The 11th revision of the International Classification of Diseases (ICD-11) has come into effect on January 1, 2022. All the Member States of the World Health Organization (WHO) will now be asked to use this new version of the classification to report their morbidity and mortality statistics. An implementation package has been made available to facilitate the transition from the ICD-10 to the ICD-11.

The ICD-11 consists of 26 chapters corresponding to groups of diseases, plus a supplementary section (Chapter V) for func­tioning assessment. Chapter 6 is on Mental, Behavioural or Neurodevelopmental Disorders. Separate chapters are provided for Sleep-Wake Disorders (Chapter 7) and for Conditions Related to Sexual Health (Chapter 17). In addition to chapters on Injury, Poisoning or Certain Other Consequences of External Causes (Chapter 22) and on Factors Influencing Health Status or Contact with Health Services (Chapter 24), already available in the ICD-10, a new Supplementary Chapter on Tradition­al Medicine Conditions (Chapter 26) has been added.

The main uses for which the classification is designed include: certification and reporting of causes of death; morbidity coding and reporting, including primary care; casemix and diagnosis-related grouping (DRG); assessing and monitoring the safety, efficacy and quality of care; research and performance of clinical trials and epidemiological studies; assessing functioning; and clinical documentation (https://icd.who.int).

The ICD-11 has 17,000 codes and more than 120,000 codable terms. It is entirely digital and accessible to everybody. It is available (by now) in English, Spanish, Chinese, Arabic and French.

The Clinical Descriptions and Diagnostic Requirements (CDDR) for mental health, corresponding to the Clinical Descriptions and Diagnostic Guidelines (CDDG) of the ICD-10, are an integral part of the ICD-11. They cover 20 groupings of disorders: Neurodevelopmental Disorders, Schizophrenia or Other Primary Psychotic Disorders, Catatonia, Mood Disorders, Anxiety or Fear-Related Disorders, Obsessive-Compulsive or Related Disorders, Disorders Specifically Associated with Stress, Dissociative Disorders, Feeding or Eating Disorders, Elimination Disorders, Disorders of Bodily Distress or Bodily Experience, Disorders Due to Substance Use or Addictive Behav­iours, Impulse Control Disorders, Disrup­tive Behaviour or Dissocial Disorders, Per­sonality Disorders and Related Traits, Para­philic Disorders, Factitious Disorders, Neu­rocognitive Disorders, Psychological or Be­havioural Factors Affecting Disorders or Dis­eases Classified Elsewhere, and Secondary Mental or Behavioural Syndromes Associated with Disorders or Diseases Classified Elsewhere.

For each category included in each of these groupings, there are sections on Es­sen­tial (Required) Features, Additional Clin­­­ical Features, Boundary with Normality (Threshold), Course Features, Developmental Pres­en­tations, Culture-Related Features, Sex- and/or Gender-Related Features, and Boundaries with Other Disorders and Conditions (Differential Diagnosis).

The development of the CDDR, to which WPA experts have extensively contributed (including through chairmanship of several Workgroups), is regarded as the most broadly international and participative pro­­cess ever implemented for a classification of mental disorders¹. The main differences between the CDDR and the DSM-5 diagnostic criteria, and the main contentious issues that have been debated in the development of the CDDR, have been extensively dealt with in this journal^2-13.

The finalization of the CDDR has been preceded by a vast programme of international field studies. These included Internet-based and clinic-based studies. The Internet-based field studies were implemented through the WHO Global Clinical Practice Network (https://gcp.network). This now includes more than 16,000 clinicians from 159 countries (51% psychiatrists, 30% psychologists; 40% from Europe, 25% from Western Pacific, 24% from the Americas, 5% from Southeast Asia, 3% from Eastern Mediterranean, and 3% from Africa; 63% from high-income countries, 37% from middle- and low-income countries). The clinic-based field studies were conducted with the participation of WHO Collaborating Centres. An Internet-based field study¹⁴ in a sample of 928 health professionals from all WHO regions found that, on average, the ICD-11 CDDR for ten selected mental disorders displayed significantly higher diagnostic accuracy (71.9% vs. 53.2%), as well as higher ease of use, higher clarity, better goodness of fit, and lower time required for diagnosis, compared to ICD-10 CDDG.

An international training programme focusing on the CDDR is now being implemented. A first comprehensive online 20-hr training course was organized by the Naples WHO Collaborating Centre on Research and Training in Mental Health and the European Psychiatric Association from 9 to 30 April, 2021. The course was coordinated by G.M. Reed and M. Maj, and covered several sections of the CDDR (Schizophrenia or Other Primary Psychotic Disorders, Mood Disorders, Anxiety or Fear-Related Disorders, Obsessive-Compulsive or Related Disorders, Disorders Specifically Associated with Stress, Feeding or Eating Disorders, Disorders Due to Substance Use or Addictive Behaviours, and Personality Disorders). W. Gaebel, M. Cloitre, M. Maj, C.S. Kogan, P. Monteleone, M. Swales, J.B. Saunders and N.A. Fineberg composed the Faculty. The live course was attended by 120 psychiatrists, selected from almost 500 applicants, representing 78 different countries. A further group of 250 psychiatrists had access to the course on demand.

A training course with exclusive access to the members of the WHO Global Clinical Practice Network has been set up by the WHO Collaborating Centre at Columbia University, in collaboration with the WHO Department of Mental Health and Substance Use. The course consists of 15 online training units, each focusing on a different disorder grouping and taking from 1 to 1.5 hours. Each unit provides a description of the relevant diagnostic grouping and the main innovations with respect to the ICD-10. Knowledge check questions are provided to ensure comprehension. Participants have the opportunity to practice by applying diagnostic guidelines to clinical case examples.

A training course co-organized by the WPA and the Global Mental Health Academy, with a structure similar to the course organized by the Naples WHO Collaborating Centre and the European Psychiatric Association, but with access also to psychologists and primary care practitioners, took place online from 8 to 29 November, 2021.

A WHO International Advisory Group on Training and Implementation for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders has been established to develop and evaluate educational, train­ing and implementation processes related to the ICD-11 in various countries. WPA former officers who contributed to the development of the CDDR – such as M. Maj, W. Gaebel and D. Stein – are members of this Advisory Group.

第 11 版国际疾病分类 (ICD-11) 已于 2022 年 1 月 1 日生效。现在将要求世界卫生组织 (WHO) 的所有会员国使用这一新版本的分类报告他们的发病率和死亡率统计。已经提供了一个实施包以促进从 ICD-10 到 ICD-11 的过渡。

ICD-11 由 26 章组成，对应于疾病组，以及用于功能评估的补充部分（第 V 章）。第 6 章是关于精神、行为或神经发育障碍的。为睡眠-觉醒障碍（第 7 章）和与性健康相关的病症（第 17 章）提供了单独的章节。除了 ICD-10 中已有的关于损伤、中毒或某些其他外部原因后果的章节（第 22 章）和关于影响健康状况或与卫生服务联系的因素（第 24 章）之外，还有一个关于传统医学的新补充章节添加了条件（第 26 章）。

设计分类的主要用途包括：死因的证明和报告；发病率编码和报告，包括初级保健；病例组合和诊断相关分组（DRG）；评估和监测护理的安全性、有效性和质量；临床试验和流行病学研究的研究和执行；评估功能；和临床文件 (https://icd.who.int)。

ICD-11 有 17,000 个代码和超过 120,000 个可编码术语。它完全是数字化的，每个人都可以访问。它（目前）有英文、西班牙文、中文、阿拉伯文和法文版本。

与 ICD-10 的临床描述和诊断指南 (CDDG) 相对应的心理健康临床描述和诊断要求 (CDDR) 是 ICD-11 的组成部分。它们涵盖 20 组障碍：神经发育障碍、精神分裂症或其他原发性精神病、紧张症、情绪障碍、焦虑或恐惧相关障碍、强迫症或相关障碍、与压力特别相关的障碍、解离障碍、进食或进食障碍、消除障碍、身体不适或身体体验障碍、由于物质使用或成瘾行为引起的障碍、冲动控制障碍、破坏性行为或反社会障碍、人格障碍和相关特征、性欲障碍、人为障碍、神经认知障碍、

对于每个分组中包含的每个类别，都有关于基本（必需）特征、附加临床特征、正常边界（阈值）、课程特征、发育演示、文化相关特征、性别和/或性别相关的部分其他疾病和病症的特征和边界（鉴别诊断）。

CDDR 的制定得到了 WPA 专家的广泛贡献（包括通过担任多个工作组的主席），被认为是有史以来为精神障碍分类实施的最广泛的国际性和参与性过程¹。CDDR 和 DSM-5 诊断标准之间的主要区别，以及在 CDDR 发展过程中争论的主要争议问题，已在本期刊^2-13中进行了广泛讨论。

在完成 CDDR 之前，有一个庞大的国际实地研究计划。这些包括基于互联网和临床的研究。基于互联网的实地研究是通过世卫组织全球临床实践网络 (https://gcp.network) 实施的。这现在包括来自 159 个国家的 16,000 多名临床医生（51% 的精神科医生，30% 的心理学家；40% 来自欧洲，25% 来自西太平洋，24% 来自美洲，5% 来自东南亚，3% 来自东地中海，3 % 来自非洲；63% 来自高收入国家，37% 来自中低收入国家）。以临床为基础的实地研究是在世卫组织合作中心的参与下进行的。基于互联网的实地研究¹⁴在来自世卫组织所有区域的 928 名卫生专业人员的样本中发现，平均而言，ICD-11 CDDR 对 10 种选定的精神疾病的诊断准确度显着提高（71.9% 对 53.2%），并且易于使用，更高与 ICD-10 CDDG 相比，清晰度、更好的拟合度和更短的诊断时间。

目前正在实施一项以 CDDR 为重点的国际培训计划。2021 年 4 月 9 日至 30 日，那不勒斯世卫组织心理健康研究和培训合作中心和欧洲精神病学协会组织了第一个 20 小时综合在线培训课程。该课程由 GM Reed 和 M. Maj 协调，以及涵盖了 CDDR 的几个部分（精神分裂症或其他原发性精神障碍、情绪障碍、焦虑或恐惧相关障碍、强迫症或相关障碍、与压力特别相关的障碍、进食或进食障碍、物质使用或成瘾行为引起的障碍和人格障碍）。W. Gaebel、M. Cloitre、M. Maj、CS Kogan、P. Monteleone、M. Swales、JB Saunders 和 NA Fineberg 组成了学院。从代表 78 个不同国家的近 500 名申请者中选出的 120 名精神科医生参加了现场课程。另外一组 250 名精神科医生可以按需访问该课程。

哥伦比亚大学的世卫组织合作中心与世卫组织精神卫生和物质使用部合作，开设了一个面向世卫组织全球临床实践网络成员的培训课程。该课程由 15 个在线培训单元组成，每个单元侧重于不同的障碍分组，时间为 1 到 1.5 小时。每个单元都提供了有关 ICD-10 的相关诊断分组和主要创新的描述。提供知识检查问题以确保理解。参与者有机会通过将诊断指南应用于临床案例来进行实践。

由 WPA 和全球心理健康学院共同组织的培训课程，其结构类似于那不勒斯世卫组织合作中心和欧洲精神病学协会组织的课程，但也可以访问心理学家和初级保健从业者，在网上进行2021 年 11 月 8 日至 29 日。

已经成立了一个世卫组织 ICD-11 精神、行为和神经发育障碍培训和实施国际咨询小组，以制定和评估各国与 ICD-11 相关的教育、培训和实施过程。为 CDDR 的发展做出贡献的 WPA 前官员——例如 M. Maj、W. Gaebel 和 D. Stein——是该咨询小组的成员。