2023-11-22 MBH CRG Meeting

0

Unfinished business:

Unfinished business: mental disorder in pregnancy

2023-06-28 - MBH-CRG Meeting

1

Phobia (finding)

@Elaine Wooler 

Are we keeping concept phobia (finding) or is phobia only a disorder?

Resolution: both concepts are clinical relevant. A phobia (fear and/or anxiety, phobic avoidance) can exist without the phobia becoming a full blown disorder (i.e, interfering with functioning and/or causing personal distress)

2

First episode psychosis

@Former user (Deleted) 

Verify this is first experience of psychosis by person, not first encounter with health professional for psychosis.  Also that a distinct concept would be useful for this.  The UK have one in their extension as a finding 1127191000000108 |First episode psychosis (finding)|.  If appropriate we could request to promote this to the international release.

Resolution: X (@Piper Ranallo PhDand @Elaine Wooler  to followup)

3

Dissociative neurological disorders

@Elaine Wooler @Piper Ranallo PhD 

Are psychogenic aphonia and psychogenic dysphonia speech disturbances?

Relationship between dissociative muteness and dissociative psychogenic aphonia

Relationship between speech and voice. While thoughts often include of internal language (i.e., thinking in sentences) does this qualify as 'speech', or does speech always refer to language spoken by way of voice (v non-vocal means)?

Resolution: confirmed that speech is language expressed vocally - it is a child of both voice and language. 

3.1

Bodily distress disorders

Illness anxiety disorder v Bodily distress disorder v Hypochondriasis

See project summary page here: Somatic Symptoms without Medical Explanation

• Bodily distress disorder >= 1 somatic symptom (symptoms + anxiety/fear about symptoms)

• Illness anxiety disorder >= 0 somatic symptoms (care seeking or care avoidant subtypes) (anxiety/fear only)

• Hypochondriasis (care seeking or care avoidant subtype) (anxiety/fear only conceived as obsessive/compulsive)

Open

Review concepts:

Appear to be outdated, inactivate as may be a bodily distress disorder?

• 397923000 | Somatization disorder (disorder) |: diagnostic criteria required at least four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudo neurological symptom

• 397826007 | Briquet's syndrome (disorder) |  outdated. may be a bodily distress disorder (SYN of above?)

No references found for this disorder:
 397795007 | Polysomatizing disorder (disorder) |

Open

DSM-5 makes a distinction between somatic symptom disorders and illness anxiety/bodily distress disorders,  Should this be inactivated and recreated for clarity? (Currently child of bodily distress disorder)

Somatoform pain disorder (disorder)

3.2cr

Psychogenic concepts

275446004 | Gardner-Diamond syndrome (disorder) | (SYN = psychogenic purpura, SYN = factitious purpura)

3.3

Functional neurological disorders

@Elaine Wooler 

@Piper Ranallo PhD 

Value of grouper concept 36480000 | Disturbance of perception associated with conversion and dissociative phenomenon (finding) | 

Relationship between functional disorder (disorder) and dissociative neurological disorder and psychogenic disorder

Psychogenic movement disorder, DEF: A rare neurologic disease with the manifestation of an underlying psychiatric illness that cannot be attributed to any known structural or neurochemical disease. The disease presents typically during adolescence or adulthood. Symptoms may include one or several types of abnormal movements seen in organic movement disorders (tremor, dystonia, chorea, bradykinesia, myoclonus, tics, athetosis, ballism, cerebellar incoordination) and also affect speech and gait. Underlying causes fall into three categories: Conversion disorder, somatic symptom disorders or in rare cases factitious disorder.

Functional movement disorder, DEF: The occurrence of abnormal involuntary movements that are incongruent with a known neurologic cause and are significantly improved on neurological exam with distraction or non-physiologic maneuvers. The disorder is defined by its clinical appearance, rather than by any causative speculation.

4

Affect

@Elaine Wooler @Piper Ranallo PhD 

Review proposed changes to concepts related to affect and expression of emotion

5

Multiple concepts describing fear and anxiety about body function

@Elaine Wooler 

@Piper Ranallo PhD 

Resolve the relationships between the following concepts:

• Fear associated with illness and body function (finding) 

  • Fear relating to body function (finding) 

• Anxiety about body function or health (finding)

Discussion: 

Andrew, Becky - use of clinical vignettes in implementation guides (other CRGs: cancer synoptic group, ophthalmology, allergy). 

Ed - consider reaching out the Nursing CRG for input

Add explicit definitions of fear and anxiety from ICD11 

Next step:  Keep concepts and add narrative definitions to distinguish between concepts AND/OR seek input for use in implementation guide

6

Complex and social behavior

@Piper Ranallo PhD 

Review proposed changes to concept and child concepts of Finding relating to complex and social behaviors (finding)