02 - Structure of ICD 10

Structure of ICD-10

© SPMM Course both diagnoses in a given patient at a point of time. This hierarchy is generally non-reflexive, i.e. each disorder tends to manifest the symptoms of those lower down but not those of disorders higher up. Despite such a hierarchical construct, co-morbidity can be still entertained, and this is explicitly encouraged when using DSM. For example, alcohol used disorder can be comorbid with depressive disorder. Multi-axial approach: Recently there has been an upsurge of interest in the multi-axial system for achieving a complete diagnosis.  This  method  helps  in  a  more  ‘holistic  assessment’ of an individual patient. o The multi-axial version of ICD-10 uses three axes. Axis 1 - the mental disorder (also personality disorder and mental handicap); Axis 2 - the degree of disability; and Axis 3 - current psychosocial problems. o The multi-axial system of DSM uses 5 axes. Axis I - Clinical Disorders; Axis II - Personality Disorders/ Mental Retardation; Axis III - General Medical Conditions; Axis IV - Psychosocial and Environmental Problems; Axis V - Global Assessment of Functioning. Note that child and adolescent mental disorders have a different axial system in DSM-IV. Structure of ICD-10 The first ICD in 1855 was concerned with a nomenclature of causes of death. World Health Organization (WHO) in 1948 adopted this version after many revisions and called ISCD 6 - Sixth Revision of the International Statistical Classification of Diseases, Injuries and Causes of Death. The ICD-10 is a general medical classification system intended for worldwide, multi-specialty use. ICD-10 classification is easy to follow and has been tested extensively all over the world in more than 51 countries and has been found to be generally applicable. ICD-10 includes 21 chapters. The Roman numeral V and the letter F denote the position of mental and behavioural disorders as the fifth chapter in the WHO classification as a whole. The disorders are identified using an open alpha-numeric system in the form Fxx.xx  from  F00  to  F99.  The  letter  ‘F’  identifies   the disorder as a mental or behavioural disorder; the first digit refers to the broad diagnostic grouping (e.g. psychotic, organic etc.); and the second digit refers to the individual diagnosis. The digits, which follow the decimal point, the code for additional information specific to the disorder such as sub-type, course, or type of symptoms. For example, F33.10 refers to recurrent depressive disorder, current episode moderate with the somatic syndrome. The Schedule for Clinical Assessment in Neuropsychiatry (SCAN), the Composite International Diagnostic Interview (CIDI), and the International Personality Disorder Examination (IPDE) are assessment instrument developed based on the ICD-10framework. Four versions of the ICD-10 classification of mental disorders exist, suitable for different purposes.