WHO has published a new international classification of diseases. WHO publishes new international classification of diseases Why the ICD is being revised

new international classification diseases (ICD-11). It contains about 55,000 unique codes for injuries, illnesses and causes of death. This classification creates mutual language for physicians around the world.

“The ICD is a special pride of the WHO. It allows us to better understand the causes of disease and death, and to take action to prevent suffering and save lives,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

The ICD-11 has been in development for over ten years. Its updated version contains significant improvements over previous versions. For the first time it is presented completely in electronic form and has a much more convenient format. Many healthcare workers took part in its development and presented their proposals at conferences. Overall, the IBC team at WHO headquarters received more than 10,000 proposals to revise certain provisions.

The ICD-11 will be presented to the World Health Assembly in May 2019 for adoption by WHO Member States and will enter into force on 1 January 2022. This version is being published for preview, which should allow participating countries to make their own plans for its use, prepare its translations and train health professionals throughout the country.

The ICD is also used by insurance companies, since the amount of compensation depends on its codes. In addition, the ICD is used by national health program managers; data collectors; and those who track progress in global health and determine the allocation of resources for the health system.

The new version (ICD-11) also reflects advances in medicine and scientific advances. For example, codes related to antimicrobial resistance are more in line with the Global Antimicrobial Resistance Surveillance System (GLASS).

The ICD-11 will also help to better collect data on health safety, which means that it is possible to identify and reduce the impact of some factors that affect health status - for example, potentially some dangerous species organization of work in hospitals.

The new ICD also includes new chapters on traditional medicine A: Despite the fact that millions of people around the world use traditional medicine, it has not yet been classified in this system. Another new chapter, on sexual health, brings together disorders that were previously classified in other ways (for example, gender incongruity was previously considered a mental disorder) or were described differently. Gambling disorder has been added to the section on addictive disorders.

“A key principle in the revision of the codes was to simplify the coding structure and electronic instrumentation, which will make it easier for health professionals to register disorders,” says Dr. Robert Jakob, Team Leader, WHO Classification Standards and Terminology.

Dr Lubna Alansari, WHO Assistant Director-General for Health System Measurement, says the ICD is the cornerstone of health information and ICD-11 will provide an updated version of the understanding of disease.

For all general epidemiological purposes and many public health management purposes. They include an analysis of the general health situation of population groups, as well as a calculation of the frequency and prevalence of diseases and other health problems in their relationship with various factors.

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ICD revisions

Periodic revisions of the ICD, beginning with the Sixth Revision in 1948, have been coordinated by the World Health Organization. As the use of the classification expanded, there was a natural desire among its users to participate in the revision process. The tenth revision is the result of a huge international activities, cooperation and compromise.

The history of the creation and development of the ICD

Francois Bossier de Lacroix.

For the first time, Francois Bossier de Lacroix (1706-1767), better known as Sauvage (fr. Sauvages), made an attempt to arrange diseases systematically. Sauvage's work was published under the title "Methodology of Nosology" (Nosologia Methodica).

The first International Statistical Congress, held in Brussels in 1853, asked Dr. Farr and Dr. Marc d'Espine of Geneva to prepare a uniform classification of causes of death applicable internationally. At the Second Congress, held in Paris in 1855, Farr and d'Espin presented two separate lists based on very different principles. Farr's classification consisted of five groups: epidemic diseases, organic (systemic) diseases, diseases subdivided according to anatomical localization, developmental diseases, and diseases that are a direct consequence of violence. D'Espin grouped diseases according to the nature of their manifestation (gouty, herpetic, hematic, etc.). Congress adopted a compromise list of 139 headings. In 1864, this classification was revised in Paris on the basis of the model proposed by W. Farr. The next revisions took place in , and 1886.

The classification prepared by Bertillon was based on the classification of causes of death used in Paris, which, after its revision in 1885, was a synthesis of English, German and Swiss versions. This classification was based on the principle adopted by Farr, which consisted in the division of diseases into systemic and related to a specific organ or anatomical localization.

ICD-5

International Conference on the Fifth Revision international list causes of death, was convened by the French government and held in Paris in October 1938.

• a detailed list of 200 headings;
• a short list of 44 headings;
• an intermediate list of 87 headings.

ICD-6

The International Conference on the Sixth Revision of the International Lists of Diseases and Causes of Death was organized by the Government of France and held again in Paris from 26 to 30 April 1948.

• International classification with a full list of rubrics included;
• Classification rules;
• Form of medical certificate of cause of death;
• Special lists for statistical developments.

The "Guide to the International Statistical Classification of Diseases, Injuries and Causes of Death" was published. "Manual of the International Classification of Diseases, Injuries, and Causes of Death") in two volumes. The second volume contained alphabetical diagnostic terms coded under the appropriate headings.

ICD-7

The International Conference on the Seventh Revision of the International Classification of Diseases was held in February 1955. In this revision, the necessary changes were made, inconsistencies were eliminated and errors were corrected.

ICD-8

The International Conference on the Eighth Revision was held July 6-12, 1965. This revision was more radical than the seventh, but the basic structure of the classification remained intact.

ICD-9

The International Conference on the Ninth Revision of the International Classification of Diseases, Injuries and Causes of Death was held by the World Health Organization in Geneva from 30 September to 6 October 1975. During the conference, it was decided to make the smallest changes, with the exception of those related to updating the classification, mainly due to the possible costs that would be required for adaptation automated systems data processing (ASOD) .

The Ninth Revision retained the basic structure of the International Classification of Diseases, and added many of the level details of the optional five-character subcategories and four-character subcategories. A system of "asterisks" (*) and "crosses" (†) has also been introduced, which is used as an optional alternative method for classifying diagnostic statements (to indicate information both about the underlying disease and its manifestations in areas of the body or specific organs) . This system is retained in the next, Tenth revision.

ICD-11

Since 2012, WHO experts have been working to revise the classifier so that it better reflects progress in the field of medical sciences and medical practice. Experts and interested parties are invited to participate in the preparation of the ICD by making comments or suggestions on the classifier through the online platform, and later by participating in the translation into national languages. For each nosological form, the etiology, symptoms, diagnostic criteria, impact on everyday life and pregnancy, as well as principles of treatment. The preparatory version (version for submission to the assembly and translation into national languages) was officially released on June 18, 2018. The ICD-11 was presented at the 144th Executive Council meeting in January 2019 and will be submitted for approval by the World Health Assembly (WHA) in May 2019. The classification will come into force on January 1, 2022 in the participating countries.

The ICD-11 includes new chapters, in particular on traditional medicine, and the chapter on sexual health combines disorders that were previously classified in other classes (for example, transsexualism was included in the category of mental disorders, and now under the name "gender mismatch" is included into a separate category of "conditions related to sexual health"). In addition to gender inconsistency, this category includes sexual dysfunctions, sexual pain disorders, and “etiological explanations” (to indicate the cause of a sexual disorder, such as surgery or radiotherapy ( HA40.0 HA40.0), psychoactive substance or drug ( HA40.2 HA40.2), lack of knowledge or experience ( HA40.3 HA40.3) etc.). Paraphilias do not belong to this category and are still coded in the group of mental disorders ( 6D30 6D30- 6D3Z 6D3Z ). A new addictive disorder has emerged - gaming disorder ( 6C51 6C51) describing a pathological addiction to computer games.

In the eleventh revision, the coding system was also changed, its structure was simplified along with electronic tools.

Basic structure and principles of the ICD-10 classification

os new classification The ICD-10 is a three-digit code that serves as the mandatory coding level for mortality data that individual countries provide to the WHO, as well as for major international comparisons. AT Russian Federation The ICD has another specific purpose. The legislation of the Russian Federation (namely, the Law of the Russian Federation on Psychiatric Care, the Law of the Russian Federation on Expert Activities) establishes the mandatory use of the current version of the ICD in clinical psychiatry and during forensic psychiatric examinations.

The structure of the ICD-10 is based on the classification proposed by William Farr. His scheme was that, for all practical and epidemiological purposes, disease statistics should be grouped as follows:

• epidemic diseases;
• constitutional or general diseases;
• local diseases grouped by anatomical localization;
• developmental diseases;

Tom

ICD-10 consists of three volumes:

• volume 1 contains the main classification;
• volume 2 contains instructions for use for users of the ICD;
• Volume 3 is an Alphabetical Index to the Classification.

Volume 1 also contains the section "Morphology of neoplasms", special lists for summary statistical developments, definitions, nomenclature rules.

Classes

The classification is divided into 22 classes. The first character of a code in the ICD is a letter, and each letter corresponds to a particular class, with the exception of the letter D, which is used in class II "Neoplasms" and in class III "Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism", and the letter H , which is used in class VII "Diseases of the eye and adnexa" and in class VIII "Diseases of the ear and mastoid". Four classes (I, II, XIX and XX) use more than one letter in the first character of their codes.

In Class II, the first axis is the nature of the neoplasms by site, although several three-character rubrics are for important morphological types of neoplasms (eg, leukemias, lymphomas, melanomas, mesotheliomas, Kaposi's sarcoma). The rubric range is given in brackets after each block title.

Three-character rubrics

Within each block, some of the three-character rubrics are for only one disease selected because of its frequency, severity, susceptibility to health services, while other three-character rubrics are for groups of diseases with some general characteristics. The block usually has rubrics for "other" conditions, making it possible to classify big number various but rare conditions, as well as "unspecified" conditions.

Four-character subcategories

Most three-digit rubrics are subdivided with a fourth digit after the decimal point, so that up to 10 more subcategories can be used. If a three-character rubric is not subdivided, it is recommended to use the letter “ ” to fill in the space for the fourth character so that the codes have a standard size for statistical processing.

Responsible for compiling and editing: Corresponding Member of the Russian Academy of Medical Sciences Professor V. K. Ovcharov, Ph.D. honey. Sciences M. V. Maksimova.

Clinical modification

Clinical modification of ICD-10 (ICD-10-KM)(English) ICD-10-CM - Clinical Modification) is the version of ICD-10 used for statistical purposes in the United States of America. Provided by the Center for Medicare and Medicaid Services (English)Russian(CMS; part of the U.S. Department of Health and Human Services responsible for the implementation of programs for the provision of preferential and free medical services to citizens) and the National Center for Health Statistics (NCHS) (English)

The history of the study of personality and its disorders has about two millennia. The first attempt to find out what predetermines individual differences in people's behavior was made by Hippocrates, and during this time, of course, much has changed.

For more than a hundred years, psychiatry has been using an established paradigm, the foundations of which were laid by Emil Kraepelin. In 1904, he describes 7 types of "psychopathic personality", which were named according to the similarity with the manifestations of major mental disorders: Schizoid - reminiscent of schizophrenia, cycloid - echoes the iconic manifestations of manic-depressive psychosis, and so on. Later, Kurt Schneider develops this idea, voicing one of the main signs of a psychopathic personality: the inability to form and maintain relationships with people. He distinguishes 9 types of personality disorders, based on his extensive clinical practice, and most of them are still present in one form or another in the classifications of disorders to this day.

But any paradigm is sooner or later questioned, and, apparently, with the advent of DSM-5 and ICD-11, the time has come for personality disorders (PD). The latest classifications offer a new approach that eliminates all specific categories of PD except for one: the very fact of having a personality disorder.

Why all this?

Many psychiatrists will ask this question, because the system works. But the developers of the new international classification of diseases do not think so. For example, half of patients who meet the criteria for one personality disorder also show signs of other personality disorders. Part of the PD are too rare, at the same time, a significant cohort of people with serious personality disorders do not fit into the criteria for any of the existing personality disorders. Patients with the same diagnosis can be strikingly different from each other, both in personal qualities and in the severity of their condition. In addition, there is currently a dichotomous division of the population into people with and without PD in the ICD. In fact, there is an intermediate category of “character accentuations”, which, although it was singled out a long time ago, had no place in the classification of diseases before. This makes it impossible for psychiatrists to reliably record subsyndromal changes.

But most main reason so global change is that the ICD-10 and DSM-IV RLs are based primarily on anecdotal clinical experience with little to no evidence-based evidence supporting their existence as discrete categories. The available descriptions of PD ignore the main personality traits that are currently established and have a consistent structure, regardless of the presence or absence of a personality disorder.

Now in order. What to do with it?

Step one.

And the lightest. Because at this stage there are practically no changes. The first step is to determine whether the patient meets the general definition of a personality disorder. According to the idea of ​​the new classification, this diagnosis can be made by both a psychiatrist and a doctor of the primary network, since the approach to the definition does not have serious differences from the ICD-10. Using the following criteria, without going into categories, the specialist establishes Availability personality disorder:

• the presence of progressive disturbances in how a person thinks and feels about himself, others and the world, which manifests itself in inadequate ways of cognition, behavior, emotional experiences and reactions;
• the identified maladaptive patterns are relatively rigid and are associated with severe problems in psychosocial functioning, which is most noticeable in interpersonal relationships;
• the impairment manifests itself in a variety of interpersonal and social situations (i.e., not limited to specific relationships or situations);
• the disturbance is relatively stable over time and has a long duration. Most often, a personality disorder first manifests itself in childhood and manifests itself clearly in adolescence.

If the disorder is first detected in adulthood, the "late onset" qualifier may be used. This specifier should be used in cases where there is no clear evidence of detectable impairment at an earlier age in history.

It is very important to determine the area of ​​detected violations. Problems in interpersonal interaction in personality disorders are characterized by general disturbances in relationships with people that interfere with mutual understanding. This must be understood, since most mental disorders are somehow related to social dysfunction. Thus, the difficulty in completing tasks, organizing life responsibilities, free time, maintaining adequate relationships at work, as well as the lack of harmony in the family, are very different from the violations associated with the inability to get along with the rest of the population. human race which is exactly what is observed in personality disorders. A person whose life is turned upside down by a family feud does not necessarily have a personality disorder. The diagnosis should only be made if there is clear evidence of widespread deterioration in relationships with everyone around.

Step two: determining the severity of RL.

Currently, personality disorders are an exclusively qualitative category, which often leads to the fact that two patients with the same diagnosis can be strikingly different from each other. ICD-11 offers 3 degrees of severity of personality changes (see tab. 1), each of which may include one or more pathological signs. Severity ranking allows for the fact that although PD is assumed to be a lifelong diagnosis, its severity may change over time.

Tab. 1 The severity of personality disorders in the ICD-11

In addition, a subthreshold level of disorder is distinguished, which corresponds to the familiar concept of “personality accentuations” and is designated as “personality difficulty” (complex / difficult personality) (see tab. 2) . “Personality difficulty” will not be a diagnosis, and, in essence, will correspond to the existing Z code in the ICD-10. Registration of accentuations is necessary, since its presence increases the risk of needing medical intervention in certain conditions, for example, under stress or under certain conditions environment. At the same time, it must be understood that some cases of mild personality disorders may not require specialist supervision. According to modern epidemiological estimates, 1 out of 14 people in the population suffers from a personality disorder, and treatment of each, firstly, is not necessary, and secondly, incurs huge economic costs. The presence of ranking by severity will allow a more professional approach to the selection of indications for therapeutic interventions.

Tab. 2 Dimensional system for classifying personality disorders according to severity.

Eliminated difficult to understand comorbidity various types PD, which may lead to a decrease in the number of patients with unspecified/mixed personality disorder. The designation of "complex personality disorder" reflects the universal finding in research on this topic that as the problem becomes more pronounced, the diagnostic boundaries between different personality disorders blur.

Step three.

Where you need to forget everything you knew before. The usual classification for us implies that personality disorders are discrete and qualitatively different syndromes and, at their core, work according to the scheme of all or nothing. The changes that have affected the problem of personality disorders in the ICD-11 indicate that PDs are maladaptive variants of personal qualities that can imperceptibly pass into normal ones, or one into another, being a kind of continuum without any strict distinctions.

The new approach was based on the line started by G. Allport, G. Eysenck and R. Cattell, about the dispositional (from the English disposition - predisposition) model of a person's personality or the so-called "Big Five". The essence of this model is that the levels of dominance of the described personality traits form the individuality of a person and, in turn, predetermine the ability to adapt this personality. Empirically, using scales, questionnaires and expert assessments five properties were identified (see tab. 3).

Tab. 3 Comparative characteristics Big Five domains and RDOCs

The same idea was picked up by the developers of the alternative RDOC classification. The features identified by these researchers can fully prove the legitimacy of the big five and domain theories used in the ICD-11 (see tab. 4) and DSM 5.

Tab. 4 ICD-11 Personality trait domains.

The DSM has a similar domain model: negative affective, dissocial, disinhibited, and also detached domain traits; and instead of anancaste, the domain of psychotism, which is absent in ICD-11.

Each of the domains can occur both in apparently healthy members of the population and among patients with a personality disorder, but in patients with PD they indicate a focus in which the disorder is manifested to a greater extent. For the diagnostician, it will be necessary to isolate the signs of domains in a particular patient, even if the clinical picture reveals phenomena characteristic of all five domains. The proposed innovations will make it possible to get rid of the temptation to make a diagnosis bypassing a comprehensive personality assessment. There is no need for such a vague diagnosis as "mixed personality disorder". Modern research, studying this approach, identify specific therapies that can be effective when the signs of individual domains predominate. For example, the domain of disinhibitory signs requires structured psychological intervention, patients with signs of the negative affectivity domain respond well to cognitive-behavioral therapy, and patients with dissocial signs are resistant to therapeutic interventions and rather require social changes.

Prepared by: Chesnokova O.I.

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Today World Organization Health (WHO) releases a new version of its International Classification of Diseases (ICD-11).

The ICD serves as the basis for trending and maintaining health statistics worldwide and contains approximately 55,000 unique codes for injuries, diseases, and causes of death. Thanks to it, health professionals around the planet have a common language that allows them to exchange information on health issues.

“ICD is a product that WHO is rightly proud of,” said the WHO Director-General

Dr. Tedros Adhanom Ghebreyesus. "It enables us to understand the many reasons why people get sick and die, and to take action to prevent suffering and save lives."

The ICD-11, which has been in preparation for over ten years, differs from previous versions in a number of important improvements. It is the first time it has been published in fully electronic form and has a much more reader-friendly format. In addition, an unprecedented number of health workers participated in the joint meetings and put forward their proposals as inputs. The ICD Group at WHO Headquarters has received over 10,000 proposals for changes to the Classification.

The ICD-11 will be submitted for adoption by Member States at the World Health Assembly in May 2019 and will enter into force on 1 January 2022. This release is preliminary and exploratory in nature and will allow countries to develop plans for the use new version, prepare its translations and conduct nationwide training for health professionals.

The ICD is also used by health insurance companies, which determine compensation payments based on the ICD codes; national health program managers; data collectors; and everyone who monitors trends in global health and makes decisions about the allocation of resources in this area.

The new ICD-11 reflects the progress in medicine and the achievements of scientific thought. For example, antimicrobial resistance codes are now more in line with the Global Antimicrobial Resistance Surveillance System (GLASS) criteria. ICD-11 also makes it possible to more effectively record health safety data and, accordingly, to identify and prevent undesirable events that may be harmful to health, such as unsafe practices in hospitals.

AT new ICD also included new chapters, in particular on folk (traditional) medicine: although the methods traditional medicine used by millions of people around the world, it has not yet been included in this classification system. Another new chapter on sexual health brings together disorders that were previously classified in other categories (for example, gender incongruity was listed in the category of mental disorders) or described differently. Gaming disorder has been added to the Addictive Disorders section.

“A key principle of this revision was to simplify the structure of codes and electronic instruments so that health professionals can more easily and comprehensively record different diseases,” said Dr Robert Jakob, Team Leader, WHO Classifications, Terminology and Standards .

According to Dr. Lubna A. Al-Ansary, assistant Director General on Metrics and Measurements, “The ICD is the cornerstone of health information, and ICD-11 will provide an updated look at the typology of diseases.”

Note to editors:

The ICD-11 is aligned with the WHO International Generic Names for Pharmaceutical Products and can be used for registration purposes oncological diseases. The ICD-11 has been designed to be used in a wide range of languages: a central multilingual platform provides functionality and data presentation in all translated languages. Switching to ICD-11 is helped by transition tables from ICD-10 and vice versa. WHO will assist countries in the process of preparing for the use of the new ICD-11.