On the background of some years of experience with ICD-10 psychiatric diagnoses in many countries of the world, an international comparison was performed to evaluate the frequency and use of the ICD-10 psychiatric diagnoses. For future revision of the ICD-10, it is important to know which diagnostic categories are either not used or are used possibly in an unspecific manner. Nineteen departments of psychiatry in 10 different countries took part in the study, presenting data on 33,857 treatment cases leading to a total of 25,470 ICD-10 main diagnoses. The analysis of data reveals that on a four-character level (Fxx.x), the 10 most often used diagnostic categories represent 40% of all main diagnoses, and 70% on a three-character level (Fxx.–). There are 32 specific diagnostic categories on a four-character level which are not used at all and 121 which are used less frequently than 0.1% in inpatient and outpatient treatment. The study shows that the ICD-10 classification is in use in a variety of treatment settings worldwide. Further results and limitations of this study are discussed against the background of transcultural differences.
During clinical experience with the "atypical" neuroleptic drugs clozapine, risperidone, and zotepine, some patients have shown a marked weight gain. To prove whether weight gain is a relevant side effect of atypical neuroleptics, the charts of all patients admitted with DSM-III-R diagnoses of schizophrenia, schizoaffective disorder, or delusional disorder in the years 1991 to 1995 were evaluated. A retrospective chart review was performed, which included all patients who were treated longer than 2 weeks with a single neuroleptic. The data analysis showed that weight gain must be considered as a common side effect of atypical neuroleptics (clozapine, risperidone, sulpiride, or zotepine). The mean weight gain (3.1, 1.5, 1.9, or 4.3 kg, respectively) was significantly higher than that of patients treated with "classic" neuroleptics (mean, 0.0-0.5 kg) (Kruskal-Wallis, p = 0.01). Young and not obese patients show the highest weight increase. Because weight gain occurs in the first weeks of treatment, particularly in previously untreated subjects, this side effect has to be considered in view of compliance with long-term neuroleptic medication.
A recent modification of German law requires quality assurance of inpatient treatment, i.e., of the quality of therapy, allowing comparison of different hospitals. In this paper a program developed to assess the outcome by means of international, frequently applied psychopathometric scales is presented. This program was evaluated in a study of 258 psychiatric inpatients. This study emphasized the identification of patients with long-term hospitalization and/or worse outcome. A concept to disclose these so-called 'problematic' patients by means of easily administered scales like the SCL90-R, GAF and WHO-Disability-Diagnostic-Scale (DDS) has been developed. Patients with a very long hospital stay (> 70 days) show a higher number and more severe symptoms in the self-rating (SCL90-R) at admission than the subjects with a short hospital stay. This pilot study demonstrated that a routine outcome analysis can be used for quality management in psychiatry.
The bodyweight of first episode schizophrenics is lower compared to the general population. In contrast, chronic schizophrenic patients frequently are overweight or show obesity. However, thus far the causes of pronounced weight gain in schizophrenic patients remain to be elucidated.
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