? Inappropriate synonyms attached to 111475002 |Neurosis (disorder)|
We have received a request to review the synonyms of 111475002 |Neurosis (disorder)|.
Current synonyms include:
Neurotic disorder
Nonpsychotic mental disorder
The requestor suggests that these synonyms are not true synonyms and that they should be inactivated and 2 new concepts of |Nonpsychotic mental disorder (disorder)| and |Neurotic disorder (disorder| should be added as subtypes of 111475002 |Neurosis (disorder)|.
We would be grateful for the views of yourself and the CRG.
Many thanks
Kind regards
Paul
Comments
Former user (Deleted)
Question in preparation for the CRG meeting on Dec 2- the concept "nonpsychotic mental disorder" would have to be modeled as a mental disorder in which psychotic symptoms are known absent (situation with explicit context). Can we check with one of the authors to see whether it's possible to even model this meaning if we model it as a disorder concept?
Can we also clarify whether the requesters are proposing to add neurosis (finding) and add neurotic disorder (disorder) as a child?
As an aside, the CRG did have some discussion about this concept previously. If I remember correctly, the jist of the conversation was that it was unclear whether the concept 'neurotic disorder' has any unambiguous, intrinsic meaning, other than representing a mental disorder without psychotic symptoms....
Thanks,
Piper
Hi Piper Ranallo PhD thanks for taking a look at this question, the submitter wishes to have a new concept Nonpsychotic mental disorder (disorder) in the disorder hierarchy, this could potentially group many other concepts and so would require further discussion with the Head of Terminology before being added however, is there agreement that Nonpsychotic mental disorder should not be a synonym for 111475002 |Neurosis (disorder) and would it be clinically accurate and useful if added as a separate concept?
To answer your question - Can we also clarify whether the requesters are proposing to add neurosis (finding) and add neurotic disorder (disorder) as a child? - it is proposed that Neurotic disorder (disorder) is added as a child of 111475002 |Neurosis (disorder) along with a second concept Nonpsychotic mental disorder (disorder). Is there a sufficient clinical distinction between 111475002 |Neurosis (disorder) and Neurotic disorder (disorder) to require two concepts or are Neurosis and Neurotic disorder actually synonymous?
Many thanks,
Maria Braithwaite (Senior Terminologist)
Thanks Maria Braithwaite. This helps.
I'm going to defer to the clinical experts on this (Former user (Deleted)and Former user (Deleted)), but my understanding is that neurosis (disorder) IS synonymous with neurotic disorder (disorder). It is also my understanding that while both concepts were used in earlier mental health nosologies, the concept has been removed from more contemporary nosologies – it was essentially used as a way of distinguishing between two very general categories of mental disorders - neurotic (psychosis absent) v. psychotic (psychosis present). In other words, the term 'nonpsychotic disorder' does appear to be an appropriate synonym for the concept.
There is also a more contemporary concept, 'neuroticism' (concept 365420001 | Finding of level of neuroticism (finding) |) that is used primarily in personality research and new clinical models of personality disorder (ICD-11, DSM-5 Section III: Emerging measures in models). Here, neuroticism describes a specific cluster of personality traits. I'm not sure if, or how, these two concepts are related (I have never seen a definition of 'neurotic disorder' defined in terms of the personality trait 'neuroticsm' - which is defined in terms of the entity 86693004 | Level of neuroticism (observable entity) |).
To your point about making other mental health concepts children of the concept 'neurotic disorder', it does seem that virtually any mental disorder in which psychosis is absent would need to be made a child of this concept.
Can you go back to the folks requesting the change, to see if there is a definition of 'neurotic disorder' they have in mind that includes some meaning beyond just 'psychosis absent' ?
Former user (Deleted)and Former user (Deleted)can you add your thoughts on what SNOMED authors may need to consider in deciding how to proceed with this concept?
Best,
Piper
Piper is absolutely correct. "neurosis" is a Freudian concept and is conceptually equivalent to milder mental disorders in contrast to psychosis, which is for more severe and disabling disorders. It is still used by therapists with a psychodynamic orientation. It does not apepar in the DSM or ICD anymore. Neuroticism is a personality trait that is characterized by a proneness to develop negative emotions such as anxiety and depression.
I concur with what Michael says regarding neurosis.
I have some concern about adding a category "non-psychotic mental disorder". My concern is that many disorders can have associated psychosis but not all individuals with that diagnosis will necessarily exhibit psychosis either in an episode or in their lifetime. For example, the majority of people with major depressive disorder will not develop psychotic symptoms but for the fraction that do, it's an essential issue to address and monitor. There are other disorders where I think there has been debate as to whether psychosis might exist or not. For example, in OCD, there are some patients who lack insight into the unrealistic nature of their obsessional concerns and it's been questioned whether that should be viewed as delusional or not. Similarly, individuals with borderline personality disorder have sometimes been described as having mini-psychotic episodes which may or may not be truly psychotic (vs. dissociative vs. some other phenomenon).
For these reasons, I think it would be hard to make a clearcut delineation of which disorders are (or are not) psychotic disorders. It would be much easier and probably more clinically relevant to have "findings" of psychosis and absence of psychosis. However, it would help to know more information on the rationale for a new non-psychotic mental disorder category from the people who're requesting the concept change.
Michael and Laura have provided excellent summaries of how the neurosis, neurotic disorders, and neuroticism terms have been treated in DSM-5 and ICD-11—the former two dropped as archaic and the latter incorporated into a summary personality trait. This personality trait is broken down into several facets in the alternative model for personality disorders in section 3 of the DSM-5 and in ICD-11. Neurosis and neurotic disorders are not included in the meta structure of these mental disorder classifications, which is organized along developmental, and related dimensional spectrum conditions. As Laura mentioned, psychotic phenomena can emerge in almost any of the various disorder groups from Neurodevelopmental to Neurocognitive disorders. There was a nice monograph on “Deconstructing Psychosis” edited by Tamminga et al. as part of the NIH sponsored conference series prior to when the DSM-5 and ICD-11 Task Forces and Committees were established.
Darrel Regier
Hi
Former user (Deleted),
We will add this to the agenda for the Dec 2 call.