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Classificazione, diagnosi ed ICD-10. I - Principi generali e considerazioni critiche*

Published online by Cambridge University Press:  11 October 2011

Giovanni de Girolamo
Giovanni de Girolamo*
Affiliation:
Division of Mental Health, World Health Organization, Geneva
*
Indirizzo per la corrispondenza: Dr. G. de Girolamo, Division of Mental Health, WHO, 1211 Geneva 27, Switzerland. Fax. (+41)22-791.0746
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Summary

Objective - To discuss some theoretical and practical problems related to classification in the medical and psychiatric fields, and to present the general structure of the Tenth Revision of the International Classification of Diseases (ICD-10), officially adopted as from January 1993. Results - This paper discusses the epistemological basis of classification, the various classification strategies adopted in the medical and psychiatric fields and the main theoretical models employed in this area. The problems related to the reliability and validity of psychiatric diagnoses are then reviewed, and the different strategies to be used in order to improve them are presented. Finally the principles which have led the development of the ICD-10, and the field trials carried out in order to test the appropriatness of this system are discussed. Conclusions - In the psychiatric field classification is essential in order to make possible an ordered systematization of new knowledge and to facilitate the communication between health workers and users of services. The ICD-10 represents the biggest effort ever carried out at an international level to build a reliable classification incorporating different psychiatric traditions.

Riassunto

Scopo - Discutere i principali problemi teorico-pratici connessi alia classificazione in campo medico e psichiatrico, e presentare la struttura generale della decima revisione della Classificazione Internazionale delle Malattie (ICD-10), entrata ufficialmente in vigore dal gennaio del 1993. Risultati - Sono dapprima discussi i fondamenti epistemologici della classificazione, le varie strategic classificatorie adottate in campo medico e psichiatrico ed i principali modelli classificatori esistenti. Sono quindi analizzati i problemi relativi alia attendibilità ed alia validità delle diagnosi psichiatriche, e vengono descritte le strategic che possono essere impiegate per migliorarle. Infine sono discussi i principi che hanno informato ia stesura dell' ICD-10 ed i field trials effettuati al fine di preparare il testo finale delle direttive diagnostiche. Conclusioni - La classificazione in psichiatria rappresenta un passaggio obbligato e necessario per rendere possibile la sistematizzazione delle nuove conoscenze e la comunicazione tra operatori, ricercatori ed utenti. La decima revisione dell' ICD rappresenta lo sforzo più ampio sinora compiuto in campo psichiatrico al fine di predisporre un sistema classificatorio rigoroso che, nel contempo, sintetizzi approcci e culture psichiatriche differenziate.

Keywords

diagnosiclassificazioneICD-10diagnosisclassificationICD-10
Type
Articoli
Information
Epidemiology and Psychiatric Sciences , Volume 2 , Issue 2 , August 1993 , pp. 83 - 103
Copyright
Copyright © Cambridge University Press 1993

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Footnotes

*

Le opinioni espresse in questo articolo sono sola responasbilità dell'autore.

References

BIBLIOGRAFIA

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (DSM III) (3rd ed.). American Psychiatric Association: Washington DC.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (DSM III) (3rd ed. revised). American Psychiatric Association: Washington DC.Google Scholar
Antiseri, D. (1983). Diagnosi clinica, logica della situazione e «oc-chio clinico». In Scoperta e Diagnosi in Medicina (ed. Scandellari, C. e Federspil, G.), pp. 97–128. Piccin: Padova.Google Scholar
Baldini, M. (1975). Epistemologia Contemporanea e Clinica Medi-ca. Citta di Vita: Firenze.Google Scholar
Barras, V. (1990). Semiologie et medicine. Gazette Medicale 18, 1869–1872.Google Scholar
Bentall, R.P. (1992). A proposal to classify happiness as a psychiatric disorder.Journal of Medical Bioethics 18, 94–98.Google ScholarPubMed
Berlinguer, G. (1982). Disease as suffering, deviation, danger, signal and stimulus. International Journal of Health Services 12, 309–319.CrossRefGoogle ScholarPubMed
Blacker, D. & Tsuang, M.T. (1992). Contested boundaries of bipolar disorder and the limits of categorical diagnosis in psychiatry. American Journal of Psychiatry 149, 1473–1483.Google ScholarPubMed
Blois, M.S. (1988). Medicine and the nature of vertical reasoning. New England Journal of Medicine 318, 847–851.CrossRefGoogle ScholarPubMed
Brown, P. (1990). The name game: toward a sociology of diagnosis. In Challenging the Therapeutic State: Critical Perspectives on Psychiatry and the Mental Health System (ed. Cohen, D.), Journal of Mind and Behaviour Special Issue, 11, 385–406.Google Scholar
Campbell, E.J.M. (1987). The diagnosing mind. Lancet I, 849–851.CrossRefGoogle Scholar
Cooper, B. & Morgan, H.G. (1981). Psichiatria Epidemiologica. Boringhieri: Torino.Google Scholar
Cooper, J.E. (1984). Diagnosi e processo diagnostico. In Manuale Cambridge di Psichiatria. I. Psicopatologia Generate (ed. Shepherd, M. e Zangwill, O.L.), pp. 205–215. Zanichelli: Bologna.Google Scholar
Cooper, J.E. (1985). La standardizzazione della valutazione e della classificazione in psichiatria. In L'Approccio Epidemiologico in Psichiatria (ed. Tanselia, M.), pp. 50–63. Boringhieri: Torino.Google Scholar
Cooper, J.E. (1988). The structure and presentation of contemporary psychiatric classifications with special reference to ICD-9 and 10. British Journal of Psychiatry Supplement No.l, 152, 21–28.CrossRefGoogle Scholar
Cooper, J.E., Ker.dell, R.E., Gurland, B.J., Sharpe, L., Copeland, J.R.M. & Simon, R. (1972). Psychiatric Diagnosis in New York and London: A Comparative Study of Mental -Hospital Admissions. (Maudsley Monograph No. 22). Oxford University: London.Google Scholar
de Girolamo, G. (1991). Schizofrenia: dal mito kraepeliano ai modelli psicosociali. In Schizofrenia e guarigione, (ed. Warner, R.), pp. 15–59. Feltrinelli: Milano.Google Scholar
de Girolamo, G. (1993). International perspectives on the treatment and prevention of post-traumatic stress disorders. In International Handbook of Traumatic Stress Syndromes (ed. Wilson, J.P. and Raphael, B.), pp. 935–946. Plenum: New York.CrossRefGoogle Scholar
de Girolamo, G. (in stampa). Mental health research: ten unresolved dilemmas. Neurologia, Psichiatria e Scienze Umane.Google Scholar
de Girolamo, G., Marchitelli, G. & Palazzi, S. (1989). Sindrome premestruale: verso una nuova isteria? Rivista Sperimentale di Freniatria 113, 113–154.Google Scholar
Editorial (1987). Diagnosis: logic and psycho-logic. Lancet 1, 840–841.Google Scholar
Eisenberg, L. (1983). The subjective in medicine. Perspectives in Biology and Medicine 27, 48–61.CrossRefGoogle ScholarPubMed
Fava, G.A. & Kellner, R. (1993). Staging: a neglected dimension in psychiatric classification. Ada Psychiatrica Scandinavica 87, 225–230.CrossRefGoogle ScholarPubMed
Federspil, G. (1980). I Fondamenti del Metodo in Medicina Clinica e Sperimentale. Piccin: Padova.Google Scholar
Federspil, G. (1982). La psichiatria come scienza: limiti e prospettive. In Controversie in Psichiatria (ed. Andreoli, V.), pp. 57–84. Masson: Milano.Google Scholar
Federspil, G. (1990). La malattia come evento biologico. Minerva Medica 81, 845–854.Google Scholar
Federspil, G. Nosografia. In Aggiornamenti della Enciclopedia Italiana. Istituto della Enciclopedia Italiana: Roma (in stampa).Google Scholar
Federspil, G. & Scandellari, C. (1986). Dalla nosografia morgagnana alia nosografia contemporanea. In De Sedibus et Causis (eds. Cappelletti, V. & Trocchio, F. Di), pp. 303–318. Istituto della Enciclopedia Italiana: Roma.Google Scholar
Feinstein, A.R. (1972). Clinical biostatistics XIII: on homogeneity, taxonomy and nosography. Clinical Pharmacology and Therapeutics 13, 114–129.CrossRefGoogle Scholar
Feinstein, A.R. (1977). A critical overview of diagnosis in psychiatry. In Psychiatric Diagnosis (ed. Rakoff, V.M., Stancer, H.C. and Kedward, H.B.), pp. 189–206. Brunner Mazel: New York.CrossRefGoogle Scholar
Feinstein, A.R. (1985). Clinical Epidemiology: The Architecture of Clinical Research. W.B. Saunders Company: Philadelphia.Google Scholar
Foucault, M. (1969). Nascita della Clinica. Einaudi: Torino.Google Scholar
Frances, A., Pincus, H., Widiger, T., First, M., Davis, W. & Hall, W. (1992). DSM-IV and international communication in psychiatric diagnosis. World Psychiatry 1, 27–32.Google Scholar
Gauron, E.F. & Dickinson, J.K. (1966). Diagnostic decision making in psychiatry. Archives of General Psychiatry 14, 225–237.CrossRefGoogle ScholarPubMed
Gauron, E.F. & Dickinson, J.K. (1969). The influence of seeing the patient first on diagnostic decision making in psychiatry. American Journal of Psychiatry 126, 199–205.CrossRefGoogle ScholarPubMed
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders. A Bio-social Model. Tavistock: London. Trad, it.: Disturb! Emotivi Comuni. Un Approccio Biosociale (ed. M. Tansella). Il Pensiero Scientifico: Roma, 1993Google Scholar
Hempel, C.G. (1968). Filosofia delle Scienze Naturali. H Mulino: Bologna.Google Scholar
Grove, W.M., Andreasen, N.C., McDonald-Scott, P., Keller, M.B. & Shapiro, R.W. (1981). Reliability studies of psychiatric diagnosis. Archives of General Psychiatry 38, 408–413.CrossRefGoogle ScholarPubMed
Hollister, L.E. (1992). Panic disorder: old wine in new bottles. Integrative Psychiatry 8, 75–83, 1992.Google Scholar
Jablensky, A. (1988). Methodological issues in psychiatric classification. British Journal of Psychiatry Supplement No.l, 152, 15–20.CrossRefGoogle Scholar
Jampala, C.V., Sierles, F.S. & Taylor, M.A. (1986). Consumers views of DSM-III: attitudes and practices of US psychiatrists and 1984 graduating psychiatric residents. American Journal of Psychiatry 143, 148–153.Google ScholarPubMed
Jampala, V., Sierles, F.S. & Taylor, M.A. (1988). The use of DSMIII in the United States: a case of not going by the book. Comprehensive Psychiatry 29, 39–47.CrossRefGoogle Scholar
Jaspers, K. (1964). Psicopatologia Generate. II Pensiero Scientifico: Roma.Google Scholar
Kendell, R.E. (1974). It Ruolo delta Diagnosi in Psichiatria. II Pensiero Scientifico: Roma.Google Scholar
Kendell, R.E. (1984). I principi classificatori in relazione alia malattia mentale. In Manuale Cambridge di Psichiatria. I. Psicopatologia Generate (ed. Shepherd, M. e Zangwill, O.L.), pp. 197–204. Zanichelli: Bologna.Google Scholar
Kendell, R.E. (1989). Clinical validity. In The Validity of Psychiatric Diagnosis (ed. Robins, L.N. and Barret, J.E.), pp.305–323. Raven Press: New York.Google Scholar
Kendell, R.E. (1991). Relationship between the DSM-IV and the ICD-10. Journal of Abnormal Psychology 3, 297–301.CrossRefGoogle Scholar
Lanteri-Laura, G. (1983). La semiologie psychiatrique: son evolution et son etat en 1982. L'Evolution Psichiatrique 48, 327–363.Google Scholar
Lanteri-Laura, G. & Del Pistoia, L. (1983). Il sapere psichiatrico e le condizioni della sua produzione. Rivista Sperimentale di Freniatria 107, 34–49.Google Scholar
Lazare, A. (1973). Hidden conceptual models in clinical psychiatry. New England Journal of Medicine 288, 345–351.CrossRefGoogle ScholarPubMed
Lipkowitz, M.H. & Idupuganti, S. (1983). Diagnosing schizophrenia in 1982: the effect of DSM-III. American Journal of Psychiatry 142, 634–637.Google Scholar
Lipkowitz, M.H. & Idupuganti, S. (1985). Diagnosing schizophrenia in 1980: a survey of US physicians. American Journal of Psychiatry 140, 52–55.Google Scholar
Lipton, A.A. & Simon, F.S. (1985). Psychiatric diagnosis in a state hospital: Manhattan State revisited. Hospital and Community Psychiatry 36, 368–373.Google Scholar
Llyod, G.G. (1986). Hysteria: a case for conservation? British Medical Journal 293, 1255–1256.CrossRefGoogle Scholar
Loranger, A.W. (1990). The impact of DSM-III on diagnostic practice in a University Hospital. Archives of General Psychiatry 47, 672–675.CrossRefGoogle ScholarPubMed
Loranger, A.W., Hirschfeld, R.M.A., Sartorius, N. & Regier, D.A. (1991). The WHO/ADAMHA International Pilot Study of Personality Disorders: background and purpose. Journal of Personality Disorders 5, 296–306.CrossRefGoogle Scholar
Loring, M. & Powell, B. (1988). Gender, race, and DSM-III: a study of the objectivity of psychiatric diagnostic behaviour. Journal of Health and Social Behavior 29, 1–22.CrossRefGoogle Scholar
Meehl, P.E. (1985). Diagnostic taxa as open concepts: metatheoretical and statistical questions about reliability and construct validity in the grand strategy of nosological revision. In Con-temporary Directions in Psychopathology: Toward the DSMIV (ed. Millon, T. and Klerman, G.L.), pp. 215–231. Guilford: New York.Google Scholar
Mezzich, J.E. (1988). On developing a psychiatric multiaxial schema for ICD-10. British Journal of Psychiatry, Supplement No.l, 152, 38–43.CrossRefGoogle Scholar
Millon, T. (1991). Classification in psychopathology: rationale, alternatives, and standards. Journal of Abnormal Psychology 3, 245–261.CrossRefGoogle Scholar
Parshall, A.M. & Priest, R.G. (1993). Nosology, taxonomy and the classification conundrum of the functional psychosis. British Journal of Psychiatry 162, 227–236.CrossRefGoogle Scholar
Pera, M. (1982). Metodologie della scienza e filosofie della mente. La psichiatria al bivio. In Controversie in Psichiatria (ed. Andreoli, V.), pp. 85–98. Masson: Milano.Google Scholar
Ponsi, I. & Bonner, M. (1979). Modelli di malattia mentale e di intervento psichiatrico. Psicoterapia e Scienze Umane 3, 47–68.Google Scholar
Pull, C.B. & Wittchen, H.U. (1991). CIDI, SCAN and IPDE: structured diagnostic interviews for ICD-10 and DSM-III-R. European Psychiatry 6, 277–285.CrossRefGoogle Scholar
Robins, L.N., Wing, J, Wittchen, H.-U., Helzer, J.E., Babor, T.F., Burke, J., Farmer, A., Jablenski, A., Pickens, R., Regier, D.A., Sartorius, N. & Towle, L.H. (1988). The Composite International Diagnostic Interview. Archives of General Psychiatry 45, 1069–1076.CrossRefGoogle ScholarPubMed
Robins, L.N. (1990). Psychiatric epidemiology - a historic review. Social Psychiatry and Psychiatric Epidemiology 25, 16–26.CrossRefGoogle ScholarPubMed
Rosaia, L. (1986). L'incertezza della medicina. Le Scienze 209, 32–39.Google Scholar
Rutter, M. & Gould, M. (1985). Classification. In Child and Adole-scent Psychiatry. Modern Approaches, (ed. Rutter, M. and Hersov, L.), pp. 304–321. Blackwell: London.Google Scholar
Sandifer, M.G., Hordern, A. & Green, L.M. (1970). The psychiatric interview: the impact of the first three minutes. American Journal of Psychiatry 126, 968–973.CrossRefGoogle ScholarPubMed
Sartorius, N. (1991). The classification of mental disorders in the Tenth Revision of the International Classification of Diseases. European Psychiatry 6, 315–322.CrossRefGoogle Scholar
Sartorius, N., de Girolamo, G., Andrews, G., German, A. & Eisenberg, L. (eds.) (1993a). Treatment of Mental Disorders. A Re-view of Effectiveness. American Psychiatric Press: Washington.Google Scholar
Sartorius, N., Kaelber, C., Cooper, J., Roper, M., Rae, D., Gulbinat, W., Ustun, B. & Regier, D. (1993b). Progress towards achieving a common language in psychiatry: results from the field trial of the clinical guidelines accompanying the WHO classification of mental and behavioural disorders in the ICD-10. Archives of General Psychiatry 50, 115–124..CrossRefGoogle Scholar
Scadding, J.G. (1988). Health and disease: whan can medicine do for philosophy? Journal of Medical Bioethics 14, 118–124.Google Scholar
Scadding, G. (1993). Nosology, taxonomy and the classification conundrum of the functional psychoses. British Journal of Psychiatry 162, 237–238.CrossRefGoogle Scholar
Scandellari, C. (1981). La Strategia della Diagnosi. Piccin: Padova.Google Scholar
Scandellari, C. & Federspil, G. (ed.) (1983). Scoperta e Diagnosi in Medicina. Piccin: Padova.Google Scholar
Shepherd, M., Brooke, E.M., Cooper, J.E. & Lin, T. (1968). An Experimental Approach to Psychiatric Diagnosis. Acta Psychiatrica Scandinavica, Supplementum No. 201, vol. 44, pp. 7–86.Google Scholar
Sokal, R.R. (1974). Classification: purposes, principles, progress. Science 185, 115–123.Google Scholar
Spitzer, R.L., Endicott, J. & Robins, E. (1978). Reliability of clinical criteria for psychiatric diagnosis. In Psychiatric Diagnosis: Exploration of Biological Predictors (ed. Akiskal, H.S. and Webb, W.L.), pp. 61–73. SP Medical & Scientific Books: New York.Google Scholar
Szasz, T. (1991). Diagnoses are not diseases. Lancet 338, 1574–1576.CrossRefGoogle Scholar
Temerlin, M.K. (1968). Suggestion effects in psychiatric diagnosis. Journal of Nervous and Mental Disease 147, 349–353.CrossRefGoogle ScholarPubMed
Terzian, E. (1993). Panico: una revisione (non esaustiva) della letteratura. Lettera (Istituto Mario Negri), 132–181Google Scholar
Wallace, E.R. (1988). What is «Truth»? some philosophical contributions to psychiatric issues. American Journal of Psychiatry 145, 137–147.Google Scholar
Wallace, E.R. (1988). What is «Truth»? some philosophical contributions contributions to psychiatric issues. American Journal of Psychiatry 145, 137–147.Google Scholar
Williams, P. (1979) Deciding how to treat - the relevance of psychiatric diagnosis. Psychological Medicine, 9 179–186.CrossRefGoogle ScholarPubMed
Wing, J.K., Babor, T., Brugha, T., Burke, J., Cooper, J.E., Giel, R., Jablenski, A., Regier, D. & Sartorius, N. (1990). SCAN: Schedules for clinical assessment in neuropsychiatry. Archives of General Psychiatry 471, 589–593.CrossRefGoogle Scholar
World Health Organization (1977). International Classification of Diseases, 9th Revision. WHO: Geneva.Google Scholar
World Health Organization (1979). The International Pilot Study of Schizophrenia. A Follow-up Study. Wiley: Chichester.Google Scholar
World Health Organization (1992). International Classification of Diseases, 10th. Revision. WHO: Geneva. Ed. it.: Decima Revisione della Classificazione Internazionale delle Sindromi e dei Disturbi Psichici e Comportamentali. Descrizioni Cliniche e Direttive Diagnostiche (ed. D. Kemali, M. Maj, F. Catapano, S. Lobrace e L. Magliano). Masson: Milano.Google Scholar