THE CLASSIFICATION OF MENTAL-DISORDERS IN PRIMARY-CARE - A GUIDE THROUGH A DIFFICULT TERRAIN

Background: Primary care physicians traditionally have a strong intere st in the mental health of their patients. Three classification system s are available for them to diagnose, label, and classify mental disor ders: 1) The ICD-10 approach with three options, 2) The DSM-IV approac h with two options, and 3) the ICPC approach with two options. This ar ticle lists important similarities and differences between the systems to help potential users choose the option that best meets their needs . Methods: Definitions for depressive disorder, anxiety disorder, and somatization disorder are compared on five characteristics of classifi cation: 1. the domain, 2. the scope, 3. the nature of the definitions, 4. focus on episodes of care, and 5. clinical guidelines. Results: Pr imary care physicians and psychiatrists have different perspectives, r eflected in different classifications. Each system has specific possib ilities and limitations with regard to the diagnosis of mental disorde rs. For common mental disorders it is possible, however, to choose cod es 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 pers pective, but once a system has been chosen the clinical comparability of a patient with the same diagnosis in other systems is limited. Conc lusion: Compatibility among systems can be optimized by strictly follo wing a number of rules. The conversion between ICPC and ICD-10 land co nsequently DSM-IV) allows simultaneous use of ICPC and ICD-10 as a cla ssification and DSM-IV as the standard nomenclature. This is of partic ular interest for computer based patient records in primary care. The clinical comparability of the same diagnosis in different systems howe ver is limited by the characteristics of the different system.