Substance-induced psychosis (SIP) is characterized by both substance use and a psychotic state, and it is assumed that the first causes the latter. In ICD-10 the diagnosis is categorized as and grouped together with substance use disorders, and to a large extent also treated as such in the health care system. Though criticism of the diagnostic construct of SIP dates back several decades, numerous large and high-quality studies have been published during the past 5–10 years that substantiate and amplify this critique. The way we understand SIP and even how we name it is of major importance for treatment and it has judicial consequences. It has been demonstrated that substance use alone is not sufficient to cause psychosis, and that other risk factors besides substance use are at play. These are risk factors that are also known to be associated with schizophrenia spectrum disorders. Furthermore, register-based studies from several different countries find that a large proportion, around one in four, of those who are initially diagnosed with an SIP over time are subsequently diagnosed with a schizophrenia spectrum disorder. This scoping review discusses the construct validity of SIP considering recent evidence. We challenge the immanent causal assumption in SIP, and advocate that the condition shares many features with the schizophrenia spectrum disorders. In conclusion, we argue that SIP just as well could be considered a first-episode psychotic disorder in patients with substance use.

We examined the accuracy of International Classification of Disease 10th iteration (ICD-10) diagnosis codes within Canadian administrative data in identifying cerebral venous thrombosis (CVT). Of 289 confirmed cases of CVT admitted to our comprehensive stroke center between 2008 and 2018, 239/289 were new diagnoses and 204/239 were acute events with only 75/204 representing symptomatic CVTs not provoked by trauma or structural processes. Using ICD-10 codes in any position, sensitivity was 39.1% and positive predictive value was 94.2% for patients with a current or history of CVT and 84.0% and 52.5% for acute and symptomatic CVTs not provoked by trauma or structural processes.

While melancholic (according to DSM) or somatic syndrome (according to ICD) has strong historical roots and substantial empirical verification, the concept of atypical features is relatively new and not sufficiently studied. The aim of the current study was to investigate the reliability of these diagnostic subcategories in patients suffering from major depression in Greece. Forty patients (eight males and 32 females) aged 19-60 years (mean 39.3, sd 12.2) suffering from major depression according to DSM-IV criteria were studied. SCAN v.2.0 was used to assess symptomatology. The presence of each criterion according to DSM-IV and ICD-10 was registered. Frequency tables were developed and factor and cluster analysis were performed. The results of the analysis suggest the existence of three syndromes which roughly reflect the melancholic and atypical but also propose a third, which can be considered as an ‘undifferentiated’ syndrome. The DSM demand that the existence of melancholic features be excluded first and then that diagnosis of atypical features be made was confirmed.

The chapter dealing with the classification of mental disorders in the Tenth Revision of the International Classification of Diseases (ICD-10) has been developed after consultation with experts in many countries. Each of the categories has been clearly defined so as to facilitate the assignment of diagnoses. The descriptions of categories and the diagnostic guidelines have then been tested in 110 centres located in over 40 countries, and the results have been used to finalize the text. The classification will be issued in several versions - one for statistical purposes, one for clinicians, one for researchers and one for general practitioners. A multiaxial presentation of the classification is being tested at present and will be made available in early 1993. The paper describes the requirements and principles which led to the classification, depicts the process outlined above and gives prospects for the future.

Since the DSM-III, the category of dysthymia includes patients that were previously considered as neurotic, reactive, characterological, temperamental, minor or atypical depressives as opposed to a category of endogenous, autonomous, morbid, major or typical depressives. Despite certain confusion, the need for a nosological category is very important for patients suffering from years of depressive mood, with a significant impact on their life-styles and adaptation, as they can benefit enormously from modern antidepressant treatments. DSM-IV and ICD-10 describe dysthymia in a very similar way although there are significant differences. The differences are the consequence of the lack of sufficient scientific data in some points and the need to take a decision, but also to indicate areas for future research. Other differences are the consequence of major discrepancies in basic perspectives of the classifications (ie, the importance given to disablement for the diagnosis). The similarities between both classifications allow the use of either of them for most purposes. Research on the different classifications should help in better defining the concept of dysthymia and mood disorders in general (ie, the cut-off points between them) and of psychiatric nosology.

The WHO Collaborative Study on Psychological Problems in General Health Care examined the frequency, form, course and outcome of psychological problems in general health care settings. A total of 25,916 general health care attenders at 15 sites in 14 countries were screened using the 12-item General Health Questionnaire (GHQ-12). Of those screened, 5,438 were assessed in detail using a Primary Health Care version of the Composite International Diagnostic Interview (CIDI-PHC) in conjunction with the Brief Disability Questionnaire, the Social Disability Schedules, a self rated overall health status form and the 28-item General Health Questionnaire. The analysis has shown that sleep problems were common at all sites with: 26.8% of all patients having some form of sleep problem and 15% of the patients examined had trouble falling or staying asleep. Of those with sleep problems, 51.5% had a well-defined International Classification of Diseases 10th Revision (ICD-10) mental disorder (such as depression, anxiety, somatoform disorders or alcohol problems) and 48.5% of those with sleep problems for at least two weeks or more did not fulfil the criteria for any well defined ICD-10 diagnosis. Persons with sleep problems reported a degree of disability in the performance of their daily activities and social roles even when they had no symptoms of psychological disorders. When such symptoms were present the disability was significantly increased.

In an attempt to assess the universal applicability of the International Classification of Disease (ICD-10), two psychiatrists from different socio-cultural backgrounds and training independently performed a chart review of 238 Chinese patients. Inter-rater reliability figures were comparable to those found in the WHO-coordinated ICD-10 field trials. The results suggest that ICD-10 has good ‘universality’ in routine clinical practice.

This study examines the stability of ICD-10 diagnoses of patients admitted to Al Ain (United Arab Emirates) inpatients psychiatric unit during the period from November 1993 to August 1995. Diagnostic stability is a measure of the degree to which diagnoses remained unchanged at a later hospital admission. One hundred and seven patients were admitted more than once during this period, accounting for 168 readmissions. High levels of diagnostic stability were found for ICD-10 Fl-psychiatric disorders (100%), F2-schizophrenia (87%), F3-bipolar disorders (87%) and F3-depressive disorders (73%). A poor level of stability was found for patients with neurotic, stress related and adjustment disorders (F4), ranging from zero for somatoform disorders to 50% for generalized anxiety and panic disorders. Poor levels of stability were also found for other psychoses (excluding schizophrenia and affective psychoses) and personality disorders. We conclude that the introduction of ICD-10 as a formal diagnostic system has greatly improved the temporal stability of the most commonly encountered psychiatric disorders (ICD-10 Fl to F3 disorders), confirming the construct validity of those psychiatric disorders. Further investigations are required to evaluate the diagnostic stability of neurotic and other psychotic disorders.

Nine raters applied ICD-10 diagnoses on 36 Danish child and adolescent psychiatric patients by screening their case records and using the DCR of ICD-10. The highest inter-rater agreement was obtained In the group of adolescent patients, the lowest was observed in emotional disorders in children. The comments on ICD-10 were generally positive but we support the creation of a category for the borderline children, and for the non-hyperactive children with attention deficit disorder.

Rather high prevalence rates of alcohol abuse in the elderly have been reported in the literature. However, there is some evidence that many elderly persons with alcohol problems are not identified, probably due to the nonspecificity of alcohol-related presentations in old individuals. Thus, there is an ongoing discussion on appropriate diagnostic criteria for alcohol dependence in elder people who frequently begin to abuse alcohol in late life. This study was aimed to explore whether alcoholics with late onset (beginning after the age of 45) differ from those with an early onset (prior the age of 25). Two hundred and sixty eight subjects consecutively referred to a ward of a general hospital specialized for alcohol detoxification were divided into three groups by the age at onset of harmful alcohol consumption. The duration of harmful drinking was rather similar in all groups. However, alcohol dependence according to the ICD-10 criteria (three or more have to be fulfilled) was diagnosed in 94.1% of the alcoholics with an early onset (≤ 25 years), but only in 62.2% of those with late onset (P < 0.0001). Significant differences between these groups were found for the following criteria: preoccupation with drinking (P < 0.0001), impaired capacity to control drinking (P < 0.01), strong desire to drink alcohol (P < 0.01), and a trend towards a lower rate of lifetime psychiatric comorbidity. The alcoholics with late onset reported fewer previous detoxifications and a lower actual alcohol consumption. Moreover, they showed a higher rate of abstinence in the 12 month follow-up. Regarding the difficulties in comparing groups of different ages at onset of harmful alcohol use our results suggest that the alcoholics with late onset differ in many ways from those with early onset.

The form, frequency and burden of sleep problems in general health care in the WHO Collaborative Study on Psychological Problems are presented in this same issue. This study was conducted in 5,438 primary care patients belonging to 15 centres in 14 countries after 25,916 patients were screened with the GHQ-12. Diagnoses according to the International Classification of Diseases (ICD-10) were obtained from the Composite International Diagnostic Interview (CIDI-PHC). The presence of difficulties falling asleep, staying asleep, waking too early or sleeping too much were assessed by the CIDI. General practitioners (GPs) gave their opinion on the existence of a psychological problem and/or a physical disease and indicated what therapeutic intervention was proposed to patients they recognized as psychological cases. The existence of sleep problems increased the recognition of patients with psychiatric disorders by their GP. No specific subtype of sleep problems influences recognition. The existence of a somatic disease had little influence on the identification of sleep problems as psychological cases. Sleep problems were not frequently expressed as a main presenting complaint. In such a case the recognition rate of patients with ICD-10 diagnosis was unchanged but a sedative treatment was offered more frequently. Overall, 85.9% of patients with sleep problems and recognized as cases were offered treatment, 53.9% drug treatment. The most frequent treatment consumed was stimulants, tonics or vitamins while the most frequently prescribed were antidepressants, hypnotic and anxiolytics with rather similar proportions. Drug consumption was substantially lower than drug prescription.

Standardization of nomenclature and terminology used in the field of mental health has been one of the main goals of the World Health Organization's (WHO) Mental Health Programme among recent activities undertaken to achieve this goal, is the development of definition and guidelines accompanying the chapter dealing with mental disorders in the tenth revision of the International Classification of Diseases (ICD-10) and of a set of instruments for the assessment of mental disorders. To enhance common understanding and uniformity of usage of the terms embedded in the classification and instruments and to facilitate their use in different cultures and settings, a series of lexica and glossaries has also been produced by WHO. The article describes the basic characteristics of the Lexicon of psychiatric and mental health terms, 2nd edition; Lexicon of alcohol and drug terms; Lexicon of crosscultural terms in mental health; SCAN glossary; and the ICD-10 symptom glossary for mental disorders.

In the present study, all patients who met the diagnostic criteria for a long-term functional psychosis (LFP) were identified within a defined uptake area in the northern part of the county of Uppsala, Sweden. LFP includes patients 1) with productive psychotic symptomatology, not caused by organic disease, for 1 week or more, at least once during the course of the illness; 2) having been affected by a psychosis for a continuous period of at least 6 months on the same occasion; 3) having shown psychotic features or residual symptoms during the index year; and 4) older than 18 years of age. Primarily, all diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R. The prevalence of schizophrenia was 4.2 per 1,000 inhabitants. The prevalence of schizoaffective disorder was 0.7 per 1,000 inhabitants and for delusional disorder, 0.1 per 1,000 inhabitants. When the patients were rediagnosed according to DSM-III, DSM-IV and International Statistical Classification of Disease (ICD)-10, it was found that the prevalence of schizophrenia, schizoaffective disorder and delusional disorder was somewhat lower according to the DSM-III criteria, while the same number of patients fulfilled the criteria according to DSM-IV. If ICD-10 was used, it resulted in a broader concept of schizophrenia and a somewhat more narrow concept of schizoaffective disorder. Thus, the introduction of the new parallel diagnostic systems, ICD-10 and DSM-IV, will result in different, but comparable, prevalence estimates concerning schizophrenia, schizoaffective disorder and delusional disorder.