Psychiatric Diagnosis: A World Perspective

350 Pages·1994·7.479 MB·English

by  Narendra N. Wig (auth.), Juan E. Mezzich M.D., Ph.D., Marianne C. Kastrup M.D., Ph.D., Yutaka Honda M.D., Ph.D. (eds.)

Psychiatrie Diagnosis
Psychiatric Diagnosis
A W orld Perspective
Edited by
luan E. Mezzich Yutaka Honda
Marianne C. Kastrup
Section on Classification, Diagnostic Assessment, and
Nomenclature, World Psychiatric Association
With 16 Illustrations
Springer Science+Business Media, LLC
luau E. Mezzich, M.D., Ph.D. Yutaka Honda, M.D., Ph.D.
Professor of Psychiatry and Director, Seiwa Hospital
Epidemiology Neuropsychiatric Research Institute
University of Pittsburgh Tokyo, lapan
Western Psychiatric Institute and Clinic
3811 O'Hara Street
Pittsburgh, PA 15213-2593 USA
Marianne C. Kastrup, M.D., Ph.D.
Associate Professor of Psychiatry
University of Copenhagen
Copenhagen, Denmark
Library of Congress Cataloging-in-Publication Data
Psychiatric diagnosis: a world perspective I edited on behalf of the
Section on Classification, Diagnostic Assessment, and Nomenclature of
the World Psychiatric Association by Juan E. Mezzich, Yutaka Honda,
Marianne C. Kastrup.
p. cm.
Updated versions of papers presented at the International
Symposium on Psychiatric Diagnosis, held in Tokyo in 1990.
Includes bibliographical references and index.
ISBN 978-1-4612-6923-6 ISBN 978-1-4612-0857-0 (eBook)
DOI 10.1007/978-1-4612-0857-0
l. Mental illness-Classification-Congresses. 2. Mental illness
Diagnosis-Congresses. 3. Psychiatry, Transcultural-Congresses.
1. Mezzich. Juan E. II. Honda, Y. (Yutaka), 1929.
III. Kastrup, M. IV. World Psychiatric Association. Section on
Classification, Diagnostic Assessment, and Nomenclature.
V. International Symposium on Psychiatric Diagnosis (1990:
Tokyo, Japan)
[DNLM: l. Mental Disorders-diagnosis-congresses. 2. Mcntal
Disorders-classification-congresses. 3. Cross-Cultural
Comparison-congresses. WM 141 P97353 1990]
RC455.2.C4P77 1994
616.89075'09-dc20
DNLM/DLC
for Library of Congress 93-46006
Printed on acid-free paper.
© 1994 Springer Science+Business Media New York
Originally published by Springer-Verlag New York Inc in 1994
Softcover reprint of the hardcover 1s t edition 1994
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Foreword
It can be said that the classical concepts of psychiatric diagnosis and
classification were developed in France and Germany, as epitomized by
the work of Emil Kraepelin. While trying to set basic nosological prin
ciples at horne, Kraepelin traveled to Indonesia to explore the compara
bility of psychiatric morbidity. In his own way, he illustrated the tension
between universality and diversity, which is central to our field.
A major actor in the modern evolution of diagnostic classification
has been the World Health Organization (WHO), taking the post from
bodies such as the International Statistical Institute, which actually ini
tiated the decennial editions of the International Classification o[ Diseases
and Causes o[ Death. Of seminal importance were the series of work
shops on various forms of psychiatric pathology that the WHO organized
between 1965 and 1975 in preparation for the ICD-9 classification of
mental disorders.
In 1980, the American Psychiatric Association (which had been weIl
known for endorsing a predominantly psychodynamic perspective) sent
shock waves throughout the world with the publication of Diagnostic and
Statistical Manual o[ Mental Disorders, 3rd edition (DSM-III). Soon its
major innovations, for example, descriptive phenomenological emphasis,
explicit diagnostic criteria, and multiaxial approach, were widely accorded
great interest and significance.
More recently, the Section on Classification, Diagnostic Assessment,
and Nomenclature of the World Psychiatric Association (WPA) has
assumed a leading role in the discussion and coordination of international
psychiatric diagnosis. While working with the WHO in the development
and implementation of the 10th revision of the International Classification
of Diseases and Health Related Problems (ICD-10), the WPA has fostered
the consideration of regional and national perspectives. In addition to
DSM-IV, there are now a number of national adaptations of the interna
tional classification, such as the Chinese Classification of Mental Disorders,
Second Edition (CCMD-II) and the Japanese Clinical Modification of
ICD-lO.
Of considerable significance for this integration of diverse viewpoints in
our field have been two major conferences organized by the WP A Classi
fication Section. First, the International Conference on Psychiatric Clas-
v
vi Foreword
sification: Unity and Diversity, held in Montreal in 1985, featured the
presentation and wide discussion of the prineiples of ICD-lO. In 1990, the
International Symposium on Psychiatrie Diagnosis held in Tokyo, whieh
I had the honor to preside, reviewed the development of various com
ponents of the ICD-lO family of classifications within an international and
transcultural framework. Updated vers ions of the symposium papers are
now presented in this book.
The loeation as weIl as the conte nt of the 1990 International Symposium
recognized several eontributions made by Japanese psychiatrists. For
example, Morita deseribed shinkeishitsu (a concept related to what would
be later known as avoidant personality disorder) in the 1930s. Shimoda
originated immodysthymic character as apremorbid personality of major
depression in 1941, earlier than the typus melancholicus described by
TeIlenbach in Germany in 1961. As a third example, Mitsuta advaneed on
genetie grounds the concept of "atypieal psyehosis" in 1953, whieh can be
contrasted to that presented by Leonhard in 1960.
I believe that every eountry or region has its own tradition al perspec
tives on psychiatrie classification, based on its particular culture. It is
hoped that in the future, ICD-ll as weIl as DSM-V and other national
adaptations may be able to integrate further those cultural characteristics,
not only in the classifieation but also in the nomenclature and diagnostic
assessment of psychiatrie problems.
Much progress has been made on international psychiatrie diagnosis as
doeumented in this volume. We expeet that etiological research and
eatamnestie outeome studies will lead to further progress in our field.
Masaaki Kato
Emeritus Professor of Psyehiatry
Tokyo Medical College
Former Direetor, National Institute of Mental Health
Japan
Preface
The complexity of our world, highlighted by the fact that more than 80%
of the planet's population (and presumably a similar proportion of all
psychiatrie patients) live in non-Western, traditional societies, makes a
compelling point for a truly international psychiatry. Furthermore, it
happens that psychiatrie diagnosis, as the field's central concept and tool,
has a remarkable international anchorage. In effect, each of the major
advances in diagnostic theory and methods of re cent times, represented
pioneering contributions emerging from a range of geographical and
cultural regions.
The current emphasis on phenomenological or descriptive approaches
to nosology had important beginnings with the construction of symptoms
as units of analysis of abnormal behavior in 19th century France (Berrios
1994). Clinical description, at a higher level of organization, was lastingly
moved forward by the delineation of clinical evolution, also in France
(Magnan and Serieux 1893), and by the conceptualization of nosological
entities in Germany (Kraepelin 1896, Leonhard 1957).
The need for greater clarity in the definition of mental disorders, which
became crucial for empirical research, was cogently argued by the British
psychiatrist Stengel (1959) on reftecting on the results of his international
survey of classifications commissioned by the World Health Organization
(WHO). The proposal of explicit diagnostic criteria or assignment rules
was pioneered by Berner (1958) in Austria for the definition of psychoses,
by the Chileans Horowitz and Marconi (1966) for the case of alcoholism
in epidemiological studies, and, more recently, by Feighner et al (1972)
in the United States for the research diagnosis of a group of 15 mental
disorders.
Regarding the third major conceptual and methodological advance, the
earliest multiaxial schemes were designed by Essen-Möller and Wohlfahrt
(1947) in Sweden; and Lecomte, Damey, Delage et al (1947) in France,
as a dichotomical assessment of syndrome and etiology; and shortly after
wards by Bilikiewicz (1951) in Poland and Lerne Lopes (1954) in Brazil,
proposing a triaxial formulation of clinical syndromes, personality, and
etiopathogenic constellations. The first pertinent use of the term multi
axial involved an inftuential classification of child psychiatrie conditions
prepared in 1969 by experts from six countries (Rutter, Levobici, Eisen-
Vll
viii Preface
berg, Sneznevskij, Sadoun, Brooke, and Lin) under WHO's auspices. In
addition to the about 20 published multiaxial systems originating in 11
different countries for general psychiatry (Mezzich 1988), there have
been schemas for specific clinical conditions, such as the one developed
by Kasahara and Kimura (1975) in Japan for depressed patients.
The advances in the standardization, precision, and thoroughness of
psychiatric diagnosis mentioned above are being incipiently supplemented
with attention to personalized or idiographic descriptive approaches. This
promises not only to enhance our understanding of the case, but to make
fuller and more effective use of the evolving range of therapeutic possi
bilities. One of the ideographic perspectives under recent development is
a cultural formulation from the perspective of the patient's personal
experience and primary reference group, and dealing with the patient's
identity; the experiencing, reporting and interpretation of psychopatho
logy, its context and impact; and the clinician-patient relationship
(Mezzich et al, in press).
In an attempt to articulate key developments in the field, the Section
on Classification, Diagnostie Assessment and Nomenclature of the World
Psychiatric Association has prepared this volume. This is inscribed within
the Section's ongoing efforts on international diagnosis, much of this
focused on ICD-lO, in close collaboration with the WHO (Sartorius
1988). The volume is built on presentations made at a major international
conference presided over by Masaaki Kato in September 1991 in Tokyo,
and later elaborated further by their authors.
The book is organized around five major themes, all among the most
prominent ones in contemporary psychiatric dia gnosis and international
psychiatry. Part I deals with major regional perspectives, whieh make
patent the richness of cultural and theoretical traditions and challenges
from which current diagnostie systems are emerging and to whieh they
have to be referred. Part II focuses on the 10th revision of the Inter
national Classification o[ Diseases and Health-Related Problems (ICD-10)
and various aspects of its extensive field trials. In connection to ICD-lO,
not only an international language for the field is emerging, but also
promising adaptations to local clinieal reality. Part III discusses the
experience and prospects for comprehensive diagnosis through the multi
axial model. Particular attention is paid to the triad of pathology, conse
quent disabilities, and contextual factors. Part IV reviews one of the basic
objectives of psychiatrie diagnosis, that is, treatment planning and
organization of health services, pointing out how important is to consider
both the individual patient and how society organizes itself for clinical
care. Last, but not least, Part V examines the role and challenges of
psychiatric diagnosis in primary health care. The topic is important not
only because most psychiatrie patients in both industrialized and tradi
tional societies are seen first by general health professionals, but because
Preface ix
of the opportunities primary care is increasingly perceived to offer for
more integrated and effective health care. The Epilogue probes an
universal approach to psychiatrie diagnosis.
The editors of this volume, representing three continents, join a dis
tinguished group of clinical scholars from Africa, Asia, Europe, North
America, Latin America and Oceania, in expressing the hope that this
work usefully illustrates the achievements of the field and will stimulate
further work toward diagnostic systems that are historically informed,
thoughtfully empirieal, and concerned with the wholeness of the patient.
Juan E. Mezzieh
Yutaka Honda
Marianne C. Kastrup
References
Berner P (1958). Psychiatrie in der Allgemeinpraxis. Paracelsus-Baihefte, Vienna.
Berrios GE (1994). The history of descriptive psychopathology. In JE Mezzieh,
MR Jorge, IM Salloum (eds), Psychiatric Epidemiology: Assessment Concepts
and Methods. Johns Hopkins University Press, Baltimore, MD.
Bilikiewiwicz I (1951). Proba ukladu nosograficznego etioepigenetycznego w
psychiatrii. Neurologia i Neurochirurgia Polska 1:68-78.
Essen-Möller E, Wohlfahrt S (1947). Suggestions for the amendment of the
official Swedish classification of mental disorders. Acta Psychiatrica Scandinavica
47:551-555 (suppl).
Feighner JP, Robins E, Guze SB, et al (1972). Diagnostic criteria for use in
psychiatrie research. Archives o[ General Psychiatry 26:57-63.
Horowitz J, Marconi J (1966). EI problema de las definiciones en el campo de la
salud mental: Definiciones aplicables en estudios epidemiol6gicos. Boletfn de la
Oficina Sanitaria Panamericana 60:300-309.
Kasahara Y, Kimura B (1975). Zur Klassifizierung der depressiven Zustände.
Psychiatria et Neurologia Japonica 77:715-735.
Kraepelin E (1986). Der psychologische Versuch in der Psychiatrie. Psychologische
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Lecomte M, Damey A, Delage E, et al (1947). Essai d'une statistique synoptique
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Leonhard K (1957). A[teilung der endogenen Psychosen. Akademie, Berlin.
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Rutter M, Lebovici S, Eisenberg L, Sneznevskij A V, Sadoun R, Brooke E, Lin
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Contents
Foreword v
Masaaki Kato
Preface vii
Juan E. Mezzich, Yutaka Honda, and Marianne C. Kastrup
Contributors xv
Part I. Regional Perspectives on Psychiatrie Diagnosis
1. An Overview of Cross-Cultural and National Issues in
Psychiatrie Classification 3
Narendra N. Wig
2. DSM-IV and International Communication in Psychiatrie
Diagnosis 11
Allen Frances, Harold Pincus, Thomas Widiger, Michael First,
Wendy Davis, Willa Hall, Kelly McKinney, and Helen Stayna
3. The Nosological Views of French-Speaking Psychiatry 23
Charles B. Pull and Gilles Chaillet
4. Scandinavian Contributions to Psychiatrie Nosology 33
Erik Strämgren
5. Perspectives on the Use oflnternational Diagnostic Systems
in the USSR 39
Peter V. Morozov
6. Latin American Contributions to Psychiatrie Nosology and
Classification 45
Miguel R. Jorge and Juan E. Mezzich
7. African Perspectives on Mental Disorder 57
Felix Attah Johnson
8. On the Second Edition of the Chinese Classification of Mental
Disorders (CCMD-II) 67
Yucun Shen
9. Perspectives on Psychiatrie Diagnosis trom Southeast Asia 75
R. Srinivasa Murthy
Xl