Bipolar disorder in the International Classification of Diseases-Eleventh version: A review of the changes, their basis, and usefulness

Table 7 Considerations guiding the notion of clinical utility in the International Classification of Diseases, 11^th version

Concept	Application to the ICD-11 CDDR
Working definition	Clinical utility of the classification and its categories includes the ability to facilitate communication among clinicians, having characteristics that help clinical practice (diagnostically accurate, easy to use, and feasible), and containing guidance for appropriate treatment choices[141,142]
Why clinical utility?	Validity is not a pragmatic goal; enhanced diagnostic reliability has not led to increased validity[143,144]. Current classifications have several shortcomings and are not useful in real-world settings[11,37,142]
Levels of utility	Clinical utility has two levels including the architectural or organizational level and the category level[24,141], utility should focus on both the levels and emphasize coverage, description of attributes, and ease of use[145]
Application to healthcare settings	The need for utility is the greatest during clinical encounters in routine practice settings. The classification must provide information of value to the clinician in these situations[9-11,13,146]
Public health utility	Consideration must be given to the features of the classification that enhance global applicability and reduce global mental health burden[9,147]
Contextual aspects	Utility is context-specific; it depends on the purpose for which a classification is used, clinical, research, or for public health[9,10,146]
Utility and scientific validity	Clinical utility has to go hand-in hand with the scientific evidence. Moreover, compromising the scientific basis of the classification to meet the needs of clinical utility has to be avoided as far as possible. There is considerable overlap between clinical utility and predictive validity and sometimes it is difficult to distinguish between them[105,145,147]
Greater emphasis on clinical utility in the ICD-11	1Clinical utility as the ultimate organizing principle is not a new notion, but the ICD-11 has paid the greatest systematic attention to this aspect[10,147,148]
Improving clinical utility in the ICD-11	Clinical utility has been the guiding principle at all the stages, from the evidence review, to content formation, and to the field trials. The standardized template or content-form was structured to enhance clinical utility. Working Groups were asked to consider the clinical utility of the changes suggested. The protype-based approach contributed to enhanced clinical utility. Cross-cultural usefulness was addressed. The ICD-11 field-trial studies used methodology specifically designed to examine clinical utility in naturalistic settings. The results of these studies have been used to improve the revision further[9-13]

¹Similarities between the ICD-11 and the DSM-5 in this regard are shown in Table 1.

ICD-11: International Classification of Diseases, 11^th version, CDDR-Clinical Descriptions and Diagnostic Requirements ICD-11[8].