Depression code for ICD 10 in adults. endogenous depression. How does a doctor choose antidepressants?

"All mental manifestations have a direct effect on the body" Avicenna

DEFINITION

Depression is a mood disorder that causes persistent feelings of sadness and loss of interest (Mayo Clinic).

Frequency of emergency visits with depression

RISK FACTORS FOR DEPRESSION (USPSTF)

adults
Women.
Young, middle age.
Undereducated, divorced, unemployed.
Chronic diseases (cancer, heart failure...).
Other psychiatric disorders (including substance abuse).
Family history of psychiatric disorders.

Pregnancy, postpartum period
Low self-esteem.
Unwanted pregnancy.
Stress associated with caring for a child.
Prenatal anxiety.
Life stress.
Weak social support.
Absence of husband, partner.
A child with a difficult temperament.
History of depression.
Prior postpartum depression.
Low socioeconomic status.

Elderly, old people
Disability.
Poor health condition associated with somatic diseases.
Complicated loss.
Chronic sleep disorders.
Loneliness.
History of depression.

Age and emergency visits with depression

Ballou S, et al. Gen Hosp Psych. 2019;59:14–9.

Causes of mental disorders

Neurotic: anxiety, stress, somatoform.
Psychotic: depressive episode, schizophrenia.
Personal: personality disorder.
Caused by a somatic or neurological disease: systemic lupus erythematosus, hyperthyroidism, hypothyroidism.
Drug-induced: corticosteroids, reserpine.
Caused by a psychoactive substance: alcohol, drugs.

Depression and mortality after myocardial infarction

SADHART. et al Arch Gen Psychiatry. 2009;66:1022–9.

CLASSIFICATION OF MOOD DISORDERS (ICD-10)

Manic episode.
Bipolar affective disorder.
depressive episode.
Recurrent depressive disorder.
Chronic affective disorders.
Organic affective disorders.
Other Mental and Behavioral Disorders Caused by Alcohol.
Adjustment Disorders.

Depression and disability

Beck A, et al. Ann Fam Med 2011;9:305–11.

CRITERIA FOR A DEPRESSIVE EPISODE (ICD-10)

A. Meeting the general criteria for a depressive episode:
1. Depressive episode must last ≥2 weeks.
2. There has never been a history of symptoms meeting the criteria for a manic or hypomanic episode.
3. The episode cannot be attributed to substance use or any organic mental disorder.
B. Have ≥2 of the following symptoms:
1. Depressive mood is reduced to a level defined as clearly abnormal for the patient, occurs most of the day almost daily for ≥2 weeks and is largely independent of the situation.
2. A distinct decrease in interest or pleasure in activities that are usually enjoyable for the patient.
3. Decreased energy and increased fatigue.
B. Additional symptoms:
1. Decreased feelings of self-confidence and self-esteem.
2. An unreasonable sense of self-condemnation or excessive and inadequate guilt.
3. Recurrent thoughts of death or suicide or suicidal behavior.
4. Violations of psychomotor activity with anxious agitation or lethargy (subjectively or objectively).
5. Sleep disturbance of any type.
6. Change in appetite (increase or decrease) with a corresponding change in body weight.

≥2 symptoms from criterion B and ≥4 symptoms from the sum of criteria B and C are required to define a mild episode; a moderate episode requires ≥2 symptoms from criterion B and ≥6 symptoms from the sum of criteria B and C; and a severe episode requires 3 symptoms from criterion B and ≥8 symptoms from the sum of criteria B and C.

CRITERIA FOR RECURRENT DEPRESSION (ICD-10)

There is at least one depressive episode in the past that lasted ≥2 weeks and was separated from the present episode by a period of ≥2 months during which no significant affective symptoms were observed.
There was never a history of hypomanic or manic episodes.
The episode cannot be attributed to substance use or any organic mental disorder.

Management of a depressive episode

FORMULATION OF THE DIAGNOSIS

Ds: Recurrent depressive disorder, mild episode.

Ds: Depressive episode, functional dyspepsia, postprandial distress syndrome.

Ds: IHD: Myocardial infarction (2015). Stable angina II FC.
Related Ds: Prolonged depressive reaction.

Who Should Treat Depression?

Olfson M, et al. JAMA Intern Med. 2016;176:1482–91.

ANTIDEPRESSANTS

Heterocyclic antidepressants
Amitriptyline 25–150 mg.
Imipramine 25–150 mg.
Clomipramine 25–150 mg.
Pipofezin 50–200 mg.

Selective serotonin reuptake inhibitors
Paroxetine 20–40 mg.
Sertraline 50-100.
Fluvoxamine 50–300 mg.
Fluoxetine 20–40 mg.
Escitalopram 10–20 mg.

Serotonin and norepinephrine reuptake inhibitors
Venlafaxine 37.5–225 mg.
Duloxetine 60–120 mg.
Milnacipran 100 mg.

noradrenergic and serotonergic
Mianserin 30–60 mg/day.
Mirtazapine 15–45 mg/day.

Reversible monoamine oxidase inhibitors
Moclobemide 300 mg.
Pirlindol 100–150 mg.

Other groups
Agomelatine 25–50 mg.
Vortioxetine 10–20 mg.
St. John's wort 1 capsule.
Trazodone 75–300 mg.

INDICATIONS FOR ANTIDEPRESSANTS

depressive disorders.
anxiety disorders.
Obsessive-compulsive disorder.
Insomnia.
Anorexia nervosa.
Bulimia.
Chronic pain (cancer, diabetic neuropathy).
Migraine, tension headache.
Syndrome of chronic fatigue.
hyperkinetic disorder.
Chronic itching.
Premenstrual dysphoric syndrome.
Climacteric flushes.
Irritable Bowel Syndrome.
functional dyspepsia.

Adherence to antidepressants and mortality in patients with CAD

Krivoy A, et al. Brit J Psych. 2015;206:297–301.

PRINCIPLES OF TREATMENT

The effect of an antidepressant is evaluated no earlier than 2 weeks.
The duration of antidepressant therapy is 6–9 months or more.

Modern approaches to the diagnosis and treatment of depressive spectrum disorders in general medical practice.
Methodical manual for doctors.

G.V.Pogosova
Federal State Institution State Research Center for Preventive Medicine of Roszdrav
Moscow Research Institute of Psychiatry of Roszdrav

Edited by:
Oganova R.G., Academician of the Russian Academy of Medical Sciences, President of the All-Russian Scientific Society of Cardiology
Krasnov V.N., Professor, Chairman of the Board of the Russian Society of Psychiatrists

2. 3. Depressive disorders

The symptoms of depressive and anxiety disorders are very similar. According to some reports, the intersection of anxiety and depressive symptoms reaches 60-70%. In other words, the same patient may have both symptoms of depression and symptoms of anxiety. In such cases, they speak of a mixed anxiety-depressive disorder. In a significant proportion of patients, anxiety chronologically precedes depression, i.e., they have an undiagnosed and untreated anxiety disorder for a long time, which is complicated by depression over time. It has been shown that generalized anxiety disorder increases the risk of developing a first depressive episode by 4-9 times.

Depression is a disorder characterized by a depressed mood and a negative, pessimistic assessment of oneself, one's position in the surrounding reality, past and future, and a decrease in motivation for activity. Along with these mental disorders, or even primarily in depression, general somatic, physiological functions suffer - appetite, sleep, wakefulness, vital tone.

The ICD-10 identifies 11 diagnostic criteria for depression, incl. 3 main (depressive triad) and 9 additional (table 3). "Major" depression (major depressive episode) is diagnosed if the patient has at least two main and two additional criteria for 2 weeks or more. However, general practitioners, cardiologists are more likely to encounter less pronounced depressive states or the so-called "minor" depression. For the diagnosis of minor depression, it is enough for the patient to have a depressed mood or decrease in interests, a feeling of pleasure for 2 weeks or more, as well as any two of the additional criteria.

Depressed mood (most of the day)
Decreased interests and ability to experience pleasure
Decreased energy, increased fatigue
Decreased concentration, inability to concentrate
Appetite disorders (with changes in body weight)
Sleep disorders
Decreased sex drive
A bleak, pessimistic vision of the future
Decreased self-esteem and self-confidence
Ideas of guilt
Suicidal thoughts, intentions, attempts

The greatest difficulties are caused by the establishment of a diagnosis of mild, mild depression, especially in somatic patients. The fact is that with mild depression, patients do not have suicidal thoughts and intentions, ideas of guilt, which are characteristic of a “typical” depression. Diagnosis is also complicated by the fact that many symptoms of depression and somatic diseases are common, such as pain of various localization, decreased performance, fatigue, decreased concentration, etc. In other words, in somatic patients, atypically occurring, masked, latent depressions are most often observed. With such depression, patients, as a rule, do not present their own depressive complaints: depressed mood, loss of interests or feelings of pleasure. They have an abundance of somatic and vegetative complaints. Most often, the “masks” of depression are chronic pain syndrome, sleep and appetite disorders, sexual dysfunctions, fatigue, weakness, and decreased performance.

Chronic pain syndrome occurs in more than half of patients with masked depression. Pain can have different localization. For patients with hypertension with comorbid depression, the most common complaints are headaches and back pain. Sometimes the pain does not have a clear localization (pain throughout the body) or is migratory in nature. The pains are most often dull, aching, they can change their intensity; are noted often, if not every day, then several times a week, and disturb patients for a long period of time, for example, several months. For patients with CVD and comorbid depression, pains in the region of the heart are very characteristic, which patients, and often their attending physicians, interpret as angina attacks, despite the fact that these pains do not always show parallelism with any objective signs, for example, ECG changes. at rest or during exercise tests.

Various sleep disturbances are very characteristic of patients with masked depression. Patients may report difficulty falling asleep or, conversely, increased drowsiness. Frequent complaints are early awakening (at 3-4 o'clock in the morning), restless dreams, frequent awakenings several times a night, a feeling of lack of sleep: the patient notes that he slept, but woke up unrested, broken.

Appetite disturbances and associated changes in body weight are also characteristic. In typical depression, appetite is reduced, sometimes to a large extent, and patients report significant weight loss > 5% of baseline. In atypical depressions, on the contrary, appetite is increased, and, accordingly, weight gain is noted (more typical for women).

Most patients with masked depression are concerned about increased fatigue, weakness, reduced physical and mental performance. Lethargy, a constant feeling of fatigue, impaired concentration, difficulty in performing usual work, difficulties in mental work are noted, accompanied by a decrease in self-esteem. These symptoms often cause patients to leave work or move to a less responsible, easier job. At the same time, rest does not bring satisfaction, a feeling of a surge of strength. The feeling of fatigue is persistent and often does not depend on the severity of the load. The usual household stresses cause fatigue, and in some patients even procedures such as bathing, washing, dressing, combing. Gradually, the interests of patients narrow, they cease to enjoy what used to always please - communication with loved ones, favorite work, an interesting book, a good movie. Decreased overall activity and interest in the environment. With severe depression, signs of mental and motor retardation are revealed.

Many patients with depression experience various problems in the genital area. In men, there is a decrease in libido, impotence often develops. In women, sexual desire also decreases, menstrual irregularities of an inorganic nature, including oligo- or dysmenorrhea, may be noted. But more often there is an accentuated premenstrual syndrome with a sharp deterioration in mood and general condition, as well as an abundance of somatic complaints a week before menstruation.

Classical depression is characterized by a special circadian rhythm - a greater severity of all symptoms (decreased mood, feeling tired, somatic complaints, etc.) in the morning. By evening, the condition of patients usually improves. It should be noted that the typical daily rhythm of depression is not observed in all patients, however, its presence definitely indicates a depressive disorder.

A major depressive episode in most patients ends in recovery, but in

25% of patients have fairly stable residual symptoms, most often asthenic or somatovegetative. Every third patient who has undergone a depressive episode has a relapse of the disease. In such cases, a recurrent form of depression is diagnosed, the treatment of which is not an easy task.

The choice of adequate medical tactics largely depends on the severity of depression. Distinguish:

lung depression (subdepression) - the symptoms are erased, of low severity, more often one depressive symptom prevails. Actually depressive symptoms can be masked by somatovegetative manifestations. Minor impact on professional and social functioning;
depression of moderate severity - the symptoms are moderately expressed, a distinct decrease in professional and social functioning;
severe depression - the presence of most manifestations of the depressive symptom complex, incl. suicidal thoughts and attempts, psychotic manifestations are possible (with delusional ideas of guilt). Severe impairment of professional and social functioning.

depressive disorder

Directory of Diseases

adults
Women.
Young, middle age.
Undereducated, divorced, unemployed.
Chronic diseases (cancer, heart failure.).
Other psychiatric disorders (including substance abuse).
Family history of psychiatric disorders.

Elderly, old people
Disability.
Poor health condition associated with somatic diseases.
Complicated loss.
Chronic sleep disorders.
Loneliness.
History of depression.

Ds: Recurrent depressive disorder, mild episode.

Ds: Depressive episode, functional dyspepsia, postprandial distress syndrome.

Ds: IHD: Myocardial infarction (2015). Stable angina II FC.
Related Ds: Prolonged depressive reaction.

Heterocyclic antidepressants
Amitriptyline 25–150 mg.
Imipramine 25–150 mg.
Clomipramine 25–150 mg.
Mianserin 30–60 mg.
Pipofezin 50–200 mg.

Selective serotonin reuptake inhibitors
Paroxetine 20–40 mg.
Sertraline 50-100.
Fluvoxamine 50–300 mg.
Fluoxetine 20–40 mg.
Escitalopram 10–20 mg.

Serotonin and norepinephrine reuptake inhibitors
Venlafaxine 37.5–225 mg.
Duloxetine 60–120 mg.
Milnacipran 100 mg.

Reversible monoamine oxidase inhibitors
Moclobemide 300 mg.
Pirlindol 100–150 mg.

Other groups
Agomelatine 25–50 mg.
Vortioxetine 10–20 mg.
St. John's wort 1 capsule.
Trazodone 50–400 mg.

therapy.irkutsk.ru

Criteria for depression according to ICD-10

Criteria for the severity of a depressive episode according to the ICD-10.

Easy . At least 2 of the 3 typical symptoms of depression are required, plus at least 2 of the other symptoms on the a-g list.

Concerned about these symptoms; Difficulty in performing normal work and social activities. However, it is unlikely that there will be a complete cessation of functioning.

Moderate . At least 2 of the 3 typical symptoms of depression must be present and at least 3 (preferably 4) of the other symptoms from the "a-g" list must be present. Significant difficulty in performing social duties, household chores and continuing to work.

Severe without psychotic symptoms . Almost all 3 of the typical symptoms are present and additionally the presence of 4 or more other symptoms from the list "a - g". At the same time, a pronounced loss of self-confidence or a feeling of worthlessness or guilt is mandatory, in especially severe cases - suicide;

significant anxiety (agitation), or severe lethargy; almost always the presence of a somatic syndrome.

Social and domestic activities may be very limited or unlikely to be performed.

Severe with psychotic symptoms . Criteria similar to severe without psychotic symptoms are supplemented by the presence of delusions, hallucinations, or depressive stupor. Delirium is more often of the following content: sinfulness, impoverishment, misfortunes threatening the patient. Auditory hallucinations, usually of accusatory and offensive content, olfactory smells of rotting meat or dirt.

Severe motor retardation may develop into stupor.

In assessing psychotic variants of depression, the ICD-10 introduces the concept of mood-congruent and incongruent delusions and hallucinations. So, incongruent include affectively neutral delusional and hallucinatory disorders, for example, delusions of a relationship without a sense of guilt or accusation; voices that talk to the patient about events that do not have emotional significance. Recall that from the point of view of nosological reference, it seems very doubtful to consider delusional ideas beyond self-accusation and self-deprecation, auditory hallucinations, a nihilistic version of Kotard's delusion, as well as a stupor with oneiroid experiences within the framework of the depressive phase of MDP (Nuller Yu.L., 1981).

Characterization of Major Depressive Episode (MDE) in DSM-III-R:

- The modality of the leading affect is not distinguished with the exception of dreary depression, but without a detailed phenomenological description of the dreary affect. The characteristic of depressed mood includes such definitions as depression, sadness, hopelessness, brokenness, discouragement, “down in the dumple”. In some cases, the patient may deny that he is depressed, but that he looks depressed and sad can be established by observing other people.

- There is a possibility of constant presence of loss of interest or pleasure. The patient declares that he is not interested in classes as before ("He does not care"). In the absence of complaints from the patient about the loss of interests and feelings of pleasure, family members usually notice the patient's alienation from family and friends, the oblivion of those activities or entertainment that were previously a source of pleasure.

- Appetite is often disturbed (usually loss of appetite), but there may be cases with increased appetite. Severe loss of appetite is accompanied by significant weight loss (children do not gain the expected weight).

- In sleep disorders, the most common complaint is insomnia, much less often

there is pathological drowsiness. Insomnia includes: difficulty falling asleep, waking up in the middle of the night and having difficulty falling asleep again, waking up early in the morning. In some cases, sleep disturbance, and not depressed mood or loss of interest and pleasure, is the most painful for the patient.

- Psychomotor agitation is manifested by the inability to sit still, constant walking, wringing hands, rubbing, the desire to pull hair, clothes and other objects. Psychomotor retardation is expressed in slow speech, long pauses before answering, sluggish or monotonous speech, a marked decrease in the volume of what was said or silence, and slow motor skills.

- Almost constantly there is a decrease in the energy level, which manifests itself in persistent fatigue, even in the absence of physical effort. The smallest task seems difficult or impossible to perform.

- Feelings of worthlessness (Worthlessness) can range from self-abasement to

completely unrealistic negative assessment of its value. The patient may reproach himself for the slightest failure, which he exaggerates; looking for hints in his environment, confirming his own negative self-esteem. The experience of guilt can relate to both past and present events and is experienced as an exaggerated responsibility for some accident or tragedy, or reaches the level of delirium.

- Frequent symptoms are difficulty concentrating, slow thinking, indecision.

- Thinking about death is typical. The patient may be convinced that he should die: suicidal thoughts with or without a special plan for their implementation, with attempts to commit suicide.

BDE-associated disorders include tearfulness, anxiety, irritability, obsessions, over-concern with one's physical health, panic attacks, and phobias.

Depression according to ICD-10

The International Classification of Diseases (ICD) exists to maintain health statistics. Currently, the ICD of the 10th revision is in force, which includes all currently existing diseases: infectious diseases, diseases of the endocrine, nervous systems, respiratory organs, digestion, etc. If we talk about mental disorders, then these are sections F00-F99, where you can find classification of neurotic disorders, schizophrenia, behavioral symptoms, mental retardation, etc. Today we will focus specifically on those sections, which include such a mood disorder disease as depression.

F30-F39: classification

According to the ICD-10, depression is included in this section, where the list of mental disorders is located. The main indicator of such a block are diseases in which a change in a person’s mood, his emotions lean towards depression. There are many other symptoms that are characteristic of each ailment individually. Another feature of the section is that each disease has a tendency to relapse, which is quite difficult to predict, because they often do not depend on the person himself, but on the events taking place around him.

Other diseases included in the list should be briefly considered:

manic episode. It is characterized by high spirits, in no way connected with the existing circumstances. In addition, there is hyperactivity, the need for proper sleep disappears, and inflated self-esteem appears.
Bipolar affective disorder. A sharp increase and decrease in mood, in which symptoms of depression and mania are observed.
depressive episode. A feeling of despondency, a decrease in vital energy, apathy towards the events taking place around.
recurrent depressive disorder. A serious mental disorder in which depressive episodes recur regularly, this is lethargy, depressed mood, slow action.
affective disorders. They can last for a long time and accompany a person all his life, they are characterized by severe apathy, disability.
Other mood disorders. There are some other diseases that are included in this classification. All of them are persistent mental disorders, in which some episodes are severe, others are not too severe.

Our task is to describe in detail exactly the depressive disorders that are included in this section of the ICD.

depressive episode

Depression according to the ICD is a serious mental disorder that develops against the background of any particular situation, stress. The disease can be of several degrees of severity:

Mild depression. This type is characterized by only 2-3 pronounced symptoms, as a rule, this is a low mood, a drop in activity and the inability to enjoy life.
An episode of moderate or moderate degree. In this case, more than 4 symptoms can be observed: a decrease in a person’s energy, sleep disturbance, constant bad mood, loss of appetite, low self-esteem, etc.
A severe episode with or without psychotic symptoms. In this case, a person constantly thinks about his uselessness, he is visited by thoughts of suicide, there is a pronounced lethargy, in the most difficult situations - delusional ideas, hallucinations arise.

All these degrees are included in the F32 classification according to ICD-10. In any case, in the presence of such disorders, it is necessary to seek medical help, and it is recommended to do this as soon as possible.

recurrent depressive disorder

The disease differs from other types of depression by frequently recurring episodes of varying severity. Also characterized by mild, moderate and severe degrees of development of the disease. The main symptoms are as follows:

Lack of pleasure from activities that previously brought joy.
Feelings of guilt and condemnation of oneself for no apparent reason.
Lack of confidence in yourself and your actions.
Sleep disturbance, the presence of disturbing thoughts.
Decreased concentration.

This condition can also be dangerous to humans. There are cases when people committed suicide without finding a way out of this situation.

Recurrent depressive disorder should be treated by a professional psychotherapist after a good diagnosis.

Treatment for depression

According to the ICD-10, depression is recognized as a mental disorder by official medicine, so there are specific methods for treating this disease. Treatment should be complex with the use of the following drugs and innovative methods:

Use of antidepressants, tranquilizers and other sedatives.
Cognitive, rational and other types of psychotherapy, consultations with a psychiatrist.
Creation of favorable conditions for human life. In some cases, it may be necessary to change jobs, remove the person from the former social circle.
A healthy lifestyle, compliance with the correct regime of work and rest.
Physiotherapy for depression. This includes music therapy, therapeutic sleep, light therapy, etc.

The doctor prescribes one or another method of treatment, depending on the symptoms, the causes of the disease and the degree of its development.

It should be understood that the classification of diseases was developed for a reason, it is designed to provide an appropriate level of health care so that medicine can constantly receive the necessary information about the health of the population. Not surprisingly, depression is included in this list, because many people suffer from it today, having no idea that it is being treated. Be sure to contact an experienced specialist who will tell you the right way to treat depression and help you get rid of its symptoms forever.

F30 Manic episode(up)

The separation of affect and mood is due to the fact that affect is understood as a vivid expression of emotions, which is reflected in behavior, mood is understood as the sum of emotions over a certain period of time, which often, but not always, manifests itself in behavior and can be successfully hidden. The range of affective disorders includes syndromes such as seasonal weight changes, evening cravings for carbohydrates, premenstrual syndromes, part of teenage aggressiveness.

Etiology and pathogenesis

Emotion is manifested in behavior, such as facial expressions, posture, gesture, features of social communications, thinking, and is subjectively described in the structure of experience. When control is lost over it, it reaches the degree of affect and can lead to self-destruction (suicide, self-harm) or destruction (aggression). Affective disorders (bipolar, recurrent, dysthymic) have several links of etiology and pathogenesis:

The genetic cause of the disease may be a gene on chromosome 11, although there are theories of genetic diversity in affective disorders. The existence of dominant, recessive and polygenic forms of disorders is assumed.
The biochemical cause is a violation of the activity of the metabolism of neurotransmitters, their number decreases with depression (serotonin) and increases with mania, as well as catecholamines: a deficiency of catecholamines is noted in depression.
Neuroendocrine causes are manifested in disruption of the rhythm of the functioning of the hypothalamic-pituitary, limbic system and pineal gland, which is reflected in the rhythm of the release of releasing hormones and melatonin. This indirectly affects the holistic rhythm of the body, in particular the rhythm of sleep / wakefulness, sexual activity, food. These rhythms are systematically disturbed in affective disorders.
Theories of loss of social contacts include cognitive and psychoanalytic interpretation. Cognitive interpretation is based on the study of the fixation of depressogenic patterns of the type: bad mood - I can not do anything - my energy is falling - I am useless - mood is decreasing. This scheme is reflected on the personal and social level. The style of depressive thinking suggests the absence of a plan for the future. Psychoanalytic concepts explain depression as a regression to narcissism and the formation of self-hatred; narcissistic elements are found in self-presentation and exhibitionism also in mania.
Affective disorders can be caused by negative (distress) and positive (eustress) stress. A series of stresses lead to overstrain and then exhaustion as the last phase of the main adaptation syndrome and the development of depression in constitutionally predisposed individuals. The most significant stressors are the death of a spouse, child, quarrels and loss of economic status.
The basis of the psychobiology of affective disorders is dysregulation in the spectrum of aggressive - auto-aggressive behavior. The selective advantage of depression is the stimulation of altruism in the group and family, and hypomania also has an obvious advantage in group and individual selection. This explains the stable figure of susceptibility to affective disorders in the population.
Prevalence

Exposure to affective disorders is 1%, the ratio of men and women is approximately the same. In children, they are rare and reach a maximum by the age of 30-40 years.

The main violation is a change in affect or mood, the level of motor activity, the activity of social functioning. Other symptoms, such as a change in the pace of thinking, psychosensory disturbances, statements of self-blame or overestimation, are secondary to these changes. The clinic manifests itself in the form of episodes (manic, depressive), bipolar (two-phase) and recurrent disorders, as well as in the form of chronic mood disorders. Intermissions without psychopathological symptoms are noted between psychoses. Affective disorders are almost always reflected in the somatic sphere (physiological functions, weight, skin turgor, etc.).

Changes in affect or mood are the main signs, the rest of the symptoms are derived from these changes and are secondary.

Affective disorders are observed in many endocrine diseases (thyrotoxicosis and hypothyroidism), Parkinson's disease, and vascular pathology of the brain. With organic affective disorders, there are symptoms of a cognitive deficit or a disorder of consciousness, which is not typical for endogenous affective disorders. They should also be differentiated in schizophrenia, however, with this disease, there are other characteristic productive or negative symptoms, in addition, manic and depressive states are usually atypical and closer to manic-hebephrenic or apathetic depressions. The greatest difficulties and disputes arise in the differential diagnosis with schizoaffective disorder, if secondary ideas of overestimation or self-blame arise in the structure of affective disorders. However, with true affective disorders, they disappear as soon as the affect is normalized, and do not determine the clinical picture.

Therapy consists of the treatment of depression and mania itself, as well as preventive therapy. Therapy for depression includes, depending on the depth, a wide range of drugs - from fluoxetine, lerivon, Zoloft to tricyclic antidepressants and ECT. Therapy for mania consists of therapy with increasing doses of lithium while monitoring them in the blood, the use of antipsychotics or carbamazepine, sometimes beta-blockers. Maintenance treatment is with lithium carbonate, carbamazepine, or sodium valprate.

F30 Manic episode

A mild degree of mania, in which changes in mood and behavior are long-term and pronounced, are not accompanied by delusions and hallucinations. An elevated mood manifests itself in the sphere of emotions as a joyful cloudlessness, irritability, in the sphere of speech as increased talkativeness with ease and superficial judgments, increased contact. In the field of behavior, there is an increase in appetite, sexuality, distractibility, a decrease in the need for sleep, individual actions that transgress the boundaries of morality. Ease of associations, increase in working capacity and creative productivity are subjectively felt. Objectively, the number of social contacts and success increase.

Partial symptoms of latent mania can be monosymptoms of the following type: disinhibition in childhood and adolescence, a decrease in the need for sleep, episodes of increased creative productivity with experiences of inspiration, bulimia, increased sexual desire (satiriasis and nymphomania).

The main criteria are:

1. Elevated or irritable mood that is abnormal for the individual and persists for at least 4 days.
2. Must present at least 3 symptoms from among the following:

increased activity or physical restlessness;
increased talkativeness;
difficulty concentrating or being distracted;
reduced need for sleep;
increased sexual energy;
episodes of reckless or irresponsible behavior;
increased sociability or familiarity.
Differential Diagnosis

Hypomanic episodes are possible with hyperthyroidism, in which case they are combined with autonomic reactions, fever, Graefe's symptom, exophthalmos, and tremor are noticeable. Patients note "internal trembling". Hypomania can also be in the phase of food arousal with anorexia or with fasting treatment. In true hypomania, appetite, on the contrary, is increased. Hypomania is also characteristic of intoxication with certain psychoactive substances, such as amphetamines, alcohol, marijuana, cocaine, but in this case there are other signs of intoxication: changes in the size of the pupils, tremor, autonomic reaction.

In therapy, small and medium doses of lithium carbonate, small doses of carbamazepine are used.

F30.1 Mania without psychotic symptoms(up)

The main difference from hypomania is that elevated mood affects the change in the norms of social functioning, manifests itself in inadequate actions, speech pressure and increased activity are not controlled by the patient. Self-esteem rises, and separate ideas of one's own significance and greatness are expressed. There is a subjective feeling of lightness of associations, distractibility is increased, the colors of the surrounding world are perceived as brighter and more contrasting, more subtle shades of sounds are distinguished. The pace of the passage of time accelerates, and the need for sleep is significantly reduced. Increased tolerance and need for alcohol, sexual energy and appetite, there is a craving for travel and adventure. There is a constant fear of contracting a venereal disease and getting into stories with unpredictable consequences. Thanks to the leap of ideas, many plans arise, the implementation of which is only planned. The patient strives for bright and flashy clothes, speaks in a loud and later hoarse voice, he incurs a lot of debt and gives money to people he hardly knows. He easily falls in love and is sure of the love of the whole world for himself. Gathering a lot of random people, he arranges holidays on credit.

The main symptoms of mania are:

An elevated, expansive, irritable (angry) or suspicious mood that is unusual for the individual. The change in mood should be distinct and persist throughout the week.
At least three of the following symptoms must be present (and if the mood is only irritable, then four):
1) increased activity or physical restlessness;
2) increased talkativeness ("speech pressure");
3) acceleration of the flow of thoughts or a subjective feeling of a "leap of ideas";
4) decrease in normal social control, leading to inappropriate behavior;
5) reduced need for sleep;
6) increased self-esteem or ideas of greatness (grandness);
7) distractibility or constant changes in activities or plans;
8) reckless or reckless behavior, the consequences of which the patients are not aware of, for example, revelry, stupid enterprise, reckless driving;
9) a noticeable increase in sexual energy or sexual promiscuity.

Absence of hallucinations or delusions, although there may be perceptual disturbances (eg, subjective hyperacusis, seeing colors as particularly bright).
Differential Diagnosis

It is necessary to differentiate mania from affective disorders in addiction diseases (euphoria when using cocaine, marijuana), organic affective disorders and manic-hebephrenic arousal in schizophrenia and schizoaffective disorders. With intoxication euphoria as a result of cocaine use, along with manic excitement, somatic symptoms are noted: headaches, a tendency to convulsions, rhinitis, increased blood pressure, tachycardia, mydriasis, hyperthermia, and increased sweating. With intoxication euphoria as a result of the use of marijuana, mania can occur with slurred speech, increased dryness of the mucous membranes, tachycardia, depersonalization, dilated pupils.

Organic manias occur with a change in consciousness, neurological and somatic disorders, other components of the psychoendocrine syndrome, such as cognitive decline, are detected. The manic-hebephrenic state, unlike the manic one, is characterized by non-infectious fun, formal thought disorders (disconnection, amorphousness, paralogical thinking), foolishness, symptoms of instinctive regression (eating inedible, distortion of sexual preference, cold aggressiveness).

Therapy

In therapy, large antipsychotics (tizercin, chlorpromazine), lithium carbonate in increasing doses with control of plasma lithium levels, and carbamazepine are used.

F30.2 Mania with psychotic symptoms(up)

Clinic

Expressed mania with a bright jump of ideas and manic excitement, to which secondary delusions of greatness, high origin, hypereroticity, value join. Hallucinatory hails, confirming the importance of personality.

The fifth character in this diagnostic group is used to determine whether delusions or hallucinations correspond to mood:

0 - with psychotic symptoms corresponding to the mood (delusions of grandeur or "voices" informing the patient about his superhuman powers);
1 - with psychotic symptoms inconsistent with mood ("voices" telling the patient about emotionally neutral things, or delusions of meaning or persecution).

The episode meets the criteria for mania but presents with psychotic symptoms consistent with and derived from elevated mood.
The episode does not meet the criteria for schizophrenia or schizoaffective disorder.
Delusions (of grandeur, meaning, erotic or persecutory content) or hallucinations.

The greatest difficulty lies in the differential diagnosis with schizoaffective disorders, however, with these disorders, there should be symptoms characteristic of schizophrenia, and delusions with them are less in line with mood. However, the diagnosis can be considered as the starting point for the evaluation of schizoaffective disorder (first episode).

Therapy involves the combined use of lithium carbonate and antipsychotics (triftazin, haloperidol, tizercin).

F30.8 Other manic episodes(up)

F30.9 Manic episode, unspecified(up)

F31 Bipolar affective disorder(up)

A disorder previously classified as manic-depressive psychosis. The disease is characterized by repeated (at least two) episodes in which the mood and level of motor activity are significantly impaired - from manic hyperactivity to depressive retardation. Exogenous factors practically do not affect the rhythm. The boundaries of episodes are determined by the transition to an episode of opposite or mixed polarity or to intermission (remission). Attacks have tropism to the seasons, more often spring and autumn exacerbation, although individual rhythms are also possible. The duration of intermissions is from 6 months to 2-3 years. The duration of manic states is from a month to 4 months, during the dynamics of the disease, the duration of depression is from a month to 6 months. Relapses may be of approximately the same duration, but may be lengthened as remissions are shortened. Depressions are clearly endogenous in nature: daily mood swings, elements of vitality. In the absence of therapy, seizures tend to spontaneously terminate, although they are more protracted.

As the disease progresses, social decline is sometimes observed.

Diagnosis is based on the detection of repeated episodes of changes in mood and the level of motor activity in the following clinical variants:

F31.0 Bipolar affective disorder, current hypomanic episode(up)

Episode with criteria for hypomania.
Past history of at least one affective episode meeting criteria for hypomanic or manic episode, depressive episode, or mixed affective episode.

F31.1 Bipolar affective disorder, current episode of mania without psychotic symptoms(up)

Episode with criteria of mania.
In the past, at least one or two affective episodes that meet the criteria for a hypomanic or manic episode, a depressive episode, or a mixed affective episode.

F31.2 Bipolar affective disorder, current episode of mania with psychotic symptoms(up)

Current episode with criteria for mania with psychotic symptoms.
A history of at least one or two affective episodes that meet the criteria for a hypomanic or manic episode, a depressive episode, or a mixed affective episode.
The fifth digit is commonly used to match psychotic symptoms to mood:

0 - psychotic symptoms corresponding to mood;

F31.3 Bipolar affective disorder, current episode of moderate or mild depression(up)

An episode that meets the criteria for a depressive episode, mild or moderate.
At least one affective episode in the past with criteria for a hypomanic or manic episode, or a mixed affective episode.
The fifth sign is used to determine the representation of somatic symptoms in the current episode of depression:

F31.4 Bipolar affective disorder
current episode of severe depression without psychotic symptoms(top )

An episode meeting the criteria for a major depressive episode without psychotic symptoms.
Past history of at least one manic or hypomanic episode or mixed affective episode.

F31.5 Bipolar affective disorder
current episode of severe depression with psychotic symptoms(up)

An episode meeting the criteria for a major depressive episode with psychotic symptoms.
Past history of at least one hypomanic or manic episode or mixed affective episode.
The fifth character is used to indicate the correspondence of psychotic symptoms to mood:

0 - mood related psychotic symptoms,
1 - psychotic symptoms inconsistent with mood.

F31.6 Bipolar affective disorder, current mixed episode(up)

An episode is characterized by either a mixed or rapid change (over several hours) of hypomanic, manic, and depressive symptoms.
Both manic and depressive symptoms must be present for at least two weeks.
In the past, at least one hypomanic or manic episode, depressive or mixed affective episode.

F31.7 Bipolar affective disorder, remission(up)

The condition does not meet the criteria for depression or mania of any severity or other mood disorders (possibly due to prophylactic therapy).
In the past, at least one hypomanic or manic episode and also at least one other affective episode (hypomania or mania), depressive or mixed.
Differential Diagnosis

Bipolar affective disorder is more often differentiated from schizoaffective disorder. Schizoaffective disorder is a transient endogenous functional disorder, which is also practically not accompanied by a defect and in which affective disturbances accompany and last longer than the productive symptoms of schizophrenia (F20). These symptoms are not characteristic of bipolar affective disorder.

The treatment of depression, mania and prophylactic therapy of seizures are divided. Features of therapy are determined by the depth of affective disorders and the presence of other productive symptoms. For depressive episodes, tricyclic antidepressants, ECT, sleep deprivation treatment, and nitrous oxide disinhibition are more commonly used. With manic episodes, a combination of lithium carbonate and antipsychotics. As maintenance therapy: carbamazepine, sodium valproate or lithium carbonate.

F31.8 Other bipolar affective disorders(up)

F31.9 Bipolar affective disorders, unspecified(up)

F32 Depressive episode(up)

Risk factors

Risk factors for depression are age 20-40, decline in social class, divorce in men, family history of suicide, loss of relatives after 11 years, personality traits with traits of anxiety, diligence and conscience, stressful events, homosexuality, sexual satisfaction problems, postpartum period especially in single women.

The clinic consists of emotional, cognitive and somatic disorders, among the additional symptoms there are also secondary ideas of self-blame, depressive depersonalization and derealization. Depression is manifested in a decrease in mood, loss of interest and pleasure, a decrease in energy, and as a result, in increased fatigue and decreased activity.

The depressive episode lasts at least 2 weeks.

The rhythm of mood changes is characterized by a typical improvement in well-being in the evening. Decreased self-esteem and self-confidence, which looks like a specific neophobia. These same sensations distance the patient from others and increase the feeling of his inferiority. With a long course of depression after the age of 50, this leads to deprivation and a clinical picture resembling dementia. Ideas of guilt and self-deprecation arise, the future is seen in gloomy and pessimistic tones. All this leads to the emergence of ideas and actions associated with auto-aggression (self-harm, suicide). The rhythm of sleep / wakefulness is disturbed, insomnia or lack of a sense of sleep is observed, gloomy dreams predominate. In the morning the patient has difficulty getting out of bed. Appetite decreases, sometimes the patient prefers carbohydrate food to protein food, appetite can be restored in the evening. The perception of time is changing, which seems infinitely long and painful. The patient ceases to draw attention to himself, he may have numerous hypochondriacal and senestopathic experiences, depressive depersonalization appears with a negative idea of \u200b\u200bhis own Self and body. Depressive derealization is expressed in the perception of the world in cold and gray tones. Speech is usually slowed down, with a monologue about one's own problems and the past. Concentration is difficult, and the formulation of ideas is slow.

On examination, patients often look out the window or at a light source, gesticulate towards their own body, clasping their hands to their chest, with anxious depression to the throat, submission posture, Veragut fold in facial expressions, lowered corners of the mouth. In case of anxiety, accelerated gestural manipulations of objects. The voice is low, quiet, with long pauses between words and low directiveness.

Endogenous affective component. The endogenous affective component is expressed in the presence of rhythm: symptoms intensify in the morning and are compensated in the evening, in the presence of criticism, in the subjective feeling of the severity of one's condition, the relationship of severity with the season, in a positive reaction to tricyclic antidepressants.

Somatic syndrome is a complex of symptoms indirectly indicating a depressive episode. The fifth character is used to designate it, but the presence of this syndrome is not specified for a severe depressive episode, since it is always detected in this variant.

To define a somatic syndrome, four of the following symptoms must be presented according to ICD 10:

Decreased interest and/or decreased enjoyment of activities normally enjoyable for the patient.
Lack of response to events and/or activities that would normally trigger it.
Waking up in the morning two or more hours before usual time.
Depression is worse in the morning.
Objective evidence of marked psychomotor retardation or agitation (noted or described by others).
Noticeable decrease in appetite:
a) weight loss (five or more percent of body weight in the last month).
b) a noticeable decrease in libido.

Nevertheless, in traditional diagnostics, many symptoms can be attributed to the somatic syndrome: such as dilated pupils, tachycardia, constipation, decreased skin turgor and increased fragility of nails and hair, accelerated involutive changes (the patient seems older than his years), as well as somatoform symptoms: such as psychogenic dyspnea, restless legs syndrome, dermatological hypochondria, cardiac and pseudorheumatic symptoms, psychogenic dysuria, somatoform disorders of the gastrointestinal tract. In addition, with depression, sometimes weight does not decrease, but increases due to cravings for carbohydrates, libido may also not decrease, but increase, since sexual satisfaction reduces the level of anxiety. Other somatic symptoms include vague headaches, amenorrhea and dysmenorrhea, chest pains and, especially, a specific sensation of "a stone, heaviness on the chest."

Diagnostics

The most important features are:

decreased ability to concentrate and attention;
decreased self-esteem and self-confidence;
ideas of guilt and self-abasement;
a gloomy and pessimistic vision of the future;
ideas or actions that lead to self-harm or suicide;
disturbed sleep;
reduced appetite.

Depression should be differentiated from the onset of Alzheimer's disease. Depression can indeed be accompanied by the pseudo-dementia clinic described by Wernicke. In addition, prolonged depression can lead to cognitive deficits as a result of secondary deprivation. Pseudo-dementia in chronic depression is referred to as Puna van Winkle syndrome. For the distinction, anamnestic information, data from objective research methods are important. Depressed patients are more likely to have characteristic diurnal mood swings and relative success in the evening, their attention is not so grossly impaired. In the facial expressions of depressed patients, the Veragut fold, pubescent corners of the mouth are noted and there is no typical for Alzheimer's disease, bewildered amazement and rare blinking. In depression, there are also no gestural stereotypes. In depression, as in Alzheimer's disease, progressive involution is noted, including a decrease in skin turgor, dull eyes, increased brittleness of nails and hair, but these disorders in cerebral atrophy are more often ahead of psychopathological disorders, and in depression they are noted with a long duration of reduced mood. Weight loss in depression is accompanied by a decrease in appetite, and in Alzheimer's disease, appetite not only does not decrease, but may increase. Patients with depression respond more distinctly to antidepressants with an increase in activity, but in Alzheimer's disease they can increase spontaneity and asthenia, giving the impression of a busy patient. However, CT, EEG and neuropsychological examination data are of decisive importance.

Antidepressants are used in the treatment: mono-, bi-, tri- and tetracyclic, MAO inhibitors, L-tryptophan, thyroid hormones, monolateral ECT on the non-dominant hemisphere, sleep deprivation. The old methods include intravenous treatment with increasing euphoric doses of novocaine, inhalation with nitrous oxide. Phototherapy with fluorescent lamps, cognitive and group psychotherapy is also used.

F32. 0 Mild depressive episode(up)

In the clinical picture, there is a decrease in the ability to concentrate and attention, a decrease in self-esteem and self-confidence, ideas of guilt and self-abasement, a gloomy and pessimistic attitude towards the future; suicidal ideas and self-harm, sleep disturbances, loss of appetite. These general symptoms of a depressive episode must be combined with a level of depressive mood that is perceived by the patient as abnormal, and the mood is not episodic, but covers most of the day and does not depend on reactive moments. The patient experiences a distinct decrease in energy and increased fatigue, although he can control his condition and often continues to work. Behavioral (facial, communicative, postural and gestural) signs of bad mood may be present, but controlled by the patient. In particular, one can notice a sad smile, motor retardation, which is perceived as "thoughtfulness". Sometimes the first complaints are the loss of the meaning of existence, "existential depression".

The fifth character is used to clarify the presence of a somatic syndrome:

0 - no somatic symptoms,
1 - with somatic symptoms.

At least two of the following three symptoms:
depressed mood;

Two of the additional symptoms:

sleep disturbance;
change in appetite.

Differential Diagnosis

Most often, a mild depressive episode has to be differentiated from an asthenic state as a result of overwork, organic asthenia, and decompensation of asthenic personality traits. With asthenia, suicidal thoughts are not characteristic, and lowered mood and fatigue increase in the evening. With organic asthenia, dizziness, muscle weakness, and fatigue during physical exertion are often noted. She has a history of traumatic brain injury. With decompensation of personality traits, the psychasthenic core is noticeable in the anamnesis, subdepression is perceived by the personality as natural.

In the treatment, benzodiazepines, antidepressants such as fluoxetine, pyrazidol, petilil, gerfonal are used, with an alarming component - zoloft. Courses of herbal medicine, psychotherapy and nootropics are shown. Sometimes the effect is given by 2-3 sessions of nitrous oxide, amytal-caffeine disinhibition and intravenous administration of novocaine.

F32. 1 Moderate depressive episode(up)

The main difference between a moderate depressive episode is that the change in affect affects the level of social activity and interferes with the realization of the personality. In the presence of anxiety, it is clearly manifested in complaints and behavior. In addition, depressions are often found with obsessive-phobic components, with senestopathies. The differences between mild and moderate episodes may also be purely quantitative.

1. 2 out of 3 symptoms of a mild depressive episode, i.e. from the following list:

depressed mood;
decreased interest or pleasure in activities that were previously enjoyable to the patient;
decreased energy and increased fatigue.
2. 3-4 other symptoms from the general criteria for depression:

decreased confidence and self-esteem;
causeless feeling of self-condemnation and guilt;
recurring thoughts of death or suicide;
complaints of decreased concentration, indecision;
sleep disturbance;
change in appetite.
3. The minimum duration is about 2 weeks. The fifth character indicates a somatic syndrome:

1 - with somatic syndrome. Differential Diagnosis

It should be differentiated from post-schizophrenic depression, especially in the absence of a clear history. A moderate depressive episode is characterized by an endogenous affective component, negative emotional and volitional disorders are absent.

In the treatment, MAO inhibitors are used against the background of a diet that excludes tyramine (smoked meats, beer, yogurt, dry wines, aged cheeses), tricyclic antidepressants (for depression with an anxiety component - amitriptyline, for anergia - melipramine), tetracyclic antidepressants. With prolonged depression - lithium carbonate or carbamazepine. Sometimes 4-6 sessions of nitrous oxide, amytal-caffeine disinhibition and intravenous administration of novocaine, as well as treatment with sleep deprivation, give an effect.

F32. 3 Major depressive episode without psychotic symptoms(up)

In the clinic of a severe depressive episode, all the symptoms of depression are present. Motor skills are agitated or significantly retarded. Suicidal thoughts and behavior are permanent, and a somatic syndrome is always present. Social activity is subordinated only to illness and is significantly reduced or even impossible. All cases require hospitalization due to the risk of suicide. If there is agitation and lethargy in the presence of other behavioral signs of depression, but no additional verbal information about the patient's condition can be obtained, this episode also belongs to severe depression.

All criteria for a mild to moderate depressive episode, i.e. a depressive mood is always present; decreased interest or pleasure in activities that were previously enjoyable to the patient; decreased energy and increased fatigue.
Additionally, 4 or more symptoms from the general criteria for a depressive episode, that is, from the list: decreased confidence and self-esteem; causeless feeling of self-condemnation and guilt; recurring thoughts of death or suicide, complaints of decreased concentration, indecision; sleep disturbance; change in appetite.
Duration at least 2 weeks.
Differential Diagnosis

It should be differentiated from organic affective symptoms and the initial stages of dementia, especially in Alzheimer's disease. Organic affective symptoms can be excluded by additional neurological, neuropsychological studies, EEG and CT. The same methods are used in the differential diagnosis with the initial stages of Alzheimer's disease.

F32. 3 Major depressive episode with psychotic symptoms(up)

At the height of severe depression, delusional ideas of self-accusation, hypochondriacal delusions about infection with some incurable disease and fear (or belief in infection) of infecting loved ones with this disease arise. The patient takes upon himself the sins of all mankind and believes that he must atone for them, sometimes at the cost of eternal life. His thoughts can confirm auditory, olfactory deceptions. As a result of these experiences, lethargy and depressive stupor occur.

Meets the criteria for a major depressive episode.
The following symptoms should be present:
1) delusions (depressive delusions, delusions of self-accusation, delusions of hypochondriacal, nihilistic or persecutory content);
2) auditory (accusing and insulting voices) and olfactory (rotten smells) hallucinations;
3) depressive stupor.

The fifth character is used to determine the correspondence of psychotic symptoms to mood.

0 - psychotic symptoms consistent with mood (delusions of guilt, self-abasement, physical illness, impending misfortune, mocking or judgmental auditory hallucinations),
1 - psychotic symptoms that do not correspond to mood (persecutory delusions or delusional self-reference and hallucinations without affective content).

The main differential diagnosis is associated with a group of schizoaffective disorders. In fact, major depressive episodes can be seen as manifestations of schizoaffective disorders. In addition, with affective disorders, there are no symptoms of the first rank characteristic of schizophrenia.

Treatment includes tricyclic and tetracyclic antidepressants, ECT and antipsychotics (stelazine, etaperazine, haloperidol), and benzodiazepines.

F32. 8 Other depressive episodes(up)

Episodes that do not fit the description of depressive episodes are included, but the overall diagnostic impression indicates their depressive nature.

For example, fluctuations in depressive symptoms in accordance (especially "somatic" syndrome) with symptoms such as tension, anxiety, distress, as well as the complication of "somatic" depressive symptoms with chronic pain or fatigue that are not due to organic causes.

F32. 9 Other depressive episode, unspecified(up)

F33 Recurrent depressive disorder(up)

Recurrent depressive episodes (mild, moderate or severe). The period between attacks is at least 2 months, during which no significant affective symptoms are observed. Episodes last 3-12 months. It occurs more often in women. Usually by late age lengthening of attacks is noted. The individual or seasonal rhythm is rather distinct. The structure and typology of attacks corresponds to endogenous depressions. Additional stress can change the severity of depression. This diagnosis is made in this case, and therapy is used that reduces the risk of recurrent episodes.

Recurrent depressive episodes with periods between attacks of at least 2 months, during which no affective symptoms are observed.

F33.0 Recurrent depressive disorder, current episode of mild severity(up)

Corresponds to the common recurrent depressive disorder.
The current episode meets the criteria for a mild depressive episode.
The fifth item is used to clarify the presence of somatic symptoms in the current episode:

0 - no somatic syndrome.
1 - with somatic syndrome.

F33.1 Recurrent depressive disorder, moderate current episode(up)

The current episode meets the criteria for a mild depressive episode of moderate severity.
The fifth item was used to assess the presence of somatic symptoms in the current episode:

0 - no somatic syndrome,
1 - with somatic syndrome.

F33.2 Recurrent depressive disorder
severe current episode without psychotic symptoms(up)

General criteria for recurrent depressive disorder.
The current episode meets the criteria for a major depressive episode without psychotic symptoms.

F33.3 Recurrent depressive disorder
severe current episode with psychotic symptoms(up)

General criteria for recurrent depressive disorder.

The current episode meets the criteria for a major depressive episode with psychotic symptoms.

The fifth item is used to determine the correspondence between psychotic symptoms and mood:

0 - with mood-appropriate psychotic symptoms,
1 - with mood-inappropriate psychotic symptoms.

F33.4 Recurrent depressive disorder, currently in remission(up)

General criteria for recurrent depressive disorder.
The present condition does not meet the criteria for a depressive episode of any severity or any other disorder in F30-F39.

Recurrent depressive disorder should be differentiated from schizoaffective disorder and organic affective disorders. With schizoaffective disorders, symptoms of schizophrenia are present in the structure of productive experiences, and with organic affective disorders, symptoms of depression accompany the underlying disease (endocrine, brain tumor, consequences of encephalitis).

Treatment includes exacerbation therapy (antidepressants, ECT, sleep deprivation, benzodiazepines, and antipsychotics), psychotherapy (cognitive and group therapy), and supportive care (lithium, carbamazepine, or sodium valproate).

F33.8 Other recurrent depressive disorders(up)

F33.9 Recurrent depressive disorder, unspecified(up)

F34 Chronic (affective) mood disorders(up)

They are chronic and usually unstable. Individual episodes are not deep enough to qualify as hypomania or mild depression. Last for years, and sometimes throughout the life of the patient. Due to this, they resemble special personality disorders such as constitutional cycloids or constitutionally depressive ones. Life events and stresses can deepen these conditions.

The cause of chronic mood disorders is both constitutional genetic factors and a special affective background in the family, for example, its orientation towards hedonism or a pessimistic perception of life. When confronted with life events that none of us manage to avoid, the personality reacts with a typical affective state, which initially seems quite adequate and psychologically understandable. This affective state causes the reaction of others and seems to them adaptive.

Often since childhood or adolescence, mood swings of a seasonal type are noted. However, this diagnosis is considered adequate only in post-puberty, when unstable mood with periods of subdepression and hypomania lasts at least two years. The clinic itself is endogenously perceived only as a period of inspiration, rash acts or blues. Moderate and severe depressive and manic episodes are absent, but are sometimes described in the anamnesis.

The period of depressed mood grows gradually and is perceived as a decrease in energy or activity, the disappearance of the usual inspiration and creativity. This in turn leads to a decrease in self-confidence and feelings of inferiority, as well as social isolation, isolation is also manifested in reduced talkativeness. Insomnia appears, pessimism is a stable property of character. The past and the future are evaluated negatively or ambivalently. Patients sometimes complain of increased drowsiness and impaired attention, which prevents them from perceiving new information.

An important symptom is anhedonia towards previously enjoyable instinctual discharges (eating, sex, travel) or pleasurable activities. A decrease in activity is especially noticeable if it followed an elevated mood. However, there are no suicidal thoughts. The episode can be perceived as a period of idleness, existential emptiness, and when it is long, it is evaluated as a character trait.

The opposite state can be stimulated by endogenous and external events and also be tied to the season. With an elevated mood, energy and activity increase, and the need for sleep decreases. Creative thinking is increased or sharpened, which leads to an increase in self-esteem. The patient tries to demonstrate intelligence, wit, sarcasm, speed of association. If the patient's profession coincides with self-demonstration (actor, lecturer, scientist), then his results are rated as "brilliant", but with a low mind, increased self-esteem is perceived as inadequate and ridiculous.

Interest in sex increases, and sexual activity increases, interest in other types of instinctive activities increases (food, travel, there is an over-involvement in the interests of one's own children, relatives, an increased interest in outfits and jewelry). The future is perceived optimistically, past achievements are overestimated.

More than two years of unstable mood, including alternating periods of both subdepression and hypomania, with or without intervening periods of normal mood.
Two years there are no moderate and severe manifestations of affective episodes. Observed affective episodes are lower in level than mild ones.
In depression, at least three of the following symptoms must be present:
decreased energy or activity;
insomnia;
decreased self-confidence or feelings of inferiority;
difficulty concentrating;
social isolation;
decreased interest or pleasure in sex or pleasurable activities;
decrease in talkativeness;
pessimistic attitude towards the future and negative assessment of the past.
An increase in mood is accompanied by at least three of the following symptoms:
increased energy or activity;
reduced need for sleep;
increased self-esteem;
heightened or unusual creative thinking;
increased sociability;
increased talkativeness or demonstration of the mind;
increased interest in sex and increased sexual relations, other pleasurable activities;
over-optimism and overestimation of past achievements.
Individual anti-disciplinary actions are possible, usually in a state of intoxication, which are rated as "excessive fun".

It should be differentiated from mild depressive and manic episodes, bipolar affective disorders occurring with moderate and mild affective attacks, hypomanic states should also be distinguished from the onset of Pick's disease.

In relation to mild depressive and manic episodes, this can usually be done on the basis of anamnesis data, since unstable mood in cyclothymia should be determined for up to two years, suicidal thoughts are also not characteristic of cyclothymics, and periods of elevated mood are socially more harmonious. Cyclothymic episodes do not reach a psychotic level, which distinguishes them from affective bipolar disorders, in addition, cyclothymics have a unique anamnestic history, episodes of mood disturbances are noted very early in puberty, and mood changes in Pick's disease at a later age and are combined with more severe disorders. social functioning.

Prevention of episodes of impaired mood in cyclothymia is carried out with lithium, carbamazepine, or sodium valproate. These same drugs can be used in the treatment of elevated mood, although in cases where it is accompanied by increased productivity, this is hardly advisable. Prozac, sleep deprivation treatment, and enotherapy are indicated for depressed mood. Sometimes the effect is given by 2-3 sessions of nitrous oxide, amytal-caffeine disinhibition and intravenous administration of novocaine.

Etiology

The types of individuals who develop dysthymia would be correct to call constitutionally depressive. These traits manifest themselves in childhood and puberty as a reaction to any difficulty, and later endogenously.

They are whiny, thoughtful and not very sociable, pessimistic. Under the influence of minor stresses for at least two years, they experience periods of constant or periodic depressive mood in post-puberty. Intermediate periods of normal mood rarely last more than a few weeks, the whole mood of the individual is colored by subdepression. However, the level of depression is lower than in mild recurrent disorder. It is possible to identify the following symptoms of subdepression: decreased energy or activity; sleep disturbance and insomnia; decreased self-confidence or feelings of inferiority; difficulties in concentrating and hence subjectively perceived memory loss; frequent tearfulness and hypersensitivity; decreased interest or pleasure in sex, other previously pleasurable and instinctive activities; feelings of hopelessness or despair due to the realization of helplessness; inability to cope with the routine responsibilities of daily life; pessimistic attitude towards the future and negative assessment of the past; social isolation; decreased talkativeness and secondary deprivation.

At least two years of persistent or recurring depressed mood. Periods of normal mood rarely last more than a few weeks.
The criteria do not meet a mild depressive episode because there are no suicidal thoughts.
During periods of depression, at least three of the following symptoms must be present: decreased energy or activity; insomnia; decreased self-confidence or feelings of inferiority; difficulty concentrating; frequent tearfulness; decreased interest or pleasure in sex or other pleasurable activities; feelings of hopelessness or despair; inability to cope with the routine responsibilities of daily life; pessimistic attitude towards the future and negative assessment of the past; social isolation; reduced need for communication.
Differential Diagnosis

It should be differentiated from a mild depressive episode, the initial stage of Alzheimer's disease. In a mild depressive episode, suicidal thoughts and ideas are present. In the initial stages of Alzheimer's disease and other organic disorders, depressions become protracted, organics can be detected neuropsychologically and with the help of other objective research methods.

Prozac, sleep deprivation treatment, and eno-therapy are indicated for depressed mood. Sometimes the effect is given by 2-3 sessions of nitrous oxide, amytal-caffeine disinhibition and intravenous administration of novocaine, as well as nootropic therapy.

F34.8 Other chronic (affective) mood disorders(up)

A category for chronic affective disorders that are not severe or long enough to meet the criteria for cyclothymia or dysthymia, mild or moderate depressive episode. Some types of depression formerly called "neurotic" are included. This type of depression is closely related to stress and, together with dysthymia, organize a circle of endoreactive dysthymia.

F34.9 Chronic (affective) mood disorder, unspecified(up)

F38 Other (affective) mood disorders(up)

F38.0 Other solitary (affective) mood disorders(up)

F38.00 Mixed affective episode(up)

The episode is characterized by a mixed clinical picture or a rapid change (within a few hours) of hypomanic, manic and depressive symptoms.
Both manic and depressive symptoms should be expressed most of the time, for at least a two-week period.
No previous hypomanic, depressive, or mixed episodes.

F38.1 Other recurrent mood disorders(up)

F38.10 Recurrent brief depressive disorder(up)

The disorders meet the symptomatic criteria for mild, moderate, or severe depression.
Depressive episodes have occurred monthly in the past year.
Individual episodes last less than two weeks (typically two to three days).
Episodes do not occur in connection with the menstrual cycle.

F38.8 Other specified (affective) mood disorders(up)

F39 Mood (affective) disorder, unspecified(up)

Patients note a decrease in the ability to concentrate and attention, which is subjectively perceived as a difficulty in memorization and a decrease in learning success. This is especially noticeable in adolescence and youth, as well as in people engaged in intellectual work. Physical activity is also reduced to lethargy (up to a stupor), which can be perceived as laziness. In children and adolescents, depression can be accompanied by aggressiveness and conflict, which mask a kind of self-hatred. It is conditionally possible to divide all depressive states into syndromes with an anxiety component and without an anxiety component.
The rhythm of mood changes is characterized by a typical improvement in well-being in the evening. Decreased self-esteem and self-confidence, which looks like a specific neophobia. These same sensations distance the patient from others and increase the feeling of his inferiority. With a long course of depression after the age of 50, this leads to deprivation and a clinical picture resembling dementia. Ideas of guilt and self-deprecation arise, the future is seen in gloomy and pessimistic tones. All this leads to the emergence of ideas and actions associated with auto-aggression (self-harm, suicide). The rhythm of sleep / wakefulness is disturbed, insomnia or lack of a sense of sleep is observed, gloomy dreams predominate. In the morning the patient has difficulty getting out of bed. Appetite decreases, sometimes the patient prefers carbohydrate food to protein food, appetite can be restored in the evening. The perception of time is changing, which seems infinitely long and painful. The patient ceases to draw attention to himself, he may have numerous hypochondriacal and senestopathic experiences, depressive depersonalization appears with a negative idea of \u200b\u200bhis own Self and body. Depressive derealization is expressed in the perception of the world in cold and gray tones. Speech is usually slowed down with a conversation about one's own problems and the past. Concentration is difficult, and the formulation of ideas is slow.
On examination, patients often look out the window or at a light source, gesticulate towards their own body, clasping their hands to their chest, with anxious depression to the throat, submission posture, Veragut fold in facial expressions, lowered corners of the mouth. In case of anxiety, accelerated gestural manipulations of objects. The voice is low, quiet, with long pauses between words and low directivity.
Indirectly, a depressive episode can be indicated by symptoms such as dilated pupils, tachycardia, constipation, decreased skin turgor and increased fragility of nails and hair, accelerated involutive changes (the patient seems older than his years), as well as somatoform symptoms, such as: psychogenic shortness of breath, syndrome restless legs, dermatological hypochondria, cardiac and pseudorheumatic Symptoms, psychogenic dysuria, somatoform disorders of the gastrointestinal tract. In addition, with depression, sometimes weight does not decrease, but increases due to cravings for carbohydrates, libido may also not decrease, but increase, since sexual satisfaction reduces the level of anxiety. Other somatic symptoms include vague headaches, amenorrhea and dysmenorrhea, chest pains and, especially, a specific sensation of "a stone, heaviness on the chest."

Depression- a feeling of despondency, often accompanied by a loss of interest in one's own existence and a decrease in vital energy. Women 20 years of age and older are more commonly affected. predisposition to depression sometimes inherited. The risk factor is the social isolation of a person.

Despondency - a completely predictable reaction of a person to an unfavorable situation or personal failures. This feeling can possess a person for quite a long time. We can talk about the development of depression when the feeling of lack of happiness intensifies and everyday life becomes painful.

Among women depression develops 2 times more often than in men. In some cases depression spontaneously passes within a few days or weeks. Other patients may need support and professional help. With the development of a severe form depression hospitalization may be required to keep the person from sinking or hurting themselves.

Depression often accompanied by anxiety symptoms.

The triggering factor is often some form of loss, such as the breaking of a close relationship or the loss of a loved one.

Trauma experienced in childhood, such as the death of a parent, may increase susceptibility to depression. depression can also cause some somatic diseases, or neurological diseases, for example, or complications after a stroke, and diseases of the endocrine system, for example, and. Depression can be caused by some mental disorders. These include , or . Some people feel depressed and despondent only during the winter, a condition known as seasonal affective disorder. Depression it can also manifest itself as a side effect of the action of certain drugs, such as steroids and.

Other symptoms of depression include:

Loss of interest in work, inability to enjoy leisure;

Decreased vitality;

Poor concentration;

Low self-esteem;

Guilt;

Tearfulness;

Inability to make decisions;

early awakenings and inability to sleep or excessive sleepiness;

Loss of hope for the future;

Periodic thoughts about death;

Weight loss or, conversely, its increase;

Decreased sex drive.

Elderly people may experience other symptoms, including confused thoughts, forgetfulness, and personality changes that can be mistaken for dementia.

Sometimes depression manifests itself through physical symptoms, such as fatigue, or leads to physical disorders, such as constipation or headache. People who are severely ill depression, can see or hear things that do not exist in reality. Depression may alternate with periods of euphoria, which is typical for people with a bipolar form of the disorder.

If a person suffering depression, meets sympathy and support from loved ones, and his illness has a mild form, its symptoms may disappear by themselves. In almost every case depression amenable to effective treatment, and the patient should not be delayed in visiting a doctor if he continues to feel depressed. At a medical appointment, the necessary examinations are carried out and blood is taken for analysis to make sure that the decrease in the patient's ability to work and mood is not associated with a somatic disease.

If depression diagnosed, the patient may be prescribed medication, psychotherapy, or a combination of the first and second methods. In some severe cases depression electroconvulsive therapy may be used. Usually the patient is prescribed a course. There are several groups of similar medicines, and the doctor's task is to choose one of them that is most suitable for a particular case. Although some of them have undesirable side effects, their effect on the underlying disease (depressive state) can be very helpful. The patient's mood usually improves after 4–6 weeks of use, although some other symptoms may resolve more quickly. If no positive effect is achieved after 6 weeks of treatment, or if its side effect on the patient causes problems, the doctor may adjust the dose of the drug or replace it with another one.

Even depression receded, the patient should continue taking it for as long as the doctor advises. Medical treatment usually requires at least six months, and its duration depends on the severity depressive symptoms and whether the patient tolerated depression previously. If the reception is stopped prematurely, depression may return.

The patient needs the support of a doctor and other medical professionals. Your doctor may refer you to a course of special treatment, such as cognitive therapy, which will help the patient get rid of negative thoughts, or psychoanalysis-based psychotherapy, which will determine the causes depression patient.

In rare cases, it may be used electroconvulsive therapy (ECT). During this procedure, which takes place under general anesthesia, an electric shock emitted by two electrodes attached to the patient's head passes through the person's brain and causes a short-term spasm. Approximately 6 to 12 electric shock sessions are performed per month of treatment. This type of therapy is mainly used to treat depression accompanied by hallucinations.

Proved to be an effective treatment for 75% of patients suffering from depression. If drug therapy is used in combination with psychotherapy, symptoms are often depression can be removed completely in 2-3 months of treatment. As for people who have completed a course of ECT, recovery occurs in 90% of cases.

In addition, to alleviate the patient's condition, the following measures should be taken:

Make a list of what needs to be done every day, starting with the most important;

Each time, take on only one thing, noting the achievements upon its completion;

Take a few minutes a day to sit down and relax, while breathing slowly and deeply;

Exercise regularly to help reduce stress.

Eat healthy food;

Find yourself an entertainment or hobby that will distract from experiences;

Join a self-help group to meet people who are experiencing similar problems.

seasonal depressive disorder

A disorder characterized by recurrent episodes of depression. The current episode is mild (as described in F32.0) and no history of mania.

A disorder characterized by recurrent episodes of depression. The current episode is mild (as described in F32.1) and no history of mania.

Endogenous depression without psychotic symptoms

Major depression, recurrent without psychotic symptoms

Manic-depressive psychosis, depressive type without psychotic symptoms

Manic-depressive psychosis, depressive type with psychotic symptoms

Repeated severe episodes:

psychogenic depressive psychosis
psychotic depression

The patient has had two or more depressive episodes in the past (as described in F33.0-F33.3) but has not had depressive symptoms for several months.

Persistent mood disorders [affective disorders] (F34)

Persistent mood instability, including a series of periods of depression and mild elation, none of which is severe or prolonged enough to warrant a diagnosis of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). Such a disorder is often found in relatives of a patient suffering from bipolar affective disorder. Some patients with cyclothymia eventually develop bipolar affective disorder.

affective personality disorder

Chronic depressive mood lasting at least several years that is not severe enough or in which individual episodes are not long enough to warrant a diagnosis of severe, moderate or mild recurrent depressive disorder (F33.-).

Depressive(s):

neurosis
personality disorder

Persistent anxious depression

Excludes: anxiety depression (mild or unstable) (F41.2)

MOOD DISORDERS [THE MOOD DISORDERS] (F30-F39)

This block includes disorders in which the main disturbance is a change in emotions and mood towards depression (with or without anxiety) or towards elation. Mood changes are usually accompanied by changes in overall activity levels. Most of the other symptoms are secondary or easily explained by changes in mood and activity. Such disorders most often tend to recur, and the onset of a single episode can often be associated with stressful events and situations.

All sub-categories of this three-digit category must be used for a single episode only. Hypomanic or manic episodes in cases where one or more affective episodes (depressive, hypomanic, manic or mixed) have already occurred in the past should be coded as bipolar affective disorder (F31.-)

Includes: bipolar disorder, single manic episode

A disorder characterized by two or more episodes in which the patient's mood and activity level are significantly affected. These disturbances are cases of elevation of mood, a surge of energy and increased activity (hypomania or mania) and cases of a drop in mood and a sharp decrease in energy and activity (depression). Repeated episodes of only hypomania or mania are classified as bipolar.

manic depression
manic-depressive (th)(th):
- disease
- psychosis
- reaction
- bipolar disorder, single manic episode (F30.-)
- cyclothymia (F34.0)
- adjustment disorder (F43.2)
- depressive episode associated with conduct disorders classified under F91.-(F92.0)
- repeat episodes:
- major depression with psychotic symptoms

Depression code for ICD 10 in adults. endogenous depression. How does a doctor choose antidepressants?

depressive disorder

Directory of Diseases

Criteria for depression according to ICD-10

Depression according to ICD-10

F30-F39: classification

depressive episode

recurrent depressive disorder

Treatment for depression

Persistent mood disorders [affective disorders] (F34)

MOOD DISORDERS [THE MOOD DISORDERS] (F30-F39)

Depressive episode (F32)

recurrent depressive disorder

Recurrent depressive disorder, current mild episode

Recurrent depressive disorder, current moderate episode

Recurrent depressive disorder, current severe episode without psychotic symptoms

Recurrent depressive disorder, current severe episode with psychotic symptoms