F0 Organic, including symptomatic, mental disorders
Disorders of organic aetiology are grouped in this subchapter, independent of whether they contain psychotic or non-psychotic symptoms. However, the use of the term 'organic' does not imply that conditions elsewhere in the classification are non-organic in the sense of having no cerebral substrate. Dementia may contain irreversible and reversible cases, and this term has been expanded similarly to DSM-IV, although one criterion is a duration of at least 6 months. The diagnosis of delirium is less specific than that used previously; for example, disturbances of sensory perception such as visual hallucinations are no longer obligatory.
F1 Mental and behavioural disorders due to psychoactive substance use
An improvement over ICD-9 is the compilation of all mental and behavioural disorders due to psychoactive substances within a single subchapter. The third digit indicates which substance or class of substances (e.g. F10 Alcohol) is responsible for the disorder, which is coded as a fourth digit (e.g. F10.3 Alcohol withdrawal state) or a fifth digit (e.g. F10.31 Alcohol withdrawal state with convulsions). It is possible to differentiate acute intoxication, harmful use, dependence syndrome, withdrawal state with or without delirium, different psychotic disorders, amnesic syndrome, and a number of other disorders. Thus the psychopathological syndrome can be described and related to the dominant substance class.
This subchapter covers schizophrenia, acute psychotic disorders, schizoaffective disorders, delusional disorders, and schizotypal disorders. Before schizophrenia can be diagnosed the symptoms have to be observed for at least 1 month, unlike DSM-IV where symptoms should be observed for 6 months before using this diagnosis, although only 1 month is required with florid psychotic symptoms. Special care is taken with the description of short-lasting psychoses, since acute and transient psychotic disorders are of particular interest to psychiatrists from developing countries where short-lasting acute psychoses with a good prognosis are observed quite frequently.
F3 Mood (affective) disorders
All mood disorders are combined in this subchapter, which represents a considerable change compared with ICD-9. The disorders previously known as endogenous and neurotic depressions are coded in this subchapter; the differentiation between these categories has been abandoned. The ICD-9 category of neurotic depression (300.4) is no longer found in ICD-10. Most of these cases are now coded as dysthymia (F34.1), although there is no fixed rule. Single manic episodes are coded as F30, while recurrent manic episodes are now coded as bipolar affective disorder (F31), regardless of whether or not there has been a previous depressive episode. A practical difficulty often arises concerning the differentiation between mild, moderate, and severe depressive episodes because of the number of symptoms. The structure of this chapter resembles that of DSM-IV, but unfortunately the grades of severity of the depressive disorders are based on slightly different criteria.
F4 Neurotic, stress-related, and somatoform disorders
The disorders in this subchapter are divided into a large number of categories. For instance, dissociative disorders are divided into seven subcategories, some of which represent rather rare disorders. The term hysteria is no longer used, and unfortunately there is no distinction between conversion and dissociation as in DSM-IV. In this subchapter reactions to severe stress and adjustment disorders are enumerated according to time criteria and severity. Here aetiology is generally accepted to mean exceptional mental stress or special life events. A new group of disorders in this classification are the somatoform disorders, which are of particular importance in developing countries. The traditional term neurasthenia is still maintained for a special category, in contrast with DSM-IV.
F5 Behavioural syndromes associated with physiological disturbances and physical factors
This subchapter brings together eating disorders, non-organic sleep disorders, sexual dysfunction, mental and behavioural disorders associated with the puerperium, and abuse of non-dependence-producing substances. In ICD-9 all sexual disorders were contained in one subchapter. In ICD-10 only disorders of sexual dysfunction are in F5; disorders of gender identity and sexual preference have been assigned to two different sections in subchapter F6 on personality disorders. This new classification of sexual disorders seems to be advantageous in that it accentuates the differences among the disorders. The special code F54, psychological and behavioural factors associated with disorders or diseases classified elsewhere, allows classification of psychosomatic disorders by coding an additional somatic diagnosis.
Specific personality disorders are coded in this subchapter. Cyclothymic personality is not included, but an equivalent appears in F3 as cyclothymia. Also, schizotypal disorders could have been assigned to this subchapter but appears instead in F2 (as F21). As in DSM-IV, the emotionally unstable personality disorder is found in this subchapter, where it is subdivided into an impulsive type (F60.30) and a borderline type (F60.31). A new entity is the factitious disorder, i.e. the intentional production or feigning of symptoms or disabilities, either physical or psychological (F68.1). If desired, narcissistic personality disorder and passive-aggressive personality disorder may be coded by using the criteria in Annex 1 of DCR.
An important aspect of this subchapter is the inclusion of enduring personality changes after catastrophic experience (F62.0) or after psychiatric illness (F62.1). Personality changes after surviving a concentration camp or torture are coded under the first of these.
F7 Mental retardation, F8 Disorders of psychological development, and F9 Behavioural and emotional disorders with onset during childhood and adolescence are mainly used in child and adolescent psychiatry.
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