ICD - 10 Classifications Flashcards
Depressive episode
Symptoms should be for at least 2 weeks
At least two of the following core symptoms:
Depressed mood
Loss of interest and enjoyment
Reduced energy or increased fatigability
AND…
At least two of the following:
Reduced concentration and attention
Reduced self-esteem and self confidence
Ideas of guilt and unworthiness
Bleak and pessimistic views of the future
Ideas or acts of self-harm or suicide
Disturbed sleep
Diminished appetite
Severity
Mild: Total of 4 or more symptoms
Moderate: Total of 5 (preferably 6) or more symptoms
Severe: Total of 7 or more symptoms including all 3 core symptoms
Severe with psychotic symptoms: In cases with delusions, hallucinations or stupor
Diagnostic guidelines for schizophrenia
One or more of the following symptoms:
1) Thought echo, insertion, withdrawal or broadcast
2) Delusions of control or passivity; delusional perception
3) Hallucinatory voices, giving a running commentary discussing the patient amongst
themselves
4) Bizarre delusions
OR
Two or more of the following symptoms:
1) Other hallucinations that either occur every day for weeks or that are associated
with fleeting delusions or sustained overvalued ideas
2) Thought disorganisation (loosening of association, incoherence, neologisms)
3) Catatonic symptoms
4) Negative symptoms
5) Change in personal behaviour (loss of interest, aimlessness, social withdrawl)
Symptoms should be present for most of the time for at least 1 month
Schizophrenia should not be diagnosed in the presence of organic brain disease or during
drug intoxication or withdrawal
Obsessive compulsive disorder
1) Obsessions or compulsions must be present for at least 2 successive weeks and are a
source of distress or interfere with the patients functioning
2) They are acknowledged as coming from the patient’s own mind
3) The obsessions are unpleasantly repetitive
4) At least one thought or act is resisted unsuccessfully
5) Compulsive act is not in itself pleasurable
Personality disorder (DSM 4)
Cluster A
Cluster A. ‘Odd or eccentric’
Paranoid: Suspects others are exploiting, harming or deceiving them. Doubts about spouse’s
fidelity, bears grudges, tenacious sense of personal rights, litigious
Schizoid personality disorder: Emotional coldness, neither enjoys nor desires close or sexual
relationships; prefers solitary activities; takes pleasure in few activities; indifferent to praise
or criticism
Schizotypal personality disorder: Eccentric behaviour; odd beliefs or magical thinking;
unusual perceptual experiences (e.g sensing another’s presence); ideas of reference,
suspicious or paranoid ideas, vague or circumstantial thinking, social withdrawal
Personality disorder (DSM)
Cluster B
Cluster B. ‘Dramatic, emotional, erratic’
Borderline EUPD. Unstable, intense relationships (fluctuating between extremes of
idealisation and devaluation), unstable self-image, impulsivity (sex, binge eating, substance
abuse, spending money), repetitive suicidal or self harm behaviour, fluctuations in mood,
frantic effort to avoid abandonment (real or imagined), transient paranoid ideation,
dissociation
Antisocial (dissocial) personality disorder: Repeated unlawful or aggressive behaviour,
deceitfulness, lying, reckless, irresponsibility, lack of remorse or incapacity to experience
guilt, often have conduct disorder in childhood
Histrionic personality disorder: Dramatic exaggerated expressions of emotion, attention
seeking, seductive behavior, labile shallow emotions
Narcissistic personality disorder: Grandiose sense of self-importance, need for admiration
Personality disorder
Cluster C
Dependent personality disorder: Excessive need to be cared for, submissive, clinging
behavior, needs others to assume responsibility for major life areas, fear of separation
Avoidant (anxious) personality disorder: Hypersensitivity to critical remarks or rejection,
inhibited in social situations, fears of inadequacy
Obsessive-compulsive personality disorder: Preoccupation with orderliness, perfectionism
and control, devoted to work at expense of leisure, pedantic, rigid and stubborn, overly
cautious
F20 – F 29 Schizophrenia, schizotypal and delusional disorder
F20
A single core symptom, or at least two secondary symptoms, present for greater than one
month:
Core symptoms
Thought withdrawal, insertion, broadcasting or echo
Hallucinations of voices giving running commentary or discussing the person or originating
from a body part
Delusions of control, influence, passivity or delusional perception.
Secondary symptoms
Thought form has breaks or interpolations – incoherence or irrelevant speech
Hallucinations in any sensory modality that are persistent and accompanied by fleeting
delusions
Catatonic features. Negative features
Schizophrenia is a psychotic disorder characterised by a collection of positive symptoms
(delusions, hallucinations and thought disorder), negative symptoms (7 As) and behaviour
deterioration with social sequelae
Seven As of negative symptoms of schizophrenia: Alogia, Avolition, Apathy, Affective
flattening, Anhedonia, Asociality and attentional impairment.
Subtypes of schizophrenia
F20 – Paranoid schizophrenia
Delusions (not necessarily persecutory) and hallucinations (usually auditory) are the
prominent features
Thought disorder and negative symptoms are less prominent
This is the most common subtype
Hebephrenic schizophrenia
Symptoms should be observed for three months
Prominent symptoms are thought disorder with loosening of associations and disorganised
behaviour characterised by inappropriate and fatuos giggling and odd mannerisms
Onset in adolescent with a progressive course leading to rapid delelopment of negative
symptoms, social incapacitation and poor self care
Recovery from first episode is rare
DSM 4 recognises this subtype as disorganised schizophrenia
Simple schizophrenia
Symptoms should be present for at least 12 months
Prominence of negative symptoms – socially withdrawn, poor planning and initiation and
limited emotional reactivity
Delusions and hallucinations are not prominent often absent
The course is often early onset in teenage years, with a progressive decline, leading to
marked social drift. Prognosis is poor
F22 Persistent delusional disorder
Symptoms lasting longer than three months:
Delusions make up almost the entirety of the psychopathology
Delusions must be personal, beyond subcultural
Depression may be present, provided it doesn’t exclude the experience of delusions
Exclusion – no organic brain disease, infrequent hallucinations, no first rank symptoms of
schizophrenia
Other acute psychotic disorders
F32 Acute and transient psychotic disorder
Acute onset – lasting between two weeks and one month
Acute stressor must be identified
F23 – Acute polymorphic psychotic disorder without symptoms of schizophrenia – acute
onset, less than two weeks where hallucination or delusion are markedly variable, changing
type and intensity from day to day
F23.1- Acute polymorphic psychotic disorder with symptoms of schizophrenia
F23.2- Acute schizophrenia like psychotic disorder
F25- Schizoaffective disorder – symptoms of schizophrenia and affective disorder
simultaneously.
F30 Manic episode
Must be a single episode with no previous affective episodes.
Symptoms for seven days, fewer if requiring hospitalisation. Distinctly abnormal level of
elevated mood or irritability
AND interference in personal functioning in daily living of at least three areas (or four if
mood is irritable)
- Physical restlessness
- Pressured speech
- Flight of ideas
- Loss of normal social inhibitions
- Decrease need for sleep
- Grandiosity
- Distractibility
- Reckless spending or other behaviour
- Marked sexual indiscretions
AND not attributed to substance use or other more appropriate diagnosis
F30.0 Hypomania
Symptoms for four days leading to interference but not complete disruption with work:
Elevated or irritable mood
AND notable increase in physical or mental activity in three or more areas:
- Physical restlessness
- Increased talkativeness
- Distractibility
- Decreased need for sleep
- Increased sexual energy
- Overspending or irresponsible behavior
- Increased sociability or over familiarity
AND not attributable to substance use or other more appropriate diagnosis.
DSM 4 states hypomania occurs without interfering with occupational or social functioning
F31 Bipolar affective disorder
A disorder of two or more authenticated affective episodes, either hypomanic/manic and/or
severe depressive episode. Has a tendency for remission and recurrence
DSM-V subtypes
Type 1- One or more authenticated manic episodes, depression is common but not
necessary for the diagnosis
Type 2- One or more hypomanic episodes; major depressive episode is necessary for the
diagnosis
Cyclothymia – hypomanic episodes with depression that doesn’t reach criteria for a major
depressive episode.
The highs of cyclothymia include symptoms of an elevated mood (hypomanic symptoms).
The lows consist of mild or moderate depressive symptoms.Cyclothymia symptoms are
similar to those of bipolar I or II disorder, but they're less severe. Can progress to Bipolar
Rapid cycling bipolar affective disorder
More common in females
4 or more affective episodes per year
Prevelance of 10-20% of bipolar diagnoses
Tends to develop in the course of bipolar
Increased suicide risk, significant life events and alcohol
When Rapid Cycling occurs, it means thatfour or more manic, hypomanic, or depressive
episodes have taken place within a twelve-month period.
F33 Recurrent depressive disorder
Repeated episodes of depression as specifies in depressive episode, without any episodes of
that fulfil the criteria of mania
F34- Cyclothymia
Persistent instability of mood, involving numerous periods of mild depression and mild
elation, not fulfilling the criteria for manic episode or depressive episode.
