Wednesday, July 30, 2014

Neurotic, stress-related and somatoform disorders ICD 10 F40

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International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010

Chapter V
Mental and behavioural disorders

Neurotic, stress-related and somatoform disorders

when associated with conduct disorder in F91.- (F92.8)

F40Phobic anxiety disorders

A group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous. As a result these situations are characteristically avoided or endured with dread. The patient's concern may be focused on individual symptoms like palpitations or feeling faint and is often associated with secondary fears of dying, losing control, or going mad. Contemplating entry to the phobic situation usually generates anticipatory anxiety. Phobic anxiety and depression often coexist. Whether two diagnoses, phobic anxiety and depressive episode, are needed, or only one, is determined by the time course of the two conditions and by therapeutic considerations at the time of consultation.
A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes. Panic disorder is a frequent feature of both present and past episodes. Depressive and obsessional symptoms and social phobias are also commonly present as subsidiary features. Avoidance of the phobic situation is often prominent, and some agoraphobics experience little anxiety because they are able to avoid their phobic situations.
Agoraphobia without history of panic disorder
Panic disorder with agoraphobia
F40.1Social phobias
Fear of scrutiny by other people leading to avoidance of social situations. More pervasive social phobias are usually associated with low self-esteem and fear of criticism. They may present as a complaint of blushing, hand tremor, nausea, or urgency of micturition, the patient sometimes being convinced that one of these secondary manifestations of their anxiety is the primary problem. Symptoms may progress to panic attacks.
Social neurosis
F40.2Specific (isolated) phobias
Phobias restricted to highly specific situations such as proximity to particular animals, heights, thunder, darkness, flying, closed spaces, urinating or defecating in public toilets, eating certain foods, dentistry, or the sight of blood or injury. Though the triggering situation is discrete, contact with it can evoke panic as in agoraphobia or social phobia.
Animal phobias
Simple phobia
dysmorphophobia (nondelusional) (F45.2)
nosophobia (F45.2)
F40.8Other phobic anxiety disorders
F40.9Phobic anxiety disorder, unspecified
Phobia NOS
Phobic state NOS

F41Other anxiety disorders

Disorders in which manifestation of anxiety is the major symptom and is not restricted to any particular environmental situation. Depressive and obsessional symptoms, and even some elements of phobic anxiety, may also be present, provided that they are clearly secondary or less severe.
F41.0Panic disorder [episodic paroxysmal anxiety]
The essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable. As with other anxiety disorders, the dominant symptoms include sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization). There is often also a secondary fear of dying, losing control, or going mad. Panic disorder should not be given as the main diagnosis if the patient has a depressive disorder at the time the attacks start; in these circumstances the panic attacks are probably secondary to depression.
  • attack
  • state
panic disorder with agoraphobia (F40.0)
F41.1Generalized anxiety disorder
Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances (i.e. it is "free-floating"). The dominant symptoms are variable but include complaints of persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort. Fears that the patient or a relative will shortly become ill or have an accident are often expressed.
  • neurosis
  • reaction
  • state
neurasthenia (F48.0)
F41.2Mixed anxiety and depressive disorder
This category should be used when symptoms of anxiety and depression are both present, but neither is clearly predominant, and neither type of symptom is present to the extent that justifies a diagnosis if considered separately. When both anxiety and depressive symptoms are present and severe enough to justify individual diagnoses, both diagnoses should be recorded and this category should not be used.
Anxiety depression (mild or not persistent)
F41.3Other mixed anxiety disorders
Symptoms of anxiety mixed with features of other disorders in F42-F48. Neither type of symptom is severe enough to justify a diagnosis if considered separately.
F41.8Other specified anxiety disorders
Anxiety hysteria
F41.9Anxiety disorder, unspecified
Anxiety NOS

F42Obsessive-compulsive disorder

The essential feature is recurrent obsessional thoughts or compulsive acts. Obsessional thoughts are ideas, images, or impulses that enter the patient's mind again and again in a stereotyped form. They are almost invariably distressing and the patient often tries, unsuccessfully, to resist them. They are, however, recognized as his or her own thoughts, even though they are involuntary and often repugnant. Compulsive acts or rituals are stereotyped behaviours that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks. Their function is to prevent some objectively unlikely event, often involving harm to or caused by the patient, which he or she fears might otherwise occur. Usually, this behaviour is recognized by the patient as pointless or ineffectual and repeated attempts are made to resist. Anxiety is almost invariably present. If compulsive acts are resisted the anxiety gets worse.
anankastic neurosis
obsessive-compulsive neurosis
obsessive-compulsive personality (disorder) (F60.5)
F42.0Predominantly obsessional thoughts or ruminations
These may take the form of ideas, mental images, or impulses to act, which are nearly always distressing to the subject. Sometimes the ideas are an indecisive, endless consideration of alternatives, associated with an inability to make trivial but necessary decisions in day-to-day living. The relationship between obsessional ruminations and depression is particularly close and a diagnosis of obsessive-compulsive disorder should be preferred only if ruminations arise or persist in the absence of a depressive episode.
F42.1Predominantly compulsive acts [obsessional rituals]
The majority of compulsive acts are concerned with cleaning (particularly handwashing), repeated checking to ensure that a potentially dangerous situation has not been allowed to develop, or orderliness and tidiness. Underlying the overt behaviour is a fear, usually of danger either to or caused by the patient, and the ritual is an ineffectual or symbolic attempt to avert that danger.
F42.2Mixed obsessional thoughts and acts
F42.8Other obsessive-compulsive disorders
F42.9Obsessive-compulsive disorder, unspecified

F43Reaction to severe stress, and adjustment disorders

This category differs from others in that it includes disorders identifiable on the basis of not only symptoms and course but also the existence of one or other of two causative influences: an exceptionally stressful life event producing an acute stress reaction, or a significant life change leading to continued unpleasant circumstances that result in an adjustment disorder. Although less severe psychosocial stress ("life events") may precipitate the onset or contribute to the presentation of a very wide range of disorders classified elsewhere in this chapter, its etiological importance is not always clear and in each case will be found to depend on individual, often idiosyncratic, vulnerability, i.e. the life events are neither necessary nor sufficient to explain the occurrence and form of the disorder. In contrast, the disorders brought together here are thought to arise always as a direct consequence of acute severe stress or continued trauma. The stressful events or the continuing unpleasant circumstances are the primary and overriding causal factor and the disorder would not have occurred without their impact. The disorders in this section can thus be regarded as maladaptive responses to severe or continued stress, in that they interfere with successful coping mechanisms and therefore lead to problems of social functioning.
F43.0Acute stress reaction
A transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days. Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions. The symptoms show a typically mixed and changing picture and include an initial state of "daze" with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, and disorientation. This state may be followed either by further withdrawal from the surrounding situation (to the extent of a dissociative stupor - F44.2), or by agitation and over-activity (flight reaction or fugue). Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are commonly present. The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and disappear within two to three days (often within hours). Partial or complete amnesia (F44.0) for the episode may be present. If the symptoms persist, a change in diagnosis should be considered.
  • crisis reaction
  • reaction to stress
Combat fatigue
Crisis state
Psychic shock
F43.1Post-traumatic stress disorder
Arises as a delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. Predisposing factors, such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness, may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence. Typical features include episodes of repeated reliving of the trauma in intrusive memories ("flashbacks"), dreams or nightmares, occurring against the persisting background of a sense of "numbness" and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situations reminiscent of the trauma. There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety and depression are commonly associated with the above symptoms and signs, and suicidal ideation is not infrequent. The onset follows the trauma with a latency period that may range from a few weeks to months. The course is fluctuating but recovery can be expected in the majority of cases. In a small proportion of cases the condition may follow a chronic course over many years, with eventual transition to an enduring personality change (F62.0).
Traumatic neurosis
F43.2Adjustment disorders
States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change or a stressful life event. The stressor may have affected the integrity of an individual's social network (bereavement, separation experiences) or the wider system of social supports and values (migration, refugee status), or represented a major developmental transition or crisis (going to school, becoming a parent, failure to attain a cherished personal goal, retirement). Individual predisposition or vulnerability plays an important role in the risk of occurrence and the shaping of the manifestations of adjustment disorders, but it is nevertheless assumed that the condition would not have arisen without the stressor. The manifestations vary and include depressed mood, anxiety or worry (or mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some degree of disability in 9the performance of daily routine. Conduct disorders may be an associated feature, particularly in adolescents. The predominant feature may be a brief or prolonged depressive reaction, or a disturbance of other emotions and conduct.
Culture shock
Grief reaction
Hospitalism in children
separation anxiety disorder of childhood (F93.0)
F43.8Other reactions to severe stress
F43.9Reaction to severe stress, unspecified

F44Dissociative [conversion] disorders

The common themes that are shared by dissociative or conversion disorders are a partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements. All types of dissociative disorders tend to remit after a few weeks or months, particularly if their onset is associated with a traumatic life event. More chronic disorders, particularly paralyses and anaesthesias, may develop if the onset is associated with insoluble problems or interpersonal difficulties. These disorders have previously been classified as various types of "conversion hysteria". They are presumed to be psychogenic in origin, being associated closely in time with traumatic events, insoluble and intolerable problems, or disturbed relationships. The symptoms often represent the patient's concept of how a physical illness would be manifest. Medical examination and investigation do not reveal the presence of any known physical or neurological disorder. In addition, there is evidence that the loss of function is an expression of emotional conflicts or needs. The symptoms may develop in close relationship to psychological stress, and often appear suddenly. Only disorders of physical functions normally under voluntary control and loss of sensations are included here. Disorders involving pain and other complex physical sensations mediated by the autonomic nervous system are classified under somatization disorder (F45.0). The possibility of the later appearance of serious physical or psychiatric disorders should always be kept in mind.
  • hysteria
  • reaction
hysterical psychosis
malingering [conscious simulation] (Z76.5)
F44.0Dissociative amnesia
The main feature is loss of memory, usually of important recent events, that is not due to organic mental disorder, and is too great to be explained by ordinary forgetfulness or fatigue. The amnesia is usually centred on traumatic events, such as accidents or unexpected bereavements, and is usually partial and selective. Complete and generalized amnesia is rare, and is usually part of a fugue (F44.1). If this is the case, the disorder should be classified as such. The diagnosis should not be made in the presence of organic brain disorders, intoxication, or excessive fatigue.
alcohol- or other psychoactive substance-induced amnesic disorder (F10-F19 with common fourth character .6)
nonalcoholic organic amnesic syndrome (F04)
postictal amnesia in epilepsy (G40.-)
F44.1Dissociative fugue
Dissociative fugue has all the features of dissociative amnesia, plus purposeful travel beyond the usual everyday range. Although there is amnesia for the period of the fugue, the patient's behaviour during this time may appear completely normal to independent observers.
postictal fugue in epilepsy (G40.-)
F44.2Dissociative stupor
Dissociative stupor is diagnosed on the basis of a profound diminution or absence of voluntary movement and normal responsiveness to external stimuli such as light, noise, and touch, but examination and investigation reveal no evidence of a physical cause. In addition, there is positive evidence of psychogenic causation in the form of recent stressful events or problems.
organic catatonic disorder (F06.1)
F44.3Trance and possession disorders
Disorders in which there is a temporary loss of the sense of personal identity and full awareness of the surroundings. Include here only trance states that are involuntary or unwanted, occurring outside religious or culturally accepted situations.
states associated with:
F44.4Dissociative motor disorders
In the commonest varieties there is loss of ability to move the whole or a part of a limb or limbs. There may be close resemblance to almost any variety of ataxia, apraxia, akinesia, aphonia, dysarthria, dyskinesia, seizures, or paralysis.
  • aphonia
  • dysphonia
F44.5Dissociative convulsions
Dissociative convulsions may mimic epileptic seizures very closely in terms of movements, but tongue-biting, bruising due to falling, and incontinence of urine are rare, and consciousness is maintained or replaced by a state of stupor or trance.
F44.6Dissociative anaesthesia and sensory loss
Anaesthetic areas of skin often have boundaries that make it clear that they are associated with the patient's ideas about bodily functions, rather than medical knowledge. There may be differential loss between the sensory modalities which cannot be due to a neurological lesion. Sensory loss may be accompanied by complaints of paraesthesia. Loss of vision and hearing are rarely total in dissociative disorders.
Psychogenic deafness
F44.7Mixed dissociative [conversion] disorders
Combination of disorders specified in F44.0-F44.6
F44.8Other dissociative [conversion] disorders
Ganser syndrome
Multiple personality
  • confusion
  • twilight state
F44.9Dissociative [conversion] disorder, unspecified

F45Somatoform disorders

The main feature is repeated presentation of physical symptoms together with persistent requests for medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupation of the patient.
dissociative disorders (F44.-)
hair-plucking (F98.4)
lalling (F80.0)
lisping (F80.8)
nail-biting (F98.8)
psychological or behavioural factors associated with disorders or diseases classified elsewhere (F54)
sexual dysfunction, not caused by organic disorder or disease (F52.-)
thumb-sucking (F98.8)
tic disorders (in childhood and adolescence) (F95.-)
Tourette syndrome (F95.2)
trichotillomania (F63.3)
F45.0Somatization disorder
The main features are multiple, recurrent and frequently changing physical symptoms of at least two years duration. Most patients have a long and complicated history of contact with both primary and specialist medical care services, during which many negative investigations or fruitless exploratory operations may have been carried out. Symptoms may be referred to any part or system of the body. The course of the disorder is chronic and fluctuating, and is often associated with disruption of social, interpersonal, and family behaviour. Short-lived (less than two years) and less striking symptom patterns should be classified under undifferentiated somatoform disorder (F45.1).
Briquet disorder
Multiple psychosomatic disorder
malingering [conscious simulation] (Z76.5)
F45.1Undifferentiated somatoform disorder
When somatoform complaints are multiple, varying and persistent, but the complete and typical clinical picture of somatization disorder is not fulfilled, the diagnosis of undifferentiated somatoform disorder should be considered.
Undifferentiated psychosomatic disorder
F45.2Hypochondriacal disorder
The essential feature is a persistent preoccupation with the possibility of having one or more serious and progressive physical disorders. Patients manifest persistent somatic complaints or a persistent preoccupation with their physical appearance. Normal or commonplace sensations and appearances are often interpreted by patients as abnormal and distressing, and attention is usually focused upon only one or two organs or systems of the body. Marked depression and anxiety are often present, and may justify additional diagnoses.
Body dysmorphic disorder
Dysmorphophobia (nondelusional)
Hypochondriacal neurosis
delusional dysmorphophobia (F22.8)
fixed delusions about bodily functions or shape (F22.-)
F45.3Somatoform autonomic dysfunction
Symptoms are presented by the patient as if they were due to a physical disorder of a system or organ that is largely or completely under autonomic innervation and control, i.e. the cardiovascular, gastrointestinal, respiratory and urogenital systems. The symptoms are usually of two types, neither of which indicates a physical disorder of the organ or system concerned. First, there are complaints based upon objective signs of autonomic arousal, such as palpitations, sweating, flushing, tremor, and expression of fear and distress about the possibility of a physical disorder. Second, there are subjective complaints of a nonspecific or changing nature such as fleeting aches and pains, sensations of burning, heaviness, tightness, and feelings of being bloated or distended, which are referred by the patient to a specific organ or system.
Cardiac neurosis
Da Costa syndrome
Gastric neurosis
Neurocirculatory asthenia
Psychogenic forms of:
  • aerophagy
  • cough
  • diarrhoea
  • dyspepsia
  • dysuria
  • flatulence
  • hiccough
  • hyperventilation
  • increased frequency of micturition
  • irritable bowel syndrome
  • pylorospasm
psychological and behavioural factors associated with disorders or diseases classified elsewhere (F54)
F45.4Persistent somatoform pain disorder
The predominant complaint is of persistent, severe, and distressing pain, which cannot be explained fully by a physiological process or a physical disorder, and which occurs in association with emotional conflict or psychosocial problems that are sufficient to allow the conclusion that they are the main causative influences. The result is usually a marked increase in support and attention, either personal or medical. Pain presumed to be of psychogenic origin occurring during the course of depressive disorders or schizophrenia should not be included here.
  • backache
  • headache
Somatoform pain disorder
backache NOS (M54.9)
tension headache (G44.2)
F45.8Other somatoform disorders
Any other disorders of sensation, function and behaviour, not due to physical disorders, which are not mediated through the autonomic nervous system, which are limited to specific systems or parts of the body, and which are closely associated in time with stressful events or problems.
  • dysmenorrhoea
  • dysphagia, including "globus hystericus"
  • pruritus
  • torticollis
F45.9Somatoform disorder, unspecified
Psychosomatic disorder NOS

F48Other neurotic disorders

Considerable cultural variations occur in the presentation of this disorder, and two main types occur, with substantial overlap. In one type, the main feature is a complaint of increased fatigue after mental effort, often associated with some decrease in occupational performance or coping efficiency in daily tasks. The mental fatiguability is typically described as an unpleasant intrusion of distracting associations or recollections, difficulty in concentrating, and generally inefficient thinking. In the other type, the emphasis is on feelings of bodily or physical weakness and exhaustion after only minimal effort, accompanied by a feeling of muscular aches and pains and inability to relax. In both types a variety of other unpleasant physical feelings is common, such as dizziness, tension headaches, and feelings of general instability. Worry about decreasing mental and bodily well-being, irritability, anhedonia, and varying minor degrees of both depression and anxiety are all common. Sleep is often disturbed in its initial and middle phases but hypersomnia may also be prominent.
Fatigue syndrome
Use additional code, if desired, to identify previous physical illness.
asthenia NOS (R53)
burn-out (Z73.0)
malaise and fatigue (R53)
postviral fatigue syndrome (G93.3)
psychasthenia (F48.8)
F48.1Depersonalization-derealization syndrome
A rare disorder in which the patient complains spontaneously that his or her mental activity, body, and surroundings are changed in their quality, so as to be unreal, remote, or automatized. Among the varied phenomena of the syndrome, patients complain most frequently of loss of emotions and feelings of estrangement or detachment from their thinking, their body, or the real world. In spite of the dramatic nature of the experience, the patient is aware of the unreality of the change. The sensorium is normal and the capacity for emotional expression intact. Depersonalization-derealization symptoms may occur as part of a diagnosable schizophrenic, depressive, phobic, or obsessive-compulsive disorder. In such cases the diagnosis should be that of the main disorder.
F48.8Other specified neurotic disorders
Dhat syndrome
Occupational neurosis, including writer cramp
Psychasthenic neurosis
Psychogenic syncope
F48.9Neurotic disorder, unspecified
Neurosis NOS

Tuesday, July 29, 2014

Sample of Certificates of Good Moral Character, NBI and other requirements

Sample of a Barangay Certificate of Good Moral Character

As a follow up to the never ending query about the certificate of good moral character, above and below are photos of samples from  barangay, school, and work.

You will notice that we attached a documentary stamp since there's an email (from PRC) to one of our likers that she is being asked to affix documentary stamp on her certified true copy of good moral character she submitted as part of the requirements to PRC.

Additional notes:

1) Dry seal is not notary. The good moral character should be notarized by a notary public. The Barangay Certificate of Good Moral  Character above also contains a dry seal of the barangay. 

2) Barangay clearance is different from Certificate of Good Moral Character. Barangay clearance is totally different from that of an NBI clearance. (update as of 01 September 2014 - for as long as the phrase  "of good moral character" is in the Barangay Clearance then it can served as your Certificate of Good Moral Character. PRC is particular on that particular phrase even for those from school, work or church.)

3) Secure three (3)  different Certificates of Good Moral Character from at least four different sources - school, work, church and barangay.

4) Documentary stamp - it seems PRC is now requiring that these Certificates of Good Moral Character should also contain documentary stamps. You can get these documentary stamps from PRC (a bit more expensive), city/municipal hall,  barangay hall, and the post office. But check first with PRC if  it is necessary. Just the same, be ready in case you will be required to put those stamps on the certificates.

5) (Additional Update as of 01 September 2014)

What are you going to submit to PRC? Original copies or it can be certified true copy of your Certificates of Good Moral Character. 
The only documents that will contain documentary stamps are the Certificates of Good Moral Character and the application form. So total of four (4) documentary stamps will be needed. 

Some notary public could also make a certified true copy (considered also as original copy). Like in some school they would issue a half page certificate of good moral character and since it is short - there's no space to notarize it. 

Notary public will ask you to have it photocopied and will make it a certified true copy. Otherwise if it is in a regular bond paper then you can have your original copies notarized. Notarized documents are usually in triplicates (3 copies) - one copy is filed and kept by the notary, and you can have two copies (whether all originals or one original and the other photocopy).

So all the three certificates of good moral character whether original copies or certified true copies when submitting to PRC -   should have one documentary stamp each and one for the application form for the licensure exam.

Bring all your original documents and photocopy them for verification and submission purposes.

Sample of a School Certificate of Good Moral Character

Sample of a Work  Certificate of Good Moral Character

Read more here:

Update - 12 April 2015 - Re: NBI

It is now much easier to apply for NBI, compare the process before and the current shown in the image below.  Once you have filled the data needed, be sure to select Local - PRC Requirement in the drop-down menu as shown in the next image

Visit  to apply for your NBI.

(Front/landing page)

(Page to select schedule, purpose/detail, and mode of payment.)

(Note - this infographics on the application process was made in 2014, be sure to check PRC Main and its regional offices for the updated process.)

Read more here:

Mood Affective Disorders ICD10 F30

Image source -

International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010

Chapter V
Mental and behavioural disorders

Mood [affective] disorders

This block contains disorders in which the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity; most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations.

F30Manic episode

All the subdivisions of this category should be used only for a single episode. Hypomanic or manic episodes in individuals who have had one or more previous affective episodes (depressive, hypomanic, manic, or mixed) should be coded as bipolar affective disorder (F31.-).
bipolar disorder, single manic episode
A disorder characterized by a persistent mild elevation of mood, increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency. Increased sociability, talkativeness, over-familiarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability. The disturbances of mood and behaviour are not accompanied by hallucinations or delusions.
F30.1Mania without psychotic symptoms
Mood is elevated out of keeping with the patient's circumstances and may vary from carefree joviality to almost uncontrollable excitement. Elation is accompanied by increased energy, resulting in overactivity, pressure of speech, and a decreased need for sleep. Attention cannot be sustained, and there is often marked distractibility. Self-esteem is often inflated with grandiose ideas and overconfidence. Loss of normal social inhibitions may result in behaviour that is reckless, foolhardy, or inappropriate to the circumstances, and out of character.
F30.2Mania with psychotic symptoms
In addition to the clinical picture described in F30.1, delusions (usually grandiose) or hallucinations (usually of voices speaking directly to the patient) are present, or the excitement, excessive motor activity, and flight of ideas are so extreme that the subject is incomprehensible or inaccessible to ordinary communication.
Mania with:
  • mood-congruent psychotic symptoms
  • mood-incongruent psychotic symptoms
Manic stupor
F30.8Other manic episodes
F30.9Manic episode, unspecified
Mania NOS

F31Bipolar affective disorder

A disorder characterized by two or more episodes in which the patient's mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression). Repeated episodes of hypomania or mania only are classified as bipolar.
  • illness
  • psychosis
  • reaction
bipolar disorder, single manic episode (F30.-)
cyclothymia (F34.0)
F31.0Bipolar affective disorder, current episode hypomanic
The patient is currently hypomanic, and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.
F31.1Bipolar affective disorder, current episode manic without psychotic symptoms
The patient is currently manic, without psychotic symptoms (as in F30.1), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.
F31.2Bipolar affective disorder, current episode manic with psychotic symptoms
The patient is currently manic, with psychotic symptoms (as in F30.2), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.
F31.3Bipolar affective disorder, current episode mild or moderate depression
The patient is currently depressed, as in a depressive episode of either mild or moderate severity (F32.0 or F32.1), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.
F31.4Bipolar affective disorder, current episode severe depression without psychotic symptoms
The patient is currently depressed, as in severe depressive episode without psychotic symptoms (F32.2), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.
F31.5Bipolar affective disorder, current episode severe depression with psychotic symptoms
The patient is currently depressed, as in severe depressive episode with psychotic symptoms (F32.3), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.
F31.6Bipolar affective disorder, current episode mixed
The patient has had at least one authenticated hypomanic, manic, depressive, or mixed affective episode in the past, and currently exhibits either a mixture or a rapid alteration of manic and depressive symptoms.
single mixed affective episode (F38.0)
F31.7Bipolar affective disorder, currently in remission
The patient has had at least one authenticated hypomanic, manic, or mixed affective episode in the past, and at least one other affective episode (hypomanic, manic, depressive, or mixed) in addition, but is not currently suffering from any significant mood disturbance, and has not done so for several months. Periods of remission during prophylactic treatment should be coded here.
F31.8Other bipolar affective disorders
Bipolar II disorder
Recurrent manic episodes NOS
F31.9Bipolar affective disorder, unspecified

F32Depressive episode

In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present. The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called "somatic" symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours before the usual time, depression worst in the morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido. Depending upon the number and severity of the symptoms, a depressive episode may be specified as mild, moderate or severe.
single episodes of:
  • depressive reaction
  • psychogenic depression
  • reactive depression
adjustment disorder (F43.2)
recurrent depressive disorder (F33.-)
when associated with conduct disorders in F91.- (F92.0)
F32.0Mild depressive episode
Two or three of the above symptoms are usually present. The patient is usually distressed by these but will probably be able to continue with most activities.
F32.1Moderate depressive episode
Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities.
F32.2Severe depressive episode without psychotic symptoms
An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt. Suicidal thoughts and acts are common and a number of "somatic" symptoms are usually present.
  • Agitated depression
  • Major depression
  • Vital depression
  • single episode without psychotic symptoms
F32.3Severe depressive episode with psychotic symptoms
An episode of depression as described in F32.2, but with the presence of hallucinations, delusions, psychomotor retardation, or stupor so severe that ordinary social activities are impossible; there may be danger to life from suicide, dehydration, or starvation. The hallucinations and delusions may or may not be mood-congruent.
Single episodes of:
  • major depression with psychotic symptoms
  • psychogenic depressive psychosis
  • psychotic depression
  • reactive depressive psychosis
F32.8Other depressive episodes
Atypical depression
Single episodes of "masked" depression NOS
F32.9Depressive episode, unspecified
Depression NOS
Depressive disorder NOS

F33Recurrent depressive disorder

A disorder characterized by repeated episodes of depression as described for depressive episode (F32.-), without any history of independent episodes of mood elevation and increased energy (mania). There may, however, be brief episodes of mild mood elevation and overactivity (hypomania) immediately after a depressive episode, sometimes precipitated by antidepressant treatment. The more severe forms of recurrent depressive disorder (F33.2 and F33.3) have much in common with earlier concepts such as manic-depressive depression, melancholia, vital depression and endogenous depression. The first episode may occur at any age from childhood to old age, the onset may be either acute or insidious, and the duration varies from a few weeks to many months. The risk that a patient with recurrent depressive disorder will have an episode of mania never disappears completely, however many depressive episodes have been experienced. If such an episode does occur, the diagnosis should be changed to bipolar affective disorder (F31.-).
recurrent episodes of:
  • depressive reaction
  • psychogenic depression
  • reactive depression
seasonal depressive disorder
recurrent brief depressive episodes (F38.1)
F33.0Recurrent depressive disorder, current episode mild
A disorder characterized by repeated episodes of depression, the current episode being mild, as in F32.0, and without any history of mania.
F33.1Recurrent depressive disorder, current episode moderate
A disorder characterized by repeated episodes of depression, the current episode being of moderate severity, as in F32.1, and without any history of mania.
F33.2Recurrent depressive disorder, current episode severe without psychotic symptoms
A disorder characterized by repeated episodes of depression, the current episode being severe without psychotic symptoms, as in F32.2, and without any history of mania.
Endogenous depression without psychotic symptoms
Major depression, recurrent without psychotic symptoms
Manic-depressive psychosis, depressed type without psychotic symptoms
Vital depression, recurrent without psychotic symptoms
F33.3Recurrent depressive disorder, current episode severe with psychotic symptoms
A disorder characterized by repeated episodes of depression, the current episode being severe with psychotic symptoms, as in F32.3, and with no previous episodes of mania.
Endogenous depression with psychotic symptoms
Manic-depressive psychosis, depressed type with psychotic symptoms
Recurrent severe episodes of:
  • major depression with psychotic symptoms
  • psychogenic depressive psychosis
  • psychotic depression
  • reactive depressive psychosis
F33.4Recurrent depressive disorder, currently in remission
The patient has had two or more depressive episodes as described in F33.0-F33.3, in the past, but has been free from depressive symptoms for several months.
F33.8Other recurrent depressive disorders
F33.9Recurrent depressive disorder, unspecified
Monopolar depression NOS

F34Persistent mood [affective] disorders

Persistent and usually fluctuating disorders of mood in which the majority of the individual episodes are not sufficiently severe to warrant being described as hypomanic or mild depressive episodes. Because they last for many years, and sometimes for the greater part of the patient's adult life, they involve considerable distress and disability. In some instances, recurrent or single manic or depressive episodes may become superimposed on a persistent affective disorder.
A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). This disorder is frequently found in the relatives of patients with bipolar affective disorder. Some patients with cyclothymia eventually develop bipolar affective disorder.
Affective personality disorder
Cycloid personality
Cyclothymic personality
A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder (F33.-).
  • neurosis
  • personality disorder
Neurotic depression
Persistent anxiety depression
anxiety depression (mild or not persistent) (F41.2)
F34.8Other persistent mood [affective] disorders
F34.9Persistent mood [affective] disorder, unspecified

F38Other mood [affective] disorders

Any other mood disorders that do not justify classification to F30-F34, because they are not of sufficient severity or duration.
F38.0Other single mood [affective] disorders
Mixed affective episode
F38.1Other recurrent mood [affective] disorders
Recurrent brief depressive episodes
F38.8Other specified mood [affective] disorders

F39Unspecified mood [affective] disorder

Affective psychosis NOS

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