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Capturing complexity: The case for a new classification system for mental disorders in primary care

Published online by Cambridge University Press:  05 September 2008

Linda Gask ,
Michael Klinkman ,
Sandra Fortes  and
Christopher Dowrick
Linda Gask*
Affiliation:
National Primary Care Research and Development Centre, 5th Floor, Williamson Building, University of Manchester, Oxford Road, ManchesterM13 9PL, UK
Michael Klinkman
Affiliation:
Departments of Family Medicine and Psychiatry, University of Michigan Medical School, 1018 Fuller Street, Ann Arbor, MI48109-0708, USA
Sandra Fortes
Affiliation:
Medical Science Faculty, University of Rio de Janeiro State, Av. 28 de setembro, 177, sala 107, Vila Isabel, Rio de Janeiro, RJ20000.000, Brazil
Christopher Dowrick
Affiliation:
Primary Medical Care, School of Population, Community & Behavioural Sciences, 2.11 Whelan Building, University of Liverpool, Liverpool, L69 3GB, UK
*
*Corresponding author Tel.: +44 161 275 1848; fax: +44 161 256 1070. E-mail address: linda.gask@manchester.ac.uk (L. Gask), mklinkma@umich.edu (M. Klinkman), sandrafortes@gmail.com (S. Fortes), cfd@liverpool.ac.uk (C. Dowrick).
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Abstract

Primary care differs considerably from specialist mental health settings: problems are presented in undifferentiated forms, with consequent difficulties in distinguishing between distress and disorder, and a complex relationship between psychological, mental and social problems and their temporal variations.

Existing psychiatric diagnostic systems, including ICD-10-PHC and DSM-IV-PC, are often difficult to apply in primary care. They do not adequately address co-morbidity, the substantial prevalence of sub-threshold disorders or problems with cross-cultural applications. Their focus on diagnosis may be too restrictive, with a need to consider severity and impairment separately.

ICPC-2, a classification system created specifically for use in primary care, provides advantages in that it allows for simple linkage between reason for encounter, diagnosis and intervention.

It is both necessary and feasible to develop a classification system for mental health in primary care that can meet four basic criteria: (1) characterized by simplicity; (2) addressing not only diagnosis but also severity, chronicity and disability; (3) feasible for routine data gathering in primary care as well as for training; and (4) enabling efficient communication between primary and specialty mental health care.

Keywords

Primary-careClassificationMental-healthDiagnosis
Type
Original article
Information
European Psychiatry , Volume 23 , Issue 7 , October 2008 , pp. 469 - 476
Copyright
Copyright © Elsevier Masson SAS 2008

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Footnotes

1

Tel.: +1 734 998 7120x309; fax: +1 734 998 7335.

2

Tel.: +55 21 25876469.

3

Tel.: +44 151 794 5821; fax: +44 151 794 5604.

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