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ICD-10 Classification : 

ICD-10 Classification Rajesh kataria Lecturer Psychiatry in SWIFT CON

Definition : 

Definition Classification is the process by which complexities of phenomena is reduced by arranging them into categories according to some established criteria.

Purposes : 

Purposes Communication To enable clinician to communicate patients symptoms, prognosis and treatment. Examples : Depression (cluster of clinical feature without having to list.) Personality Disorder

Control Ideally involves ability to either prevent there occurrence or to modify their courses with treatment.

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Comprehension It implies understanding the causes and processes of mental disorder involved

Types : 

Types Categorical Classification Traditionally Divide them into categories It includes an implicit hierarchy of categories for example: OMD and Schizophrenia

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Dimensional Classification Rejects the use of separate categories Example: Eysenck system of 3 dimesions. Psychoticism Neuroticism Introversion- Extroversion

Multiaxial Two or more separate sets of information are coded. Example : DSM-IV 1: Clinical Syndrome 2: Personality disorders 3: Physical disorders 4: Severity of Psychosocial stressors 5. Highest level of adaptive Functioning in the last year

ICD-10 : 

ICD-10 By WHO Mental disorders included in 6th edition 1948 Like DSM-IV it is a Descriptive Classification. It is a mixture of symptoms and aetiology ICD-10 (1992)

Differences between ICD-9 & ICD-10 : 

Differences between ICD-9 & ICD-10 Much larger than ICD-9 Numeric codes ( 001-999 ) were used in ICD-9 where as an alphanumeric coding , based on codes with a single letter followed by two numbers at the three character level ( A00-Z99) has been adopted in ICD-10. It enlarged the number of categories available for the classification Further detail by means of decimal numeric subdivisions at the four character level ICD-9 had only 30 three character categories ( 290-319); chapter V (F) of ICD-10 has 100 such categories

Differences : 

Differences Traditional division between neurosis and psychosis not used in ICD-10 Disorders are now arranged in groups according to major common themes Psychotic has been retained as a convenient descriptive term, it does not involve assumption about psychodynamic mechanisms but simply indicates presence of hallucinations or delusions, gross excitement or over activity, marked psychomotor retardation and catatonic behavior

Differences (cont) : 

Differences (cont) All disorders attributable to an organic cause are grouped together: F00--F09 Disorders due to psychoactive substances : F10—F19..it is more useful than earlier system, third character indicates substance used , the fourth and the fifth characters the psychopathological syndrome e. g. acute intoxication Thus substances involved is indicated by means of second and third characters( the first two digits after letter F ) and the fourth and fifth character specify the clinical states

Alcohol (Cont.) : 

Alcohol (Cont.) F-10: Mental & behavioral disorders due to use of alcohol Four character codes may be used to specify the clinical conditions, as follows: F1x.0 Acute intoxication F1x.1 harmful use F 1x.2 Dependence syndrome F1x.3 Withdrawal state F1x.4 delirium F 1x.5 Psychotic disorder F 1x.6 Amnestic syndrome F1x.9 unspecified mental & behavioral disorder

Alcohol (cont) : 

Alcohol (cont) Diagnosis of the dependence syndrome may be further specified by the following five character codes: F 1x.20 Currently abstinent F 1x.21 Currently abstinent , but in a protected environment ( e.g. in hospital, in a therapeutic community , in prison etc.) F 1x.22 currently on a clinically supervised maintenance or replacement regime ( e.g. with methadone, nicotine gum or patch) F 1x.23 currently abstinent but on aversive drugs (naltrexone or dilsulfiram) F 1x.24 currently using substance F 1x.25 continuous use F 1x.26 episodic use ( dipsomania)

New disorders : 

New disorders Block F60—F69 contains new disorder of adult behavior such as pathological gambling, fire setting, and stealing. Disorders of sexual preference (e.g.Fetishism, Voyeurism) are clearly differentiated from the disorder from disorder of sexual identity (e.g. transsexualism)

Terminology : 

Terminology Term Disorder is used to avoid greater problems inherent in the use of terms such as disease and illness Disorder is not exact term but imply existence of a clinically recognizable set of symptoms or behaviour associated with most cases with distress Term psychogenic and psychosomatic are not used

Dementia and its relationship with impairment, disability and handicap : 

Dementia and its relationship with impairment, disability and handicap Impairment : loss of abnormality…of structure or function ( e.g.interference with memory, attention and emotive function) Disability : a restriction or lack …of ability to perform an activity in the manner or within the range considered normal for human being( Interference with activities of daily life , dementia) Handicap : the disadvantage for the individual …that prevents or limits the performance of a role that is normal… for that individual.

F 00—F09 Organic, including symptomatic, mental disorders : 

F 00—F09 Organic, including symptomatic, mental disorders F 00 Dementia in Alzheimer’s disease F 01 Vascular dementia F 05 Delirium , not induced by alcohol and other psychoactive substances F 06 Other mental disorders due to brain damage and dysfunction and to physical disease : F 06.0 organic hallucinosis F 06.1 organic catatonic disorder F 06.2 organic delusional disorder F 06.3 organic mood disorder F 06.4 organic anxiety disorder F 06.5 organic dissociative disorder F 06.7 mild cognitive disorder F 07 Personality & behavioral disorder due to brain disease , damage and dysfunction F09 Unspecified organic or symptomatic mental disorder

F 10—F19Mental & behavioral disorder due to psychoactive substance use : 

F 10—F19Mental & behavioral disorder due to psychoactive substance use F 10-mental & beh. Disorders due to use of alcohol F 11- opioids F 12- cannabinoids F 13- sedatives or hypnotics Cocaine Stimulants Hallucinogens Tobacco Volatile solvents F 19-.. multiple drug use and use of other psychoactive substances

F 20– F29Schizophrenia, schizotypal and delusional disorders : 

F 20– F29Schizophrenia, schizotypal and delusional disorders F 20 – Schizophrenia F 20.0 – paranoid schizophrenia F 20.1 –hebephrenic schizophrenia F 20.2 – catatonic schizophrenia F 20.3 –undifferentiated schizophrenia F 20.4 – post schizophrenic depression F 20.5 –residual schizophrenia F 20.6 –simple schizophrenia F 20.9 –schizophrenia unspecified

Fifth character : 

Fifth character A fifth character may be used to classify course: .x0- Continuous .x1- Episodic with progressive deficit Episodic with stable deficit Episodic remittent Incomplete remission Complete remission Other .x9- Period of observation less than one year

Schizophrenia, schizotypal and delusional disorder (F20-F29) : 

Schizophrenia, schizotypal and delusional disorder (F20-F29) F 21- Schizotypal Disorder F 22-Persistent delusional disorders F 23-Acute and transient psychotic disorder F 24-Induced delusional disorder F25 -Schizoaffective disorder F 28- other nonorganic psychotic disorder F 29 –unspecified nonorganic psychosis

Mood ( affective ) disorder F 30-- F 39 : 

Mood ( affective ) disorder F 30-- F 39 F 30 -Manic Episode F 30. 0 - Hypomania Mania with psychotic Symptoms Mania without psychotic Symptoms F 30.9 – Manic episode, unspecified

F-31- Bipolar Affective Disorder ( BAD) : 

F-31- Bipolar Affective Disorder ( BAD) F 31.0- BAD, current episode hypomanic Manic without psychotic symptoms With psychotic symptoms F 31.3 -BAD current episode mild or moderate depression .30 -Without Somatic symptom .31 -With Somatic (Biological) symptoms F 31.5 -BAD current episode severe depression without psychotic symptom Severe depression with psychotic symptom F 31.6 BAD current episode mixed F 31.7- BAD currently in remission F 31.9 – BAD unspecified

F 32 Depressive episode : 

F 32 Depressive episode F 32.0 – Mild depressive episode .00 –without somatic symptom .01 - with somatic symptom F 32.1 – Moderate depressive episode without somatic symptom with somatic symptom F 32.2 –severe depressive episode without psychotic symptom Severe depressive episode with psychotic symptom

Mood disorders : 

Mood disorders F 33- Recurrent depressive disorder F 34 – persistent mood disorders - Cyclothymia - Dysthymia F 38 - Other mood disorder F 39 – Unspecified mood disorder

Mood Disorders (DSM-IV) Primary Secondary Unipolar Depression Bipolar Disorders Major Depressive Disorder. (MDD) Dysthymic Disorder Depression Disorder NOS Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder BPD-NOS

Secondary Systematic Medical Diseases CNS Disorder Endocrine Disorder Infections Drug Induced Disorder Other Psychiatric Disorders Schizophrenia Dementia Substance abuse Disorder

Neurotic, stress-related and Somatoform Disorders (F40- F48) : 

Neurotic, stress-related and Somatoform Disorders (F40- F48) F 40 -Phobic anxiety disorders Other anxiety disorders e.g. GAD OCD Reaction to severe stress and adjustment disorders Dissociative ( conversion) disorders F 45- Somatoform Disorders F 48 - Other neurotic disorders e.g. Neurasthenia

Somatoform Disorders : 

Somatoform Disorders

F 50– F 59 : 

F 50– F 59 Behavioural syndromes associated with physiological disturbances and physical factors: F50 – Eating disorders F 51 – nonorganic sleep disorders F 52 -Sexual dysfunction F 53 – disorder with puerperium F 55 – Abuse of non-dependence- producing substances e.g. antidepressants, analgesics, antacids, vitamins, herbal or folk remdies

F 60—F 69Disorders of adult personality and behaviour : 

F 60—F 69Disorders of adult personality and behaviour F 60- Personality Disorders F 63 – Habit & Impulse disorders F 64 – Gender identity disorders F 65 – Disorders of sexual preference

F 70 – F79 : 

F 70 – F79 Mental retardation F 70 -Mild mental retardation Moderate mental retardation Severe mental retardation F73 – profound mental retardation F78 – other mental retardation F79- Unspecified mental retardation

F 80- F89Disorders of psychological development : 

F 80- F89Disorders of psychological development Specific developmental disorder of speech and language Specific developmental disorder of scholastic skills Specific developmental disorder of motor function Pervasive developmental disorders

F 90- F 98Behavioural and emotional disorders with onset usually occurring in childhood and adolescence : 

F 90- F 98Behavioural and emotional disorders with onset usually occurring in childhood and adolescence F 90 -Hyperkinetic disorders Conduct disorders Tic disorders F 99 – Unspecified mental disorder : Non-recommended residual category, when no other code from F00– F98 can be used

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