ICD 10 Training Kit - (in collaboration with WHO)

WORLD HEALTH ORGANIZATION
WORLD PSYCHIATRIC ASSOCIATION
THE INTERNATIONAL CLASSIFICATION OF MENTAL AND BEHAVIOURAL DISORDERS
(ICD-10 Chapter V)
EDUCATIONAL PROGRAMME
Prepared by
Norman Sartorius
Juan J. Lopez-Ibor
Jenny van Drimmelen
Dolores Crespo
PRESENTATION

The appearance of the ICD-10 Classification of Mental and Behavioral Disorders has beenan event of vast importance for psychiatry. The classification is an essential part of thelanguage which will allow national and international communication in the field of mentalhealth and facilitate joint work across cultures and countries.

The challenge now is to familiarize psychiatrists and other mental health workers withthe ICD-10 Classification of Mental and Behavioral Disorders to help them to use it well.

The World Psychiatric Association, the World Health Organization as well as othereducational institutions and Centers have carried out presentations and seminarsconcerning the role of ICD-10 in different countries with great success. This disketteprovides materials that have been developed on the basis of experience gained in suchprocess. It has been prepared to help those who would like to undertake similar training activities.

The production of the ICD-10 Classification of Mental and Behavioural Disorders and thefamily of related materials is the result of a joint effort of many people andinstitutions, worldwide. To them should go the credit for this major contribution to thescience and practice of psychiatry; before them and before the WHO and WPA is now also theduty to ensure the widespread and correct use of these materials of the ICD and relatedinstruments.

A first version of this diskette has been produced by the World Psychiatric Associationand the WHO Division of Mental Health and Prevention of Substance as a courtesy to theparticipants of the 10th. World Congress of Psychiatry.

CONTENTS
Preface

Acknowledgements

Section 1 Presentations and workshops

Section 2 Contents of the ICD-10 lectures

Section 3 Listing of materials, useful for training

Section 4 Transparencies

Section 5 Case histories

Appendix 1 - List of references to key books and articles Appendix 2 - Editorial guidelines for the production of case histories

Appendix 3 - Guidelines for the production of videotapes

Appendix 4 - List of WHO Reference and Training Centres on Classification,Diagnosis and Assessment of Mental and Behavioural Disorders

Appendix 5 - Information about computer programmes

Appendix 6 - Form for recording diagnosis

Appendix 7 - Model for evaluation of lecture or workshop

Appendix 8 - Model for certificate for participation in ICD-10 familiarization workshop

Section 1. provides suggestions for the organization of workshops. Section 2. and 3.contain description of the content, as well as suggestions concerning materials to be usedin training.

The text of Section 4. (transparencies) may be used to produce slides or transparentsheets for an overhead projector. For this purpose the files (especially the ASCII files)need adjustments concerning the font, letter sice, etc..

Section 5 (case histories) contains 25 cases, accompanied by a discussion of thediagnosis according to the ICD-10 guidelines and criteria. These cases can be used toilustrate the use of ICD-10 and to provide practice materials for the participants ofworshops or seminars. Teachers may wish to complement this collection with a descriptionof cases linked to the local situation where the participants in the training live andwork.

The text is provided both in Word Perfect 6.0 for Windows (*.wp6) and ASCII (*.asc)text (DOS) and consists of the following files:

PREFACE

The appearance of the ICD-10 Classification of Mental and Behavioural Disorders in itsvarious versions and many languages has been an event of great importance for psychiatry.For the first time in its history psychiatry has produced a classification based on aconsensus of experts and schools of psychiatry world-wide. The new classification is acornerstone, an essential part of the effort to develop a language which will allownational and international communication in the field of mental health and facilitatejoint work across cultures and countries. The production of the classification and of theassessment instruments which are linked to it was an important first step: the nextchallenge is to familiarise psychiatrists and other mental health workers - as well asothers involved in mental health and general health care - with the principles on whichthe ICD classification of mental disorders is based and to help them to use it well.

The nature of this challenge makes collaboration between governmental andnongovernmental organizations in the conduct of relevant programmes highly desirable.WHO's international network of centres and experts which has helped in the development ofthe classification and other WHO mechanisms facilitating technical cooperation are clearlyof great importance in this effort: it is however obvious that the education ofpsychiatrists and of others dealing with mental illness will be greatly helped if majornon-governmental organizations participate in this activity. Among the latter, the WorldPsychiatric Association is already in a particularly useful position because it bringstogether more than 100 psychiatric associations which count among its members the vastmajority of psychiatrists worldwide. The WPA has collaborated in the formulation of theICD-10 participating in a special committee, chaired by the late Professor E. Strömgren,through the WPA's Section on Classification and Diagnosis and by contributions to thedevelopment of the ICD-10 made by many of WPA's member societies.

In view of the above, the Division of Mental Health and Prevention of Substance Abuseof the World Health Organization and the World Psychiatric Association have agreed tocollaborate in the development of materials that can be used in training on the ICD-10classification of mental disorders and its assessment instruments. These materials weremade available to WHO collaborating centres, to the WPA member societies, to institutionsinvolved in the teaching of psychiatry, to other non-governmental organizations and toministries of health of WHO Member States.

The materials which are included in the present educational programme include:

1. standard curricula for workshops introducing ICD-10;
2. sheets to be used for the production of transparencies or slides;
3. a set of case history exercises;
4. models that can be used for an evaluation form and for a certificate;
5. a list of selected references;
6. other appendices, e.g., listings of training centres, and guidelines for the production of case histories and videotapes.

Dr A. Bertelsen, Risskov, Denmark
Dr J.E. Cooper, Nottingham, United Kingdom
Dr H. Dilling, Lübeck, Germany
Dr M. Gelder, Oxford, United Kingdom
Dr G. Harrison, Nottingham, United Kingdom
Dr A. Janca, Geneva, Switzerland
Dr Y. Nakane, Nagasaki, Japan
Dr A. Okasha, Cairo, Egypt
Dr C. Pull, Luxembourg, Luxembourg
Dr B. Üstün, Geneva, Switzerland
SECTION 1
PRESENTATIONS AND WORKSHOPS

Introduction

The materials included in this package can be used in different settings and for thetraining of various audiences. The different options are summarized in the table I,followed by more detailed information on the following pages. Section 3 (page 15 listsmaterials for the trainer and the participants.
The first option is appropriate when time is limited to one to two hours. Thelecture should make participants understand the nature of the ICD-10 Classification ofMental and Behavioural Disorders. The lecture could be given to any qualified audience, inany setting, and for any number of participants. The presentation can be supported by alimited number of transparencies or slides (listed in Section 4). This lecture can be inserted into the one-day training course on the use of the PrimaryCare Version of ICD-10 Mental and Behavioural Disorders (see option 4) or within any othercourse on psychiatric matters.
Option 2 is recommended, when the purpose of the presentation is to familiarizethe audience with the classification to a degree which will enable them to use ICD-10 inclinical practice. This familiarization workshop lasts a minimum of two half days,contains several lectures and offers the participants a possibility of doing somediagnostic exercises. The full set of transparencies and slides, offered in this trainingpackage (Section 4), would be useful for such a workshop: the trainers may, however, wishto select a subset according to the interest of the audience and complement it with other materials.
This familiarization workshop could be combined with training in the use of themultiaxial presentation of Chapter V of ICD-10, for which a separate training package isavailable, or with training in the application of the Diagnostic Criteria for Research(see options 3a and 3b).
Option 2 could also be combined with familiarization or full training courses for theICD-10 related instruments, CIDI, SCAN or IPDE, which are available separately, usuallylasting 5 days.
Future trainers should familiarize themselves with the classification. A workshop forfuture trainers may be composed of option 2 with an extra day for diagnostic exercises and discussion.

Table I: Overview of options for ICD-10 presentations and workshops

Option 1
Lecture: Understanding ICD-10 Ch. V

Duration: ca. 2 hours

Objective: to present the International Classification of Mental and Behaviouraldisorders (ICD-10 Ch. V) and associated texts and instruments. At the end of the lecturethe participants will be able to understand the basic principles, the structure and thepractical rules of the ICD-10 classification.

Number of participants: unlimited.
Target group: (mental) health workers: psychiatrists, general practitioners,coders.
Number of presentators: 1 or 2.
Material to be used: selected transparencies or slides (see Section 4).
Material to be distributed (optional):

• paper copies of transparencies that are used during the lecture, with room for personal notes;
• evaluation form: name and address and a few questions (see appendix 7);
• pocket reference booklet: "Understanding the ICD-10" by N. Sartorius.

• clinical and diagnostic guidelines
• diagnostic criteria for research
• multiaxial presentation
• version for primary health care
• conversion tables
• computer applications

• ICD-10 Checklists
• CIDI, SCAN, and IPDE

• paper copies of transparencies that are used during the lecture (see appendix 9);
• forms for recording diagnoses (see appendix 6);

  - evaluation form: name and address and a few questions (see appendix 7);

• certificate to participants for ICD-10 Ch. V familiarization workshop (see appendix8);
• pocket reference booklet: "Understanding the ICD-10" by N.Sartorius;
• written case histories (see Section 5).

• Description of the ICD-10 family and its members 45 min
• Contents of Chapter V
• Coding rules and guidelines
• Future of ICD-10 60 min

• ICD-10 Checklists
• CIDI
• SCAN
• IPDE

(vii) Discussion and closure 15 min

Option 3

ICD-10 Ch. V familiarization workshop in combination withfamiliarization with the multiaxial presentation (3a), or diagnostic criteria for research (3b)

Option 3a. ICD-10 Ch. V familiarization workshop (option 2) in combination with familiarization with the multiaxial presentation

Duration:three half days of 3 hours each. The third period of three hours will beused to familiarize the participants with the multiaxial schema.

Objective: to familiarize participants with the application of the InternationalClassification of Mental and Behavioural Disorders (ICD-10 Ch. V) and its variousversions, to present the related assessment instruments, and to familiarize theparticipants with its multiaxial presentation. At the end of the workshop the participantswill be able to use the ICD-10 classification as well as its multiaxial presentation intheir clinical work.

Number of participants: up to 50.

Target group: mental health workers: psychiatrists, psychologists and others.

Number of trainers: 3 or 4.

Material to be used: complete training set and the Multiaxial Presentation text.

Material to be distributed: see option 2.

• paper copies of transparencies that are used during the lecture (see appendix 9);
• forms for recording diagnoses (see appendix 6);
• evaluation form: name and address and a few questions (see appendix 7);
• certificate to participants for ICD-10 Ch. V familiarization workshop (see appendix8);
• pocket reference booklet: "Understanding the ICD-10" by N.Sartorius;
• copy of the Multiaxial version of ICD-10 chapter V;
• written case histories (see Section 5).

• paper copies of transparencies that are used during the lecture (see appendix 9);
• forms for recording diagnoses (see appendix 6);
• evaluation form: name and address and a few questions (see appendix 7);
• certificate to participants for ICD-10 Ch. V familiarization workshop (see appendix8);
• pocket reference booklet: "Understanding the ICD-10" by N.Sartorius;
• copy of the Diagnostic Criteria for Research version of the ICD-10 chapter V;
• written case histories (see Section 5).

• paper copies of transparencies that are used during the lecture, with room for personal notes;
• evaluation form (see appendix 7);
• pocket reference booklet: "Understanding the ICD-10" by Sartorius;
• copy of the Primary Care Version of the ICD-10 Chapter V.

• Neurological Adaptation
• Psychiatric version for administrators

• listing of chapters
• explanation of ICD-10 codes
• listing of other related codes (Z codes)
• Part 2
  
  Presentation of Chapter V
  
  Development of common language in psychiatry
  
  Main differences between the classification of mental and behavioural disorders in ICD-10 and in previous versions, e.g. ICD-9
  
  Relationships between ICD-10 Chapter V and national and specialty classifications, e.g. the International Classification of Sleep Disorders and DSM-IV
  
  Features of Chapter V, results of field trials of Chapter V
  
  Family of Chapter V
  
  Different versions of the classification
  
  Short Glossary (contained in ICD-10)
  
  Clinical Descriptions & Diagnostic Guidelines (Blue book)
  
  Diagnostic Criteria for Research (Green book)
  
  ICD-10 Primary Care Version
  
  Multiaxial Presentation of ICD-10
  
  Tools
  
  conversion tables
  
  lexica
  
  computer applications
  
  casebook
  
  Training materials
  
  

• organization of chapter
• overview of content, section by section (F0 - F9)
• explanation of coding rules and guidelines

• Description of instruments
• principles of application
• information on training courses
• sample pages or items
• how to obtain the instruments

• Part I and II of this section lists those materials that are included in this training set.
  
  
• Concerning the materials listed in Part III and IV of this section, some are available on request, others are not yet available and again others are to be obtained elsewhere, as indicated in the list.
  
  
• The items marked with * are intended only for the participants of option 2.

I. Materials to be used by the trainer


1. Introduction
2. Curricula: options for presentation of, or familiarization with ICD-10 Chapter V and possibilities of combination with additional courses on members of the "family" of ICD-10 Chapter V
3. Editorial guidelines for production of "local"case histories (see appendix 2)
4. Complete set of transparencies, (or slides)
5. Videotapes (see Guidelines for the production of videotapes, appendix 3)
6. Additional information on various subjects:
   list of training and reference centers for ICD-10 Chapter V
II. Materials to be distributed to the participants (optional)


7. Pocket reference: "Understanding the ICD-10", by N. Sartorius, Sciencepress, 1995
8. List of key references (see appendix 1)
9. Set of paper copies of slides or transparencies, used during the lecture, with room for personal notes
10. Reprints of key articles with background information:
1. Sartorius N. WHO's work on the epidemiology of mental disorders.Soc Psychiatr Epidemiol (1993) 28: 147-155
   
2. Sartorius N. et al. Progress towards achieving a common language in psychiatry: results from the field trails of the clinical guidelines accompanying the WHO Classification of Mental and Behavioural Disorders in ICD-10. Archives of General Psychiatry (1993) 50: 115-124.
3. Janca A, Üstün TB, Sartorius N. New versions of World Health Organization instruments for the assessment of mental disorders. Acta Psychiatr Scand (1994) 90: 73-83
11. * 3 sets of 5 case histories, to be used during the diagnostic case historyexercises
12. * Form for recording of diagnosis (see appendix 6)
13. * Forms for evaluation of lecture or workshop (see appendix 7)
14. * Certificate for participation in familiarization workshop of ICD-10 Ch V, SCAN, CIDI or IPDE, to be prepared by local organizer(see appendix 8)
III. Materials which the trainer should know well


1. ICD-10, volume 1, 2 and 3
2. ICD-10 Chapter V Clinical Descriptions and Diagnosic Guidelines version (Blue Book)
3. ICD-10 Chapter V Diagnostic Criteria for Research version (Green Book)
4. Checklists
5. Conversion tables between ICD-8, ICD-9, ICD-9-CM and ICD-10, rev. 1, 1994
6. Casebook
7. ICD-10 Chapter V Multiaxial version
8. Primary care version
9. Catalogue of WHO assessment instruments
10. Lexica
11. Multilingual dictionary
12. Appendix of DSM-IV with ICD-10 codes