Amazwana achaphazelekayo karhulumente kwii-ICD-11 izahluko ezinxulumene nempilo yengqondo kunye neyesondo (2019)

Izimvo ze-YBOP: Iphepha liqulethe icandelo elixoxa ngezimvo malunga noxilongo olutsha "lokunyanzeliswa kokuziphatha ngokwesondo". Kwicandelo elingqindilili ababhali bachaza uNicole Prause ongazange aphawule ngamaxesha angama-14 kodwa ngaphezu kwamaxesha angama-20. Uninzi lwamagqabaza akhe lubandakanya uhlaselo lomntu, iingxelo zobuxoki, ukumelwa kakubi kophando, ukukha i-cherry kunye nokungcoliswa.

Ingxaki yokuziphatha ngokwezesondo efumanekileyo ifumene inani eliphezulu lokungeniswa kweengxaki zeengqondo (N = 47), kodwa ngokuphindaphindiweyo ukusuka kubantu abafanayo (N = 14). Ukuqaliswa kwesi sigaba sokuxilonga kuye kwaxutyushwa kakhulu3 kunye neenkcazo kwi-ICD-11 incazelo ichazwe ngokugqithisileyo kwintsimi. Iziphakamiso zazibandakanya ukuphazamiseka kweziphakamiso phakathi kwabathengisi, njengamangqina omngquzulwano wentshisekelo okanye ukungakwazi (48%; κ = 0.78) okanye amabango ukuba imibutho ethile okanye abantu baya kuzuza ngokufaka okanye ukukhutshwa kwi-ICD-11 (43%; κ = 0.82). Elinye iqela livakalise inkxaso (i-20%; κ = 0.66) kwaye liqwalasele ukuba kukho ubungqina obaneleyo (i-20%; κ = 0.76) yokubandakanywa, ngelixa elinye lichasene ngokuqatha (28%; κ = 0.69), kugxininisa ukuqonda okungalunganga (33 %; κ = 0.61), ubungqina obaneleyo (28%; κ = 0.62), kunye neziphumo eziyingozi (22%; κ = 0.86). Omabini la maqela acaphule ubungqina be-neuroscience (35%; κ = 0.74) ukuxhasa iingxoxo zabo. Bambalwa abavakalisi abacebise utshintsho lwangempela kwinkcazo (4%; κ = 1). Endaweni yoko, omabini amacala axoxa ngemibuzo ye-nosological njengokuqonda imeko njengokunyanzelwa, ukunyanzelwa, isimilo sokuziphatha okanye intetho yokuziphatha okuqhelekileyo (65%; κ = 0.62). I-WHO ikholelwa ukuba ukufakwa kwesi sigaba esitsha kubalulekile ukuba uluntu olusemthethweni lufumane iinkonzo4. Ukukhathazeka malunga nokugqithiswa kwe-overpathologizing kubhekiswe kwiCDDG, kodwa esi sikhokelo asibonakali kwiinccazo ezimfutshane ezikhoyo kubavakalisi bee-beta.

Ukuba ufuna ukufunda amazwana karhulumente kwii-ICD-11 CSBD iziqendu (kubandakanywa inzondo / inqambi / idibanisa) sebenzisa ezi zixhumanisi:

  • https://icd.who.int/dev11/f/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1630268048
  • https://icd.who.int/dev11/proposals/f/en#/http://id.who.int/icd/entity/1630268048
  • https://icd.who.int/dev11/proposals/f/en#/http://id.who.int/icd/entity/1630268048?readOnly=true&action=DeleteEntityProposal&stableProposalGroupId=854a2091-9461-43ad-b909-1321458192c0

Uzakufuna ukudala igama lomsebenzisi ukufunda amazwana.

UFuss, uJohannes, uKyle Lemay, uDan J. Stein, uFraner Briken, uRobert Jakob, uGeffrey M. Reed kunye noCary S. Kogan.

Ihlabathi leengqondo 18, akukho. 2 (2019): 233-235.

Amandla angqalileyo okuphuhliswa kwe-World Health Organisation (WHO) ye-ICD-11 ukuhlukaniswa kwengxaki yengqondo, yokuziphatha kunye neyokuphuhliswa kwe-neurodevelopmental kuye kwaba yimpembelelo ebonakalayo evela kubachaphazelekayo behlabathi abaninzi.

Iziqulatho eziphambili ze-ICD-11 yokuThengiswa koMzimba kunye nokuThengiswa koLuntu (iMMS), kuquka iinkcazo ezimfutshane, ziye zafumaneka kwi-platform ye-ICD-11 beta (https://icd.who.int/dev11/l‐m/en) ukuhlaziywa koluntu kunye neengxelo zeminyaka embalwa edlulileyo1. Iziphakamiso zahlaziywa yi-WHO ngokuphuhliswa kokubhaliweyo kwe-MMS ye-ICD-11 kunye neenguqu zokusetyenziswa klinikhi ngabachwephesha bezempilo yengqondo, Iinkcazo zeKliniki kunye neZikhokelo zoLwazi (i-CDDG)1. Apha, sishwankathela izihloko eziqhelekileyo zokungeniswa kwezigaba eziye zenza impendulo enkulu.

Zonke iziphakamiso kunye neziphakamiso zahlaziywa kwizintlu ezikhoyo ngokuhlukileyo kwisahluko malunga neengxaki zengqondo nokuziphatha kwi-ICD-10, nangona ezinye zazo ziye zahlengahlengiswa kwaye zafudukela kwiziganeko ezintsha ze-ICD-11 malunga neengxaki zokulala kunye nemiqathango enxulumene nempilo yesondo2.

Phakathi kukaJanuwari 1, 2012 kunye noDisemba 31, 2017, amagqabantshintshi angama-402 kunye nezindululo ezili-162 zangeniswa kukuphazamiseka kwengqondo, isimilo kunye nokuphazamiseka kwengqondo, ukuphazamiseka kokulala, kunye neemeko ezinxulumene nempilo yesondo. Elona nani likhulu lokungeniswa okunxulumene nengqondo, indlela yokuziphatha kunye nokuphazamiseka kwengqondo kwi-neurodevelopmental egxile kukunyanzelwa kokuziphatha ngokwesini (N = 47), ubunzima bokubandezeleka emva koxinzelelo (N = 26), ukuphazamiseka komzimba (N = 23), ukuphazamiseka kwembonakalo yengqondo ( N = 17), kunye nengxaki yokudlala (N = 11). Ukungeniswa kwemeko ezinxulumene nempilo yesondo ikakhulu kujongwana nokungaziphathi ngokwesini kwinqanaba lokufikisa kunye nokuba mdala (N = 151) kunye nokungaziphathi ngokwesini kubuntwana (N = 39). Ukungeniswa okumbalwa kunxulumene nokuphazamiseka kokulala (N = 18).

Senze uhlalutyo lomxholo oluchanekileyo ukuchonga imixholo ephambili yokungeniswa enxulumene namacandelo apho ubuncinci kukho izimvo ezili-15. Ke, i-59% yazo zonke izimvo kunye ne-29% yazo zonke izindululo zabhalwa ngekhowudi. Ukungeniswa kwavavanywa ngokuzimeleyo ngabavavanyi ababini. Iikhowudi ezininzi zomxholo zinokufaka isicelo kwisingeniso ngasinye. Ukunyaniseka konxibelelwano kubalwe kusetyenziswa i-kappa kaCohen; ziikhowudi kuphela ezinokuthenjwa okuphakathi kokuphakathi (κ≥⃒0.6) eziqwalaselwe apha (82.5%).

Ingxaki yokuziphatha ngokwezesondo efumanekileyo ifumene inani eliphezulu lokungeniswa kweengxaki zeengqondo (N = 47), kodwa ngokuphindaphindiweyo ukusuka kubantu abafanayo (N = 14). Ukuqaliswa kwesi sigaba sokuxilonga kuye kwaxutyushwa kakhulu3 kunye nezimvo kwinkcazo ye-ICD-11 iphinda iphindaphinda ukuhlengahlengiswa okuqhubekayo ebaleni. Ukungeniswa kubandakanya izimvo ezichasayo phakathi kwamagqabantshintshi, ezinje ngezityholo zongquzulwano lomdla okanye ukungakwazi ukusebenza (48%; κ = 0.78) okanye amabango athi imibutho ethile okanye abantu baya kuzuza ngokubandakanywa okanye ukukhutshwa kwi-ICD-11 (43%; κ = 0.82) . Elinye iqela livakalise inkxaso (i-20%; κ = 0.66) kwaye liqwalasele ukuba kukho ubungqina obaneleyo (i-20%; κ = 0.76) yokubandakanywa, ngelixa elinye lichasene ngokuqatha (28%; κ = 0.69), kugxininisa ukuqonda okungalunganga (33 %; κ = 0.61), ubungqina obaneleyo (28%; κ = 0.62), kunye neziphumo eziyingozi (22%; κ = 0.86). Omabini la maqela acaphule ubungqina be-neuroscience (35%; κ = 0.74) ukuxhasa iingxoxo zabo. Bambalwa abavakalisi abacebise utshintsho lwangempela kwinkcazo (4%; κ = 1). Endaweni yoko, omabini amacala axoxa ngemibuzo ye-nosological njengokuqonda imeko njengokunyanzelwa, ukunyanzelwa, isimilo sokuziphatha okanye intetho yokuziphatha okuqhelekileyo (65%; κ = 0.62). I-WHO ikholelwa ekubeni ukufakwa kolu didi lutsha kubalulekile kubemi abasemthethweni abafumana iinkonzo4. Ukukhathazeka malunga nokugqithiswa kwe-overpathologizing kubhekiswe kwiCDDG, kodwa esi sikhokelo asibonakali kwiinccazo ezimfutshane ezikhoyo kubavakalisi bee-beta.

Inombolo yeziphakamiso ezinxulumene nesifo esixinzelelekileyo esisemva kwengxaki yokuxinwa kwenkxalabo esekelwe ukuxhaswa kwayo kwi-ICD-11 (16%; κ = 0.62), kungekho nanye ngokucacileyo ukuphikisana nokufakwa (κ = 1). Nangona kunjalo, iziphakamiso eziliqela ziphakanyisiwe utshintsho kwenkcazo (36%; κ = 1), zangeniswa izimvo eziphambili (i-24%; κ = 0.60) (umzekelo, ngokubhekiselele ekucingeni), okanye ukuxubusha iilebuli yokuxilongwa (20%; κ = 1) . Iimbono eziliqela (i-20%; κ = 0.71) igxininise ukuba ukuqwalaselwa kwesi sifo njengengxaki yengqondo kuya kukhuthaza uphando kwaye kuququzelele ukuxilongwa nokunyangwa.

Ininzi yeziphakamiso malunga nokukhubazeka komzimba zazibaluleke kakhulu, kodwa zenziwa ngabantu abafanayo (N = 8). Ukugxekwa kugxininise ekugqibeleni (48%; κ = 0.64) kunye negama lesifo (43%; κ = 0.91). Ukusetyenziswa kwegama lokuxilonga elihambelana ngokuthe ngqo kunye nesifo sengqondo esisemzimbeni5 yabonwa njengengxaki. Omnye ukugxekwa kukuba inkcazo incike kakhulu kwisigqibo sekliniki esipheleleyo sokuba izigulane ezijoliswe kwiimpawu zomzimba "zigqithiseleyo". Inani lamagqabaza (i-17%; κ = 0.62) ibonisa ukukhathazeka ukuba oku kuya kubangela ukuba izigulane zibekwe ngokwahlukileyo kwengqondo kwaye zibavimbele ekufumaneni unyango olulungelelaniso lwezinto eziphilayo. Abanye abanikelayo banikele iziphakamiso zenguqu kwiinkcazo (30%; κ = 0.89). Abanye baphikisana nokufakwa kwesi sifo ngokupheleleyo (26%; κ = 0.88), ngelixa kungangeniswa (κ = 1) ibonise inkxaso yokufakwa. I-WHO inqume ukugcina ingxaki yomzimba njengesifo sokuxilonga6 kunye nokujongana neengxaki ngokufuna ukuba i-CDDG ibonakale kwimiba eyongezelelweyo, njengobunzima bokusebenza.

Iziphakamiso malunga nezimo ezinxulumene nempilo yezesondo zibonisa inkxaso enamandla yokususwa kwezidakamizwa zesondo kunye nokuxilongwa ngokwesini kwiingxaki zengqondo kunye nokudala isahluko esahlukileyo (35%; κ = 0.88)7. Iziphakamiso ezininzi (i-25%; κ = 0.97) isetyenziswe umyalezo weethempyuthe obonelelwe nguMbutho wehlabathi wezeMpilo. Iziphakamiso eziliqela zithi ukugcinwa kwesigxina sobulili kwisigaba sesifo kuya kubangela ukulimaza nokubandlulula abantu be-transgender (14%; κ = 0.80), kucetyiswa ukutshintshana okuchaziweyo kwenkcazo (18%; κ = 0.71) okanye iilebula ezahlukeneyo zokuxilonga (23%; κ = 0.62). I-WHO yatshintsha iingcaciso kwiinxalenye ezisekelwe kwiimvo ezifunyenweyo7.

Into enomdla kukuba, iqela elikhulu lokungeniswa kwenkcazo ecetywayo ye-ICD-11 yesini sokungaziphathi ngokwesini kubuntwana ibonakalise inkcaso kwimigangatho yangoku yokhathalelo ngokuchasa ngokucacileyo utshintsho lwentlalo kunye nokunyanga ngokwesini-okuqinisekisa unyango lwabantwana (46%; κ = 0.72), imicimbi ethi , nangona ibalulekile kwaye iphikisana, inento yokwenza nonyango endaweni yokuhlelwa. Inkcazo ecetywayo yagxekwa okanye yachaswa kwi-31% yokungeniswa (κ = 0.62), abanye besebenzisa itemplate ebonelelwe nguMbutho weHlabathi wezeMpilo kwezesondo ukukhuthaza uhlaziyo olusekwe kuthethwano noluntu (15%; κ = 0.93). Abanye bachasile ukuxilongwa okubonisa uloyiko lokwahlukahlukana kwesini kubantwana (15%; κ = 0.93) kwaye bathi oko akuyomfuneko kuba akusayi kubakho luxinzelelo (11%; κ = 0.80) kwaye akukho mfuneko yokuqinisekisa ukhathalelo lwempilo ngokwesini (28% ; κ = 0.65) ebantwaneni. Abanye baphinde bathi ukuxilongwa akufuneki kwiinjongo zophando, bebonisa ukuba uphando ngobufanasini buye bachuma okoko kwasuswa kwi-ICD (9%; κ = 0.745). Ngelixa ivuma impikiswano ejikeleze unyango, i-WHO igcine udidi ukunceda ukuqinisekisa ukufikelela kukhathalelo olufanelekileyo lweklinikhi ngelixa isombulula ukubekwa ibala kwisahluko esitsha seemeko ezinxulumene nempilo yezesondo kunye nangolwazi olongezelelweyo kwi-CDDG7.

Ngokutolika ezi mpendulo, kucacile ukuba ezininzi iziphakamiso zenziwe kwimiba yokubhengezwa, ihlala ijoliswe kwicandelo elithile. Kuyafaneleka iingcali zenzululwazi ukuphonononga iingcebiso zabo ngokukhanya kwamava kunye nesigidimi. I-WHO isetyenzisile izimvo kunye neziphakamiso kwiplatifti ye-beta ngokudibanisa neminye imithombo yolwazi, ingakumbi izifundo zophuhliso zentsimi8, 9, njengesiseko sokwenza utshintsho kwi-MMS kunye neCDDG.

Ucaphulo