The ICD‐11 clinic‐based field studies are about to be concluded
Authors: Luca Steardo
Journal: World Psychiatry (2017)

The clinic-based (or ecological implementation) field studies, which will contribute to guide the construction of the chapter on mental and behavioural disorders of the 11th revision of the International Classification of Diseases and Related Health Problems, are about to be concluded. The participating field studies coordinating centres have included the Department of Psychiatry of the Federal University of São Paulo, Brazil; the Royal Ottawa Mental Health Centre in Ottawa, Canada; the Shanghai Mental Health Centre in Shanghai, China; the Department of Psychiatry and Psychotherapy of the Heinrich-Heine University in Düsseldorf, Germany; the Department of Psychiatry of the University of Naples SUN in Naples, Italy; the Department of Psychiatry of the All India Institute of Medical Sciences in Delhi, India; the Japanese Society of Psychiatry and Neurology in Tokyo, Japan; the Department of Psychiatry of the American University of Beirut, Lebanon; the National Institute of Psychiatry Ramón de la Fuente in Mexico City, Mexico; the Department of Psychiatry of the University of Ibadan, Nigeria; the Moscow Research Institute of Psychiatry in Moscow, Russian Federation; the Department of Psychiatry of the Universidad Autónoma de Madrid in Madrid, Spain; the Department of Psychiatry of the University of Cape Town, South Africa; and the Department of Psychiatry of the Columbia University in New York, USA. The clinic-based field studies have included two components: clinical consistency studies and clinical utility studies1, 2. The clinical consistency studies have covered the mental disorders accounting for the highest disease burden and utilization of mental health services worldwide3, 4. One protocol has covered psychotic and mood disorders in patients presenting with any psychotic symptom; a second protocol has focused on mood disorders, anxiety disorders and disorders specifically associated with stress in patients presenting with relevant symptoms but no psychotic feature; a third protocol has dealt with common childhood and adolescence mental disorders (attention deficit, disruptive behaviour, mood and anxiety disorders) in children and adolescents presenting with relevant symptoms. The studies have aimed to explore whether independent clinicians, based on the same information, arrive at the same diagnostic conclusion using the field study version of the ICD-11 diagnostic guidelines. The studies are allowing to identify the aspects of that version of the guidelines which are more likely to be interpreted differently by independent clinicians. The clinical utility studies have covered the mental disorders considered in the clinical consistency studies plus additional disorders of interest to study sites. Clinical utility has been repeatedly identified as a major objective of classifications of mental disorders5-7, but this is the first time that the clinical utility of a diagnostic system has been tested widely and systematically. The specific elements assessed have been: conceptualization (do the proposed diagnostic guidelines help in understanding and communicating the patient's condition?); goodness of fit (do the guidelines accurately capture patients’ symptom presentation?); ease of use (are the guidelines clear and easy to use in ordinary practice?); and adequacy (how adequate are the guidelines for the assessment of patients and for making clinical management decisions?). These studies have been conducted in patients seeking routine health care in specialty mental health care settings. Clinicians have applied the clinical guidelines and made ratings of their clinical utility with regards to each patient. The field study version of the ICD-11 diagnostic guidelines for the various groups of mental disorders is being published on the Internet platform called GCP.Network (http://gcp.network) and is open for comments by registered members of the Global Clinical Practice Network. A reflection of the ongoing debate on the ICD-11 characterization of some groups of mental disorders – such as disorders related to sexuality and gender identity, bodily distress disorder, pathological gambling, Internet-related disorders, childhood disruptive behaviour and grief-related disorders – can be found in previous issues of this journal8-12. Luca Steardo Jr WHO Collaborating Centre for Research and Training in Mental Health, University of Naples SUN, Naples, Italy