What is New in the ICD-11 on Mental, Behavioural or Neurodevelopmental Disorders Structure of Chapter 06 The hierarchy of Chapter 06 comprises: 1st level - Broad category of disease/disorder type 2nd level - Specific disease/disorder type 3rd level - Further specificity of disease/disorder type The Rationale for Chapter 06 Since the time of the Advisory Group’s initial appointment in 2007, the overall linear structure of the proposed mental, behavioural, or neurodevelopmental disorders chapter for ICD–11 has been the subject of substantive and comprehensive discussions by the Topic Disorders Advisory Group for Mental Health, as well as extensive interactions with the American Psychiatric Association concerning the just-published Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (1), from the time of the Advisory Group’s initial appointment in 2007. The architecture of diagnostic classification of mental and behavioural disorders is an issue that has rec

Childhood Disintegrative Disorder: Clinical Features and Diagnostic Criteria Waleed Ahmad Published online by MRCPsych UK: Tuesday, 03 May 2022 Introduction There is a loss of skills in several areas of development and deficits in social, communicative, and behavioural functioning that follow normal development in this condition. Often the condition follows a prodromic period during which children develop obscure symptoms; they become restive, irritable, anxious, and overactive. Impoverishment follows this and then loss of speech and language, accompanied by behavioural disintegration. Sometimes the loss of skills is persistently progressive (especially if there is an underlying progressive neurological condition), but more often, the decline over some months and then a slight improvement. The prognosis is usually abysmal, and it leaves most individuals with severe intellectual disability. There is uncertainty about the extent to which this condition differs from autism. Sometimes, th

Fragile X Syndrome Fragile x syndrome is characterised by large ears, velvety skin, flat feet, testicular enlargement after puberty, speech “cluttered” attentional deficit, hand flapping. Autistic traits. CGG repeats over two hundred. Support –MDT. Speech and language, physio, psychological techniques for teachers/parents, look at educational needs. family support –carers' assessment. Genetic Aberration A mutation on the X chromosome at the Xq27.3 site.  Fragile-X mental retardation -1 Gene FMR1 is a human gene that codes for a protein called Fragile-X mental retardation protein (FMRP) that may help regulate synaptic plasticity, important for learning and memory.  Prevalence 1 of every 1,000 males 1 of every 2,000 females Intellectual disability Mild to severe. Eighty per cent of boys with fragile X syndrome have an intelligence quotient lower than 80. Co-morbidities Attention deficit hyperactivity, learning disorders, autism spectrum disorders Physical Features long face, long ear

A 16-year-old girl presents with multiple unconsciousness. These started about six months ago and have become progressively worse. During the episodes, there is the jerky movement of the body but no urinary or faecal incontinence. These symptoms last for a few minutes and are followed by drowsiness. Neurological examination is normal. What differential diagnoses would you consider in this case? What other information would you enquire from the family about the episodes? Which specific investigations would you like to order? Differential Diagnosis Conversion disorder (F44.5 Dissociative convulsions) suggested by the episodes of unconsciousness and lack of findings on neurological examination and absence of incontinence. Epilepsy suggested by the recurrent brief episodes of unconsciousness, accompanied by jerky movements and followed by drowsiness Vasovagal syncope suggested by the brief episodes of unconsciousness, jerky movements (may occur) and normal physical examination Paroxysmal a

 Schizotypal Personality Disorder  Scenario During an informal gathering, a teacher at a medical school discusses with you a first-year student who has just moved away from his parents to a hostel. The teacher states that he behaves strangely and tries to avoid socialisation. He does not have any friends but passes his time with video games. He sometimes enjoys spiritual activities and shows interest in magic. When a colleague tried to make fun of him, he resented a lot and lodged a written complaint with the principal. The parents state he is like this since his former life and has always been "different" but a "good" child. His academic record varies from average to above average. What is the most likely diagnosis? What psychodynamic factors may have contributed? What are the risk factors for developing this disorder? Diagnosis  Schizotypal disorder/schizotypal personality disorder Risk factors This is more frequent among biological relatives of individuals with s

Cluttering A rapid rate of speech  with a breakdown in fluency, Speech is irregular, with rapid, jerky bursts that include broken phrasing patterns There are no repetitions or hesitations of severity to give rise to reduced speech intelligibility.  F98.6  

Normal speech dysfluency whole-word or phrase repetitions (e.g., 'I want, I want an apple"),  incomplete phrases,  interjections,  unfilled pauses,  parenthetical remarks.  If these difficulties increase in frequency or complexity as the child grows older, a diagnosis of childhood-onset fluency disorder is appropriate