Automated ICD Classification of Psychiatric Diagnoses: From Classical NLP to Large Language Models

Mental health has become a global priority, leading to a massive administrative burden in the coding of clinical diagnoses. This study proposes the automation of psychiatric diagnostic analysis by mapping free-text descriptions to the International Classification of Diseases (ICD) using Natural Language Processing (NLP) and Machine Learning (ML) techniques. Utilizing a specialized dataset of 145,513 Spanish psychiatric descriptions, various text representation paradigms were evaluated, ranging from classical frequency-based models (BoW, TF-IDF) to state-of-the-art Large Language Models (LLMs) such as e5large, BioLORD, and Llama-3-8B. Results indicate that transformer-based embeddings consistently outperform traditional methods by capturing implicit semantic cues and nuanced medical terminology. The e5large model, through end-to-end fine-tuning, achieved the highest performance with a F1micro score of 0.866. This research demonstrates that adapting LLMs to specific clinical nomenclature is essential for overcoming the challenges of ``long-tail'' label distributions and the inherent ambiguity of psychiatric discourse.