Classification of Anxiety and Depressive disorders: problems and solutions

Abstract

The American Psychiatric Association and the World Health Organization have begun to revise their classifications of mental disorders. Four issues related to these revisions are discussed in this study: the structure of the classifications, the relationship between categories and dimensions, the sensitivity of categorical thresholds to definitions, and maximizing the utility and validity of the diagnostic process. There is now sufficient evidence to consider replacing the present groupings of disorders with an empirically based structure that reflects the actual similarities among disorders. For example, perhaps the present depression and anxiety disorders would be best grouped as internalizing disorders. Most mental disorders exist on a severity dimension. The reliability and validity of the classification might be improved if we accepted the dimensional nature of disorders while retaining the use of categorical diagnoses to enhance clinical utility. Definitions of the thresholds that define categories are very susceptible to detail. In International Classification of Diseases-11(ICD-11) and Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V), disorders about which there is agreement should be identically defined, and disorders in which there is disagreement should be defined differently, so that research can identify which definition is more valid. The present diagnostic criteria are too complex to have acceptable clinical utility. We propose a reduced criterion set that can be remembered by clinicians and an enhanced criterion set for use with decision support tools.

Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity?

“…Could co-morbidity within clusters inform rather than impair our understanding of the natural structure of mental disorders ? DSM-III/IV and ICD-10 were designed to facilitate clinical care as the first priority but the classifications and their thresholds are too complex for many clinicians to use (Andrews et al 2008). Could grouping disorders into clinically meaningful clusters facilitate both patient care and research ?…”

Design and Rationale for a Parent-Led Intervention to Increase Fruit and Vegetable Intake in Young Childhood Cancer Survivors (Reboot): Protocol for a Pilot Study (Preprint)

“…A validated emotion thermometers tool will also be used to assess participant distress and emotional state at the start of each intervention session. [30,31] This tool individually screens for emotional upset, anxiety, depression, and anger by asking the participant to rate each emotion on a scale of 0-10 (where 0 is none and 10 is extreme), and the level of assistance required to manage these emotions. [30,31] A participant will be deemed 'distressed' if they score above seven on any of the thermometers,[24] requiring facilitators to enquire about the participants available psychological supports (e.g.…”

The possibility of using standardized self-report anxiety and depression scales in elderly patients: anxiety scales/questionnaires

“…Заметим, что при равной тяжести тре-воги и депрессии у пожилых больных обычно диагности-руется депрессия с тревогой, но не тревожное расстрой-ство со снижением настроения [17,18,25,28,29,39,40,41,46,49,50,52,53,55,56,58].…”