STUDY - Technical - New Dacian's Medicine

Mental and Behavioural Disorders

Translation Draft

It excludes certain diseases that originate in the perinatal period, certain infectious and parasitic diseases, complications of pregnancy, childbirth and lausion, congenital malformations, chromosomal deformities and abnormalities, endocrine, nutrition and metabolism diseases, traumatic injuries, poisoning and certain consequences of external causes, malignant tumors, symptoms, signs and abnormal results of clinical and laboratory investigations not classified elsewhere.

A. Organic mental disorders including symptomatic disorders.

Are included a number of mental disorders grouped together on the basis of a common etiology demonstrable in brain disease, brain injury or other injury that leads to a cerebral dysfunction.

Dysfunction can be primary as in diseases, injuries and injuries that affect the brain directly and selectively, or secondary, as in diseases and systemic disorders that attack the brain only as one of the multiple organs or systems of the body that are involved.

Dementia is a syndrome due to brain disease, usually of a chronic or progressive nature, in which there is alteration of multiple higher cortical functions, including memory, thinking, orientation, understanding, calculus, learning capacity, language and judgment. Consciousness is not obnubilated. Deficiencies in cognitive function are usually accompanied and occasionally preceded by a deterioration in emotional control, emotional behavior, social behavior or motivation. This syndrome occurs in Alzheimer's disease, cerebrovascular disease and other primary or secondary conditions that touch the brain.

1. Dementia in Alzheimer's disease (Alzheimer's disease is a primary degenerative brain disease of unknown etiology, with characteristic neuropathological and neurochemical features; The disorder is usually insidious at onset and develops slowly but progressively over a period of several years) (Dementia in Alzheimer's disease with early onset – dementia in Alzheimer's disease with onset before 65 years, with a relatively rapid evolution of deterioration and with multiple marked disorders of higher cortical functions – Alzheimer's disease type 2, Presenile dementia type Alzheimer's type, Primary degenerative dementia of Alzheimer's type presenile onset; Dementia in late-onset Alzheimer's disease – dementia in Alzheimer's disease with onset after the age of 65, usually at the end of the 7th decade or above, with a slow progress and memory impairment as the main feature – Alzheimer's disease type 1, Primary degenerative dementia of Alzheimer's type senile onset, Senile dementia type Alzheimer's type; Dementia in Alzheimer's disease atypical or mixed form: Atypical dementia type Alzheimer's; Dementia in unspecified Alzheimer's disease);

2. Vascular dementia – Vascular dementia is the result of heart attacks of the brain due to vascular disease, including hypertensive cerebrovascular disease; infarcts are usually small but with cumulative effect; onset usually occurs in old age – includes arteriosclerotic dementia (Acute-onset vascular dementia – usually develops rapidly after a succession of strokes related to cerebrovascular thrombosis, embolism or hemorrhage – in rare cases, a single massive infarction can be the cause; Vascular dementia through multiple infarctions – Progressive at onset, following a number of transient ischemic episodes that produce an accumulation of infarctions in the cerebral parenchyma – Predominantly cortical dementia; Subcortical vascular dementia – Includes cases with a history of hypertension and foci of ischemic destruction in the deep white matter of the cerebral hemispheres – The cerebral cortex is usually preserved and this contrasts with the clinical picture that can be very similar to that of dementia in Alzheimer's disease – Mixed cortical and subcortical vascular dementia; Other forms of vascular dementia; Unspecified vascular dementia);

3. Dementia in other diseases classified elsewhere – Cases of dementia due to or presumed to be due to causes other than Alzheimer's disease or cerebrovascular disease; the onset can occur at any time of life, but rarely occurs in an advanced age (Dementia in Pick's disease – a progressive dementia starting at a mature age, characterized by early and slowly progressive character changes and by social deterioration, followed by the deficiency of intellectual functions, memory and language, with apathy, euphoria and occasionally extrapyramidal phenomena; Dementia in Creutzfeldt-Jakob disease – a progressive dementia with extensive neurological signs due to specific neuropathological changes that are supposed to be caused by a communicable agent; the onset is usually at mature or old age but can be at any adult age; the evolution is subacute leading to death in a year or two; Dementia from Huntington's disease – a dementia that occurs as part of an extensive degeneration of the brain; the disorder is transmitted by a single autosomal dominant gene; symptoms typically appear in the third and fourth decade, progress is slow, leading to death in 10 – 15 years – dementia in choreea Huntington's; Dementia in Parkinson's disease – a dementia that develops during the course of confirmed Parkinson's disease; no distinctive clinical feature has been demonstrated yet – dementia in: agitating paralysis, parkinsonism; Dementia in human immunodeficiency virus (HIV) disease – dementia that develops during HIV disease in the absence of a concomitant disease or condition other than HIV infection that could explain clinical features; Dementia in other diseases classified elsewhere – dementia in: cerebral lipidosis, epilepsy, hepatolenticular degeneration, hypercalcemia, acquired hypothyroidism, poisoning, multiple sclerosis, neurosyphilis, deficiency in nicotinic acid (pellagra), polyarteritis nodosa, systemic lupus erythematosus, trypanosomiasis, deficiency in vitamin B12);

4. Unspecified dementia (presenile: NOS dementia, NOS psychosis; Nos primary degenerative dementia – senile: dementia: paranoid depressive type, NOS, nos psychosis – excludes senile dementia with delirium or acute confused state, nos senility);

5. Organic amnetic syndrome not induced by alcohol and other psycho-active substances – a syndrome of pronounced alteration of recent and old memory while immediate memory is preserved, with a reduced ability to learn a new material and disorientation over time; a marked feature may be confabulation, but perception and other cognitive functions, including the intellect, usually remain intact; the prognosis depends on the evolution of the subadiacente lesion – excludes anterograde, dissociative, NOS, retrograde amnesia, Korsakov syndrome: alcohol-induced or unspecified, induced by other psycho-active substances (post-traumatic amnesia; Unspecified post-traumatic amnesia; Post-traumatic amnesia lasting less than 24 hours; Post-traumatic amnesia lasting between 24 hours and 14 days; Post-traumatic amnesia lasting more than 14 days; Unspecified amnetic syndrome: psychosis or non-alcoholic Korsakov syndrome);

6. Delirium not induced by alcohol and other psycho-active substances – an organic nonspecific etiological cerebral syndrome characterized by simultaneous disturbances of consciousness and attention, perception, thinking, memory, psychomotor behavior, emotion and sleep-wake rhythm; duration is variable and the degree of severity varies from mild to very severe – includes acute(a) or subacute(a): cerebral syndrome, confusional (nonalcoholic) state, infectious psychosis, organic reaction, psycho-organic syndrome and excludes alcohol-induced or unspecified delirium tremens (unsupled delirium - added to a dementia described as such; Delirium over-added to a dementia: conditions that meet the above criteria but develop during a dementia; Other forms of delirium: mixed-origin delirium; Unspecified delirium);

7. Other mental disorders due to injury and dysfunction of the brain and physical illness – includes various conditions causally related to brain disorder due to primary brain disease, systemic disease that affects the brain in a secondary way, toxic exogenous substances or hormones, endocrine disorders or other somatic diseases – exclude associated with: delirium, dementia resulting from the use of alcohol and other psycho-active substances (Organic hallucinosis – a disorder through persistent hallucinations, usually auditory and visual, which occur in the absence of obnubilation of consciousness and may or may not be recognized by the subject as such; delusional elaboration of hallucinations may occur, but delusions do not dominate the clinical picture; the internal state can be preserved – State of organic hallucination (non-alcoholic) – excludes alcoholic hallucinosis, schizophrenia; Organic catatonic disorder – a disorder of diminished psychomotor activity (stupor) or increased (excitation) associated with catatonic symptoms; may alternate the extremes of psychomotor disorder – excludes catatonic schizophrenia, stupor: dissociative, NOS; Organic delusional (schizophrenic allure) disorder – a disorder in which persistent or recurrent delusion dominates the clinical picture; delusions may be accompanied by hallucinations; some features suggestive of schizophrenia may be present, such as bizarre hallucinations or thought disorder – Paranoid and hallucinatory-paranoid organic states; schizophrenic psychosis in epilepsy – excludes the disorder: acute and transient psychotics, persistent delusional, drug-induced psychotics, schizophrenia; Organic mood disorders (affective) – disorders characterized by a change in mood or affect usually accompanied by a change in the entire activity; depressive, hypomanic, manic or bipolar, but occurring as a consequence of an organic disorder – excludes non-organic or unspecified mood disorders; Organic anxiety disorders – a disorder characterized by the essential descriptive features of a generalized anxiety disorder, a panic disorder or a combination of the two, but occurring as a consequence of an organic disorder – excludes non-organic or unspecified anxiety disorders; Organic dissociative disorders – a disorder characterized by a partial or complete loss of normal integration between memories of the past, the consciousness of identity and immediate sensations and the control of body movements, but occurring as a consequence of an organic disorder – exclude dissociative (conversion) disorders that are non-organic or unspecified; Emotional labile (asthenic) organic disorder – a disorder characterized by emotional incontinence or lability, exhaustion and a variety of unpleasant physical sensations (e.g. vertigo) and pain, but occurring as a consequence of an organic disorder – excludes non-organic or nonspecific somatoform disorders; Mild cognitive impairment – a disorder characterized by altered memory, learning difficulties and reduced ability to concentrate on a task for more than short periods; often there is a marked sense of mental fatigue when mental tasks are undertaken, and gaining new knowledge is subjectively considered to be difficult even if objectively it is a success; none of these symptoms is so severe as to make a diagnosis of either dementia or delirium; This diagnosis should only be made in association with a specific physical disorder and should not be put in the presence of any of the classified mental or behavioral disorders; the disorder may precede, accompany or follow a wide variety of infections and physical disorders, both cerebral and systemic, but the evidence of a cerebral involvement is not necessarily present; it can be differentiated from the post-encephalitic syndrome and from the post-comotional syndrome by its different etiology, by a narrower series of symptoms generally lighter and usually of shorter duration; Other mental disorders specified due to a brain injury and dysfunction and a physical illness: nos epileptic psychosis; Unspecified mental disorder due to injury and dysfunction of the brain and a mental illness – organic: NOS cerebral syndrome, NOS mental disorder);

8. Personality and behavioural disorders due to illness, injury and brain dysfunction – Alteration of personality and behavior can be a residual or concomitant disorder of a brain disease, injury or dysfunction (Organic personality disorder – a disorder characterized by a significant alteration of the types of behavior common to the subject before the onset of the disease, involving the expression of emotions, needs and impulses; also, the alteration of cognitive and thought functions and altered sexuality may be part of the clinical – organic picture: pseudopsychopathic personality, pseudoretarded personality, frontal lobe syndrome, personality with limbic epilepsy, lobotomy, postleucotomy – excludes the lasting change of personality after a catastrophic experience, a psychiatric disease, postcomotional syndrome, postencephalitic syndrome, specific personality disorder; Postencephalitic syndrome – variable and residual nonspecific behavioral change following healing after encephalitis either viral or bacterial; the reversibility of the syndrome is the main difference between this disorder and organic personality disorders – it excludes organic personality disorder; Postcommodational syndrome – a syndrome that occurs as a result of a head injury (usually serious enough to result in loss of consciousness) and includes a number of disparate symptoms such as headache, vertigo, fatigue, irritability, difficulty concentrating and performing mental tasks, altered memory, insomnia and reduced tolerance to stress, emotional arousal or alcohol; Post-traumatic brain syndrome nepsihotic, postcontusional syndrome (encephalopathy); Other organic personality and behavioral disorders due to a disease, injury and brain dysfunction – organic affective disorder of the right hemisphere; Organic personality and behavior disorder due to an unspecified brain disease, injury and dysfunction – organic psychosyndrome; Unspecified organic or symptomatic mental disorder – psychosis: organic NOS, symptomatic NOS – excludes nos psychosis);

B. Mental and behavioral disorders due to the use of psychoactive substances.

This group of diseases comprises a wide variety of disorders that differ in severity and clinical form but which all can be attributed to the use of one or more psychoactive substances, with the possibility of having been medically prescribed or not; identification of the psychoactive substance should be based on as many sources of information as possible – these include self-reported data, analysis of blood and other body fluids, characteristic physical and psychological symptoms, clinical behaviour and signs and other evidence such as a drug in the patient's possession or reports of other informed persons; many people who use drugs use more than one type of psychoactive substance; The main diagnosis should be classified, wherever possible, by the substance or class of substances that caused or contributed most to the respective clinical syndrome; the diagnosis of disorders resulting from the use of multiple drugs should be used only in cases where the modes of use of psychoactive substances are chaotic and indiscriminating or where the contributions of different psychoactive substances are mixed without the possibility of being resolved – excludes the harmful use of non-addictive substances (Acute intoxication – a condition arising from the administration of a psychoactive substance and which produces disorders at the level of consciousness, knowledge, perception, affect or behavior or other psycho-physiological functions and responses; the disorders are directly related to the acute pharmacological effects of the substance and resolve over time, with complete recovery, except for the part where the tissue has been injured or other complications have occurred; complications may include trauma, inhalation of vomiting, delirium, coma, convulsions and other medical complications; the nature of these complications depends on the pharmacological class of the substance and the method of administration – Acute drunkenness in alcoholism, "Harmful habits" (drugs), NOS drunkenness, Pathological intoxication, Trance and possession disorders in intoxication with psychoactive substances; Harmful use – a type of psychoactive substance that is the harmful cause of health; the injury may be physical (e.g. cases of hepatitis due to self-administration of injectable psychoactive substances) or mental (e.g. episodes of depressive disorder secondary to high alcohol consumption) Disorder following the use of a psychoactive substance NOS; Addiction syndrome – a set of behavioral, cognition and physiological phenomena that develop after repeated use of the substance and which typically includes the strong desire to consume the drug, difficulties in controlling its use, persistence in its use despite the harmful consequences, being given a higher priority to the use of the drug than other activities and obligations, increased tolerance and sometimes a physical state of withdrawal; the dependency syndrome may be present for a specific psychoactive substance (e.g. tobacco, alcohol or diazepam), for a class of substances (e.g. opioid drugs) or for a wider spectrum of pharmacologically different psychoactive substances; Chronic alcoholism, Dipsomanie, Addiction; Withdrawal state – a set of symptoms having a variable grouping and severity that occur in the case of a total or partial withdrawal of the psychoactive substance after persistent use of that substance; the onset and course of the withdrawal state are limited in time and are related to the type and dose of the psychoactive substance consumed immediately before stopping or reducing the use; withdrawal state can be complicated by convulsions; Withdrawal state with delirium – a condition in which the withdrawal state is complicated by delirium; it will be monitored if the organic factors are considered to play a role in the etiology; Delirium tremens (alcohol-induced); Psychotic disorder – a set of psychotic phenomena that occur during or after the use of the psychoactive substance but which are not explained only on the basis of an acute intoxication and are not part of the withdrawal state; The disorder is characterized by hallucinations (usually auditory, but often polysensory), by perceptual distortions, manias (often of paranoid or persecution in nature), psychomotor disorders (excitation or stupor) and by an abnormal affectation that can stretch from intense fear to ecstasy; the sensory part is usually clear, but a certain degree of darkening of consciousness may be present, without, however, being a serious confusion; Alcoholic: hallucination, jealousy, paranoia, psychosis NOS – excludes residual psychotic disorder and late onset induced by alcohol or other psychotic substances; Amnetic syndrome – a syndrome associated with pronounced chronic alteration of recent and old memory; immediate memory is usually preserved, and recent memory is characteristically more disturbed than old memory; Disturbances in the perception of time and in the chronology of events, such as difficulties in learning new material, are usually evident. confabulation may be marked but is not invariably present; other cognitive functions are relatively well preserved, and the amnesiac defects are disproportionate compared to the other disturbances; Amnesiac disorder, induced by alcohol or drugs; Psychosis or Korsakov syndrome, alcohol-induced or other psychoactive or unspecified substance – excludes psychosis or non-alcoholic Korsakov syndrome, post-traumatic amnesia; Residual and late-onset psychotic disorder – a disorder in which changes induced by alcohol or psychoactive substances in cognition, affect, personality or behaviour persist beyond the period when the direct effect of the substance could be considered functional; the onset of the disorder should be directly related to the use of the psychoactive substance; cases where the initial onset of the condition occurs later than the episode(s) of use of such substance should be encoded here only when there is clear and categorical evidence of the attribution of the state of residual effect of the psychoactive substance; flash-backs can be differentiated from the psychotic state in part by their episodic nature, frequently of very short duration, and in part because they multiply previous experiences related to alcohol or other psychoactive substance; Nos alcoholic dementia; Chronic alcoholic cerebral syndrome; Dementia and other milder forms of persistent alteration of cognitive functions; Flashbacks; Psychotic disorder induced by the psychoactive substance with late onset; Perception disorder after the use of hallucinogenic substances; Residual: affective disorder, personality disorder – excludes: induced by alcohol or a psychoactive substance, Korsakov syndrome, psychotic state; Other mental and behavioral disorders; Nonspecific mental and behavioral disorders);

1. Metal and behavioral disorders due to the use of alcohol;
2. Mental and behavioral disorders due to the use of opioid substances;
3. Mental and behavioral disorders due to the use of substances derived from cannabis;
4. Mental and behavioral disorders due to the use of sedatives or hypnotics;
5. Mental and behavioral disorders due to the use of cocaine;
6. Mental and behavioral disorders due to the use of other stimulants including caffeine;
7. Mental and behavioral disorders due to the use of hallucinogens;
8. Mental and behavioral disorders due to the use of tobacco;
9. Mental and behavioral disorders due to the use of volatile solvents;
10. Mental and behavioural disorders due to the use of multiple drugs and other psychoactive substances – this category should be considered when it is known that two or more substances are involved, but it is impossible to assess which substance contributes the most to the disorders; it should also be used when the identity of some or even all of the psychoactive substances that have been used is unsafe or unknown, since many of those who use multiple drugs often do not know for themselves what they are using – it includes the misuse of drugs.

C. Schizophrenia, schizotypal and delusional disorders - this block brings together schizophrenia, as the most important member of the group, schizotypal disorder, persistent delusional disorders and a larger group of acute and transient psychotic disorders; schizophrenic-affective disorders have been maintained here despite their controversial nature:

1. Schizophrenia – Schizophrenic disorders are generally characterized by characteristic distortions of thought and perception and affectations that are inadequate and weakened; clear consciousness and intellectual capacity are usually maintained, though certain knowledge deficiencies may evolve over time; the most important psychopathological phenomena include the repetition of thoughts as an echo; influencing thought or stealing it; transmission of thoughts; delusional perception and delusional ideas of control, influence or passivity; hallucinations in which voices speak or discuss the subject in the third person; thought disorders and negative symptoms; the evolution of schizophrenic disorders can be both continuous and episodic with a progressive or stable deficit or there may be one or more episodes with complete or incomplete remission; the diagnosis of schizophrenia should not be put in the presence of extensive depressive or manic symptoms unless it is clear that schizophrenic symptoms preceded the affective disorder; a diagnosis of schizophrenia should not be made either in the presence of a manifest brain disease or intoxication due to a drug or in the presence of a withdrawal (as well as in the presence of epilepsy or other brain disease with another classification) – exclude schizophrenia: acute (undifferentiated), cyclic, schizophrenic reaction, schizotypal disorder (Paranoid schizophrenia – paranoid schizophrenia is dominated by relatively stable delusional ideas, often paranoid, usually accompanied by especially auditory hallucinations, and perceptual disturbances; disorders of affect, will and language as well as catatonic symptoms are either absent or relatively discreet – Paraphrenic schizophrenia – excludes the paranoid state of involution, paranoia; Hebephrenic schizophrenia – a form of schizophrenia in which affective changes are the main ones, delusional ideas and floating and fragmentary hallucinations, irresponsible and unpredictable behavior, and mannerism is common; the mood is superficial and inappropriate, the thinking is disorganized, and the speech is incoherent; there is a tendency to social isolation; usually the prognosis is unfavorable due to the rapid development of "negative" symptoms, especially the flattening of the affect and the loss of willpower; hebephrenia should be normally diagnosed in adolescents or young adults – disorganized schizophrenia, hebephrenia; Catatonic schizophrenia – catatonic schizophrenia is dominated by important psychomotor disorders that can alternate between extremes, such as hyperkinesis and stupor or automatic submission and negativism; the attitudes and postures imposed can be maintained for long periods; episodes of violent agitation can be a striking feature of the disease; catatonic phenomena can be combined with a dream-like state (onyroid) with intense scenic hallucinations – catatonic stupor, schizophrenic: catalepsy, catatonia, cerous flexibility; Undifferentiated schizophrenia – psychotic conditions that meet the general diagnostic criteria for schizophrenia but do not comply with any of the presented conditions – atypical schizophrenia – exclude psychotic disorder similar to acute schizophrenia, chronic undifferentiated schizophrenia, post-schizophrenic depression; Post-schizophrenic depression – an episode of schizophrenia, which can be prolonged, occurring as a consequence of a schizophrenic disease; some schizophrenic symptoms, either "positive" or "negative", may still be present, but they no longer dominate the clinical picture; these depressive states are associated with an increased risk of suicide; if a patient no longer presents any schizophrenic symptoms should be diagnosed with depressive episode; if schizophrenic symptoms are still mild and prominent, the diagnosis should remain that of the schizophrenic subtype; Residual schizophrenia – i chronic condition in the development of a schizophrenic disease in which there was a clear progress from an early stage to a late one characterized by long-lasting "negative" symptoms although they are not irreversible, for example psychomotor slowdown; hypoactivity; weakening of the affect; passivity and lack of initiative; poverty of quantity or coherence of speech; poor non-verbal communication through facial expression, eye contact, voice modulation and posture; lack of self-care and poor social performance – chronic undifferentiated schizophrenia, schizophrenic residual state; Simple schizophrenia – a disorder in which there is an insidious but progressive development of some bizarre behavior, the impossibility to meet the demands of society and a decline in total performance; the negative features of residual schizophrenia (for example, the weakening of the affect and loss of will) develop without being preceded by any manifest psychotic symptom; Other forms of schizophrenia – cenestope schizophrenia, schizophrenic: NOS disorder, NOS psychosis – exclude short-term schizophrenic disorders; Unspecified schizophrenia);

2. Schizotypal disorder – a disorder characterized by eccentric behavior and thought abnormalities and affection that resembles those observed in schizophrenia, although no defined and characteristic schizophrenic anomaly occurs at any stage; symptoms may include a cold or inappropriate affectation; anhedonia; strange or eccentric behavior; a tendency to social isolation; paranoid or bizarre ideas that do not live up to the level of the truly delusional ones; obsessional ruminations; thought disorder and perceptual disturbances; occasional transient quasipsychotic episodes with intense delusions, auditory or other hallucinations and delirium-like ideas, usually occurring without external provocation; there is no definite onset, and the evolution and course are generally those of a personality disorder (Slow schizophrenic reaction, schizophrenia: limit, latent, pre-psychotic, prodromic, presudo-neurotic, pseudo-psychopathic, Schizotypal personality disorder – excludes Asperger's syndrome, schizoid personality disorder);

3. Persistent delusional disorders – includes a variety of disorders in which long-term delusional ideas constitute the only or most essential clinical characteristic and which cannot be classified as organic, schizophrenic or affective (delusional disorders that have had a period of time under a few months must be classified to other conditions) (Delusional disorder – a disorder characterized by the development of either a single delusional idea or a set of related delusional ideas that are usually persistent and a2eori lasting a whole life; the content of the delusional idea or ideas is very variable; clear and persistent auditory hallucinations (voices), schizophrenic symptoms such as delusional ideas of control and marked weakening of the affect as well as the reliable evidence of brain disease are all incompatible with this diagnosis; however, the presence of occasional or transient auditory hallucinations in elderly patients does not eliminate this diagnosis, provided that they are not typical schizophrenia and form only a small part of the entire clinical picture – paranoia, paranoid: psychosis, state; paraphrenia (late), delirium with sensory sensations (Sensitiver Beziehunggswahn) – excludes paranoid: personality disorder, psychogenic psychosis, reaction, schizophrenia; Other persistent delusional disorders – disorders in which the delusional idea or ideas are accompanied by persistent hallucinatory voices or schizophrenic symptoms that do not justify a diagnosis of schizophrenia – delusional dysmorphopho-phobia, involutional paranoid state, cverulent paranoia; Unspecified persistent delusional disorder);

4. Acute and transient psychotic disorders – A heterogeneous group of disorders characterized by the acute onset of psychotic symptoms such as delusional ideas, hallucinations and perceptual disturbances and by serious disorganization of the usual behavior; acute onset is defined as an increasing development of the clinical picture obviously abnormal over a period of two weeks or less; there is no evidence of an organic causality for these disorders; perplexity and confusion are often present, but disorientation in time, space, and in respect to the person is not persistent or severe enough to justify a diagnosis of organically produced delirium; complete healing usually occurs in a few months, often in a few weeks or even days; if the disorder persists, a change of diagnosis will be required; the disorder may or may not be associated with acute stress, defined as usually stressful events that precede the onset by one or two weeks (Acute polymorphic psychotic disorder without schizophrenic symptoms – an acute psychotic disorder in which hallucinations, delusional ideas or perceptual disturbances are clear but very variable, changing from day to day or even from hour to hour; there is also frequently an emotional upheaval with intense transient feelings of happiness or ecstasy or anxiety and irritability; polymorphism and instability are characteristic for the entire clinical picture, and psychotic features do not justify a diagnosis of schizophrenia; these disorders often have a steep onset, developing rapidly in a few days and they show a rapid cure of symptoms without relapse; if the symptoms persist should the diagnosis be changed into persistent delusional disorder; Delusional buliff without symptoms of schizophrenia or unspecified; Cycloid psychosis without symptoms of schizophrenia or unspecified; Acute psychotic disorder with schizophrenic symptoms – a psychotic disorder in which the polymorphic and unstable picture is present, as described in the previous medical condition; despite the instability, however, some typical symptoms for schizophrenia are also evident most of the time; if schizophrenic symptoms persist, the diagnosis should be changed to schizophrenia; Delusional bulpha with symptoms of schizophrenia; Cycloid psychosis with symptoms of schizophrenia; Acute psychotic disorder similar to schizophrenia – an acute psychotic disorder in which psychotic symptoms are relatively stable and justify the diagnosis of schizophrenia, but have a duration of less than about a month; unstable polymorphic features, described in the previous primary disease, are absent; if schizophrenic symptoms persist the diagnosis should be changed to schizophrenia; Acute schizophrenia (undifferentiated); Short-term schizophrenia: disorder, psychosis; Onirofrenie; Schizophrenic reaction – excludes organic delusional disorder (similar to schizophrenia), SCHIZOPHRENIC DISORDERS NOS; Other predominantly delusional acute psychotic disorders – acute psychotic disorders in which delusional ideas or relatively stable hallucinations are the main clinical features, but do not justify a diagnosis of schizophrenia; if delusional ideas persist, the diagnosis should be changed to delusional disorder; Paranoid reaction, Psychogenic paranoid psychosis; Other acute and transient psychotic disorders – any other specified acute psychotic disorders for which there is no proof of an organic causality and which does not justify another previous diagnosis; Acute and transient unspecified psychotic disorder: Short reactional psychosis NOS, Reactional psychosis);

5. Induced delusional disorder – a delusional disorder shared by two or more people with close emotional connections; only one person suffers from a real psychotic disorder; delusional ideas are induced in the other/other people and usually disappear when they are separated: Madness in two; Induced: paranoid disorder, psychotic disorder.

6. Schizo-affective disorders – episodic disorders in which both affective and schizophrenic symptoms are prominent, but do not justify a diagnosis of either schizophrenia or depressive or manic episodes; other conditions in which the affective symptoms overlap with a pre-existing schizophrenic disease coexist or alternate with delusional disorders of other types, previously classified; psychotic symptoms inconsistent with mood in affective disorders do not justify a diagnosis of schizophrenic-affective disorder (Schizo-affective disorder manic type – a disorder in which both schizophrenic and manic symptoms are prominent so that the episode of disease does not justify a diagnosis of either schizophrenia or a manic episode; this category should be used both for a single episode and for a recurrent disorder in which most of the episodes are schizo-affective, manic; Schizo-affective psychosis manic type; Schizophrenic psychosis manic type; Schizophrenic-affective depressive disorder – a disorder in which both schizophrenic and depressive symptoms are prominent so that the episode of illness does not justify a diagnosis of either schizophrenia or depressive episode; this category should be used both for a single episode and for a recurrent disorder in which most of the episodes are schizo-affective depressive type; Schizo-affective psychosis depressive type; Schizophrenic psychosis of the depressive type; Mixed schizo-affective disorders: cyclic schizophrenia, mixed affective and schizophrenic psychosis; Other schizo-affective disorders; Unspecified schizo-affective disorder: schizo-affective psychosis NOS);

7. Other non-ororgan psychotic disorders – delusional or hallucinatory disorders that do not justify a diagnosis of schizophrenia, persistent delusional disorders, acute and transient psychotic disorders, psychotic types of manic episode or severe depressive episode; Chronic hallucinatory psychosis;

8. Unspecified non-organic psychosis: Psychosis NOS – excludes nos mental disorder, organic or symptomatic psychosis NOS.

D. Mood disorders (affective)

- this block includes disorders in which the fundamental disturbance is a change in the affect or mood to depression (with or without associated anxiety) or to expansiveness; the change of mood is usually accompanied by a change at the entire level of activity; most of the other symptoms are either secondary to it or easy to understand in the context of the change of mood and activity; most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events and situations:

1. Manic episode – all subdivisions of this category should be used only for one episode; hypomanic or manic episodes in individuals who have had one or more previous affective episodes (depressive, hypomanic, manic or mixed) should be considered as bipolar affective disorders – includes bipolar disorder unique manic episode (Hypomania – a disorder characterized by a slight increase in mood, increased energy and activity, and usually intense feelings of well-being and efficacy, both physical and mental; increased sociability, talk, extreme familiarity, increased sexual energy and a low need for sleep are often present but not in a manner which leads to a serious interruption of work or results in social rejection; irritability, vanity or gross behavior may take the place of a more euphoric society in general; disturbances of mood and behavior are not accompanied by hallucinations or delusional ideas; Mania without psychotic symptoms – the mood is increased not matching the patient's circumstances and can range from uncaring joviality to an almost uncontrollable agitation; expansiveness is accompanied by an increased energy resulting in hyperactivity, pressure to converse and a decreased need for sleep; attention cannot be withheld and there is often a marked distractibility; self-esteem is often high with grand ideas and great self-confidence; the loss of normal social inhibitions may result in behavior that is indifferent, reckless or inappropriate to circumstances and unreasonable; Mania with psychotic symptoms – in addition to the clinical picture described above, delusional (usually grandiose) ideas or hallucinations (usually voices that speak directly to the patient) or agitation, excessive motor activity and the flight of ideas are present so extreme that the subject becomes incomprehensible or inaccessible to a normal communication; Mania with: psychotic symptoms according to mood, psychotic symptoms non-conforming to mood, manic stupor; Other manic episodes; Unspecified manic episode – NOS mania);

2. Bipolar affective disorder – a disorder characterized by two or more episodes in which the patient's mood and activity levels are significantly disturbed, this disturbance consisting of some occasions of increased mood and increased energy and activity (hypomania or mania) and other occasions of decreased mood and energy and low activity (depression); Repeated episodes of hypomania or mania are classified only as bipolar – includes manic-depressive: illness, psychosis, reaction and exclude bipolar disorder with single manic episode, cyclothymia (Bipolar affective disorder with current hypomanic episode: the patient is currently hypomanic and has had at least one other affective episode (hypomaniac, manic, depressive or mixed) in the past; Bipolar affective disorder with current manic episode without psychotic symptoms – the patient is currently maniacal without psychotic symptoms and has had at least one other affective episode (hypomaniac, manic, depressive or mixed) in the past; Bipolar affective disorder with current manic episode with psychotic symptoms – the patient is currently maniacal without psychotic symptoms and has had at least one other affective episode (hypomaniac, manic, depressive or mixed) in the past; Bipolar affective disorder with current episode of mild or medium depression – the patient is currently depressed, as in a depressive episode of either mild or moderate severity and has had at least one confirmed hypomaniac, manic or mixed affective episode in the past; Bipolar affective disorder with current episode of severe depression without psychotic symptoms – the patient is currently depressed, as in a severe depressive episode without psychotic symptoms and has had at least one confirmed hypomanic, manic or mixed affective episode in the past; Bipolar affective disorders with episode of severe depression with psychotic symptoms – the patient is currently depressed as in a severe depressive episode with psychotic symptoms and has had at least one confirmed hypomaniac, manic or mixed affective episode in the past; Bipolar affective disorder mixed current episode – the patient had at least one confirmed hypomaniacal, manic, depressive or mixed affective episode in the past and currently manifests either a combination or a rapid alteration of the manic and depressive symptoms – excludes the single mixed affective episode; Bipolar affective disorder currently in remission – the patient has had at least one confirmed active hypomaniac, manic or mixed episode in the past and, in addition, at least another affective episode (hypomaniac, manic, depressive or mixed) but does not currently suffer from any significant disturbance of mood and which has not occurred for several months; periods of remission during the course of prophylactic treatment should be diagnosed here; Other bipolar affective disorders: Bipolar II disorder, NOS recurrent manic episodes; Unspecified bipolar affective disorder);

3. Depressive episode – in typical mild, moderate or severe depressive episodes, the patient suffers from decreased mood, reduced energy and decreased activity; the ability to feel pleasure, interest and concentration is reduced, and marked fatigue is common even after minimal effort; sleep is usually disturbed and appetite diminished; self-esteem and self-confidence are always low and, even in mild form, ideas of guilt or devaluation are often present; the low mood varies little from day to day, is insensitive to the circumstances and can be accompanied by so-called "somatic" symptoms such as loss of interest and feelings of pleasure, waking up in the morning a few hours before the usual one of waking up, more aggravated depression in the morning, marked psychomotor slowdown, agitation, loss of appetite, weight loss and loss of libido; depending on the number and severity of symptoms, a depressive episode can be specified as mild, moderate or severe; the delimitation will be made in "unspecified as occurring in the postnatal period", "occurring in the postnatal period" – it includes unique episodes of: depressive reaction, psychogenic depression, reactional depression and excludes adaptation disorder, recurrent depressive disorder, in association with conduct disorders (Mild depressive episode – two or three of the symptoms presented generally are usually present; the patient is usually tormented by them but will probably be able to communicate those several activities; Moderate depressive episode – four or more of the general symptoms are usually present and the patient seems to have difficulty continuing the usual activities; Severe depressive episode without psychotic symptoms – an episode of depression in which several of the general symptoms, the typical loss of self-esteem and the ideas of devaluation and guilt are marked and excruciating; thoughts and acts of suicide are common and a number of "somatic" symptoms are usually present: Agitated depression single episode without psychotic symptoms, Major depression single episode without psychotic symptoms, Single episode vital depression without psychotic symptoms; Severe depressive episode with psychotic symptoms – an episode of depression as described above but with the presence of hallucinations, delusional ideas, psychomotor slowdown or stupor so severe that usually ordinary social activities are impossible; life may be endangered due to ideas of suicide, dehydration or starvation; hallucinations and delusional ideas may or may not be consistent with mood – unique episodes of: Major depression with psychotic symptoms, Psychogenic depressive psychosis, Psychotic depression, Reactional depressive psychosis; Other depressive episodes: Atypical depression, Unique episodes of depression "masked" NOS; Unspecified depressive episode: Depression NOS, NOS depressive disorder);

4. Recurrent depressive disorder – a disorder characterized by repeated episodes of depression as described in general symptoms without any history of independent episodes of mood lifting and increased energy (mania); however, there may be brief episodes of slight lifting of mood and over-activity (hypomania) immediately after a depressive episode, sometimes precipitated by antidepressant treatment; more severe forms of recurrent depressive disorder have much in common with previous concepts such as manic-depressive, melancholic depression, vital depression and endogenous depression; the first episode can occur at any age, from childhood to old age, the onset can be acute or insidious, and the duration varies from several weeks to several months; the risk of a patient with a recurrent depressive disorder having an episode of mania never disappears completely, however, many depressive episodes have been experienced; if such an episode occurs, the diagnosis should be changed to that of bipolar affective disorder – it includes recurrent episodes of: depressive reaction, psychogenic depression, reactional depression, seasonal depressive disorder and excludes recurrent short-term depressive episodes (Recurrent depressive disorder mild current episode – a disorder characterized by repeated episodes of depression, the current episode being mild and without any history of mania; Recurrent depressive disorder severe current episode without psychotic symptoms – a disorder characterized by repeated episodes of depression, the present episode being severe without psychotic symptoms and without any history of mania – Endogenous depression without psychotic symptoms, Recurrent major depression without psychotic symptoms, Manic-depressive psychosis depressive type without psychotic symptoms, Recurrent vital depression without psychotic symptoms; Recurrent depressive disorder severe current episode with psychotic symptoms – a disorder characterized by repeated episodes of depression, the present episode being severe with psychotic symptoms and without previous episodes of mania – Endogenous depression with psychotic symptoms, Manic-depressive psychosis depressive type with psychotic symptoms, Recurrent severe episodes of: major depression with psychotic symptoms, psychogenic depressive psychosis, psychotic depression, reactional depressive psychosis; Recurrent depressive disorder in remission in the present – the patient has had two or more depressive episodes in the past but has not shown depressive symptoms for several months; Other recurrent depressive disorders; Unspecified recurrent depressive disorder – monopolar depression NOS);

5. Persistent (affective) mood disorders – persistent and usually fluctuating mood disorders in which most individual episodes are not severe enough to justify the description of hypomanic or slightly depressive episodes; because they last for several years and sometimes over a longer period of the patient's adult life they involve a considerable torment and incapacity; in certain circumstances, recurrent or unique depressive or manic episodes may overlap with a persistent affective disorder (Cyclothymia – a persistent mood instability involving numerous periods of depression and mild exaltation, none of them is severe or prolonged enough to justify a diagnosis of bipolar affective disorder or recurrent depressive disorder; this disorder is frequently found in relatives of the patient with a bipolar affective disorder; some patients with cyclothymia eventually develop bipolar affective disorder – Affective Personality Disorder, Cycloidic personality, Cycloidic personality; Dysthymia – a chronic mood depression lasting at least a few years that is not severe enough or in which the individual episodes are not prolonged enough to justify a diagnosis of mild, moderate or severe recurrent depressive depressive disorder – depressive: neurosis, personality disorder, Neurotic depression, Persistent anxious depression – excludes anxious depression (mild or unperercing); Other persistent mood disorders (affective); Unspecified mood disorder (affective);

6. Other mood disorders (affective) – any mood disorders that do not justify the classification elsewhere because they are not severe enough or do not have a sufficient duration (Other unique mood disorders (affective) – mixed affective episode; Other recurrent mood disorders (affective) – recurrent depressive episodes of short duration; Other specified mood disorders (affective);

7. Unspecified mood disorders (affective) – nos affective psychosis;

E. Neurosive, stress and somatoform disorders – excludes association with a conduct disorder.

1. Phobic anxiety disorders – a group of disorders in which anxiety is only evoked or prevalent in certain well-defined situations that are not currently dangerous; as a result, these situations are characteristically avoided or endured with fear; the patient's concern may focus on individual symptoms such as palpitation or fainting and are often associated secondary with fear of death, loss of control or going crazy; the meditative transition to a phobic situation usually generates an anticipated anxiety; Phobic anxiety and depression often coexist; the fact that two diagnoses are necessary, phobic anxiety and depressive episode, or only one, is determined by the evolution in time of the two diseases and by the therapeutic considerations at the time of the consultation (Agoraphobia – a relatively well-defined group of phobias comprising fears of leaving home, of entering shops, of crowds and public places or of traveling alone on trains, buses or planes; panic disorder is a frequent feature of both present and past episodes; also depressive and obsessional symptoms as well as social phobias are commonly present as auxiliary traits; avoidance of the phobic situation is often prominent and some agoraphobes manifest a slight anxiety because they are able to avoid their phobic situations; Agoraphobia without mention of panic disorder; Agoraphobia with panic disorder; Social phobias – the fear of the searching gaze of other people, which leads to the avoidance of social situations; more penetrating social phobias are usually associated with low self-esteem and fear of criticism; they can be manifested by redness, trembling of the hands, nausea or the urgent need to urinate, the patient being sometimes convinced that one of these secondary manifestations of their anxiety is the primary problem; symptoms may progress to panic attacks – anthropophobia, social neurosis; Specific phobias (isolated) – phobias limited to very specific situations such as proximity of certain animals, heights, lightning, darkness, flying on the plane, enclosed spaces, urination or defecation in public toilets, consumption of certain foods, dental care or the sight of blood or injuries; although the triggering situation is discreet, the contact with it can trigger panic just like in agoraphobia or social phobia: acrophobia, animal phobia, claustrophobia, simple phobia – excludes: dysmorphophobia (non-delusional), nosophobia; Other phobic anxious disorders; Unspecified phobic anxious disorders: NOS phobia, NOS phobic state);

2. Other anxiety disorders – disorders in which the manifestation of anxiety is the major symptom and is not limited to any particular environmental situation; depressive and obsessional symptoms and even some elements of phobic anxiety may also be present, provided that they are clearly secondary or less severe (Panic disorder (paroxysmal episodic anxiety) – the essential feature is the recurrent attacks of severe anxiety (panic), which is not limited to any particular situation or group of circumstances and are therefore unpredictable; as in other anxiety disorders, the dominant symptoms include the sudden onset of palpitations, chest pain, sensations of suffocation, dizziness and feelings of unreality (depersonalisation or derealisation); there is also a secondary fear of dying, losing control or going crazy; panic disorder should not be considered as the main diagnosis if the patient has a depressive disorder at the time the attack begins; in these circumstances panic attacks are probably secondary to depression – panic: attack (of), state (of) – excludes panic disorder with agoraphobia; Generalized anxiety disorder – anxiety is generalized and persistent but not limited to any of the particular environmental circumstances or may even be prevalent in one of them (i.e. it is "floating"); the dominant symptoms are variable but include complaints from the patient of persistent nervousness, trembling, muscle tension, sweating, feeling of "empty head", palpitations, dizziness and epigastric discomfort; fears are often expressed that the patient or a relative will get sick or have an accident – anxious: neurosis, reaction, condition – excludes neurasthenia; Mixed anxious and depressive disorder – this category should be used when symptoms of anxiety and depression are both present, but neither is clearly predominant and no type of symptom is present enough to justify a diagnosis if considered separately; when both anxiety and depression symptoms are present and are serious enough to justify individual diagnoses, both diagnoses should be recorded – Anxious depression (mild or non-persistent); Other mixed anxiety disorders – symptoms of mixed anxiety with features of other disorders in which no type of symptom is serious enough to justify a diagnosis if considered separately; Other specified anxiety disorders – anxious hysteria; Unspecified anxious disorder – nos anxiety; Obsessive-compulsive disorder – recurrent obsessive thoughts or compulsive acts are the essential feature; obsessive thoughts are ideas, images or impulses that penetrate into the patient's mind relentlessly and stereotypically; are almost invariably excruciating and the patient often tries, unsuccessfully, to resist them; nevertheless, they are recognized as his or her own thoughts, even though they are involuntary and often repugnant; compulsive acts or rituals are stereotypical behaviors that are repeated relentlessly; they are not pleasant in themselves, nor do they result from completing useful tasks by themselves; their function is to prevent an objectively unlikely event, often involving injury to or caused by the patient, which he or she fears might otherwise occur; usually this behavior is recognized by the patient as pointless or ineffective and many attempts are made to resist; anxiety is present almost invariably; if compulsive acts are resisted, anxiety is accentuated – it includes anancast neurosis, obsessive-compulsive neurosis and excludes obsessive-compulsive personality (disorder); Predominantly obsessive or meditating thoughts – these can be the form of ideas, mental images or impulses to act, which are almost always troublesome for the subject; sometimes ideas are an undecided and endless consideration of alternatives, associated with an inability to make trivial but necessary decisions for everyday living; the relationship between obsessive meditations and depression is especially trance, and a diagnosis of obsessive-compulsive disorder would be preferable only if the meditations occur or persist in the absence of a depressive episode; Predominantly compulsive acts (haunting rituals) – most compulsive acts have as their concern cleanliness (especially hand washing), repeated checking to ensure that no potentially dangerous situation has been allowed to develop, or order and order; the obvious behavior is of fear, usually of danger to the patient either caused by him, and the ritual is an ineffective or symbolic attempt to avoid that danger; Mixed obsessive thoughts and acts; Other obsessive-compulsive disorders; Unspecified obsessive-compulsive disorder; Reaction to severe stress and adaptation disorders – this category differs from the others in that it includes identifiable disorders not only based on symptoms and evolution but also on the existence of one or another of the two causal influences: an extremely stressful event in life that produces an acute stressful stress reaction or a significant change in life that leads to continuous unpleasant circumstances resulting in an adaptation disorder; although less severe psycho-social stress ("life events") may precipitate the onset or may contribute to the presentation of a very wide range of disorders classified elsewhere, in this group of diagnoses its etiological importance is not always clear and in each case it will be discovered that it depends on individual vulnerability, often idiosyncratic, that is, the events in life are neither necessary nor sufficient to explain the production and form of the disorder; in contrast, the disorders gathered here are considered to always occur as a direct consequence of severe acute stress or persistent trauma; stressful events or continuous unpleasant circumstances are the primary causative factor, and the disorder would not have occurred without their impact; the disorders in this section can thus be considered as unsusionable responses to persistent and severe stress, in that they come into conflict with the adaptive mechanisms of success and thus lead to problems of social functioning; Acute reaction to stress – a transient disorder that develops in an individual without any other mental disorder in response to extraordinary physical and mental stress and that usually disappears within a few days or hours; individual vulnerability and the ability to cope with problems play a role in the production and severity of acute stress reactions; the symptoms show a mixed and changing picture and include an initial state of "astonishment" with a certain restriction of the field of consciousness and a diminution of attention, inability to understand stimuli and disorientation; this state can be followed either by a new withdrawal from the environment (which can reach up to dissociative stupor) or by a agitation and over-activity (withdrawal and flight reaction); autonomous signs of extreme anxiety (tachycardia, sweating, redness) are usually present; symptoms usually appear within a few minutes of the impact of the stimulus or stressful event and disappear within two to three days (often within a few hours); partial or complete amnesia of the episode may be present; if the symptoms persist, a change in diagnosis should be taken into account – acute: reaction to the crisis, reaction to stress, fighting fatigue, crisis state, mental shock; Post-traumatic stress disorder – occurs as a delayed or prolonged response to a stressful event or situation of either short or long duration) of an extremely threatening or catastrophic nature, and which is likely to cause in almost anyone a penetrating restlessness; predisposing factors, such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic disease, may lower the threshold for the development of the syndrome or the aggravation of its evolution, but they are neither necessary nor sufficient to explain its occurrence; typical traits include episodes of repeated reliving of trauma in hissing memories ("flashbacks"), dreams or nightmares, occurring against a persistent background of "torpor" and emotional weakening, detachment from other people, lack of response to the environment, anhedonia and avoidance of activities and situations reminiscent of trauma; there is usually a state of autonomic hypertrezire with hypervigilance, an increased reaction of startle and insomnia; anxiety and depression are commonly associated with the above symptoms and signs, myas suicidal ideation is common; the onset follows the trauma a latency period that can last from several weeks to months; the evolution is fluctuating but we can expect recovery in most cases; in a small proportion of cases, the disease can follow a chronic course for a period of several years, with an eventual transition to a lasting personality change – traumatic neurosis; Adaptation disorder – states of subjective suffering and emotional disturbance, usually preventing social functioning and social performance, occurring during the period of adaptation to a significant life change or a stressful life event; the stress factor may have affected the integrity of an individual's social recipe (irreparable loss, separation experiences) or the wider system of social supports and values (emigration, refugee status) or represented a major developmental transition or crisis (going to school, becoming a parent, failure to achieve a beloved personal goal, retirement, etc.); individual predisposition or vulnerability plays an important role in the risk of producing and forming manifestations of adaptation disorders, but, nevertheless, it is assumed that the disease would not have occurred without the stress factor; manifestations vary and include depressive mood, anxiety or worry (or a combination thereof), a feeling of inability to face, to do future projects, or to continue the situation in the present as well as a certain degree of impossibility to perform daily routine activities; conduct disorders can be an associated trait, especially in adolescents; the predominant feature may be a short or long-term depressive reaction or a disturbance of other emotions and behaviors – Culture shock, Deep grief reaction; Hospitalization in the child – excludes anxiety disorder on the separation from childhood; Other reactions to a severe stressor; Reaction to a severely unspecified stressor);

3. Dissociative (conversion) disorders – the common ideas that appear in dissociative or conversion disorders are a partial or complete loss of normal integration between memories of the past, identity consciousness and immediate sensations as well as control of body movements; all types of dissociative disorders tend to resign after a few weeks or months, especially if their onset is associated with a traumatic event in life; more chronic disorders may develop, especially paralysis and anesthesia, if the onset is associated with insoluble interpersonal problems or difficulties; these disorders have previously been clarified as various types of "conversion hysteria"; they are supposed to be psychogenic at origin, being associated with traumatic events, insoluble and intolerable problems or uncomfortable relationships that happened in the near past; symptoms often represent the patient's conception of how a physical illness would manifest itself; medical examination and investigation does not reveal the presence of any known physical or neurological disorder; in addition, there is evidence that the loss of function is an expression of conflicts or emotional needs; symptoms can develop in close relation to psychological stress and often appear suddenly; this includes only physical function disorders that normally occur under voluntary control and loss of sensations; disorders involving pain and other complex physical sensations mediated by the autonomic nervous system are classified to somatization disorder; it should be taken into account the possibility of the later occurrence of serious physical or mental disorders – includes conversion: hysteria, reaction; hysteria, hysterical psychosis and excludes the simulation of a disease (conscious simulation) (Dissociative amnesia – the main feature is memory loss, usually of important recent events, which is not due to an organic mental disorder and is too essential to be explained by ordinary forgetfulness or fatigue; amnesia is usually based on traumatic events, such as accidents or unexpected irreparable losses, and is usually partial or selective; complete amnesia and generalized is rare and usually a part of the flight; if this is the cause, the disorder should be classified as such; the diagnosis should not be made in the presence of organic brain disorders, intoxication or excessive fatigue – excludes amnesic disorder induced by alcohol or other psychoactive substances of the fourth usual character – amnesia: anterograde, NOS, retrograde; organic nonalcoholic amnetic syndrome; post-critical amnesia in epilepsy; Dissociative flight – dissociative flight has all the features of dissociative amnesia, in addition the motivated departure exceeding the usual daily radius; although there is amnesia for the period of flight, the patient's behavior during this time may seem completely normal to outside observers – excludes post-critical flight in epilepsy; Dissociative stupor – dissociative stupor is diagnosed on the basis of a profound diminution or absence of voluntary movement and normal reaction to external stimuli, such as light, noise and touch; but the examination and investigation reveals no evidence of a physical cause; In addition, there is positive proof of psychogenic causality in the form of recent stressful events or problems – excludes organic catatonic disorder, stupor: catatonic, depressive, manic, NOS; Disorders regarding the state of trance and possession – disorders in which there is a temporary loss of the sense of personal identity and complete consciousness regarding the environment; this includes states of trance that are involuntary or undesirable, occurring outside the accepted religious or cultural situations – excludes the states associated with: transient and acute psychotic disorders, organic personality disorder, post-commotional syndrome, intoxication with psychoactive substances of the fourth common character, schizophrenia; Dissociative motor disorders – in the most common forms there is a loss of the ability to move in whole or in part of a limb or limb; there may be a great similarity with almost all forms of ataxia, apraxia, akinesis, aphonia, dysarthria, dyskinesis, attacks or paralysis – psychogenic: aphonia, dysphonia; Dissociative seizures – dissociative seizures can very well mimic movements during epileptic attacks, but biting of the tongue, scratching due to falling and urinary incontinence are rare, and consciousness is maintained or replaced by a state of stupor or trance; Dissociative anesthesia and sensory loss – anesthetized areas of the skin often have limits that clearly show that they are associated with the patient's ideas about body functions rather than with certain medical knowledge; it can be a differential loss between sensory types that cannot be due to a neurological damage; sensory loss may be accompanied by paresthesia; loss of vision and hearing are very rare in dissociative disorders – psychogenic deafness; Mixed dissociative (conversion) disorders; Other dissociative disorders (conversion); Ganser syndrome; Multiple personality disorder; Transient dissociative (conversion) disorders that occur in childhood and adolescence; Other dissociative (conversion) disorders specified – psychogenic confusion; Unspecified dissociative (conversion) disorder);

4. Somatoform disorders – the main feature is a repeated presence of physical symptoms along with persistent requests for medical investigations despite repeated negative results and assurances given by doctors that the symptoms have no physical basis; if some physical disorders are present, they do not explain the nature and extent of the symptoms or the sufferings and concern of the patient – exclude dissociative disorders, plucking of hair, lalation, wheezing, nail biting, psychological or behavioral factors associated with disorders or diseases classified elsewhere; sexual dysfunction un caused by an organic disorder or disease; sucking the thumb; tics (in childhood and adolescence); Tourette's syndrome; trichotillomania; Somatization disorder – the main features are multiple, recurrent, frequently changing the physical symptoms over a period of at least two years; most patients have a long and complicated history of contact with both primary and specialized healthcare services, during which time many negative investigations and unnecessary exploratory operations may have been performed; symptoms can relate to any part or system of the body; the evolution of the disorder is chronic and fluctuating and is often associated with the alteration of the social, interpersonal and family behavior; patterns of symptoms of short duration (less than two years) or less obvious should be classified to undifferentiated somatoform disorder – Briquet's disorder, multiple psychomotor disorder – excludes simulation of a disease (conscious simulation); Undifferentiated somatoform disorder – when the somatoform sufferings are multiple, variants and persistent, but the typical and complete clinical picture of the somatization disorder is not completed, the diagnosis of undifferentiated somatoform disorder – undifferentiated psychosomatic disorder – undifferentiated psychosomatic disorder – should be taken into account; Hypochondriac disorder – the essential feature is a persistent preoccupation with the possibility of having one or more progressive and serious physical disorders; patients experience persistent somatic suffering or persistent concern about their physical appearance; normal or banal physical sensations and appearances are often interpreted by the patient as abnormal and troublesome, and attention is usually focused only on one or two organs or systems of the body; marked depression and anxiety are often present and can justify additional diagnoses – Body dysmorphic disorder, Dysmorphopho-phobia (undelusional), Hypochondriac neurosis, Hypochondria, Hypochondria, Nosophobia – excludes dismorphophobia-delusional phobia, fixed delusional ideas about body functions or its shape; Autonomous somatoform dysfunction – the symptoms are presented by the patient as if they were caused by a physical disorder of a system or organ that is mostly or completely under the control and autonomic innervation, i.e. the cardiovascular, gastrointestinal, respiratory and uro-genital systems; the symptoms are usually of two types, neither of them indicates a physical disorder of the respective organ or system; in the first type are complaints based on objective signs of response to autonomous stimuli, such as palpitations, redness, trembling and the expression of fear and unhappiness regarding the possibility of a physical disorder; Second, there are subjective complaints of an unspecified or changeable nature, such as vague pain, burning sensations, heaviness, straining and the feeling of being puffy or swollen that are attributed by the patient to a specific organ or system – Cardiac neurosis, Da Costa syndrome, Gastric neurosis, Neurocirculatory asthenia, Psychogenic forms of: aerophagia, cough, diarrhea, dyspepsia, dysuria, flatulence, hiccups, hyperventilation, increased frequency of urination, irritable bowel syndrome, spasm of the pylorus – excludes behavioral and psychological factors associated with disorders or diseases classified elsewhere; Autonomic dysfunction of the unspecified somatoform organ or system; Autonomic dysfunction of the somatoform heart and cardiovascular system; Autonomic dysfunction of the upper gastrointestinal tract somatoform; Autonomic dysfunction of the lower gastrointestinal tract somatoform; Autonomic dysfunction of the respiratory system somatoform; Autonomic dysfunction of the genitourinary system somatoform; Autonomic somatoform dysfunction of another organ or system; Autonomic dysfunction of somatoform organs or multiple systems; Persistent somatoform pain syndrome – the predominant complaint is of persistent, severe and troublesome pain, which cannot be fully explained by a physiological process or a physical disorder; it occurs in association with an emotional conflict or psychosocial problems, being sufficient to allow the conclusion that they are the main causative influences; the result is usually an important increase in attention and support either personally or medically; this should not include pain that is supposed to be of psychogenic origin occurring in the case of depressive disorders or schizophrenia – Psyhalgia, Psychoghene: dorsalgia, headache, Somatoform pain disorder – excludes nos dorsalgia, pain: acute, chronic, irreducible, NOS, tension headache; Other somatoform disorders – any other disorders of sensation, function and behavior, not due to physical disorders, which are not produced by the autonomic nervous system, which are limited to specific systems or parts of the body and which are closely related in time with problems or stressful events – Psychogenic: dysmenorrhea, dysphagia including "hysterical globe", pruritus, torcolis, bruxism; Unspecified somatoform disorder – psychosomatic disorder NOS;

5. Other neurotic disorders (Neurasthenia – in the presentation of this disorder there are considerable cultural variations, and two main types can be observed with a substantial intersection; in one of the types the main feature is a complaint of increased fatigue after mental exertion, often associated with some diminution of professional performance or ability to cope effectively with daily tasks; mental fatigue is typically described as an unpleasant penetration of unsettling associations and memories, as a difficulty in concentration and an ineffective thinking in general; in the other type, the emphasis is placed on feelings of bodily or physical weakness and exhaustion after minimal effort, accompanied by a feeling of muscle pain and helplessness of relaxation; in both types a variety of other unpleasant physical feelings, such as vertigo, headache of tension and feelings of general instability; all the following are also common, namely the care regarding the degradation of mental and physical health, irritability, anhedonia and the minor degrees varied by both depression and anxiety; sleep is often disturbed in its initial and medium phase, but hypersomnia can also be prominent – fatigue syndrome – excludes NOS asthenia, overwork, malaise and fatigue, post-viral fatigue syndrome, psychasthenia; Depersonalization syndrome – derealization – a rare disorder in which the patient spontaneously complains that his mental activity, body and environment are changed in terms of their quality, perceived as unreal, distant or automated; among the various phenomena of the syndrome patients complain most frequently of the loss of emotions and feelings of strangeness or detachment from their thinking, their body or the real world; despite the dramatic nature of the experience the patient is aware of the unreality of the change; the brain's ability to receive and interpret sensory stimuli is normal and the capacity for emotional expression intact; symptoms of depersonalization-derealization may occur as part of a diagnosable schizophrenic, depressive, phobic or obsessive-compulsive disorder; in such cases the diagnosis should be that of the main disorder; Other specified neurotic disorders – Dhat syndrome, Professional neurosis including writer's hand cramps, Psyhasthenia, Psychasthenic neurosis, Psychogenic syncope; Unspecified neurotic disorder – NOS neurosis);

F. Behavioral syndromes associated with physiological disturbances and physical factors:

1. Disorders regarding the way of eating - exclude anorexia NOS, (de) feeding: difficulty and poor administration, disorder in infant or child, polyphagia (Anorexia nervosa – a disorder characterized by deliberate weight loss, induced and supported by the patient; it often occurs in teenage girls and young women, but teenage boys and young men can also be affected, as can children approaching puberty and older women up to menopause; the disorder is associated with a specific psychopathology in which the fear of getting fat and having a fat body persists as a scathing and overpriced idea and patients impose a low weight limit themselves; there is usually a malnutrition of varying severity with secondary endocrine and metabolic changes and disturbances in the body functions; symptoms include restrictive choice of regimen, excessive exercise, vomiting and purgation induced by the use of appetite-related substances and diuretics – excludes loss of appetite: NOS, psychogenic; Atypical anorexia nervosa – disorders that have some features of the features of the anorexia nervosa but in which the complete clinical picture does not justify this diagnosis; for example, one of the key symptoms, such as amenorrorrion or particular fear of fattening, may be missing in the presence of marked weight loss and weight reduction behaviour; this diagnosis should not be made in the presence of known physical disorders associated with weight loss; Bulimia nervosa – a syndrome characterized by repeated bouts of excessive appetite and an excessive concern for the control of body weight, leading to a way of eating beyond measure followed by vomiting or the use of purgatives; this disorder has many psychological traits in common with anorexia nervosa, including an excessive preoccupation with body shape and heaviness; repeated vomiting probably causes disorders of the body's electrolytes and physical complications; often, but not always, there is an earlier history of an episode of anorexia nervosa, the time interval being several months to several years – Bulimia NOS, Hyperorexia nervosa; Atypical bulimia nervosa – Disorders that comprise some of the features of bulimia nervosa, but in which the entire clinical picture does not justify that diagnosis; for example, there may be recurrent bouts of excessive appetite and excessive use of purgatives without significant weight change, or typical excessive concern for body shape and weight may be absent; Excessive appetite associated with other psychological disorders – excessive appetite due to stressful events such as irreparable loss, accident, childbirth, etc. – excessive psychogenic appetite – excludes obesity; Vomiting associated with other psychological disorders – repeated vomiting that occurs in dissociative disorders and hypochondrial disorder and which is not due only to the conditions already presented; also, this category can be used additionally (excessive vomiting during pregnancy) when emotional factors are predominant in provoking nausea and recurrent vomiting during pregnancy – psychogenic vomiting – excludes nausea, VOMITING NOS; Other appetite disorders – spades in adults, Psychogenic loss of appetite – excludes spades in infants and children; Unspecified appetite disorder);

2. Non-ororgan sleep disorders – in many cases, a sleep disorder is one of the symptoms of another disorder, either mental or physical; if a sleep disorder in a given patient is an independent condition or is simply one of the features of another disorder classified elsewhere, in this group of conditions, or in others, it should be determined on the basis of its clinical presentation and evolution as well as on the basis of therapeutic considerations and priorities at the time of consultation; in general, if the sleep disorder is one of the major sufferings and is perceived as a condition in itself, this medical condition should be considered together with other relevant diagnoses describing the psychopathology and pathophysiology involved in a given case; this category includes only those sleep disorders in which emotional causes are considered to be a primary factor and which are not due to identifiable physical disorders classified elsewhere – excludes sleep disorders (organic) (Non-organic) insomnia (Non-organic insomnia ) (non-organic insomnia – a condition of the quantity and/ or quality of sleep, which persists for a considerable period of time, including difficulties in falling asleep, staying asleep or waking up early in the morning; insomnia is a common symptom in many mental and physical disorders and should be classified here in addition to the basic disorder only if it dominates the clinical picture – excludes insomnia (organic); Non-ororgan hypersomnia – hypersomnia is defined as a condition of either excessive daytime sleepiness and sleep attacks (not taking into account an inadequate amount of sleep) or a prolonged transition to the state of complete awakening at the time of awakening; in the absence of an organic factor for the production of hypersomnia, this medical condition is usually associated with metal disorders – excludes hypersomnia (organic), narcolepsy; Non-organic sleep/wakefulness schedule disorder – a lack of synchronization between the sleep/wake schedule and the sleep/wake schedule desired for the patient's environment, resulting from a suffering of either insomnia or hypersomnia – Psychogenic inversion of rhythm (of): circadian, nictemeral, sleep – excludes disorders of the schedule (organic); Sleepwalking (walking through sleep) – a state of altered consciousness in which the phenomena of sleep and wakefulness are combined; during an episode of walking through sleep, the individual rises from bed, usually during the first third of the night's sleep, and wanders with low levels of consciousness, reactivity and motor skill; upon awakening, no memory of the event is kept; Terror in sleep (night terror) – nocturnal episodes of terror and extreme panic associated with intense vocalizations, motility and high levels of autonomic discharge; the individual gets up or wakes up, usually in the first third of the night's sleep, with a scream of panic; quite often he or she runs towards the door as if trying to escape, although he rarely leaves the room; the memory of the event, if any, is very imitated (usually it is limited to one or two fragmented mental images); Nightmares – dream experiences loaded with anxiety or fear; there is a very detailed memory of the content of the dream; the dream experience is very vivid and usually includes themes involving threats to life, security or self-esteem; there is quite often a recurrence of the same or similar themes of nightmares that cause fear; during a typical episode there is a degree of autonomous discharge but without appreciable vocalizations or body motility; upon awakening the individual quickly becomes alert and oriented – anxiety disorder in the dream; Other non-ororgan sleep disorders; Unspecified non-ganic sleep disorders – nos emotional sleep disorder;

3. Sexual dysfunction unprovoked by an organic disorder or disease – sexual dysfunction encompasses different ways in which an individual is incapable of having the sexual relationship as he or she would like it; sexual response is a psychosomatic process and both the psychological and somatic processes are usually involved in causing sexual dysfunction – it excludes Dhat syndrome; (Absence or loss of sexual desire – loss of sexual desire is the main problem and is not secondary to other sexual difficulties, such as erection failure or dyspareunia – frigidity, hypoactive sexual desire disorder; Sexual aversion and lack of pleasure – either the prospect of sexual relations produces a fear or anxiety sufficient for sexual activity to be avoided (aversion) or the sexual response is normal and orgasm is felt but there is a lack of specific pleasure (lack of sexual pleasure) – anhedonia (sexual); Failure of the genital response – the main problem in men is erection dysfunction (difficulty in developing or maintaining an erection suitable for a satisfactory ratio); in women, the main problem is vaginal dryness or lubrication failure – Sexual response disorder in women, Male erection disorder, Psychogenic impotence – excludes impotence of organic origin; Orgasmic dysfunction – orgasm either does not occur or is particularly delayed – Inhibited orgasm (female) (male); Premature ejaculation – the inability to control ejaculation enough for both partners to feel pleasure in sexual intercourse; Nonorganic vaginisma – spasm of the pelvic floor muscles surrounding the vagina, causing occlusion of the vaginal opening; the introduction of the penis is either impossible or painful – psychogenic vaginismus – excludes vaginismus (organic); Non-oral dyspareunia – dyspareunia (or pain during sexual intercourse) occurs in both women and men; it can often be attributed to local pathology and then the classification to the pathological condition would be correct; this category is to be used only if there is no primary non-organic sexual dysfunction (eg vaginismus or vaginal dryness) – Psychogenic dyspareunia – excludes dyspareunia (organic); Excessive sexual necessity: Nymphomania, Satirisis; Other non-sexual dysfunction caused by an organic disorder or disease; Unspecified sexual dysfunction not caused by an organic disorder or disease);

4. Behavioral and mental disorders associated with puerperium not elsewhere classified – this category includes only mental disorders associated with puerperium (starting with the period of six weeks after birth) that do not meet the criteria for disorders classified elsewhere in this group of conditions, either because insufficient information is available, or because special additional clinical features are considered to be present thus making their classification somewhere inappropriate (Mild mental and behavioral disorders associated with puerperium not elsewhere classified – depression: post-natal NOS, post-partum NOS; Severe mental and behavioral disorders associated with puerperium not elsewhere classified – puerperal psychosis NOS; Other mental and behavioral disorders associated with puerperium not elsewhere classified – postpartum: somber NOS, dysphoria NOS, MOOD DISORDER NOS, SADNESS NOS; Unspecified puerperal mental disorder);

5. Psychological and behavioral factors associated with diseases or disorders classified elsewhere – this category should be used to record the presence of behavioral or psychological influences considered to have played an important role in the etiology of physical disorders that can be classified elsewhere; any mental disorders that result are usually mild and often prolonged (such as worry, emotional conflict, distrust) and do not in themselves justify the use of any category of this group – asthma, dermatitis, gastric ulcer, mucous colitis, ulcerative colitis, urticaria, psychological factors that affect physical disorders – exclude headache caused by tension;

6. Harmful use of non-addictive substances – a wide variety of medicines and folk remedies may be involved, but the very important groups are: a. non-addictive psychotropic drugs, such as antidepressants, b. laxatives and c. analgesics that can be bought without medical prescription, such as aspirin and paracetamol; persistent use of these substances often involves unnecessary contacts with medical professionals or their teams and is sometimes accompanied by the harmful physical effects of the substances; attempts to persuade that the substance should not be used or to prohibit its use are often resistant; it can occur for laxatives and painkillers, despite warnings about physical injury (or even its development) such as kidney dysfunction or electrolyte disorders; although it is usually clear that the patient has a serious motivation to take the substance, the symptoms of addiction or withdrawal do not develop as in the case of psychoactive substances – the habit of taking laxatives – disorder of using: antacids, herbal or folk remedies, steroids or hormones, vitamins – excludes: the disorder of use of psychoactive substances that cause addiction (Antidepressants; Laxatives; Analgesics; Antacids; Vitamins; Steroids or hormones; Specific herbal or folk remedies; Other non-addictive substances; Unspecified);

7. Unspecified behavioral syndromes associated with physiological disturbances and physical factors – psychogenic physiological dysfunction NOS;

G. Personality and behavioral disorders in adults - this group of conditions includes a variety of clinically significant conditions and patterns of behavior that tend to be persistent and appear as an expression of the individual's lifestyle and the way of establishing relationships with himself or herself and others; some of these conditions and patterns of behavior appear early in the course of individual development as a result of both constitutional factors and social experience, while others are acquired later in life; specific personality disorders, other personality disorders and mixed personality disorders and lasting personality changes are sustainable and deeply rooted patterns of behavior, manifesting as inflexible responses to a wide range of social and personal situations; they represent significant or extreme deviations from the way in which the ordinary individual in a given culture perceives, thinks, feels and, above all, is related to others; such patterns of behavior tend to be stable and encompass multiple areas of psychological behavior and functioning; they are frequently, but not always, associated with varying degrees of subjective suffering and social performance problems:

1. Specific personality disorders – are severe disturbances in the personality and behavioral tendencies of the individual; it does not result directly from a disease, injury or other brain injury or from another psychiatric disorder; usually involving several areas of personality; almost always associated with considerable personal suffering and social upheaval; and is usually manifested from childhood or adolescence and continues in adulthood (Paranoid Personality Disorder – personality disorder characterized by excessive sensitivity to interruptions, non-forgiveness of insults; suspicion and a tendency to distort the experience by misinterpreting the neutral or friendly actions of others as hostile or contemptuous; recurrent suspicion, without justification, regarding the sexual fidelity of the spouse or sexual partner; and the combative and tenacious sense of one's own rights; there may be an excessive self-importance and there is often an excessive self-reference – personality (disorder of): expansive paranoid, fanatical, paranoid, paranoid, paranoid, sensitive paranoid – excludes nos paranoia, cverulent; paranoid: psychosis, schizophrenia, state; Schizoid personality disorder – personality disorder characterized by a restriction of affective, social and other contacts with a preference for fantasy, solitary activities and introspection; there is a limited ability to express feelings and experience pleasure – excludes Asperger's syndrome, delusional disorder, schizoid childhood disorder, schizophrenia, schizotypal disorder; Dissociated personality disorder – personality disorder characterized by a contempt for social obligations and a cold indifference to the feelings of others; there is a considerable difference between behaviour and existing social norms; the behavior is not easily modifiable by an unfavorable experience, including punishment; there is a low tolerance for frustration and a minimum limit on the discharge of aggression, including violence; there is a tendency to blame others or to offer plausible reasoning for the behavior that brought the patient into conflict with society – personality (disorder): amoral, antisocial, asocial, psychopathic, sociopathic – excludes conduct disorders, emotionally unstable personality disorder; Emotionally unstable personality disorder – personality disorder characterized by a defined tendency to act impulsively without taking into account the consequences; the disposition is unpredictable and capricious; there is a predisposition to emotional outbursts and an inability to control behavioral explosions; it is a tendency towards quarrelsome behavior and conflict with others, especially when impulsive actions are counteracted or prevented; two types can be distinguished: the impulsive type, predominantly characterized by emotional instability and lack of control over impulse and the limit type, characterized in addition by disturbances of self-image, personal goals and preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships and by a tendency of self-destructive behavior, including gestures and suicide attempts – excludes dissocial personality disorder: Impulsive type – personality (disorder): aggressive, explosive; Limit type: Histrionic personality disorder – personality disorder characterized by superficial and labile affectivity, self-dramatization, theatricality, exaggerated expression of emotions, suggestibility, egocentrism, indulgence towards one's own weaknesses, lack of consideration for others, feelings easily hurt and continuous search for appreciation, excitation and attention – personality (disorder of): hysterical, psycho-infantile; Anancastic personality disorder – personality disorder characterized by a sense of doubt, perfectionism, excessive conscientiousness, checking and preoccupation with details, stubbornness, prudence and rigidity; there may be insistent and troublesome thoughts or impulses that do not reach the severity of an obsessive-compulsive disorder – personality (disorder of): compulsive, obsessive, obsessive-compulsive – excludes obsessive-compulsive disorder; Anxious (avoidant) personality disorder – personality disorder characterized by feelings of tension and fear, insecurity and inferiority; there is a continuous burning desire to be wanted and accepted, a hypersensitivity to criticism and removal with restricted personal attachments, and a tendency to avoid certain activities through a regular exaggeration of potential dangers or risks in everyday situations; Dependent personality disorder – personality disorder characterized by a predominant and passive trust in other people in order for them to make major or minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive consent to the desires of the elderly and others, and a weak response to the demands of daily life; lack of vigor can manifest itself in the intellectual and emotional realms; often there is a tendency to transfer responsibility to others – personality (disorder): asthenic, inadequate, passive, self-defense; Other specific personality disorders – personality (disorder of): "no doubts" type, eccentric, immature, narcissistic, passive-aggressive, psycho-neurotic; Unspecified personality disorder – neurosis of NOS character, NOS pathological personality)

2. Mixed personality disorders – this category is intended for personality disorders that are often difficult but do not demonstrate the specific pattern of symptoms described above; as a result they are more difficult to diagnose; examples include: personality disorders with features of several disorders described above but without a set of predominant symptoms that would allow a more specific diagnosis; difficult personality changes and considered as secondary to a main diagnosis given to a coexisting anxiety or affective disorder – excludes accentuated personality traits;

3. Lasting personality changes that cannot be attributed to a brain injury or disease – personality and behavioural disorders in adults that have developed in people without any previous disorder as a result of exposure to a catastrophic or excessively prolonged stressor or as a result of severe psychiatric illness; these diagnoses should be made only when there is evidence of a definite and lasting change in a person's pattern of perception, connection or thinking about the environment and that of him or herself; personality change should be significant and be associated with inflexible behavior and an adaptation defect absent before the pathogenic experience; the change should not be a direct manifestation of another mental disorder or a residual symptom of any previous mental disorder – excludes behavioural and personality disorder due to illness, injury and cerebral dysfunction (Lasting personality change after a catastrophic experience – personality change, present for at least two years as a result of exposure to a catastrophic stress factor; stress must be so intense that it is not it is necessary to consider personal vulnerability in order to explain its profound effect on personality; the disorder is characterized by a hostile attitude or distrust of the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of "standing as if on the thorn" as if constantly threatened, and alienation; post-traumatic stress disorder can precede this type of personality change – personality change after: concentration camp experiences, disasters, prolonged: captivity with an imminent possibility of being killed, exposure to situations representing a vital danger such as the victim of an act of terrorism, torture – excludes post-traumatic stress disorder; Lasting personality change after a psychiatric illness – personality disorder, persisting for at least two years, which is attributed to the traumatic experience of suffering following a severe psychiatric illness; the change cannot be explained by a previous personality disorder and should be differentiated from residual schizophrenia and other states of incomplete recovery following a previous mental disorder; this disorder is characterized by an addiction and attitude of excessive demand towards others; the conviction to be changed or stigmatized by illness leading to an inability to form and maintain close and reliable personal relationships and social isolation; passivity, low interests and low involvement in recreational activities; Persistent complaints of being ill, which may be associated with hypochondriac complaints and sick behavior; dysphoric or labile mood unprovoked by the presence of a current mental disorder or previous mental disorder with residual affective symptoms; and long-standing problems of social and occupational functioning; Other lasting personality changes – personality syndrome with chronic pain; Sustainable unspecified personality change);

4. Disorders of impulses and habits – this category includes certain behavioral disorders that are not classified into other categories; they are characterized by repeated acts which have no clear rational motivation, cannot be controlled, and generally harm the patient's own interests and those belonging to other people; the patient claims to have a behavior associated with impulses to act; the cause of these disorders is not understood and the disorders are grouped together because of the broad descriptive similarities, not because they are known to share any other important traits – excludes the usual misuse of alcohol or psychoactive substances, impulse and habits disorders involving sexual behavior (The pathology of gambling – the disorder consists of frequent episodes, repeated gambling dominating the patient's life to the detriment of social, professional, material and family values and commitments – compulsive gambling play – excludes excessive gambling play by manic patients, gambling and NOS betting, gambling in gambling in dissociated personality disorder; Pathological arson (pyromania) – disorder characterized by multiple actions or attempts to set fire to property or other objects, without an apparent reason, and by a persistent preoccupation with people who are related to fire and burning; this behavior is often associated with feelings of increasing tension before the action and of intense excitation immediately afterwards – excludes arson (by) (through) (in): adult with dissociated personality disorder, alcohol or intoxication with psychoactive substances of the fourth usual character, as a reason for observation for suspicion of mental disorder, conduct disorders, organic mental disorders, schizophrenia; Pathological theft (kleptomania) – disorder characterized by the repeated failure to resist impulses to steal objects that are not acquired for personal use or for money gain; instead, items may be removed, discarded, given alms or stored; this behavior is usually accompanied by an increasing state of tension before, and by a state of satisfaction during and immediately after the action – excludes: depressive disorder associated with theft, organic mental disorders, shoplifting as a reason for putting under observation for suspicion of mental disorder; Trichotylomanie – a disorder characterized by visible hair loss due to a recurrent failure to resist the impulses of plucking hair from the head; plucking of hair is usually preceded by increasing tension and is followed by a state of relief or satisfaction; this diagnosis should not be made if there is a pre-existing inflammation of the skin or if the plucking of the hair is in response to a delusional idea or a hallucination – exclude stereotypical movement disorder with plucking hair; Other disorders of impulses and habits – other types of behavior with persistently repeated adaptation defect that are not secondary to a recognized psychiatric syndrome, and in which it seems that the patient repeatedly fails to resist the impulses to adopt this behavior; there is a prodromal period of tension with a sense of discharge at the time of action – intermittent explosive disorder; Disorder of impulses and unspecified habits);

5. Sexual identity disorders (Trans-sexualism – a desire to live and be accepted as a member of the opposite sex, usually accompanied by a feeling of discomfort or inadequacy to one's own anatomical sex and a desire to undergo surgery and hormonal treatment to make one's own body as compatible as possible with the favorite sex; Bivalent travesty – wearing clothing of the opposite sex for a period of time of the individual's existence in order to enjoy a temporary experience through which he belongs to the opposite sex, but without any desire for permanent change of sex or associated surgical transformation and without sexual arousal to accompany the change of clothing – sexual identity disorder in adolescence or non-transgender maturity – excludes fetishist transvestheism; Childhood sexual identity disorder – a disorder, usually manifested in the first childhood (and always long before puberty), characterized by a persistent and intense suffering regarding one's own sex, along with a desire to be (or the insistence that it is already) a member of the opposite sex; there is an intense concern about the clothing and activities of the opposite sex and about repudiating one's own sex; to make a diagnosis requires a deep disturbance of normal sexual identity; only boyish grasps in girls and girl behavior in boys are not enough; sexual identity disorders in individuals who have reached or are just entering puberty should not be included here – exclude egodistonic sexual orientation, sexual maturation disorder; Other disorders of sexual identity; Unspecified sexual identity disorders – disorder on the role of sex NOS);

6. Disorders of sexual preference – includes paraphilias (Fetishism – trust given to objects that are not animate as stimuli for sexual arousal and sexual satisfaction; many fetishes are extensions of the human body, such as clothing or footwear; other common examples are characterized by some special textures, such as rubber, plastic or leather; fetish objects vary according to their importance to the individual; in some cases they simply serve to strengthen the sexual arousal produced in normal ways (for example, it makes the partner wear a specific clothing); Fetishist travestyism – wearing the clothing of the opposite sex in order to achieve mainly sexual arousal and to create the appearance of a person of the opposite sex; fetishist transvestheism is distinguished from transgender transvestheism by its clear association with sexual arousal and with the strong desire to remove clothing once orgasm occurs and sexual arousal decreases; it can occur as an early phase in the development of transsexualism – fetishism of transvestite; Exhibitionism – a recurrent or persistent tendency to expose the genitals to strangers (usually to the opposite sex) or people in public places, without inviting or intending closer contact; there is usually, but not invariably, sexual arousal at the time of exposure and the act is routinely followed by masturbation; Voyeurism – a recurrent or persistent tendency to look at people who have a sexual relationship or intimate behavior, such as nakedness; this is done without the observed persons being aware of it, and usually leads to sexual arousal and masturbation; Pedophilia – a preference for children, boys or girls or both, usually of prepubertal age or early pubertal age; Sado-masochism – a preference for sexual activity that involves causing pain or humiliation or enslavement; we refer to masochism if the subject prefers to be the object of such stimulation; if it is the executor, then we are talking about sadism; an individual can often obtain a sexual arousal through both a masochistic and a sadistic behavior – masochism, sadism; Multiple disorders of sexual preference – sometimes op person may exhibit more sexual preferences than one, none being at the forefront; the most common combination is fetishism, transvestites and sado-masochism; Other disorders of sexual preference – a variety of patterns of sexual preference and activity, including obscene phone calls, rubbing the body of another person in crowded public places, sexual activity with animals and the use of strangulation and anoxysy to intensify sexual arousal – rubbing, necrophilia; Disorders of unspecified sexual preference – nos sexual deviation);

7. Behavioral and psychological disorders associated with sexual development and orientation – note: sexual orientation by itself is not to be considered as a disorder (Sexual maturity disorder – the patient suffers from uncertainty regarding his/her sexual identity or orientation, causing him/her anxiety or depression; this occurs most of the time in adolescents who are not sure if they are gay, heterosexual or bisexual in their orientation or in individuals who, after a period of apparently stable sexual orientation (often in a long-term relationship) discover that their sexual orientation changes; Egodistonic sexual orientation – sex identity or sexual preference (heterosexual, homosexual, bisexual or prepubertal) is not in doubt but the individual wants them to be due to associated behavioral and psychological disorders and may seek treatment for change; Sexual relationship disorder – sex identity or sexual orientation (heterosexual, homosexual or bisexual) is responsible for the difficulties of forming or maintaining a relationship with a partner; Other disorders of psychosexual development; Unspecified psychosexual developmental disorder);

8. Other personality and behavioral disorders in adults (Development of physical symptoms for psychological reasons – the physical symptoms compatible and initially due to a confirmed physical disorder, disease or incapacity become exaggerated or prolonged due to the patient's psychological state; usually, the patient is very worried about this pain or incapacity and often worries, which may be justified, about the possibility of prolonged or progressive pain or incapacity – neurosis of compensation; Intentional production or simulation of the symptoms of an incapacity either physical or psychological (artificial disorder) – the patient simulates symptoms repeatedly for no clear reason and may even cause self-mutilation to produce symptoms or signs; the motivation is obscure and probably of an internal nature in order to adopt the role of the sick person; the disorder is often combined with marked personality and relationship disorders – frequent addressability syndrome for hospitalization, Munchausen's syndrome, itinerant patient – excludes self-duced dermatitis, the person simulating the disease (with clear motivation); Other specified personality and behavioral disorders in adults – NOS character disorder, NOS relationship disorder);

9. Unspecified personality and behavior disorder in the adult;

H. Mental retardation

- a condition of interrupted or incomplete development of the intellect that is characterized especially by the deficiency of some abilities manifested during the development period, abilities that contribute to the entire level of intelligence, i.e. cognitive, language, motor and social skills; retardation can occur with or without any other mental or physical condition; degrees of mental retardation are conventionally estimated by standardized intelligence tests; they may be supplemented by graduated scales evaluating social adaptation in a given environment; these measures provide an approximate indication of the degree of mental retardation; also, the diagnosis will depend on the total evaluation of the intellectual functioning performed by an authorized diagnostician; intellectual abilities and social adaptation can change over time and, however little, improve as a result of training or rehabilitation; diagnosis should be based on the present levels of operation; additional diagnoses will be used to identify associated conditions, such as autism, other developmental disorders, epilepsy, conduct disorders or severe physical disability; the extent of the character deficiency can be identified by considering the following circumstances: with the declaration of a minimum deficiency of behavior or none; significant deficiency of behavior requires attention or treatment, other behavioral deficiencies, without mentioning the deficiency of behavior (Mild mental retardation – approximate IQ range from 50 to 60 (in adults, mental age of 9 to under 12 years); it probably results in some learning difficulties at school; many adults will be able to work and maintain good social relations, having contributions in society – includes mild mental arrears, mild intellectual subnormality; Moderate mental retardation – approximate IQ range from 35 to 49 (in adults mental age from 6 to under 9 years); it probably results in marked developmental delays in childhood, but most may learn to develop some degree of independence in their own care and to acquire adequate communication and conventional skills; adults will need varying degrees of support to live and work in the community – includes moderate intellectual subnormality; Severe mental retardation – approximate iq range from 20 to 34 (in adults mental age from 3 to under 6 years); perhaps a continuous need for support results – includes severe mental subnormality; Deep mental retardation – IQ below 20 (in adults the mental age under 3 years); the result is severe limitation in one's own care, continence, communication and mobility – includes deep mental subnormality; Other mental retardation; Unspecified mental retardation – includes: mental: NOS deficiency, NOS subnormality);

I. Psychological developmental disorders

- the disorders included in this block have in common: a. invariably onset in the period of the first childhood or childhood; b. deficiency or delay in the development of functions that are closely related to the biological maturation of the central nervous system; and c. a stable evolution without remissions and relapses; in most cases, the affected functions include language, visual-spatial skills and motor coordination; usually, delay or deficiency is present from the moment when it could certainly be detected and will progressively decrease as the child grows older, although there are often slight deficits in adult life:

1. Specific developmental disorders regarding speech and language – disorders in which normal patterns of language acquisition are disturbed from the early stages of development; the affections are not directly attributable to neurological abnormalities or the mechanism of speech, sensory impairments, mental retardation or environmental factors; specific developmental disorders regarding speech and language are often followed by associated problems, such as difficulties in reading and writing, abnormalities in interpersonal relationships, and emotional and behavioral disorders (Specific speech articulation disorder – a specific developmental disorder in which the child's use of speech sounds is below the level appropriate to his or her mental age, but in which there is a normal level of language skills – Developmental disorder: phonological, regarding speech articulation, Distaly, Functional speech articulation disorder, Lalopathy – excludes speech articulation deficiency (due to): NOS aphasia, apraxia, hearing loss, mental retardation; with language development disorder: expressive, responsive; expressive language disorder – a specific developmental disorder in which a child's ability to use an expressive speech language is markedly below the appropriate level for his mental age, but in which the understanding of language is within normal limits; there may or may not be abnormalities in the joint – dysphasia or developmental aphasia expressive type – excludes acquired aphasia with epilepsy (Landau-Kleffner), dysphasia or developmental aphasia of the receptive type, dysphasia or aphasia of NOS, elective mutism, mental retardation, deep developmental disorder; Receptive language disorder – a specific developmental disorder in which the child's understanding of language is below the appropriate level for his mental age; in almost all cases the expressive language will also be markedly affected, and the anomalies of the speech sound production are common – Congenital auditory deficiency, Development: dysphasia, aphasia, receptive type (de), Wernicke aphasia (de), verbal deafness – excludes acquired aphasia with epilepsy (Landau-Kleffner), Autism, Dysphasia or aphasia: expressive type, NOS, Elective Mutism, Language retardation due to deafness, Mental retardation; Aphasia acquired with epilepsy (Landau-Kleffner) – a disorder in which the child, making a previous normal progress in language development, loses his language skills both expressively and receptively but generally retains his intelligence; the onset of the disorder is accompanied by paroxysmal abnormalities observable to the EEG, and also by attacks of epilepsy in most cases; onset is usually between the ages of three and seven, with skills that were lost in a few days or weeks; the temporal association between the onset of attacks and the loss of language is variable, with one preceding the other (regardless of order) from a few months to two years; an inflammatory encephalitic process has been suggested as a possible cause of this disorder; about two thirds of patients remain with a more or less severe receptive language deficit – excludes aphasia (due to): autism, childhood disintegrative disorders, NOS; Other disorders of speech and language development – whispered, hissed speech; Unspecified speech and language development disorder – NOS language disorder);

2. Specific developmental disorders regarding school skills – disorders in which the normal patterns of acquiring skills are disturbed from the early stages of development; this is not a simple consequence of the lack of possibility to learn, it is not only a result of mental retardation, and it is not due to any form of trauma or acquired brain disease (Specific reading disorders – the main feature is a specific and significant deficiency in the development of reading skills that is not justified only by mental age, problems of visual acuity or improper schooling; the ability to understand reading, the recognition of the word read, the ability to read orally and perform tasks requiring reading can all be performed; utterance and spelling difficulties are frequently associated with specific reading disorder and often remain in adolescence even after some progress in reading has been made; specific disorders of reading development are usually preceded by a history of speech or language developmental disorders; associated emotional disorders and behaviors are common during school age – "Reversed Reading", Developmental Dyslexia, Specific Retardation on Reading – excludes NOS alexia, NOS dyslexia, reading difficulties secondary to emotional disorders; Specific utterance and spelling disorders – the main feature is a specific and significant deficiency in the development of utterance and spelling skills in the absence of a history of specific reading disorder, which is not justified only by young mental age, visual acuity problems or improper schooling; the ability to utter and to spell words correctly are both affected – specific retardation of utterance (without reading disorder) – excludes NOS agraphy, difficulty uttering and spelling: associated with reading disorder, due to improper teaching; Specific disorder regarding arithmetic abilities – involves a specific deficiency in arithmetic abilities that is not explained only on the basis of general mental retardation or improper schooling; the deficit concerns the mastery of basic abilities regarding the calculation of addition, subtraction, multiplication and division rather than the more abstract mathematical abilities involved in algebra, trigonometry, geometry or infinitesimal calculus – development: acalculia (de), mathematical developmental disorder, Gertsmann syndrome – excludes NOS acalculia, arithmetic difficulties: associated with a reading or utterance and spelling disorder, due to improper teaching; Mixed school skills disorder – a residual category – a badly defined residual category of disorders in which the arithmetic abilities as well as those of reading or utterance and spelling are significantly altered, but in which the disorder is not explained only in terms of general mental retardation or improper schooling – excludes: specific: arithmetic skills disorder, reading disorder, utterance and spelling disorder; Other disorders of the development of school skills – expressive writing development disorder; Disorders of the development of unspecified school skills – Inability to acquire knowledge NOS, Learning: incapacity (of) NOS, disorder (of) NOS);

3. Disorder of specific development of motor function – a disorder in which the main feature is a serious deficiency in the development of motor coordination that is not explained in terms of general intellectual retardation or any specific acquired or congenital neurological disorder; however, a careful clinical examination shows in most cases immaturities marked by neurological development, for example choreiform movements of the limbs without support or imitation syncokinesis and other associated motor features as well as signs of a slight or very deficient motor coordination – prevented child's syndrome, developmental development: coordination disorder, dyspraxia – excludes gait and motility anomalies, lack of coordination: NOS, secondary to mental retardation;

4. Specific mixed developmental disorders – a residual category for disorders in which there is a combination of specific developmental disorders on speech and language, on school skills, and motor function, but in which none predominates sufficiently to constitute a primary diagnosis; the mixed category should only be used where there is a significant overlap between each of these specific developmental disorders; disorders are usually, but not always, associated with a degree of general deficiency of cognitive functions; this group of diagnoses should be used when there are dysfunctions that meet the criteria for two or more of the conditions presented above;

5. Profound developmental disorders – a group of disorders characterized by qualitative anomalies of mutual social interactions and communication patterns and by the totality of repetitive, stereotypical, restrictive interests and activities; these qualitative abnormalities are a profound feature of the functioning of the individual in all situations (Infantile autism – a type of deep development that is defined by: a. the presence of abnormal or altered development that manifests itself before the age of three, and b. the characteristic type of development of abnormal functioning in all three areas of psychopathology: mutual social interaction, repetitive, stereotypical, restrictive communication and behavior; in addition, other nonspecific problems such as phobias, sleep disorders and eating, bouts of anger and self-aggression – autistic, infantile disorder are common to these specific diagnostic features; Atypical autism – a type of deep development that differs from infantile autism either by the age of onset or by the failure to fulfill all three diagnostic sets; this subcategory should be used when there is an abnormal and altered development that is present only after the age of three, and a lack of abnormalities that can be sufficiently demonstrated in one or two of the three areas of psychopathology required for the diagnosis of autism (i.e. mutual social interactions, communication and repetitive, stereotypical, restrictive behavior) despite the abnormalities characteristic in another field(s); atypical autism occurs most often in deeply retarded individuals and in individuals with a specific severe receptive language disorder – atypical infantile psychosis, mental retardation with autistic features; Rett syndrome – a condition, so far discovered only in girls, in which the apparently normal early development is followed by partial or complete loss of speech and locomotor abilities and the use of hands, along with slowing of the growth of the head, usually with onset at the ages of seven to 24 months; the loss of voluntary hand movements, the stereotypes of hand breaking and hyperventilation are characteristic; social development and play are stopped, but social interest tends to be maintained; trunk ataxia and apraxia begin to develop at the age of four, and choreothetosic movements frequently follow; severe mental retardation results almost invariably);

6. Another childhood disintegration disorder – a type of deep development that is defined by a period of completely normal development before the onset of the disorder, followed by a definitive loss of skills previously acquired in several areas of development within a few months; typically, it is accompanied by a general loss of interest in the environment, through stereotypical repetitive motor mannerisms and autistic abnormalities in social and communication interaction; it can be seen in some cases that the disorder is due to an associated encephalopathy, but the diagnosis should be made according to behavioral features – infantile dementia, disintegrative psychosis, Heller's syndrome, symbiotic psychosis – excludes Rett syndrome (Hyperactive disorder associated with mental retardation and stereotypical movements – a badly defined disorder with an uncertain nosological validity; the category is designated to include a group of children with severe mental retardation (IQ below 34) who have major problems of hyperactivity and attention, as well as stereotypical behaviors; they tend not to benefit from stimulating drugs (unlike those with normal IQ) and may show a severe dysphoric reaction (sometimes with psychomotor retardation) when they are given stimulants; hyperactivity tends to be replaced in adolescence with hypoactivity (a pattern that is not usually in hyperkinetic children with normal intelligence); often this syndrome is also associated with a variety of developmental delays, either specific or global; it is not known to what extent the behavioral pattern is a function of low IQ or organic brain injury; Asperger's syndrome – a disorder with an uncertain nosological validity, characterized by the same type of qualitative abnormalities of the mutual social interaction that are typical for autism, along with a totality of repetitive, stereotypical, restrictive interests and activities; they differ from autism mainly in that there is a general delay or retardation in language and cognitive development; this disorder is often associated with a marked clumsyness; there is a great tendency for abnormalities to persist in adolescence and adult life; psychotic episodes occur occasionally at the beginning of adult life – autistic psychosis, schizoid disorder of childhood; Other profound developmental disorders; deep developmental disorder);

7. Other disorders of psychological development – developmental agnosia;

8. Unspecified developmental disorder – NOS developmental disorder;

J. Behavioral and emotional disorders with onset usually in childhood and adolescence:

1. Hyperkinetic disorders – a group of disorders characterized by an early onset (usually in the first five years of life), lack of perseverance in activities that require cognitive involvement and a tendency to move from one activity to another without ending any, along with a disorganized, irregular and excessive activity; many other abnormalities can be associated; hyperkinetic children are often reckless and impulsive, prone to accidents and have disciplinary problems due to reckless violations of the rules rather than deliberate disobedience; their relationships with adults are often uninhibited socially, lacking normal prudence and reserve; they are unsympathetic to other children and may become isolated; deficiency of cognitive functions is common, and specific delays in motor and language development are frequently disproportionate; secondary complications include dissocial behavior and low self-esteem – exclude anxiety disorders, mood disorders (affective), deep developmental disorders, schizophrenia (Disruption of activity and attention – attention deficit: hyperactivity disorder, hyperactivity disorder, hyperactivity disorder, hyperactivity disorder – exclude hyperkinetic disorder associated with conduct disorder; Hyperkinetic conduct disorder – hyperkinetic disorder associated with conduct disorder; Other hyperkinetic disorders; Unspecified hyperkinetic disorder – hyperkinetic reaction of childhood or adolescence NOS, hyperkinetic nos syndrome);

2. Conduct disorders – disorders characterized by a persistent and repetitive pattern of dissocial, aggressive and provocative conduct; such behaviour should go beyond the major violence expected in similar social age groups; therefore, it should be more serious than the childish malice or the state of revolt of the adolescents and should involve a pattern of lasting behavior (six months or more); the features of the conduct disorder may also be symptomatic of other psychiatric conditions, in which case the basic diagnosis should be preferred; examples of behaviour on which the diagnosis is based include excessive levels of struggle or tyranny, cruelty to other people or animals, serious destruction of property, arson, theft, repeated lies, the rush to school and fleeing home, unusually frequent and serious bouts of anger and disobedience; any of these behaviors, if significant, is sufficient for the diagnosis, but isolated dissocial acts are not enough – exclude mood disorders (affective), deep developmental disorders, schizophrenia, when they are associated with: emotional disorders, hyperkinetic disorders (Conduct disorder limited to the family context – conduct disorder involving dissocial or aggressive behavior (and not just oppositional behavior, provocative, disturbing) in which the abnormal behavior is completely or almost completely limited at home and to the interactions with the members of the family nucleus or with those in the respective household; the disorder requires that all the above criteria be ednified; only severely disturbed parent-child relationships are not in themselves sufficient for a diagnosis; Unsocial conduct disorder – disorder characterized by the combination of persistent aggressive or dissocial behavior (meeting all the above mentioned criteria and not including only the oppositional, provocative, disruptive behavior) with the profound significant anomalies in the relations with other children – aggressive behavior disorder solitary type, unsocialized aggressive disorder; Socialized conduct disorder – disorder involving an aggressive or dissocial behavior (meeting all the aforementioned criteria and not including only oppositional, provocative, disruptive behavior) that occurs in individuals who are generally well integrated into the respective group – group-type conduct disorder, group delinquency, gang delicto, theft in the company of others, theft in the company of others, the chiul from school; Oppositional conduct disorder – a conduct disorder usually caused in young children, characterized first by a marked provocative, disobedient, disruptive behavior that does not include acts of delinquency or more extreme forms of aggressive or dissocial behavior; the disorder requires that all the criteria stated above be met, only the mischievous or disobedient behavior not being sufficient in themselves to make the diagnosis; caution should be exercised before using this category, especially with older children, since clinically significant conduct disorder will usually be accompanied by aggressive or dissocial behaviour that overcomes the challenge, disobedience or disturbance; Other conduct disorders; Unspecified conduct disorder (a) of childhood: NOS behavioral disorder, NOS conduct disorder;

3. Mixed disorders of conduct and emotions – a group of disorders characterized by the combination of persistent provocative, dissocial or aggressive behavior and the symptoms of open and marked by depression, anxiety or other emotional ailments; the criteria for both childhood and childhood emotional disorders or for a neurotic diagnosis in adults or for a mood disorder (Depressive conduct disorder – this category requires the combination of conduct disorder and the marked and persistent depressive mood, as demonstrated by symptoms such as excessive sadness, loss of interest and pleasure in ordinary activities, culpability and loss of hope; sleep and appetite disorders – conduct disorder associated with depressive disorder may also be present; Other mixed conduct and emotional disorders – this category requires the combination of conduct disorder and marked and persistent emotional symptoms, such as anxiety, obsessions or compulsions, depersonalization or derealization, phobias or hypochondria – emotional disorder, neurotic disorder; Mixed disorder of unspecified conduct and emotions);

4. Emotional disorders with specific onset in childhood – Mainly they are exaggerations of normal developmental tendencies rather than phenomena that are by themselves qualitatively abnormal; the adequacy of development is used as a key diagnostic feature in defining the difference between these emotional disorders, with specific onset in childhood, and neurotic disorders – exclude: when they are associated with conduct disorder (Anxiety disorder of separation from childhood – should be diagnosed when the fear of separation is the center of anxiety and when such anxiety first appears in the early years of childhood; it differentiates itself from normal separation anxiety when it has a certain degree (severity) that is statistically unusual (including an abnormal persistence under the usual age period), and when it is associated with significant problems in social functioning – excludes mood disorders (affective), neurotic disorders, childhood phobic anxiety disorder, childhood social anxiety disorder; Phobic anxiety disorder of childhood – fear in childhood that shows a marked specificity of the developmental phase and occurs (to some extent) in most children, but have degrees of normality; other states of fear that occur in childhood but are not a normal part of psychosocial development (for example, agoraphobia) should be considered as another diagnosis – exclude generalized anxiety disorder; Childhood social anxiety disorder – in this disorder there is a caution towards strangers and fear or social anxiety when encountering new, strange or socially threatening situations; this category should be used only where such fears occur during the early years and are both unusual in gradation and accompanied by problems of social functioning – avoidance disorder in childhood or adolescence; Sibling rivalry disorder – most young children have some degrees of emotional turmoil that usually follows the birth of their next brother; a sibling rivalry disorder should only be diagnosed if the degree or persistence of the disorder is both statistically unusual and associated with abnormalities of social interaction – jealousy between siblings; Other emotional disorders of childhood: identity disorders, hyperanxious disorder – excludes sex identity disorder in childhood; Unspecified emotional disorder of childhood);

5. Social functioning disorders with specific onset in childhood and adolescence – a group of somewhat heterogeneous disorders that have in common abnormalities of social functioning starting from the development period, but which (contrary to deep developmental disorders) are not characterized mainly by an apparent social-constitutional incapacity or by a deficit that includes all areas of functioning; in many cases, a crucial role in etiology is probably played by distortions or serious deprivations in the environment (Elective Mutism – characterized by a marked selectivity in speech, emotionally determined, so that the child demonstrates a capacity of language in some situations, but fails to speak in other (defined) situations); the disorder is usually associated with marked personality traits involving anxiety, isolation, sensitivity or social resistance – elective mutism – excludes deep personality disorders, schizophrenia, specific developmental disorders regarding speech and language, transient mutism as part of separation anxiety in young children; Reactive disorder towards the entourage in childhood – begins in the first five years of life and is characterized by persistent abnormalities in the pattern of social relations of the child that are associated with emotional disturbance and are reactive to changes in environmental circumstances (e.g. fear and hypervigilance, poor social interaction with groups of children of the same age, aggression towards oneself and others, sadness and, in some cases, insufficient growth); the syndrome probably occurs as a direct result of parental neglect, abuse or serious disregard – an additional diagnosis can be used to identify any failure in development or growth retardation – excludes Asperger's syndrome, the disorder regarding the disinhibition towards the entourage in childhood, the syndromes regarding the mistreatment, normal variations in the selective attachment model, the sexual or physical abuse in childhood resulting in psychosocial problems; Disorders regarding the disinhibition towards the entourage in childhood – a special pattern of abnormal social functioning that occurs during the first five years of life and which tends to persist despite marked changes in the circumstances of the environment, e.g. diffuse behavior, with non-selective focus towards the entourage, behavior that seeks the attention of those around and friendly without discrimination, weak interactions with groups of children of the same age; depending on the circumstances, behavioral or emotional disorder can also be associated – psychopathy due to lack of disease, institutional syndrome – excludes reactive disorder towards the entourage in childhood, Asperger's syndrome, hospitalization in children, hyperkinetic disorders; Other disorders of social function in childhood; Disorder of social function in unspecified childhood);

6. Disorders of tics – syndromes in which the predominant manifestation is in the form of tic; a tic is a non-irritating, recurrent, rapid, involuntary motor movement (usually involving determined muscle groups) or a vocal generation that has a sudden onset and does not have an obvious purpose; tics tend to be felt as irresistible, but usually they can be suppressed over varying periods of time, are exacerbated by stress and disappear during sleep; common simple motor hems include only blinking in the eyes, sudden neck movements, shrugs and facial grimaces; common simple vocal tics include throat drenching, barking, sniffing and hissing; common complex tics include self-driving, jumping and jumping; common complex vocal tics include the repetition of certain words and sometimes the use of certain (often obscene) socially unacceptable words (coprolaly), and the repetition of one's own sounds or words (palillalia) (Transient tic disorder – meets the general criteria for a tic disorder but the tics do not persist for more than 12 months; tics usually take the form of blinking in the eyes, facial grimaces or sudden movements of the head; Chronic motor or vocal tic disorder – meets the general criteria for a tic disorder, in which there are motor or vocal tics (but not both), which can be both single and multiple (but usually multiple), and which last more than a year; Disorder of multiple motor tics combined with vocal tics (Gilles de la Tourette) – a form of tics disorder in which there are, or have been, multiple motor tics and one or more vocal tics, although there is no need for them to occur simultaneously; the disorder usually worsens during adolescence and tends to persist during adult life; Vocal tics are often multiple with explosive repetitive vocalizations, rinsing the throat and grunting, and obscene words or phrases can be used; sometimes there is associated echopraxia of gestures that can also be of an obscene nature (copropraxia); Other disorders of tics; Unspecified tics disorder);

7. Other emotional and behavioral disorders with onset usually occurring in childhood and adolescence – a heterogeneous group of disorders that have in common a characteristic, namely the onset in childhood, otherwise differ in many respects; some of these conditions represent well-defined syndromes, but others are no more than complex of symptoms that require inclusion because of their frequency and association with psychosocial problems, and because they can not be incorporated into other syndromes – exclude sleep disorders due to emotional causes, spasms of crying roar, childhood sex identity disorder, Kleine-Levin syndrome, obsessive-compulsive disorder (Neorgan enuresis – a disorder characterized by involuntary, diurnal and nocturnal urination, which is abnormal in connection with the mental age of the individual, and which is not the consequence of the loss of control over the bladder due to some neurological disorder, epilepsy attacks or structural abnormality of the urinary tract; enuresis may have been present from birth or may have occurred as a result of a period of acquired control over the bladder; it may or may not be that enuresis may or may not have been associated with a bladder more widespread behavioral or emotional disorder – enuresis (primary) (secondary) of functional enuresis of non-ororgan origin, psychogenic enuresis, urinary incontinence of non-ororgan origin – excludes enuresis NOS; Non-ororgan encopression – repeated emission of feces, voluntary or involuntary, usually of normal or almost normal consistency, in places unsuitable for this purpose from the individual's own socio-cultural environment; the condition may represent an abnormal continuity of normal infantile incontinence, may involve a loss of continence as a result of acquired control over the intestines, or may involve the deliberate emission of feces in inappropriate places despite normal physiological control over the intestines; the disease may appear as a monosymptomatic disorder or may be part of a greater disorder, especially emotional or conduct – functional encopression, fecal incontinence of non-ororgan origin, psychogenic encopression – excludes NOS encopression; Infant and child eating disorder – an eating disorder with various manifestations that are usually specific to the infant and the first childhood; it generally involves the refusal of food and excessive whims in the presence of adequate feed, of the competent carers and in the absence of organic disease; rumination (repeated regurgitation without nausea or gastrointestinal disease) – rumination disorder of the infant – excludes anorexia nervosa and other disorders of the way of eating, nutrition: difficulty and poor administration, problems of the newborn, drops of the infant or child may or may not be associated; Drops of infant and child – persistent consumption of nonnutrient substances (such as earth, plaster, etc.); it can occur as one of many other symptoms that are part of a more widespread psychiatric disorder (such as autism), or as a relatively isolated psychopathological behavior; only the latter is classified here; the phenomenon is most common in retarded children and, if mental retardation is also present, the main diagnosis must be reconsidered; Disorders of stereotypical movements – voluntary, repetitive, stereotypical, non-functional (and often rhythmic) movements that are not part of any recognized neurological or psychiatric disorder; ; when such movements occur as symptoms of another disorder, only the disorder in its entirety must be recorded; movements that are not a variety of self-mutilations include: swaying the body, swaying the head, plucking the hair from the head, twisting the hair, snapping the fingers and shaking hands; self-mutilating stereotypical behaviour includes hitting the repetitive head, slapping, inserting the finger into the eyes and biting the hands, lips or other parts of the body; all disorders of stereotypical movements occur most frequently in association with mental retardation (when this is the case, both of which need to be recorded); if the introduction of the finger into the eye occurs in a child with visual impairment, both should be recorded in this category, and the visual condition in the appropriate somatic disorder – skill disorder / stereotyping – excludes abnormal involuntary movements, disorders of movements of organic origin, gnawing nails, nose scooping, stereotypes that are part of a wider psychiatric disorder, finger sucking, tic disorders, trichotillomania; Stuttering (babbling) – speech that is characterized by frequent or prolonged repetition of sounds, syllables, words or by frequent hesitations or pauses that interrupt the rhythmic fluency of speech; it should be classified as a disorder only if its severity is such as to blatantly disturb the fluency of speech – excludes babbling, tic disorders – a rapid rate of speech with interruptions in fluency, but without repetition or hesitation, of a severity that gives rise to a diminished intelligibility of speech; speech is irregular and unrithmated, with rapid jerky outbursts that usually involve patterns of erroneous expression – excludes stuttering, tic disorders; Other specified disorders of behavioral and emotional disorders with onset usually in childhood and adolescence – attention deficiency disorder without hyperactivity, excessive masturbation, scooping in the nose, sucking the thumb; Unspecified behavioral and emotional disorders with onset usually in childhood and adolescence);

K. Unspecified mental disorder:

1. Otherwise unspecified mental disorder – NOS mental illness – excludes NOS organic mental disorder.

Dorin, Merticaru