The ICD-11, the first major revision of the ICD in three decades, was approved by the 72nd World Health Assembly in May 2019, and came into effect as a basis for reporting of health statistics by World Health Organization (WHO) member states in January 2022. Countries around the world are in various stages of implementing the ICD-11 in their clinical and health information systems, a process that will continue for the next several years.

The WHO has now taken a major step towards the implementation of the ICD-11 in mental health systems by publishing the Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders (CDDR)¹.

The CDDR are designed as a comprehensive diagnostic manual that will support mental health and other health professionals in accurately diagnosing mental disorders in health care settings across the world. They provide consistent, clinically useful information for all diagnostic categories in the ICD-11 chapter on mental, behavioural and neurodevelopmental disorders. This information includes the features that clinicians can expect to see in all cases of the disorder (essential features), their boundaries with normality (threshold) and other conditions (differential diagnosis), and features related to course, developmental stage, gender and culture. Although a diagnostic manual had been published for the ICD-10, the CDDR represent a substantial expansion and improvement in the consistency of information provided, the integration of systematic information related to developmental stage, gender and culture, and more careful attention to differential diagnosis², in addition to being based on current research and best practices.

For the WHO Department of Mental Health and Substance Use, a central goal in developing the ICD-11 CDDR was to provide a better tool for reducing the global burden of mental disorders. Based on this goal, we focused explicitly on clinical utility and global applicability – in addition to validity – in the CDDR's development³. An accurate diagnosis is often the first critical step towards receiving appropriate care and treatment. A more clinically useful diagnostic manual that is more applicable in settings across the world is more likely to be implemented systematically, supporting both the earlier identification of those who need care and the selection of effective treatment. In turn, this will improve the quality of health data aggregated from clinical encounters that are used to guide policy and allocate resources at facility, system, national and global levels.

To develop the CDDR, the Department appointed sixteen expert working groups in different areas, ensuring through their composition a multidisciplinary process that represented all WHO regions, including a substantial proportion of individuals from low- and middle-income countries. In developing proposals for the ICD-11, these working groups conducted rigorous reviews of the evidence, including work done as a part of the development of the DSM-5.

Further, proposed diagnostic requirements for the ICD-11 were extensively tested in a systematic program of field studies. The Global Clinical Practice Network (GCPN) was set up to enable the participation of clinicians in the development of the CDDR, and now consists of more than 19,000 mental health and primary care professionals from 165 countries. GCPN members participated in 20 Internet-based field studies to test the CDDR, each conducted in up to six languages^{3, 4}. The CDDR were also tested among patients in clinical settings in 15 countries, representing all WHO regions and nearly 50% of the world's population. These studies documented broad improvements in reliability and clinical utility when clinicians used the ICD-11 CDDR as compared to the equivalent diagnostic guidance for ICD-10.

The ICD-11 and the CDDR incorporate important innovations. These include new disorder categories that describe populations with clinically important and distinctive features and specific treatment needs, substantially contributing to an expansion of related research and a significant increase in the availability of appropriate services⁵. Other categories have been eliminated due to their lack of validity. The ICD-11 and the CDDR have made a significant movement toward dimensional conceptualizations of mental disorders, especially in psychotic and personality disorders⁶.

In order to implement the ICD-11 and the CDDR, there is a huge need for workforce capacity-building for both specialist and non-specialist providers of services. The implementation of the ICD-11 also represents the most important opportunity in a generation to reform the diagnostic process, incorporating the needs and perspectives of those who receive our care⁸. The WHO will need the collaboration and support of member states, professional societies (importantly including the World Psychiatric Association), WHO Collaborating Centres, academic institutions, non-governmental organizations, civil society and service user organizations to ensure an implementation of the ICD-11 that fulfils its potential. The CDDR should be systematically integrated into training programs for mental health and primary care professionals, and a range of more specialized materials should be developed for this purpose⁹.

The CDDR are the product of more than 15 years of collaborative work led by the WHO Department of Mental Health and Substance Use within the context of the overall development of the ICD-11. Hundreds of experts and thousands of clinicians from around the world were involved in developing and testing the CDDR as part of the most international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders.

With the publication of the CDDR, health professionals have a better tool for identifying mental health conditions; WHO member states have a better tool for reducing the disease burden associated with mental disorders; and people who need mental health services have a greater likelihood of receiving the care they need.

ICD-11 是 ICD 三十年来的首次重大修订，于 2019 年 5 月获得第 72 届世界卫生大会批准，并于 2022 年 1 月作为世界卫生组织 （WHO） 会员国报告卫生统计数据的基础生效。世界各国正处于在其临床和卫生信息系统中实施 ICD-11 的不同阶段，这一过程将在未来几年内持续。

WHO 现已通过发布 ICD-11 精神、行为和神经发育障碍 （CDDR） 的临床描述和诊断要求 （CDDR） 1，向在精神卫生系统中实施 ICD-11 迈出了重要一步。

CDDR 旨在作为一本全面的诊断手册，将支持心理健康和其他卫生专业人员准确诊断世界各地医疗保健环境中的精神障碍。它们为 ICD-11 章节中关于精神、行为和神经发育障碍的所有诊断类别提供了一致的、临床有用的信息。这些信息包括临床医生在所有疾病病例中可以看到的特征（基本特征）、它们与正常状态（阈值）和其他疾病（鉴别诊断）的界限，以及与病程、发育阶段、性别和文化相关的特征。尽管已经出版了 ICD-10 的诊断手册，但 CDDR 除了基于当前的研究和最佳实践外，还代表了所提供信息一致性的实质性扩展和改进，整合了与发育阶段、性别和文化相关的系统信息，并更加仔细地关注鉴别诊断²。

对于 WHO 精神卫生和物质使用司来说，制定 ICD-11 CDDR 的一个中心目标是为减轻全球精神障碍负担提供更好的工具。基于这一目标，除了有效性之外，我们还明确关注 CDDR 开发中的临床效用和全球适用性³。准确的诊断通常是获得适当护理和治疗的第一步。更适用于世界各地环境的更具临床用途的诊断手册更有可能得到系统实施，从而支持早期识别需要护理的人和选择有效的治疗方法。反过来，这将提高从临床就诊中汇总的健康数据的质量，这些数据用于指导政策并在设施、系统、国家和全球层面分配资源。

为了制定 CDDR，该部在不同领域任命了 16 个专家工作组，确保通过他们的组成形成一个代表 WHO 所有区域的多学科进程，包括来自低收入和中等收入国家的很大一部分个人。在为 ICD-11 制定提案时，这些工作组对证据进行了严格的审查，包括作为 DSM-5 开发的一部分所做的工作。

此外，ICD-11 的诊断要求在系统的现场研究计划中进行了广泛测试。全球临床实践网络 （GCPN） 的成立是为了让临床医生能够参与 CDDR 的开发，现在由来自 165 个国家/地区的 19,000 多名心理健康和初级保健专业人员组成。GCPN 成员参与了 20 项基于互联网的实地研究，以测试 CDDR，每项研究以多达六种语言进行^{3， 4}。CDDR 还在 15 个国家/地区的临床环境中对患者进行了测试，这些患者代表了 WHO 的所有区域和近 50% 的世界人口。这些研究记录了与 ICD-10 的等效诊断指南相比，临床医生使用 ICD-11 CDDR 时，可靠性和临床实用性得到了广泛的改善。

ICD-11 和 CDDR 融合了重要的创新。这些包括新的疾病类别，这些类别描述了具有临床重要性和独特特征以及特定治疗需求的人群，极大地促进了相关研究的扩展和适当服务可用性的显着增加⁵。其他类别由于缺乏有效性而被删除。ICD-11 和 CDDR 已经朝着精神障碍的维度概念化迈出了重大进展，尤其是在精神病和人格障碍⁶ 中。

为了实施 ICD-11 和 CDDR，专业和非专业服务提供者都迫切需要劳动力能力建设。ICD-11 的实施也代表了一代人改革诊断过程的最重要机会，纳入接受我们护理的人的需求和观点⁸。WHO 需要会员国、专业协会（重要的是包括世界精神病学协会）、WHO 合作中心、学术机构、非政府组织、民间社会和服务用户组织的合作和支持，以确保 ICD-11 的实施能够发挥其潜力。CDDR 应系统地整合到心理健康和初级保健专业人员的培训计划中，并为此目的开发一系列更专业的材料⁹。

CDDR 是 WHO 心理健康和物质使用司在 ICD-11 整体开发背景下领导的超过 15 年合作工作的产物。来自世界各地的数百名专家和数千名临床医生参与了 CDDR 的开发和测试，这是有史以来为精神障碍分类实施的最具国际化、多语言、多学科和参与性的修订过程的一部分。

随着 CDDR 的发布，卫生专业人员拥有了更好的工具来识别心理健康状况;世卫组织会员国有更好的工具来减轻与精神障碍相关的疾病负担;需要心理健康服务的人更有可能获得他们需要的护理。