Progress Toward Achieving a Common Language in Psychiatry: Results From the Field Trial of the Clinical Guidelines Accompanying the WHO Classification of Mental and Behavioral Disorders in ICD-10
Abstract
In preparing for the 10th revision of the International Classification of Diseases (ICD-10), the Division of Mental Health of the World Health Organization organized an international field trial to help evaluate draft clinical descriptions and diagnostic guidelines that were produced to facilitate use of the chapter dealing with mental and behavioral disorders. These clinical guidelines were prepared in equivalent versions in most of the world's widely spoken languages. The field trial aimed to obtain data that would help in assessing whether the classification fits the diagnoses made in different countries, whether it is easy to use, and whether psychiatrists after a short period of familiarization with the classification can reach agreement about their diagnoses and classification. The field trial was carried out at 112 clinical centers in 39 countries by 711 clinicians who conducted 15,302 individual assessments. The trial included joint clinical assessments of patients and case history exercises. The results of the joint assessment part of the trial are reported here. Most clinicians reported that the draft document was easy to use and that the classification provided a good fit for the vast majority of the clinical conditions encountered. While interrater reliability was satisfactory for most categories, some (for example, those dealing with personality disorders) were somewhat difficult to use, and reliability of assignment for those was lower. The trial demonstrated that the ICD-10 chapter dealing with mental and behavioral disorders is on the whole suitable for general use. It provided valuable indications about changes needed for subsequent versions and demonstrated the feasibility of large-scale international research on classification and diagnosis in psychiatry.
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Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines.
“Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines.”
In the ICD-10 field trials, less severe disorders had lower reliability than more severe disorders such as schizophrenia and bipolar disorder.
“This is reassuring, because the reliability of milder disorders compared to more severe disorders (e.g., schizophrenia and bipolar disorder) was lower in ICD-10 field trials 16,33 .”
ICD-11 acute and transient psychotic disorder now covers only acute psychoses with polymorphic presentation, making it not strictly comparable with the broader concept tested in the ICD-10 field trial.
“ICD-11 acute and transient psychotic disorder now exclusively comprises acute psychoses with “polymorphic” presentation 3 , which is not strictly comparable to the broader concept tested in the ICD-10 field trial 16 .”
The case conference methodology used in the ICD-10 field study is likely to produce more consensus-based results, with correspondingly higher reliability.
“The case conference methodology is likely to produce more consensus-based results, in which reliability would be correspondingly higher.”
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- Authors
- Sartorius, N.
- Affiliations
- World Health Organization (CH)
- Corresponding author
- Sartorius, Norman
- ORCID
- Sartorius, Norman
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 1993-02-01
- Volume
- 50
- Issue
- 2
- Pages
- 115
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2077896336
- Cited by
- 195
- References
- 13
- Citations by year
- 2026: 4 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 9 · 2017: 3 · 2016: 8 · 2015: 5 · 2014: 6 · 2013: 4 · 2012: 8
- FWCI
- 169.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- ICD-10, psychiatric classification, diagnostic criteria, inter-rater reliability, mental and behavioral disorders, personality disorders, diagnostic agreement, World Health Organization
- MeSH terms
- Adult, Age Factors, Aged, Mental Disorders, Cross-Cultural Comparison, Female, Humans, Male, Middle Aged, Terminology as Topic, Psychiatric Status Rating Scales, Psychiatry, Sex Factors, World Health Organization, Reproducibility of Results, Practice Guidelines as Topic
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