ICD-10 criteria

Question 1

What are the 7 ICD-10 classifications of affective disorders?

Answer 1

1. Manic episode: including hypomania, mania without psychotic symptoms and mania with psychotic symptoms.
2. Bipolar affective disorder.
3. Depressive episode: including mild, moderate, severe and severe with psychotic symptoms.
4. Recurrent depressive disorder.
5. Persistent mood disorders: cyclothymia, dysthymia.
6. Other mood disorders.
7. Unspecified mood disorder.

Question 2

Describe ICD-10 classification of depression

Answer 2

Mild depression = 2 core symptoms + 2 other symptoms
Moderate depression = 2 core symptoms + 3– 4 other symptoms
Severe depression = 3 core symptoms + ≥4 other symptoms
Severe depression with psychosis = 3 core symptoms + ≥4 other symptoms + psychosis

Question 3

What are the core, cognitive, biological and psychotic symptoms of depression?

Answer 3

Core: Anhedonia, low mood (present for at least 2 wks), lack of energy
Cogntive: Lack of concentration, negative thoughts, excessive guilt, suicidal ideation (Recurrent thoughts of death, recurrent suicidal ideation without a specific plan. Negative views about oneself)

Biological:
Diurnal variation in mood (low moof more pronounced at certain times of the day)
early morning wakening (2hrs earlier than usual.)
Loss of libido
psychomotor retardation
weight loss and loss of appetite

Psychotic: Hallucinations (usually second person auditory hallucinations)
Delusions (usually hypochondriacal, guilt, nihilistic or persecutory in nature)

Question 4

ICD-10 criteria for mania and BPAD?

Answer 4

Mania requires 3/9 symptoms to be present: (1) Grandiosity/inflated self-esteem; (2) Decreased sleep; (3) Pressure of speech; (4) Flight of ideas; (5) Distractibility; (6) Psychomotor agitation (restlessness); (7) Reckless behaviour, e.g. spending sprees, reckless driving; (8) Loss of social inhibitions (leading to inappropriate behaviour); (9) Marked sexual energy.

Mania - symptoms present for >1wks, with complete disruption of work and social activities.
May have grandiose ideas and excessive spending could lead to debts. There may be sexual disinhibition and reduced sleep may lead to exhaustion

Hypomania - Mildly elevated mood or irritable mood present for ≥4 days . Symptoms of mania, where present, are to a lesser extent than true mania. Considerable interference with work and social life but not severe disruption . Partial insight may be preserved.

Bipolar affective disorder requires at least two episodes in which a person’s mood and activity levels are significantly disturbed – one of which MUST be mania or hypomania .

ICD-10 divides bipolar disorder into five states : (1) Currently hypomanic; (2) Currently manic; (3) Currently depressed; (4) Mixed Disorder; (5) In remission.

Question 5

ICD-10 classification of schizophrenia and other psychotic disorders?

Answer 5

1. Schizophrenia
2. Schizotypal disorder
3. Persistent delusional disorder
4. Acute and transient psychotic disorders
5. Induced delusional disorder
6. Schizoaffective disorder
7. Other non-organic psychotic disorders
8. Unspecified non-organic psychosis

Question 6

ICD-10 classification of schizophrenia?

Answer 6

Paranoid schizophrenia - Most common. Dominated by positive symptoms (hallucinations and delusions). Postschizophrenic depression - Depression predominates with schizophrenic illness in the past 12 months with some schizophrenia symptoms still present.
Hebephrenic schizophrenia - Thought disorganization predominates. Onset of illness is earlier (15– 25) and has poorer prognosis.
Catatonic schizophrenia - Rare form characterized by one or more catatonic symptoms .
Simple schizophrenia - Rare form where negative symptoms develop without psychotic symptoms.
Undifferentiated schizophrenia - Meets diagnostic criteria for schizophrenia but does not conform to any of the other subtypes.
Residual schizophrenia - 1 year of chronic negative symptoms preceded by a clear-cut psychotic episode.

Question 7

ICD-10 criteria for schizophrenia?

Answer 7

At least one very clear symptom from Group A (A– D) or two or more from Group B (E– H) for at least 1 month or more. Schizophrenia should not be diagnosed in the presence of organic brain disease.

Group A:
A. Thought echo/insertion/withdrawal/ broadcast.
B. Delusions of control, influence or passivity phenomenon.
C. Running commentary auditory hallucinations.
D. Bizarre persistent delusions.

Group B:
E. Hallucinations in other modalities that are persistent.
F. Thought disorganization (loosening of associations, neologisms, incoherence).
G. Catatonic symptoms.
H. Negative symptoms.

Question 8

ICD-10 classification of neurotic and stress-related disorders?

Answer 8

1. Phobic anxiety disorders: Agoraphobia (with or without panic disorder), social phobia, specific phobia.
2. Other anxiety disorders: Panic disorder, generalized anxiety disorder, mixed anxiety and depressive disorder.
3. Obsessive– compulsive disorder: Predominantly obsessional thoughts, predominantly compulsive thoughts, mixed.
4. Reaction to severe stress and adjustment disorders: Acute stress reaction, post-traumatic stress disorder, adjustment disorder.

Question 9

ICD-10 criteria for GAD?

Answer 9

A. A period of at least 6 months with prominent tension , worry and feelings of apprehension about everyday events and problems.
B. At least four of the following symptoms with at least one symptom of autonomic arousal :
Symptoms of autonomic arousal: palpitations , sweating , shaking/tremor , dry mouth .
Other symptoms:
Symptoms concerning chest and abdomen: Difficulty breathing, Feeling of choking, Chest pain or discomfort, Nausea, Abdominal distress or pain, Loose motions.
Symptoms concerning the brain and mind: Feeling dizzy or light headed, Fear of dying, Fear of losing control, Derealization and depersonalization.
General symptoms: Hot flushes or cold chills, Numbness or tingling, Headache.
Symptoms of tension: Muscle tension, aches or pains ; Restlessness ; Feeling on edge ; Difficulty swallowing ; Sensation of lump in throat.
Non-specific symptoms: Being startled ; Concentration difficulty and mind blanks ; Persistent irritability ; Sleep problems

Question 10

ICD-10 criteria for Agoraphobia?

Answer 10

A. Marked and consistently manifest fear in , or avoidance of, at least two of the following:
1. Crowds
2. Public spaces
3. Travelling alone
4. Travelling away from home
B. Symptoms of anxiety in the feared situation with at least two symptoms present together (and at least one symptom of autonomic arousal) (GAD symptoms)
C. Significant emotional distress due to the avoidance, or anxiety symptoms. Recognized as excessive or unreasonable .
D. Symptoms restricted to (or predominate in) feared situation .

Question 11

ICD-10 criteria for social phobia?

Answer 11

A. Marked fear ( or marked avoidance ) of being the focus of attention , or fear of acting in a way that will be embarrassing or humiliating.

B. At least two symptoms of anxiety in the feared situation plus one of the following:

1. Blushing
2. Fear of vomiting
3. Urgency or fear of micturition/defecation

C. Significant emotional distress due to the avoidance or anxiety symptoms.

D. Recognized as excessive or unreasonable .

E. Symptoms restricted to (or predominate in) feared situation .

Question 12

ICD-10 criteria for specific phobia?

Answer 12

A. Marked fear ( or avoidance ) of a specific object or situation that is not agoraphobia or social phobia.
B. Symptoms of anxiety in the feared situation
C. Significant emotional distress due to the avoidance or anxiety symptoms. Recognized as excessive or unreasonable .
D. Symptoms restricted to the feared situation

Question 13

ICD-10 criteria for diagnosis of panic disorder?

Answer 13

A. Recurrent panic attacks that are not consistently associated with a specific situation or object , and often occur spontaneously . The panic attacks are not associated with marked exertion or with exposure to dangerous or life-threatening situations.

B. Characterized by ALL of the following:

(1) Discrete episode of intense fear or discomfort ;
(2) Starts abruptly ;
(3) Reaches a crescendo within a few minutes and lasts at least some minutes;
(4) At least one symptom of autonomic arousal : palpitations, sweating, shaking/ tremor, dry mouth;
(5) Other symptoms: GAD symptoms

Question 14

ICD-10 criteria for PTSD?

Answer 14

A. Exposure to a stressful event or situation of extremely threatening or catastrophic nature (would likely cause distress in almost anyone).

B. Persistent remembering (‘reliving’) of the stressful situation.

C. Actual or preferred avoidance of similar situations resembling or associated with the stressor.

D. Either (1) or (2)

1. Inability to recall some important aspects of the period of exposure to the stressor.
2. Persistent symptoms of increased psychological sensitivity and arousal .

E. Criteria B, C & D all occur within 6 months of the stressful event, or the end of a period of stress

Question 15

ICD-10 criteria for OCD?

Answer 15

A. Either obsessions or compulsions (or both) present on most days for a period of at least 2 weeks .

B. Obsessions (thoughts, ideas or images) or compulsions (acts) share a number of features (see Clinical features ), ALL of which must be present.

C. The obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning, usually by wasting time.

NOTE: The diagnosis can be specified as ‘predominantly obsessional thoughts or ruminations’, ‘predominantly compulsive acts’, or ‘mixed obsessional thoughts and acts’.

Question 16

ICD-10 categories of dissociative disorder?

Answer 16

Dissociative amnesia - Amnesia, either partial or complete for recent events or problems that were traumatic or stressful. Too extensive and persistent to be explained by ordinary forgetfulness.

Dissociative fugue - An unexpected physical journey away from usual surroundings followed by amnesia for the journey. Self-care is maintained.
Dissociative stupor - Profound reduction in, or absence of, voluntary movements, speech and normal responses to stimuli. Normal muscle tone.

Trance and possession disorders -
Trance: temporary alteration in state of consciousness.
Possession: absolute conviction by the patient that they have been taken over by a spirit, power or person.

Dissociative motor disorders - Loss of the ability to perform movements that are under voluntary control (including speech) or ataxia.

Dissociative convulsions - Sudden, unexpected spasmodic movements that resemble epilepsy but without loss of consciousness.

Dissociative anaesthesia and sensory loss - Partial or complete loss of cutaneous sensation, vision, hearing or smell.

Question 17

ICD-10 categories for somatoform disorders?

Answer 17

Persistent somatoform pain disorder 
Undifferentiated somatoform disorder 
Somatization disorder
Hypochondriacal disorder (including body dysmorphic disorder) 
SOMATOFORM autonomic dysfunction

Question 18

ICD-10 criteria for somatization disorder?

Answer 18

Somatization disorder requires all four to be present:
A. At least 2 years’ duration of physical symptoms that cannot be explained by any detectable physical disorder .

B. Preoccupation with symptoms causes physical distress which leads to them seeking repeated medical consultations and requesting investigations .

C. Continuous refusal by patients to accept reassurance from doctors that there is no physical cause for their symptoms.

D. A total of six or more symptoms:

GI: Abdo pain, N+V, bloating, regurgitation, loose bowel motions, swallowing difficulty
CVS - chest pain, breathlessness, palpitations
Genitourinary - dysuria, frequency, incontinence, vaginal discharge, menstrual problems
Others: Discolouration or itching of skin, Arthralgia, Paraesthesia in limbs, Headaches, Visual disturbance

Question 19

ICD-10 criteria for anorexia nervosa?

Answer 19

FEED
Fear of weight gain

Endocrine disturbance resulting in amenorrhoea in females and loss of sexual interest and potency in males.

Emaciated (abnormally low body weight): >15% below expected weight or BMI <17.5 kg/m 2 .

Deliberate weight loss with ↓ food intake or ↑ exercise.

Distorted body image

NOTE: The above features must be present for at least 3 months and there must be the ABSENCE of

(1) recurrent episodes of binge eating ;
(2) preoccupation with eating/craving to eat

Question 20

ICD-10 criteria for bulimia nervosa?

Answer 20

Bulimia Patients Fear Obesity

1. Behaviours to prevent weight gain (compensatory) - Compensatory weight loss behaviours include: self-induced vomiting , alternating periods of starvation , drugs (laxatives, diuretics, appetite suppressants, amphetamines, and thyroxine), and excessive exercise - diabetics may omit or reduce insulin dose
2. Preoccupation with eating - A sense of compulsion (craving) to eat which leads to bingeing.
3. Fear of fatness - There is typically regret or shame after an episode.
4. Overeating - Including a self-perception of being too fat. At least two episodes per week over a period of 3 months

Question 21

ICD-10 criteria for substance misuse?

Answer 21

1. Acute intoxication: The acute, usually transient, effect of the substance.
2. Harmful use: Recurrent misuse associated with physical, psychological and social consequences, but without dependence.
3. Dependence syndrome (see Key facts 1 ): Prolonged, compulsive substance use leading to addiction, tolerance and the potential for withdrawal syndromes.
4. Withdrawal state: Physical and/or psychological effects from complete (or partial) cessation of a substance after prolonged, repeated or high level of use.
5. Psychotic disorder: Onset of psychotic symptoms within 2 weeks of substance use. Must persist for more than 48 hours .
6. Amnesic syndrome: Memory impairment in recent memory (impaired learning of new material) and ability to recall past experiences. Also defect in recall, clouding of consciousness and global intellectual decline.
7. Residual disorder: Specific features (flashbacks, personality disorder, affective disorder, dementia, persisting cognitive impairment) subsequent to substance misuse.

Question 22

ICD-10 criteria for alcohol intoxication?

Answer 22

A. General criteria for acute intoxication met:

(1) clear evidence of psychoactive substance use at high dose levels;
(2) disturbance in consciousness, cognition, perception or behaviour;
(3) not accounted for by medical or mental disorder.

B. Evidence of dysfunctional behaviour: disinhibition, argumentativeness, aggression, labile mood, impaired attention/concentration, interference with personal functioning. One of following signs: unsteady gait, difficulty standing, slurred speech, nystagmus, flushing, ↓ consciousness, conjunctival injection.

Question 23

ICD-10 criteria for alcohol withdrawal?

Answer 23

A. General criteria for a withdrawal state met:

(1) clear evidence of recent cessation or reduction of substance after prolonged or high level usage;
(2) not accounted for by medical or mental disorder.

B. Any three of the following: tremor, sweating, nausea/vomiting, tachycardia/ ↑ BP, headache, psychomotor agitation, insomnia, malaise, transient hallucinations, grand mal convulsions.

Question 24

ICD-10 criteria for delirium?

Answer 24

Impairment of consciousness and attention 
Global disturbance in cognition 
Psychomotor disturbance 
Disturbance of sleep-wake cycle 
Emotional disturbances.

Question 25

ICD-10 classification of dementia?

Answer 25

A. Evidence of the following:

1. A decline in memory , which is most evident in the learning of new information, although in more severe cases, the recall of previously learned information may also be affected.
2. A decline in other cognitive abilities , characterized by deterioration in judgement and thinking , such as planning and organizing, and in the general processing of information.

B. Preserved awareness of the environment for a period of time long enough to demonstrate (A).

C. A decline in emotional control or motivation , or a change in social behaviour , manifested by one of the following:

(1) Emotional lability ;
(2) Irritability ;
(3) Apathy ;
(4) Coarsening of social behaviour .

D. For a confident diagnosis (A) must have been present for at least 6 months .

Question 26

ICD-10 classification for alzheimer’s?

Answer 26

A. The general criteria for dementia A– D must be met.
B. No evidence for any other possible cause of dementia or systemic disorder.

Early onset Alzheimer’s disease
A. General criteria for Alzheimer’s met and age of onset is <65.
B. At least one of the following must be met:
(1) relatively rapid onset and progression;
(2) in addition to memory impairment there is aphasia , agraphia ( ↓ ability to communicate through writing), alexia ( ↓ ability to read), acalculia ( ↓ ability to perform mathematical tasks) or apraxia .

Late onset Alzheimer’s disease
A. General criteria for Alzheimer’s met and age of onset is >65.
B. At least one of the following must be met:
(1) slow, gradual onset and progression;
(2) predominance of memory impairment over intellectual impairment.

Question 27

ICD 10 criteria for autism Dx?

Answer 27

A. Presence of abnormal or impaired development before the age of three .
B. Qualitative abnormalities in social interaction .
C. Qualitative abnormalities in communication .
D. Restrictive, repetitive and stereotyped patterns of behaviour, interests and activities.
E. The clinical picture is not attributable to other varieties of pervasive developmental disorder.

Question 28

ICD 10 criteria for hyperkinetic disorder Dx?

Answer 28

A. Demonstrable abnormality of attention , activity and impulsivity at home , for the age and developmental level of the child.

B. Demonstrable abnormality of attention and activity at school or nursery (if applicable), for the age and developmental level of the child.

C. Directly observed abnormality of attention or activity. This must be excessive for the child’s age and developmental level.

D. Does not meet criteria for a pervasive developmental disorder, mania, depressive or anxiety disorder.

E. Onset before the age of 7 years .

F. Duration of at least 6 months .

G. IQ above 50.