mental Health (TAGMH): https://extranet.who.int/icdrevision/GroupPage.aspx?gcode=104

The paper: Kroenke K: Somatoform disorders and recent diagnostic controversies. Psychiatr Clin North Am 2007 Dec;30(4):593-619: http://www.ncbi.nlm.nih.gov/pubmed/17938036 contains the caveat:

“Although the CISSD is an ad hoc group that includes many international experts on somatoform disorders, it was neither appointed nor sanctioned by the APA or WHO, the organizations authorized to approve revisions of DSM and ICD, respectively. As such, the CISSD recommendations should be considered advisory rather than official. Also, there were some suggestions for which the CISSD achieved near consensus but other issues where opinions diverged considerably.”

——————

Note: An unpublished paper refered to on the DSM-5 site at this URL under “Rationale”

Complex Somatic Symptom Disorder [Rationale Tab]
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

“A key issue is whether the guidelines for CSSD describe a valid construct and can be used reliably. A recent systematic review (Lowe, submitted for publication) shows that of all diagnostic proposals, only Somatic Symptom Disorder reflects all dimensions of current biopsychosocial models of somatization (construct validity) and goes beyond somatic symptom counts by including psychological and behavioral symptoms that are specific to somatization (descriptive validity). Predictive validity of most of the diagnostic proposals has not yet been investigated.”

is thought to be this paper currently “In Press” on the Journal of Psychosomatic Research, for which DSM-5 SDD Work Group member, Frances Creed, is a co-editor. Access to full paper requires subscription or pay per paper:

Articles in Press
http://www.jpsychores.com/inpress

Towards positive diagnostic criteria: A systematic review of somatoform disorder diagnoses and suggestions for future classification
In Press Corrected Proof , Available online 15 March 2010
Katharina Voigt, Annabel Nagel, Björn Meyer, Gernot Langs, Christoph Braukhaus, Bernd Löwe
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.01.015
Abstract | Full Text | Full-Text PDF (183 KB)

Abstract
http://www.jpsychores.com/article/S0022-3999(10)00020-6/abstract

Towards positive diagnostic criteria: A systematic review of somatoform disorder diagnoses and suggestions for future classification

Katharina Voigta 1, Annabel Nagel a1, Björn Meyer a, Gernot Langs b, Christoph Braukhaus b, Bernd Löwe a
Received 1 November 2009; received in revised form 12 January 2010; accepted 14 January 2010. published online 15 March 2010. Corrected Proof

Abstract

Objectives
The classification of somatoform disorders is currently being revised in order to improve its validity for the DSM-V and ICD-11. In this article, we compare the validity and clinical utility of current and several new diagnostic proposals of those somatoform disorders that focus on medically unexplained somatic symptoms.

Methods
We searched the Medline, PsycInfo, and Cochrane databases, as well as relevant reference lists. We included review papers and original articles on the subject of somatoform classification in general, subtypes of validity of the diagnoses, or single diagnostic criteria.

Results
Of all diagnostic proposals, only complex somatic symptom disorder and the Conceptual Issues in Somatoform and Similar Disorders (CISSD) example criteria reflect all dimensions of current biopsychosocial models of somatization (construct validity) and go beyond somatic symptom counts by including psychological and behavioral symptoms that are specific to somatization (descriptive validity). Predictive validity of most of the diagnostic proposals has not yet been investigated. However, the number of somatic symptoms has been found to be a strong predictor of disability. Some evidence indicates that psychological symptoms can predict disease course and treatment outcome (e.g., therapeutic modification of catastrophizing is associated with positive outcome). Lengthy symptom lists, the requirement of lifetime symptom report (as in abridged somatization), complicated symptom patterns (as in current somatization disorder), and imprecise definitions of diagnostic procedures (e.g., missing symptom threshold in complex somatic symptom disorder) reduce clinical utility.

Conclusion
Results from the reviewed studies suggest that, of all current and new diagnostic suggestions, complex somatic symptom disorder and the CISSD definition appear to have advantages regarding validity and clinical utility. The integration of psychological and behavioral criteria could enhance construct and descriptive validity, and confers prospectively relevant treatment implications. The incorporation of a dimensional approach that reflects both somatic and psychological symptom severity also has the potential to improve predictive validity and clinical utility.

Keywords: Classification, Diagnosis, Diagnostic and Statistical Manual of Mental Disorders, International Classification of Diseases, Somatoform disorders, Validation studies as topic

a Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany
b Medical and Psychosomatic Hospital Bad Bramstedt, Bad Bramstedt, Germany
Corresponding author. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 59733; fax: +49 40 7410 54975.
1 Both authors contributed equally to this paper.
PII: S0022-3999(10)00020-6
doi:10.1016/j.jpsychores.2010.01.015

Compiled by Suzy Chapman

DSM-5 Draft Criteria Available for Public Comment 10 February through 20 April

DSM-5 Draft Criteria Available for Public Comment 10 February through 20 April

Shortlink: http://wp.me/pKrrB-x2

Source: Student Doctor

The American Psychiatric Association is seeking your comments on proposed criteria for the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard classification of mental disorders used by mental health and other health professionals for diagnostic and research purposes.

Proposed DSM-5 draft criteria will be available for review and comment at http://www.DSM5.org from February 10 to April 20, 2010. Health professionals, mental health consumers and family members are invited to visit the site to review and comment on the draft criteria.

DSM-5 remains a work in progress: following the public comment period, the DSM-5 Task Force and Work Groups will spend two years reviewing and refining proposed criteria based on public comments and the results of field trials, which will be conducted in three phases to test some of the proposed diagnostic criteria in real-world clinical settings.

The release of the final DSM-5 is expected in May 2013.

For more information, visit http://www.DSM5.org .

New documents on ICD-11 Revision site

New documents on ICD-11 Revision site: WHO iCAMP ICD-ICF Linkages Meeting, Geneva, 28–29 January 2010:

Shortlink: http://wp.me/p5foE-2IP

On 28 to 29 January, a two day iCAMP Face-to-Face Meeting was held at WHO HQ, Geneva, Switzerland.

The International Classification of Functioning, Disability and Health, also known as ICF, is a classification of the health components of functioning and disability. The ICF classification complements the WHO’s ICD-10, which contains information on diagnosis and health condition, but not on functional status. The ICD and ICF constitute the core classifications in the WHO Family of International Classifications (WHO-FIC).

A List of Participants, Meeting Agenda, Background Documentation, PowerPoint presentations and other documents can be found here on the Face-to-Face Meeting page, ICD-11 Revision Site: ICD-ICF Linkages Meeting

Three documents that may be of interest:

Style Guide for the Content Model of the ICD-11 Alpha draft

The “Content Model” identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.

Most recent version of Content Model Style Guide (at 27.01.10)

Note: It is not yet known how much textual content might be included in ICD-11: Volume 1, and ICD-11: Volume 3: The Alphabetical Index, for the terms that are the focus for this site. But this is the most recent version of this important document and it needs to be scrutinised.

ICD Revision Project Executive Summary

Project milestones and budget, and organizational overview  Page 5

New document: ICD Revision Project Executive Summary (at 25.01.10)

Note: Project milestones on Page 5 gives a release date for the ICD-11 Alpha draft as February 2010.  Other current ICD Revision resources give a date of May 2010.

Alpha Drafting Workflow

Sets out lines of responsibility between the various contributors for the alpha drafting phase.
TAG = Topic Advisory Group; RSG = Revision Steering Group.

• TAG members and TAG workgroup members
• Classification Experts. (mainly the experts on the classification with respect to the mortality and morbidity use cases)
• TAG managing Editors
• Reviewers who are asked to review portions of the content in a structured fashion
• TAGs
• RSG
• WHO

Alpha Drafting Workflow (at 06.10.09)

Additional resources and documents are being posted by ICD Revision on a dedicated public access site. Some of these documents are works in progress and subject to internal review and revision. Please refer to the site for the most recent versions. The three documents posted here are as they stood at 28 January 2010.

ICD-11 Revision site  |  Revision and iCAMP meeting resources

ICD-11 Revision site Documents Page  |  Key revision documents

Notes:

1] The APA now plans to publish draft proposals for changes to diagnostic criteria on 10 February. The Alpha Draft for ICD-11 is currently timelined for May 2010.

2] DSM-V Somatic Symptom Disorders Work Group proposals so far can be found at: DSM-5 and ICD-11 Watch at: http://wp.me/PKrrB-hT

3] The Academy of Psychosomatic Medicine November ’09 Annual Meeting slide presentations here:

Francis Creed, MD, FRCP: Can We Now Explain Medically Unexplained Symptoms?

PDF Creed Presentation Slides (No transcript)
http://www.apm.org/ann-mtg/2009/presenter-slides/HackettAward-creed.pdf

PDF References
http://www.apm.org/ann-mtg/2009/presenter-slides/HackettAward-creed-refs.pdf




(A lengthy but important slide presentation by DSM-V Somatic Symptom Disorders Work Group member, Francis Creed. No transcript available but please view the slides – there are many references to “Chronic fatigue syndrome”, chronic fatigue and IBS and to the so called “Functional Somatic Syndromes”.)

Lawson Wulsin, MD, FAPM, DSM V for Psychosomatic Medicine: Current Progress and Controversies
PDF Wulsin Presentation Slides (No transcript)

http://www.apm.org/ann-mtg/2009/presenter-slides/W15-wulsin.pdf

Joel Dimsdale, MD, FAPM, Update on DSM V Somatic Symptoms Workgroup
Text version (No slides)

http://www.apm.org/ann-mtg/2009/presenter-slides/W15-dimsdale-text.pdf

4] ICD-11 and DSM-V (DSM-5) focussed editorials and articles in January 2010 edition of Advances in Psychiatric Treatment: Shortlink to DSM-5 and ICD-11 Watch posting: http://wp.me/pKrrB-up

ICD-11 and DSM-V focussed editorials and articles: Advances in Psychiatric Treatment, Jan 10

ICD-11 and DSM-V (DSM-5) focussed editorials and articles in: Advances in Psychiatric Treatment, Jan 10

Shortlink: http://wp.me/p5foE-2G1

In the January 2010, Volume 16, Issue 1 edition of Advances in Psychiatric Treatment there are two editorials and some articles around ICD-11 and DSM-V revision classificatory issues.

The Bouch editorial commentary, the Sartorius editorial and the Thornicroft et al article all include brief references to “chronic fatigue syndrome”.

Read on at DSM-5 and ICD-11 Watch