Luciano Mario, Sampogna Gaia, Del Vecchio Valeria, Giallonardo Vincenzo, Palummo Carmela, Pocai Benedetta, Steardo Luca, Zinno Francesca, Rebello Tahilia, Reed Geoffrey M, Fiorillo Andrea
WHO Collaborating Center for Research and Training in Mental Health, University of Campania "L. Vanvitelli", Naples, Italy.
2Dipartimento di Scienze della Salute, Università della Magna Graecia, Catanzaro, Italy.
Int J Ment Health Syst. 2020 Jan 24;14:4. doi: 10.1186/s13033-020-0338-z. eCollection 2020.
The 11th revision of the International Classification of Diseases and Related Disorders (ICD-11) has been released. In order to test the clinical consistency and the clinical utility of the proposed guidelines the World Health Organization (WHO) has carried out the Ecological Implementation Field Studies in various countries. In this paper the results of the Italian field trials on the clinical utility of the ICD-11 diagnostic guideline concerning schizophrenia and related disorders will be presented.
In Italy, field trials have been carried out at the Department of Psychiatry of the University of Campania "L. Vanvitelli". All patients showing any psychotic symptom and referring to the outpatient and inpatient units have been recruited. Patients were interviewed by two clinicians with whom they had not had any prior clinical contact. At the end of each interview, clinicians were asked to complete 12 questions about the clinical utility of the diagnostic guidelines as applied to each patient.
Fourteen clinicians and 100 patients have been involved. The ICD-11 clinical guidelines were perceived as easy to use, with an adequate goodness of fit, clear and understandable and with an adequate level of details and specificity to describe the essential features of the diagnoses. Clinicians rated very positively their usefulness in describing the threshold between patient's disorder and normality. Despite still very positive, the guidelines have been perceived as less useful to select a treatment, to assess patients' prognosis and to communicate with other mental health professionals.
The 11th revision of the chapter on Mental, Behavioural and Neurodevelopmental Disorders has made substantive changes to the conceptualization of mental disorders which could have impacted on their reliability and clinical utility. Results of the Italian field studies, in line with those reported by the international sample, highlight that ICD-11 has been rated as highly clinically useful by participating clinician, more than the ICD-10. This could be considered a good reason to be optimistic about the implementation of the ICD-11 among global clinicians. The study has been approved by the Ethical Review Board of the University of Campania "L. Vanvitelli" (N. 416, 2016).
《国际疾病及相关健康问题统计分类》（ICD - 11）的第11次修订版已发布。为测试拟议指南的临床一致性和临床实用性，世界卫生组织（WHO）在多个国家开展了生态实施现场研究。本文将展示意大利针对ICD - 11关于精神分裂症及相关障碍诊断指南的临床实用性进行的现场试验结果。
在意大利，坎帕尼亚大学“L. 万维泰利”精神病学系开展了现场试验。招募了所有出现任何精神病性症状并前往门诊和住院部就诊的患者。由两名此前未与患者有过临床接触的临床医生对患者进行访谈。每次访谈结束时，要求临床医生完成12个关于诊断指南应用于每位患者时临床实用性的问题。
共有14名临床医生和100名患者参与。ICD - 11临床指南被认为易于使用，拟合优度足够，清晰易懂，且具有足够的细节和特异性来描述诊断的基本特征。临床医生对其在描述患者疾病与正常状态之间界限方面的有用性给予了非常积极的评价。尽管仍然非常积极，但指南在选择治疗方法、评估患者预后以及与其他心理健康专业人员沟通方面被认为用处较小。
关于精神、行为和神经发育障碍的章节的第11次修订对精神障碍的概念化进行了实质性改变，这可能影响其可靠性和临床实用性。意大利现场研究的结果与国际样本报告的结果一致，表明参与的临床医生对ICD - 11的临床有用性评价很高，超过了ICD - 10。这可被视为对ICD - 11在全球临床医生中实施持乐观态度的一个很好理由。该研究已获得坎帕尼亚大学“L. 万维泰利”伦理审查委员会的批准（编号416，2016）。
