Evaluation of the Applicability and Usefulness of the Latin American Guide for Psychiatric Diagnosis, Revised Version, in Comparison with other International Systems among Latin American Psychiatrists

Abstract

Background: The Latin American Guide to Psychiatric Diagnosis, Revised Version (GLADP-VR) represents an adaptation of the ICD-10 that seeks through a biopsychosocial approach to better reflect the holistic framework and culture of Latin American countries. This revision of the original GLADP included updated Latin American annotations and a new integrated diagnostic model centered on the person. Objectives: The aim of this study was to evaluate among Latin American psychiatrists the levels of applicability and usefulness of the GLADP-VR in comparison with major international diagnostic classification systems. Method: The survey evaluation instrument included questions about fundamental characteristics of a useful diagnostic guide and comparative questions about the acceptability and usefulness of the GLADP-VR, the original ICD-10, DSM-IV and DSM-5, and suggestions to improve the guide. The sample included 127 Latin American psychiatrists with an interest on Diagnosis and Classification and membership in one of the 17 national psychiatric societies affiliated with Latin American Psychiatric Association (APAL). They were sent the evaluation instrument by e-mail. Thirty-seven (29.1%) responses were obtained. There were no indications of demographic bias among respondents and no-respondents.The vast majority of respondents answered the questionnaire completely. Ninety-two percent reported knowing the GLADP-VR before the survey and 65.6% had actually used it before.Results: The most commonly used diagnostic system was the original ICD-10 (86.5%), followed by the GLADP-VR (56.8%). Regarding applicability, the diagnostic system recognized as the most user-friendly was the ICD-10 followed by the GLADP-VR, with the most difficult being the DSM-5. Concerning diagnostic accuracy, the GLADP-VR was found most useful; and the DSM-5 was least useful. Regarding usefulness for clinical care and professional practice, the ICD-10 was rated highest, followed by the GLADP-VR, and lowest was DSM-5. The least valued in this regard was the DSM-5. Regarding usefulness for yielding a complete view of the clinical situation, the GLADP-VR was best (83.3%), and DSM-5 was the lowest. Concerning cultural and psychosocial contextualization, the GLADP-VR was considered most useful, well above ICD-10 and the DSMs. Furthermore, the GLADP-VR was considered more useful for teaching and research by about 80% of psychiatrists, superior to the other diagnostic systems.Discussion: The findings of this study on the most prevalent use of ICD-10 are consistent with the results of a survey conducted earlier by the World Psychiatric Association across the world. In addition, in the present study less than half of the respondents used regularly the DSMs. The findings of the present study concerning the GLADP-VR were quite consistent with the corresponding findings of an earlier preliminary evaluation of the GLADP-VR. This seems to be related to the GLADP-VR comprehensive personalized diagnostic formulation with various components, including narratives. Conclusions: There are indications that the GLADP-VR is seen in Latin America as having higher diagnostic accuracy, yielding a comprehensive view of the clinical situation and its context, and more suitable for teaching, research, and work in community mental health.