The reliability and clinical utility of ICD-11 schizoaffective disorder: A field trial.

A major goal for the revision of the International Classification of Diseases and Related Health Problems, Tenth Edition (ICD-10) is to increase the clinical utility of the diagnostic system. Schizoaffective disorder has a history of poor diagnostic reliability due to the similarities and overlap in symptoms that it shares with other disorders, especially primary psychotic and mood disorders. The present study was part of the case-controlled field trials for ICD-11 and examines how the proposed changes for schizoaffective disorder may improve differential diagnosis and diagnostic accuracy. Clinicians from around the globe (n = 873) were provided with either ICD-10 or ICD-11 diagnostic guidelines and asked to apply them to case vignettes comparing schizoaffective disorder to schizophrenia and mood disorders with psychotic symptoms. Participants were asked to respond to follow-up diagnostic questions to determine which components of the diagnostic guidelines affected diagnostic accuracy. Overall, clinicians showed small improvements in accurately diagnosing vignettes using ICD-11 over ICD-10. Results suggest the discrepancy in diagnosing schizoaffective disorder is related primarily to the presence of mood symptoms and discrepancies about whether those symptoms are more consistent with schizoaffective disorder or a mood disorder diagnosis. Continuing to identify ways to more accurately capture this symptom picture will be important in the future as well as systematic efforts to educate clinicians about differential diagnosis.

Developing a science of clinical utility in diagnostic classification systems field study strategies for ICD-11 mental and behavioral disorders.

The World Health Organization (WHO) Department of Mental Health and Substance Abuse has developed a systematic program of field studies to evaluate and improve the clinical utility of the proposed diagnostic guidelines for mental and behavioral disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11). The clinical utility of a diagnostic classification is critical to its function as the interface between health encounters and health information, and to making the ICD-11 be a more effective tool for helping the WHO's 194 member countries, including the United States, reduce the global disease burden of mental disorders. This article describes the WHO's efforts to develop a science of clinical utility in regard to one of the two major classification systems for mental disorders. We present the rationale and methodologies for an integrated and complementary set of field study strategies, including large international surveys, formative field studies of the structure of clinicians' conceptualization of mental disorders, case-controlled field studies using experimental methodologies to evaluate the impact of proposed changes to the diagnostic guidelines on clinicians' diagnostic decision making, and ecological implementation field studies of clinical utility in the global settings in which the guidelines will ultimately be implemented. The results of these studies have already been used in making decisions about the structure and content of ICD-11. If clinical utility is indeed among the highest aims of diagnostic systems for mental disorders, as their developers routinely claim, future revision efforts should continue to build on these efforts. (PsycINFO Database Record

Brain electrical dysfunction of the anterior cingulate in schizophrenic patients.

The anterior cingulate cortex (ACC) is a key region within the human prefrontal cortex that has been shown to be dysfunctional in schizophrenic patients. Supporting evidence for this notion has been collected with neuroimaging methods during various cognitive activation tasks. Recently, electrophysiological ACC activity has been demonstrated by means of a three-dimensional source location with low resolution electromagnetic tomography (LORETA) in the event-related potentials elicited during the NoGo condition of the Continuous Performance Test (CPT) as compared to its Go condition. Thirty-one schizophrenic patients and 31 age- and gender-matched healthy volunteers were investigated with this newly developed electrophysiological method. LORETA analysis revealed a significantly diminished brain electrical activity in the ACC of schizophrenic patients as compared to controls during the NoGo condition of the CPT. This result supports the assumption of a functional deficit of the ACC during this cognitive task as a central feature in schizophrenias and, thereby, specifies the general concept of hypofrontality. Moreover, this investigation underscores the value of sophisticated electrophysiological methods in combination with unambiguously designed mental tasks for the evaluation of the pathophysiological processes underlying schizophrenic diseases.