After making important advances in diagnostic reliability, the field of psychiatry seems to be turning its attention back to diagnostic validity. In psychiatric nosology two parallel efforts seem to be taking place: one, addressed at the development of a truly international system for classifying psychiatric disorders, and a second one, concerned with the incorporation of cultural variables in the formulation of the psychiatric diagnosis in order to make it more useful for treatment planning and health promotion. These efforts are not merely academic, they are necessary for clinical practice, as ethnic and cultural diversity of those seeking mental health services increase around the world, especially in developed societies, such as the United States.<sup>11Guarnacia P.J., Rogler L.H. Research on culture-bound syndromes: New directions American Journal of Psychiatry 1999 ;  156 : 1322-1327

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Among recent efforts to update diagnostic validity, existing universalistic diagnostic systems are being examined critically in order to pay closer attention to local realities and the uniqueness of the individual patient. The first type of these developments involves adaptations of the international classification system to regional or national clinical patterns and needs.<sup>21Mezzich J.E., Otero-Ojeda A., Lee S. International psychiatric diagnosis Kaplan & Sadock's Comprehensive textbook of psychiatry Philadelphia: Lippincott, Williams & Wilkins (2000).  839-853

Haga clic aquí para ir a la sección de Referencias</sup> A second one is the recognition of the practical importance of making contextual factors an important part of the diagnostic formulation, including the perspectives of the patient and his or her family, as recently proposed by the World Psychiatric Association.<sup>40World Psychiatric Association  Essentials of the International Guidelines for Psychiatric Diagnosis. Technical Report New York: World Psychiatric Association (2000). 

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The ICD-10 Classification of Mental and Behavioral Disorders<sup>37World Health Organization  International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) Geneva: Author (1992). 

Haga clic aquí para ir a la sección de Referencias</sup> is being accepted currently by most countries and by the World Psychiatric Association as the international standard in the field for statistical reporting and for clinical care and research. Emerging now is the need to harmonize international communication with recognition of cultural diversity and specific local requirements. Developers of the United States classification system in psychiatry have admitted that “specific and consistent attention to the role of culture in presentation and diagnosis is an innovation of DSM-IV.”<sup>10Davis W., Widiger T.A., Frances A.J., y al. Introduction to final volume DSM-IV Sourcebook, vol. 4 Washington: American Psychiatric Association (1998).  1-15

Haga clic aquí para ir a la sección de Referencias</sup> They go on to recognize that this reflects their concern on the misapplication in different countries and ethnic populations of a diagnostic system that, like any other, is a product of the specific cultural and socioeconomic forces of the specific setting in which it has been developed. A consequence of this recognition of culture by North American nosologists is the inclusion, in the description of disorders in DSM-IV, of information on “the ways in which varied cultural backgrounds affect the content and form of the symptom presentation.”<sup>6American Psychiatric Association  Diagnostic and Statistical Manual of Mental Disorder, ed 4, (DSM-IV) Washington, DC: Author (1994). 

Haga clic aquí para ir a la sección de Referencias</sup> Another is the inclusion of a Cultural Formulation Outline in DSM-IV.<sup>19Mezzich J.E., Kleinman A., Fabrega H., y al.   Culture and Psychiatric Diagnosis: A DSM-IV Perspective Washington, DC: American Psychiatric Press (1996). 

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