YBOP inoti: Iine chikamu nezve "Kumanikidza kuita kwehutano hwepabonde":
Kuita zvepabonde kuita zvepabonde
Kuita zvepabonde zvekuita zvepabonde zvinoratidzirwa nenzira inoramba ichinge isingakwanisi kudzora kudzokorora zvakanyanya kudzokorora zvepabonde kana kukurudzira, zvichiita kuti uite zvekare zvepabonde kuita kwenguva yakareba (semwedzi mitanhatu kana kupfuura) inokonzera kutambudzika kana kuora mwoyo mumunhu, mhuri, , dzidzo, basa kana zvimwe zviitiko zvinokosha zvekushanda.
Zviratidziro zvinokwanisika zvechimiro chinoramba chiripo chinosanganisira: kudzokorodza zviitiko zvebonde kuva chinhu chakakosha chehupenyu hwomunhu kusvika pakuregeredza hutano nekuchengetwa kwega kana zvimwe zvido, zviitwa nemabasa; iye munhu anoita akawanda asingabudirire kuyedza kudzora kana zvakanyanya kudzora kudzokorora kuita bonde; munhu ari kuramba achidzokorora kuita hunhu hwepabonde kunyangwe paine mhedzisiro senge kudzokororwa kwehukama kukanganiswa; uye iye munhu achiramba achidzokorora kuita zvehunhu bonde kunyangwe kana iye asisiri kuwana chero kugutsikana kubva kwazviri.
Kunyangwe ichi chikwata ichi chinowanzofanana nekuchengetedza zvinhu, chinosanganiswa muCI-11 kusagadzikana kwehutano hwechikamu chikamu mukuziva kwekushaiwa kwekutsanangurira ruzivo kuti kana nzira dzinobatanidzwa mukukudziridza nekugadzirisa kwechirwere zvakaenzana neavo vanoonekwa mukushandiswa kwezvinhu zvinoshandiswa uye zvinokanganisa tsika. Kuiswa kwayo muCI-11 kuchabatsira kugadzirisa zvinodiwa zvekurapa kutsvaga varwere uye pamwe nekudzikisa kunyadziswa uye mhosva kunobatanidza nekubatsira kutsvaga pakati pevanhu vakaora mwoyo50.
Reed, GM, Kutanga, MB, Kogan, CS, Hyman, SE, Gureje, O., Gaebel, W., Maj, M., Stein, DJ, Maercker, A., Tyrer, P. naClaudino, A., 2019.
World Psychiatry, 18 (1), pp.3-19.
ngovepo
Ichitevera kubvumidzwa kweiyo ICD-11 neWorld Health Assembly muna Chivabvu 2019, nyika dzeWorld Health Organisation (WHO) dzichachinja kubva kuICD-10 kuenda kuICD-11, nekutaurwa kwehuwandu hwehutano zvichienderana nehurongwa hutsva kutanga Ndira 1, 2022. Dhipatimendi reWHO reMental Health and Substance Abuse richashambadza Clinical Descriptions uye Diagnostic Guidelines (CDDG) yeICD-11 Mental, Behavioral uye Neurodevelopmental Disorders zvichitevera kubvumidzwa kweICD-11. Kubudirira kwe ICD-11 CDDG pamusoro pemakore gumi apfuura, zvichibva pamisimboti yekiriniki yekushandisa uye kushanda kwepasirese, ndiyo yakave nzira yepamusorosoro yepasi rese, mitauro yakawanda, dzakasiyana siyana uye yekutora mukana yakamboitwa pakuratidzwa kwekushushikana kwepfungwa. Zvigadzirwa muICD-11 zvinosanganisira kupihwa ruzivo rwakaringana uye rwakarongeka, kugamuchirwa kwenzira yehupenyu, uye nhungamiro inoenderana netsika nedambudziko rega. Dimensional nzira dzakabatanidzwa muchikamu, kunyanya kune kusagadzikana kwehunhu uye kwekutanga kusagadzikana kwepfungwa, munzira dzinoenderana neuchapupu hwazvino, dzinowirirana neyakagadziriswa nzira, kubvisa kusagadzikana kwekuita, uye zvinobudirira kutora shanduko nekufamba kwenguva. Pano isu tinotsanangura shanduko huru kuchimiro cheICD-11 kurongeka kwekushushikana kwepfungwa kana ichienzaniswa neICD-10, uye kusimudzirwa kwezvikamu zviviri zvitsva zveICD-11 zvine chekuita nehutano hwepfungwa. Isu tinoratidzira seti yemapoka matsva akawedzerwa kune iyo ICD-11 uye vanopa chikonzero chekubatanidzwa kwavo. Pakupedzisira, isu tinopa rondedzero yeshanduko dzakakosha dzakaitwa mune yega yega ICD-11 dambudziko rekubatanidza. Idzi ruzivo rwakagadzirirwa kuve rwakakosha kune vese varapi uye vaongorori mukuzvitenderedza ivo kune iyo ICD-11 uye mukugadzirira kuitisa mune yavo yega mamiriro ehunyanzvi.
Muna June 2018, World Health Organization (WHO) yakabudisa shanduro yekupedzisira ye 11th yekudzokorora kweInternational Classification of Zvirwere uye Matambudziko Ehutano Akafanana (ICD-11) yekufa uye nhamba dzekutadza kune dzimwe nyika dzenyika dze194, kuti dziongorore uye Kugadzirira kushandiswa1. World Health Assembly, iyo inosanganisira vashumiri vehutano hwemamiriro ose enyika, inotarisirwa kugamuchira ICD-11 pamusangano wayo unotevera, muna May 2019. Kutevera kubvumirwa, nhengo dzehurumende dzichatanga nzira yekuchinja kubva ku ICD-10 kuenda ku ICD-11, nekutaura kwehuwandu hwehutano kune WHO inoshandisa ICD-11 kutanga panaJanuary 1, 20222.
Dhipatimendi reWHO reMental Health and Substance Abuse rave nebasa rekugadzirisa kukura kwezvikamu zvina zveICD-11: kusagadzikana kwepfungwa, kwehunhu uye neurodevelopmental; kurara - kumutsa kusagadzikana; zvirwere zvetsinga; uye mamiriro ane hukama nehutano hwepabonde (pamwe chete neDhipatimendi reWHO reHutano Hwekubereka uye Ongororo).
Chitsauko chepfungwa chepfungwa ye ICD-10, shanduro yezvino ye ICD, ndiyo inonyanya kushandiswa kushandiswa kwehutano hwepfungwa pasi pose3. Munguva yekuvandudzwa kwe ICD-10, WHO Dhipatimendi reMental Health uye Mishonga Dzakashata yakarangarira kuti shanduko dzakasiyana dzekugadzirisa dzinofanira kubudiswa kuitira kuti zvigadzirise zvido zvevashandisi vayo vakasiyana-siyana. Shanduro ye ICD-10 yekuenzanisa nhoroondo ine zvinyorwa zvishomanana zvemashoko ezvinyorwa zvechirwere chega chega, asi izvi zvaifungidzirwa kuti hazvina kukwana kushandiswa nevanoita nezvehutano hwepfungwa mumakiriniki4.
Kune vashandi vehutano hwepfungwa, Dhipatimendi rakagadzira Clinical Descriptions uye Diagnostic Guidelines (CDDG) yeCI-10 Mental and Behavioral Disorders4, zvisingazivikanwi kuzivikanwa se "bhuku rebhuruu", rinotarisirwa kuti zvive zvekliniki, zvekudzidzisa uye zvekushandira. Kune chirwere chimwe nechimwe, tsanangudzo yemakiriniki makuru uye maitiro akabatanidzwa zvakapiwa, kuteverwa nemamwe maitiro ekuongorora zvirwere zvakagadzirirwa kubatsira varapiki vezvehutano hwepfungwa mukuita kuti vawane chivimbo chekuziva. Mashoko kubva kuongororo yechangobva kuitwa5 inoratidza kuti vanachiremba vanogara vachishandisa mashoko aya muCDDG uye vanowanzorangarira zvakarongeka pavanotanga kuongororwa, izvo zvinopesana nokutenda kwakapararira kuti vanachiremba vanongoshandisa sarudzo kuitira chinangwa chekuwana zvirongwa zvekuongororwa zvekutungamirira uye zvinangwa zvekubhadhara. Dhipatimendi ichabudisa shanduro yakafanana yeCDDG ye ICD-11 nokukurumidza sezvinobvira mushure mokubvumirwa kwenyika yose neWorld Health Assembly.
Zvinopfuura gumi gumi zvebasa rakaoma zvakapinda mukugadzirwa kweCI-11 CDDG. Yakabatanidzwa mazana emakwikwi ekugadzirisa senhengo dzeBhuku reKubatsira uye Sekushanda Mapoka uye sevadzidzisi, uyewo kubatana kwakanyatsobatanidzwa neHIV nhengo dzezvematongerwo enyika, masangano ekubhadhara mari, uye masangano anyanzvi uye masayenzi. Kubudirira kwe ICD-11 CDDG kwave iri yenyika yose, mitauro yakawanda, mitauro yakawanda uye inobatanidzwa inoshandiswa pakugadziriswa kwehutano hwehutano hwepfungwa.
GENERATING ICD-11 CDDG: MAITIRO UYE ZVINOKOSHA
Takave tatsanangura kukoshesa kwechirongwa chemakiriniki sehurongwa hwekugadzira ICD-11 CDDG6, 7. Utano hwehutano hunomiririra hutano pakati pehutano hwehutano nehutano hwehutano. Sangano risina kupa ruzivo rwekliniki ruzivo muhutano hwehutano hwehutano hahuzovimbiswa nekuvimbika nemakiriniki uye naizvozvo haigoni kupa chikonzero chakanaka chekupfupiswa kwehutano hwehutano hunoshandiswa pakuita zvisarudzo pane hurongwa hwehutano, nyika uye nyika yose.
Clinical utility, saka, yakasimbiswa zvakasimba mumirayiridzo yakapiwa kune zvakatevedzana zveKushanda Mapoka, kazhinji yakarongedzwa nehutano hwekusangana, hwakasarudzwa neDhipatimendi reW WHO reMental Health uye Mishonga Dzakashata kuita mazano pamusoro pezvakagadzirwa nehurukuro ye ICD-11 CDDG .
Ehezve, pamusoro pekuve nekiriniki inobatsira uye pasirese inoshanda, iyo ICD-11 inofanirwa kuve nesainzi inoshanda. Saizvozvo, Kushanda Mapoka akakumbirwa kuti aongorore humbowo hwesainzi huripo hunoenderana nenzvimbo dzawo dzebasa sehwaro hwekuvandudza zvirevo zveICD-11.
Kukosha kwekushandiswa kwenyika yose6 yakasimbiswawo zvakanyanya kuVashandi Vanoshanda. Mapoka ese aisanganisira vamiririri vanobva kumatunhu epasi rose eWHO - Africa, America, Europe, Eastern Mediterranean, Southeast Asia, uye Western Pacific - uye chikamu chakakura chevanhu vanobva nyika dzakaderera- nepakati - dzinowana inopfuura 80% huwandu hwenyika8.
Kukanganisa kwe ICD-10 CDDG kwaiva kusava nekusagadzikana kwezvinyorwa zvakapiwa pahutano hwekushungurudzika9. Kune ICD-11 CDDG, Mapoka Ekushanda akakumbirwa kuendesa mazano avo se "mafomu ezvemukati", kusanganisira ruzivo rwakaenzana uye rwakarongeka rwechirwere chimwe nechimwe chakapa hwaro hwenhungamiro yekuongorora.
Takave takabudisa tsanangudzo yakajeka yebasa rekushanda uye chimiro cheIndaneti-11 yekuongorora mazano9. Kubudirira kwe ICD-11 CDDG kwakaitika panguva yakanyanyisa kudengana nekugadzirwa kweDMM-5 neAmerican Psychiatric Association, uye mazhinji ICD-11 Working Groupes yaisanganisira kubatana kwehutano neboka rinobatanidza kushanda pa DSM-5. ICD-11 Makambani Akashanda akakumbirwa kuti aongorore kushandiswa kwekliniki uye kushandiswa kwepasi rose kwezvinhu zvakagadzirirwa DSM-5. Chinangwa chaiva chokuderedza kusawirirana kana kusagadzikana pakati pe ICD-11 uye DSM-5, kunyange zvazvo kururamisa kwemaonero akasiyana kwakabvumirwa.
MISANGANO MU ICD-11 CDDG
Chimwe chinonyanya kukosha cheCI-11 CDDG ndiyo nzira yavo yekutsanangura zvinhu zvinokosha zvechirwere chimwe nechimwe, izvo zvinomiririra zviratidzo izvo kana zviitiko izvo chiremba anogona kutarisira kuti awane mamiriro ezvinhu ose echirwere. Kunyange zvazvo mazita ezvinhu zvakakosha mumitungamiri yakangoita seinofananidza kuongorora, zvinokonzerwa nekodzero uye zvakakosha zvinoenderana nezviratidzo zvechiratidzo uye nguva yakawanda zvinowanzodziviswa, kunze kwekuti izvi zvichisimbiswa munyika dzose uye pamitambo kana pane chimwe chikonzero chinokurudzira kuti chibatanidze.
Iyi nzira inofanirwa kuenzanirana nenzira iyo vanachiremba vanoita zvirwere zvekurapa, nekugadzirisa maitiro ekurapa kwechipatara, nekuwedzera kliniki yekubatsira kuburikidza nekubvumira mitsika yakasiyana-siyana mukuratidza pamwe nemamiriro ezvinhu nehutano-hurongwa hunogona kuchinja kuongorora maitiro. Iyi nzira inoshandiswa nenzira yakajeka inopesana nemigumisiro yekuongororwa kwevamwe vezvepfungwa neyepfungwa dzepfungwa dzakagadzirira kutanga kwe ICD-11 hurongwa hwekuvandudza pamusoro pezvinhu zvinodiwa zvehutano hwehutano hwehutano hwehutano3, 10. Zvidzidzo zvemunda mumakiriniki epakirini munyika dze13 dzakatsigira kuti vanachiremba vanofunga kuti chirini chinoshandiswa nenzira iyi yepamusoro11. Zvinonyanya kukosha, kuvimbika kwehutano hwekambani ye ICD-11 inoratidzika kuva yepamusoro seyoyo yakagadziriswa uchishandisa nzira yakasimba-yakagadziriswa12.
Zvimwe zvinhu zvitsva muIndaneti-11 CDDG zvakatorwawo nenzira ye template yakapiwa Kubata Ma Groups kuti aite mazano avo (ndiko kuti, "fomu yehupenyu"). Sechikamu chehutano hwemashoko akapiwa mumitungamiri, kutarisirwa kwakagadzirirwa chirwere chimwe nechimwe kugadzirisa kuratidzika kwemuganhu nemaitiro akasiyana-siyana uye kuwedzera kwemashoko anopiwa pamiganhu nemamwe matambudziko (kusiyana kwekutsvaga).
Nzira yemararamiro yakagamuchirwa kuti ICD-11 inoreva kuti kuparadzanisa kwakasiyana kwehutano hwehutano uye hwepfungwa nehuwandu hunowanzoitika muhuduku nekuyaruka kwakabviswa, uye izvi zvinetso zvakagoverwa kune mamwe maitiro avanogovera zviratidzo. Semuenzaniso, kupatsanidza kushungurudzika kwepfungwa kwakaendeswa kune kuzvidya mwoyo uye kukanganiswa kwehutano hwehutano. Uyezve, ICD-11 CDDG inopa ruzivo rwechirwere chimwe nechimwe uye / kana kuunganidza apo dhiyabhorosi yaivepo iri kurondedzera kusiyanisa mukuratidzira kwechirwere pakati pevana nevechiri kuyaruka uye pakati pevakuru.
Zvinyorwa zvine chokuita netsika zvakagadziridzwa zvakagadziridzwa zvichienderana nekuongorora kwezvinyorwa nezvemagariro ehutano hwepfungwa dzepfungwa uye mazwi ayo kune rimwe nerimwe ICD-11 kuongororwa kweboka pamwe nekuongororwa kwakadzama kwezvinhu zvine chokuita netsika muIndaneti-10 CDDG uye DSM- 5. Maitiro ekutungamirirwa kwekutya chirwere anowanikwa muTebvu 1 semuenzaniso.
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Chimwe chinhu chikuru mune zvinyorwa muCI-11 chikamu chave chiri kuiswa kwemaonero ekumhanya mukati memamiriro ekunyatsorongeka kwehurongwa nematambudziko akasiyana-siyana. Izvi zvakasimbiswa nouchapupu hwokuti matambudziko akawanda epfungwa anogona kunyatsotsanangurwa pamwe chete nehuwandu hwechiratidzo chekubatanidza hupamhi pane kuti zvive zvakasiyana siyana13-15, uye yakagadziriswa nehutano mukunyora kwekodhi ye ICD-11. Izvo zvingave zvakakosha zve ICD-11 zvinonyatsooneka mukugadzirwa kwehutano hwehupenyu16, 17.
Nezvisiri zvehunyanzvi marongero, iyo yekuyera chiyero chekuomarara kweICD-11 hunhu hunhu hunopa kureruka kukuru uye kiriniki utility kupfuura iyo ICD-10 kurongeka kwehumwe hunhu hunhu, kuvandudzwa kusiyaniswa kwevarwere vanoda kuomarara zvichienzaniswa nemishonga iri nyore, uye zvirinani Maitiro ekutsvaga shanduko nekufamba kwenguva. Mune mamwe marongero akasarudzika, boka renyeredzi rehunhu hwemunhu hunogona kuzivisa nzira dzekupindira. Iyo yekumeso sisitimu inobvisa zvese zvakagadziriswa kusagadzikana kwehunhu kusagadzikana uye husingazivikanwe hunhu kusagadzikana kuongororwa, pamwe nekupa hwaro hwekutsvagisa muzvikamu zvepasi uye kupindira pane akasiyana hunhu kusagadzikana kuratidzwa.
Iyo seti yeakadzimira ekufanirwa akaunzwawo kutsanangura chiratidzo chechiratidzo chechiratidzo cheschizophrenia uye zvimwe zvepfungwa zvekutanga zvepfungwa.18. Panzvimbo pokufungisisa nezvekuongororwa kwemauto, chidimbu chinotarisa chinotarisa pane zvakakosha zvechirongwa chechirwere chemazuva ano nenzira dzinowirirana zvakanyanya nekugadzirisa-based psychiatric rehabilitation approaches.
Nzira dzakasiyana-siyana dzekushushikana kweunhu uye zviratidzo zvinoratidza zvirwere zvepfungwa zvepfungwa zvinonyatsorondedzerwa zvakadzama muzvikamu zvakapfuura mushure pepa pepa.
ICD-11 FIELD STUDIES
Purogiramu yeCI-11 yepurogiramu yemumunda inomiririrawo nzvimbo inoshandiswa mutsva. Iyi purogiramu yebasa yakasanganisira kushandiswa kwemitemo inoverengeka yekudzidza kliniki yevashandi yezvinyorwa zvekuongorora kuongororwa, kusanganisira kunyatsoziva uye kusagadzikana kwekushandiswa kwevakiriniki sekuenzaniswa neCI-10 pamwe nezvinhu zvakananga zvinotarisirwa kune chero upi zvake akacherechedza kuora mwoyo19. Simba guru rerongwa hwekutsvakurudza rave kuti zvidzidzo zvakawanda zvakaitwa munguva yakareba zvichibvumira migumisiro yavo kupa chikonzero chekudzokorora kwemitemo yekugadzirisa chero upi zvake hwakatadza20.
Kubatana kwenyika yose kwave kuchiriwo kujekesa kwechirongwa cheCI-11 CDDG chekudzidza. Global Clinical Practice Network (GCPN) yakagadzirirwa kubvumira hutano hwepfungwa nevanonyanya kutarisira kubva kumativi ose enyika kuti vabatanidzwe zvakananga mukusimbiswa kweCI-11 CDDG kuburikidza neIndaneti-based field study.
Nokufamba kwenguva, GCPN yakawedzera kuti inosanganisira madhigirii anonzi 15,000 kubva munyika ye155. Zvose IW WHO yenyika dzakawanda dzinomiririrwa muhuwandu hunonyanya kuongorora kuwanikwa kwehutano hwehutano hwepfungwa nenharaunda, uye hukuru hwakakura hunobva kuAsia, Europe neAmerica (inenge yakaenzana zvakaenzana pakati peU.S. naCanada kune rumwe rutivi uye Latin America pa zvimwe). Inopfuura hafu yevamiriri veGCPN ndivo vanachiremba, avo vanonyanya kuongorora masayendisiti, uye 30% vane masayendisiti epfungwa.
Inenge gumi nemaviri GCPN zvidzidzo zvakapedzwa kusvika panguva ino, kunyanya kurongedza kuenzanirana kweCI-11 yekuongororongedza mazano ne ICD-10 mirayiridzo maererano nekururama uye kusagadzikana kwemakiriniki ekuongorora zvirongwa, achishandisa maitiro akachengetedzwa akaenzaniswa kuti aongorore kusiyana kukuru19, 21. Zvimwe zvidzidzo zvakarongedza kuwedzera kwezvidzidzo zvekuongorora22 uye kuti vanachiremba vanoshandisa sei zvinyorwa5. GCPN zvidzidzo zvakaitwa muchiChinese, chiFrench, chiJapan, chiRussia uye chiSpanish, kuwedzera kuChirungu, uye chakabatanidza kuongororwa kwemigumisiro nenharaunda uye mutauro kuti uzive zvinetso zvingangoitika munyika yose kana tsika dzekushandisa uyewo matambudziko mukushandura.
Chirongwa chekliniki-yakadzidzawo chakaitwa kuburikidza nehutano hwemarudzi ose emunharaunda yekuongorora nzvimbo yekuongorora kliniki yekushandisa uye kushandiswa kweCDD-11 kuongororwa kwekutsvaga maitiro mumamiriro ezvinhu epanyama, muzvigadziro zvavanenge vachida kushandiswa11. Idzo zvidzidzo zvakare dzakaongorora kuvimbika kwekuongororwa kuti nhoroondo yehuwandu hwehutano hwehutano uye hutano hwehutano hunoshandiswa12. Shanduro dzenyika dzepasi pose dzakanga dziri munyika ye14 kune dzose dzeWMS munyika dzose, uye mhinduro dzevarwere dzekuongorora dzaitungamirirwa mumutauro wemunyika imwe neimwe.
KUCHENGA KWOSE KWENYIKA-11 CHITSAUKO MUMWE MITEMO, ZVINOKUDZIDZA NEZVEVANHU ZVOKUTANGA
MuIndaneti-10, nhamba yezvikwata zvekushungurudzika zvakasimbiswa nechepamusi yekunyora coding system inoshandiswa mukugadzirisa, zvakadai kuti zvinongogoneka kuva nepamusoro pegumi zvakakosha masangano mukati mechitsauko chinetso chepfungwa uye chetsika. Somugumisiro, kuongororwa kweboka kwakasikwa kwakange kusingagadziri kuchechi yehutano kana uchapupu hwezvesayenzi (semuenzaniso, kushungurudzika kwekushungurudzika kunosanganiswa sechikamu chemasangano akawandisa eurostro, stress-related, uye somatoform disorders). Kushandisa ICD-11 yekushandura kwakagadzirika kwekodhi yakagadziriswa kwakagadzirirwa kuwanda kwemazana emapoka, zvichiita kuti zvikwanise kukudziridza mapoka ekuongororwa zvakanyatsoenderana neuchapupu hwezvesayenzi uye zvinodiwa zvechipatara.
Kuti upe ruzivo rwekubatsira mukudziridza sangano rehurongwa iro raizove rakanyanya kubatsira muchipatara, zviitiko zviviri zvekudzidzira masimba zvakaitwa23, 24 kuti aongorore mazano akachengetwa nevadzidzisi vehutano mupfungwa munyika yose pamusoro pehukama hwehutano hwepfungwa. Iyi data inosarudza zvisarudzo pamusoro pehutano hwakanaka hwehutano. Sangano reCI-11 sangano rakakonzerwawo nemabasa eOMS neAmerican Psychiatric Association kuti iwirirane sarudzo yose yeCI-11 chitsauko pamusoro pezvinetso zvepfungwa nemafungiro nehutano hwe DSM-5.
Sangano reiyo ICD-10 chitsauko pane kusagadzikana kwepfungwa uye kwehunhu zvakanyanya kuratidza chitsauko sangano rakamboshandiswa muKraepelin's Textbook yePsychiatry, iyo yakatanga nematambudziko ehupenyu, ichiteverwa nema psychoses, neurotic kusagadzikana, uye hunhu hunhu.25. Nheyo dzinotungamirira sangano re ICD-11 dzakabatanidza kuedza kurongedza maitiro ekuongororwa mushure mekusimudzira mafungiro (saka, neurodevelopmental disorders inotanga matambudziko ekutanga uye eurocognitive inopera muchirongwa) uye kuunganidza matambudziko pamwechete zvichienderana nekuisa maitiro etiological pamwe nemaitiro (eg, zvinetso zvakanyanya kunokonzerwa nokuzvidya mwoyo) pamwe chete nekugoverana kwezvinhu (eg, dissociative disorders). Tafura 2 inopa urongwa hwekuongororwa kwemazana muChitsuwa cheCI-11 pamusoro pematambudziko epfungwa, maitiro uye neurodevelopmental.
| Neurodevelopmental disorders |
| Schizophrenia uye zvimwe zvinetso zvepfungwa zvepfungwa |
| Catatonia |
| Matambudziko epfungwa |
| Kuzvidya mwoyo uye zvinetso zvekutya |
| Matambudziko anokanganisa-akamanikidza uye akafanana |
| Kushungurudzika zvakananga kusangana nekuzvidya mwoyo |
| Dissociative disorders |
| Zvokudya uye zvinetso zvekudya |
| Kusagadzikana kwekugadzirisa |
| Kushungurudzika kwemuviri kunetseka uye ruzivo rwomuviri |
| Kushungurudzwa kunokonzerwa nekushandisa zvinoshandiswa uye kushandiswa kwemishonga |
| Kufuridzirwa kwekutonga kushungurudzika |
| Zvinokanganisa maitiro uye zvinetso zvekusaziva |
| Unhu hwemunhu |
| Paraphilic zvinetso |
| Zvinokonzerwa nezvinetso |
| Neurocognitive disorders |
| Matambudziko epfungwa uye maitiro anobatana nekuzvitakura, kubereka uye puerperium |
| Mafungiro uye maitiro anokonzera matambudziko kana zvirwere zvinoratidzwa kune dzimwe nzvimbo |
| Secondary mind or behavioral syndromes inosangana nezvinetso kana zvirwere zvinoratidzwa kune imwe nzvimbo |
Kurongeka kwematambudziko ekurara mu ICD-10 kwakavimbana nekuparadzana kwekusagadzikana pakati pezvirwere zviripo uye zvisingaitiki, zvichiita kuti matambudziko e "asina-organic" ave akabatanidzwa muchitsauko chekushungurudzika kwepfungwa uye kwetsika kwe ICD-10, uye zvinonzi "organic" kurara zvinosanganiswa mune zvimwe zvitsauko (kureva, zvirwere zvehurongwa hwemagandanga, zvirwere zvekufema, uye endocrine, zvinetso zvekudya uye zvemagetsi). Muna ICD-11, chitsauko chakasiyana chakasikwa nekuda kwekurara kwekurara kunosanganisira zvose zvinokonzera kurara-zvine chokuita nekuongorora.
II ICD-10 yakaitawo dichotomy pakati pezvisikwa uye zvisingaiti muhutano hwehutano hwepabonde, ne "zvisingaiti" zvepabonde zvinokonzerwa nekuita zvepabonde zvinowanikwa muchitsauko chepfungwa nemafungiro ehutano, uye "zvakasikwa" zvepabonde zvekuita zvepabonde kune chikamu chikuru chakanyorwa muchitsauko pamusoro pezvirwere zve genitourinary system. Chitsauko chitsva chakabatanidzwa kune mamiriro ehutano hwepabonde akawedzerwa kuI ICD-11 kuti agadzirise kuwirirana kwepabonde nekusawirirana kwepabonde26 pamwe nekushandurwa kwemurume nemukadzi kutomy. Uyezve, ICD-10 chirwere chekuzivikanwa kwepabonde chakatumidzwa zvakare se "chirwere chepabonde" mu ICD-11 uye yakabva pane chinyorwa chinokonzera matambudziko kune chitsauko chitsva chehutano hwepabonde26, zvinoreva kuti chitenderwe chechi transgender hachifaniri kuonekwa sechirwere chepfungwa. Gender incongruence haisi kurongerwa kuparadzwa muIndaneti-11 nokuti munyika dzakawanda kuwana rusununguko rwehutano hwakakosha kunopfurikidza nehutano hwakakodzera. Izwi re ICD-11 rinotsanangura zvakajeka kuti hutano hwakasiyana-siyana uye zvaunofarira chete hazvikwanise kuita kuti uongororwe.
NEW MENTAL, MATENDE NEZENYODZO ZVINOKUDZIDZISIRA MU ICD-11
Kubva pakuongororwa kwehuchapupu huripo pamusoro pesayenzi yakarurama, uye kuongorora kwechipatara uye kushandiswa kwenyika yose, hutano hutsva hutsva hwakawedzerwa kune chitsauko che ICD-11 pamusoro pehutano hwepfungwa, hutsika uye neurodevelopmental. Tsanangudzo yezvinetso izvi sezvinotsanangurwa muIndaneti-11 tsananguro yekuongorora uye chikonzero chekuiswa kwavo kunowanikwa pasi apa.
Catatonia
MuCI-10, catatonia yakabatanidzwa semumwe we subtypes we schizophrenia (kureva, catatonic schizophrenia) uye seimwe yezvinetso zvehupenyu (kureva, organic catatonic disorder). Mukuziva kwekuti chirwere che catatonia chinogona kuitika mukubatana nekusiyana kwepfungwa dzepfungwa27, hutsva hutsva hunokonzera catatonia (panguva imwechete yepamusoro-soro yepamusoro pehutano hwepfungwa, kushungurudzika uye zvinetso zvinotyisa, nezvimwewo) zvakawedzerwa mu ICD-11.
Catatonia inoratidzwa nezvinoitika zviratidzo zvakasiyana-siyana zvakadai sokuputika, catalepsy, waxy flexibility, mutism, negativism, kugadzirisa, maitiro, stereotypies, psychomotor kushungurudzika, grimacing, echolalia uye echopraxia. Zvinhu zvitatu zvakabatanidzwa mune zvitsva zvekuongorora: a) catatonia inobatanidzwa nedzimwe chirwere chepfungwa (zvakadai sehutano hwepfungwa, schizophrenia kana imwe chirwere chepfungwa chepfungwa, kana kuti autism spectrum disorder); b) catatonia inokonzerwa ne-psychoactive substances, kusanganisira mishonga (semuenzaniso, antipsychotic medication, amphetamines, phencyclidine); uye c) catatonia yechipiri (kureva,, inokonzerwa nechirwere chetachiona, zvakadai sesheabheti ketoacidosis, hypercalcemia, hepatic encephalopathy, homocystinuria, neoplasm, head trauma, cerebrovascular disease, kana encephalitis).
Bipolar type II disorder
Iyo DSM-IV yakaunza marudzi maviri ebipolar kusagadzikana. Bipolar mhando I kusagadzikana kunoshanda kune mharidzo dzinoonekwa neinenge imwechete manic episode, nepo bipolar yerudzi rwechipiri kusagadzikana kunoda kanenge kamwe hypomanic episode pamwe neyakaipisisa huru yekuora mwoyo, mukushayikwa kwenhoroondo yemanic episodes. Uchapupu hunotsigira huchokwadi hwesiyano pakati pemhando mbiri idzi hunosanganisira misiyano yeanodzvinyirira monotherapy mhinduro28, neurocognitive measures28, 29, genetic effects28, 30, uye neuroimaging zvakawanikwa28, 31, 32.
Zvichipa uchapupu uhwu, uye kliniki yekubatsira kusiyanisa pakati pemhando mbiri idzi33, bipolar disorder mu ICD-11 yakave yakagoverwa mupepeti I uye inonzi II bipolar disorder.
Mutumbi dysmorphic disorder
Vanhu vane muviri dysmorphic disorder vanoramba vachifungisisa nezvimwe kana zvikanganiso kana zvikanganiso pakuonekwa kwavo mumuviri zvisingaoneki kana kuti zvisingaratidziki zvishoma kune vamwe34. Kunyanya kufambidzana kunowirirana nekudzokorora zvakare nekunyanyisa maitiro, kusanganisira kuongororwa kuonekwa kwechimiro kana kuoma kwechakaremara chakanaka kana kukanganisa, kuedza kwakawanda kuedza kufungidzira kana kuchinja kukanganisika kunonzwisisika, kana kuregwa kusachengetedzwa kwemamiriro ezvinhu evanhu kana zvinokonzera kuwedzera kushushikana pamusoro pekukanganisa kunonzwisisika kana kukanganisa.
Pakutumidzwa kunzi "dysmorphophobia", iyi mamiriro ekutanga akabatanidzwa mu DSM-III-R. Izvo zvakaonekwa muIndaneti-10 sechinyorwa chakaiswa asi chisingadikanwi chinyorwa chinonzi under hypochondriasis, asi vanachiremba vakarayirwa kuti vaongorore sekushungurudzika kwepfungwa mumamiriro ezvinhu umo zvitendero zvakabatana zvaifungidzirwa kuti hazvina kunaka. Izvi zvakagadzirisa zvingaita kuti chirwere chakadaro chigoverwe zvakasiyana-siyana zvinongororwa pasina kuona kuzara kwehutano hwechirwere, izvo zvinogona kusanganisira zvinotendwa zvinoratidzika kusinganzwisisiki zvichienderana nehuwandu hwekutenda kana kugadzirisa kwavanoitwa.
Mukucherechedza zvaro zvakasiyana-siyana zviratidzo, huwandu hwehuwandu hwevanhu uye kufananidzwa kune zvinokanganisa-zvinokonzera uye zvinokonzera kukanganisa (OCRD), muviri dysmorphic disorder wakabatanidzwa mune iri boka rekupedzisira mu ICD-1135.
Olfactory reference disorder
Ichi chiitiko chinoratidzwa nekufungisisa kusingagumi nekutenda kuti mumwe ari kubudisa kunhuhwa kwakaipa kana kunopisa muviri wemuviri kana kufema, izvo zvisingataurikiki kana zvisingaratidziki zvishoma kune vamwe34.
Mukupindira pane zvavanotarisira, vanhu vanoita kudzokorora uye kuzvibata zvakanyanya sekuita sekuongorora kwekunhuhwira kwemuviri kana kutarisa kunzwisisika kunobva kunhuwa; kazhinji kutsvaga kuvimbiswa; kunyanya kuedza kuvhara, kuchinja kana kudzivirira kunzwisisika kunhuhwirira; kana kuregererwa kwekunamata kwemamiriro ezvinhu evanhu kana zvinokonzera kuwedzera kutambudzika pamusoro pekuonekwa kunosvibisa kana kunhuhwirira kunonyangadza. Vanhu vakagadzikana vanotya kana vanogutsikana kuti vamwe vanocherechedza kunhuwa kunoramba kana kuvanyadzisa ivo36.
Olfactory reference disorder inosanganisirwa muboka reI ICD-11 OCRD, sezvo ichigovana zvimisikidzo nezvimwe zvinetso muboka iri zvine chekuita nekuvapo kwekuramba uchifungisisa uye hunhu hunodzokororwa.35.
Hoarding chirwere
Kuvhara dambudziko kunoratidzirwa nekuunganidza zvinhu, nekuda kwekutsvaga kwavo zvakanyanya kana kuti kuoma kuvarasira, pasinei nekukosha kwavo kwechokwadi35, 37. Kuwedzerwa kwekutsvaga kunoratidzirwa nekudzokorora kudzokorora kana maitiro ane chokuita nekuunganidza kana kutenga zvinhu. Kuoma kurasikirwa kunoratidzwa nekunzwisiswa kunoda kuchengetedza zvinhu uye kutambudzika kunobatanidza nekudzirasa. Kuunganidzwa kwezvinhu kunoguma munzvimbo dzekugara dzichigadzikana kusvika pakuti kushandiswa kwavo kana kuchengetedzwa kunokanganisa.
Kunyangwe hunhu hwekuzvibata hunogona kuratidzwa sechikamu chehupamhi hwakawanda hwekushushikana kwepfungwa nehunhu uye mamwe mamiriro - kusanganisira obsessive - kusagadzikana kusagadzikana, kushushikana kwekushushikana, schizophrenia, dementia, autism spectrum kusagadzikana uye Prader - Willi syndrome - pane humbowo hwakakwana hunotsigira kuunganidza kusagadzikana sechakasiyana uye chakasarudzika kusagadzikana38.
Vanhu vanokanganiswa nehutachiona hwehutachiona havazivikanwe uye vanozvidzwa, iyo inopokana kubva kune hutano hweveruzhinji maonero ayo kuiswa muICD-1139.
Excoriation disorder
Chimwe chikwata chekuongorora chirwere chepfungwa, kukanganiswa kwezvemuviri kunokonzerwa nekudzokorora, kwave kuchiwedzerwa kuboka reOCRD. Inosanganisira trichotillomania (iyo yakabatanidzwa mukubatanidzwa kwemaitiro uye kushungurudzika kwepfungwa mu ICD-10) uye mamiriro ezvinhu matsva, kufungidzirwa kwepfungwa (inozivikanwawo seganda-picking disorder).
Kushushikana kwekushushikana kunoonekwa nekunhonga zveganda rako pachako, zvichitungamira kuzvironda zveganda, zvichiperekedzwa nekuedza kusabudirira kwekudzora kana kumisa hunhu. Kunhonga ganda kunofanirwa kuve kwakakomba zvakakwana kuti kukonzere kushushikana kwakanyanya kana kukanganisika mukushanda. Excoriation kusagadzikana (uye trichotillomania) akasiyana nemamwe maOCR mukuti maitiro acho kashoma anotungamirwa nekuziva zviitiko sekufungidzira kwepfungwa, kushushikana kana kufungisisa, asi panzvimbo pezvo zvinogona kutungamirwa nezviitiko zvekunzwa.
Kubatanidzwa kwavo muboka reOCRD kunobva pane zvakagadziriswa zvinowanzoitwa, maitiro emhuri yekubatana, uye maitiro ezvakagadziriswa ehutano nemamwe matambudziko mune izvi kuunganidza35, 40.
Dambudziko rakapedzisira rinotambudza kuora mwoyo
Dambudziko rekugadzirisa dambudziko rinokonzerwa nehutano (yakaoma PTSD)41 zvinowanzoita zvinetso zvakanyanya zvekugara kwenguva refu, kana zviitiko zvakasiyana-siyana kana zvakadzokidzwa zvinoshandiswa kubva kune izvo zvisiri nyore kana zvisingaitiki, zvakadai sokutambudzwa, uranda, kurwisana kwehutongerwo enyika, kurwisana kwenguva refu mumhuri, kana kubatwa zvepabonde zvepabonde kana kushungurudzwa.
Chiratidzo chiratidzo chinoratidzirwa nematatu epakati maficha ePTSD (kureva, kuona zvakare chiitiko chinoshungurudza kana zviitiko zviripo nenzira yechiratidziro chendangariro dzakajeka, kupenya kana kurota zvinotyisa; kudzivirira kwepfungwa uye ndangariro dzechiitiko kana zviitiko, mamiriro kana vanhu vanoyeuchidza nezvechiitiko; maonero anoramba aripo ekutyisidzira kwazvino), ayo anofambidzana nekuwedzera kusagadzikana, kwakapararira nekutsungirira mukukanganisa mutemo, kuzvifunga uye kuita kwehukama.
Kuwedzerwa kwePTSD yakaoma kusvika kuCI-11 kunonzwisisika pamusana pehuchapupu hwokuti vanhu vane chirwere vane hutano hwakashata uye vanobatsirwa nemishonga yakasiyana-siyana kana vachienzaniswa nevanhu vane PTSD42. PTSD yakazara inoshandura nzvimbo yeCD-10 inoputika yehupenyu hunogara huchigadziriswa pashure pechiitiko chinotyisa41.
Kusuruvara kwenguva refu
Kuora mwoyo kwenguva refu kunotsanangura kusinganzwisisiki kusingagumi uye kuvhara mhinduro dzekufirwa41. Kutevera kufa kweumwe wako, mubereki, mwana kana mumwe munhu wepedyo neakafirwa, kune kuramba kuripo uye kwakapararira kushungurudzika kunzwisisika nekushuvira mushakabvu kana kuramba uchingofungisisa nemufi, uchiperekedzwa nekurwadziwa kukuru pamoyo. Zviratidzo zvinogona kusanganisira kusuwa, mhosva, kutsamwa, kuramba, mhosva, kunetseka kubvuma rufu, kunzwa kuti munhu arasikirwa nechikamu chake, kusakwanisa kuve nemafungiro akanaka, kushushikana kwepfungwa, uye kuomerwa nekubatana nehukama kana zvimwe zviitiko. Mhinduro yekusuwa inofanirwa kuenderera kwenguva yakati rebei zvichitevera kurasikirwa (inopfuura mwedzi mitanhatu) uye zvakajeka kupfuura tsika dzinotarisirwa dzemagariro, tsika kana chitendero chetsika nemamiriro emunhu.
Kunyange zvazvo vanhu vazhinji vanotaura zvishoma nezvishoma kusunungurwa kubva pamarwadzo ekurwadziwa kwakanyanya kwemwedzi mitanhatu inotevera kushungurudzwa, avo vanoramba vachiwana kushungurudzika kukuru kwekushungurudzika vanowanzova nekukanganisa kukuru mukushanda kwavo. Kuvhiringidzwa kwekushungurudzika kwenguva refu kushungurudza mu ICD-11 inopindura uchapupu huri kuwedzera hwehupenyu hwakasiyana uye hunokanganisa husingawanikwi zvakajeka neyezvino ICD-10 kuongorora43. Kuiswa kwayo uye kusiyanisa kubva mumatambudziko ekurasikirwa uye kuora mwoyo kunokosha, nekuda kwekusiyana kwekusarudzwa kusarudzwa uye kujekesa kwezvinetso zvekupedzisira44.
Binge kudya chirwere
Kunyanya kudya chirwere chinoratidzika kakawanda, zvikamu zvekare zvekudya zvekudya (semuenzaniso, kamwe kamwe pavhiki kana kupfuura kune imwe nguva yemwedzi inoverengeka). A binge kudya episode ndeye nguva yakatarwa iyo iyo munhu anoona kurasikirwa kwekudzivirirwa kwekutonga pamusoro pekudya, anodya zvakajeka zvakanyanya kana zvakasiyana nezvakaitika, uye anonzwa asingakwanisi kumira kudya kana kugadzirisa rudzi kana chiyero chezvokudya zvinodyiwa.
Kudya kwekudya kunosangana nekushungurudzika uye kunowanzosangana nemafungiro asina kunaka sekuda mhosva kana kunyangadza. Zvisinei, kusiyana nemuBlimia nervosa, zvipembenene zvekudya zvisingabatsiri nguva dzose zvinoteverwa nemafambiro asina kukodzera anogadziriswa achidzivirira kudzivirira kuwedzerwa (semuenzaniso, kuzvirutsa kunoshandiswa, kushandiswa zvisina kunaka kweaxatives kana enemas, chiito chinotyisa). Kunyange zvazvo kunetseka kwekudya chirwere chinowanzobatanidzwa nekurema kunowedzera nekurema, izvozvi hazvisi izvo zvinodikanwa uye chirwere chinogona kuvapo muhuwandu hwehutano hwevanhu.
Kuwedzeredzwa kwekudhakwa kwekudya kusagadzikana muICD-11 kunoenderana nekutsvagisa kwakawanda kwakabuda mukati memakore ekupedzisira e20 kutsigira kushanda kwayo uye kiriniki utility45, 46. Vanhu vanorondedzera zviitiko zvekudya zvakadzama pasina maitiro asina kukodzera kubhadhara zvinomiririra boka rinowanikwa pakati peavo vanogamuchira ICD-10 kuongororwa kwezvimwe zvirwere zvinoratidzika kana zvisingazivikanwi zvekudya, kuitira kuti zvinotarisirwa kuti kuiswa kwechirwere chekudya binge kunoderedza izvi zvirwere47.
Kudzivisa / kudzivisa zvinetso zvekudya zvekudya
Kuzvidzivirira / kuvharidzira chirwere chekudya kwekudya (ARFID) kunoratidzirwa nekudya kusinganzwisisiki kana maitiro ekudyisa zvinoita kuti kuve nekuwana zvakakwana kana kuti zvakasiyana-siyana zvekudya kuti uwane simba rakakwana kana zvinoda kudya. Izvi zvinokonzera kukurashika kwemahombekombe, kusakwanisa kuwedzera uremu sezvinotarisirwa muhucheche kana pamuviri, kuchipatara kunokonzera kukanganisa kwezvokudya, kuvimba pamuromo kunowedzera kudya kunovaka muviri kana kuti kudyidzana kwekombiyuta, kana kuti zvimwe zvinokanganisa hutano hwomunhu mumwechete kana kuti zvinokonzera kukanganisa kwakakosha kwebasa.
ARFID inosiyaniswa neanorexia nervosa nekushaikwa kwezvinonetsa nezvehuremu hwemuviri kana chimiro. Kuiswa kwaro muICD-11 kunogona kutaridzirwa sekuwedzera kweiyo ICD-10 chikamu "kudyisa kusagadzikana kwehucheche nehucheche", uye zvingangoita kuvandudza kiriniki utility muhupenyu hwese (kureva, kusiyana neiyo ICD-10 shamwari, ARFID inoshanda kune vana, vachiri kuyaruka uye vakuru) pamwe nekuchengetedza kuenderana neDSM-545, 47.
Mutumbi kuvimbika dysphoria
Mutumbi kuvimbika dysphoria chirwere chisingawanzozivikanwa chinoratidzirwa chido chekuve nekuremara kwepanyama (semuenzaniso, kupindira, paraplegia, kupofu, kushaya matsi) kubva muhucheche kana kuti achiri muduku48. Chido chacho chinogona kuratidzwa nenzira dzakasiyana-siyana, kusanganisira kufungidzira nezvekuremara mumuviri, uchiita "kuzviita" (semuenzaniso, kupedza maawa muwiricheya kana kushandisa mitsipa yepamakumbo kuti uenzanise kuti une simba rakasimba), uye kushandisa nguva uchitsvaga nzira dzekuzadzisa hurema hwekuda.
Kunyanya kufarira nechishuvo chekuremara kwepanyama (kusanganisira nguva inoshandiswa kuzviita) kunopesana nehupfumi, mabasa ekuzorodza, kana hutano hwevanhu (semuenzaniso, munhu wacho haadi kuda kuva noukama hwepedyo nokuti zvingaita kuti zvive zvakaoma kuzviita). Uyezve, nokuda kwevanhu vashomanana vevanhu vane chido ichi, kunyanya kwavo kunongopfuura kungofungidzira, uye vanotsvaga kugadziriswa kwechido kuburikidza nekugadzira zviratidzo (kureva, kuburikidza nekutsvaga kusarudzwa kwechimwe chikamu chine utano) kana kuzvikuvadza chikamu imwe yamuti kuvharwa ndiyo chete nzira yokurapa (semuenzaniso, kufungira chikwata mumvura yakaoma).
Gaming disorder
Sezvo kutamba kwepaIndaneti kwakawedzera zvikuru mukuzivikanwa mumakore achangobva kupfuura, matambudziko ave akaonekwa achienderana nekupindira kunobata mumitambo. Kutamba kwemagariro kwakabatanidzwa mune imwe nguva ichangobva kuwedzera kuongororwa kunonzi "zvinetso nekuda kwekuita zvepabonde" (iyo inewo chirwere chekubhejera) mukupindura kushushikana kwepasi pose pamusoro pemigumisiro yemitambo yakaoma, kunyanya fomu iri paIndaneti49.
Gadziriro yehutano inoratidzirwa nehutano hwehupenyu hunoramba huchienderera mberi kana hwekutsvaga hutachiona hweIndaneti kana "offline gaming behavior" ("digital gaming" kana "vhidhiyo yemitambo") inoratidzirwa nekushaya simba pamusoro pemafambiro (semuenzaniso, kusakwanisa kupedza nguva yakawanda yakashandiswa mitambo), zvichipa kukoshesa kumitambo kusvika pamwero inotanga kutangira kupfuura zvimwe zveupenyu uye mabasa ezuva nezuva; uye kuenderera mberi kana kuwedzera kutamba pasinei nemigumisiro yaro yakaipa (semuenzaniso, kuramba uchidzingwa kubva kumabasa nekuda kwokusagona kurega pamusana pemitambo). Icho chinokonzererwa kubva kuhutachiona husingazivikanwi nehutachiona kuburikidza nehutano hwemakiriniki kana kukanganisa mukushanda kunobereka.
Kuita zvepabonde kuita zvepabonde
Kuita zvepabonde zvekuita zvepabonde zvinoratidzirwa nenzira inoramba ichinge isingakwanisi kudzora kudzokorora zvakanyanya kudzokorora zvepabonde kana kukurudzira, zvichiita kuti uite zvekare zvepabonde kuita kwenguva yakareba (semwedzi mitanhatu kana kupfuura) inokonzera kutambudzika kana kuora mwoyo mumunhu, mhuri, , dzidzo, basa kana zvimwe zviitiko zvinokosha zvekushanda.
Zviratidziro zvinokwanisika zvechimiro chinoramba chiripo chinosanganisira: kudzokorodza zviitiko zvebonde kuva chinhu chakakosha chehupenyu hwomunhu kusvika pakuregeredza hutano nekuchengetwa kwega kana zvimwe zvido, zviitwa nemabasa; iye munhu anoita akawanda asingabudirire kuyedza kudzora kana zvakanyanya kudzora kudzokorora kuita bonde; munhu ari kuramba achidzokorora kuita hunhu hwepabonde kunyangwe paine mhedzisiro senge kudzokororwa kwehukama kukanganiswa; uye iye munhu achiramba achidzokorora kuita zvehunhu bonde kunyangwe kana iye asisiri kuwana chero kugutsikana kubva kwazviri.
Kunyangwe ichi chikwata ichi chinowanzofanana nekuchengetedza zvinhu, chinosanganiswa muCI-11 kusagadzikana kwehutano hwechikamu chikamu mukuziva kwekushaiwa kwekutsanangurira ruzivo kuti kana nzira dzinobatanidzwa mukukudziridza nekugadzirisa kwechirwere zvakaenzana neavo vanoonekwa mukushandiswa kwezvinhu zvinoshandiswa uye zvinokanganisa tsika. Kuiswa kwayo muCI-11 kuchabatsira kugadzirisa zvinodiwa zvekurapa kutsvaga varwere uye pamwe nekudzikisa kunyadziswa uye mhosva kunobatanidza nekubatsira kutsvaga pakati pevanhu vakaora mwoyo50.
Dambudziko rakaputika rinoputika
Dambudziko rekuputika kwepakati pekare rinoratidzwa nekupfupiswa kwemashoko mashoma emashoko kana kuti kuparadza kwepfuma iyo inomiririra kukundikana kudzora mafungiro ane utsinye, nekuderera kwekuputika kana kuti kukwikwidzana kunenge kusina kuenzana nekushungurudzwa kana kukonzera kushungurudzika kwepfungwa.
Nokuti zviitiko zvakadai zvinogona kuitika mune zvimwe zvakasiyana-siyana (semuenzaniso, kupikisa kusagadzikana chirwere, kuipa kwehutano, bipolar disorder), chirwere chisingawaniki kana zvikamu zviri nani zvakatsanangurirwa nemumwe mupfungwa, maitiro kana neurodevelopmental disorder.
Kunyange zvazvo chirwere chinoputika chinoputika chakatanga kubudiswa muDMM-III-R, yakaonekwa muIndaneti-10 chete sekuiswa kwechirevo pasi pe "mamwe maitiro uye kushungurudzika kwepfungwa". Inosanganiswa muchikamu cheCI-11 chekudzivirira kukanganiswa kwepfungwa munzvimbo yekucherechedza humwe uchapupu huripo hwehutano hwahwo uye hunobatsira mumakiriniki epiriniki51.
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) inoratidzirwa nemhando dzakasiyana-siyana dzemafungiro akaoma, somatic kana zviratidzo zvekuziva kuti dzinotanga mazuva anoverengeka kusati kwatanga, kutanga kuvandudza mukati memazuva mashomanana, uye kusanyanya kana kusipo mukati mevhiki imwe mushure mekutanga kwe menses.
Kunyanya kunyanya, kuongororwa kunoda chimiro chezviratidzo zvemufaro (kuora mwoyo, kusagadzikana), zviratidzo zvemazuva ano (marwadzo, marwadzo akabatana, overeating), kana zviratidzo zvekufungisisa (kukanganiswa kwematambudziko, kukanganwa) zvakaitika panguva yakawanda yekuenda kumwedzi mukati mekare gore. Zviratidzo zvacho zvakakura zvokuti zvinokonzera kushungurudzika kukuru kana kukanganisa kwakakura mumunhu oga, mhuri, hutano, hudzo, basa kana zvimwe zviitiko zvinokosha zvekushanda, uye hazvirevi kukura kweimwe dambudziko repfungwa.
MuI ICD-11, PMDD inoparadzaniswa kubva kune yakajairika premenstrual tension syndrome nekuomarara kwezviratidzo uye chinodikanwa chekuti vanokonzeresa kutambudzika kana kukanganisika52. Kubatanidzwa kweMDC-D muzvinyorwa zvekutsvakurudza zve DSM-III-R uye DSM-IV zvakasimudzira tsvakurudzo dzakawanda dzakagadzirisa kuvimbika uye kuvimbika52, 53, zvichiita kuti iiswe mune zvose ICD-11 uye DSM-5. Kunyange zvazvo inonyanya kukosha muIndaneti-11 iri muchitsauko chezvirwere zvejenitourinary system, PMDD inonyorwa-siyana mumasangano ekudzvinyirira kushungurudzika nekuda kwekukudzwa kwezviratidzo zvepfungwa.
CHIMUMWE CHEZVINHU ZVAKASIKWA NEI ICD-11 GROUPING DISCOER
Zvikamu zvinotevera zvinopfupikisa kuchinja kwakaiswa mune imwe neimwe yepfungwa huru mapoka ehurukuro ye ICD-11 pamusoro pematambudziko epfungwa, maitiro uye neurodeveloppmental pamwe nekutsvaga kwezvikamu zvakatsanangurwa muchikamu chekare.
Kuchinja uku kwakagadzirwa pamusana pekuongororwa kweuchapupu hwechiSayenzi huripo neCI-11 Working Groupes uye vadzidzisi vezviongorori, kuongororwa kwechipatara uye kushandiswa kwenyika yose, uye, kana zvichibvira, migumisiro yekuongorora munda.
Neurodevelopmental disorders
Neurodevelopmental disorders ndiyo iyo inosanganisira matambudziko makuru mukutenga nekushandiswa kwevamwe vadzidzisi, motokari, mutauro kana hutano hunoshandiswa nekutanga panguva yekuvandudza nguva. ICD-11 neurodevelopmental disorders inosanganisira ICD-10 mapoka ekurasika kwepfungwa uye kushungurudzika kwekuvandudzwa kwepfungwa, nekuwedzera kwekushaya pfungwa kwehutano hwehutano (ADHD).
Kuchinja kukuru muIndaneti-11 kunosanganisira kuongororwazve kwekushungurudzika kwekuvandudzwa kwenyanzvi kubva kuCD-10 kuora mwoyo kwepfungwa, iyo yaiva nguva isingagumi uye yakashata iyo isina kukwana zvakakwana mararamiro emhando uye etiologies inobatanidza nemamiriro aya54. Kushungurudzika kwekuvandudza kwepfungwa kunoramba kuchirondedzerwa pamusana pekukanganisa kwakakosha mukuita kweunyanzvi nekugadzirisa maitiro, zvakagadziriswa nemaitiro akaenzana, akakodzera uye akasarudzwa. Mukuona kwekushayikwa kwekuwana maitiro akakodzera akaenzana nepamunharaunda kana avo vakadzidziswa kuti vagovatungamirira munzvimbo dzakawanda dzenyika, uye nekuda kwekukosha kwekutsanangura kusimba kwekuronga kurapwa, ICD-11 CDDG inopawo maitiro akazara ehutano hwekuita tafura55.
Dhiyabhorosi akaparadzanisa magadzirirwo ekugadzirisa nekushandura mafungiro ekuita masimba (mazano, zvemagariro, ehutano) anorongeka maererano nemazera emakore matatu (achiri muduku, ucheche / ucheche uye munhu mukuru) uye maitiro mana okuoma (munyoro, kuenzanisa, akaoma, akadzika). Maitiro ekuzvibata anotsanangura unyanzvi uye unyanzvi hunogona kuonekwa mukati mezvikamu izvi zvezvikamu uye zvinotarisirwa kuvandudza kuvimbika kwekufananidzira kwekuoma nekuvandudza data yehutano hwehupfumi hune chokuita nemutoro wekushungurudzika kwekuvandudzwa kwenyanzvi.
Autism spectrum kusagadzikana muICD-11 inosanganisira zvese zvevacheche autism uye Asperger's syndrome kubva kuICD-10 pasi pechikamu chimwe chinozivikanwa nekushomeka kwekutaurirana kwevanhu uye kudzivirirwa, kudzokorora uye kusachinjika maitiro ehunhu, zvido kana zviitiko. Nongedzo ye autism spectrum kusagadzikana yakagadziridzwa zvakanyanya kuratidza zvinyorwa zvazvino, kusanganisira midhiya muhupenyu hwese. Vanokodzera vanopihwa iwo huwandu hwekuremara mukushanda kwehungwaru nemashandiro emitauro anoshanda kuti utore huwandu hwakazara hwekuratidzwa kweiyo autism spectrum kusagadzikana munzira yekuwedzera.
ADHD yakatsiva ICD-10 hyperkinetic disorders uye yakatamirwa kuisanganiswa kweeurodevelopmental disorders nekuda kwekukura kwayo kunotanga, kukanganisika kwezvinhu zvinowanikwa mumagetsi, motokari uye hutano hwevanhu, uye zvinowanzobatanidzwa pamwe nemamwe marwadzo neurodevelopmental. Izvi zvinotaurirawo kushaya simba kwekutarisa ADHD sehukama hwakanyatsobatana nekukanganisa maitiro nekusawirirana kwemahara, zvichipiwa kuti vanhu vane ADHD havawanzovhiringidzi nechinangwa.
ADHD inogona kuonekwa mune ICD-11 inoshandiswa nevanodzidza zvisingatauriki, zvakanyanya kunyanyisa-kusagadzikana, kana rudzi rwakabatanidzwa, uye rinorondedzerwa mukati mehupenyu hwose.
Pakupedzisira, zvirwere zvisingagumi zvechi, zvinosanganisira Tourette syndrome, zvinorondedzerwa muchitsauko cheCI-11 pamusoro pezvirwere zvehutano hwemitsipa, asi zvinongororwa zvakanyorwa mubato rehutachiona hwehutachiona nekuda kwekukwirirana kwavo kwepamusoro (semuenzaniso, neAdHD) uye zvinowanzoitika panguva yekukura.
Schizophrenia uye zvimwe zvinetso zvepfungwa zvepfungwa
ICD-11 kuunganidza schizophrenia nezvimwe zvinetso zvepfungwa zvepfungwa zvinotora nzvimbo dzeCD-10 dzekuchera schizophrenia, schizotypal uye kushungurudzika kwepfungwa. Izwi rokuti "primaire" rinoratidza kuti maitiro epfungwa anonyanya kukosha, kusiyana nezviratidzo zvepfungwa zvinogona kuitika sechimwe cheimwe nzira dzepfungwa dzepfungwa (semuenzaniso, matambudziko emagariro)18.
Mune ICD-11, zviratidzo zvechichikafu zvinoramba zvisingashanduki kubva kuI ICD-10, kunyange kukosha kweSchneiderian zviratidzo zvekutanga zvakasimbiswa. Kuchinja kunonyanya kukosha ndekuparadzana kwemazana ose e schizophrenia (semuenzaniso, paranoid, hebephrenic, catatonic), nekuda kwekushaiwa kwekufananidzira kwechokwadi kana kushandiswa mukusarudzwa kwekurapa. Munzvimbo ye subtypes, sarudzo yezvinyorwa zvitsvene yakatangwa18. Izvi zvinosanganisira: zviratidzo zvakanaka (kunyengedza, kukanganisa, kusanganisa mafungiro nemafambiro, zviitiko zvekusaziva uye kutonga); Zviratidzo zvisingaiti (zvinongororwa, zvisinganzwisisiki kana zvakasvibiswa zvine chokuita, alogia kana paupity wekutaura, kubvumira, anhedonia); kuora mwoyo kwezviratidzo; manic zviratidzo; psychomotor zviratidzo (psychomotor agitation, psychomotor delay, catatonic zviratidzo); uye zviratidzo zvekunzwisisa (kunyanya kukanganisa mukukurumidza kwekugadziriswa, kutarisa / kutarisa, kutarisa, kutonga, kurega, kutaura kwemashoko kana kuona, uye kushanda chiyeuchidzo). Izvozvi zviratidzo zviratidzo zvinogona kushandiswawo kune mamwe maitiro muboka iri (schizoaffective disorder, chirwere chakanyanya uye chinopedzisira chinokanganisa pfungwa, chirwere chekunyengera).
ICD-11 schizoaffective disorder inoda kuswedera pedyo panguva imwe chete yechipiri schizophrenia syndrome uye chiitiko chechiitiko. Kuongororwa kunofanirwa kuratidza chiitiko chezvino chechirwere uye hachina kugadziriswa sezvazvakagadzikana kwenguva refu.
ICD-11 chirwere chakanyanya uye chepfungwa chinokonzerwa nehupfungwa chinoratidzika kamwe kamwe-kamwe kwechirwere chepfungwa chinogadzirisa chinokonzerwa nokukurumidza mumasikirwo uye kusimba kwechinguva chiduku kwenguva uye chinopfuurira chisisviki mwedzi mitatu. Izvi zvinongobatana chete ne "polymorphic" maitiro echirwere chepfungwa chinokonzerwa neCI-10, iyo ndiyo inonyanya kuiswa mharidzo uye iyo isiri chiratidzo chechichichiphrenia56, 57. Non-polymorphic subtypes yehutano hwepfungwa yakanyanya muCI-10 yakabviswa uye yaizoiswa muCI-11 se "rimwe dambudziko repfungwa repfungwa".
Sezvakanyorwa muCI-10, schizotypal disorder inorondedzerwa muchikwata ichi uye haifaniri kuonekwa sehutano hwemunhu.
Matambudziko epfungwa
Kusiyana neIndaneti-10, ICD-11 mamiriro epfungwa haisi mamiriro ezvinhu akazvimiririra zvinongoraridzika, asi pane zvavanoita pane nguva inoshandiswa senheyo yekugadzirisa chinetso chepfungwa chinonyatsokodzera kuchipatara.
Matambudziko emafungiro akaparadzana ari kuora mwoyo (izvo zvinosanganisira kusanganisa kushungurudzika kwepfungwa, dysthymic disorder, uye kuora mwoyo kwakavhiringidzika uye kuora mwoyo) uye bipolar disorders (iyo inosanganisira bipolar type I disorder, bipolar type II disorder, uye cyclothymia). II ICD-11 inoparadzanisa ICD-10 bipolar affective disorder mu bipolar yerudzi rwekutanga uye chirwere chechipiri II. Iga ega ICD-10 subgrouping yezvinetso zvinoramba zvichirwara, zvinosanganisira dysthymia uye cyclothymia, zvabviswa58.
Nhungamiro yekuongororwa kwechiitiko chekuora mwoyo ndeimwe yezvikamu zvishomanana muIndaneti-11 uko kunotora kuwanda kwechiratidzo kunodiwa. Izvi zvinokonzerwa nekutsvakurudza kwenguva refu uye chipatara tsika yekufungisisa kuora mwoyo nenzira iyi. Chinhu chiduku chezviratidzo zvishanu pane gumi chinodarika panzvimbo yezvine mapfumbamwe zvinogona kuitika zviratidzo zvinotaurwa muCI-10, zvichidaro zvichiwedzera kuwirirana ne DSM-5. ICI-11 CDDG inoronga zviratidzo zvinodzvinyirira mumasumbu matatu - mafungiro, mafungiro uye neurovegetative - kubatsira vhigirizheni mukufungisisa nekuyeuka zvakakwana zvekuora mwoyo zviratidzo. Kuneta chikamu chemukoko wezviratidzo zvehutachiona asi haachiri kutaridzirwa zvakakwana sechiratidzo chekupinda; panzvimbo pacho, inenge inenge yoga yoga yezuva nezuva yakaora mwoyo kana kuderedza kufarira mabasa anogara kwemavhiki maviri anodiwa. Kusatenda kwakange kwawedzerwa sechimwe chikonzero chekuziva nezvekuziva nekuda kwesimba rakasimba rehuwandu hwekufananidzira kwekuongororwa kwekutambudzika kwekuora mwoyo59. ICI-11 CDDG inopa mazano akajeka pamusiyano pakati pemaitiro ehupenyu hunoshungurudzika uye matanho anoratidza kuongorora sechiitiko chinodzvinyirira muchirevo chekufirwa60.
Kune manic episodes, ICD-11 inoda kuvapo kwechiratidzo chemukati chekupinda kwekuwedzera kwebasa kana kuti kuzviona kwechiitiko chekuwedzerwa simba, kuwedzera pakufara, kusagadzikana kana kuwedzera. Izvi zvinoreva kuchengetedza pamusana pezvakaipa zvenhema izvo zvingave zviri nani zvakanzwisiswa sekusimudzira kushanduka kwemafungiro. ICD-11 hypomanic episodes inofungidzirwa sechimiro chechimiro chemashoko evanhu pamusana pekusavapo kwehuwandu hwehutachiona hunoshanda.
Mixed episodes inotsanangurwa mu ICD-11 nenzira inofananidzwa neCI-10, inobva pauchapupu hwehutano hwehuyu nzira61. Nhungamiro inopiwa pamusoro pezviratidzo zvinowanzoitika zvepachikadziro zvinowanikwa kana manic kana zvirwere zvinorwadza zvinowanzoitika. Kuvapo kwechiitiko chakakanganiswa kunoratidza bipolar rudzi I diagnosis.
II ICD-11 inopa maitiro akasiyana-siyana kurondedzera mamiriro ezvinhu epanguva ino kana kuti kuregererwa mamiriro (kureva, mune zvishoma kana mukuregererwa kwakakwana). Kushungurudzika, manic uye zvikamu zvakasanganiswa zvinogona kurondedzerwa seana kana pasina zviratidzo zvepfungwa. Maitiro epanguva ino anoodza mwoyo mumamiriro ezvinhu ekuora mwoyo kana bipolar zvinogona kuonekwa zvakare nekuoma (kunyoro, kuenzanisa kana kuoma); kuburikidza nehupenzi hunofanirwa kuti hunobata hukama hwakananga nemafungiro eti somatic syndrome mu ICD-10; uye nekodzero yekutsanangurira zvikamu zvisingagumi zvemakore anopfuura maviri. Zvose zvinetso zvepfungwa mumamiriro ezvinhu ekuora mwoyo kana bipolar zvinogona kutsanangurwa zvakare uchishandisa zviratidzo zvakakurumbira zviratidzo; chifananidzi chinoratidza kuvepo kwekutya kusangana; uye chikwata chekuziva mamiriro emwaka. Chikwata chekufambisa mabhiriji chinowanikwawo kune bipolar disorder diagnoses.
II ICD-11 inosanganisira chikamu chekuvhiringidzika kwepfungwa uye kushungurudzika kwepfungwa nekuda kwekukosha kwayo muzvigadziriro zvekuchengetedza62, 63. Ichi chikamu chave chichibva kune zvinetso zvekushungurudza muIndaneti-10 kune zvinorwadza kuora mwoyo muIndaneti-11 nekuda kwehuchapupu hwahwo hunova nemafungiro emanzwiro64.
Kuzvidya mwoyo uye zvinetso zvekutya
ICI-11 inounza pamwe chete kushungurudzika nekuzvidya mwoyo kana kutya sechinhu chinonyanya kukosha muchikwata ichi chitsva65. Zvinopesana neCI-11 yekufamba kwenguva, kuunganidza uku kunosanganisira kuparadzana kwekushungurudzika kwepfungwa uye kusarudza mutism, iyo yakaiswa pakati pekushungurudzika kwevana mu ICD-10. Kuparadzana kweCI-10 pakati pezvinetso zvekushungurudzika kwepfungwa uye zvimwe zvinetso zvekuzvidya mwoyo zvakabviswa muCI-11 mukufarira nzira inobatsira yekugadzirisa kushushikana uye dambudziko rinotarisana nekutya maererano nekunetseka kwaro66; izvo zvinoreva, kukurudzirwa kunoratidzwa nemumwe munhu sekukonzera kushungurudzika kwake, kunyanya kushanda kwepamweya uye maradaptive behavioral response. Chirwere chinokonzera kushungurudzika (GAD) chinoratidzika nekutya kukuru kana kushungurudzika hakusi kungowanikwa kune chimwe chinhu chinokurudzira.
Mune ICD-11, GAD ine sarudzo yakanyatsorondedzerwa yezvinhu zvinokosha, kuratidzira kufambira mberi pakunzwisisa kwezvinhu zvakasiyana-siyana zvinoshamisa; kunyanya, kunetseka kunowedzerwa kutyisidzira kwevanhu sechinhu chikuru chechirwere. Kusiyana neCI-10, ICD-11 CDDG inotsanangura kuti GAD inokwanisa kuitika pamwe nekudzvinyirira kunetseka chero bedzi zviratidzo zviripo zvisingabatsiri zvikamu zvepfungwa. Saizvozvowo, mamwe maitiro eCDD-10 ekuchengetedzeka kwemashoko (eg, GAD haigoni kuonekwa pamwe chete nedambudziko rekunyanya kunetseka kana kuora mwoyo-kusagadzikana-kusagadzikana) kwakabviswawo, zvichienderana nekuwedzera kwechirwere chechirwere chiitiko mune ICD-11 uye uchapupu hwokuti iyo mitemo kunopesana nokuona uye kurapwa kwemamiriro ezvinhu anoda kupatsanurwa zvakananga kuchipatara.
Mu ICD-11, agoraphobia inofungidzirwa sekucherechedzwa uye kutya kwakanyanya kana kushushikana kunoitika mukati, kana mukutarisira, kwakawanda mamiriro ezvinhu apo kutiza kungave kwakaoma kana kubatsira kusingawanikwe. Chinangwa chekutya kutya kutya kwakashata mhedzisiro iyo inogona kunge ichikanganisa kana kunyadzisa mumamiriro ezvinhu aya, ayo akasiyana nepfungwa yakatetepa muICD-10 yekutya nzvimbo dzakashama nemamiriro anoenderana, senge mapoka, uko kutizira kune nzvimbo yakachengeteka inogona kunge yakaoma.
Panic disorder inotsanangurwa muI ICD-11 nekudzoka kusingatarisirwi panic inorwisa iyo isingorevi kune zvimwe zvinokonzera kana mamiriro ezvinhu. Iyo ICD-11 CDDG inoratidza kuti kutyisidzira kunowanzoitika zvachose mukupindurwa nekutsvaga kana kutarisira kwekutyisidzirwa kunotyisa mune chirwere chinopa (semuenzaniso, kutaurira vanhu pachena mumagariro evanhu munzanga) hazvirevi zvimwe zvekuongororwa kwekutya chirwere. Pane kudaro, "nekutya" kunogona kushandiswa kune rimwe dambudziko rekuzvidya mwoyo kuongororwa. Izvo "nekutya kupikisa" chiyeuchidzo chinogona kushandiswawo mumamiriro ezvinhu ezvimwe zvinetso apo kushungurudzika kunoratidzika kunyange kusingarevi chiitiko (semuenzaniso, mune vamwe vanhu munguva yekunetseka kwenguva).
ICD-11 chirwere chekushungurudzika kwevanhu munzanga, rinotsanangurwa pamusana pekutya kusakanganiswa kwevamwe nevamwe, inotsiva ICD-10 social phobias.
II ICD-11 CDDG inonyatsotsanangura kupatsanurana kushungurudzika kwevanhu vakuru, uko kunonyanya kuiswa kune mumwe munhu waanofarira kana mwana.
Matambudziko anokanganisa-akamanikidza uye akafanana
Kubudiswa kweboka reOCRD muIndaneti-11 kunomirira kusimuka kukuru kubva kuI ICD-10. Chikonzero chekugadzira OCRD grouping yakasiyana nekuzvidya mwoyo uye zvinetso zvekutya, pasinei nekuitika kwezvinhu zvinotyisa, zvinoenderana nekliniki yekushandiswa kwekushungurudzika kwekugadzirisa nekugoverana kwezviratidzo zvekudzokorora pfungwa dzisina kufanirwa uye zvakakodzokorora zvidzidzo sechinhu chinonyanya kukosha. Kubatana kwekuongororwa kweboka iri kunobva kubva kune uchapupu huripo hunobuda huripo hunobvumirana pakati pezvinetso zvakabatanidza kubva kumagariro, maitiro ezvemagariro uye eurochemical35.
ICD-11 OCRD inosanganisira kukanganisa-kusagadzikana kwepfungwa, muviri dysmorphic disorder, inofanirwa kuongororwa zvirwere, hypochondriasis (chirwere chinetseka chirwere) uye hoarding chirwere. Zvimwe zvakafanana zvikamu izvo zviripo muI ICD-10 zviri munzvimbo dzakasiyana. Zvimwewo zvinowanikwa muOCRD inongororwa nehutano hwezvemamiriro ekudzokorora hutano hunosanganisira trichotillomania (kusveta-bvudzi-kusveta) uye kusarudzwa (kukanda-ganda-ganda), zvose kugoverana nheyo yezvekudzokorora mafambiro pasina kunyatsoziva zvimwe zveOCRDs. Tourette syndrome, chirwere chemagandanga emagetsi muCI-11, inonyorerwa mumatare eOCRD nekuda kwekwakaitika kakawanda pamwe nekusaziva-kusagadzikana kwepfungwa.
II ICD-11 inoramba iine humwe hutsika hwe ICD-10 kushungurudzika-kusagadzirisa chirwere, kureva, kuramba kuchikanganiswa uye / kana kumanikidzirwa, asi nezvimwe zviitiko zvinokosha. Iyo ICD-11 inowedzera pfungwa yekunyengera kunze kwemafungiro asina kufanira kuisa mifananidzo isina kudiwa uye kukurudzira / mafungiro. Uyezve, pfungwa yekumanikidzika inowedzera kuisa kuvhara (semuenzaniso, kudzokorora kuverengwa) pamwe nekuwedzerwa kudzokorora maitiro.
Kunyangwe kuzvidya mwoyo ndicho chiitiko chinowanzobatwa nehutano chinobatanidza nekutadza, ICD-11 inotaura zvakajeka nezvimwe zviratidzo zvinoratidzwa nevarwere, zvakadai sekunyadziswa, kunyadziswa, pfungwa ye "kusakwana", kana kusagutsikana kuti zvinhu hazvitarisiri kana kunzwa "zvakarurama". ICD-10 subtypes yeOCD inobviswa, nokuti vazhinji vevarwere vanoparidza zvose zvinyorwa uye zvinomanikidzwa, uye nokuti havakwanisi kupupurira kutenderwa kwekurapa. Dare reCI-10 rinorambidza kuongorora kusagadzikana-kusagadzikana kwepfungwa pamwe nekuora mwoyo kunobviswa mu ICD-11, kuratidza huwandu hwakawanda hwekubatana kwezvinetso izvi uye kudiwa kwemishonga yakasiyana.
Hypochondriasis (utano hwehutano hwehutano) hunoiswa muOCRD panzvimbo pekuzvidya mwoyo uye zvinetso zvekutya, kunyange zvazvo kutarisa kwehutano kunowanzobatanidzwa nekuzvidya mwoyo nekutya, nekuda kwekugoverana kwezvinhu uye maitiro emhuri yekubatana neOCRD67. Zvisinei, hypochondriasis (utano hwehutano hwehutano) inonyorwa-muzvinyorwa mumatambudziko uye zvinotyisa zvinokonzera boka, mukuziva kwezvimwe zvinoshamisa zvinowanikwa.
Mutumbi dysmorphic disorder, inofungidzirwa referenced disorder, uye hoarding chirwere ndezvezvikamu zvitsva mu ICD-11 iyo yakabatanidzwa muchikwata cheOCRD.
Mune maOCRDs ane ruzivo rwekuziva, zvitendero zvinogona kuitwa nehukuru hwakadaro kana hunoti hunoita sehunyengeri. Kana izvi zvisingatendi zvitendero zvakanyatsoenderana nematauriro eOCRD, musipo kwevamwe maitiro e-psychotic, ivo vanofananidzira "nevarombo kuti varege kunzwisisa" vanofanira kushandiswa, uye kuongororwa kwechirwere chisingafaniri kupiwa. Izvi zvakagadzirirwa kubatsira kuchengetedza kusapindira kwakashata kwe psychosis pakati pevanhu vane OCRDs35.
Kushungurudzika zvakananga kusangana nekuzvidya mwoyo
Iko ICD-11 kuunganidzana kwekushungurudza zvakananga kuwirirana nekudzvinyirira kunotsiva kukanganisa kwe ICD-10 kumatambudziko makuru nekugadzirisa kusagadzikana, kusimbisa kuti izvi zvinetso zvinopawo zvinodiwa (asi zvisina kukwana) zvinonzi etiologic zvinokonzerwa nekusangana nechiitiko chinoodza mwoyo, uyewo kusiyanisa yaisanganisira kushungurudzwa kubva kune zvimwe zvakasiyana-siyana zvinetso zvepfungwa zvinomuka sezvinoita kugadzikana (semuenzaniso, kushushikana kwepfungwa)41. ICD-10 yakashandura kugadzirisa kushungurudzwa kwehucheche uye kudzivisa kushungurudzika kwekubatana kwehuduku huri kukonzererwa kuboka iri nekuda kwekufamba kwenguva kweCI-11 uye pakuziva kwezvimwe zvibatanidzi-zvinokonzera kushungurudzika izvo zvinokonzerwa nezvinetso izvi. II ICD-11 inosanganisira dzinoverengeka dzinoshandiswa pakuvandudzwa kweCI-10 pamwe nekusanganiswa kwePTSD yakaoma uye kwenguva yakareba chirwere chinoshungurudza, chisingaenzani neCI-10.
PTSD inotsanangurwa nezvikamu zvitatu zvinofanirwa kunge zviripo mumamiriro ezvinhu ose uye zvinokonzera kukanganisa kukuru. Izvo ndezvekuti :zve-vanoona chiitiko chinotambudza muzvino; kudzivisa nemaune zviyeuchidzo zvingangodaro kubudisazvezve; uye mafungiro anoramba achiwedzera ekuwedzera kwehutano hwemazuva ano. Kubatanidzwa kwechidimbu chekudzokorora zvakare kuziva, kugadzirisa kana hupenyu hwezvinhu zvinoshungurudza zviri pano uye zvino pane kungoyeuka chiitiko chacho chinotarisirwa kugadzirisa chirwere chepasi chePTSD muCI-1042.
Kugadziriswa kwehutano muCI-11 kunotsanangurwa pamusana pechikonzero chekutanga chekufungisisa nehupenyu hwehupenyu kana zvinetso zvayo, nepo ICD-10 chirwere chacho chakaonekwa kuti kana zviratidzo zvichiitika mukupindura kwehupenyu hwekushushikana hazvina kusangana nemamiriro ezvinhu yeimwe chirwere.
Pakupedzisira, kushungurudzika kwakanyanya kunenge kusisati kwaonekwa sechirwere chepfungwa mu ICD-11, asi pane zvinonzwisisika sechinhu chinowanzogadziriswa kune zvakanyanya kuora mwoyo. Nokudaro, inotsanangurwa muchitsauko cheCI-11 pamusoro pe "zvikonzero zvinokonzera hutano hwehutano kana kutaurirana nehutano hwehutano", asi zvakanyorwa mumatambudziko ekugadzirisa zvakananga nekushungurudzika kubatsira nekusiyanisa kuongororwa.
Dissociative disorders
ICD-11 dissociative disorders grouping inokonzera matambudziko eCI-10 dissociative (kutendeuka), asi yakanyatsogadziriswa uye yakarongeka, kuratidza kutsvaga kutsvaga kwekutsvaga uye kukurudzira kliniki yekushandisa. Dzorera shoko rokuti "kutendeuka" rinobviswa kubva pachikwata cheboka68. ICD-11 dissociative neurological symptom disorder inogadzirisa zvakagadzikana neCI-10 dissociative zvinetso zvekufamba uye kunzwa, asi inoratidzika sechirwere chimwe chete neine gumi nechinomwe chinyorwa chinotsanangurwa maererano neshoko rinonyanya kushaya maitiro (semuenzaniso, kuvhiringidzika kunoonekwa, kusagadzikana kwepfungwa , kutaura kunetseka, kupora simba kana kushaya simba). ICD-11 dissociative amnesia inosanganisira chifananidzi kuratidza kana futi inopesana iripo, chimwe chinhu chinoratidzika sechirwere chakasiyana muCI-10.
ICD-11 inoparadzanisa ICD-10 kutora chirwere chepfungwa mumatambudziko akasiyana-siyana ehutano hwepfungwa uye hutachiona hwehutachiona. Kupatsanurana kunoratidza hunhu hwakasarudzika mukubata trance kusagadzikana uko kwetsika tsika yekuzivikanwa kwako kwakatsiviwa neyekunze "kuve" nehunhu hunofungidzirwa kufurirwa nemweya, simba, huMwari kana chimwe chinhu chemweya. Uye zvakare, hwakawanda hukuru hwemhando dzakaomarara dzinogona kuratidzwa mukubata trance kusagadzikana, nepo chirwere chepfungwa chinowanzo sanganisira kudzokororwa kweiyo diki repertoire yemaitiro akareruka.
ICD-11 dissociative identity disorder inoenderana nepfungwa ye ICD-10 yakawanda hunhu kusagadzikana uye inotumidzwazve zita kuti inowirirana neyazvino inoshandiswa zita remazita emakiriniki uye ekutsvagisa mamiriro. Iyo ICD-11 zvakare inounza chidimbu dissociative kuzivikanwa kusagadzikana, kuratidza chokwadi chekuti kupererwa kweICD-10 kusazivikanwa dissociative kusagadzikana kunoverengerwa nezviratidziro umo husina-hukuru hunhu hunhu husingawanzo tora hutongi hwehutongi hwemunhu kuziva uye kushanda.
Kuisa pasi uye kusagadzikana kwepfungwa, iri mune mamwe maitiro eurotic disorders boka mu ICD-10, inoshandiswa kune dissociative disorders boka mu ICD-11.
Zvokudya uye zvinetso zvekudya
Iyo ikambani yeCI-11 yekudyisa nekudya kwekudya inobatanidza ICD-10 zvinetso zvekudya nekudyisa kwehutano hwehucheche, mukuziva kwekubatana kwezvinetso izvi kumativi ese eupenyu, pamwe nekuratidzira humwe uchapupu hwekuti zvinetso izvi zvinogona kushandiswa kune vanhu vari kwose kwose mararamiro emakore45, 47.
II ICD-11 inopa mazano ekuvandudzwa kweanorexia nervosa uye bulimia nervosa kuti aise uchapupu huchangobva kuitika, hunobvisa kudiwa kwe ICD-10 "mauto". Inosanganisirawo masangano matsva ekudya chirwere chekudya, iyo inotanga kuburikidza nekusimbiswa kwebasa kwehutano hwavo uye kliniki yevashandi, uye ARFID, iyo inowedzera chirwere chekuita ICD-10 kubva paucheche nehucheche.
Anorexia nervosa muI ICD-11 inobvisa iyo ICD-10 chinodikanwa chekuvapo kweyakajairika endocrine kusagadzikana, nekuti humbowo hunoratidza kuti izvi hazviitike mune zvese zviitiko uye, kunyangwe kana zviripo, mhedzisiro yehuremu hwemuviri kwete pane zvakasiyana kutsanangura chimiro chechirwere. Uyezve, kesi dzisina endocrine kusagadzikana dzainyanya kukonzeresa atypical anorexia diagnoses. Chikumbaridzo chehuremu hwemuviri wakadzika muICD-11 inokwidzwa kubva pa17.5 kg / m2 kusvika 18 kg / m2, asi mirayiridzo inogadzirisa mamiriro ezvinhu umo muviri wehuwandu huwandu hunogona kunge husingaregi kuratidzira chirwere chechirwere chinowedzera (semuenzaniso, kukurumidza kuora muviri mumamiriro ezvimwe zvinhu zvechirwere). Anorexia nervosa hairevi "fat phobia" seCI-10, kubvumira zvizere zvemhando dzakasiyana-siyana dzemagariro ezvokudya zvekudya uye zvinoratidzirwa zvekutora muviri.
Vadzidzi vanopiwa kuti vatarise kuoma kwehuwandu hwehupombwe, sezvo hutsika hwakanyanya hukuru hukuru hunosanganiswa nehuwandu hwekuparara nekufa. Chidziro chekufananidzira chimiro chekuzvibata chinosanganiswa chinosanganiswa (kureva, kurega muenzaniso, binge-purge pattern).
Bulimia nervosa mu ICD-11 inogona kuonekwa zvisingaiti kuwanda kwemazuva ano, chero bedzi muviri wehuwandu huwandu huri hwakanyanya kuderera kuti uwane zvido zvinoreva anorexia nervosa. Mune dzimwe nzvimbo dzisinganyanyi kubhadhara, izvo, chaizvoizvo, dzisingabatsirwi nehupupuriro, ICD-11 inopa humwe hutungamiri hutungamiri. Bhulimia nervosa diagnosis hairevi "chinangwa" binges uye inogona kuongororwa pamusana pe "maitiro" anozvidzivirira, umo munhu wacho anodya zvakanyanya kana zvakasiyana nezvakaitika uye anoona kurasikirwa kwekutonga pamusoro pekudya pamwe nekutambudzika, pasinei nemari zvekudya zvinodyiwa zvirokwazvo. Shanduko iyi inotarisirwa kuderedza nhamba yekusazivikanwa kudyidzana uye kudya chirwere chinorwara.
Kusagadzikana kwekugadzirisa
Izwi rokuti "non-organic" rinobviswa kubva kuIndd-11 kubudisa matambudziko, anosanganisira enuresis uye encopresis. Matambudziko aya akasiyaniswa kubva kune avo vanogona kunge vari nani kune mamwe maitiro ehutano kana hupenyu hwehupenyu hwezvinhu.
Kushungurudzika kwemuviri kunetseka uye ruzivo rwomuviri
ICD-11 kusagadzikana kwekushushikana kwemuviri uye chiitiko chemuviri chinosanganisira matambudziko maviri: muviri kushushikana kusagadzikana uye muviri kutendeka dysphoria. ICD-11 muviri kushungurudzika kwepfungwa kunotsiva ICD-10 somatoform kusagadzikana uye zvakare inosanganisira iyo pfungwa ye ICD-10 neurasthenia. ICD-10 hypochondriasis haina kubatanidzwa uye panzvimbo payo inopihwa kuboka reOCRD.
Bodily dambudziko disorder inoratidzwa nekuvapo kwezviratidzo zvemuviri zvinotambudza munhu uye kunyanya kutarisirwa kunotarisana nezviratidzo, izvo zvingaratidzwa nekuwanzoonana nevanorapa utano69. Chirwere chacho chinonzwisiswa sechinhu chiripo pakuenderera mberi kwechisimba uye chinogona kukwanisa kuenderana (kunyoro, kuenzanisa kana kuoma) zvichienderana nemigumisiro yekushanda. Zvakakosha, mumuviri kushungurudzika kwehutano kunotsanangurwa maererano nekuvapo kwezvinhu zvinokosha, zvakadai sokutambudzika uye pfungwa dzakawandisa nemafambiro, panzvimbo yepamusoro pekusavapo kwechirwere kutsanangurwa kwezviratidzo zvinoshungurudza, sekuna ICD-10 somatoform disorders.
ICD-11 kutendeseka kwemuviri dysphoria inobva ichangobva kuongororwa inobatanidzwa muchikwata ichi48.
Kushungurudzwa kunokonzerwa nekushandisa zvinoshandiswa uye kushandiswa kwemishonga
ICI-11 kuunganidza kwekushungurudzika kwekushandisa kwezvinhu zvinoshandiswa nekushandisa zvinodhaka zvinosanganisira zvinetso zvinokura semugumisiro wekushandiswa kwezvinhu zvepfungwa, kusanganisira mishonga, uye kushungurudzika nekuda kwezvipikiso zvinodhaka zvinokurudzirwa semugumisiro wekudzokorora kunokomborera nekusimudzira maitiro.
Sangano reHIVD-11 zvinokonzerwa nekushandisa zvinhu zvinowirirana neyo nzira iri muIndaneti-10, apo makiriniki epirini anotsanangurwa maererano nezvidzidzo zvezvinhu70. Zvisinei, urongwa hwezvinhu mu ICD-11 huwedzerwa kuratidza kuwanikwa kwezvino uye kushandiswa kwemaitiro emagetsi. Chinhu chimwe nechimwe chinhu kana chigadzirwa chemhando chinogona kuwirirana pamwe chete nechirwere chekutanga chinonzi clinical syndromes: chimwe chikamu chekushandisa zvinokuvadza zvinoshandiswa kana zvinowanzovhiringidza zvekushandiswa kwezvinhu, izvo zvinomirira kucheneswa kwe ICD-10 kushandiswa kwekukuvadza; uye kuzvidzora kwezvinhu. Kunyanya kunwa doro uye kuregererwa kwezvinhu zvinogona kuonekwa pamwe chete nemakiriniki epirinic syndromes kana kuzvimiririra sechikonzero chekuendesa hutano huripo kana nzira yekushandiswa kana kukwanisa kuvimba hakuzivikanwi.
Zvichibva kune yakakura zvikuru yezvirwere zvehutano hwehutano hwehutano hunokonzerwa nekushandisa zvinhu, kubatana kwave kwakadzokororwa kuitira kuti zvibvumirwe kubatwa kwehutano hwehutano huchave huchibatsira munyaya dzakasiyana-siyana, kutsigira zvakajeka kutarisa nekubika, uye kuzivisa zvose kudzivirira uye kurapa70. Kuwedzerwa kweCI-11 imwe yezviitiko zvekushandisa zvinokuvadza zvinopa mukana wekupindira kwekutanga nekudzivirira kuwedzera kwekushandiswa nekukuvadza, asi kuongororwa kwekukuvadza kwomuitiro wezvishandiswa uye kushandiswa kwezvinhu zvinoratidza kudikanwa kwekuwedzera kwekugadzirisa.
Iyo ICD-11 inowedzera pfungwa yekukuvadza kuhutano nekuda kwezvinhu zvinoshandiswa kushandiswa kwezvinhu zvinosanganisira kukanganisa kuhutano hwevamwe vanhu, izvo zvinogona kusanganisira kana kukuvadzwa mumuviri (semuenzaniso, nemhaka yekufambisa panguva inodhakwa) kana kukuvara kwepfungwa (semuenzaniso, kukura kwePTSD inotevera njodzi yemotokari).
Iyo ICD-11 inosanganisira kushungurudzwa kwepfungwa-kunokonzerwa mupfungwa sey syndromes inoratidzirwa nehutano hwezviratidzo zvepfungwa kana hutsika hunofanana nehumwe humwe hutano hwepfungwa asi hunobudirira nekuda kwekushandiswa kwemishonga inoshandiswa mupfungwa. Matambudziko anokonzerwa nemishonga anogona kuenzaniswa nekudhakwa kana kuregererwa kwezvinhu, asi kuwedzera kana nguva yezviratidzo zvakanyanya kudarika izvo zvinoratidza kudhakwa kana kubviswa nekuda kwezvinhu zvakataurwa.
II ICD-11 inosanganisira zvikamu zvekushandisa zvinokuvadza zvinodhaka, izvo zvisingaverengeki sekusawirirana kwepfungwa asi pane zviri muchitsauko che "zvinhu zvinokonzera hutano hwehutano kana kutaurirana nemishonga yehutano". Izvi zvinogona kushandiswa apo muenzaniso wezvinhu zvinoshandiswa unowedzera mukana wekukuvadza muviri kana wepfungwa migumisiro yehutano kumushandi kana kune vamwe kusvika pamwero unotarisira kutarisirwa uye mazano kubva kuvashandi vehutano, asi hapana kukuvara kwakanyanya kusati kwaitika. Izvo zvinotarisirwa kuratidza mikana yekugadzirisa kwepakutanga uye pfupi, kunyanya mumamiriro ekutarisira.
Matambudziko eCDD-11 akangokonzerwa nemishonga inokanganisa zvinosanganisira mbiri dzekuongororwa: kubhejera chirwere (pathological kubheja muIndaneti-10) uye chinetso chekubheja, chinotanga kubudiswa49. Muna ICD-10, kubhejera kwepathological kwakarongerwa seitiro uye kuora mwoyo kwepfungwa. Zvisinei, huchapupu huchangobva kuitika hunoti hunokosha hunoitika kune humwe humwe hunokonzerwa nehutano hunokonzerwa nekunyadzisa mafungiro uye zvinetso zvekushandisa zvinoshandiswa, zvinosanganisira kukwirira kwavanoita pamwe chete uye humwe humwe hunoonekwa hwekutanga hunofadza hunotevera nekufambira mberi kwekurasikirwa kwehedonic kukosha uye kudiwa kwekuwedzerwa kushandiswa. Uyezve, kushungurudzwa kunokonzerwa nekushandiswa kwemishonga uye kushungurudzika nekuda kwekuita zvepabonde kunowanzogovana neurobiology yakafanana, kunyanya kushandiswa uye neuroadaptation mukati memubairo uye zvinokurudzira neural circuits71.
Kufuridzirwa kwekutonga kushungurudzika
ICD-11 kushungurudzika kwepfungwa yekudzivirira kunoratidzirwa nekukundikana kunoramba kurwisa simba rakasimba, motokari kana kukurudzira kuita chimwe chinhu chinopa mubayiro kumunhu wacho, kunyanya munguva shomanana, pasinei nekukurumidza-nguva kukuvara kumunhu mumwechete kana kuti kune vamwe.
Uku kuunganidza kunosanganisira pyromania uye kleptomania, iyo inotsanangurwa muIndaneti-10 pasi pemitemo uye kushungurudzika kwepfungwa.
Iyo ICD-11 inotanga chirwere chinoputika chepakati uye inogadzirisa ICD-10 kuderedza zvepabonde zvepabonde kune boka iri seC ICD-11 kusagadzikana kwehutano hwehutano hwehutano50, 72, 73.
Zvinokanganisa maitiro uye zvinetso zvekusaziva
Iko ICD-11 kuunganidzwa kwekuvhiringidza kwehutano nekusawirirana kwemaharasi kunotsiva maitiro eCD-10 ekutenda. Izwi idzva iri nani rinoratidza huwandu hwakazara hwekuzvibata uye zviitiko zvinowanikwa mumamiriro maviri aya akabatanidzwa mune boka iri: oppitional disorder disorder and conduct-dissocial disorder. Shanduko inokosha yakataurwa muIndaneti-11 ndeyekuti zvinetso zviviri izvi zvinogona kuonekwa kune dzimwe nyika, asi ICD-10 inovamanikidza sevhiringidzi hwehuduku. Uyezve, ICD-11 inotanga zvidzidzo zvinoratidzira maitiro ekuvhiringidza maitiro uye zvinetso zvekusawirirana zvakagadziridzwa kugadzirisa chirongwa chechipatara (semuenzaniso, chirevo).
ICD-11 inopesana nehutano husina kunaka inofanirwa kufanana neyoyo ICD-10 yakaenzana. Zvisinei, "ane kusagadzikana kusagadzikana uye kutsamwa" kunofanirwa kujekesa izvo zvinoratidzira zvechirwere pamwe chete, zvinogara zvichitsamwisa mafungiro kana kutsamwa. Iyi mharidzo inozivikanwa kuti inowedzera kuwedzera kungozi kwekudengenyeka kwekupedzisira nekuzvidya mwoyo. Iyo ICD-11 kugadzirisa yemharidzo iyi sechimiro chekupikisa kusagadzikana kwechirwere chinopindirana nehuchapupu huripo zvino uye kuparadzanisa kubva mu DSM-5 nzira yekuisa dambudziko retsva, kuora mwoyo mafungiro ekuderedza dambudziko74-76.
ICD-11 chirwere chinokonzera chirwere chinogadzirisa zvitatu zvakasiyana zvakasiyana-siyana zvinokonzerwa nehutano hwehutano hutsanangurirwa muCI-10 (kureva, kuvharidzirwa kumamiriro ezvinhu emhuri, kusabatana, kushamwaridzana). Iyo ICD-11 inobvuma kuti kusavhiringidza kwehutano nekusawirirana kwekusawirirana kazhinji kunowanzobatana nezvinetso zvinotambudza zvepfungwa uye zvepfungwa dzinokonzera njodzi, zvakadai sezera rekurambwa, kupesana nevezera revanhu, uye kuvhiringidzika kwepfungwa kwevabereki. Kusiyana kwechipatara pakati pehuduku uye kutanga kwevechiri kuyaruka kwechirwere kunogona kuratidzirwa neine chikwata, zvichibva pauchapupu hwokuti pakutanga kutanga kunobatanidza nehutachiona hwakanyanya uye nzira isina urombo yehutano.
Anokodzera kuratidza mashoma prosocial manzwiro anogona kupihwa kune ese ari maviri maitiro ekuvhiringidza uye kusagadzikana kwevanhu kusagadzikana. Muchirevo chechinopesana nekushora kusagadzikana kwekuongorora, iyi mharidzo inosanganisirwa neyakagadzikana uye yakanyanyisa maitiro eanopokana maitiro. Muchirevo chemufambiro - dissocial kusagadzikana, inosanganiswa neyakajairwa kune yakashata, ine hukasha uye yakagadzikana maitiro ehunhu husina hukama.
Unhu hwemunhu
Zvinetso neCI-10 kusarudzwa kwe gumi zvakashata zvinetso zvemunhu zvakabatanidza zvakanyanya kuongororwa kwepfungwa maererano nekuwanda kwavo pakati pevanhu vane zvimwe zvirwere zvepfungwa, kuti ihwo chete huviri hwehutano hwehutano hwakanaka (mafungiro asina kugadzikana kwehutano hwevanhu, zvakanyorwa nehuwandu hwehuwandu hwemashoko ehutano hunoonekwa pachena, uye kuti kuwanda kweizvi-zviitiko zvakange zvakakwirira kwazvo, uye vazhinji vane zvirwere zvakakomba vachisangana nezvido zvehutano hwehutano hwakawanda16, 17.
ICD-11 CDDG inokumbira chiremba kuti atange kuona kana kiriniki yemunhu inosangana neyakajairwa kuongororwa kwehunhu kusagadzikana. Chiremba anobva asarudza kuti kuongororwa kwehunyoro, zvine mwero kana hwakakomba hunhu hunokodzera, zvichibva pa: a) chiyero nekupararira kwekukanganisa mukushanda kwezvinhu zvega (semuenzaniso, kugadzikana uye kubatana kwehunhu, kukosha kwako, kururamisa yekuzvionera-wega, kugona kwekuzvitungamira); b) chiyero nekupararira kwekushomeka kwehukama (semuenzaniso, kunzwisisa maonero evamwe, kuvandudza nekuchengetedza hukama hwepedyo, kugadzirisa kusawirirana) munzvimbo dzakasiyana siyana nehukama; c) kupararira, kuomarara uye kusagadzikana kwemanzwiro, kuziva uye maitiro ekuratidzira kwehunhu kusagadzikana; uye d) chiyero icho mapatani aya anofambidzana nekushungurudzika kana kukanganisika kwepfungwa.
Hunhu hunhu hunobva hwatsanangurwa zvakare kuratidza huvepo hwehunhu husina kunaka hunhu. Nzvimbo shanu dzematanho akasanganisirwa: kusagadzikana kusagadzikana (iyo tsika yekuona huwandu hwakawanda hweasina kunaka manzwiro); uto (iyo tsika yekuchengetedza dunhu uye hukama pakati pevamwe); kusave nehukama (kusaremekedza kodzero nemanzwiro evamwe, zvinosanganisira zvese kuzvifunga uye kusava netsitsi); disinhibition (iyo tsika yekuita nekukasira mukupindura kune izvozvi zvemukati kana zvemhoteredzo zvinokonzeresa pasina kufunga nezve mhedzisiro - yemhedzisiro mhedzisiro); uye anankastia (yakamanikana inotarisa pane yakaomarara chiyero chekukwana uye yezvakanaka nezvakaipa uye nekudzora kwako uye kwevamwe maitiro kuti uone kutevedzera kune izvo zviyero). Sezvo mazhinji eaya maitiro madunhu anogona kupihwa sechikamu chekuongororwa sekutongwa kunge kwakakurumbira uye kuchikonzera kuhunhu kwehunhu uye kuomarara kwayo.
Mukuwedzera, chikwata chekuzvipira chinopa "borderline pattern". Izvi zvinotarisirwa kuita kuti hurumende ichinetseke nekugadziriswa panguva yekuchinja kubva kuI ICD-10 kusvika kuCI-11 uye inogona kuwedzera hutano hwekliniki kuburikidza nekuita kuti vanhu vanogona kutarisa kune mamwe maitiro ekurapa kwepfungwa. Kutsvakurudza kuwedzera kuchadiwa kuti uone kana ichipa ruzivo rwakasiyana nezvakapiwa nemitemo domains.
II ICD-11 inosanganisirawo rutivi rwehutano hwehutano, husingaoneki sehutano hwepfungwa, asi huri kurongwa mukubatanidzwa kwezvinetso zvinobatanidza nekubatana kwevamwe muchitsauko che "zvinhu zvinokonzera hutano hwehutano kana kutaurirana nehutano hwehutano". Unhu hwekuoma hunoreva hunoti hunhu hunoita hunoita kuti huve nehutano kana hupi hwehutano hwehutano asi hukasimudzi kusvika pamwero wekunyanyisa kuratidza kugadziriswa kwehutano hwehutano.
Paraphilic zvinetso
Iko ICD-11 kuunganidzwa kwematambudziko eparaphilic kunotsiva ICD-10 kuunganidzwa kwekushungurudzika kwepabonde, zvichienderana nemashandisirwo emagariro anowanzoshandiswa mukutsvakurudza uye mamiriro ekurapa. Chinhu chikuru chepfungwa dze paraphilic ndechekuti dzinosanganisira zvekuita zvepabonde zvidzidzo zvinotarisa kune vamwe vasina kubvuma77.
Dambudziko rePIdi-11 paraphilic rinosanganisira zviratidzo zvinoshungurudza, voyeuristic disorder, uye pedophilic disorder. Ichangobva kubudiswa masangano inomanikidzira chishuvo chepabonde chechishuwo, frotteuristic disorder, uye zvimwe zvirwere zveparaphilic zvinosanganisira kusabvumirana nevamwe. Chimwe chitsva cheimwe chirwere cheparaphilic chinosanganisira kuzvimirira oga kana kubvumirana nevamwe chinosanganiswa, icho chinogona kugoverwa kana pfungwa dzepabonde, mafungiro, kukurudzira kana kuzvibata kunosangana nekutambudzika kukuru (asi kwete sechikonzero chekurambwa kana kutyiswa kurambwa kwemufananidzo nevamwe) kana kupa mungozi chaiyo yekukuvara kana kufa (semuenzaniso, asphyxophilia).
ICI-11 inosiyanisa pakati pemamiriro ezvinhu anoshanda kune hutano hwehutano uye kliniki yepfungwa dzepfungwa uye izvo zvinongoratidzira mafambiro emunhu oga, uye nekuda kweizvi ICD-10 zvikamu zvesadomasochism, fetishism, uye kushanduka kwechibereko chekuberekwa kwakabviswa26.
Zvinokonzerwa nezvinetso
Iyo ICD-11 inotanga boka idzva rematambudziko anokonzera zvinosanganisira dambudziko rechokwadi rinopihwa pamusoro pechimwe uye chirwere chinokonzerwa kune chimwe. Izvi zvakagadzirisa zvakaenzana neCI-10 kuongororwa kwekuzvipira kwekugadzira kana kuenzanisa kwezviratidzo kana kuremara, kungava mumuviri kana mupfungwa (chinokonzera kukanganisa), asi kunowedzera kuisa mumakirini ezvinhu apo munhu anozvifungidzira, anokanganisa, kana anoita nemaune kuita zvinopesana kana kuwedzera zvirwere , zvepfungwa kana hutsika zviratidzo uye zviratidzo mune mumwe munhu (kazhinji mwana).
Maitiro aya haangokurudzirwe nemubairo wekunze wekunze kana zvinokurudzirwa, uye anosiyaniswa pahwaro uhwu kubva mukukuvadza, uko kusinga tsanangurwe sehurwere hwepfungwa, hunhu kana neurodevelopmental, asi zvinowanzoonekwa muchitsauko che "zvinhu zvinokonzeresa hutano kana kusangana ne mabasa ehutano ".
Neurocognitive disorders
ICD-11 chirwere chinokonzerwa neurocognitive chinowanikwa mamiriro ezvinhu anonyanya kugadziriswa kwekliniki mukukanganisa kwekushanda, uye anosanganisira maitiro akawanda anotsanangurwa pakati pe ICD-10 organic, kusanganisira zviratidzo, zvirwere zvepfungwa. Nokudaro, kubatanidza kunosanganisira zvinoratidzira, zvinyoro-neurocognitive disorder (inonzi mild cognitive disorder in ICD-10), amnestic disorder, uye dementia. Dhiriamu uye chirwere chemasimba chinogona kuenzanisirwa sechikonzero chechiremba chinorongwa kune imwe nzvimbo, nekuda kwechinhu kana mishonga, kana nekuda kwezviitiko zvakawanda zvezvidzidzo. Dhementia inogona kuenzanisirwa seyoro, inononoka kana yakaoma.
Zviratidzo zvehutano hwehutano hwemagumisiro ehutano hunoenderana nehutano hwakasiyana-siyana (semuenzaniso, kuora mwoyo kweAlzheimer's disease, kuora mwoyo kwevanhu nekuda kwehutachiona hwehutachiona hwehutachiona) hunotsanangurwa uye hunorondedzerwa mukati mechitsauko chepfungwa, maitiro uye neurodevelopmental disorders, asi zvinyorwa zvinyorwa zvinoshandiswa uchishandisa zvikamu zve chitsauko pamusoro pezvirwere zvehurongwa hwemitsipa kana zvimwe zvikamu zve ICD, zvakakodzera78. Kuchengetedza neurocognitive disorder kunogona kuonekwawo pamwe chete nehutano hwekudzivirira, kuratidza nzira dzakagadziriswa yekuwana nzira yekurasika kwekufunga, izvo zvinomirira mukana wekurapa kuitira kuti kunonoka kukura kwezvirwere. I-ICD-11 saka inonyatsoziva maitiro ekuziva, mafungiro uye manzwiro ehutano hwehutano pamwe chete nezvinokonzera zvinokonzera.
CONCLUSIONS
Iko kuvandudzwa kweICD-11 CDDG yematambudziko epfungwa, maitiro uye neurodevelopmental uye kwavo kwakavakirwa kuwanda chiratidzo kunomiririra kwekutanga kudzokororwa kwepasirese kusarudzika kwepasirese kwekushushikana kwepfungwa mumakore angangoita makumi matatu. Izvo zvaisanganisira chisingaenzaniswi nhanho uye huwandu hwepasirese, mitauro yakawanda uye multidisciplinary kutora chikamu. Shanduko dzakakosha dzakaitwa kuti dziwedzere kushanda kwesainzi muchiedza cheuchapupu hwazvino nekusimudzira kiriniki kushandiswa uye kushanda kwepasirese zvichienderana nechirongwa chakarongeka chekuyedza munda.
Ikozvino, zvese vhezheni yeICD-11 chitsauko chinoshandiswa nenhengo dzenyika dzeWHO kune huwandu hwehutano uye CDDG yekushandisa muzvirongwa zvekiriniki nevashandi vehutano hwepfungwa zvakazara zvakakwana. Kuti ICD-11 iite kugona kwayo pasirese, tarisiro yeWHO inozoshandira mukushanda nenyika dzenhengo uye nevanoona nezvehutano mukuitwa uye kudzidziswa.
Kuitwa kwechirongwa chitsva kunosanganisira kudyidzana kwechikamu nemitemo yenyika imwe neimwe, marongero, hutano masisitimu uye ruzivo rwehupfumi. Maitiro akati wandei anofanirwa kugadzirirwa kudzidzisa huwandu hwakawanda hwevashandi vezvehutano vekunze. Tinotarisira kuenderera mberi nekubatana kwedu kune zvibereko neWPA uye nekushanda pamwe nenhengo dzenhengo, nzvimbo dzedzidzo, masangano ehunyanzvi nesainzi uye nemasangano ehurumende muchikamu chinotevera chebasa.
ZVINONYANYA
Vanyori vega ndivo vanokonzera maonero anotsanangurwa munyaya ino uye havasi kureva zvisarudzo, mazano kana maonero e WHO. Vanyori vanotaura kuvonga kwavo kune avo vakapa zvakabatanidzwa zvikuru mukufambisa kweCI-11 kusarudzwa kwepfungwa, maitiro uye neurodevelopmental disorders: 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 naBaraceno. Vakatendawo dzimwe nhengo dze ICD-11 Working Groupes nevadzidzisi, vakawanda kwazvo kuzita pano (tapota ona http://www.who.it/mental_health/evidence/ICD_11_contributors kuitira mamwe mazita akazara).
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