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      Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies

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          Abstract

          An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO’s focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.

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          Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.

          Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
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            The Lancet Commission on global mental health and sustainable development

            The Lancet, 392(10157), 1553-1598
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              Bipolar disorder.

              Bipolar disorder is a recurrent chronic disorder characterised by fluctuations in mood state and energy. It affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status. Bipolar disorder is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. A high prevalence of psychiatric and medical comorbidities is typical in affected individuals. Accurate diagnosis of bipolar disorder is difficult in clinical practice because onset is most commonly a depressive episode and looks similar to unipolar depression. Moreover, there are currently no valid biomarkers for the disorder. Therefore, the role of clinical assessment remains key. Detection of hypomanic periods and longitudinal assessment are crucial to differentiate bipolar disorder from other conditions. Current knowledge of the evolving pharmacological and psychological strategies in bipolar disorder is of utmost importance.
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                Author and article information

                Contributors
                dan.stein@uct.ac.za
                peter.szatmari@utoronto.ca
                wolfgang.gaebel@uni-duesseldorf.de
                mikebe@barwonhealth.org.au
                evieta@clinic.cat
                majmario@tin.it
                y.a.de.vries@rug.nl
                a.m.roest@rug.nl
                peter.de.jonge@rug.nl
                maercker@psychologie.uzh.ch
                c.brewin@ucl.ac.uk
                kmp2@cumc.columbia.edu
                carlos.grilo@yale.edu
                naomi.fineberg@btinternet.com
                briken@uke.de
                pt.cohen-kettenis@amsterdamumc.nl
                gmr2142@cumc.columbia.edu
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                27 January 2020
                27 January 2020
                2020
                : 18
                : 21
                Affiliations
                [1 ]ISNI 0000 0004 1937 1151, GRID grid.7836.a, SA Medical Research Council Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, , University of Cape Town, ; Cape Town, South Africa
                [2 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Centre for Addiction and Mental Health, Hospital for Sick Children, , University of Toronto, ; Toronto, ON Canada
                [3 ]ISNI 0000 0001 2176 9917, GRID grid.411327.2, Department of Psychiatry and Psychotherapy, Medical Faculty, , Heinrich-Heine University, ; Düsseldorf, Germany
                [4 ]Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
                [5 ]GRID grid.488501.0, Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, ; Parkville, Australia
                [6 ]ISNI 0000 0004 0606 5526, GRID grid.418025.a, Florey Institute for Neuroscience and Mental Health, ; Parkville, Australia
                [7 ]ISNI 0000 0001 2179 088X, GRID grid.1008.9, Department of Psychiatry, , University of Melbourne, ; Parkville, Australia
                [8 ]Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia Spain
                [9 ]Department of Psychiatry, University of Campania ‘L. Vanvitelli’, Naples, Italy
                [10 ]ISNI 0000 0004 0407 1981, GRID grid.4830.f, Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, , University of Groningen, ; Groningen, The Netherlands
                [11 ]ISNI 0000 0004 1937 0650, GRID grid.7400.3, Department of Psychology – Psychopathology and Clinical Intervention, , University of Zurich, ; Zurich, Switzerland
                [12 ]ISNI 0000000121901201, GRID grid.83440.3b, Research Deparment of Clinical, Educational and Health Psychology, , University College London, ; London, UK
                [13 ]ISNI 0000000419368729, GRID grid.21729.3f, Department of Psychiatry, , Columbia University Vagelos College of Physicians and Surgeons, ; New York, NY USA
                [14 ]ISNI 0000000419368710, GRID grid.47100.32, Department of Psychiatry, , Yale University School of Medicine, ; New Haven, CT USA
                [15 ]Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Welwyn Garden City, UK
                [16 ]ISNI 0000 0001 2180 3484, GRID grid.13648.38, Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, , University Medical Centre Hamburg-Eppendorf, ; Hamburg, Germany
                [17 ]Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
                [18 ]ISNI 0000000121633745, GRID grid.3575.4, Department of Mental Health and Substance Abuse, , World Health Organization, ; Geneva, Switzerland
                Author information
                http://orcid.org/0000-0001-7218-7810
                Article
                1495
                10.1186/s12916-020-1495-2
                6983973
                31983345
                8d596725-f9a1-40e1-844d-e6fd19fac94d
                © The Author(s). 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 October 2019
                : 9 January 2020
                Categories
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                Custom metadata
                © The Author(s) 2020

                Medicine
                mental disorder,diagnosis,classification,icd-11
                Medicine
                mental disorder, diagnosis, classification, icd-11

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