Department of Psychiatry and WHO Collaborating Centre for Research and Capacity Building in Global Mental Health, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
Arch Med Res. 2019 Nov;50(8):490-501. doi: 10.1016/j.arcmed.2019.12.012. Epub 2020 Feb 1.
This article reports the results of one of a series of global field studies implemented by the World Health Organization (WHO) to evaluate the accuracy, clinical utility, and global applicability of the new diagnostic guidelines for Mental, Behavioural and Neurological Disorders included in the next version of WHO's International Classification of Diseases (ICD-11).
The purpose of this study was to compare the diagnostic accuracy and clinical utility ratings of global clinicians implementing the ICD-11 diagnostic guidelines for Anxiety and Fear-Related Disorders, relative to those applying ICD-10 guidelines. The study also aimed to identify elements of the guidelines that required further refinement or clarification.
1840 global mental health professionals registered with WHO's Global Clinical Practice Network completed the study in one of six study languages. Participants were randomly assigned to apply either the ICD-11 or ICD-10 guidelines to diagnose standardized case vignettes, and to rate the clinical utility of their assigned guidelines.
ICD-11's diagnostic accuracy and clinical utility were equivalent or superior to that of ICD-10. Global clinicians were significantly more accurate in diagnosing Generalized Anxiety Disorder, Specific Phobia and adult cases of Separation Anxiety Disorder when using ICD-11 and provided high clinical utility ratings for these disorders. Clinicians also found the ICD-11 guidelines easy to use, clear, and a good fit to patients they see in their clinical practice. However, clinicians had difficulty with distinguishing the boundary between disorder and normality for subthreshold cases of anxiety, and also with applying the new ICD-11 guidelines on panic attacks.
The new diagnostic guidelines for Anxiety Disorders in ICD-11 can be applied in an acceptably consistent manner by global clinicians and perform as well or better than the previous guidelines for ICD-10. Study findings also helped identify aspects of the ICD-11 guidelines that required refinement prior to their publication and areas that should be emphasized in training programs.
本文报告了世界卫生组织（WHO）实施的一系列全球现场研究的结果之一，旨在评估即将发布的《国际疾病分类》（ICD-11）中精神、行为和神经障碍新诊断指南的准确性、临床实用性和全球适用性。
本研究旨在比较全球临床医生在应用 ICD-11 焦虑和恐惧相关障碍诊断指南和应用 ICD-10 指南时的诊断准确性和临床实用性评分。该研究还旨在确定指南中需要进一步细化或澄清的要素。
1840 名在世界卫生组织全球临床实践网络注册的全球精神卫生专业人员使用六种研究语言之一完成了这项研究。参与者被随机分配应用 ICD-11 或 ICD-10 指南来诊断标准化病例描述，并对其分配的指南的临床实用性进行评分。
ICD-11 的诊断准确性和临床实用性与 ICD-10 相当或更高。全球临床医生在使用 ICD-11 诊断广泛性焦虑障碍、特定恐惧症和成人分离性焦虑障碍时准确性显著提高，对这些障碍的临床实用性评分较高。临床医生还发现 ICD-11 指南易于使用、清晰，与他们在临床实践中看到的患者非常契合。然而，临床医生在区分焦虑亚阈值病例的障碍和正常之间的界限以及应用 ICD-11 关于惊恐发作的新指南方面存在困难。
ICD-11 中焦虑障碍的新诊断指南可以被全球临床医生以可接受的一致方式应用，其表现与 ICD-10 之前的指南一样或更好。研究结果还帮助确定了 ICD-11 指南在发布前需要细化的方面以及培训计划中应强调的领域。
