Lamberts H, Magruder K, Kathol R G, Pincus H A, Okkes I
Academic Medical Center, University of Amsterdam, The Netherlands.
Int J Psychiatry Med. 1998;28(2):159-76. doi: 10.2190/N03F-3F84-7HC0-XR1G.
Primary care physicians traditionally have a strong interest in the mental health of their patients. Three classification systems are available for them to diagnose, label, and classify mental disorders: 1) The ICD-10 approach with three options, 2) The DSM-IV approach with two options, and 3) the ICPC approach with two options. This article lists important similarities and differences between the systems to help potential users choose the option that best meets their needs.
Definitions for depressive disorder, anxiety disorder, and somatization disorder are compared on five characteristics of classification: 1. the domain, 2. the scope, 3. the nature of the definitions, 4. focus on episodes of care, and 5. clinical guidelines.
Primary care physicians and psychiatrists have different perspectives, reflected in different classifications. Each system has specific possibilities and limitations with regard to the diagnosis of mental disorders. For common mental disorders it is possible, however, to choose codes from one system while maintaining compatibility with the other two. Comparability as to the diagnostic content of the different classes, however, is more difficult to establish. The available classification systems give both primary care physicians and psychiatrists options to diagnose, label, and to classify mental disorders from their own perspective, but once a system has been chosen the clinical comparability of a patient with the same diagnosis in other systems is limited.
Compatibility among systems can be optimized by strictly following a number of rules. The conversion between ICPC and ICD-10 (and consequently DSM-IV) allows simultaneous use of ICPC and ICD-10 as a classification and DSM-IV as the standard nomenclature. This is of particular interest for computer based patient records in primary care. The clinical comparability of the same diagnosis in different systems however is limited by the characteristics of the different system.
初级保健医生传统上对患者的心理健康有着浓厚兴趣。有三种分类系统可供他们用于诊断、标记和分类精神障碍：1）国际疾病分类第十版（ICD - 10）方法，有三种选项；2）精神疾病诊断与统计手册第四版（DSM - IV）方法，有两种选项；3）基层医疗国际分类（ICPC）方法，有两种选项。本文列出了这些系统之间的重要异同点，以帮助潜在用户选择最符合其需求的选项。
对抑郁症、焦虑症和躯体化障碍的定义，从分类的五个特征进行比较：1. 领域；2. 范围；3. 定义的性质；4. 对诊疗过程的关注；5. 临床指南。
初级保健医生和精神科医生有不同的观点，这反映在不同的分类中。每个系统在精神障碍诊断方面都有特定的可能性和局限性。然而，对于常见精神障碍，有可能从一个系统中选择编码，同时与其他两个系统保持兼容性。然而，不同类别诊断内容的可比性更难确定。现有的分类系统为初级保健医生和精神科医生都提供了从各自角度诊断、标记和分类精神障碍的选项，但一旦选择了一个系统，同一诊断的患者在其他系统中的临床可比性就有限。
通过严格遵循一些规则，可以优化系统之间的兼容性。ICPC与ICD - 10（以及相应的DSM - IV）之间的转换允许同时使用ICPC和ICD - 10作为分类，以及DSM - IV作为标准术语。这对于基层医疗中基于计算机的患者记录尤为重要。然而，不同系统中同一诊断的临床可比性受到不同系统特征的限制。
