Classification of mental disorders ICD-10. Research diagnostic criteria.  

Organic emotionally labile disorder is a mental disorder that occurs after complications of pregnancy or childbirth, severe infection, or organic brain disease (trauma, tumor, stroke). Characterized by pronounced emotional incontinence and lability (instability, rapid change) of a person’s mood.

The diagnosis and treatment of this disorder should be carried out jointly by a psychiatrist (or psychotherapist) and a neurologist.

The disorder is also called asthenic (from the Greek asthenia - weakness, impotence). In addition to constant and severe mood swings, patients are characterized by general weakness, fatigue, headache, and dizziness. A person may get tired after 2-3 hours of work, cannot stand a full day of work, and several times a day there is a need to lie down to rest.

According to the international classification of diseases, ICD-10 is coded as F06.68 - “Organic emotionally labile asthenic disorder due to mixed diseases.” Its most common causes include:

• head injury
• pregnancy and childbirth of the mother, which occurred with complications (toxicosis, threat of miscarriage, eclampsia)
• severe condition of the child after birth (for example, the baby was given mechanical ventilation), severe illnesses/infections of early childhood
• vascular diseases of the brain (atherosclerosis, hypertension, cerebrovascular accidents - strokes)
• epilepsy
• brain tumors
• HIV infection
• neurosyphilis and other neuroinfections, encephalitis (inflammation in the brain)
• intoxication with drugs, alcohol
• consequences of anesthesia

Psychoorganic syndrome

Organic mental disorders are characterized by the mandatory presence of the so-called. psychoorganic syndrome (impaired emotions, memory and intelligence). The mood may be inappropriately increased or decreased, anxiety or a sad-angry mood may be observed. Affect (emotional manifestations) is characterized by lability (variability), explosiveness (explosiveness), flattening (insufficient depth of experience). All memory processes (memorization, storage, reproduction of information) are reduced. False memories are observed (confabulations), memory for some periods of life is completely absent (amnesia). Thinking is characterized, on the one hand, by inhibition of mental processes (torpidity), difficulty switching (rigidity), and on the other hand, by increased exhaustion. The general level of thinking decreases (concepts and ideas become impoverished), a tendency to unnecessary detail appears, and perseverations arise (“getting stuck” and constant repetition of the same thought or expression). The ability to navigate is impaired - first in the environment, and then in one’s own personality. The ability to grasp the full meaning of a situation disappears; only partial details are perceived.

Symptoms of psychotic disorder

Symptoms are varied, individual in nature, and may change over time. Main signs: delusions and hallucinations. The latter represent extraordinary sensory sensations that are incomparable with reality. For example:

• vision of images, paintings;
• hearing voices;
• sensation of touch;
• sensation of smells, tastes.

Hallucinations can be tactile, auditory, olfactory, visual, or somatic. An image appears in thinking without an external stimulus. A person can be in a world of dreams and unfulfilled fantasies. A deceptive perception of reality can be observed when:

• severe fatigue;
• taking psychoactive substances;
• neurological diseases;
• schizophrenia.

This mental disorder is also characterized by delusional ideas. A person insists on his point of view, despite the fact that there is clear evidence and logical explanations for his wrongness. The patient may feel as if someone is constantly following him. These could be the intelligence services of various states, as well as mythical creatures and aliens. In other cases, the patient feels that his husband/wife is constantly cheating on him. Some patients may experience delusions of grandeur. They are simply convinced that they are able to perform various miracles, that they are prophets. Others consider themselves descendants of a noble family. Delusion can also manifest itself in relation to one’s sexuality. It seems to the patient that all strangers fall in love with him at first sight. Unrealistic ideas may appear due to:

• infection with an incurable disease;
• the imminent end of the world;
• creation of a perpetual motion machine;
• carrying out ridiculous social reforms;
• parasite infestation.

You should also consult a doctor if you notice the following symptoms:

• slurred speech;
• illogical thinking;
• inappropriate behavior;
• indifference to appearance;
• excessive irritability;
• tendency to harm one's health;
• lack of plans for the future;
• inhibition of actions and thoughts;
• apathy towards everything that happens;
• depressive moods.

Relatives can call a doctor to your home. Don't wait for the situation to get worse. It is possible to change the life of a loved one for the better. Don't be afraid to tell a specialist about your problem. We are ready to listen right now, provide confidentiality, and provide effective assistance.

Variants of the course of organic mental disorders

Organic mental disorders can be acute (for example, delirium, organic hallucinosis), which arise suddenly, and chronic, which begin unnoticed, flow slowly and, most often, irreversibly (dementia, organic personality change).

The most common causes of organic brain lesions are trauma, infection, intoxication, tumors, primary degenerative processes and vascular lesions of the brain.

Psychoorganic syndrome occurs in four variants:

• asthenic (exhaustion, irritability with intact intelligence),
• explosive (explosiveness, aggression, slight memory loss),
• euphoric (elevated mood, carelessness, disinhibition of drives) and
• apathetic (apathy, decreased interest in the environment and one’s own life, marked memory loss)

These four options are sequential stages of the course of organic brain disease.

Psychotic levels of disorder

There are a large number of mental disorders that are reflected differently in the behavior and thinking of the patient. Common features of the disorders: inappropriate behavior, inability to socialize. The most common mental illnesses are: depression, schizophrenia, dementia, mental retardation, autism, anxiety, obsessive-compulsive disorder, and phobias.

Acute psychotic disorder

In this situation, the patient's condition deteriorates very quickly. Signs of nervous system imbalance appear within 3-14 days. Symptoms: strong euphoria or, on the contrary, detachment from the outside world, delusional ideas, various hallucinations. Symptoms are constantly changing. It is assumed that the causative factors of the disease are severe stress:

• loss of loved ones;
• car accident;
• loss of a favorite job;
• traumatic brain injuries;
• mental and physical violence;
• postpartum depression.

Drug use and excessive alcohol consumption can also trigger the disorder. Symptoms can be eliminated within a few weeks with drug therapy. They use drugs that stimulate brain activity and increase stress resistance: vitamins, neurometabolic stimulants, drugs that promote the restoration of liver cells, new generation neuroleptics. However, it is important to attend a consultation with a psychotherapist so that central nervous system failure does not lead to the development of schizophrenia. The dosage of medications is reduced gradually. In the acute phase, the support of loved ones is important. A psychologist can also work with them. This is the only way to eliminate the risk of relapse.

Polymorphic psychotic disorder

Characterized by rapid development (hallucinations, delusions, depression, euphoria appear within 14 days). Symptoms change and are quickly relieved with the help of special medications. The exact causes of mental disorder are unknown. It has been reliably established that the onset of the disease is preceded by severe stress. Acute polymorphic psychotic disorders are confirmed in 0.4-0.6% of cases. If symptoms do not disappear within several months, the patient is given a different diagnosis.

Organic psychotic disorder

Deviations arise as a result of disturbances in brain structures. This could be a traumatic brain injury, circulatory disorders, infection, autoimmune disease, oxygen starvation of brain cells.

Psychotic affective disorders

The appearance of depressive moods is characteristic. A person loses the ability to enjoy life, withdraws into himself, and shows indifference to everything that happens around him. Other manifestations of depression:

• low self-esteem;
• pessimistic perception of reality;
• impaired concentration;
• disturbance of sleep and wakefulness;
• refusal to eat;
• suicidal tendencies;
• inappropriate feeling of guilt.

Transient psychotic disorder

In severe cases of the disease, inhibition of action and thinking and loss of mood are observed. Depression in psychotic affective disorder can be replaced by a joyful mood, excessive physical activity, increased activity, and overexcitement.

Danger to yourself and others

The social significance of the clinical picture is great. If at the asthenic stage patients can take care of themselves, and many are able to work, then with increasing severity of the disease they can first become dangerous for people around them (explosive, euphoric stage), and later for themselves (apathetic stage) due to pronounced apathy and helplessness.

Therefore, organic mental disorders require timely correction. If there is one or another option, you need to contact a psychiatrist.

All materials on the site are presented for informational purposes only, approved by certified physician Mikhail Vasiliev, diploma series 064834, in accordance with license No. LO-77-005297 dated September 17, 2012, by a certified specialist in the field of psychiatry, certificate number 0177241425770.

Classification of mental disorders ICD-10. Research diagnostic criteria.

ICD-10 Preface.

In the early 1960s, the World Health Organization began active work on a program aimed at improving the diagnosis and classification of mental disorders.
At that time, WHO held a series of meetings at which representatives of various disciplines and schools of psychiatry from around the world summarized the then existing knowledge in this area. WHO stimulated and conducted research into classification criteria and diagnostic reproducibility. In addition, procedures for joint diagnostic assessments of clinical material based on the study of videotaped interviews with patients and other methods were developed and disseminated. As a result of numerous proposals to improve the classification of mental disorders, the 8th revision of the International Classification of Disease (ICD-8) was carried out during the widest consultations. A special glossary has been developed to define each category of mental disorder in ICD-8. Work on the above program also led to the creation of a team of individuals and a network of national centers dealing with the problems of improving psychiatric classification. The 1970s saw increased interest in improving psychiatric taxonomy throughout the world. This was facilitated by the expansion of international contacts, the organization of several international collaborative studies and the emergence of the possibility of new forms of therapy. The development of specific classification criteria has been encouraged in a number of countries to improve diagnostic reproducibility. In particular, the American Psychiatric Association developed and disseminated the 3rd revision of the Diagnostic and Statistical Manual, which included the use of operational criteria in its classification system.

In 1978, WHO entered into a long-term project with the US Administration on Alcohol and Drug Abuse to further improve the classification and diagnosis of mental disorders and alcohol and drug use problems. In a series of workshops that brought together scientists from different psychiatric traditions, knowledge in their respective fields was reviewed and recommendations for further research were developed. These recommendations were summarized at a major international conference in Copenhagen, Denmark in 1982.

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Several major studies have been undertaken to implement the recommendations of the Copenhagen Conference. One of them, which involved centers in 17 countries, aimed to develop the Composite International Diagnostic Interview, an instrument that would be suitable for conducting epidemiological studies of mental disorders in general populations in different countries. Another major project focused on developing an assessment tool suitable for use by clinicians. Another study was devoted to the development of an instrument to assess personality disorders in different countries.

In addition, several more dictionaries with clear definitions of terms have been prepared and are being prepared. Work on these projects was fruitfully associated with the development of definitions of mental and behavioral disorders in the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The translation of diagnostic criteria into diagnostic algorithms included in assessment tools has proven useful in identifying inconsistencies, points of contention, and repetition that can be eliminated. On the other hand, work on ICD-10 has helped in the development of assessment tools. The final result was the creation of a clear system of ICD-10 criteria and assessment tools that can provide the data needed to classify disorders according to the criteria included in Chapter V(F) of ICD-10.

The Copenhagen Conference also recommended that the positions of the various schools of psychiatry be presented in publications on the sources of the ICD-10 classification. As a result, several major publications appeared.

The first book among the publications compiled on the basis of Chapter V (F) of ICD-10 was the glossary “Clinical Descriptions and Diagnostic Guidelines”. It represents the culmination of the efforts of many people who have worked on it over a number of years. In the course of this work, several large projects were prepared, each of which came out after numerous consultations with groups of experts, national and international psychiatric associations and individual consultants. The 1987 project led to trials at 40 national centers, an unprecedented study of its kind aimed at improving psychiatric diagnosis. The results of these trials were used to prepare the final clinical guidelines.

The text presented in this book has also been widely reviewed. Researchers and clinicians from 32 countries participated. Subsequent publications will include a version for general practitioners, a multi-axis version of the classification, a series of publications detailing more specific problems (for example, on the assessment and classification of mental retardation), as well as reference materials allowing comparison of relevant terms in ICD-10, ICD-10 9 and ICD-8.

With the accumulation of experience and the expansion of our knowledge, it should be possible to further improve the classification of mental disorders. This task will be assigned primarily to those WHO centers that participated in the preparation of this classification.

There are numerous publications from national centers based on and related to ICD-10 research. A complete list of these and reprints of the articles can be obtained on request from the Department of Mental Health, WHO, 1211 Geneva 27, Switzerland.

Classification is a way of seeing the world at a certain time stage. Without a doubt, scientific progress and experience with the present research criteria will require their revision and updating. I hope that such a revision will be the result of the same cordial and productive international scientific cooperation as in the preparation of this classification.

Norman Sartorius

Director of the WHO Division of Mental Health

Causes of organic brain damage

Factors influencing the state of the central nervous system can be both external and internal provocateurs. The most common of them are:

• congenital damage to the nervous system;
• open and closed injury;
• past infections;
• general poisoning of the body with chemical compounds, alcohol, drugs;
• violation of the integrity of blood vessels, tumor processes, cancerous lesions;
• diagnosed multiple sclerosis;
• degenerative diseases.

In most cases, the development of pathology is caused by the careless behavior of the patient himself, provoking traumatic situations, abusing toxic substances, or trying to independently treat infectious diseases at home.

Acute polymorphic psychotic disorder with symptoms of schizophrenia

Psychotic and affective symptoms are stable. There are no sudden changes in behavior or mood. The onset of the disease is within two weeks after the occurrence of the provoking factor. Symptoms are typical for schizophrenia:

• depressive moods;
• echo of thoughts;
• expression of inappropriate emotions;
• various kinds of hallucinations;
• persecution mania.

To diagnose this disorder, it is important to conduct a thorough examination of the patient. It is necessary to exclude the fact of schizophrenia, schizoaffective psychosis or bipolar disorder, the presence of traumatic brain injuries, the influence of toxic, psychoactive substances on the body. The following diagnostic methods are mandatory:

• general blood analysis;
• electroencephalography;
• interviewing the patient;
• survey of relatives;
• Neurotest;
• Neurophysiological test system.