Personality Disorders L 301.5 301.4 Hysterical Obsessive Compulsive (less severe symptoms) NOTE: A good example where treatment can be difficult and long. Behavior Disorders of Childhood and Adolescence (any of the less severe behavior problems in an otherwise apparently healthy young person) Alcoholism 303.0 Drug Dependence 304 Episodic excessive drinking (addiction not clearly established) Series as listed (less severe and with good ego strength) Psychophysiologic Disorders 305 Series as listed (less severe with basically good ego strength) Special Symptoms 306 Series as listed (less severe speech disturbances, tics, etc. with basically good ego strength) Behavior Disorders of Childhood and Adolescence 308 Series as listed (more severe and in more troubled personality) Category IV Characteriological or Emotional with poor adaptation in some or involving many areas Psychoses 295 296 Schizophrenia series as listed, with some social functioning Major affective disorders series as listed, with some social functioning 302 Paranoid Explosive (severe with poor control) Inadequate or infantile (marked) Series as listed (more severe problem with poor ego strength) Short-term break with reality in otherwise fairly well integrated personality Category V Severe Emotional Disorder Neuroses 300 Schizophrenia 295 Series as listed, unable to function in a crucial area, but showing change in treatment Series as listed, unable to function in one or more crucial areas, but showing response to treatment, and with history and onset suggesting some favorable possibilities Major Affective Disorders 296 Series as listed (with some qualifications as Category VI Most Severe Emotional Disorder Any chronic neurotic, characteriologic, or psychotic disorder so poorly adapted that constant supervision is necessary, and having shown no response to previous active, continued treatment, but will require symptomatic treatment or constant supervision. Examples of coding as noted above, many factors may be determined by the reporting psychiatrist that cannot be foreseen in such a generalized plan. He will obviously use his judgement as to how a specific patient fits the general intent of the Code system. The use of DSM II is dictated by it being the one officially adopted by the APA, and does not represent any judgement on its general acceptability. Again, it is being used to give some suggestions how the Code system might be applied. It might be well to repeat that, whatever basis for using a Code number for any specific patient is used, it should be recorded in the psychiatrist's own records, since some form of peer review will probably be instituted. Some examples follow: 1. A brief emotional crisis period might be resolved in one interview, or the severity of the symptoms might require a brief period of intervention for the patient to cope with the crisis and regain his equilibrium. It might be diagnosed "307.3 - Adjustment reaction of adult life." It could then be coded "I". If the same crisis really provoked an underlying neurosis, but with good reintegration, it could be coded "II." 2. A mild reactive depression which in DSM II is coded 300.4, Depressive Neurosis, could use code "II." 3. A patient whose depression was more severe, but not psychotic, could have the same DSM II diagnosis, but be coded "III." 4. Making a diagnosis of 301.81, Passive-Aggressive Personality Disorder, with enough interference in functioning could be coded "III." 5. A patient diagnosed Schizophrenic could be coded "IV," "V,” or "VI," depending on the severity and interference of the symptoms, the nature of the onset, the response to treatment, or the chronicity and failure of responding to treatment; so could a "paralytic" conversion hysteric who had been neglected. If, in special instances, the hazard to the patient of disclosure is exceptional, this should be made known to the Medical Director of the insurance carrier and the necessary information made known directly to him. Appendix C: Position Statement on the Need for National Health Care System This statement was approved by the Board of Trustees of the American Psychiatric Association on October 1, 1971, upon recommendation of the Task Force on Confidentiality as It Relates to Third Parties.* Many approaches to establishing a national health care system are now being considered. Whatever system may eventually be adopted will inevitably entail the collection of intimate and private *The task force included Maurice Grossman, M.D., chairman; Jack D. Barchas, M.D.; Richard G. Johnson, M.D. and Joseph Satten, M.D. medical, psychological, and social data concerning those who use it. How these data are utilized can have a tremendous impact on the privacy and lives of identifiable individuals and, collectively, on the entire body politic. Protecting the confidentiality of medical disclosures is especially imperative for those who need and obtain psychiatric treatment, as has already been recognized, e.g., by the laws of many states, in court decisions, and in the drafting of the code of evidence for the federal judiciary. Two separate bodies of data will be collected. The first will include identification of the individual in the process of establishing eligibility for treatment and in reporting the treatment process. In our view the confidentiality of these data can be safeguarded by limiting the information disclosed to the least amount necessary for establishing eligibility and by developing methods to control overusage of the system. Review of such identifiable data, if it is necessary at all, should be minimal, and the availability of the data should be confined to carefully selected personnel at the treatment site. Under no circumstances should the data be duplicated and recorded elsewhere or rendered available to groups that are not connected with the treatment situation. The data should be used only to facilitate the treatment process. The second group of data will be needed for program review, for the evaluation of the efficacy and efficiency of the system, and for medical and administrative research. These data will be computerized. In the case of program review and evaluation, it will be vital to protect the identity of the patient with reference to the data that are collected and stored. (There can be no objection to identifying providers, individual or group, for whatever review is needed.) However, medical research will entail the collection of much intimate data on the individual; this will require careful planning concerning how the material is to be stored and who will control accessibility to the data and for what purposes. Specific legislation governing these matters must be carefully framed if the confidentiality of the records of the individual patient is to be fully protected. The framers of national health care proposals should be fully cognizant of the imperative need for safeguarding the confidentiality of medical records in the contexts described here. Appendix D. Position Statement on The Role Of Confidentiality In Volunteer Military The American Psychiatric Association was much encouraged and 57-282 O 76 pt. 1 38 |