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ICD-10 - Mood/Affective Disorders

Posted by Dr.K@meleon Labels:

[From World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Copyright, World Health Organization, Geneva, 1993.] ...

Manic episode
Hypomania
  1. The mood is elevated or irritable to a degree that is definitely abnormal for the individual concerned and sustained for at least 4 consecutive days.
  2. At least three of the following signs must be present, leading to some interference with personal functioning in daily living:
    1. increased activity or physical restlessness;
    2. increased talkativeness;
    3. distractibility or difficulty in concentration;
    4. decreased need for sleep;
    5. increased sexual energy;
    6. mild overspending, or other types of reckless or irresponsible behavior;
    7. increased sociability or overfamiliarity.
  3. The episode does not meet the criteria for mania, bipolar affective disorder, depressive episode, cyclothymia, or anorexia nervosa.
  4. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
Mania without psychotic symptoms
  1. Mood must be predominantly elevated, expansive, or irritable, and definitely abnormal for the individual concerned. The mood change must be prominent and sustained for at least 1 week (unless it is severe enough to require hospital admission).
  2. At least three of the following signs must be present (four if the mood is merely irritable), leading to severe interference with personal functioning in daily living:
    1. increased activity or physical restlessness;
    2. increased talkativeness (“pressure of speech”);
    3. flight of ideas or the subjective experience of thoughts racing;
    4. loss of normal social inhibitions, resulting in behavior that is inappropriate to the circumstances;
    5. decreased need for sleep;
    6. inflated self-esteem or grandiosity;
    7. distractibility or constant changes in activity or plans;
    8. behavior that is foolhardy or reckless and whose risks the individual does not recognize, e.g., spending sprees, foolish enterprises, reckless driving;
    9. marked sexual energy or sexual indiscretions.
  3. There are no hallucinations or delusions, although perceptual disorders may occur (e.g., subjective hyperacusis, appreciation of colors as especially vivid).
  4. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
Mania with psychotic symptoms
  1. The episode meets the criteria for mania without psychotic symptoms with the exception of Criterion C.
  2. The episode does not simultaneously meet the criteria for schizophrenia or schizoaffective disorder, manic type.
  3. Delusions or hallucinations are present, other than those listed as typically schizophrenic in Criterion G1(1)b, c, and d for schizophrenia (i.e., delusions other than those that are completely impossible or culturally inappropriate, and hallucinations that are not in the third person or giving a running commentary). The commonest examples are those with grandiose, self-referential, erotic, or persecutory content.
  4. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
Specify whether the hallucinations or delusions are congruent or
incongruent with the mood:
With mood-congruent psychotic symptoms (such as grandiose delusions or voices telling the individual that he or she has superhuman powers)
With mood-incongruent psychotic symptoms (such as voices speaking to the individual about affectively neutral topics, or delusions of reference or persecution)
Other manic episodes
Manic episode, unspecified
Bipolar affective disorder
Note. Episodes are demarcated by a switch to an episode of opposite mixed polarity or by a remission.
Bipolar affective disorder, current episode hypomanic
  1. The current episode meets the criteria for hypomania.
  2. There has been at least one other affective episode in the past, meeting the criteria for hypomanic or manic episode, depressive episode, or mixed affective episode.
Bipolar affective disorder, current episode manic without psychotic symptoms
  1. The current episode meets the criteria for mania without psychotic symptoms.
  2. There has been at least one other affective episode in the past, meeting the criteria for hypomanic or manic episode, depressive episode, or mixed affective episode.
Bipolar affective disorder, current episode manic without psychotic symptoms
  1. The current episode meets the criteria for mania without psychotic symptoms.
  2. There has been at least one other affective episode in the past, meeting the criteria for hypomanic or manic episode, depressive episode, or mixed affective episode.
Specify whether the psychotic symptoms are congruent or incongruent with the mood:
With mood-congruent psychotic symptoms
With mood-incongruent psychotic symptoms
Bipolar affective disorder, current episode moderate or mild depression
  1. The current episode meets the criteria for a depressive episode of either mild or moderate severity.
  2. There has been at least one other affective episode in the past, meeting the criteria for hypomanic or manic episode, depressive episode, or mixed affective episode.
Specify the presence of the “somatic syndrome” in the current episode of depression:
Without somatic syndrome
With somatic syndrome
Bipolar affective disorder, current episode severe depression without psychotic symptoms
  1. The current episode meets the criteria for a severe depressive episode without psychotic symptoms.
  2. There has been at least one well-authenticated hypomanic or manic episode or mixed affective episode in the past.
Bipolar affective disorder, current episode severe depression with psychotic symptoms
  1. The current episode meets the criteria for a severe depressive episode without psychotic symptoms.
  2. There has been at least one well-authenticated hypomanic or manic episode or mixed affective episode in the past.
Specify whether the psychotic symptoms are congruent or incongruent with the mood:
With mood-congruent psychotic symptoms
With mood-incongruent psychotic symptoms
Bipolar affective disorder, current episode mixed
  1. The current episode is characterized by either a mixture or a rapid alternation (i.e., within a few hours) of hypomanic, manic, and depressive symptoms.
  2. Both manic and depressive symptoms must be prominent most of the time during a period of at least 2 weeks.
  3. There has been at least one well-authenticated hypomanic or manic episode, depressive episode, or mixed affective episode in the past.
Bipolar affective disorder, currently in remission
  1. The current state does not meet the criteria for depressive or manic episode of any severity or for any other mood [affective] disorder (possibly because of treatment to reduce the risk of future episodes).
  2. There has been at least one well-authenticated hypomanic or manic episode in the past and in addition at least one other affective episode (hypomanic or manic, depressive, or mixed).
Other bipolar affective disorders
Bipolar affective disorder, unspecified
Depressive episode
G1. The depressive episode should last for at least 2 weeks.
G2. There have been no hypomanic or manic symptoms sufficient to meet the criteria for hypomanic or manic episode at any time in the individual's life.
G3. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
Somatic syndrome
Some depressive symptoms are widely regarded as having special clinical significance and are here called “somatic.” (Terms such as biological, vital, melancholic, or endogenomorphic are used for this syndrome in other classifications.)
A fifth character may be used to specify the presence or absence of the somatic syndrome. To qualify for the somatic syndrome, four of the following symptoms should be present:
  1. marked loss of interest or pleasure in activities that are normally pleasurable;
  2. lack of emotional reactions to events or activities that normally produce an emotional response;
  3. waking in the morning 2 hours or more before the usual time;
  4. depression worse in the morning;
  5. objective evidence of marked psychomotor retardation or agitation (remarked on or reported by other people);
  6. marked loss of appetite;
  7. weight loss (5% or more of body weight in the past month);
  8. marked loss of libido.
In The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines, the presence or absence of the somatic syndrome is not specified for severe depressive episode, since it is presumed to be present in most cases. For research purposes, however, it may be advisable to allow for the coding of the absence of the somatic syndrome in severe depressive episode.
Mild depressive episode
  1. The general criteria for depressive episode must be met.
  2. At least two of the following three symptoms must be present:
    1. depressed mood to a degree that is definitely abnormal for the individual, present for most of the day and almost every day, largely uninfluenced by circumstances, and sustained for at least 2 weeks;
    2. loss of interest or pleasure in activities that are normally pleasurable;
    3. decreased energy or increased fatigability.
  3. An additional symptom or symptoms from the following list should be present, to give a total of at least four:
    1. loss of confidence or self-esteem;
    2. unreasonable feelings of self-reproach or excessive and inappropriate guilt;
    3. recurrent thoughts of death or suicide, or any suicidal behavior;
    4. complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation;
    5. change in psychomotor activity, with agitation or retardation (either subjective or objective);
    6. sleep disturbance of any type;
    7. change in appetite (decrease or increase) with corresponding weight change.
A fifth character may be used to specify the presence or absence of the “somatic syndrome”:
Without somatic syndrome
With somatic syndrome
Moderate depressive episode
  1. The general criteria for depressive episode must be met.
  2. At least two of the three symptoms listed for Criterion B above must be present.
  3. Additional symptoms from depressive episode, Criterion C, must be present, to give a total of at least six.
A fifth character may be used to specify the presence or absence of the “somatic syndrome”:
Without somatic syndrome
With somatic syndrome
Severe depressive episode without psychotic symptoms
Note: If important symptoms such as agitation or retardation are marked, the patient may be unwilling or unable to describe many symptoms in detail. An overall grading of severe episode may still be justified in such a case.
  1. The general criteria for depressive episode must be met.
  2. All three of the symptoms in Criterion B, depressive episode, must be present.
  3. Additional symptoms from depressive episode, Criterion C, must be present, to give a total of at least eight.
  4. There must be no hallucinations, delusions, or depressive stupor.
Severe depressive episode with psychotic symptoms
  1. The general criteria for depressive episode must be met.
  2. The criteria for severe depressive episode without psychotic symptoms must be met with the exception of Criterion D.
  3. The criteria for schizophrenia or schizoaffective disorder, depressive type, are not met.
  4. Either of the following must be present:
    1. delusions or hallucinations, other than those listed as typically schizophrenic in Criterion G1(1)b, c, and d for general criteria for paranoid, hebephrenic, catatonic, and undifferentiated schizophrenia (i.e., delusions other than those that are completely impossible or culturally inappropriate and hallucinations that are not in the third person or giving a running commentary), the commonest examples are those with depressive, guilty, hypochondriacal, nihilistic, self-referential, or persecutory content
    2. depressive stupor
A fifth character may be used to specify whether the psychotic symptoms are congruent or incongruent with mood:
With mood-congruent psychotic symptoms (i.e., delusions of guilt, worthlessness, bodily disease, or impending disaster, derisive or condemnatory auditory hallucinations)
With mood-incongruent psychotic symptoms (i.e., persecutory or self-referential delusions and hallucinations without an affective content)
Other depressive episodes
Episodes should be included here which do not fit the descriptions given for depressive episodes, but for which the overall diagnostic impression indicates that they are depressive in nature. Examples include fluctuating mixtures of depressive symptoms (particularly those of the somatic syndrome) with nondiagnostic symptoms such as tension, worry, and distress, and mixtures of somatic depressive symptoms with persistent pain or fatigue not due to organic causes (as sometimes seen in general hospital services).
Depressive episode, unspecified
Recurrent depressive disorder
G1. There has been at least one previous episode, mild, moderate, or severe, lasting a minimum of 2 weeks and separated from the current episode by at least 2 months free from any significant mood symptoms.
G2. At no time in the past has there been an episode meeting the criteria for hypomanic or manic episode.
G3. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
It is recommended that the predominant type of previous episodes is specified (mild, moderate, severe, uncertain).
Recurrent depressive disorder, current episode mild
  1. The general criteria for recurrent depressive disorder are met.
  2. The current episode meets the criteria for mild depressive episode.
A fifth character may be used to specify the presence or absence of the “somatic syndrome,” in the current episode:
Without somatic syndrome
With somatic syndrome
Recurrent depressive disorder, current episode moderate
  1. The general criteria for recurrent depressive disorder are met.
  2. The current episode meets the criteria for moderate depressive episode.
A fifth character may be used to specify the presence or absence of the “somatic syndrome.” in the current episode:
Without somatic syndrome
With somatic syndrome
Recurrent depressive disorder, current episode without psychotic symptoms
  1. The general criteria for recurrent depressive disorder are met.
  2. The current episode meets the criteria for severe depressive episode without psychotic symptoms.
Recurrent depressive disorder, current episode severe with psychotic symptoms
  1. The general criteria for recurrent depressive disorder are met.
  2. The current episode meets the criteria for severe depressive episode with psychotic symptoms.
A fifth character may be used to specify whether the psychotic symptoms are congruent or incongruent with the mood:
With mood-congruent psychotic symptoms
With mood-incongruent psychotic symptoms
Recurrent depressive disorder, currently in remission
  1. The general criteria for recurrent depressive disorder have been met in the past.
  2. The current state does not meet the criteria for a depressive episode of any severity or for any other disorder in mood [affective] disorders.
Comment
This category can still be used if the patient receives treatment to reduce the risk of further episodes.
Other recurrent depressive disorders
Recurrent depressive disorder, unspecified
Persistent mood [affective] disorders
Cyclothymia
  1. There must have been a period of at least 2 years of instability of mood involving several periods of both depression and hypomania, with or without intervening periods of normal mood.
  2. None of the manifestations of depression or hypomania during such a 2-year period should be sufficiently severe or long-lasting to meet criteria for manic episode or depressive episode (moderate or severe); however, manic or depressive episode(s) may have occurred before, or may develop after, such a period of persistent mood instability.
  3. During at least some of the periods of depression at least three of the following should be present:
    1. reduced energy or activity;
    2. insomnia;
    3. loss of self-confidence or feelings of inadequacy;
    4. difficulty in concentrating;
    5. social withdrawal;
    6. loss of interest in or enjoyment of sex and other pleasurable activities;
    7. reduced talkativeness;
    8. pessimism about the future or brooding over the past.
  4. During at least some of the periods of mood elevation at least three of the following should be present:
    1. increased energy or activity;
    2. decreased need for sleep;
    3. inflated self-esteem;
    4. sharpened or unusually creative thinking;
    5. increased gregariousness;
    6. increased talkativeness or wittiness;
    7. increased interest and involvement in sexual and other pleasurable activities;
    8. overoptimism or exaggeration of past achievements.
Note. If desired, time of onset may be specified as early (in late teenage or the 20s) or late (usually between age 30 and 50 years, following an affective episode).
Dysthymia
  1. There must be a period of at least 2 years of constant or constantly recurring depressed mood. Intervening periods of normal mood rarely last for longer than a few weeks, and there are no episodes of hypomania.
  2. None, or very few, of the individual episodes of depression within such a 2-year period should be sufficiently severe or long-lasting to meet the criteria for recurrent mild depressive disorder.
  3. During at least some of the periods of depression at least three of the following should be present:
    1. reduced energy or activity;
    2. insomnia;
    3. loss of self-confidence or feelings of inadequacy;
    4. difficulty in concentrating;
    5. frequent tearfulness;
    6. loss of interest in or enjoyment of sex and other pleasurable activities;
    7. feeling of hopelessness or despair;
    8. a perceived inability to cope with the routine responsibilities of everyday life;
    9. pessimism about the future or brooding over the past;
    10. social withdrawal;
    11. reduced talkativeness.

Note. If desired, time of onset may be specified as early (in late teenage or the 20s) or late (usually between age 30 and 50 years, following an affective episode).
Other persistent mood [affective] disorders
This is a residual category for persistent affective disorders that are not sufficiently severe or long-lasting to fulfill the criteria for cyclothymia or dysthymia but that are nevertheless clinically significant. Some types of depression previously called “neurotic” are included here, provided that they do not meet the criteria for either cyclothymia or dysthymia or for depressive episode of mild or moderate severity.
Persistent mood [affective] disorder, unspecified Other mood [affective] disorders
There are so many possible disorders that could be listed that no attempt has been made to specify criteria, except for mixed affective episode and recurrent brief depressive disorder. Investigators requiring criteria more exact than those available in Clinical Descriptions and Diagnostic Guidelines should construct them according to the requirements of their studies.
Other single mood [affective] disorders
Mixed affective episode
  1. The episode is characterized by either a mixture or a rapid alternation (i.e., within a few hours) of hypomanic, manic, and depressive symptoms.
  2. Both manic and depressive symptoms must be prominent most of the time during a period of at least 2 weeks.
  3. There is no history of previous hypomanic, depressive, or mixed episodes.
Other recurrent mood [affective] disorders
Recurrent brief depressive disorder
  1. The disorder meets the symptomatic criteria for mild, moderate, or severe depressive episode.
  2. The depressive episodes have occurred about once a month over the past year.
  3. The individual episodes last less than 2 weeks (typically 2–3 days).
  4. The episodes do not occur solely in relation to the menstrual cycle.
Other specified mood [affective] disorders
This is a residual category for affective disorders that do not meet the criteria for any other categories above.


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