Ndemanga za YBOP: Muli ndi gawo lokhudza "Zovuta zogonana":
Kusokonezeka kwa khalidwe la kugonana
Matenda opatsirana okhudzana ndi kugonana amadziwika ndi chizoloŵezi cholephera kuthetsa zofuna zokhudzana ndi kugonana mobwerezabwereza kapena zolimbikitsa, zomwe zimabweretsanso khalidwe la kugonana mobwerezabwereza kwa nthawi yaitali (mwachitsanzo, miyezi isanu ndi umodzi kapena kuposerapo) yomwe imayambitsa kukhumudwa kapena kuwonongeka kwaumwini, banja, chikhalidwe , maphunziro, ntchito kapena mbali zina zofunika pakugwira ntchito.
Zisonyezero zomwe zingachitike pakuphatikizika ndikuphatikizira: Kugonana mobwerezabwereza kumakhala chinthu chofunikira kwambiri pamoyo wa munthu mpaka kunyalanyaza thanzi ndi chisamaliro chaumwini kapena zokonda zina, zochita ndi maudindo; munthu amene akuyesetsa kangapo kuti athetse kapena kuchepetsa kwambiri machitidwe obwerezabwereza ogonana; munthu akupitilizabe kuchita zachiwerewere mobwerezabwereza ngakhale atakumana ndi zovuta monga kusokonekera kwaubwenzi mobwerezabwereza; ndipo munthuyo akupitilizabe kuchita zachiwerewere mobwerezabwereza ngakhale pomwe sakupezanso chisangalalo.
Ngakhale kuti gululi limafanana ndi kudalira mankhwala osokoneza bongo, lili m'gawo la ICD-11 impulse control disorders pozindikira kusowa kwa chidziwitso chotsimikizika chokhudza ngati njira zomwe zimakhudzidwa pakukula ndi kusunga vutoli ndizofanana ndi zomwe zimawonedwa m'mavuto ogwiritsa ntchito mankhwala osokoneza bongo komanso zizolowezi zamakhalidwe. Kuphatikizidwa kwake mu ICD-11 kudzathandiza kuthana ndi zosowa zosakwaniritsidwa za odwala omwe akufuna chithandizo komanso mwina kuchepetsa manyazi ndi kudzimva chisoni komwe kumakhudzana ndi kufunafuna thandizo pakati pa anthu omwe ali ndi nkhawa 50.
Reed, GM, Choyamba, MB, Kogan, CS, Hyman, SE, Gureje, O., Gaebel, W., Maj, M., Stein, DJ, Maercker, A., Tyrer, P. ndi Claudino A., 2019.
World Psychiatry, 18 (1), pp.3-19.
Kudalirika
Pambuyo povomerezedwa ndi ICD-11 ndi World Health Assembly mu Meyi 2019, mayiko mamembala a World Health Organisation (WHO) asintha kuchoka ku ICD-10 kupita ku ICD-11, ndikufotokozera ziwerengero zaumoyo kutengera dongosolo latsopanoli kuyamba Januware 1, 2022. Dipatimenti ya WHO ya Mental Health and Substance Abuse idzafalitsa Clinical Descriptions and Diagnostic Guidelines (CDDG) ya ICD-11 Mental, Behavioral and Neurodevelopmental Disorder kutsatira kuvomerezedwa ndi ICD-11. Kukula kwa ICD-11 CDDG pazaka 11 zapitazi, kutengera mfundo zakuchipatala komanso kugwiritsidwa ntchito kwapadziko lonse lapansi, yakhala njira yowunikiranso yapadziko lonse lapansi, zilankhulo zambiri, mitundu yambiri komanso kutengapo gawo pamagulu amisala. Zatsopano mu ICD-11 zimaphatikizapo kupereka chidziwitso chofananira komanso chodziwika bwino, kukhazikitsidwa kwa njira yamoyo, ndi chitsogozo chokhudzana ndi chikhalidwe pamavuto aliwonse. Njira zowoneka bwino zakhala zikuphatikizidwa mgulu, makamaka zovuta zamunthu komanso zovuta zoyambirira zama psychotic, m'njira zomwe zikugwirizana ndi umboni wapano, ndizogwirizana kwambiri ndi njira zochotsera, kuthana ndi zovuta, komanso kusintha kusintha kwakanthawi. Pano tikulongosola kusintha kwakukulu kwa kapangidwe ka ICD-10 yamavuto amisala poyerekeza ndi ICD-11, ndikukula kwa mitu iwiri yatsopano ya ICD-11 yokhudzana ndi thanzi lamisala. Tikuwonetsera magulu atsopano omwe awonjezedwa ku ICD-11 ndikuwonetsa chifukwa chophatikizira. Pomaliza, tikufotokozera zosintha zofunika zomwe zachitika mgulu lililonse la ICD-11. Izi zimapangidwa kuti zikhale zothandiza kwa onse azachipatala komanso ofufuza kuti adziwongolere ku ICD-XNUMX ndikukonzekera kukhazikitsa m'malo mwa akatswiri awo.
Mu June 2018, bungwe la World Health Organization (WHO) linatulutsa buku lomaliza la 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) la ziwerengero za imfa ndi matenda ku mayiko 194 omwe ali mamembala ake, kuti liwunikenso ndikukonzekera kukhazikitsidwa 1. Bungwe la World Health Assembly, lomwe lili ndi nduna za zaumoyo za mayiko onse omwe ali mamembala, likuyembekezeka kuvomereza ICD-11 pamsonkhano wake wotsatira, mu Meyi 2019. Pambuyo povomereza, mayiko omwe ali mamembala adzayamba njira yosinthira kuchoka ku ICD-10 kupita ku ICD-11, ndi malipoti a ziwerengero zaumoyo ku WHO pogwiritsa ntchito ICD-11 kuti ayambe pa Januware 1, 2022 2.
Dipatimenti ya WHO ya Mental Health and Substance Abuse ndi yomwe yathandizira kukonza chitukuko cha mitu inayi ya ICD-11: zovuta zamaganizidwe, machitidwe ndi ma neurodevelopmental; Matenda ogona; matenda amanjenje; ndi zikhalidwe zokhudzana ndi kugonana (molumikizana ndi dipatimenti ya WHO ya Uchembele Wathanzi ndi Kafukufuku).
Gawo la matenda amisala la ICD-10, lomwe ndi mtundu wa ICD wamakono, ndilo gulu lomwe limagwiritsidwa ntchito kwambiri padziko lonse lapansi 3. Pakupangidwa kwa ICD-10, Dipatimenti ya WHO ya Zaumoyo wa Maganizo ndi Kugwiritsa Ntchito Mankhwala Osokoneza Bongo inaganiza kuti mitundu yosiyanasiyana ya gululo iyenera kupangidwa kuti ikwaniritse zosowa za ogwiritsa ntchito osiyanasiyana. Mtundu wa ICD-10 wa malipoti a ziwerengero uli ndi matanthauzo afupiafupi ofanana ndi mawu a gulu lililonse la matenda, koma izi zinaonedwa kuti sizokwanira kugwiritsidwa ntchito ndi akatswiri azaumoyo wamaganizo m'malo azachipatala 4.
Kwa akatswiri azaumoyo wamaganizo, Dipatimentiyi idapanga Mafotokozedwe a Zachipatala ndi Malangizo Odziwitsa Matenda (CDDG) a Matenda a Mitsempha ndi Khalidwe la ICD-10 , omwe amadziwika kuti "buku labuluu", omwe cholinga chake ndi kugwiritsa ntchito kuchipatala, maphunziro ndi ntchito. Pa matenda aliwonse, kufotokozera za zinthu zazikulu zachipatala ndi zina zokhudzana nazo kunaperekedwa, kutsatiridwa ndi malangizo owonjezera owunikira omwe adapangidwa kuti athandize asing'anga azaumoyo wamaganizo kupeza matenda odalirika. Chidziwitso kuchokera ku kafukufuku waposachedwa 5 chikusonyeza kuti asing'anga nthawi zonse amagwiritsa ntchito zomwe zili mu CDDG ndipo nthawi zambiri amaziwunikanso mwadongosolo akamapanga matenda oyamba, zomwe zimatsutsana ndi chikhulupiriro chofala chakuti asing'anga amagwiritsa ntchito gululi kuti apeze ma code ozindikira matenda pazolinga zoyang'anira ndi zolipirira. Dipatimentiyi idzafalitsa mtundu wofanana wa CDDG wa ICD-11 mwachangu pambuyo poti dongosolo lonselo lavomerezedwa ndi World Health Assembly.
Zaka zoposa khumi za ntchito yaikulu zapita patsogolo ku ICD-11 CDDG. Zakhudzana ndi akatswiri ambiri okhudzidwa ngati a Advisory and Working Groups ndi alangizi, komanso mgwirizanowu waukulu ndi mayiko omwe ali ndi bungwe la WHO, mabungwe opereka ndalama, komanso magulu a zaumisiri ndi a sayansi. Kupititsa patsogolo kwa ICD-11 CDDG yakhala ndondomeko yowonongeka kwambiri padziko lonse, yambirimbiri, yambirimbiri komanso yowonongeka yomwe inagwiritsidwa ntchito potsata mndandanda wa matenda a maganizo.
KUGWIRITSA ICD-11 CDDG: NTCHITO NDI ZOFUNIKA KWAMBIRI
Tafotokoza kale kufunika kwa kugwiritsidwa ntchito kwachipatala ngati mfundo yokonzekera popanga ICD-11 CDDG 6 , 7. Kugawa magulu azaumoyo kumayimira mgwirizano pakati pa zochitika zaumoyo ndi chidziwitso chaumoyo. Dongosolo lomwe silipereka chidziwitso chothandiza kuchipatala pamlingo wa zochitika zaumoyo silidzagwiritsidwa ntchito mokhulupirika ndi asing'anga ndipo motero silingapereke maziko oyenera a chidziwitso chachidule cha zochitika zaumoyo chomwe chimagwiritsidwa ntchito popanga zisankho pazaumoyo, dziko lonse komanso padziko lonse lapansi.
Choncho, ntchito zachipatala zinkatsindika kwambiri mu malangizo operekedwa ku Mndandanda wa Magulu Ogwira Ntchito, omwe amachitidwa ndi magulu okhudzana ndi chisokonezo, osankhidwa ndi bungwe la WHO la Matenda a Mitsempha ndi Matenda Osokoneza Bongo kuti apange malingaliro okhudzana ndi kapangidwe ka zinthu za ICD-11 CDDG .
Inde, kuphatikizapo kukhala othandiza kuchipatala komanso padziko lonse lapansi, ICD-11 iyenera kukhala yovomerezeka mwasayansi. Chifukwa chake, Magulu Ogwira Ntchito amafunsidwanso kuti awunikenso umboni womwe ulipo wasayansi wogwirizana ndi madera awo ngati maziko opangira malingaliro awo ku ICD-11.
Kufunika kwa kugwiritsidwa ntchito padziko lonse lapansi 6 kunagogomezeredwanso kwambiri ku Magulu Ogwira Ntchito. Magulu onsewa anali oimira ochokera m'madera onse a WHO padziko lonse lapansi - Africa, America, Europe, Eastern Mediterranean, Southeast Asia, ndi Western Pacific - komanso chiwerengero chachikulu cha anthu ochokera m'mayiko osauka ndi apakati, omwe ali ndi anthu oposa 80% ya anthu padziko lonse lapansi 8.
Cholakwika cha ICD-10 CDDG chinali kusowa kwa kusinthasintha kwa zinthu zomwe zinaperekedwa m'magulu a matenda 9. Pa ICD-11 CDDG, Magulu Ogwira Ntchito adapemphedwa kuti apereke malingaliro awo ngati "mafomu okhutira", kuphatikizapo chidziwitso chokhazikika komanso chokhazikika cha matenda aliwonse omwe amapereka maziko a malangizo odziwira matenda.
Talemba kale tsatanetsatane wa momwe ntchito ikuyendera komanso kapangidwe ka malangizo owunikira matenda a ICD-11 9. Kupanga kwa ICD-11 CDDG kunachitika panthawi yomwe idagwirizana kwambiri ndi kupanga kwa DSM-5 ndi American Psychiatric Association, ndipo Magulu Ogwira Ntchito a ICD-11 ambiri adaphatikizapo mamembala ogwirizana ndi magulu ofanana omwe amagwira ntchito pa DSM-5. Magulu Ogwira Ntchito a ICD-11 adapemphedwa kuti aganizire za kugwiritsidwa ntchito kwachipatala komanso kugwiritsidwa ntchito kwa zinthu zomwe zikupangidwira DSM-5 padziko lonse lapansi. Cholinga chinali kuchepetsa kusiyana kwachisawawa kapena kopanda pake pakati pa ICD-11 ndi DSM-5, ngakhale kuti kusiyana koyenera kwa malingaliro kunaloledwa.
MAVUTO MU ICD-11 CDDG
Chofunika kwambiri cha ICD-11 CDDG ndi njira yawo yofotokozera zofunikira za matenda aliwonse, omwe amaimira zizindikilo kapena zizindikiro zomwe wodwala angathe kuyembekezera kuti awone m'mavuto onsewa. Ngakhale mndandandanda wa zofunikira zomwe zili mu ndondomekoyi zimakhala zofanana ndi zizindikiro zoganizira, zifukwa zomveka zokhudzana ndi chidziwitso cha chidziwitso ndi nthawi zambiri zimapewa, pokhapokha izi zakhazikitsidwa m'mayiko ndi zikhalidwe kapena pali chifukwa china choyikira.
Njira imeneyi cholinga chake ndi kugwirizana ndi momwe asing'anga amapezera matenda, pogwiritsa ntchito njira yosinthasintha ya chiweruzo chachipatala, ndikuwonjezera kufunika kwachipatala mwa kulola kusiyana kwa chikhalidwe pakuwonetsa komanso zinthu zokhudzana ndi thanzi zomwe zingakhudze machitidwe ozindikira matenda. Njira yosinthasintha iyi ikugwirizana ndi zotsatira za kafukufuku wa asing'anga amisala ndi akatswiri a zamaganizo omwe adachitika koyambirira kwa njira yopangira ICD-11 yokhudza makhalidwe abwino a dongosolo logawa matenda amisala 3 , 10. Kafukufuku m'malo azachipatala m'maiko 13 atsimikizira kuti asing'anga amaona kuti kugwiritsa ntchito njira imeneyi ndi kwakukulu 11. Chofunika kwambiri, kudalirika kwa malangizo a ICD-11 kumawoneka ngati kokwera kwambiri kuposa komwe kumapezeka pogwiritsa ntchito njira yokhazikika yokhazikika 12.
Zina mwazinthu zina za ICD-11 CDDG zinayambitsidwanso kudzera muzithunzi zoperekedwa ku Magulu Ogwira ntchito kuti apange malingaliro awo (omwe ali, "mawonekedwe okhutira"). Monga gawo la mfundo zomwe zafotokozedwa muzitsogozozo, chidwi chinali choperekedwa kwa matenda aliwonse kuti awonetsere malirewo ndi malire osiyana siyana komanso kufalikira kwa mfundo zomwe zimaperekedwa pa malire ndi zovuta zina.
Njira yowonjezera moyo yomwe inagwiritsidwa ntchito ku ICD-11 imatanthawuza kuti magulu osiyana a makhalidwe ndi maganizo omwe amayamba nthawi zambiri amapezeka mu ubwana ndi unyamata amachotsedwa, ndipo mavutowa amagawidwa ku magulu ena omwe amagawana nawo zizindikiro. Mwachitsanzo, vuto lodzipatula lokhazika mtima pansi linasunthika ku magulu oda nkhawa komanso okhudzana ndi mantha. Komanso, ICD-11 CDDG imapereka chidziwitso cha matenda alionse ndi / kapena kugawana kumene pali deta yomwe ikufotokoza kusiyana kwa kusokonezeka kwa ana ndi achinyamata komanso akuluakulu.
Chidziwitso chokhudzana ndi chikhalidwe chinaphatikizidwa mwadongosolo potengera kuwunikanso mabuku okhudza chikhalidwe pa matenda amisala ndi momwe amafotokozera gulu lililonse la matenda a ICD-11 komanso kuwunikanso mwatsatanetsatane zinthu zokhudzana ndi chikhalidwe mu ICD-10 CDDG ndi DSM-5. Malangizo a chikhalidwe cha matenda a mantha aperekedwa mu Table 1 monga chitsanzo.
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Chinthu china chachikulu chomwe chapangidwa mu gulu la ICD-11 chakhala kuphatikiza njira zoyezera zinthu m'magulu a dongosolo lodziwika bwino lomwe lili ndi zoletsa zinazake za taxonomic. Khama limeneli linalimbikitsidwa ndi umboni wakuti matenda ambiri amisala amatha kufotokozedwa bwino m'magulu angapo a zizindikiro zomwe zimagwirizana m'malo mokhala magulu osiyana 13-15 , ndipo athandizidwa ndi zatsopano mu kapangidwe ka ma code a ICD-11. Mphamvu ya ICD-11 imadziwika bwino kwambiri mu gulu la matenda a umunthu 16 , 17.
Kwa zosagwiritsa ntchito akatswiri, kukula kwake kwa zovuta za umunthu za ICD-11 kumapereka kuphweka komanso kugwiritsidwa ntchito kwazachipatala kuposa momwe ICD-10 imagwirizira zovuta zamunthu, kusiyanitsa kwabwino kwa odwala omwe amafunikira zovuta poyerekeza ndi mankhwala osavuta, komanso bwino Njira yotsatirira kusintha kwakanthawi. M'malo ena apadera, kuwundana kwa mikhalidwe yaumunthu kumatha kudziwitsa njira zina zothetsera vutoli. Makulidwe amachotsa zovuta zamatenda amunthu komanso zovuta zosadziwika zaumunthu, komanso kupereka maziko ofufuzira pazoyambira ndi kulowererapo pamitundu yosiyanasiyana yamatenda.
Gulu la zizindikiro zosonyeza momwe munthu amaonekera mu schizophrenia ndi matenda ena amisala oyamba 18 laperekedwanso kuti lifotokoze zizindikiro za matenda amisala ndi matenda ena amisala oyamba 18. M'malo mongoyang'ana kwambiri mitundu yosiyanasiyana ya matenda, gulu la zizindikiro limayang'ana kwambiri mbali zofunikira za momwe matenda akufotokozera panopa m'njira zomwe zimagwirizana kwambiri ndi njira zochiritsira matenda amisala zochokera ku kuchira.
Kuyandikira kwa maonekedwe a umunthu ndi mawonetseredwe a zizindikiro za matenda oyambirira a psychotic akufotokozedwa mwatsatanetsatane mu zigawo zomwe zapitazo pamapepala.
MAPHUNZIRO A DZIKO LA ICD-11
Pulogalamu yophunzirira ya ICD-11 imayimiranso gawo la zatsopano. Pulogalamu iyi yaphatikizapo kugwiritsa ntchito njira zatsopano zophunzirira kufunika kwa malangizo oyambira ozindikira matenda, kuphatikizapo kulondola kwawo komanso kugwiritsidwa ntchito kosasinthasintha ndi asing'anga poyerekeza ndi ICD-10 komanso zinthu zina zomwe zimayambitsa chisokonezo chilichonse chomwe chawonedwa 19. Mphamvu yayikulu ya pulogalamu yofufuzira yakhala kuti maphunziro ambiri achitika munthawi yomwe yalola zotsatira zawo kupereka maziko okonzanso malangizowo kuti athetse zofooka zilizonse zomwe zawonedwa 20.
Kuphatikizidwa kwa dziko lonse kwakhala chidziwitso cha pulogalamu ya ICD-11 CDDG. Pulogalamu ya Global Clinical Practice Network (GCPN) inakhazikitsidwa kuti apange odwala matenda aumoyo ndi ophunzirira apadziko lonse kuti athe kutenga nawo mbali mwachitukuko cha kayendetsedwe ka ICD-11 CDDG kupyolera pa maphunziro a masukulu a intaneti.
Patapita nthawi, GCPN yakula ndikuphatikizapo madokotala pafupifupi 15,000 ochokera m'mayiko a 155. Mayiko onse a WHO omwe amaimiridwa m'zinthu zambiri zomwe zimayang'anitsitsa kupezeka kwa akatswiri a thanzi la m'madera ndi dera, ndizomwe zikuchokera ku Asia, Europe ndi America (pafupifupi pakati pa US ndi Canada ndi dzanja limodzi ndi Latin America pa zina). Oposa theka la mamembala a GCPN ndi madokotala, makamaka amatsenga, ndipo 30% ndiwo amalingaliro a maganizo.
Maphunziro pafupifupi khumi ndi awiri a GCPN atsirizidwa mpaka pano, makamaka akuyang'ana kwambiri kufananiza malangizo owunikira a ICD-11 ndi malangizo a ICD-10 pankhani yolondola komanso kusinthasintha kwa njira zowunikira za asing'anga, pogwiritsa ntchito zinthu zokhazikika zomwe zasinthidwa kuti ziyese kusiyana kwakukulu 19 , 21. Maphunziro ena afufuza kuchuluka kwa ziyeneretso zowunikira 22 ndi momwe asing'anga amagwiritsira ntchito magulu 5. Maphunziro a GCPN achitika mu Chitchaina, Chifalansa, Chijapani, Chirasha ndi Chisipanishi, kuwonjezera pa Chingerezi, ndipo aphatikizapo kufufuza zotsatira malinga ndi chigawo ndi chilankhulo kuti adziwe zovuta zomwe zingachitike pakugwiritsa ntchito padziko lonse lapansi kapena chikhalidwe komanso mavuto pakumasulira.
Kafukufuku wozikidwa pa zipatala wachitikanso kudzera m'malo osiyanasiyana ophunzirira padziko lonse lapansi kuti awone momwe malangizo owunikira a ICD-11 omwe akuperekedwa akugwiritsidwira ntchito m'malo achilengedwe, m'malo omwe akuyenera kugwiritsidwa ntchito 11. Kafukufukuyu adawunikanso kudalirika kwa matenda omwe amachititsa kuti chiwerengero chachikulu cha matenda ndi ntchito zathanzi la maganizo chigwiritsidwe ntchito 12. Kafukufuku wapadziko lonse lapansi adapezeka m'maiko 14 m'madera onse apadziko lonse lapansi a WHO, ndipo kuyankhulana ndi odwala pa maphunzirowa kunachitika m'chinenero cha dziko lililonse.
KUKHALA KWAMBIRI KWA ICD-11 CHAPULE PA ZOCHITIKA ZOCHITA, ZOPHUNZITSIDWA NDI ZOCHITA ZOPHUNZITSA NTCHITO
Mu ICD-10, chiwerengero cha magulu a matendawa chinali choponderezedwa ndi dongosolo la chikhododomali chomwe chimagwiritsidwa ntchito pamagulu, kotero kuti zinangotheka kukhala ndi magulu khumi akuluakulu okhudzana ndi mavuto m'mutuwu pa zovuta za m'maganizo ndi khalidwe. Chotsatira chake, magulu owonetsa matenda omwe adagwiritsidwa ntchito omwe sankagwiritsidwa ntchito ndichipatala kapena umboni wa sayansi (mwachitsanzo, matenda opsinjika maganizo akuphatikizidwa ngati gawo limodzi la magulu okhudzana ndi maganizo, maganizo, ndi masoka). Kugwiritsidwa ntchito kwa ICD-11 yokhala ndi zolembera zowonongeka kwa alphanumeric kunathandiza kuti pakhale magulu ochulukirapo a magulu, kuti athe kukonza magulu ozindikira omwe amatsatira kwambiri zokhudzana ndi sayansi komanso zosowa za kuchipatala.
Pofuna kupereka deta yothandizira pakupanga dongosolo la bungwe lomwe lingakhale lothandiza kwambiri pazachipatala, maphunziro awiri oyambilira adachitika kuti afufuze malingaliro omwe akatswiri azaumoyo padziko lonse lapansi ali nawo okhudza ubale pakati pa matenda amisala. Deta iyi idathandizira zisankho zokhudzana ndi kapangidwe kabwino ka gulu. Kapangidwe ka bungwe la ICD - 11 kanakhudzidwanso ndi zoyesayesa za WHO ndi American Psychiatric Association kuti agwirizanitse kapangidwe ka mutu wonse wa ICD-11 pa matenda amisala ndi machitidwe ndi kapangidwe ka DSM-5.
Kukonza mutu wa ICD-10 wokhudza matenda amisala ndi khalidwe kunawonetsa kwambiri kapangidwe ka mutu womwe unagwiritsidwa ntchito koyamba mu Buku la Kraepelin la Psychiatry, lomwe linayamba ndi matenda achilengedwe, kutsatiridwa ndi matenda amisala, matenda amisala, ndi matenda aumunthu 25. Mfundo zomwe zinkatsogolera bungwe la ICD-11 zinaphatikizapo kuyesa kugawa magulu a matenda motsatira malingaliro a chitukuko (chifukwa chake, matenda a neurodevelopmental amayamba kuwonekera ndipo matenda a neurocognitive amakhala otsiriza m'gulu) ndikugawa matenda pamodzi kutengera zinthu zomwe zimayambitsa matenda ndi matenda (monga matenda omwe amagwirizanitsidwa makamaka ndi kupsinjika maganizo) komanso zochitika zomwe zimagawana (monga matenda a dissociative). Gome 2 limapereka mndandanda wa magulu a matenda mu mutu wa ICD-11 wokhudza matenda amisala, machitidwe ndi chitukuko cha mitsempha.
| Matenda a Neurodevelopmental |
| Schizophrenia ndi mavuto ena oyambirira a maganizo |
| Catatonia |
| Matenda a maganizo |
| Nkhawa ndi matenda okhudzana ndi mantha |
| Matenda osokoneza maganizo ndi ofanana |
| Matenda okhudzana ndi nkhawa |
| Matenda a dissociative |
| Kudyetsa ndi matenda odwala |
| Matenda othetsa mavuto |
| Kusokonezeka kwa masautso ndi thupi |
| Kusokonezeka chifukwa cha kugwiritsira ntchito mankhwala ndi makhalidwe oledzera |
| Pewani kusokoneza maganizo |
| Zosokoneza khalidwe ndi matenda a dissocial |
| Matenda a umunthu |
| Matenda a Paraphilic |
| Zovuta zenizeni |
| Matenda osokoneza maganizo |
| Matenda a maganizo ndi makhalidwe omwe amapezeka ndi mimba, kubala ndi puerperium |
| Zinthu zamaganizo ndi zamakhalidwe zomwe zimakhudza matenda kapena matenda omwe amapezeka kumadera ena |
| Matenda a m'maganizo kapena achikhalidwe omwe amagwirizana ndi matenda kapena matenda omwe amagawidwa kwina kulikonse |
Mndandanda wa matenda a kugona mu ICD-10 inadalira kusiyana komwe kuli kosalekanitsidwa komwe kulipo pakati pa matenda osakanikirana ndi aumunthu, zomwe zimapangitsa kuti "matenda osagwirizana" omwe akuphatikizidwa mu mutu wokhudzana ndi vuto la maganizo ndi khalidwe la ICD-10, ndi "matenda" ogona akuphatikizidwa mu mitu ina (mwachitsanzo, matenda a mitsempha ya matenda, matenda a mpweya wopuma, ndi endocrine, matenda a zakudya ndi kagayidwe kachakudya). Mu ICD-11, chaputala chosiyana chinayambitsidwa chifukwa cha matenda omwe akugona nawo omwe akuphatikizitsa matenda onse ogonana.
ICD-10 inalinso ndi kusiyana pakati pa zinthu zachilengedwe ndi zinthu zopanda chilengedwe pankhani ya matenda opatsirana pogonana, ndi mavuto okhudzana ndi kugonana "osakhala achilengedwe" omwe akuphatikizidwa mu mutu wokhudza matenda amisala ndi machitidwe, ndi mavuto okhudzana ndi kugonana "osapangidwa" omwe atchulidwa kwambiri mu mutu wokhudza matenda a genitourinary system. Mutu watsopano wophatikizidwa wa zinthu zokhudzana ndi thanzi la kugonana wawonjezedwa ku ICD-11 kuti ukhale ndi gulu logwirizana la mavuto okhudzana ndi kugonana ndi matenda opweteka pogonana 26 komanso kusintha kwa thupi la amuna ndi akazi. Kuphatikiza apo, matenda okhudzana ndi kugonana a ICD-10 asinthidwa kukhala "kusalingana kwa amuna ndi akazi" mu ICD-11 ndipo asunthidwa kuchokera ku mutu wa matenda amisala kupita ku mutu watsopano wa thanzi la kugonana 26 , zomwe zikutanthauza kuti kudziwika kwa transgender sikungaganizidwenso ngati matenda amisala. Kusalingana kwa amuna ndi akazi sikunaperekedwe kuti kuchotsedwe mu ICD-11 chifukwa m'maiko ambiri kupeza chithandizo choyenera chaumoyo kumadalira matenda oyenerera. Malangizo a ICD-11 amanena momveka bwino kuti khalidwe ndi zokonda zosiyana za amuna ndi akazi zokha sizokwanira pozindikira matenda.
ZINTHU ZATSOPANO, ZOKHUDZA NDIPONSO ZOKHUDZA NTCHITO MU ICD-11
Potsata ndemanga ya umboni womwe ulipo pa sayansi, komanso kulingalira za ntchito zamagetsi ndi zochitika zapadziko lonse, matenda ena atsopano awonjezeredwa ku chaputala cha ICD-11 pa matenda, maganizo ndi makhalidwe omwe amachititsa anthu kuti asinthe. Kufotokozera za matendawa monga momwe tafotokozera mu malangizo a ICD-11 ndi chiganizo cha kulowetsedwa kwawo amaperekedwa pansipa.
Catatonia
Mu ICD-10, catatonia idaphatikizidwa ngati imodzi mwa mitundu ya schizophrenia (mwachitsanzo, catatonic schizophrenia) komanso ngati imodzi mwa matenda achilengedwe (mwachitsanzo, organic catatonic disorder). Pozindikira kuti matenda a catatonia amatha kuchitika mogwirizana ndi matenda osiyanasiyana amisala 27 , gulu latsopano la matenda a catatonia (pamlingo womwewo monga matenda amisala, nkhawa ndi matenda okhudzana ndi mantha, ndi zina zotero) lawonjezedwa mu ICD-11.
Catatonia imadziwika ndi zizindikiro zambiri monga chiphuphu, catalepsy, kusinthasintha kwa thupi, mutism, kunyalanyaza, kunyalanyaza, zizoloŵezi, kusokoneza maganizo, kugwedezeka kwa maganizo, grimacing, echolalia ndi echopraxia. Zitatu zikuphatikizidwa m'magulu atsopano a matenda: a) catatonia yogwirizanitsidwa ndi matenda ena aumphawi (monga matenda a maganizo, schizophrenia kapena matenda ena oyambirira a maganizo, kapena matenda a autism spectrum); b) catatonia imapangidwanso ndi mankhwala osokoneza bongo, kuphatikizapo mankhwala (monga antipsychotic drugs, amphetamines, phencyclidine); ndipo c) catatonia yachiwiri (mwachitsanzo, chifukwa cha matenda, monga matenda a shuga ketoacidosis, hypercalcemia, kupweteka kwapadera, homocystinuria, neoplasm, matenda aakulu, matenda a cerebrovascular, kapena encephalitis).
Matenda a bipolar mtundu wa II
DSM-IV inayambitsa mitundu iwiri ya matenda a bipolar. Matenda a bipolar type I amagwira ntchito pa mawonetsero omwe amadziwika ndi gawo limodzi la manic episode, pomwe matenda a bipolar type II amafuna gawo limodzi la hypomanic kuphatikiza gawo limodzi lalikulu la depression, popanda mbiri ya manic episodes. Umboni wotsimikizira kutsimikizika kwa kusiyana pakati pa mitundu iwiriyi umaphatikizapo kusiyana kwa antidepressant monotherapy response 28 , neurocognitive measures 28 , 29 , majini zotsatira 28 , 30 , ndi zotsatira za neuroimaging 28 , 31 , 32.
Popeza umboniwu, komanso kufunika kwa matenda osiyanitsa mitundu iwiriyi ya 33 , matenda a bipolar mu ICD-11 agawikanso m'magulu awiri a matenda a bipolar a mtundu woyamba ndi wachiwiri.
Matenda a dysmorphic disorder
Anthu omwe ali ndi vuto la thupi losakhazikika amakhala otanganidwa ndi vuto limodzi kapena angapo kapena zolakwika m'mawonekedwe awo omwe mwina sawoneka kapena samawonekera pang'ono kwa ena . 34. Kuganizira kwambiri kumayenderana ndi machitidwe obwerezabwereza komanso ochulukirapo, kuphatikizapo kuwunika mobwerezabwereza mawonekedwe kapena kuopsa kwa vuto kapena cholakwika chomwe chikuwoneka, kuyesa kwambiri kubisa kapena kusintha cholakwika chomwe chikuwoneka, kapena kupewa zochitika za anthu kapena zinthu zomwe zimayambitsa nkhawa ndi vuto kapena cholakwika chomwe chikuwoneka.
Poyambirira amatchedwa "dysmorphophobia", vutoli poyamba linaphatikizidwa mu DSM-III-R. Idawoneka mu ICD-10 monga mawu ophatikizidwa koma osagwiritsidwa ntchito mwachindunji pansi pa hypochondriasis, koma odwala adalangizidwa kuti azindikire kuti ndi matenda osokoneza bongo pamene zikhulupiriro zomwe zimagwirizanitsidwa zinkaonedwa ngati zopanda pake. Izi zinayambitsa matenda omwewo kuti apatsidwe matenda osiyanasiyana popanda kuzindikira kukula kwa matendawa, omwe angaphatikizepo zikhulupiliro zomwe zimawoneka zosokonezeka chifukwa cha chikhulupiliro kapena kukonzekera komwe akugwiritsidwa ntchito.
Pozindikira zizindikiro zake zosiyana, kufalikira kwa anthu ambiri komanso kufanana ndi matenda odziletsa komanso okhudzana ndi zinthu zina (OCRD), matenda osokoneza thupi aphatikizidwa m'gulu lomalizali mu ICD- 1135.
Zovuta zowonongeka
Vutoli limadziwika ndi kumangoganizira kwambiri kuti munthu akupereka fungo loipa kapena loipa la thupi kapena mpweya, lomwe silingaonekere kapena limangooneka pang'ono kwa ena.
Poyankha nkhawa zawo, anthu amachita zinthu zobwerezabwereza komanso zopitirira muyeso monga kuyang'ana fungo la thupi mobwerezabwereza kapena kuyang'ana komwe fungolo likuchokera; kufunafuna chitsimikizo mobwerezabwereza; kuyesera kwambiri kubisala, kusintha kapena kuletsa fungo lomwe likuoneka; kapena kupewa zochitika za anthu kapena zinthu zomwe zimawonjezera nkhawa chifukwa cha fungo loipa kapena loipa lomwe likuoneka. Anthu omwe akukhudzidwa nthawi zambiri amaopa kapena amakhulupirira kuti ena omwe akuwona fungolo adzawakana kapena kuwachititsa manyazi 36.
Matenda obwerezabwereza akuphatikizidwa mu gulu la ICD-11 OCRD, chifukwa amagawana zofanana ndi matenda ena omwe ali m'gululi poyerekeza ndi kukhalapo kwa nkhawa zosalekeza komanso machitidwe obwerezabwereza ogwirizana nawo.
Kusokoneza matenda
Kusunga zinthu mopitirira muyeso kumadziwika ndi kusonkhanitsa katundu, chifukwa cha kupeza zinthu mopitirira muyeso kapena kuvutika kuzitaya, mosasamala kanthu za mtengo wake weniweni 35 , 37. Kupeza zinthu mopitirira muyeso kumadziwika ndi chilakolako chobwerezabwereza kapena machitidwe okhudzana ndi kusonkhanitsa kapena kugula zinthu. Kuvuta kutaya zinthu kumadziwika ndi kufunika kosunga zinthu komanso vuto lokhudzana ndi kuzitaya. Kusonkhanitsa katundu kumapangitsa kuti malo okhala azikhala odzaza kwambiri mpaka kufika poti kugwiritsa ntchito kapena chitetezo chake chimasokonekera.
Ngakhale kuti makhalidwe osunga ndalama angasonyezedwe ngati mbali ya matenda osiyanasiyana amisala ndi machitidwe ndi matenda ena - kuphatikizapo matenda ovutika maganizo, matenda ovutika maganizo, schizophrenia, matenda a dementia, matenda a autism spectrum ndi Prader-Willi syndrome - pali umboni wokwanira wotsimikizira kuti matenda osunga ndalama ndi matenda osiyana komanso apadera 38.
Anthu omwe akhudzidwa ndi vuto la kuchuluka kwa anthu omwe ali ...
Chisokonezo chachisokonezo
Magulu atsopano ogwiritsira ntchito, omwe akugwiritsidwa ntchito mobwerezabwereza, akuwonjezeredwa ku gulu la OCRD. Zimaphatikizapo trichotillomania (yomwe idaphatikizidwa mu kagulu ka chizolowezi ndi matenda osokoneza bongo ku ICD-10) ndi matenda atsopano, matenda osokoneza bongo (omwe amadziwikanso kuti matenda otola khungu).
Matenda okhumudwa amadziwika ndikutola khungu lako mobwerezabwereza, komwe kumabweretsa zotupa pakhungu, limodzi ndi zoyesayesa zakulephera kapena kuletsa khalidweli. Kutola khungu kuyenera kukhala kokwanira kuthana ndi vuto lalikulu kapena kuwonongeka kwa magwiridwe antchito. Matenda a Excoriation (ndi trichotillomania) ndi osiyana ndi ma OCRD ena chifukwa chikhalidwecho sichimayambitsidwa ndi zochitika zazidziwitso monga malingaliro olowerera, kutengeka kapena chidwi, koma m'malo mwake zimatha kutsogozedwa ndi zokumana nazo.
Kuphatikizidwa kwawo mu gulu la OCRD kumadalira zochitika zomwe zimagawidwa, machitidwe a kusonkhana kwa mabanja, ndi njira zoyesera za etiological ndi matenda ena mu gulu ili 35 , 40.
Kusokonezeka kwapweteka kwapweteka kwambiri
Matenda ovutika maganizo pambuyo pa zoopsa (complex PTSD) 41 nthawi zambiri amatsatira zinthu zovutitsa maganizo zomwe zimakhalapo kwa nthawi yayitali, kapena zochitika zoipa zambiri kapena zobwerezabwereza zomwe kuthawa kumakhala kovuta kapena kosatheka, monga kuzunza, ukapolo, ma kampeni a kupha anthu ambiri, nkhanza zapakhomo zomwe zimachitika nthawi yayitali, kapena nkhanza zogonana kapena zakuthupi zomwe zimachitika mobwerezabwereza paubwana.
Chizindikiro cha chizindikiro chimadziwika ndi zinthu zitatu zazikuluzikulu za PTSD (mwachitsanzo, kukumana ndi zoopsa kapena zochitika pakadali pano monga zikumbukiro zowoneka bwino, zoopsa kapena zoopsa; kupewa malingaliro ndikukumbukira zomwe zidachitika kapena zochitika, zochitika kapena anthu okumbutsa za mwambowu; malingaliro opitilira chiwopsezo chamakono), zomwe zimatsagana ndi zosokoneza zowonjezereka, zofalikira komanso zopirira zomwe zimakhudza malamulo, malingaliro anu ndi magwiridwe antchito.
Kuwonjezera kwa PTSD yovuta ku ICD-11 kuli koyenera potengera umboni wakuti anthu omwe ali ndi vutoli ali ndi chiyembekezo choipa ndipo amapindula ndi chithandizo chosiyanasiyana poyerekeza ndi anthu omwe ali ndi PTSD 42. PTSD yovuta imalowa m'malo mwa gulu la ICD-10 lomwe limaphatikizapo kusintha kwa umunthu kosatha pambuyo pa zochitika zoopsa 41.
Matenda achisoni nthawi yaitali
Matenda a chisoni omwe amapitirira nthawi yayitali amafotokoza momwe munthu amayankhira mopitirira muyeso komanso molepheretsa kumwalira 41. Pambuyo pa imfa ya mnzanu, kholo, mwana kapena munthu wina amene ali pafupi ndi woferedwa, pamakhala kuyankha kosalekeza komanso kofala kwa chisoni komwe kumadziwika ndi kulakalaka woferedwayo kapena kuganizira kwambiri za woferedwayo, limodzi ndi ululu waukulu wamaganizo. Zizindikiro zake zingaphatikizepo chisoni, kudzimva kuti ndi wolakwa, mkwiyo, kukana, kuimba mlandu, kuvutika kuvomereza imfayo, kumva kuti munthuyo wataya gawo lake, kulephera kukhala ndi maganizo abwino, kusamva bwino m'maganizo, komanso kuvutika kuchita zinthu zina. Kuyankha kwa chisoni kuyenera kukhalapo kwa nthawi yayitali pambuyo pa imfayo (miyezi yoposa isanu ndi umodzi) ndipo kupitirira bwino miyambo ya chikhalidwe, chikhalidwe kapena chipembedzo yomwe munthuyo amayembekezera pa chikhalidwe ndi malo ake.
Ngakhale anthu ambiri amanena kuti akumva chisoni chachikulu kwa miyezi isanu ndi umodzi atatha kumwalira, anthu amene akupitirizabe kukhala ndi chisoni chachikulu amakhala ndi vuto lalikulu pakugwira ntchito kwawo. Kuphatikizidwa kwa matenda a chisoni kwa nthawi yayitali mu ICD-11 ndi yankho la umboni wowonjezereka wa vuto losiyana komanso lofooketsa lomwe silikufotokozedwa mokwanira ndi matenda a ICD-10 omwe alipo pano . 43. Kuphatikizidwa kwake ndi kusiyanitsa kwake ndi kumwalira kwachikhalidwe komanso nthawi yachisoni ndikofunikira, chifukwa cha zotsatira zosiyanasiyana za mankhwala ndi zomwe zanenedwa za matendawa 44.
Kudya matenda osokoneza bongo
Matenda odyera kudya amadziwika ndifupipafupi, nthawi zambiri zomwe zimadya kudya (mwachitsanzo, kamodzi pa sabata kapena kupitirira miyezi ingapo). Kudya chakudya chokwanira ndi nthawi yapadera yomwe munthu amatha kudziletsa kuti asadye zakudya, amadya kwambiri kapena mosiyana ndi momwe amachitira nthawi zonse, ndipo amamva kuti sangaleke kudya kapena kuchepetsa mtundu kapena chakudya chodyedwa.
Kudya chakudya kumakhala kovuta kwambiri ndipo nthawi zambiri kumakhala ndi maganizo oipa monga kudziimba mlandu kapena kunyansidwa. Komabe, mosiyana ndi bulimia nervosa, zizolowezi zodya kudya sizimatsatiridwa ndi makhalidwe osayenera osayenera kuti athetse kulemera kwa thupi (mwachitsanzo, kusanza komweko, kugwiritsa ntchito molakwa mankhwala osokoneza bongo kapena kuchita masewera olimbitsa thupi). Ngakhale kuti kudya zakudya zolimbitsa thupi nthawi zambiri kumakhudzana ndi kulemera kwa thupi ndi kunenepa kwambiri, izi sizowonjezera ndipo vutoli lingakhalepo mwa anthu olemera.
Kuwonjezeka kwa vuto la kudya mopitirira muyeso mu ICD-11 kumachokera ku kafukufuku wambiri womwe wachitika m'zaka 20 zapitazi wotsimikizira kuti ndi wolondola komanso wothandiza kuchipatala 45 , 46. Anthu omwe amanena kuti amadya mopitirira muyeso popanda kuchita zinthu zosayenera zolipirira ndi gulu lofala kwambiri pakati pa omwe amalandira matenda ena okhudzana ndi kudya omwe atchulidwa kapena osatchulidwa mu ICD-10, kotero kuti kuyembekezera kuti kuphatikizidwa kwa vuto la kudya mopitirira muyeso kudzachepetsa matendawa 47.
Peŵani matenda / kudya zoletsa kudya
Matenda oletsa kudya (ARFID) amadziwika ndi makhalidwe odyetsa kapena odyetsa omwe amachititsa kuti munthu asadye chakudya chokwanira kapena chokwanira kuti athe kupeza mphamvu kapena zakudya zoyenera. Izi zimapangitsa kulemera kwakukulu, kulephera kulemera monga momwe akuyembekezerekera muubwana kapena mimba, kuchipatala chosowa zakudya, kukhudzana ndi zowonjezera zakudya zamakono kapena kupatsa chubu, kapena kusokoneza mwakuthupi umoyo wa munthuyo kapena zotsatira za kuwonongeka kwakukulu kwabwino.
ARFID imasiyanitsidwa ndi anorexia nervosa chifukwa chosakhala ndi nkhawa zokhudza kulemera kwa thupi kapena mawonekedwe ake. Kuphatikizidwa kwake mu ICD-11 kungawonedwe ngati kufalikira kwa gulu la ICD-10 la "matenda odyetsa ana aang'ono ndi aang'ono", ndipo mwina kungathandize kwambiri pa moyo wonse (monga, mosiyana ndi ICD-10, ARFID imagwira ntchito kwa ana, achinyamata ndi akuluakulu) komanso kusunga mgwirizano ndi DSM-5 45 , 47.
Thupi la umphumphu dysphoria
Dysphoria ya thupi ndi matenda osowa omwe amadziwika ndi chilakolako chofuna kukhala ndi chilema china chake chakuthupi (monga kudula ziwalo, kulumala ziwalo, khungu, kusamva) kuyambira ali mwana kapena ali mwana 48. Chilakolakocho chingawonekere m'njira zingapo, kuphatikizapo kuganiza za chilema chomwe mukufuna, kuchita zinthu "zodzionetsera" (monga, kukhala maola ambiri mu wheelchair kapena kugwiritsa ntchito zomangira miyendo kuti muyerekezere kuti muli ndi kufooka kwa miyendo), komanso kugwiritsa ntchito nthawi kufunafuna njira zopezera chilema chomwe mukufuna.
Kutanganidwa ndi chilakolako chokhala ndi thupi (kuphatikizapo nthawi yogwiritsira ntchito) kumalepheretsa kwambiri zokolola, zosangalatsa, kapena chikhalidwe cha anthu (mwachitsanzo, munthuyo sakufuna kukhala ndi ubale wapamtima chifukwa zingakhale zovuta kudziyerekezera). Kuwonjezera apo, kwa anthu ochepa omwe ali ndi chikhumbochi, nkhawa zawo zimangotengera zongoganizira, ndipo zimapangitsa kuti chilakolakocho chikhale chonchi kupyolera mwa njira zopaleshoni (mwachitsanzo, pochotsa chiwalo chopatsa thanzi labwino) kapena kudzivulaza thupi digiri yomwe amputation ndiyo njira yokhayo yokhayokha (mwachitsanzo, kuzizira kwa nthambi pamsana wouma).
Matenda a masewera
Popeza masewera a pa intaneti atchuka kwambiri m'zaka zaposachedwapa, mavuto awonedwa okhudzana ndi kutenga nawo mbali kwambiri pamasewera. Matenda a masewera aphatikizidwa mu gulu latsopano lodziwitsa matenda lotchedwa "matenda obwera chifukwa cha machitidwe osokoneza bongo" (lomwe lilinso ndi vuto la kutchova juga) poyankha nkhawa zapadziko lonse lapansi zokhudzana ndi momwe masewera ovuta amakhudzira, makamaka fomu 49 ya pa intaneti.
Matenda a masewera amadziwika ndi kachitidwe kachitetezo chokhazikika kapena chosakhalitsa cha intaneti (kapena "masewera a pakompyuta") omwe amawonetseredwa ndi kusokonekera kwa khalidwe (mwachitsanzo, kulephera kuchepetsa nthawi yomwe amathera masewera), zomwe zimapangitsa kuti maseŵera atenge patsogolo kwambiri kuposa momwe amachitira patsogolo pa zofuna zina za moyo ndi ntchito za tsiku ndi tsiku; komanso kupitiliza kapena kusefukira maseŵera ngakhale kuti zotsatira zake sizikhala zoipa (mwachitsanzo, kupitilizidwanso ntchito chifukwa cha kupezeka kwambiri chifukwa cha masewera). Zimasiyanitsa ndi khalidwe losasewera la masewera chifukwa cha matenda aakulu kapena kuwonongeka kwa ntchitoyi.
Kusokonezeka kwa khalidwe la kugonana
Matenda opatsirana okhudzana ndi kugonana amadziwika ndi chizoloŵezi cholephera kuthetsa zofuna zokhudzana ndi kugonana mobwerezabwereza kapena zolimbikitsa, zomwe zimabweretsanso khalidwe la kugonana mobwerezabwereza kwa nthawi yaitali (mwachitsanzo, miyezi isanu ndi umodzi kapena kuposerapo) yomwe imayambitsa kukhumudwa kapena kuwonongeka kwaumwini, banja, chikhalidwe , maphunziro, ntchito kapena mbali zina zofunika pakugwira ntchito.
Zisonyezero zomwe zingachitike pakuphatikizika ndikuphatikizira: Kugonana mobwerezabwereza kumakhala chinthu chofunikira kwambiri pamoyo wa munthu mpaka kunyalanyaza thanzi ndi chisamaliro chaumwini kapena zokonda zina, zochita ndi maudindo; munthu amene akuyesetsa kangapo kuti athetse kapena kuchepetsa kwambiri machitidwe obwerezabwereza ogonana; munthu akupitilizabe kuchita zachiwerewere mobwerezabwereza ngakhale atakumana ndi zovuta monga kusokonekera kwaubwenzi mobwerezabwereza; ndipo munthuyo akupitilizabe kuchita zachiwerewere mobwerezabwereza ngakhale pomwe sakupezanso chisangalalo.
Ngakhale kuti gululi limafanana ndi kudalira mankhwala osokoneza bongo, lili m'gawo la ICD-11 impulse control disorders pozindikira kusowa kwa chidziwitso chotsimikizika chokhudza ngati njira zomwe zimakhudzidwa pakukula ndi kusunga vutoli ndizofanana ndi zomwe zimawonedwa m'mavuto ogwiritsa ntchito mankhwala osokoneza bongo komanso zizolowezi zamakhalidwe. Kuphatikizidwa kwake mu ICD-11 kudzathandiza kuthana ndi zosowa zosakwaniritsidwa za odwala omwe akufuna chithandizo komanso mwina kuchepetsa manyazi ndi kudzimva chisoni komwe kumakhudzana ndi kufunafuna thandizo pakati pa anthu omwe ali ndi nkhawa 50.
Matenda osokoneza bongo
Matenda osokoneza bongo amadziwika mobwerezabwereza mwachidule pamaganizo kapena kuwonongedwa kwa katundu omwe akuyimira kulephera kuthetsa chilakolako chokwiya, ndi kupwetekedwa kwa chipolowe kapena kupwetekedwa mtima kwakukulu mopanda kufanana ndi kukhumudwa kapena kusokoneza maganizo a maganizo.
Chifukwa chakuti zigawo zoterezi zingathe kuchitika m'madera osiyanasiyana (mwachitsanzo, kutsutsana ndi matenda osokoneza bongo, matenda osokonezeka maganizo, matenda osokoneza bongo), sichiperekedwa ngati zigawozi zikufotokozedwa bwino ndi matenda ena, maganizo kapena a neurodevelopmental disorder.
Ngakhale kuti vuto la kuphulika kwadzidzidzi linayambitsidwa mu DSM-III-R, linkaoneka mu ICD-10 ngati mawu ophatikizidwa pansi pa "matenda ena a chizolowezi ndi kusokonezeka maganizo". Linaphatikizidwa mu gawo la ICD-11 la matenda oletsa kusokonezeka maganizo pozindikira umboni wokwanira wa kuvomerezeka kwake ndi ntchito yake m'malo azachipatala 51.
Matenda opatsirana kwambiri
Matenda opatsirana am'mimba (PMDD) amadziwika ndi zizindikiro zoopsa, zovuta kapena zamaganizo zomwe zimayambira masiku angapo kusanayambike, kumayamba kusintha mkati mwa masiku angapo, ndipo zimakhala zochepa kapena sizikhalapo pakatha sabata imodzi isanayambe sungani.
Zowonjezereka, matendawa amafunika kukhala ndi zizindikiro za maganizo (kukhumudwa, kukhumudwa), zizindikiro za m'mimba (kuthamanga, kupweteka pamodzi, kudya mopitirira muyeso), kapena zizindikilo zamaganizo (zovuta, kusaiwala) zomwe zachitika nthawi zambiri m'masiku apitawo chaka. Zizindikiro zimakhala zovuta kwambiri kuti zisawonongeke kwambiri kapena kuwonongeka kwakukulu payekha, banja, chikhalidwe, maphunziro, ntchito kapena zinthu zina zofunika kwambiri, ndipo sizikuyimira matenda ena a m'maganizo.
Mu ICD-11, PMDD imasiyanitsidwa ndi matenda ofala kwambiri a premenstrual tension syndrome chifukwa cha kuopsa kwa zizindikirozo komanso kufunika koti zibweretse mavuto aakulu kapena kufooka 52. Kuphatikizidwa kwa PMDD mu zowonjezera zofufuza za DSM-III-R ndi DSM-IV kunayambitsa kafukufuku wambiri womwe watsimikizira kuti ndi wodalirika komanso wodalirika 52 , 53 , zomwe zinapangitsa kuti iphatikizidwe mu ICD-11 ndi DSM-5. Ngakhale kuti malo ake akuluakulu mu ICD-11 ali mu mutu wokhudza matenda a genitourinary system, PMDD yalembedwa m'gulu la matenda ovutika maganizo chifukwa cha kutchuka kwa zizindikiro za maganizo.
SUMMARY OF CHANGES NDI ICD-11 GULU LA GULU
Zigawo zotsatirazi zikufotokozera mwachidule kusintha komwe kunayambika m'magulu akuluakulu a matenda a ICD-11 chaputala pa matenda a maganizo, makhalidwe ndi mavuto a m'mayiko ena kuphatikizapo magulu atsopano omwe afotokozedwa m'gawo lapitalo.
Kusintha kumeneku kwachitika potsata ndondomeko ya sayansi yomwe ilipo ndi ICD-11 Working Groups ndi akatswiri othandizira, kuganizira za ntchito zamagetsi ndi zochitika zonse, ndipo ngati n'kotheka, zotsatira za kuyesedwa kwa munda.
Matenda a Neurodevelopmental
Matenda a Neurodevelopmental ndi omwe akuphatikizapo mavuto aakulu pakudziwa ndi kuchitidwa kwa nzeru, magalimoto, chilankhulo kapena chikhalidwe cha anthu poyambira pa nthawi yopititsa patsogolo. Matenda a ICD-11 a neurodevelopmental akuphatikizana ndi magulu a ICD-10 a kuchepa kwa maganizo ndi mavuto a chitukuko cha maganizo, ndi kuwonjezeredwa kwa kuchepa kwa matenda osokoneza bongo (ADHD).
Kusintha kwakukulu mu ICD-11 kumaphatikizapo kusintha mayina a matenda a chitukuko cha nzeru kuchokera ku ICD-10 mental retardation, yomwe inali mawu achikale komanso onyoza omwe sanathe kufotokoza bwino mitundu ndi zifukwa zogwirizana ndi vutoli 54. Matenda a chitukuko cha nzeru akupitilizabe kufotokozedwa potengera zofooka zazikulu pakugwira ntchito kwa nzeru ndi khalidwe losinthasintha, zomwe zimatsimikiziridwa bwino ndi njira zokhazikika, zoyenera komanso zoperekedwa payekhapayekha. Pozindikira kusowa kwa njira zoyenera zokhazikika m'deralo kapena antchito ophunzitsidwa kuti azipereke m'madera ambiri padziko lapansi, komanso chifukwa cha kufunika kodziwa kuopsa kwa kukonzekera chithandizo, ICD-11 CDDG imaperekanso mndandanda wathunthu wa matebulo owonetsa khalidwe 55.
Masamba osiyana omwe amagwiritsidwa ntchito mwachidwi ndi magulu ogwira ntchito omwe amagwira ntchito moyenera (amalingaliro, chikhalidwe, othandizira) amalinganiza malinga ndi magulu atatu a zaka (ubwana wawo, ubwana / unyamata ndi munthu wamkulu) ndi zovuta zinayi (zofatsa, zochepa, zazikulu, zakuya). Zizindikiro za makhalidwe zimalongosola maluso awo ndi luso lomwe liyenera kuwonetsedwa mkati mwa magawo awa onse ndipo akuyembekezerekanso kudalirika kwa kuonetsa kuopsa kwake ndikukonzekera deta yaumphawi yokhudzana ndi umoyo wokhudzana ndi zovuta za chitukuko cha nzeru.
Matenda a Autism mu ICD-11 amaphatikiza autism yaubwana ndi Asperger's syndrome kuchokera ku ICD-10 pansi pagulu limodzi lomwe limadziwika ndi kuchepa kwa njira yolumikizirana ndi anthu ochepera, obwerezabwereza komanso osasintha machitidwe, zokonda kapena zochitika. Malangizo a vuto la Autism spectrum adasinthidwa kwambiri kuti awonetse zolemba zomwe zilipo, kuphatikiza ziwonetsero m'moyo wonse. Oyenerera amaperekedwa pamlingo wakusokonekera pakugwira ntchito kwanzeru ndi kuthekera kwa chilankhulo kuti athe kujambula zowonetsera zonse za vuto la autism masanjidwe modabwitsa.
ADHD yasintha matenda a ICD-10 hyperkinetic ndipo yasunthira ku gulu la matenda a neurodevelopmental chifukwa cha kukula kwake, kusokonezeka kwaumisiri, magalimoto ndi chikhalidwe cha anthu, komanso zochitika zofanana ndi matenda ena. Kusunthika uku kumayesetsanso kufooka kwachidziwitso cha kuwona ADHD monga chogwirizana kwambiri ndi makhalidwe okhumudwitsa ndi dissocial, chifukwa anthu omwe ali ndi ADHD sakhala osokoneza mwadala.
ADHD ikhoza kudziwika ndi ICD-11 pogwiritsira ntchito ziyeneretso zopanda chidwi, zowopsa kwambiri, kapena zofanana, ndipo zimafotokozedwa kudutsa moyo wonse.
Mapeto ake, matenda aakulu a chi tichipatala, kuphatikizapo matenda a Tourette, amagawidwa mu chaputala cha ICD-11 pa matenda a mitsempha ya mitsempha, koma amalembedwa mndandandanda wa zovuta zokhudzana ndi matendawa chifukwa cha zochitika zawo zapamwamba (mwachitsanzo, ndi ADHD) ndi zomwe zimayambira nthawi yopititsa patsogolo.
Schizophrenia ndi mavuto ena oyambirira a maganizo
Gulu la ICD-11 la matenda amisala ndi matenda ena oyambitsa matenda amisala limalowa m'malo mwa gulu la ICD-10 la matenda amisala, matenda amisala ndi matenda obisika. Mawu oti "oyamba" akusonyeza kuti njira zamisala ndi chinthu chachikulu, mosiyana ndi zizindikiro zamisala zomwe zingachitike ngati mbali ya mitundu ina ya matenda amisala (monga matenda amisala) 18.
Mu ICD-11, zizindikiro za schizophrenia sizinasinthe kwenikweni kuchokera ku ICD-10, ngakhale kufunika kwa zizindikiro zoyambirira za Schneiderian sikunatchulidwe. Kusintha kwakukulu kwambiri ndikuchotsa mitundu yonse ya schizophrenia (monga paranoid, hebephrenic, catatonic), chifukwa chosowa kuneneratu kapena kugwiritsa ntchito posankha chithandizo. M'malo mwa mitundu iyi, gulu la mafotokozedwe amitundu yayamba 18. Izi zikuphatikizapo: zizindikiro zabwino (kusokeretsa, kuwona zinthu m'maganizo, kuganiza molakwika ndi khalidwe losakonzedwa, zochitika za kungokhala chete ndi kulamulira); zizindikiro zoipa (kuchepa, kufooka kapena kusinthasintha, alogia kapena kusakwanira kwa kulankhula, kulephera kulankhula, anhedonia); zizindikiro za maganizo okhumudwa; zizindikiro za maganizo osokonezeka; zizindikiro za maganizo (kusokonezeka kwa maganizo, kuchedwa kwa maganizo, zizindikiro za matenda); ndi zizindikiro zamaganizo (makamaka kusowa kwa liwiro la kukonza, chidwi/kuganizira, kuyang'ana, kuweruza, kusokoneza, kuphunzira pakamwa kapena kuwona, ndi kukumbukira ntchito). Zizindikiro zomwezi zingagwiritsidwenso ntchito m'magulu ena omwe ali m'gululi (schizoaffective disorder, acute and transient psychotic disorder, delusional disorder).
Kachilombo ka ICD-11 schizoaffective chimafunikanso kuti pakhale nthawi yomweyo kukhalapo kwa matenda a schizophrenia ndi nthawi yachisokonezo. Matendawa amatanthauza kufotokoza zochitika zomwe zikuchitika pakadwala ndipo sizimangoganizira mozama nthawi zonse.
Matenda amisala ofulumira komanso osakhalitsa a ICD-11 amadziwika ndi kuyamba mwadzidzidzi kwa zizindikiro zabwino zamisala zomwe zimasinthasintha mofulumira m'chilengedwe komanso mwamphamvu kwa nthawi yochepa ndipo sizipitirira miyezi itatu. Izi zikugwirizana ndi mtundu wa "polymorphic" wa matenda amisala ofulumira mu ICD-10, womwe ndi mtundu wofala kwambiri komanso womwe susonyeza schizophrenia 56 , 57. Mitundu yosakhala ya polymorphic ya matenda amisala ofulumira mu ICD-10 yachotsedwa ndipo m'malo mwake imayikidwa mu ICD-11 ngati "matenda ena oyamba amisala".
Monga momwe zilili ndi ICD-10, matenda a schizotypal amagawidwa mu gululi ndipo sali ngati vuto la umunthu.
Matenda a maganizo
Mosiyana ndi ICD-10, mafilimu a ICD-11 sizomwe amadziwiratu okha, komabe chitsanzo chawo pa nthawi chimagwiritsidwa ntchito ngati maziko a chisokonezo chomwe chimapangitsa kuti munthu adziwe bwino.
Matenda a maganizo amagawidwa m'magulu awiri: matenda ovutika maganizo (omwe akuphatikizapo matenda ovutika maganizo a episode imodzi, matenda ovutika maganizo obwerezabwereza, matenda a dysthymic, ndi matenda osokonezeka maganizo ndi nkhawa) ndi matenda a bipolar (omwe akuphatikizapo matenda a bipolar type I, matenda a bipolar type II, ndi cyclothymia). ICD-11 imagawa matenda a bipolar a ICD-10 m'magulu awiri: matenda a bipolar type I ndi type II. Magulu awiri osiyana a ICD-10 a matenda osatha a maganizo, omwe ali ndi dysthymia ndi cyclothymia, achotsedwa.
Malangizo odziwira matenda a nthawi ya kuvutika maganizo ndi amodzi mwa malo ochepa mu ICD-11 komwe kumafunika kuwerengera kochepa kwa zizindikiro. Izi zikuchitika chifukwa cha kafukufuku wakale komanso mwambo wazachipatala woganizira za kuvutika maganizo motere. Zizindikiro zosachepera zisanu mwa khumi ndizofunikira m'malo mwa zizindikiro zinayi mwa zisanu ndi zinayi zomwe zafotokozedwa mu ICD-10, motero zimawonjezera kufananiza ndi DSM-5. CDDG ya ICD-11 imagawa zizindikiro za kuvutika maganizo m'magulu atatu - affective, cognitive and neurovegetative - kuti ithandize asing'anga kuganizira ndikukumbukira zizindikiro zonse za kuvutika maganizo. Kutopa ndi gawo la gulu la zizindikiro za neurovegetative koma sikuonedwanso ngati kokwanira ngati chizindikiro choyamba; m'malo mwake, kuvutika maganizo pafupifupi tsiku lililonse kapena kuchepa kwa chidwi pa zochita zomwe zimakhalapo kwa milungu iwiri kapena kucheperako ndikofunikira. Kutaya mtima kwawonjezeredwa ngati chizindikiro china cha chidziwitso chifukwa cha umboni wamphamvu wa kufunika kwake kodziwira matenda a kuvutika maganizo 59. CDDG ya ICD-11 imapereka chitsogozo chomveka bwino pakusiyanitsa pakati pa machitidwe achisoni ndi zizindikiro zomwe zimafunika kuganiziridwa ngati gawo la kuvutika maganizo pankhani ya kuferedwa 60.
Pachiyambi cha manic, ICD-11 imafuna kukhalapo kwa chizindikiro cha msinkhu wowonjezereka wa ntchito yowonjezereka kapena kudzidzimutsa kwachidziwitso cha mphamvu yowonjezera, kuphatikizapo kuwonjezeka, kukhumudwa kapena kuwonjezeka. Izi zikutanthawuza kuti asamangidwe ndi zolakwika zomwe zingakhale bwino monga chizoloŵezi chosinthika. Magulu a ICD-11 amapangidwa ngati njira yowonongeka ya ziwalo za munthu popanda kukhala ndi vuto lalikulu.
Zochitika zosakanikirana zimafotokozedwa mu ICD-11 m'njira yofanana ndi ICD-10, kutengera umboni wotsimikizira kuti njira iyi ndi yolondola 61. Malangizo amaperekedwa okhudza zizindikiro za contrapolar zomwe zimawonedwa pamene zizindikiro za manic kapena depression zimawonekera kwambiri. Kupezeka kwa zochitika zosakanikirana kumasonyeza matenda a bipolar type I.
ICD-11 imapereka ziyeneretso zosiyanasiyana kufotokozera zochitika zamakono kapena kukhululukidwa (mwachitsanzo, mwachindunji kapena mu chikhululukiro chonse). Zosokonezeka, zaumunthu komanso zowonjezereka zikhoza kufotokozedwa ngati ziri ndi kapena popanda zizindikiro za psychotic. Mipingo yodetsa nkhaŵa yamakono pambali ya matenda opsinjika maganizo kapena ochititsa munthu kusinthasintha zolaula amatha kudziwika kwambiri ndi kuuma (yofatsa, yochepa kapena yovuta); ndi zizindikiro zosakanikirana zomwe zimagwirizana ndi maganizo a somatic syndrome ku ICD-10; ndi choyenerera kuti adziwe zigawo zosalekeza za zaka zoposa ziwiri. Zochitika zonse zapakati pa matenda ovutika maganizo kapena ochititsa munthu kusinthasintha zochitika zingathe kufotokozedwa mogwiritsidwa ntchito pogwiritsa ntchito zizindikilo zapamwamba zozizwitsa; choyimira chosonyeza kuti pali mantha; ndi choyenerera kuti muzindikire kachitidwe ka nyengo. Cholinga cha maulendo oyendetsa njinga amapezekanso pa matenda a bipolar matenda.
ICD-11 imaphatikizapo gulu la matenda osokonezeka maganizo ndi nkhawa chifukwa cha kufunika kwake m'malo osamalira odwala oyambilira 62 , 63. Gululi lasamutsidwa kuchoka ku matenda ovutika maganizo mu ICD-10 kupita ku matenda ovutika maganizo mu ICD-11 chifukwa cha umboni woti limafanana ndi zizindikiro za maganizo 64.
Nkhawa ndi matenda okhudzana ndi mantha
ICD-11 imabweretsa matenda okhala ndi nkhawa kapena mantha ngati chizindikiro chachikulu cha matenda mu gulu latsopanoli 65. Mogwirizana ndi njira ya moyo wa ICD-11, gululi limaphatikizaponso matenda odzipatula a nkhawa ndi kusankha kusagwirizana kwa ziwalo, zomwe zidayikidwa pakati pa matenda aubwana mu ICD-10. Kusiyana kwa ICD-10 pakati pa matenda oopa nkhawa ndi matenda ena a nkhawa kwachotsedwa mu ICD-11 pofuna njira yothandiza kwambiri yofotokozera nkhawa iliyonse ndi matenda okhudzana ndi mantha malinga ndi cholinga chake cha mantha 66 ; ndiko kuti, chilimbikitso chomwe munthuyo adanena kuti chimayambitsa nkhawa yake, kukwiya kwambiri kwa thupi komanso mayankho osasinthika a khalidwe. Matenda a nkhawa ofala (GAD) amadziwika ndi mantha kapena nkhawa zomwe sizimangokhala ndi chilimbikitso china chilichonse.
Mu ICD-11, GAD ili ndi zida zofunikira kwambiri, zomwe zikuwonetseratu kupita patsogolo pomvetsetsa zochitika zake zodabwitsa; makamaka, kudandaula kumawonjezeredwa ndi mantha ambiri monga chinthu chachikulu cha matendawa. Mosiyana ndi ICD-10, ICD-11 CDDG imanena kuti GAD ikhoza kugwirizanitsa ndi vuto lachisokonezo malinga ngati zizindikiro zilipo pokhapokha pazigawo zozizwitsa. Mofananamo, malamulo ena a ICD-10 oletsedwa (mwachitsanzo, GAD sangapezedwe ndi matenda a phobic kapena matenda osokoneza maganizo) amachotsedwanso, chifukwa cha kupambana kwa chisokonezo cha ICD-11 komanso umboni wakuti malamulowa kusokoneza ndi kupeza ndi kuchiza zinthu zomwe zimafuna kuti munthu asamangoganizira zachinsinsi.
Mu ICD-11, agoraphobia amadziwika kuti ndi mantha komanso nkhawa kapena nkhawa zomwe zimachitika, kapena kuyembekezera, zochitika zingapo pomwe kuthawa kungakhale kovuta kapena kuthandizira kupezeka. Chowopsya chimakhala mantha a zotsatira zoyipa zomwe zitha kutilepheretsa kapena kuchititsa manyazi munthawiyo, zomwe ndizosiyana ndi lingaliro laling'ono mu ICD-10 kuwopa malo otseguka ndi zochitika zina, monga unyinji, komwe kuthawira ku malo otetezeka atha kukhala ovuta.
Kusokonezeka kwapanikizi kumatanthauzidwa mu ICD-11 ndi zosayembekezereka zosayembekezereka zomwe zimachitika mosayembekezereka zomwe sizingowonjezera zokhumudwitsa kapena zochitika zinazake. CDD-11 CDDG imasonyeza kuti kuopsezedwa kumene kumachitika kwathunthu poyang'ana kuwonetseredwa kapena kuyembekezera chiopsezo chowopsya mu matenda opatsidwa (mwachitsanzo, kuyankhula pagulu mu matenda a chisokonezo cha anthu) sizikutanthauza kuti pali vuto lina lakumangika kwa mantha. M'malo mwake, "ndi mantha" amatha kugwiritsidwa ntchito ku matenda ena odwala matendawa. Cholinga cha "mantha ndi mantha" chingagwiritsidwe ntchito pa zovuta zina zomwe nkhawa ndizodziwika ngakhale kuti sizinapangidwe (mwachitsanzo, mwa anthu ena pa nthawi yachisoni).
Matenda a ICD-11, omwe amawadetsa nkhawa chifukwa cha mantha omwe anthu ena amawayeza, amalowetsa ziwalo za ICD-10.
CDD-11 CDDG imalongosola momveka bwino kupatukana kwa matenda akuluakulu pakati pa anthu akuluakulu, komwe nthawi zambiri imakhala pa wokondedwa kapena mwana.
Matenda osokoneza maganizo ndi ofanana
Kuyambitsidwa kwa gulu la OCRD mu ICD-11 kukuyimira kusiyana kwakukulu ndi ICD-10. Chifukwa chopangira gulu la OCRD losiyana ndi nkhawa ndi matenda okhudzana ndi mantha, ngakhale kuti pali kusiyana kwa zochitika, kumadalira pa kugwiritsidwa ntchito kwa matenda ophatikizana ndi zizindikiro zofanana za malingaliro obwerezabwereza komanso machitidwe obwerezabwereza okhudzana ndi matendawa ngati chizindikiro chachikulu chachipatala. Kugwirizana kwa matenda a gululi kumachokera ku umboni womwe ukubwera wa zizindikiro zomwe zimagwirizanitsidwa pakati pa matenda omwe akuphatikizidwa kuchokera ku kujambula, maphunziro a majini ndi a neurochemical 35.
ICD-11 OCRD ikuphatikizapo matenda osokoneza bongo, matenda osokoneza thupi, matenda osokoneza bongo, hypochondriasis (matenda ovutika ndi matenda) ndi kusokoneza matenda. Milandu yofanana yomwe ilipo mu ICD-10 ili m'magulu osiyana. Kuphatikizapo OCRD ndi kagulu kakang'ono kamene kamangoyamba kugwiritsidwa ntchito mobwerezabwereza kamene kamakhala ndi trichotillomania (matenda okoka tsitsi) ndi kuwonetsa khungu (zokopa khungu), zonse zigawenga zomwe zimachitika mobwerezabwereza popanda zozindikira za OCRDs zina. Matenda a tourette, matenda a mitsempha ya ICD-11, ndi yolembedwa m'magulu a OCRD chifukwa chakuti nthawi zambiri amakhala ndi vuto losautsa.
ICD-11 imakhala ndi zigawo zazikulu za matenda a ICD-10 ovuta kwambiri, omwe amatanthauza obsessions obsessions ndi / kapena makakamizo, koma ndi zofunikira zina. ICD-11 imakulitsa lingaliro la obsessions kupitirira malingaliro osayenerera kuti aziphatikiza mafano osafunidwa ndi zofuna / zofuna. Kuwonjezera apo, lingaliro la makakamizo likuwonjezeredwa kuphatikizapo chidziwitso (mwachitsanzo, mobwerezabwereza kuwerengera) komanso makhalidwe obwerezabwereza.
Ngakhale kuti nkhaŵa ndizovuta kwambiri zomwe zimagwirizanitsidwa ndi obsessions, ICD-11 imatchula momveka bwino zochitika zina zomwe odwala amanyalanyaza, monga kunyansidwa, manyazi, "kutengeka", kapena kusowa mtendere kuti zinthu siziwoneka kapena "zolondola". ICD-10 subtypes ya OCD imachotsedwa, chifukwa odwala ambiri amafotokoza zonse zovuta ndi zovuta, ndipo chifukwa chakuti alibe umboni wodalirika woti ayankhidwe. Kuletsa kwa ICD-10 kukana matenda osokoneza bongo limodzi ndi matenda ovutika maganizo kumachotsedwa ku ICD-11, kuwonetsa kuchuluka kwa zochitika zina za matendawa ndi kufunikira kwa mankhwala osiyana.
Hypochondriasis (vuto la nkhawa yathanzi) imayikidwa mu OCRD osati pakati pa nkhawa ndi matenda okhudzana ndi mantha, ngakhale kuti nkhawa zaumoyo nthawi zambiri zimagwirizanitsidwa ndi nkhawa ndi mantha, chifukwa cha zochitika zofanana komanso machitidwe a mabanja ogwirizana ndi OCRD 67. Komabe, hypochondriasis (vuto la nkhawa yathanzi) imalembedwa m'gulu la matenda okhudzana ndi nkhawa ndi mantha, pozindikira kuphatikizika kwa zochitika zina.
Matenda a dysmorphic, matenda osokoneza bongo, komanso kuletsa matenda ndi magulu atsopano ku ICD-11 omwe aphatikizidwa mu gulu la OCRD.
Mu ma OCRD omwe ali ndi gawo la chidziwitso, zikhulupiriro zimatha kusungidwa mwamphamvu kwambiri kapena mosasunthika kotero kuti zimaoneka ngati zongopeka. Pamene zikhulupiriro zokhazikikazi zikugwirizana kwathunthu ndi zochitika za OCRD, popanda zizindikiro zina zamaganizo, chizindikiro "chopanda chidziwitso chokwanira" chiyenera kugwiritsidwa ntchito, ndipo matenda amisala sayenera kuperekedwa. Izi cholinga chake ndi kuthandiza kupewa chithandizo chosayenera cha psychosis pakati pa anthu omwe ali ndi ma OCRD 35.
Matenda okhudzana ndi nkhawa
Kugawidwa kwa ICD-11 kwa matenda omwe amagwirizanitsidwa makamaka ndi kupsinjika maganizo kumalowa m'malo mwa machitidwe a ICD-10 ku mavuto aakulu a kupsinjika maganizo ndi kusintha, kuti agogomeze kuti matendawa ali ndi zofunikira (koma zosakwanira) za etiologic kuti akumane ndi vuto lopsinjika maganizo, komanso kusiyanitsa matenda omwe akuphatikizidwa ndi matenda ena amisala omwe amayamba chifukwa cha kupsinjika maganizo (monga matenda ovutika maganizo) 41. Matenda a ICD-10 ogwirizana ndi ubwana ndi matenda oletsa kupsinjika maganizo a ubwana amagawidwanso m'gululi chifukwa cha njira ya moyo wa ICD-11 komanso kuzindikira zovuta zokhudzana ndi kupsinjika maganizo zomwe zimayambitsidwa ndi matendawa. ICD-11 ikuphatikizapo zosintha zingapo zofunika kwambiri za ICD-10 komanso kuyambitsa PTSD yovuta komanso matenda achisoni okhalitsa, omwe alibe ofanana ndi ICD-10.
PTSD imafotokozedwa ndi zinthu zitatu zomwe ziyenera kukhalapo nthawi zonse ndipo ziyenera kuyambitsa kuwonongeka kwakukulu. Izi ndi: kukumananso ndi chochitika choopsa chomwe chikuchitika pakali pano; kupewa dala zikumbutso zomwe zingabweretse kukumananso ndi vuto; ndi malingaliro okhazikika a zoopsa zomwe zikuchitika panopa. Kuphatikizidwa kwa chofunikira chokumananso ndi zinthu zamaganizo, zamaganizo kapena za thupi zomwe zachitika pa nthawi ino m'malo mongokumbukira chochitikacho kukuyembekezeka kuthana ndi vuto lochepa la PTSD mu ICD-10 42.
Matenda osinthika mu ICD-11 amafotokozedwa motengera pa chikhalidwe chachikulu chokhudzidwa ndi nkhawa ya moyo kapena zotsatira zake, pamene ICD-10 matendawa anapezeka ngati zizindikiro zikuchitika chifukwa cha zovuta za moyo sizikugwirizana ndi zofunikira zenizeni wa matenda ena.
Potsirizira pake, kupanikizika kwakukulu sikunayambanso kuganiza kuti ndi matenda a maganizo mu ICD-11, koma kumamveka kuti ndi njira yachizolowezi yowonongeka kwambiri. Motero, amagawidwa mu chaputala cha ICD-11 pa "zinthu zomwe zimakhudza umoyo kapena kukhudzana ndi mautumiki a zaumoyo", koma mndandanda wa zovuta zomwe zimagwirizanitsa ndi nkhawa kuti zithandizidwe ndi matenda osiyanasiyana.
Matenda a dissociative
Kugawika kwa matenda a ICD-11 dissociative disorders kukugwirizana ndi matenda a ICD-10 dissociative (conversion), koma kwakonzedwanso kwambiri komanso kosavuta, kuti kuwonetse zomwe zapezeka posachedwapa komanso kuwonjezera kufunika kwachipatala. Kutchula mawu oti "conversion" kwachotsedwa pamutu wa gulu 68. Matenda a ICD-11 dissociative neurological symptoms amagwirizana ndi matenda a ICD-10 dissociative a kayendedwe ndi kumva, koma amawonetsedwa ngati matenda amodzi okhala ndi mitundu khumi ndi iwiri yomwe imafotokozedwa kutengera chizindikiro chachikulu cha mitsempha (monga kusokonezeka kwa maso, khunyu losakhala ndi khunyu, kusokonezeka kwa kulankhula, ziwalo kapena kufooka). ICD-11 dissociative amnesia imaphatikizapo chizindikiro chosonyeza ngati dissociative fugue ilipo, chochitika chomwe chimagawidwa ngati matenda osiyana mu ICD-10.
ICD-11 imagawaniza matenda a ICD-10 kukhala ndi matenda azisokonezo m'matenda osiyanasiyana azovuta zamatenda amisala komanso matendawa. Kulekanitsidwaku kumawonetsera mawonekedwe apadera okhala ndi vuto lamisala momwe malingaliro achikhalidwe aumwini amasinthidwa ndikudziwika "wakunja" komwe kumachitika chifukwa cha mphamvu yamzimu, mphamvu, mulungu kapena chinthu china chauzimu. Kuphatikiza apo, mitundu yambiri yazovuta kwambiri imatha kuwonetsedwa ili ndi vuto lokhala ndi chizimbwizimbwi, pomwe vuto la tulo limangobwereza kubwereza repertoire yaying'ono yazikhalidwe zosavuta.
Matenda osokoneza bongo a ICD-11 amafanana ndi lingaliro la ICD-10 vuto la umunthu ndipo amatchulidwanso kuti likhale logwirizana ndi dzina lomwe likugwiritsidwa ntchito pakadali pano pachipatala komanso pakafukufuku. ICD-11 imayambitsanso vuto losadziwika bwino, posonyeza kuti kusokonekera kwa matenda osadziwika a ICD-10 kumawerengedwa ndi mawonetseredwe omwe sianthu odziwika kwambiri omwe samagwiritsa ntchito mphamvu zawo pakumvetsetsa.
Kusokoneza maganizo ndi matenda osokoneza bongo, omwe ali m'magulu ena a matenda a ubongo ku ICD-10, amasunthira ku magulu a dissociative matenda mu ICD-11.
Kudyetsa ndi matenda odwala
Gulu la ICD-11 la matenda okhudzana ndi kudya limaphatikiza matenda okhudzana ndi kudya a ICD-10 ndi matenda okhudzana ndi kudya a ubwana, pozindikira kugwirizana kwa matendawa pa moyo wawo wonse, komanso kusonyeza umboni wakuti matendawa amatha kugwira ntchito kwa anthu azaka zosiyanasiyana zapakati pa 45 , 47.
ICD-11 imapereka ndondomeko zatsopano za anorexia nervosa ndi bulimia nervosa kuti ziphatikize umboni waposachedwa, womwe umathetsa kufunikira kwa ICD-10 "magawo". Zimaphatikizansopo magulu atsopano a matenda oledzeretsa, omwe amawunikira pogwiritsa ntchito thandizo lothandizira kuti likhale lovomerezeka, komanso ARFID, yomwe imawonjezera matenda a ICD-10 kuyambira ukhanda ndi ubwana.
Matenda a anorexia nervosa mu ICD-11 amachotsa lamulo la ICD-10 la kukhalapo kwa matenda a endocrine ofala, chifukwa umboni umasonyeza kuti izi sizichitika nthawi zonse ndipo, ngakhale zitakhalapo, zimakhala chifukwa cha kulemera kochepa m'malo mwa chizindikiro chodziwika bwino cha matendawa. Kuphatikiza apo, milandu yopanda matenda a endocrine inali yomwe imayambitsa matenda a anorexia. Chiwerengero cha kulemera kochepa mu ICD-11 chakwera kuchoka pa 17.5 kg/m2 mpaka 18 kg/m2 , koma malangizowa amagwirizana ndi zochitika zomwe index ya body mass index singasonyeze bwino chithunzi chachipatala chomwe chikuipiraipira (monga kuchepa thupi kwambiri poyerekeza ndi zizindikiro zina za matendawa). Matenda a anorexia nervosa safuna "mantha onenepa" monga momwe zilili mu ICD-10, kuti alole zifukwa zosiyanasiyana zachikhalidwe zokana chakudya ndi kuwonetsa nkhawa ya thupi.
Oyenerera amaperekedwa kuti awononge kukula kwa chiwerengero cha kuchepa kwa thupi, chifukwa chakuti chiwerengero chochepa kwambiri cha thupi chimakhudzidwa ndi chiopsezo chachikulu cha kufooka ndi kufa. Choyimira chofotokozera chitsanzo cha makhalidwe ogwirizana chikuphatikizidwa (mwachitsanzo, kuletsa chitsanzo, chitsanzo cha binge-purge).
Bulimia nervosa mu ICD-11 ikhoza kupezedwa mosavuta kulemera kwake kwa munthu payekha, malinga ngati chiwerengero cha misala cha thupi sichiri chochepa kwambiri kuti chikwaniritse zofunikira zenizeni za anorexia nervosa. M'malo mwazigawo zochepa zomwe zimakhala zochepa, zomwe sizigwirizana ndi umboni, ICD-11 imapereka malangizo othandizira. Bulimia nervosa matenda sikutanthauza kuti "cholinga" chabongo ndipo chingapezeke chifukwa cha "mabongo" omwe munthu amadya kwambiri kapena mosiyana ndi momwe amachitira nthawi zonse ndipo amatha kusokonezeka chifukwa chodya limodzi ndi mavuto, mosasamala kanthu za kuchuluka kwake chakudya chomwe amadya. Kusintha kumeneku kuyenera kuchepetsa chiwerengero cha kudyetsedwa kosadziŵika bwino ndi matenda odwala matenda.
Matenda othetsa mavuto
Mawu akuti "non-organic" amachotsedwa ku matenda a ICD-11, omwe amachititsa enuresis ndi encopresis. Matendawa amasiyana kwambiri ndi omwe angakhale abwino chifukwa cha matenda ena kapena ziwalo za thupi.
Kusokonezeka kwa masautso ndi thupi
Matenda a ICD-11 wamavuto amthupi komanso zokumana nazo zathupi zimaphatikizira zovuta ziwiri: kusokonezeka kwa thupi komanso kukhulupirika kwa thupi dysphoria. Matenda achilengedwe a ICD-11 amalowetsa m'matenda a ICD-10 somatoform komanso malingaliro a ICD-10 neurasthenia. ICD-10 hypochondriasis sichiphatikizidwa ndipo m'malo mwake imatumizidwa mgulu la OCRD.
Matenda a kuvutika maganizo m'thupi amadziwika ndi kukhalapo kwa zizindikiro za thupi zomwe zimamuvutitsa munthuyo komanso chidwi chochuluka chomwe chimaperekedwa ku zizindikirozo, zomwe zingawonekere mwa kukhudzana mobwerezabwereza ndi ogwira ntchito zachipatala 69. Matendawa amaonedwa kuti alipo mopitirira muyeso ndipo amatha kufotokozedwa moyenerera (ofatsa, ochepa kapena ovuta) kutengera momwe amagwirira ntchito. Chofunika kwambiri, matenda a kuvutika maganizo m'thupi amatanthauzidwa malinga ndi kukhalapo kwa zinthu zofunika, monga kuvutika maganizo ndi malingaliro ndi machitidwe opitirira muyeso, osati chifukwa cha kufotokozera kwachipatala kwa zizindikiro zovutitsa, monga matenda a ICD-10 somatoform.
Dysphoria ya ICD-11 body integrity ndi matenda atsopano omwe aphatikizidwa mu gulu ili 48.
Kusokonezeka chifukwa cha kugwiritsira ntchito mankhwala ndi makhalidwe oledzera
Magulu a ICD-11 a mavuto chifukwa cha kugwiritsiridwa ntchito kwa mankhwala ndi zizolowezi zoledzera amaphatikizapo mavuto omwe amayamba chifukwa cha kugwiritsa ntchito zinthu zakuthupi, kuphatikizapo mankhwala, ndi mavuto chifukwa cha khalidwe lachilendo lomwe limakhalapo chifukwa cha kubwereza kowonjezera kopindulitsa ndi kulimbikitsa makhalidwe.
Kukonza matenda a ICD-11 chifukwa cha kugwiritsa ntchito mankhwala osokoneza bongo kumagwirizana ndi njira ya ICD-10, pomwe matenda amisala amagawidwa malinga ndi magulu azinthu 70. Komabe, mndandanda wa zinthu mu ICD-11 ukukulitsidwa kuti uwonetse kupezeka kwa zinthu zomwe zilipo komanso momwe zinthu zimagwiritsidwira ntchito masiku ano. Gulu lililonse la mankhwala kapena gulu la zinthu likhoza kugwirizanitsidwa ndi matenda oyamba amisala omwe amagwirizana: gawo limodzi la kugwiritsa ntchito mankhwala osokoneza bongo kapena njira yowopsa yogwiritsira ntchito mankhwala osokoneza bongo, zomwe zikuyimira kusintha kwa kugwiritsa ntchito mankhwala osokoneza bongo kwa ICD-10; ndi kudalira mankhwala osokoneza bongo. Kuledzera ndi kusiya mankhwala osokoneza bongo kumatha kuzindikirika limodzi ndi matenda oyamba amisala kapena paokha ngati chifukwa choperekera chithandizo chamankhwala pamene njira yogwiritsira ntchito kapena kuthekera kwa kudalira sikudziwika.
Popeza matenda ambiri padziko lonse lapansi amabwera chifukwa cha kugwiritsa ntchito mankhwala osokoneza bongo, gululi lasinthidwa kuti lithe kugwira bwino ntchito yopezera chidziwitso chaumoyo chomwe chingakhale chothandiza m'njira zosiyanasiyana, kuthandizira kuwunika ndi kupereka malipoti molondola, komanso kupereka chithandizo chopewera ndi kuchiza 70. Kuwonjezeredwa kwa ICD-11 kamodzi kokha kogwiritsa ntchito mankhwala oopsa kumapereka mwayi wothandiza mwachangu komanso kupewa kuwonjezereka kwa kugwiritsa ntchito ndi kuvulaza, pomwe kuzindikira kwa njira yoyipa yogwiritsira ntchito mankhwala osokoneza bongo komanso kudalira mankhwala osokoneza bongo kukuwonetsa kufunikira kwa njira zochizira kwambiri.
ICD-11 imafotokoza lingaliro la kuvulaza kwa thanzi chifukwa cha mankhwala ogwiritsira ntchito mankhwala kuti awononge thanzi la anthu ena, zomwe zingaphatikizepo kuvulaza thupi (mwachitsanzo, chifukwa choyendetsa mowa mwauchidakwa) kapena kuvulaza maganizo (mwachitsanzo, kukula kwa PTSD kutsatila ngozi ya galimoto).
ICD-11 imaphatikizapo matenda omwe amachititsa munthu kukhala ndi matenda monga syndromes omwe amadziwika ndi zizindikiro zamaganizo kapena zamakhalidwe zomwe zimakhala zofanana ndi matenda ena amtima koma zomwe zimachitika chifukwa cha kugwiritsa ntchito mankhwala osokoneza bongo. Matenda omwe amachititsa kuti thupi likhale ndi vutoli akhoza kugwirizana ndi kuledzeretsa kapena kutaya mankhwala, koma kukula kwake kwa nthawi yaitali kapena kuchuluka kwa zizindikiro zimakhala zochulukirapo pazoledzeretsa kapena kutaya chifukwa cha zinthu zomwe zafotokozedwa.
ICD-11 imaphatikizapo magulu omwe amagwiritsa ntchito mankhwala osokoneza bongo, omwe sagwiritsidwa ntchito ngati matenda osokonezeka maganizo koma amakhala mu chaputala pa "zifukwa zomwe zimakhudza umoyo kapena kukhudzana ndi zaumoyo". Magulu amenewa angagwiritsidwe ntchito ngati njira yogwiritsira ntchito mankhwala imapangitsa kuti pakhale mavuto omwe amachititsa munthu wogwiritsa ntchito mankhwala kapena ena kuopsa kwa thanzi kapena kwa ena, malinga ndi zomwe zimapereka malangizo ndi uphungu kuchokera kwa akatswiri azaumoyo, koma palibe choipa choposa chomwe chinachitika. Amafuna kuti awonetsere mwayi wochitapo kanthu mofulumira komanso mwachidule, makamaka m'makonzedwe apadera.
Matenda a ICD-11 omwe amayamba chifukwa cha zizolowezi zoipa akuphatikizapo magulu awiri ozindikira: vuto la kutchova juga (kutchova juga kwa pathological mu ICD-10) ndi vuto la masewera, lomwe layambitsidwa kumene 49. Mu ICD-10, kutchova juga kwa pathological kunatchulidwa kuti ndi vuto la chizolowezi ndi kutengeka maganizo. Komabe, umboni waposachedwapa ukusonyeza kufanana kwakukulu pakati pa matenda omwe amayamba chifukwa cha zizolowezi zoipa komanso mavuto ogwiritsira ntchito mankhwala osokoneza bongo, kuphatikizapo kupezeka kwawo kwakukulu komanso mawonekedwe ofala a kukhala osangalatsa poyamba kutsatiridwa ndi kupita patsogolo mpaka kutaya phindu la hedonic ndi kufunika kogwiritsa ntchito kwambiri. Kuphatikiza apo, matenda omwe amayamba chifukwa cha kugwiritsa ntchito mankhwala osokoneza bongo ndi mavuto omwe amayamba chifukwa cha zizolowezi zoyipa amawoneka kuti ali ndi neurobiology yofanana, makamaka kuyambitsa ndi kusintha kwa neurological mkati mwa mphotho ndi chilimbikitso cha neural circuits 71.
Pewani kusokoneza maganizo
Matenda a ICD-11 amachititsa kuti munthu asamangokhalira kumangokhalira kukakamizika, kuyendetsa galimoto kapena kukakamiza kuchita zinthu zomwe zimapindulitsa munthuyo, panthawi yochepa, ngakhale pangozi yowononga munthuyo kapena kwa ena.
Gululi limaphatikizapo pyromania ndi kleptomania, zomwe zimayikidwa mu ICD-10 pansi pa chizoloŵezi ndi matenda osokoneza.
ICD-11 imayambitsa matenda obwera mwadzidzidzi ndipo imaikanso ICD-10 kukhala chilakolako chogonana chopitirira muyeso m'gululi ngati ICD-11 compulsive sexual behavior disorder [ 50 , 72 , 73 ].
Zosokoneza khalidwe ndi matenda a dissocial
Magulu a ICD-11 a mikhalidwe yosokoneza ndi matenda a dissocial amachititsa matenda a ICD-10. Mawu atsopano bwino akuwonetsa kukula kwathunthu kwa makhalidwe ndi zozizwitsa zomwe zimachitika muzigawo ziwiri zomwe zikuphatikizidwa mu magulu awa: kutsutsana ndi matenda osokoneza bongo komanso khalidwe la dissocial. Kusintha kwakukulu komwe kunayambika mu ICD-11 ndikuti matenda onsewa angathe kupezeka pa nthawi yonse ya moyo, pamene ICD-10 imawauza ngati mavuto a ubwana. Kuonjezerapo, ICD-11 imayambitsa ziyeneretso zomwe zimayambitsa makhalidwe okhumudwitsa ndi matenda a dissocial omwe cholinga chawo chikuthandizira kusintha chithandizo chamagetsi (mwachitsanzo, mwatsatanetsatane).
Matenda otsutsa a ICD-11 otsutsana ndi kukwiya ali ofanana ndi gulu lake lofanana ndi ICD-10. Komabe, chizindikiro cha "chokhala ndi kukwiya kosatha komanso mkwiyo" chimaperekedwa kuti chiwonetse zomwe zikuwonetsa matendawa ndi mkwiyo kapena mkwiyo womwe ulipo nthawi zonse. Chiwonetserochi chimadziwika kuti chikuwonjezera kwambiri chiopsezo cha kuvutika maganizo ndi nkhawa zomwe zingachitike pambuyo pake. Kulingalira kwa ICD-11 kwa chiwonetserochi ngati mtundu wa matenda otsutsa kumagwirizana ndi umboni wamakono ndipo kumasiyana ndi njira ya DSM-5 yoyambitsa matenda atsopano, matenda osokoneza maganizo osokonezeka 74-76.
Matenda a ICD-11 amalimbitsa zizindikiro zitatu zosiyana siyana zomwe zimachitika ku ICD-10 (mwachitsanzo, kutsekeredwa ku banja, kusagwirizana, kusagwirizana). ICD-11 imavomereza kuti mavuto okhumudwitsa ndi a dissocial nthawi zambiri amakhudzidwa ndi zovuta zochitika m'maganizo ndi zoopsa za maganizo, monga kukanidwa kwa anzanga, zovuta za anzawo, komanso matenda a maganizo a makolo. Kusiyana kwakukulu pakati pa ubwana ndi chiyambi cha matendawa kungasonyezedwe ndi chidziwitso, malinga ndi umboni wakuti poyamba wayamba kudwala matenda ovuta kwambiri komanso matenda osauka.
Woyenerera kuwonetsa kukondera kwakanthawi kochepa atha kupatsidwa zochitika zosokoneza komanso zovuta zamtundu wina. Potengera matenda omwe amatsutsana ndi omwe akutsutsana, chiwonetserochi chimalumikizidwa ndi chikhalidwe chokhazikika komanso chotsutsana kwambiri. Pankhani yamakhalidwe osokoneza bongo, imalumikizidwa ndi chizolowezi chokhwima, chankhanza komanso chokhazikika pamakhalidwe osagwirizana ndi anthu.
Matenda a umunthu
Mavuto omwe adapezeka mu gulu la ICD-10 la matenda khumi a umunthu adaphatikizapo kusapezeka kwa matenda ambiri poyerekeza ndi kufalikira kwawo pakati pa anthu omwe ali ndi matenda ena amisala, mfundo yakuti matenda awiri okha mwa matenda a umunthu (matenda osakhazikika a umunthu, mtundu wa malire, ndi matenda a umunthu wosasinthasintha) ndi omwe adalembedwa pafupipafupi m'ma database omwe amapezeka pagulu, ndipo kuchuluka kwa zochitika zomwe zimachitika nthawi imodzi kunali kwakukulu kwambiri, ndipo anthu ambiri omwe ali ndi matenda oopsa amakwaniritsa zofunikira za matenda osiyanasiyana a umunthu [ 16 , 17 ].
ICD-11 CDDG imufunsa wachipatala kuti adziwe ngati zomwe akuwonetserako zachipatala zikukwaniritsa zofunikira za matenda amunthu. Wodwala ndiye amalingalira ngati kuzindikira kuti ali ndi vuto lofatsa, lochepa kapena lovuta la umunthu ndiloyenera, kutengera: a) kuchuluka ndi kufalikira kwa zosokoneza pakugwira ntchito zaumwini (mwachitsanzo, kukhazikika ndi mgwirizano wazidziwitso, kudzidalira, kulondola odziwonera wekha, kuthekera kodziwongolera); b) kukula ndi kufalikira kwa kusagwirizana pakati pa anthu (mwachitsanzo, kumvetsetsa malingaliro a ena, kukulitsa ndikusunga maubwenzi apamtima, kukonza mikangano) m'malo osiyanasiyana ndi maubale; c) kufalikira, kulimba komanso kufalikira kwamalingaliro amalingaliro, ozindikira komanso machitidwe a kusokonekera kwa umunthu; ndi d) momwe izi zimalumikizidwira ndi mavuto kapena kuwonongeka kwamalingaliro.
Mavuto amunthu amafotokozedwanso ndikuwonetsa kukhalapo kwa mikhalidwe yolakwika. Madera asanu ali ndi magawo omwe akuphatikizidwa: kusakhudzidwa (kukonda kukhala ndi malingaliro osiyanasiyana); gulu (chizolowezi chokhala kutali ndi anthu ena); kusagwirizana (kunyalanyaza ufulu ndi malingaliro a ena, kuphatikiza kudzikonda komanso kusamvera chisoni); Disinhibition (chizolowezi chochita zinthu mopupuluma poyankha zoyambitsa zamkati kapena zachilengedwe popanda kulingalira za zotsatira zazitali); ndi anankastia (kuyang'ana pang'ono pamiyeso yokhwima ya ungwiro ndi chabwino ndi cholakwika ndikuwongolera mayendedwe anu ndi ena kuti mutsimikizire kutsatira miyezoyo). Madera ambiri amtunduwu atha kugawidwa ngati gawo la matendawa omwe amaweruzidwa kuti ndiwodziwika bwino ndipo amathandizira pakusokonezeka kwa umunthu komanso kuuma kwake.
Kuonjezerapo, choyimira chotsatira chimaperekedwa kwa "patternline pattern". Choyenerera ichi ndi cholinga choonetsetsa kuti chisamaliro chisamalire panthawi ya kusintha kuchokera ku ICD-10 kupita ku ICD-11 ndipo izi zingapangitse kuti ntchito zachipatala zitheke powunikira anthu omwe angayankhe matenda ena opatsirana pogonana. Kafukufuku wowonjezera adzafunika kuti adziwe ngati zimapereka chidziwitso chosiyana ndi chimene chinaperekedwa ndi madera a makhalidwe.
ICD-11 imaphatikizapo gulu la vuto laumunthu, lomwe silikuwoneka kuti ndi matenda a maganizo, koma mndandanda wa zovuta zomwe zimagwirizanitsidwa ndi kugwirizana pakati pa mutu pa "zinthu zomwe zimakhudza umoyo wabwino kapena kukhudzana ndi mautumiki a zaumoyo". Vuto laumunthu limatanthawuza umunthu wotchulidwa ndi umunthu umene ungakhudze chithandizo kapena kupereka thandizo la zaumoyo koma sichikwera pamlingo wovuta kuti chidziwitso cha kusokonezeka kwa umunthu.
Matenda a Paraphilic
Gulu la ICD-11 la matenda a paraphilic limalowa m'malo mwa gulu la ICD-10 la matenda omwe amakonda kugonana, mogwirizana ndi mawu amakono omwe amagwiritsidwa ntchito mu kafukufuku ndi zamankhwala. Mbali yaikulu ya matenda a paraphilic ndikuti amakhudza machitidwe ogonana omwe amayang'ana kwambiri ena osavomerezana.
Matenda a paradilic a ICD-11 ndi odwala matenda owonetserako zizindikiro, matenda a voyeuristic, ndi matenda a pedophilic disorder. Magulu atsopano omwe amadziwika amachititsa kuti anthu azivutika ndichisoni chogonana, chisokonezo cha frotteuristic, ndi matenda ena a paraphilic omwe sali ovomerezeka. Gawo latsopano la matenda ena a paraphilic omwe ali ndiokhaokha kapena omwe amavomerezana nawo akuphatikizidwanso, omwe angaperekedwe ngati kugonana, malingaliro, zolimbikitsa kapena makhalidwe akugwirizana ndi kukhumudwa kwakukulu (koma osati chifukwa cha kukana kapena kukanidwa kukanidwa ndi ena) kapena kuika chiopsezo chodzivulaza cha kuvulaza kapena kufa (mwachitsanzo, asphyxophilia).
ICD-11 imasiyanitsa pakati pa mikhalidwe yomwe ili yokhudzana ndi thanzi la anthu komanso matenda amisala ndi yomwe imangowonetsa khalidwe laumwini, ndipo pachifukwa ichi magulu a ICD-10 a sadomasochism, fetishism, ndi fetishistic transvestism achotsedwa 26.
Zovuta zenizeni
ICD-11 imayambitsa magulu atsopano a zovuta zomwe zimaphatikizapo matenda opatsirana omwe amadzipangira okha ndi matenda enieni omwe amaperekedwa kwa wina. Gululi ndilofanana ndi ICD-10 matenda omwe amawoneka mwadzidzidzi kapena kuwonetsa zizindikiro kapena zolemala, kaya thupi kapena maganizo (matenda oopsa), koma akuonjezeranso kuti pali zochitika zachipatala zomwe munthu amadzipangira, amachititsa, kapena amachititsa kuti adziwe ngati akudwala. , zizindikiro zokhudzana ndi maganizo kapena khalidwe linalake (makamaka mwana).
Makhalidwewa samangotengeka ndi mphotho zoonekeratu zakunja kapena zolimbikitsa, ndipo amasiyanitsidwa ndi izi chifukwa chakuwononga, komwe sikunatchulidwe ngati matenda amisala, machitidwe kapena ma neurodevelopmental, koma kumawonekera mchaputala cha "zinthu zomwe zimakhudza thanzi kapena kulumikizana ndi zaumoyo ".
Matenda osokoneza maganizo
Matenda a ICD-11 amapezedwa zinthu zomwe zimadziwika ndi zovuta zogwiritsira ntchito zachipatala, komanso zimakhala zovuta kwambiri zomwe zimafotokozedwa pakati pa ICD-10 organic, kuphatikizapo matenda, matenda. Choncho, gululi limaphatikizapo matenda okhudzidwa bwino, omwe amatchedwa matenda ozindikira ku ICD-10, matenda a amnestic, ndi dementia. Delirium ndi matenda amnestic amatha kusankhidwa chifukwa cha matenda omwe amagawidwa kwina kulikonse, chifukwa cha mankhwala kapena mankhwala, kapena chifukwa cha zinthu zambiri zamatenda. Dementia ikhoza kusankhidwa kukhala yofatsa, yochepa kapena yovuta.
Makhalidwe a matenda a dementia okhudzana ndi zifukwa zosiyanasiyana (monga matenda a Alzheimer, dementia chifukwa cha kachilombo ka HIV) amagawidwa m'magulu ndi kufotokozedwa mkati mwa mutu wokhudza matenda amisala, machitidwe ndi chitukuko cha mitsempha, pomwe zifukwa zake zimagawidwa pogwiritsa ntchito magulu ochokera mu mutu wokhudza matenda a mitsempha kapena magawo ena a ICD, monga momwe zilili 78. Matenda ofatsa a mitsempha amathanso kuzindikirika limodzi ndi matenda a etiological, kuwonetsa njira zabwino zodziwira kuchepa kwa chidziwitso msanga, zomwe zimayimira mwayi wopereka chithandizo kuti achedwetse kupita patsogolo kwa matenda. Chifukwa chake ICD-11 imazindikira bwino magawo azidziwitso, machitidwe, komanso malingaliro a matenda a neurocognitive komanso zomwe zimayambitsa.
MAFUNSO
Kukula kwa ICD-11 CDDG yamavuto amisala, machitidwe ndi ma neurodevelopmental and their statistical classification limayimira kukonzanso kwakukulu koyambirira kwapadziko lonse lapansi kwamatenda amisala pafupifupi zaka 30. Zaphatikizaponso gawo lomwe linali lisanachitikepo pamlingo wambiri komanso kutengapo gawo kwapadziko lonse lapansi, zilankhulo zambiri komanso maphunziro osiyanasiyana. Zosintha zazikulu zapangidwa kuti ziwonjezere kutsimikizika kwasayansi potengera umboni wapano komanso kupititsa patsogolo ntchito zakuchipatala ndi kugwiritsidwa ntchito kwapadziko lonse potengera pulogalamu yoyeserera m'minda.
Tsopano, mutu wonse wa ICD-11 womwe ungagwiritsidwe ntchito ndi mayiko mamembala a WHO pazowerengera zaumoyo ndi CDDG kuti ugwiritsidwe ntchito m'malo azachipatala ndi akatswiri azaumoyo wamaliza kwathunthu. Kuti ICD-11 ichite bwino padziko lapansi, cholinga cha WHO chidzagwira ntchito ndi mayiko ena komanso akatswiri azaumoyo pakukhazikitsa ndi kuphunzitsa.
Kukhazikitsidwa kwa dongosolo latsopanoli kumaphatikizapo kulumikizana kwa magawidwewo ndi malamulo adziko lililonse, mfundo zake, machitidwe azaumoyo ndi zomangamanga. Njira zingapo ziyenera kupangidwa kuti ziziphunzitsa akatswiri osiyanasiyana azaumoyo padziko lonse lapansi. Tikuyembekeza kupitiliza mgwirizano wathu wopindulitsa kwambiri ndi WPA ndikugwira ntchito ndi mayiko mamembala, malo ophunzirira, akatswiri ndi mabungwe asayansi komanso mabungwe aboma mgawo lotsatira lantchito.
ZIZINDIKIRO
Olemba okha ndi omwe ali ndi udindo pa malingaliro omwe afotokozedwa mu pepalali ndipo sakutanthauza kuti akuyimira zisankho, mfundo kapena malingaliro a WHO. Olembawo akuthokoza anthu otsatirawa omwe adathandizira kwambiri pakukula kwa ICD-11 ya matenda amisala, machitidwe ndi chitukuko cha mitsempha: G. Baird, J. Lochman, LA Clark, S. Evans, BJ Hall, R. Lewis-Fernández, E. Nijenhuis, RB Krueger, MD Feldman, JL Levenson, D. Skuse, MJ Tassé, P. Caramelli, HG Shah, DP Goldberg, G. Andrews, N. Sartorius, K. Ritchie, M. Rutter, R. Thara, Y. Xin, G. Mellsop, J. Mezzich, D. Kupfer, D. Regier, K. Saeed, M. van Ommeren ndi B. Saraceno. Amayamikiranso mamembala ena a ICD-11 Working Groups ndi alangizi, ambiri kwambiri oti tiwatchule apa (chonde onani http://www.who.it/mental_health/evidence/ICD_11_contributors kuti mupeze mndandanda wonse).