Since 1995, a national multi-centres field trial, organized by CCMD-3 task force, has been conducted. The task force has completed its field trial and published " CCMD-3"
I.The edition principles of CCMD-3
1. To improve the service for the patients, and to meet the needs of our society.
2. To maintain the superiority of CCMD-2R.
3. To match ICD and DSM systems.
4. To be concise and manipulative.
II. The classification principles of CCMD-3
The classification of CCMD-3 is one of medical classifications based on both symptoms, and etiological and pathological factors.
In CCMD-3, Chinese psychiatrists seek either to be accordance with ICD-10, or to sustain a nosology with Chinese cultural characteristics. Therefore broad similarities between the ICD-10 & CCMD-3 are obvious.
However, based on the prospective field trials, in CCMD-3, there are the particular additions
For example, 42 Mental disorders related to culture [F43.8]
42.1 Mental disorders due to Qigong [F43.8]
42.2 Mental disorders due to witchcraft[F43.8 ]
42.3 Koro [F43.8]
42.9 Other or unspecified mental disorders related to culture [F43.8; F43.9]
The draft of organic mental disorders was sent to neurologists at Beijing Union Hospital & Shandong University
In CCMD-3, Code 0 organic mental disorders
02mental disorder due to other encephalopathies
[F02dementia, other diseases]
02.1mental disorder due to brain degenerative diseases [F02]
02.2 mental disorder due to intracranial infection [F02.8]
02.21 mental disorder due to acute viral encephalitis [F02.8]
02.22 Creutzfeldt-Jakob mental disorder [F02.1 dementia, Creutzfeldt-Jakob d.]
02.23 post-encephalitic syndrome [F07.1]
In this case, CCMD-3 is classified mainly in accordance with etiology and pathology
e.g.,Creutzfeldt-Jakob disease is sorted as a subtype of mental disorders due to intracranial infection.
III. Glossary:
CCMD-3 directly cites its glossary from that of ICD-10,only makes some adaptation or complement,
e.g. ,to distinguish personality disorder from personality changes; F07.0 organic personality disorder in ICD-10,changes to organic personality change
IV. Definition and compilation
We emphasize descriptive definite and standard compilation to edit CCMD-3. The major mental disorders are compiled in the sequence as follows:
Descriptive definition
Symptomatic criteria
Severity of illness
Course criteria
Exclusion and Note.
For example, 42 Mental disorders related to culture [F43.8]
Descriptive definition:
Culture-related syndrome refers to special culture-related syndrome, the characteristics of which are:
understood and accepted by particular culture or subculture;
pathological causes representing and symbolizing core implication and patterns of behavior of this culture;
the diagnosis depending on particular cultural knowledge and conception;
success of treatment depending on participators of the culture, e.g., mental disorder due to Qigong, Koro has those characteristics.
42.1 Mental disorders due to Qigong [F43.8]
In the tradition of our country, Qigong is a way to keep healthy and cure the sickness. The method is usually to keep special posture or practice some exercises, and keep concentration on some points, pondering and reading silently, relaxation and regulating respiration.
Mental disorder due to Qigong refers to the phenomena that an exerciser is kept in a state of Qigong for so long as not to stop because of improper operation of Qigong (e.g., excessive exercise), the manifestations include symptoms of thought, emotion, and behavior, loss of ability of self-control.
A. Symptom criteria:
(1) Directly caused by Qigong exercise;
(2) The symptoms are closely related to the content of Qigong books and periodicals, and exercise of Qigong. The patients show abnormally mental symptoms repeatedly and continuously, without self-control;
(3) With at least 1 of the following:
psychotic symptoms, e.g. auditory hallucination, delusion;
hysteria-like syndrome;
neurosis-like syndrome.
B. Severity criteria:
Impairment of social function;
C. Course criteria:
The course is transient, patients may recover immediately by being out of spot, stopping exercise and proper treatment.
D. Exclusion:
(1) Excluding similar manifestations regarded as tricks to cure the sickness for oneself or others, or tricks to obtain money or attain other goals, excluding similar manifestations that can be involuntarily self-induced or self-ended;
(2) Excluding any kind of other disorders, especially hysteria or stress disorder due to psychological trauma.
Note: Pay attention to the use of diagnostic criteria and its marched diagnostic instrument, correctly
T10 Delusions of RTHD
The section 13 (thought symptoms) of RTHD is concerned with abnormal beliefs, they are arranged, both as to order and to content, for convenience of interviewing, not clarity of underlying theoretical ideas.
Thus Section 13.2 contain items that deal with delusions. T29 about primary and secondary phenomena. The items in the section3 contain definitions that are relevant to all the others.
The following general points should be read in conjunction with those for psychotic symptoms rated in Section13 (Thought symptoms). Particular care is necessary when Responders (Rs) have a language or speech problem of any kind (see section3 Physical health and Medical conditions)
Vague or rambling answers should be rated under the items speech disorder ( see section13.1 Thought form symptoms). R must be able to give a clear description of the symptom. A response of Yes to a question, in itself, provides no evidence either way.
Four necessary but not sufficient features of a delusion;
1) The belief is described clearly in the Rs own words, not simply an assented to following a leading question.
2) It is held with a basic and compelling subjective conviction, though the degree of certainty may fluctuate or be concealed.
3) It is not susceptible, or only briefly, to modification by experience or evidence that contradicts it; i.e. it is incorrigible.
4) The belief is impossible, incredible or false (often called bizarre).
Beliefs with all four characteristics that are not delusional: including social, cultural, religious and political beliefs
5) A belief with all the features listed
1)-4) is not necessarily idiosyncratic to the individual who holds it. It may be a normal and unsurprising characteristic of belonging to a particular social group and of sharing its dogmas, tenets and values.
In other words, beliefs shared and fully explained by particular religious or political or other social groups are not delusional, no matter how passionately they are held, or how false or bizarre they seem to non-members. Thus if a priestess of a particular cult says that she is possessed, when in a trance, by a god (given a special name in that cult), this is understandable in a social context.
It is not evidence for a delusional belief. Similarly, when natural events are said to happen by divine intervention in a way that is accepted by all members of the group, there is no delusion, and there are no items in RTHD that allow them to be rated as such. overvalued ideas
6) Some ideals that are held idiosyncratically (i.e. they are not understandable in terms of membership of a social group) may be understandable in terms of the circumstances and development of a particular personality. For example, a physicist who has spent a lifetime trying to solve a problem may become convinced of an idiosyncratic answer to it although all competent colleagues provide evidence against it and no one thinks the solution tenable. Such overvalued ideas are eccentric, but they sometimes turn out to be true. They are not rated in RTHD.
7) Induced delusions: If R, who has never previously been deluded, begins to express abnormal beliefs that are clearly derived (induced) from someone else with whom R is or has been closely related, rate at T10, and T29. These items include the situation where a group of impressionable people is influenced (and sometimes concerned) in this way.
8) Including monothematic delusion: Only one type of delusion is present though it may be predominant in the clinical picture and dominate the behavior of R. Delusions that others think R smells, or is homosexual; delusion that R is pregnant, or has misshapen teeth, delusion of jealousy, etc. Direct elaboration of the central delusion, e.g. when a jealous R interprets a light being switched on as a signal to a lover, are acceptable.
9) Suspiciousness: The symptom of suspiciousness usually accompanies a disorder such as depression, hypomania, delusional psychosis, schizophrenia or cognitive impairment.
However it should only be rated present if there is a degree of insight concerning its internal origin; either an attribution to a mood change or failing memory, or simply a knowledge that it has no (or insufficient) external justification. Severity depends on the extent to which insight is partial and on the behavior that occurs when it lapses.
Differentiation of suspiciousness from delusions should be made according to insight concerning its internal origin. The Rs with delusion is lack of insight of the symptom.
V. Treatment Guideline
We followed ICD-10 PHC and APA:"Practice guideline" and worked out "Treatment and Nursing of Mental Disorders Relevant to CCMD-3", Because of shortage of professionals in China, & the reality is that most patients are treated in primary care level or at home.
The Rating Test for Health Problems and Diseases (RTHD) and its software
Professor Darrel A.Regier says:
1. The use of explicit diagnostic criteria and structured interviews that incorporate these criteria has also been accomplished in China. Several large epidemiological studies have been accomplished by WHO associated investigators using the PSE/SCAN interview and the CIDI interview.
Prior to this meeting, I received copies of computer software and text descriptions from Professor Yanfang Chen, of a computer assisted interview, the Rating Test for Health Problems and Diseases (RTHD).
This program was built with SCAN and CIDI questions, to be able to produce diagnoses according to the ICD-10, DSM-IV, and the Chinese Classification and Diagnostic Criteria of Mental Disorders-Version 3 (CCMD-3).
In addition to providing a structured approach for obtaining and rating the severity of mental disorder signs and symptoms, the program is designed as a electronic health record to obtain social history and the history of present illness for both psychiatric and general medical conditions.
Since it is built with the SCAN and CIDI algorithms, the completed version will permit comparison of mental disorder syndromes in China with those evaluated by these instruments in other countries.
2. In this context, Professor Chen will be chairing an international symposium on diagnostic instrument requirements for future diagnostic revisions at the upcoming World Congress of Psychiatry in Cairo.
The willingness and ability of leading international psychiatrists to participate in methodological scientific conferences of this type is essential for laying the groundwork for a collaborative international effort to update diagnostic criteria based on the latest scientific evidence.
3. In the context of this symposium, the agreement to follow internationally accepted guidelines for mental disorders is an important mechanism for preventing the abuse of psychiatric diagnosis for idiosyncratic political purposes.
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Ministry of Health, (2003) No.013
ICP:No.040657