A diagnostic system using broad categories with clinically relevant specifiers: lessons for ICD-11

Amyotrophic lateral sclerosis: moving towards a new classification system

Amyotrophic lateral sclerosis is a progressive adult-onset neurodegenerative disease that primarily affects upper and lower motor neurons, but also frontotemporal and other regions of the brain. The extent to which each neuronal population is affected varies between individuals. The subsequent patterns of disease progression form the basis of diagnostic criteria and phenotypic classification systems, with considerable overlap in the clinical terms used. This overlap can lead to confusion between diagnosis and phenotype. Formal classification systems such as the El Escorial criteria and the International Classification of Diseases are systematic approaches but they omit features that are important in clinical management, such as rate of progression, genetic basis, or functional effect. Therefore, many neurologists use informal classification approaches that might not be systematic, and could include, for example, anatomical descriptions such as flail-arm syndrome. A new strategy is needed to combine the benefits of a systematic approach to classification with the rich and varied phenotypic descriptions used in clinical practice.

A review of Latin American studies on binge eating disorder

OBJECTIVE

To review the state of the art of the scientific literature on binge eating disorder in Latin America.

METHOD

A literature search of studies conducted in Latin American countries using the term "binge eating" was performed in the following electronic databases: PubMed, LILACS, SciELO, and PsycINFO. Selected articles described studies developed with Latin American samples that met partial or complete DSM-IV diagnostic criteria for binge eating disorder.

RESULTS

8,123 articles were screened and 30 studies met the inclusion criteria (18 cross-sectional studies, 5 clinical trials, 4 case reports, 2 validity studies, and 1 cohort study). Most of the studies were conducted in Brazil (27), one in Argentina, one in Colombia, and one in Venezuela. The prevalence of binge eating disorder among obese people attending weight loss programs ranged between 16% and 51.6%. The comparison between obese people with and without binge eating disorder showed a tendency of higher weight, longer history of weight fluctuation, more concern about shape and weight, and association with psychiatric comorbidity in those with binge eating disorder.

CONCLUSION

Binge eating disorder is a detectable phenomenon in Latin America with clinical features similar to those found in the international literature. This review provides support for the consideration of binge eating disorder as a distinct eating disorder in the International Classification of Diseases - 11th edition.

Transforming mental health services

Specialist teams have had a major impact on service delivery in England. Their effectiveness is now being questioned and integrated teams are developing in some areas. However, the gains made in terms of improved access, engagement and early intervention must not be lost.

Making eating disorders classification work in ICD-11

The time has come again for the revision of the existing classifications systems and the creation of new versions, DSM-V and ICD-11. In September 2009, an initial call for comments and views regarding the development of the ICD-11 was made to the Eating Disorders Section of the Royal College of Psychiatry. This Viewpoint summarises the main points collected from child and adolescents and eating disorder (ED) psychiatrists in response to this consultation, outlines some proposals for modification of the relevant section(s) of ICD-11 and gives our views.