Mental and Behavioural Health Clinical Reference Group

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Mental and Behavioural Health CRG

2021.10.04

Attendees

Apologies

Discussion items

ItemDescriptionOwnerNotesAction
1PhobiaPiper Allyn Ranallo Elaine Wooler

386808001 |Phobia (finding)| - Descriptions

FSN:     Phobia (finding)

PT:       Phobia

SYN:     Abnormal fear

SYN:     Fear of

Suggest that synonyms of the type – Fear of X should be inactivated as these aren’t synonymous with phobia.  If appropriate a new concept created under 1402001 |Fear (finding)|.

Is "abnormal fear' correct or could this be better expressed?

There are also subtypes of 386808001 |Phobia (finding)| that do not seem to be phobias and have no description with the word phobia present e.g. 288251000119107 |Fear of injury (finding)| - which may well be rational for example in someone who is frail.

Review notes from previous discussion in Mar 2020:

  • Phobia findings , move from |Phobia (finding)| => | Fear (finding)|
    • ‘Irrational fear of X’ as FSN for concepts under phobia finding that are clinical findings only 
  • Phobic disorders
    • ‘Phobic disorder’ for FSN of concepts that represent true phobic disorders
    • ‘Phobia of X’ for preferred term

SYN: Fear of

  •  Agreed that 'Fear of' is not synonymous with phobia, and descriptions should be inactivated as not semantically equivalent
  •  Agreed that 'fear of' concepts are valid as distinct concepts that should be created under 1402001 |Fear (finding)|
  •  Consensus that the thing that distinguishes an irrational fear (finding) from phobia (disorder) is that response to the feared stimulus is 'maladaptive'  ('abnormal' could apply to both, since the response is irrational)
  •  Consensus that the thing that distinquishes |Fear (finding)| from | Irrational fear (finding)| is that the fear in the latter is  irratiional (see below) (this could be more clearly defined later)
  •  Based on claim matrix below,  288251000119107 |Fear of injury (finding)| would be a | Fear (finding) | not a a phobia
  •  Elaine Woolerwill make changes in template
  •  Piper Allyn Ranallo will send list of concepts identified by the CRG as 'fear' v. 'irrational fear' v 'phobia' in previous review
  •  Piper Allyn Ranallo will create list of concepts that have a relationship to  somataform/ psychogenic/ hysterical/ illness anxiety concepts for review on next call (10/18/2021)
  •  Piper Allyn Ranallo will create list of concepts that were tabled during last review - also for review on next call (10/18/2021)

Claims Matrix:

2Fearful mood/Fear

Elaine Wooler

Siblings 1402001 | Fear (finding) and 367545001 | Fearful mood (finding)
The distinction between these two concepts seems difficult to justify in day to day clinical practice and the modelling is identical for both.

All but one of the 59 descendants of 367545001 | Fearful mood (finding) are also descendants of 1402001 | Fear (finding) with the exception of 231508009 | Examination fear (finding)

It is suggested that 367545001 | Fearful mood (finding) is inactivated as a duplicate of 1402001 | Fear (finding) which would be the preferred FSN representation.  

Options:

  • Optiion 1: Inactivate | Fearful mood (finding) |   as a duplicate of 1402001 | Fear (finding) |
  • Option 2: Keep  | Fearful mood (finding) | to represent the idea of  a longer duration / baseline emotional state of 'fear' and move any child concepts of  | Fearful mood (finding) |  that reflect fearful state (versus fearful mood) under concept  | Fear (finding) |

For existing child concepts of |Fearful mood (finding)|

  •  Inactivate is-a relationship to |Fearful mood (finding)| 
  •  Add is-a relationship to | Fear (finding)|

For concept  |Fear (finding)|

  •  Remove is-a relationship to | Mood finding (finding) | 
  •  In need of further discussion: Create is-a relationship to | Emotional state finding (finding) |   OR create a new concept | Emotion  (finding) | for emotion in the broadest sense - emotion state, mood, affect, etc.

For concept | Fearful mood (finding) |, keep it for now

  •  Add is-a relationship to | Fear (finding| to capture the quality of the mood




Notes:

CRG discussed the ambiguity inherent in the use of the terms 'mood', 'emotion', 'affect'; terms are used inconsistently in practice, in theories, in the literature, and in text books.

Questions asked:

  • Should SNOMED included concepts for all possible meanings of these terms and focus on FSNs, narrative defs, and explicitly modeling that makes the nuanced distinctions clear? (Does not meet URU criteria)
  • Should SNOMED include the core concept (e.g., emotion) and none of the nuanced distinctions with the understanding that the concept when captured can only be assumed to mean "any or all" of the many definitions clinicians have in mind when using the concept? (meets URU crtieria)
  • Agreed that this is a bigger piece of work that require more reserach, discussion, and therefore will table for now







3Anxiety

Piper Allyn Ranallo Elaine Wooler

For later discussion:

What is the relationship between 

  • Emotion  (finding) 
  • Emotional state (finding)

One option:




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