Manico depressive psychosis of the ICD 10. Current episode of mania with psychotic symptoms

Disorder characterized by repeated episodes of depression corresponding to the description of the depressive episode (F32.-), without the presence of independent episodes of lifting mood and tide of energy (mania). However, there may be brief episodes of light lifting of mood and hyperactivity (hypologia) immediately after a depressive episode, sometimes caused by treatment with antidepressants. The most severe forms of recurrent depressive disorder (F33.2 and F33.3) have a lot in common with the previous concepts, such as manico-depressive depression, melancholy, vital depression and endogenous depression. The first episode may occur at any age, starting from childhood to old age. Its beginning can be sharp or inconspicuous, but duration - from a few weeks to many months. It never completely disappears the danger that a patient with a recurrent depressive disorder will not arise a manic episode. If this happens, the diagnosis should be changed to a bipolar affective disorder (F31.-).

Included:

• repeated episodes:
  • depressive reaction
  • psychogenic depression
  • reactive depression
• seasonal depressive disorder

Excluded: recurrent brief depressive episodes (F38.1)

Disorder characterized by repeated episodes of depression. The current episode is easily expressed (as described in the F32.0 subhead) and without mania in history.

Disorder characterized by repeated episodes of depression. The current episode is moderately expressed (as described in the subheading F32.1) and without mania in history.

Disorder characterized by repeated episodes of depression. The current episode is significantly pronounced, without psychotic symptoms (as described in the subwoofer F32.2) and without mania in an anamnesis.

Endogenous depression without psychotic symptoms

Significant depression, recurrence without psychotic symptoms

Manico-depressive psychosis, depressive type without psychotic symptoms

Vital depression, recurrence without psychotic symptoms

Disorder characterized by repeated episodes of depression. The current episode is significantly pronounced, accompanied by psychotic symptoms, as described in the subheading F32.3, but without indicating the previous episodes of Mania.

Endogenous depression with psychotic symptoms

Manico-depressive psychosis, depressive type with psychotic symptoms

Repeated heavy episodes:

• significant depression with psychotic symptoms
• psychogenic depressive psychosis
• psychotic depression
• reactive depressive psychosis

In the past, in the past, two or more depressive episodes were noted in the past (as described in the subheadings F33.0-F33.3), but for several months there is no depressive symptomatics.

Bipolar Affective Personal Disorder

This is ambiguous, to the end not studied and not well-defined mental illness, as a bipolar disorder, was known to psychiatras in the middle of the XIX century. As soon as he was not called in due time, and an insidiance in two forms, and circular psychosis. There was a period when the manic phases, as well as schizophrenia, even considered the manifestation of genius. At the end of the XIX century, the famous German psychiatrist Emil Farthenin introduced a familiar name to all the name - manico-depressive psychosis (TIR), and only a century, it was changed to the formulation more correct and faithful to the diagnosis - bipolar affective disorder (bar). This is the name is present in the ICD-10. What is a bar, how to live with him and how to avoid disability?

In the ICD-10, bipolar affective disorder is included in the F30-F39 block of mood disorder [Affective disorders] and has code:

F31 bipolar affective disorder

• F31.0 bipolar affective disorder, the current episode of hypomania
• F31.1 bipolar affective disorder, the current episode of mania without psychotic symptoms
• F31.2 Bipolar affective disorder, the current episode of mania with psychotic symptoms
• F31.3 bipolar affective disorder, the current episode of light or moderate depression
• F31.4 Bipolar affective disorder, the current episode of severe depression without psychotic symptoms
• F31.5 Bipolar affective disorder, the current episode of severe depression with psychotic symptoms
• F31.6 Bipolar Affective Disorder, Current Mixed Episode
• F31.7 Bipolar affective disorder, current remission
• F31.8 Other biopolar affective disorders
• F31.9 Bipolar affective disorder Uncomputed

Brief characteristic of bipolar affective syndrome



How is it clear and accessible to outline TIR in general terms? Bipolar disorder can be represented as a wave-like current mood disorder with compression of depression and mania (or hypologia). However, the criteria for diagnostics are so wide that the variants of the flow and forms of affective syndrome there are many, from episodic hypologies to paroxy manic-delusional schizophrenia. The difference between different cases of disorder is the frequency of episodes and the nature of the exacerbations. The duration of a phase is also very diverse (from week to two years), but on average, the manic attack lasts four months, and depressive - half a year. The change in symptoms of mania on the state of depression occurs suddenly. In some cases, episodes are followed by each other in a row, in others - through intermissions, they are also called "bright" periods of mental health, since in these intervals of the personality practically completely restored. Duration of intermissions can be from three to seven years. There are sometimes a variety of mixed states. It is noteworthy that ¾ of all patients with TIR have further psyche disorders of another nature.

How common is the disease?



Objectively evaluate the prevalence of such ambiguous from the position of psychiatrists, as bipolar depression is rather difficult. The evaluation criteria are very diverse, which means that the diagnostic process is not deepened. The data of foreign statisticians indicate that the signs of bipolar disorder are found in 5-8 people per thousand population, and domestic studies show that it falls from only 2,000 people. The probability of sick is the same for all adults, it does not depend on gender, cultural, ethnicity and is 4%. It is difficult to accurately assess how often there is a bipolar disorder in children, because it is impossible to fully apply to small patients intended for adults diagnostic criteria. Regarding the age of the launch of the disease, it is known that approximately half of the cases occur for the period of 25-44 years. Moreover, bipolar types of flows mainly take place at a young age (up to 25 years), and unipolar more often meet after 30. For people of mature age, an increase in the number of depressive type phases is characteristic of aging.

Etiology and pathogenetic mechanisms

To this day, research is underway to establish the exact causes of the emergence and mechanisms of TIR development. The greatest interest is how bipolar disorder is transmitted by inheritance, and how the biochemical brain biochemical processes affect the development of the syndrome. Despite the fact that all the causes of this mood disorder are not fully known, many scientific information show that the greatest weight in etiology is the hereditary factors, and the environment affects only 20-30%. The biological foundations of bipolar affective syndrome are due to certain pathological processes of the body. The development of the bar influences the following reasons:

• features of the Constitution;
• genetic violations that are inherited;
• pathology of human biological watches (changes in biological processes depending on the time of day);
• changes in the water and electrolyte metabolic process;
• shifts in the endocrine system;
• violation of the work of neurotiator systems.



The fact that the bar is inherited, does not yet guarantee the development of the disease by 100%. As in schizophrenia, genetic predisposition can only work under the influence of certain media factors, especially in-family. The educational process and the atmosphere of the family are able to influence the chances of getting sick for more than 20%. Factors such as gender and age have no longer affect the likelihood of the syndrome in adults, but on the nature of its flow, the types of psychosis and key symptoms.

Additional risk factors

Confirmation of the influence of endocrine processes on the development of the bar is the fact that manic-depressive psychosis in women is often sharpened after pregnancy and in the menopacteric period, as well as during menstruation. The risk of developing the bar also in women who have undergone postnatal depression or other mental disorders immediately after pregnancy and childbirth. At the beginning of the manifestation of syndrome, various psychogenic and somatogenic causes are often affected. These include various mental disorders, physiological diseases and injuries, alcohol abuse, a loss of a loved one, strong stress and various psychologically traumatic situations. It is noteworthy that the larger the manic component is expressed, the less the disease is subject to the influence of exogenous factors. While the bipolar depression, which flows with weakly pronounced attacks, either without without them, strongly depends on external factors, which is observed throughout the disease.

Higher risk of getting the bar associate with some features of the person. As a rule, it is melancholic, responsible oriented, stability and orderliness of people. There is even such a concept as manic-depressive pedanthism, which emphasizes the leading role in the formation of affective episodes of the personality features. Enhance the risk of developing the bar and such traits such as emotional instability, conservatism, monotony, lack of flexibility. Provice the recurrence of the syndrome can such factors as a sharp change of the usual lifestyle, especially sleep, pregnancy, alcohol, sharp stress. There is evidence that high level Intellect enhances the risk of TIR development several times, this means that the genius of a person can cause its madness.

Classification



According to clinical manifestations, the bar is made to distinguish between leading symptoms. Manic depression may flow with episodes or with the dominance of manic or depressive phases. In addition, unipolar TIRs are distinguished with episodes of only one type. Despite the diversity of the diagnoses present in the ICD-10, several variants of the bar can be distinguished:

• Circular psychosis. The attacks of mania and depression alternately alternately with each other without episodes of the intermission.
• Double type disorder. Two opposite phases proceed in a row, and after that an intermission comes.
• The flow of incorrectly intermittent type. Depressive and manic episodes alternate through the intermissions without a clear sequence, for example, after the attack of Mania, a manic syndrome can occur again.
• Bipolar disorder correctly alternating type. Phase mania and depression alternately change each other through the intermissions.
• Unipolar type. These mood disorders include periodic manic attacks, as well as regular depressive episodes (although in the ICD-10 this type of syndromically ranked recurrent depression).

Maniacal phase

How does the manic psychosis flow? Classical symptoms, testifying to the beginning of Mania, is a raised mood, mental and motor arousal. Man during maniacal phase It begins to show an abnormal activity for him. The development of the attack can be divided into certain stages. Hypolomaniac psychosis - everything begins with him. The mood gradually rises, a sense of vigor appears, a person begins to speak more and faster, often distracted. Sleep becomes a little shorter, and your appetite is better. Next follows the stage of pronounced mania, however, with some embodiments of the flow of disorder, hypomanical psychosis is not exacerbated further. The difference between the pronounced manic phase is that the main symptoms are sharper and bright. The speech of the patient becomes excited, he constantly laughs, speaks of the genius of his ideas, loses the sequence of thinking and sleeps only four hours. Next, maniacal psychosis reaches the degree of fury. At this stage, the main symptoms are extremely acute, the motor activity is distinguished by rawness, and it becomes like a muttering. Externally, this can remind the manifestations of schizophrenia. Next follows the phase of reducing motor excitation with still raised mood. On the latter, the reactive stage is normalization of symptoms, after which the bipolar disorder passes either to the depressive phase or to intermissivity.



Depressive psychosis, symptoms and development

What is the difference in the development of depressive phases? Bipolar affective disorder is more often manifested by states of this type. Symptoms observed in a patient in an episode of a depressive nature are on another pole compared to manic. Mood is reduced, motor activity and thinking inhibitable. All people who are experiencing a depressive phase feel a slightly annoying improvement in the state. In the process of aging the patient, an alarming component of depression becomes more and more significant. This phase may flow as simple depressionAnd maybe there is a hypochondriac, mounted or, as in schizophrenia, a delusional bias. The flow of the depressive phase is also divided in the stage. At the initial stage, a person is experiencing small difficulties with sleep, it becomes less workable and more dull. At the next stage, the symptoms of depression increase, a feeling of anxiety appears, the activity, the tempo of speech and thinking, disappears, disappears. Next follows the phase of a pronounced depressive state. The key features reach a maximum, a painful longing appears, the patient is very losing weight in weight, becomes prone to suicidal attempts, as it does not see the meaning to live on. A person can lie for a long time without movement and reflect on his worthlessness. On the last reactive stage, the patient's condition is gradually normalized, the symptoms are not going to no, after which the manic depression goes into another phase.

Ultipical flow options

TIR episodes are quite often, especially in young patients, there are mixed type, when one of the key phase symptoms is opposite. For example, with an agitated or alarming depression, motor activity is not inhibited, but increased. The states of a mixed nature refers unproductive mania, in which there is a slowdown in thinking, as well as mania with motor insertion and dysphoric mood. There is also a variant of an affective attack of a mixed type, when the symptoms of depression and mania are replaced by each other very quickly - literally in a couple of hours. Such states are difficult to diagnose and treat, such patients are often immune to pharmacotherapy, which can lead to disabilities. Difficulties in diagnosis may cause circular psychosis, referred to as a different rapid cycle. Such a manic depression can flow with four and more affective episodes per year. There are also situations where circular psychosis proceeds with a very fast change of phases - more than four per month. The forecast for people with disorder of this type is usually unfavorable, and the disability is almost inevitable.

Diagnostic methods



Bipolar disorder is important to recognize as early as possible, because the treatment started immediately after the manifest manic attack, much more efficiently, rather than therapy after a series of affective phases. To form a diagnosis, the psychotherapist should take into account a large number of factors. And given the fact that in the ICD-10, manic-depressive psychosis has many forms, it is often an erroneous diagnosis to patients. American studies suggest that about a third of people contacting help can get a correct diagnosis only after a decade from the debut of the mood disorder. In order to avoid mistakes at the diagnostic stage, it is necessary to take into account that bipolar affective disorder is often adjacent to other mental illness.

The exact diagnosis is important for the right choice of treatment tactics as a whole, especially for adequate purpose of drugs (lithium, conlude, antidepressants or other tablets). Differential diagnosis should also be used to eliminate various types of depression, personal disorders, certain forms of schizophrenia, neurosis, the influence of psychoactive substances (alcohol, narcotic drugs), the pathology of the thyroid gland, as well as impaired affect caused by the causes of a neurological or somatic nature. The most difficult to differentiate manic-depressive psychosis from schizophrenia and recurrent depressive syndrome. Erroneously diagnosed schizophrenia instead of a bar can cause irreparable consequences from unreasonably prescribed neuroleptics or other drugs, up to the disability of the patient.

Treatment of bipolar disorder



The consequences of the TIR for the personality and psyche of a person is difficult to predict, so timely and correctly selected treatment reduces the risk for the patient to get disability. Bipolar disorder belongs to diseases, which are quite difficult to treat. It is especially difficult to choose the right medication (whether lithium, convoilelex, antidepressants or other tablets). It is important to correctly determine the dose to and remove psychotic symptoms, and prevent a sharp transition to the opposite phase due to overdose. Too low dose of medication, for example, can cause a resistant state, and too active antidepressants can lead to inversion into the manic phase, which worsens the condition of the patient and the forecast as a whole. The most popular in the treatment of the bar drugs to stabilize the mood - normatimics (drugs of lithium, atypical neuroleptics, conservalex and other anti-epileptic drugs).

It has been proven that lithium preparations reduce the likelihood of suicide, since lithium suppresses the level of impulsiveness and aggressiveness in the patient. Lithium, conludelex and other antiepileptic tablets are also very effective as preventive drugs, reduce the risk of recurrence of both phases. Convooveks, produced in tablets, drops or capsules, on a row with other hollows proved its effectiveness precisely in the treatment of manic states. In depressive periods, such pills are not particularly helped even in a complex with antidepressants. For a short time, the doctor may prescribe antipsychotic drugs to neutralize the maniacal signs. However, with the long-term period of taking drugs of lithium and hollows will be preferable to antipsychotics. A bipolar affective disorder in its depressive phase is treated with the help of antidepressants, which must be combined with lithium, conjoulex or other norms. Antidepressants are selected depending on the direction of the depressive phase. It is important to understand that if antidepressants are appointed incorrectly, without taking into account their sedative or stimulating orientation, it may aggravate the psychomotor inhibition of the patient or enhance anxiety and anxiety.



The main goal when choosing pharmacotherapy tactics for each psychiatrist or psychotherapist is to maximize the remission. The effectiveness of treatment and the likelihood of recurrences depends on how many affective phases have already transferred the patient than they are more, the more favorable forecast, and the disability is more likely. In the prescription, the patient of various tablets, the doctor must be careful and not to overdo it. It is not recommended to simultaneously use more than three drugs related to different categories, as well as the purpose of several types of tablets of one pharmacological group (for example, at the same time conlude and another anti-epileptic drug). With this position, the optimal pharmacotherapy scheme looks like this: antidepressant plus an antipsychotics plus lithium or conludelex.

In many cases, bipolar personality disorder causes irreparable consequences of the patient. A person with such a diagnosis is sometimes difficult to adapt to the working and consumer regime, as well as to other requirements of everyday life. Therefore, manic-depressive syndrome requires the use of psychotherapeutic techniques at all stages of treatment. Treatment of bipolar disorder with the help of psychotherapy allows a person to manage the symptoms of the disease, adhere to the mode of reception of drugs, achieve an acceptable level of functioning in society. After working with a psychologist or psychotherapist, the patient becomes more resistant to stressful factors, easily copes with them, which is an excellent prevention of exacerbations of the disease. Well, if a person's family experiencing manic-depressive syndrome will actively participate in family psychotherapy. This will allow all relatives to relate to the disease and help the patient to cope with his condition.

Such a disease, like a bipolar psyche disorder, cannot be cured quickly. Even after the signs of affective disorders become invisible, patients require long-term supporting therapy with use in order to prevent conlude in tablets, lithium or other normotimics. Of course, life on tablets brings little joy, but at the bar it is not avoided. Many people do not think what to live with such a person? This means that at any moment you may need your help and support. You will have to constantly monitor the preservation of the balance between the help of the patient and the observance of the personal space.

What should be known if someone from relatives is diagnosed with manic-depressive syndrome? People who have bipolar depression are extremely sensitive to changing habits, especially related to sleep and wakefulness. This means that it is necessary to do everything possible to maintain a clear observance of the usual mode of sleep and life in general.

Do not overload yourself, remember that people from the bar thinly feel loved ones, so your irritation is definitely not beneficial to the patient. Do not treat such a person as a helpless. Even if it has a disability or is experiencing a sharp period, let him solve simple stencil tasks yourself. Watch over the course of the syndrome in order to react when a sharp attack begins. Control compliance with the mode of reception of drugs (antidepressants, lithium, conlude preparations, and other tablets), this help will simply need. Considering the fact that manic-depressive psychosis is inherited, it would be not bad at the stage of pregnancy planning to consult with geneticists to determine the risk of development of the bar. Of course, it is not easy to live with affective syndrome, but you should not despair, Isaac Newton, at one time, suffered at the same time from bipolar disorder, and from schizophrenia, however, it is unlikely that anyone can doubt the genius of this famous personality.

Bipolar Affective Disorder, Current Mixed Episode

Definition and general information [edit]

It is often believed that TIR is such a condition in which periods of extraordinary lifting, stormy joy and happiness alternate with the recession periods, oppression, depression. In fact, such a proper alternation of attacks, or phases, is not so often: depressive attacks arise more than 6 times more often manic. The manic and depressive states have been known for several centuries ago, but the TIR was first described only in the middle of the XIX century in the works of Fetret ("Circular Psychosis") and Bayarge ("Dual psychosis"). Later, theft allocated TIR in an independent nosological unit, retraining it from schizophrenia based on the frequency of the flow and predominance in the clinical picture of emotional disorders, in contrast to thinking disorders during schizophrenia. Almost 60 years later, in 1957, Leongard piped the TIR on bipolar (with maniacal and depressive attacks) and monopolar (only depressed or only with manic attacks) Types [Note Translation Editor: Here we call TIR only bipolar type.]

Etiology and pathogenesis [edit]

Clinical manifestations [edit]

Bipolar affective disorder, current mixed episode: diagnostics [edit]

A. Types of manic-depressive disorders.

1. TIR with manic attacks is an option of TIR, in which the patient had at least one manical attack. At the same time, the disease in the form of exclusively manic attacks (without depressive, hypomanic or mixed manic-depressive) is extremely rare; All cases of this course faced by the author, it would be possible to take more to the parrey.

2. TIR with hypomaniacal attacks is an option of TIR, in which there is at least one depressive and one hypomaniacal attack, but not a single manic or mixed manico-depressive. Mania, depression or hypologia can be provoked by an organic disease (for example, sclerosis or thyrotoxicosis), drug addiction (for example, amphetamine use or cocaine), treatment with antidepressants (for example, inhibitors of Mao), sympathomimetics (including rhinch inhibitors), corticosteroids or by the use of electrosculus Therapy. In these cases, it is sometimes diagnosed with "bipolar disorder without additional clarifications." In some such patients (for example, in the treatment of prednisone or use of cocaine), manic attacks can be alternating with paranoid.

Diagnostic criteria for depressive attack (see Table 22.1) with monopolar depression and TIR are the same. At the same time, many indicate that depressive attacks in these two diseases are somewhat different: in particular, when TIR, the attacks begin in a smaller age, less long and more often accompanied by hypersmith (and not shortening sleep and early awakening, as with monopolar depression). Differences concern and the effectiveness of different methods of treatment; In particular, lithium is more effective when TIR. Depressive attacks with TIR often arise in autumn and winter. Severe postpartum depression is usually an attack of TIR.

The diagnostic criteria of the manic attack are given in Table. 23.1. The severity of symptoms varies significantly both in one patient and in different patients. The attack can begin sharply (in a few hours or days) or undercoins (in a few weeks). More often seizures occur in spring. Their durability is also different, but according to modern criteria should not be less than a week. Before the emergence of effective methods of treatment, they could last 4-13 months, and often four such attacks were noted for ten years. Sometimes they are provoked by external factors (for example, the death of a loved one), but they can develop without visible reasons.

Up to 50% of manic attacks are accompanied by psychotic symptoms. According to some data, the probability of its development is the higher, the earlier the TIR begins. Combat and violations of behavior can be like a hull, that is, the appropriate affect (for example, "I - Messiah"), and the Negotmists (for example, "God ordered it to strike it"). The compliance of the character of nonsense affect is difficult to determine, as the ideas that the actions are managed by God, they can be like delirium mastering and excessive self-selfhood and sense of chosenness. When the same thoughts express patients with schizophrenia or a psychotic form of depression, this is usually not related to his religious feelings.

With manic state, patients are prone to jokes. Often their humor is infectious, but it is caustic and evil. Patients are usually annoying, assertors and differ in the instability of the mood, some are aggressive. Aggression, as a rule, is observed in the special severity of symptoms in the untreated patients or as a result of the incorrect assessment of the situation (the false perception of intentions of those surrounding in a noisy, crowded or other restless setting).

The diagnostic criteria of the hypomanical attack are given in Table. 23.2. Lifting mood or irritability in this state is not so pronounced as with mania; Perhaps that is why the behavior of the patient is less constant and predictable. Some believe that in a state of hypologia, suicide attempts are committed more often than in a state of mania. Treatment is often unsuccessful. Most patients like a hypomaniacal state - in particular, a sense of freedom, creative rise, increased productivity, and their behavior is rarely so unbearable or dangerous that the treatment of treatment is raised by others.

Mixed manic-depressive attacks include states corresponding to criteria for both mania and depression and more than 7 days. Many believe that these states are similar to the so-called angry mania. According to a single review, an amphibious mania is found in almost a third of patients with TIR. It also indicates that the appearance of mixed seizures is possible at any stage of the disease and that the forecast (both short-term and long-term) is worse at these attacks.

The form with frequent attacks ("with rapid cycles") is isolated in DSM-IV as a special version of the flow of both TIR types (with manic and hypomaniac attacks), in which the attacks occur more than three times a year. This option is observed about 20% of patients with TIR, however, this figure varies, which is partly due to differences in the criteria of the duration of attacks, and in part with the attribution to this group of patients with cyclotimia. Apparently, TIR with frequent attacks is an inhomogeneous subgroup: In some cases, frequent attacks are celebrated from the very beginning, in others - after many years of illness without treatment. Perhaps in some cases, this flow contributes to the reception of antidepressants.

Inheritance, prevalence and current. MDP accounts for 20% of all affective disorders. In most cases, the first attack is developing aged 15-24; The average age of the onset of the disease is 21 years (under monopolar depression - 27 years). The ratio of floors is approximately the same (although some studies show a slightly large prevalence of TIR in women). On the contrary, the monopolar depression of women suffer 2-3 times more often. If TIR is developing after 60 years, then it is usually secondary (for example, due to the defeat of the right temporal share). The probability of disease during life is 1.2% (for monopolar depression - 4.4%). According to international studies, this indicator ranges from 0.6 to 3.3%. Some data indicate a somewhat large prevalence of TIR with manic attacks compared with TIR with hypomaniacal attacks (0.8% and 0.5%, respectively). The frequency of maniacal and hypomanical seizures is 3% per year.

Twin Studies confirm the presence genetic predisposition to TIR. At the sameous twins, the concordancy is 65-80%, and in binary - approximately 20%. Genealogical studies also confirm the hereditary nature of the TIR: among the relatives of patients with TIR of the first degree of kinship, this disease occurs more often than those who have no TIR in a family history (although their monopolar depression is more often found). The study of adoptive children did not give convincing results.

As mentioned above, severe postpartum depression and postpartum psychoses turn out to be attacks of TIR. The prevalence of such attacks is approximately 1 per 1000 lies. In 3-4% of cases at the time of attack, decaying is made. With postpartum attacks of the TIR, the usual treatment is effective: lithium, anticonvulsant and benzodiazepine preparations with normotimic effect, neuroleptics and electrical sound therapy.

Between the first and second attack of TIR, they are often remission to 3-5 years, then they are becoming very shorter. Currently, most patients with MDP with manic attacks are either abused by drugs, or they are incorrectly used.

Differential diagnosis [edit]

Bipolar affective disorder, the current episode of mixed nature: treatment [edit]

Most patients with TIR are treated outpatient. For successful treatment It often happens to attract close relatives or reliable friends. Since most patients like raised mood periods, they are not inclined to seek help when manic symptoms appear. In this regard, family members and loved ones should be aware of how MDP leaks and what the principles of its treatment are. It is important that they know about the likely deviations in the behavior of the patient and had an action plan for neutralizing adverse effects. For example, if you can expect excessive cash spending from the patient, it is advisable to limit the amount of funds available to it. There must be an action plan for compulsory hospitalization in case of initiation, aggression or suicidal behavior. When mania, criticism to its state and awareness of its consequences for others are almost completely absent, and therefore information about the dangerous changes in the patient's behavior should be obtained from relatives and friends. In addition, they can often ensure the implementation of medical prescriptions. Family and individual psychotherapy is particularly useful when attacks are provoked by external factors or accompanied by behavior, unbearable for family members.

At the height of the manic attack, hospitalization is often required. It may be extremely useful to reduce external stimuli, especially drugs have not yet begun. For this, the patient is placed in a quiet chamber or even in an insulator (see ch. 7). To prevent self-injunations and violence, sometimes you have to resort to fixation (see ch. 8).

The main means for TIR - lithium. With depressive attacks, antidepressants are also used. Imipramine more often than other antidepressants, causes a depressive attack into a manic. Mao inhibitors cause this complication somewhat less often, and many believe that when with depressive attacks of TIR, they are especially useful. Inhibitors reverse grip Serotonin and ampbutamon, apparently cause a manic attack even less often.

If, with a manic attack of lithium, it is not effective or a state does not allow to wait until it works, it is advisable to add neuroleptics (for example, hanoperidol, mesonidazine, pimozide) or benzodiazepines (for example, clonazepams, oilzepam). In resistance to lithium, anticonvulsant and benzodiazepine preparations with a normal measurement (for example, carbamazepine or valproic acid) are used; With formats with frequent attacks and mixed manic-depressive attacks, these means (or closapine) may be preferable to lithium.

1. Lithium. It is curious that in 1949, when Cade described the action of lithium carbonate during Mania, in the journal of the American Medical Association (J.A.M.A.) several reports were published on serious, sometimes fatal poisoning with a chloride lithium, used as a substitute salt. However, the value of Cade was evaluated by the Danish scientist Shu. Together with his employees, he began to actively study the action of lithium carbonate under TIR. As a result, in 1970, Lithium carbonate was officially applied to the USA for the treatment of manic attacks, and in 1974 - and for warning them. With regard to depressive attacks, FDA recommendations are missing.

The mechanisms of action of lithium at TIR are extremely diverse and to the end are unknown. These include: 1) moderate, but permanent serotonergic effect, including sensitization of postsynaptic serotonin receptor receptors in the hippocampus (Ca 3 field); 2) an increase in the synthesis and release of acetylcholine in the crust of large hemispheres; 3) suppressing the emission of norepinephrine from the presynaptic endings; 4) oppression of circadian rhythms; 5) Action on systems of second intermediaries, including the slowdown of phosphoinozitol exchange and inhibiting adenylate cyclase, stimulated by mediators.

but. Preparations, pharmacokinetics and doses. Lithium carbonate is quickly absorbed into the gastrointestinal tract, the maximum serum lithium concentration is achieved in 1-6 hours after reception. Citrate of lithium is absorbed even faster: complete suction occurs in 8 h. Lithium concentrates in saliva, thyroid gland And bones, in bone tissue, he can linger for years. The content of lithium in red blood cells is rarely determined, although this indicator correlates more with the action of lithium than the serum concentration. 3-5% lithium is released from then that sometimes causes skin irritation and can be particularly unpleasant with psoriasis.

Based on litria pharmacokinetics, it is usually prescribed 2 times a day. However, there is evidence that the reception 1 time per night reduces the likelihood of nephrotoxic effects. It is important to consider when appointing high doses (in addition, reception 1 time is more convenient for the patient). Some doctors prefer prolonged drugs. At the same time, in our experience, less frequency of gastrointestinal disorders and tremor, as the maximum serum concentration of lithium is below; At the same time, the time of exposure to the drug on the kidneys is extended. Therefore, we prefer to prescribe prolonged drugs only if you need high doses - from 450 to 900 mg / day inside.

In tab. 23.3 shows trade names, doses and dosage forms of carbonate and citrate lithium, allowed for use in the United States. The serum concentration of lithium varies significantly depending on the drug used, which, apparently, is determined by the particle size and the type of filler.

Monitoring. Before stabilizing the state of the frequency with which the serum concentration of lithium is determined, depends on the severity of the positive effect on the one hand, and side reactions on the other. By achieving stabilization, the intervals between the analyzes can be increased to 3 months. The therapeutic concentration of lithium varies significantly from different patients. In most cases, during the attack, it is 0.3-1.2 meq / l. The concentrations corresponding to the lower boundary (0.3-0.5 MEKV / L) can be effective in the elderly and sometimes in patients with a stabilized state. In these cases, it is enough to determine the serum concentration of lithium every 6-12 months. If it is necessary to maintain a concentration above 1.2 MKV / l, the reasons for the exceeding conventional doses should be reflected in the history of the disease.

Before treatment and annually, during it, the function of the thyroid gland and kidneys is checked. For this, the level of TSH, T 4, anti-ramp antibodies, AMK and Creatinine serum are determined. Depending on the values \u200b\u200bobtained and the state of the patient, these tests can be carried out more often. Some consider the annual definition of creatinine clearance to be sufficient.

Cancel. With a properly chosen individual dose, most patients are well tolerated long, sometimes for several decades, lithium reception. Approximately half of the patients with recurrent attacks within 6 months after lithium cancellation occurs another attack. If the cancellation of lithium after many years of use led to a relapse, the resumption of therapy by Lithium does not always give a positive result. Moreover, sensitivity and other drugs can decrease. Therefore, some specialists, including the author, are not recommended to interrupt the treatment with lithium in its good efficiency and tolerability. During pregnancy, treatment relies temporarily, however, there are many cases of birth of healthy children in women who took lithium. Reception of lithium during the I trimester of pregnancy can cause Abstein anomaly, but not as often, as previously thought.

The most common side effects are nausea, diarrhea, polydipsy, polyuria, metal taste in the mouth, headaches and tremor, eliminated by propranolol, 20-80 mg / day inside, or atenolol, 25-50 mg / day inside. Perhaps the deterioration of mental performance. Most side effects disappear when a dose decreases. Since many of them arise against the background of the maximum serum concentration of lithium, its portability is improved when prescribed after eating or night, as well as when using prolonged forms. Lithium citrate less often causes gastrointestinal disorders than carbonate.

Hypothyroidism is observed in 5-30% of patients constantly receiving lithium for 6-18 months, more often in women and in shape with frequent attacks. Lithium can cause or enhance hypothyroidism with chronic lymphocytic thyroid (thyroid hacimoto).

In the toxic concentrations of lithium, it is often a confusion of consciousness, anxiety, drowsiness and vitality of speech; It is possible to develop a copor and coma. Elderly sensitive to overdose are especially sensitive. Treatment of lithium intoxication is considered in ch. 14, p. V.D.3.

Interaction with other drugs. With a stable depression of lithium, they are often combined with inhibitors of serotonin injecting, which sometimes causes a serotonin syndrome (see ch. 22, paragraph viii.b.1.g.7). However, even more dangerous combination of lithium with thiazide diuretics (for example, hydrochlorostiazide). At the same time, lithium removal decreases and its serum concentration increases, which can lead to lithium intoxication. Safety-saving diuretics (for example, amyloride or triamtenen). Data on the combination of lithium with loop diuretics (for example, furosemide) and carbonic henching inhibitors (for example, acetasolamide) contradictory. Sometimes lithium combined with a potassium-saving or thiazide diuretic to reduce polyurium or nephrogenic diabetes caused by the litigation. You can also go to anticonvulsant or benzodiazepine normal norms. The interaction of lithium with other drugs is considered in ch. 16, PP. II.E, V.I, VI.

2. Anticonvulsant and benzodiazepine normation

but. Carbamazepine refers to iminoelbenam. It is structurally close to tricyclic antidepressants, but has a side carbamile chain defining its anticonvulsant effect. Apparently, carbamazepine acts mainly on the structures of the limbic system. Despite the fact that carbamazepine is not yet recommended by the FDA as an antimanical agent and the normatimic agent, it is widely used in TIR, especially for the prevention of attacks during lithium resistance and with frequent attacks. Sometimes it is combined with lithium and other drugs.

The ratio between the serum concentration of carbamazepine and its effect at the TIR is finally not established, but in most cases the therapeutic concentration is 4-12 μg / ml. It is usually achieved at a dose of 100-1000 mg / day. When taking inside, carbamazepine is absorbed slowly, as it is poorly dissolved in water. The most frequent side effects are ataxia, headache, dizziness, rash and sedative action. Quite often carbamazepine causes light neutropenia, but the deaths of agranulocytosis and aplastic anemia are described. The oppression of blood formation is more often observed when combined with other anticonvulsants. It is recommended to regularly determine whey concentration of carbamazepine and conduct general analysis blood.

Carbamazepine causes the induction of cytochrome P450 IID6 (and therefore, apparently, reduces the serum concentration of haloperidol). In turn, the initial stage of its metabolism is obviously hampered by drugs, in the metabolism of which is involved in cytochrome P450 IIIA4 (verapamil, erythromycin, alprazolam). The main active metabolite of carbamazepine is 10.11-epoxy, and toxicity of the drug is largely related to its accumulation. The concentration of this metabolite may increase, for example, with a combination of carbamazepine with a phenobarbital (as a result of induction of enzymes). Valproic acid inhibits epoxydroxylase and therefore also increases the concentration of epoxy metabolite carbamazepine.

b. Valproic acid (2-propylvaleryanic acid) - increases the effect of the GABA, increases potassium permeability and, apparently, reduces depolarization mediated by glutamate NMDA receptors and due to the opening of calcium channels. Cross-resistance to carbamazepine and valproic acid at lightweight convulsive activity in the almond-shaped body was found. There is data on the desensitization of presynaptic receptors GABS under the action of valproic acid. It is still unclear how the antimanical action of valproic acid with those or other cellular mechanisms is associated.

Valproic acid is effective both to relieve manic attacks and for their warning (although it is not approved by the FDA as an antimanical agent). Apparently, it is especially useful in shapes with frequent attacks and with mixed attacks (and amphous mania). In tab. 23.4 Listed trade names of valproic acid preparations. Its serum concentration - 50-125 μg / ml; It slightly correlates with therapeutic effect. The initial dose depending on the severity of the state is 500-1500 mg / day (in several techniques), and the supporting dose is 1000-2000 mg / day.

The most frequent side effects are nausea, anorexia, other gastrointestinal disorders, sedative effect, ataxia and tremor, eliminated by propranolol. Many prefer Depair - the drug in the shell soluble in the intestine, and therefore providing a less pronounced effect on the gastrointestinal tract. Quite often, the reversible asymptomatic increase in the activity of hepatic aminotransferase activity occurs, rare fatal cases of liver damage are described (by type of idiosyncrasy). It is possible to increase the appetite and hair loss. There is data on the feasibility of the combination of valproic acid with a daily reception of polyvitamin preparations containing selenium and zinc.

in. Clonazepam and Lorazepam (see also ch. 12, ch. 14, ch. 21, ch. 25, p. IV.G.2.G.2). Although all benzodiazepines activate the GABA type A receptors and have sedative and anticonvulsant properties, cloneazepams and Lorazepams are more often used when mania. They relatively weakly interact with other drugs, except for the enhancement of the sedative effect. Neither the other do not have active metabolites. Benzodiazepines are often preferable to secondary mania (somatogenic, drug or narcotic), as well as with pronounced extrapyramidal disorders caused by neuroleptics. T 1/2 (18-50 h) and the duration of the validity of the clonazepam is somewhat larger than the Lorazepam (T 1/2: 8-24 h). The maximum serum concentration of cloneazepam is achieved faster than the Laurempama (1-2 h and 1-6 h, respectively). Doses: clonazepam - 1.5-20 mg / day inside, Lorazepam - 2-10 mg / day inside. Clonazepam and oilzepam are sometimes combined with lithium, the effect of which compared to these two drugs occurs more slowly or with other antimanic drugs. Lorazepams are also used in / m, 2 mg every 2 h, sometimes in combination with haloperidol, 1-5 mg in / m. The most frequent side effect of clonazepam and a laurezepam - sedative; Clonazepam often causes daily drowsiness due to longer action. High doses of both drugs used to relieve manic excitation, often cause anterograd amnesia.

3. Neuroleptics. With a manic attack, all groups of neuroleptics are applied. It is believed that their action is due to the blockade D 2 -receptors.

but. Haloperidoli mesonidazine. The most common neuroleptic is haloperidol. It is prescribed inside and in / m in a dose of 2-40 mg / day; T 1/2: about 18 hours. Sometimes a haloperidol is prescribed at a sharp excitation, 1-5 mg per / m every 2-6 h, and lithium: haloperidol quickly stops excitement, and lithium acts slower, but longer. To enhance the sedative effect, hanoperidol can be combined with a laureplate. Haloperidol causes extrapyramidal disorders (see also ch. 27, p. Vi.B.5.V).

Mesoridazine is often used - the drug, which is simultaneously the main active tioridazine metabolite. In contrast to the latter, mesonidazine is used not only inward (75-300 mg / day), but also in / m (12.5-50 mg every 6 h). T 1/2 is extremely variable (1-3 days). Mesonidazine, like haloperidol, in the first days of treatment are often combined with lithium. Extrapyramidal disorders are rare, but information about pigment retinopathy, observed when using high thiuridazine doses, no. Mesonidazine is almost twice as much more than thiuridazine.

b. Pimozide (see also ch. 26, p. X.B.2, and table. 27.8 and Table. 27.9) - an atypical neuroleptic, blocking not only D 2-receptors, but also calcium channels. Some doctors, especially in Europe, confirm its effectiveness in a manic attack, but the FDA as an antimanical agent is not approved. Pyzimide has sedative and M-cholin-blocking side effects; It also causes ECG changes, in particular, the dose-dependent elongation of the Qt interval. There are reports of heart rhythm violations, including fibrillation of ventricles. In this regard, it is necessary to register the ECG before and during treatment, which is sometimes difficult at a manic attachment. Maximum serum concentration is achieved slowly, removal is also slow; T 1/2: 1.5-2.5 days. Dose - 2-20 mg / day inside.

in. Clozapine (see also ch. 27, p. VI.B.1.B.1) - atypical neuroleptic. According to single messages and tests on small samples, it is effective at an amphibian mania (FDA for use for this purpose is not approved). Doses - 250-800 mg / day inside. T 1/2: About 8 hours. Sometimes there is enough clozapine monotherapy, in other cases it is combined with other means (for example, with valproic acid or lithium). It is necessary to monitor the number of leukocytes, since granulocyptopenia is possible, especially when combined with other drugs affecting blood formation.

4. Cardiovascular normation

but. Clonidine stimulates central alpha 2 -adrenoreceptors, thereby reducing the tone of the sympathetic nervous system (see also ch. 13, p. III.V.7). Due to this, it is sometimes effective in mania (FDA for use for this purpose is not approved). In addition, it stimulates peripheral presynaptic alpha 2 -adrenoreceptors, thereby reducing the emission of norepinephrine from the presynaptic endings; This is accompanied by a decrease in blood pressure. Clonidine is quickly absorbed and quickly reaches the necessary concentration in brain tissue. Doses - 0.2-1.2 mg / day inside. At higher doses it is possible to increase hell. The main side effects in addition to the hypotensive - dry mouth, dizziness, possibly aggravating depression. Clonidine is prescribed only with the ineffectiveness of the usual methods of treatment and under thorough observation.

b. Calcium antagonists. Verapamil, 240-400 mg / day inside, and diltiazem, 150-300 mg / day inside, can reduce manifestations of mani (FDA for use for this purpose are not approved). The validity of the use of these drugs is confirmed by the fact that the calcium concentration in the CMF is reduced during manic attacks and increases during depressive. Both drugs increase calcium content in synaptic endings. Verapamil has a weakly pronounced anticonvulsant action; Neither one nor another is a drug selection with mania, and they are prescribed only with the ineffectiveness of ordinary methods. Sometimes Verapamil strengthens depression and anxiety.

B. Electrosusproy therapy (see ch. 15). Most doctors and patients prefer drug treatment, however, there are convincing data on greater efficiency of electrosculation therapy compared to lithium in the early stages of heavy mania. Due to the safety and efficiency, electrosusproy therapy is sometimes the only means of treating TIR during pregnancy.

Prevention [edit]

Other [edit]

Despite the smaller prevalence of TIR compared to other psychosis, its social consequences are significant. On the one hand, many patients are creatively productive, energetic and achieve great success in art, politics, science and business. On the other hand, a huge damage is applied to society due to the wasted of the shelted talents and means, long-term disability and destroyed families, suicides, hospitalizations and the mass of other consequences associated with the absence or late treatment of many patients. Currently, no more than a quarter of patients with TIR receive proper treatment. It takes a lot of work to persuade them to be treated and fulfilling the prescriptions of the doctor. More efficient and safe preparations. Finally, it is necessary to learn better and understand how the wrong treatment of attacks (or its complete absence) affects the abolition of medicines on severity, frequency, duration and resistance to the treatment of subsequent attacks.

Sources (links) [edit]

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2. BaaStrup, P. C. The Use of Lithium in Manic-Depressive Psychosis. COMPR. PSYCHIATRY 5: 396-408, 1964.

3. BaaStrup, P. C., Schou, M. Lithium As A Prophylactic Agent: Its Effects Against Recurrent Depression and Manic-Depressive Psychosis. Arch. Gen. PSYCHIATRY 16: 162-172, 1967.

4. Cade, J. F. J. Lithium Salts in the Treatment of Psychotic Excitement. Med. J. Australia 2: 349-352, 1949.

5. Cade, J. F. J. Lithium - Past, Present and Future. In F. N. Johnson, S. Johnson (EDS.), Lithium in Medical Practice. Baltimore: University Park Press, 1978, PP. 5-16.

6. Caillard, V. Treatment of Mania Using A Calcium Antagonist - Preliminary Trial. Neurosschobiology 14: 23-26, 1985.

7. Calabrese, J. R., Markovitz, P. J., et al. Spectrum of Efficacy of Valproate In 78 Rapid-Cycling Bipolar Patients. J. Clin. Psychopharmacol. 12: 53S-56S, 1992.

8. Chouinard, G. Clonazepam In Acute and Maintenance Treatment of Bipolar Affective Disorder. J. Clin. Psychiatry, 48 (Suppl): 29-36, 1987.

9. Clothier, J., Swann, A. C., Freeman, T. DYSPHORIC MANIA. J. Clin. Psychopharmacol. 12: 13S-16S, 1992.

10. Dunner, D. L. Mania. In J. P. Tupin, R. I. Shader, D. S. Harnett (EDS.), Handbook of Clinical Psychopharmacology (2nd Ed.). NorthVale, NJ: ARONSON, 1988, PP. 97-109.

11. Dunner, D. L., Fieve, R. R. Clinical Factors in Lithium Carbonate Prophylaxis Failure. Arch. Gen. PSYCHIATRY 30: 229-233, 1974.

12. Gerner, R. H., Stanton, A. Algorithm for Patient Management of Acute Manic States: Lithium, Valproate, Or Carbamazepine? J. Clin. Psychopharmacol. 12: 57S-63S, 1992.

13. Gershon, E. S., Hamovit, J., et al. A Family Study Of Schizoaffective, Bipolar I, Bipolar II, UniPolar, and Normal Control Probands. Arch. Gen. Psychiatry 39: 1157-1167, 1982.

14. Goodwin, F. K., Jamison, K. F. MANIC-DEPRESSIVE ILLNESS. New York: Oxford Univ. Press, 1990.

15. Hurowitz, G. I., Liebowitz, M. R. Antidepressant-Induced Rapid Cycling: Six Case Reports. J. Clin. Psychopharmacol. 13: 52-56, 1993.

16. Janicak, P. G., Sharma, R. P., et al. A Double-Blind, Placebo Controlled Trial Of Clonidine In The Acute Treatment of Mania. Psychopharm. Bull. 25: 243-245, 1989.

17. Judd, L. L. Effects of Lithium on Mood, Cognitive and Personality Function in Normal Subjects. Arch. Gen. PSYCHIATRY 36: 860-865, 1979.

18. Leonhard, K. Aufteilung der Endogenen Psychosen. Berlin: Akademie-Verlag, 1957.

19. Mcelroy, S. L., Keck, P. E., et al. Valproate in the Treatment of Bipolar Disorder: Literature Review and Clinical Guidelines. J. Clin. Psychopharmacol. 12: 42S-52S, 1992.

20. Mcelroy, S. L., Keck, P. E., et al. Clinical and Research Implications of the Diagnosis of Dysphoric Or Mixed Mania or Hypomania. Am. J. Psychiatry 149: 1633-1644, 1992.

21. Modell, J. G., Lenox, R. H., Weiner, S. INPATIENT CLINICAL TRIAL OF LORAZEPAM IN THE MANAGEMENT OF MANIC AGITATION. J. Clin. Psychopharmacol. 5: 109-113, 1985.

22. POST, R. M., LEVERICH, G. S., ET AL. Lithium Discontinuation-Induced Refractoriness: Preliminary Observations. Am. J. Psychiatry 149: 1727-1729, 1992.

23. POST, R. M., Weiss, S. R. B., Chuang, D. M. Mechanisms of Action of AntiConvulsants In Action Disorders: Comparisons with Lithium. J. Clin. Psychopharmacol. 12: 23s-35s, 1992.

24. Santos, A. B., Morton, W. A. \u200b\u200bMore on CLONAZEPAM IN MANIC AGITATION. J. Clin. Psychopharmacol. 7: 439-440, 1987.

25. Schou, M. Normothymics, Mood-Normalizers: Are Lithium and The Imipramine Drugs Specific for Affective Disorders? Br. J. Psychiatry 109: 803-809, 1964.

26. Shader, R. I., Jackson, A. H., Dodes, L. M. The Antiaggressive Effects of Lithium in Man. Psychopharmacologia 40: 17-24, 1974.

27. Small, J. G., Klapper, M. H., et al. ElectroConvulsive Treatment Compared With Lithium in The Management of Manic States. Arch. Gen. Psychiatry 45: 727-732, 1988.

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29. Wilder, B. J. Pharmacokinetics of Valproate or Carbamazepine. J. Clin. Psychopharmacol. 12: 64S-68S, 1992.

Bipolar affective disorder (F31)

Disorder, characterized by two or more episodes, in which the mood and the level of patient activity is significantly violated. These violations are cases of lifting mood, enjoying and enhancing activity (hypologia or mania), and cases of falling mood and a sharp reduction in energetic and activity (depression). Repeated episodes of only hypologia are classified as bipolar (F31.8).

Included: Manico-depressive (s)
- Disease
- Psychosis
- Reaction

F31.0 bipolar affective disorder, the current episode of hypomania

In the patient, at the moment there are hypolomical phenomena and in the past was noted, at least once, another affective episode (hypomanical, manic, depressive or mixed character).

F31.1 bipolar affective disorder, the current episode of mania without psychotic symptoms

In the patient, at the moment there are manic phenomena without psychotic symptoms (like a subheading F30.1), and in the past, at least once, another affective episode (hypomanical, manic, depressive or mixed nature) is observed.

F31.2 Bipolar affective disorder, the current episode of mania with psychotic symptoms

In the patient, at the moment there are manic phenomena with psychotic symptoms (like a subheading F30.2), and in the past, at least once, another affective episode (hypomaniacal, manic, depressive or mixed nature) is observed.

F31.3 bipolar affective disorder, the current episode of light or moderate depression

In the patient, at the moment there are depression phenomena, as with a depressed episode of light or moderate severity (F32.0 or F32.1), and in the past, at least once, confirmed by a hypomaniacal, manic or mixed affective episode.

F31.4 Bipolar affective disorder, the current episode of severe depression without psychotic symptoms

In the patient, at the moment there are depression phenomena, as with a severe depressive episode without psychotic symptoms (F32.2), and in the past, at least once, a confirmed hypomanical, manic or mixed affective episode was observed.

F31.5 Bipolar affective disorder, the current episode of severe depression with psychotic symptoms

The patient at the moment there are depression phenomena, as with a severe depressive episode with psychotic symptoms (F32.3), and in the past, at least once, a confirmed hypomanical, manic or mixed affective episode was observed.

F31.6 Bipolar Affective Disorder, Current Mixed Episode

The patient in the past had at least once, confirmed by a hypomaniacal, manic, depressive or mixed affective episode, and the current state is either a combination, or a quick change of manic and depressive symptoms.

F31.7 Bipolar affective disorder, current remission

The patient in the past had at least once, confirmed by a hypomaniacal, manic or mixed affective episode and in addition to at least one other affective episode (hypomanical, manic, depressive or mixed), but at the moment he does not suffer from any significant mood violations which are not already within a few months. Periods of remission during preventive treatment should be encoded by the same subhead.

F31.8 Other bipolar affective disorders

Bipolar II disorder

Recurient manic episodes

F31.9 Bipolar affective disorder Uncomputed

Bipolar affective disorder

Bipolar affective disorder (bar) - mental illness with alternating phases inadequately increased (mania, maniacal phase) and highly reduced (depression, depressive phase) of mood. Unlike the change of mood in a healthy person or emotional lability, bipolar disorder is a disease with an inadequate assessment of the surrounding, inability to work and even the threat of life in the form of suicide. A psychiatrist or psychotherapist doctor is engaged in diagnosis and treatment.

A person's life with a bar is divided into "stripes": a few months - a dark strip of impenetrable longing and depression, then a few more - a bright strip of mania, euphoria, carelessness. And so indefinitely, if you do not seek help.

The causes and mechanisms of the development of the disease are still unknown. Doctors only know that bipolar disorder is more common in humans, among the relatives of whom have already been patients with a bar or other affective disorders (depression, distilium, cyclotimia). That is, genetic and hereditary factors are involved in the development of the disease.

Bipolar disorder is an endogenous disease. This means that it can develop without a visible cause. Even if the first episode was associated with external influence (stress, physical or mental overvoltage, infectious or other body disease) - most likely it was a start-up factor that showed a hidden predisposition.

Patients who began the depressive phase (bipolar depression), tell: on the eve of the evening everything was fine, and the next morning I woke up - I don't want to live.

After the first attack, the role of external factors decreases, new attacks arise "on scratch". So patients who started the depressive phase (bipolar depression), tell: on the eve of the evening everything was fine, and the next morning I woke up - I don't want to live. Therefore, even if you protect a person from stress and overloads, the disease will not retreat - you need to be treated.

Bipolar affective disorder of ICD-10 ( International Classification Diseases) describes in the section "Mood Disorders" (synonym - affective disorders). Options for the development of the disease and symptoms are described in the next part.

Symptomatics of bipolar affective personality disorder

The old name of bipolar affective disorder is a manic-depressive psychosis (TIR). Now it is considered incorrect, since the bar is not always accompanied by rude violations of mental processes, as in psychosis.

A bipolar affective disorder in the ICD-10 corresponds to the heading F31, which includes:

F31.0 bipolar affective disorder, the current episode of the hypomania;

F31.1 bipolar affective disorder, the current episode of mania without psychotic symptoms;

F31.2 bipolar affective disorder, the current episode of mania with psychotic symptoms;

F31.3 Bipolar affective disorder, the current episode of light or moderate depression;

F31.4 Bipolar affective disorder, the current episode of severe depression without psychotic symptoms;

F31.5 bipolar affective disorder, the current episode of severe depression with psychotic symptoms;

F31.6 bipolar affective disorder, the current episode of mixed nature;

F31.7 Bipolar affective disorder, current remission;

F31.8 Other bipolar affective disorders;

F31.9 Bipolar affective disorder is unspecified.

The word "bipolar" says that during the illness, the emotional state of a person varies between two poles - from Mania to depression.

The manic phase is characterized by triad major symptoms:

increased mood - often, if not always, for no reason;

motor excitement - the movements of the pivars, a person cannot stop in place, grabs for everything in a row;

ideacher-mental arousal - jumps from the theme on the topic, speech is accelerated, up to the point that it becomes difficult to disassemble.

In addition, it is characteristic:

• the need for a dream is reduced - a person sleeps for several hours (2-3) or all the time awake;
• enhanced sexual desire and sexual activity;
• sometimes irritability and alentability arise, right up to aggression;
• revaluation of our own opportunities - a person may argue that he has supernormalities that invented "medicine from all diseases" or that he is actually a relative of famous, high-ranking people.

The depressive phase of bipolar affective disorder lasts longer than the maniacal (without treatment on average about 6 months) and is characterized by signs of endogenous depression of varying severity:

• reduced, depressed mood;
• slow thinking - a little thoughts in the head, such a person speaks slowly, responds after a pause;
• motor storage - movement slow, the patient can lie in bed in a monotonous pose;
• sleep disorders - restless Son., lack of a feeling of rest in the morning or permanent drowsiness;
• reduction or loss of appetite;
• angedonia - loss of ability to experience pleasure, loss of interest in hobbies, hobbies, communicating with friends and relatives;
• in particularly severe cases, suicidal thoughts and intentions.

Successful in all senses a person - family, friends, career - due to illness ceases to see in all sense, forgets, what to enjoy life, and constantly thinks how to stop his suffering.

In addition, mixed affective episodes may be observed, when the patient at the same time is present signs of mania and depression. For example, a reduced mood, longing and self-consolidating thoughts can be combined with motor anxiety, euphoric state - with motor intensity.

The person has a completely lack of criticism for his state, it is not able to adequately assess the consequences of his actions. During any episode, the bar, regardless of its polarity, the actions of a person can take a dark, risky nature, pose a threat to the life and health of its own and other people.

As during the depressive and during the manic phase, the patient needs professional medical care.

The diagnosis of a bipolar affective disorder is engaged in a psychotherapist or psychiatrist, together with a clinical psychologist. In addition to a clinical and anamnestic examination at a specialist (conversation with a doctor), with the possibility and availability of readings, laboratory and instrumental methods (blood tests, EEG, MRI / CT, neurotest, neurophysiological test system are used. Read more about the diagnosis of bipolar affective disorder.

Bipolar depressive disorder: prognosis of recovery

Bipolar affective disorder (manic-depressive psychosis) with a timely manner of treatment has a favorable forecast. Therapy Bar includes three main directions:

1. The relief of acute state is a drug treatment outpatient or stationary, if there is indications for hospitalization.
2. Supporting therapy of the patient for the purpose of rehabilitation and prevention of relapses - includes psychotherapy, medical therapy, additional general metering procedures for indications (physiotherapy, massage, therapeutic physical education).
3. Work with relatives and close patients for their rehabilitation and raising awareness of the features of the disease.

The effectiveness of treatment is determined by the accuracy of the diagnosis of the disease, which is often complex due to prolonged intermissions (the "Calm" periods between the attacks). As a result, the phase of the disease is taken for individual disorders or for the debut of another mental illness (for example, schizophrenia). Significant differential diagnosis can only hold a specialist - a psychiatrist.

In the absence of treatment, the duration of "light" gaps decreases, and the affective phases, on the contrary, increases, while the affect can become a monopolar. Affective disorder in this case acquires the character of a protracted depression or mania.

Bipolar affective disorder In case of timely treatment for medical help, it is good to treat. The therapy bar has its own characteristics depending on the individual clinical picture and the current phase of the disease. Started during the current affective episode or during interphase, the correct treatment allows you to achieve a rack and long-term remission with full disability and social adaptation. Read more about the treatment of bipolar affective disorder.

Bipolar affective disorder is a severe mental illness, it is it that "dictates" patients with certain forms of behavior and actions. It is important for loved ones to understand that they do not deal with a bad, wrinkling or hot-tempered character of a family member, but with manifestations of severe illness, which at the time of the episode completely takes control of the person and torments a patient of a person at least what he is tormented by others.

Bipolar affective disorder uncomfortable

Definition and general information [edit]

The prevalence among the population is 0.3-1.5% (0.8% - for bipolar type I form; 0.5% - type II). The number of men and women suffering from bipolar disorder is approximately the same: I type is more common in men, II type and fast cycles - in women.

In the debut of bipolar disorder (especially i type), men prevailing (hypologia), women are depressive condition. Bipolar disorder usually arises between the ages of 15 and 50 years and more. The peak of morbidity is noted in patients aged 21.

Etiology and pathogenesis [edit]

The main role in the occurrence of the disease belongs to genetic factors. The risk of developing the disease near the nearest relatives of the patient seven times higher than the average in the population, and is 10-15%. In children, one of whose parents suffers from bipolar disorder, the risk is about 50%. At the same time, they may occur bipolar, and schizoaffective disorder, and schizophrenia. Concordance for monosigital twins is 33-90%, for violated - about 23%.

Neurotransmitters (norepinens, dopamine, serotonin) are involved in the development and course of bipolar disorder. Glucocorticoids and other stressful hormones are also considered involved in its development.

Among the various hypotheses explaining the nature of bipolar disorder, the concept of "Kindling" is undoubted interest (English. Kindling - "Ignition"), formulated by R.M. POST and S.R. Weiss (1989). In accordance with it, the main role in the occurrence of bipolar disorder belongs to cerebral pathophysiological mechanisms close to paroxysmal. The reasons are the action of stimulants and other surfactants, sharp physiological shifts, stressful factors. They predispose to the emergence of the first episode of the disease, followed by the autochthonium of repetition of seizures and sensitization to various provoking factors. This course of the disease is similar to the development of epilepsy. It is not by chance that this hypothesis originated in connection with the study of anti-epileptic means - carbamazepine and hollows - as thymostabilizers (means of treatment and preventing bipolar disorder).

Clinical manifestations [edit]

Manic, depressive and mixed affective symptoms and syndromes are characteristic not only to affective disorders. They are often found in schizophrenia, schizophrenic spectrum disorders, various symptomatic psychosis accompanying somatic (cardiovascular, endocrine) and organic diseases of traumatic, intoxication and cerebrovascular nature. In many cases, the comorbidity of depression and somatic diseases is noted. The use of steroid hormones and psychostimulants often provokes the development of manic and hypolomanical states. This kind of "secondary" affective violations are characterized by other patterns, rather than bipolar disorders and recurrent depression.

Bipolar affective disorder Uncomfortable: diagnostics [edit]

Diagnostic criteria for hypologia, mania, depressive episode and recurrent depressions, set out in the ICD-10, give a formal basis for the diagnosis of affective disorder. In the ICD-10, as in DSM-IV, the need to exclude the influence of exogenous factors, mental, heavy somatic and organic diseases, i.e. The endogenous nature of affective disorders is indirectly recognized, contrary to the use of the concept of endogenesis, declared in these classifications.

The phenomenology of hypomanical and manic states is represented by a characteristic complex of emotional, vegetative-somatic, sensory, motor, conitative (motivational-volitional, violations of deposits), cognitive and general behavioral disorders.

Emotional changes cover all types of hyperthythmia - from emotional instability with the predominance of the positive tone of emotional reactions, inability to chagrin, easy-to-lift mood or excessive expression of joy due to a relatively adequate reason, to unrestrained inadequate fun and turbulent joyful exaltation. Euphoria and hyperthythmia are also possible, although their occurrence is not typical for bipolar disorder and indicates organically and somatic changed soil (Zhislin S.G., 1965). The same value may have pronounced irritability, dysphoric reactions.

The only hypertension phenomenon that contradicts the diagnosis of bipolar disorder and simple endogenomorphic mania is Moria.

Vegetative changes are nonspecific: signs of increasing the tone of the sympathetic nervous system prevail, dissensity with shortening sleep and early awakening. Amendments of vegetative regulation are often similar to those in depressive states, but the vital tone is raised, the aneryga is absent. Patients are almost inexhaustible, the need for a dream is reduced. In relation to these features, it is legitimate not only about vegetative, but also on general general changes: an increase in physical and mental tone; Such depressive, but opposite per diems with the most pronounced activity of activity (up to excitement) in the first half of the day, usually immediately after morning awakening; Some calm occurs in the middle of the day, in the evening it is possible to re-raise activity, but usually more moderate.

Sensory disorders in manic states are not mandatory, perception is not violated (with the exception of the sensual tone of perception - special sensual saturation, brightness of impressions from what he seen and heard). Sensory hyperesthesia is possible, usually indicating organically modified soil. Sometimes patients inform the special brightness of perception, improving vision, hearing, smell, especially in contrast with the corresponding level of perceptual functions in preceding depressions. Apparently, it also matters the overall increase in the vital tone, not excluding the positive shifts of vegetative-trophic functions along with a positive subjective assessment of general well-being, self-adequation and perceptual opportunities. Physiological changes (mental, vegetative, endocrine) in manic states are less studied compared to those in depression. This can be explained by certain difficulties in organizing patient behavior, non-complainity of patients (optional in the implementation of recommendations) in manic and hypomanical states.

Motor excitation of varying degrees of severity is a characteristic feature of manic and hypomanical states. In the hypomania, not only mental excitation usually occurs, but also the overall strengthening of activity, mobility, the appearance of a special dexterity and accuracy of movements, invisible to the doctor or familiar patient. When the symptoms of the manic disorder are increasing, both more apparent disorders of coordination, lack of plasticity, gustiness, incompleteness of actions and individual movements. The extreme form of motor excitement is "Furibunda" (Mania Furibunda). Spontaneous aggressiveness is rarely observed, but with pronounced mania, we should expect active resistance to any restrictions that should be taken into account when conducting medical measures forced.

Acceleration of the speech pace, excessive spelling, is unusually loud for a given patient speech (sometimes to a sipal voice) accompanies the overall increase in activity and motor excitation.

Convative violations (motivation of activities, volitional manifestations, the sphere of deposits) are very significant and are equally important than emotional symptoms of the disease. The motivation of activities for hypolomaniacal and manic states is strengthened and acquires a spontaneous, inconsistent, disorganizing nature. Perseverance, perseverance, passionland something (often extraordinary) is fairly easily replaced by another activity. Patients are prone to extravagant actions, irrational attempts of entrepreneurship, careless waste of funds, unnecessary shopping, distribution of money and gifts. Sometimes they neglect their professional, family responsibilities, make rampant trips, vagrants. The ability to a targeted volitional effort and control of its actions is possible only for a short time: distractions prevent the completion of actions and intent.

An important feature of hypologia and mania is an increase in sexual attraction (often with a romantic tint) up to illegibility in sexual relations. Changes in appetite are inhomogeneous - from its increase to a more characteristic decrease in either irregularity of food intake. The patient often forgets about food, which leads to a decrease in body weight. Sometimes in the long period and the initial stage of development of hypologia, the mass of the body, on the contrary, is rising.

Cognitive disorders for hypomasics, manic states and affective disorders should be divided into executive (functional), meaningful (ideator) and systemic. Among the pathology of the executive functions (attention, memory, pace, volume, connectedness and sequences of associations) is the most characteristic of the disorders of the concentration of attention and its frequent switching (up to hyperprintances), accompanied by inconsistency of actions and judgments. Sometimes in the hypomania of moderate degree of severity, a certain "disorder" is noted, the ability to notice the special parts and the essence of individual phenomena. Ease of switching attention in combination with a moderately pronounced acceleration of the tempolation and an increase in the volume of associations can impress the shine and acuteness of the mind. The painful nature of these changes is detected in the superficialness of the judgments, the unlimited tendency to jokes, calamibras. In manic states, hyperprintsia in combination with a constant change of the direction of the flow of associations takes the character of the "Jade jumps", i.e. It borders with the incoherence of thinking and speech, although with patients you can usually determine the productive contact in the conversation at least for a short time and return them to a given topic. Speech head in some cases replaces obvious depletion with elements of speech stereotypes, which indicates possible associated astheniac influences.

Memory changes are heterogeneous: from hypermnezia, ease of memorization and reproduction to moderately pronounced transient violations of RAM associated with excessive distractions. Even with pronounced mania, long-term memory suffers slightly.

Content (ideatory) cognitive violations have a certain "optimistic-expansive" focus: from the ultra-subject registration of their achievements, underscore and exaggeration of real capabilities and advantages, an optimistic assessment of the circumstances, willingness to accept an unusual role without appropriate abilities and skills to explicitly reassess their identity. Apparently, it should be considered a random error mentioning the ICD-10 suspicion among the signs of maniacal states. Patients are rather trusty and friendly; The talkativeness, bordering the annoying, expressed curiosity up to the tactlessness, appear. With the development of the manic state, the patients are increasingly characterized by excessive sociability, boastful statements, replicas relating to their advantages, participation in well-known events, dating with influential people, explicit embellishment, exalcating themselves with elements of pseudology. Typically, these violations do not go beyond the scope of instant fantasy, changeable and accessible corrections. Affective malformation of a manic type (the ideas of magnitude) during bipolar disorder does not have the characteristic structural features of a systematic interpretative nonsense with the establishment of pathological ties between real and alleged phenomena. There are ideas of invention, a special mission, but inconsistency of thinking, "Jade's jumps" impede any completion of the delusional fabul and a sustainable concept. In a conversation with a patient's doctor, it usually easily reduces the scale of the ideas of greatness to an ordinary level. Megalomanian nonsense, who was previously considered a sign of pronounced mania, are not currently considered in the framework of bipolar disorder. Persecutory paranoid ideas for bipolar disorder are not characteristic and must be alarmed with respect to the schizophrenic nature of the disease or paranoid psychoses close to schizophrenia. Acute sensual nonsense also contradicts a diagnosis of bipolar disorder, as well as visual and auditory deceptions. Diagnosis complexities arise in cases of congruence of these symptoms by a manic affect. Also difficult to assess the episodes of pseudo-resection with celebrities with celebrities, involvement in historical events, etc. There are reason to believe that these phenomena are close to special phenomena type of delusional fiction (WahneInfall) in sewage-effective disorders. When maniah, as part of a bipolar disorder, it is possible to correct such experiences with the refusal of patients from the reality of fantastic events, recognizing their fiction and fantasy game.

Changes in systemic cognitive activity is expressed in violation of criticism, which is supported by subjective well-being, the feeling of completeness. Recognition of the pathological nature of some signs of hypologia or mania (for example, sleep disorders, body weight changes) is available to patients, but the criticism of unstable. The productivity of mental activity can be high in hypologia, but inevitably decreases as the state transformation into a manic. Identification of self is not violated. In some cases, this is not so obvious due to the characteristics of the behavior, speech products of patients, but in conversation, patients are always able to give reliable biographical information about themselves and their real social situation. Orientation in the surrounding is practically not violated (even at the height of the development of a manic state), but in spontaneous behavior of the patient does not always take into account real circumstances. The flow of bipolar disorder that began in the form of a manic or hypomaniacal episode is relatively unfavorable. Up to 15% of hypologians further acquire the structure of maniacal states and prone to progress. You should also consider the evasion of patients from therapeutic measures. As the disease, the development of depressive episodes (phases) should be expected sooner or later, and this should serve as one of the arguments that are convinced of the patient in the need for treatment. Unipolar manic variants of bipolar disorder make up a minor share among affective disorders, especially compared with unipolar recurrent depression.

Differential diagnosis [edit]

Bipolar affective disorder Uncomfortable: Treatment [edit]

Modern treatment of affective disorders is based on continuity and combination of active focusing (discontinuing), stabilizing and maintenance therapy and recurrence prevention.

The final stages of treatment and prevention of recurrence of affective disorders involve the use of not only biological agents of therapy, but also psychosocial measures aimed at socio-psychological support for patients, deestigmatization and the establishment of therapeutic partnership. The latter is no less necessary for the prevention than for the active therapy stage: systematic therapeutic actions, following the acute phase of the phase relief (episode), with regular execution of recommendations and the possible control of the concentration of the drug in the blood, to some extent to influence the course of affective disorders, In general, recurrence and advertising or to lose weight, enhance the severity and structural complexity of each subsequent phase.

In the magical therapy of manic and hypolomanical states, as in the prevention of bipolar disorder, the means of the first choice are salts of lithium.

As a binding agent, with severe, with signs of psychomotor excitation, lithium is usually inferior in the speed of action to some neuroleptics with a predominantly sedative profile of the action (chlorpromazine, levomepromazine, clozapine, zucopentixol), especially when the injecting use of the latter. However, with a "clean" line of lithium, it is preferable from a pathogenetic point of view and in the future its further use as a thymostabilizer is tools for the prevention of affective phase oscillations. The lack of the most common drug lithium - lithium of carbonate is the absence of its injection forms.

According to the effectiveness of impact on the mania and preventing manic and depressive recurrences within the bipolar type I bipolar, with a lithium, comparable salt of valproic acid (Valproauts), widely used in epileptology as anti-wurals. The daily dose of sodium valproate is 500-1000 mg, for supporting therapy and subsequent prophylaxis does not exceed 500 mg.

With bipolar type II, cyclotimia, as well as with fast cycles, another well-known anti-kvulsant - carbamazepine is considered the most justified or comparable in action with hippoats and lithium salts - carbamazepine. It should be noted that with unipolar recurrent depression, precisely carbamazepine is the preparation of the first choice in constructing preventive tactics.

For emergency relief mania of neuroleptics (primarily chlorpromazine, clozapine, zukopentixol, as well as haloperidol) in the injection form, are undoubtedly more reliable and effective: they have a sedative effect shortly after administration or several injections. However, this action is most likely only symptomatic: neuroleptics practically do not affect the main clinical symptoms and alleged phase flow mechanisms. With the termination of their application, the previous symptoms usually returns. The combination of neuroleptics with lithium reception is fraught with the appearance of neurotoxic effects (tremor, acatius), vegetative lability, bodily discomfort, sometimes creating the impression of the development of mixed states.

In recent years, more and more works concerning the use of these modern antipsychotics, such as Questiapine, Olanzapine, Aripiprazole, and other drugs, however, the data on the feasibility of their use under these states is not enough.

The clinical effects of neuroleptics can serve as differential diagnostic signs to find out the nature of manic or hypolomanic states: if there is not only motor and speech arousal, but also characteristic ideological disorders (for example, the ideas of magnitude) are reduced under the influence of neuroleptics), then it is possible to assume not affective, but Diseases, and if the phenomena of expansive delusions lag behind the reduction of actually affective disorders, then the diagnosis of schizophrenia is more likely. On the other hand, if the use of lithium salts or anticonvulsants causes a harmonious reduction of emotional, vegetative-somatic, motor and cognitive violations, then there are more reason to talk about belonging a painful state to affective disorders.

Injection administration of benzodiazepines (diazepama, phenazepama, Lorazepama, clonazepama) is safer (including in combination with lithium preparations), it can be used in the first stages of active therapy with thymostabilizers as a background for pathogenetically substantiated therapy, followed by the prevention of lithium preparations or anti-wurals.

Bipolar affective disorders mkb-10

F30 Manic Episode (up)

The separation of affect and mood is due to the fact that under the affect means a bright expression of emotions, which is reflected in behavior, is understood by the amount of emotions for a certain period of time, which often, but not always, manifests itself in behavior and can be successfully hidden. The circle of affective disorders includes such syndromes as a seasonal change in weight, evening craving for carbohydrates, premenstrual syndromes, part of the teenage aggressiveness.

Etiology and pathogenesis

Emotion is manifested in behavior, for example, facial expressions, pose, gesture, features of social communications, thinking and subjectively described in the structures of the experience. When control is lost above it, it reaches the degree of affect and can lead to autodistractions (suicide, self-injuring) or destruction (aggression). Affective disorders (bipolar, recurrent, distortic) have several links of etiology and pathogenesis:

The genetic cause of the disease can be gene in the 11th chromosome, although there are theories of the genetic diversity of affective disorders. The existence of a dominant, recessive and polygenic forms of disorders is assumed.
Biochemical cause It is a violation of the activity of the exchange of neuro-transmitters, their number decreases when depressed (serotonin) and increases with mania, as well as catecholamines: Catecholamines deficiency is noted during depression.
Neuroendocrine causes are manifested in violation of the rhythm of the functioning of the hypothalamic-pituitary, limbic system and epiphyse, which is reflected in the rhythm of emissions of release hormones and melatonin. This indirectly affects the holistic rhythm of the body, in particular the rhythm of sleep / wakefulness, sexual activity, food. These rhythms are systematically violated in affective disorders.
The theory of loss of social contacts includes cognitive and psychoanalytic interpretation. Cognitive interpretation is based on studying the fixation of depressogenic type schemes: bad mood - I can't do anything - my energy falls - I am useless - the mood is reduced. This scheme is reflected in personal and social level. The stylistics of depressive thinking involves the lack of a future plan. Psychoanalytic concepts explain the depression on narcissism regression and the formation of hate to itself, the narcotic elements are detected in self-testing and exhibitionism also with mania.
The cause of affective disorders may be negative (distress) and positive (eustess) stress. A series of stresses lead to overvoltage, and then depletion as the last phase of the main adaptation syndrome and the development of depression in constitutionally predisposed personalities. The most significant stressors are the death of a spouse / spouse, child, quarrel and loss of economic status.
The basis of psychoscience of affective disorders is the violation of the regulation in the spectrum of aggressive - auto-aggressive behavior. The selective advantage of depression is the stimulation of altruism in a group and family, an obvious advantage in group and individual selection differs and hypologia. This explains the stable digit of exposure to affective disorders in the population.
Prevalence

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

The main impairment is to change the affect or mood, the level of motor activity, the activity of social functioning. Other symptoms, such as a change in the rate of thinking, psychosensory disorders, self-evaluation, or revaluation, are secondary to these changes. The clinic is manifested in the form of episodes (manic, depressive), bipolar (two-phase) and recurrent disorders, as well as in the form of chronic mood disorders. Intermissions are noted between psychosis without psychopathological symptoms. Affective disorders are almost always reflected in the somatic sphere (physiological shipments, weight, turgor of the skin, etc.).

The main features are changes in affect or mood, the remaining symptoms are displayed from these changes and secondary.

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

Therapy develops from the treatment of depressions itself and mania, as well as preventive therapy. The treatment of depression includes, depending on the depth of a wide range of drugs - from fluoxetine, Lerivon, Caloft to tricyclic antidepressants and EST. Therapy of the mania is made of therapy with increasing doses of lithium when controlling them in the blood, the use of neuroleptics or carbamazepine, sometimes beta blockers. Supporting treatment is carried out by lithium carbonate, carbamazepine or sodium hap.

F30 Manic Episode

Easy degree of mania, in which changes in mood and behavior are long-term and expressed, are not accompanied by nonsense and hallucinations. Increased mood is manifested in the sphere of emotions as joyful cloudness, irritability, in the sphere of speech as an increased talkativeness with relief and superficial judgments, increased contact. In the field of behavior, there is an increase in appetite, sexuality, distractions, reducing the need for a dream, separate actions, the bulging scope of morality. Subjectively feels the ease of associations, improving performance and creative productivity. Objectively increases the number of social contacts and success.

The partial symptoms of hidden mania can be monosimptoms of the following type: disbuits in children's and adolescence, reducing the need for a dream, episodes of increasing creative productivity with experiences of inspiration, bulimia, increase in sexual entry (satyriasis and nymphomania).

The main criteria are:

1. Increased or irritable mood, which is anomalous for this individual and maintains at least 4 days.
2. Must be presented at least 3 symptoms from among the following:

increased activity or physical anxiety;
increased spelling;
difficulties in focusing attention or distractions;
reduced dream need;
enhance sexual energy;
episodes of reckless or irresponsible behavior;
increased sociability or familiarity.
Differential diagnosis

Hypoloman episodes are possible with hyperthyroidism, in this case they are combined with vegetative reactions, an increase in temperature, noticeable with a symptom of Gref, Exophthalm, Tremor. Patients celebrate "inner trembling". Hypologan can also be on the phase of food excitation during anorexia or when hovering treatment. With true hypologia appetite, on the contrary, increased. Hypologania is also characteristic of intoxication by some psychoactive substances, such as amphetamines, alcohol, marijuana, cocaine, but in this case there are other signs of intoxication: a change in the sizes of pupils, tremor, a vegetative reaction.

The therapy uses small and medium doses of lithium carbonate, small doses of carbamazepine.

F30.1 Mania without psychotic symptoms (up)

The main difference from hypologia is that the increased mood affects the change in the norms of social functioning, manifests itself in inadequate actions, speech pressure and increasing activity are not controlled by the patient. Self-assessment increases, and individual ideas of their own importance and greatness are expressed. There is a subjective feeling of lightness of associations, an absence of distractions, the paints of the surrounding world are perceived brighter and contrasting, more subtle shades of sounds differ. The rate of flow of time is accelerated, and the need is significantly reduced in a dream. The tolerance and need for alcohol, sexual energy and appetite increase, arises for travel and adventure. Constant fear of infection with a venereal disease and inching in history with unpredictable consequences. Thanks to the jump of ideas, many plans arise, the implementation of which is only planned. The patient strives for bright and catchy clothes, says loud and later with a hoarse voice, he makes many debts and gives money barely familiar people. He is easily falling in love and confident in love of all over the world. Collecting many random people, he arranges holidays.

The main symptoms of Mania are the following:

Increased, expansive, irritable (angry) or suspicious mood, which is unusual for this individual. Changing the mood should be distinct and persist for a week.
There must be at least three of the following symptoms (and if the mood is only irritable, then four):
1) an increase in activity or physical anxiety;
2) increased spelling ("speech pressure");
3) acceleration of the flow of thoughts or subjective feeling of "Idea's jumps";
4) a decrease in normal social control, leading to inadequate behavior;
5) reduced need in a dream;
6) increased self-esteem or the ideas of magnitude (grandeur);
7) distractions or constant changes in activities or plans;
8) reckless or reckless behavior, the consequences of which patients are not realized, for example, couments, stupid enterprise, reckless control of the car;
9) a noticeable increase in sexual energy or sexual insecurity.

The absence of hallucinations or nonsense, although there may be perception disorders (for example, subjective hyperactus, perception of paints as especially bright).
Differential diagnosis

It should differentiate with affective disorders in case of dependence (euphoria when using cocaine, marijuana), with organic affective disorders and with manic-habifreno excitation during schizophrenia and schizoaffective disorders. At intoxication euphoria, as a result of the use of cocaine, along with the nicinal excitation of somatic symptoms: headaches, inclination to cramps, rhinitis, increased blood pressure, tachycardia, mydriasis, hyperthermia, increased sweating. With intoxication euphoria, as a result of the use of marijuana, mania can flow with a vague speech, increased dryness of mucous membranes, tachycardia, depersonalization, expansion of pupils.

Organic men proceed with a change in consciousness, neurological and somatic disorders are detected, other components of psychoendocrine syndrome, for example, a cognitive decline. A nicinal-habiefrenny state is unlike the manic cells are characterized by non-infectious fun, formal thinking disorders (torn, amorphousness, paraluded thinking), foolishness, symptoms of instinctive regression (eating inedible, distortion of sexual preference, cold aggressiveness).

In therapy, large neuroleptics are used (tiercin, aminazine), lithium carbonate in increasing doses with lithium level control in plasma, as well as carbamazepine.

F30.2 Mania with psychotic symptoms (up)

A pronounced mania with a bright impact of ideas and a maniac excitation, to which the secondary delusional ideas of greatness, high origin, hyperootype, values \u200b\u200bare joined. Hallucinatorial appeals confirming the significance of the personality.

The fifth sign in this diagnostic group is used to determine the conformity of nonsense or hallucinations of the mood:

0 - with psychotic symptoms corresponding to the mood (nonsense or "voices", informing the patient about its superhuman forces);
1 - with psychotic symptoms that are not relevant mood ("voices", speaking a patient about emotionally neutral things, or nonsense or prosecution).

The episode meets the criteria of Mania, but proceeds with psychotic symptoms corresponding to and derived from increased mood.
The episode does not meet the criteria of schizophrenia or schizoaffective disorder.
Brad (grandeur, values, erotic or perceluent content) or hallucinations.

The greatest difficulties consist in differential diagnosis with schizoaffective disorders, however, with these disorders, symptoms are characteristic of schizophrenia, and delusional ideas with them to a lesser extent correspond to the mood. However, the diagnosis can be considered as initial to assess the schizoaffective disorder (first episode).

Therapy implies the combined use of lithium and neuroleptic carbonate (triftatazine, haloperidol, tiezer).

F30.8 Other manic episodes (up)

F30.9 Manic Episode, Uncomfortable (up)

F31 bipolar affective disorder (up)

Disorder qualified earlier as manico-depressive psychosis. The disease is characterized by repeated (at least two) episodes, in which the mood and the level of motor activity is significantly violated - from manic hyperactivity to depressive inhibition. Exogenous factors practically do not affect rhythm. The borders of episodes are determined by the transition to the episode of the opposite or mixed polarity or to the intermissivity (remission). The attacks have tropiness to seasons, often spring and autumn aggravation, although individual rhythms are possible. Duration of intermissions from 6 months to 2-3 years. The duration of manic states from month to 4 months, during the dynamics of the disease Duration of depression from month to 6 months. Recurrements can be approximately the same duration, but can be lengthened during the shortening of remissions. Depression is clearly endogenous: daily mood fluctuations, vitality elements. In the absence of therapy, the attacks tend to spontaneous cliff, although they are more protracted.

As the disease, there is sometimes a social decline.

The diagnosis is based on the identification of repeated episodes of changes in mood and the level of motor activity in the following clinical versions:

F31.0 bipolar affective disorder, current hypomaniacal episode (up)

Episode with criteria of hypologia.
In the past, at least one affective episode with criteria of a hypomaniacal or manic episode, a depressive episode or a mixed affective episode.

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

Episode with criteria Mania.
In the past, at least one or other affective episode corresponding to the criteria of a hypomaniacal or manic episode, a depressive episode or a mixed affective episode.

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

Current episode with criteria of mania with psychotic symptoms.
Formerly in the past at least one or other affective episode corresponding to the criteria of a hypomaniacal or manic episode, a depressive episode or a mixed affective episode.
The fifth sign is usually used to determine the compliance of psychotic symptoms mood:

0 - psychotic symptoms corresponding to the mood;

F31.3 Bipolar affective disorders, the current episode of moderate or easy depression (up)

Episode with depressive episode criteria, light or moderate severity.
At least one affective episode in the past with criteria of a hypomaniacal or manic episode, or a mixed affective episode.
The fifth sign is used to determine the representation of somatic symptoms in the current episode of depression:

0 - without somatic symptoms,
1 - with somatic symptoms.

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

Episode with criteria of a severe depressive episode without psychotic symptoms.
In the past, at least one manic or hypomaniacal episode or a mixed affective episode.

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

Episode with criteria of a severe depressive episode with psychotic symptoms.
In the past, at least one hypomaniacal or a manic episode or a mixed affective episode.
The fifth sign is used to indicate the consistency of psychotic symptoms of the mood:

0 - psychotic symptoms corresponding to the mood,
1 - psychotic symptoms that do not match the mood.

F31.6 Bipolar Affective Disorder, Current Mixed Episode (up)

The episode is characterized by either mixed or fast shift (in a few hours) of hypomanical, manic and depressive symptoms.
And manic, and depressive symptoms should be expressed at least two weeks.
In the past at least one hypomaniacal or manic episode, depressive or mixed affective episode.

F31.7 Bipolar affective disorder, remission (up)

The state does not correspond to the criteria of depression or the mania of any severity or other mood disorders (possibly due to the prophylactic therapy).
In the past, at least one hypomaniacal or manic episode and at least another affective episode (hypomania or mania), depressive or mixed.
Differential diagnosis

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

The treatment of depression, mania and preventive therapy attacks. Features of therapy are determined by the depth of affective disorders and the presence of other productive symptoms. When depressed episodes, tricyclic antidepressants, EST, treatment of sleep deprivation, raster-massation of nitrogen are used. With manic episodes of combination of lithium and neuroleptics carbonate. As supporting therapy: carbamazepine, sodium valproate or lithium carbonate.

F31.8 Other bipolar affective disorders (up)

F31.9 Bipolar affective disorders, unspecified (up)

F32 depressive episode (up)

Risk factors

The risk factors for the development of depression is the age of 20-40 years, the decline in social class, the divorce in men, the family history of suicides, the loss of relatives after 11 years, personal qualities with the features of anxiety, diligence and conscientiousness, stressful events, homosexuality, sexual satisfaction problems, postpartum period, especially in lonely women.

The clinic is consisted of emotional, cognitive and somatic violations, among the additional symptoms there are also secondary self-evidence ideas, depressive depersonalization and delinealization. Depression is manifested in reducing the mood, loss of interests and pleasure, reducing the energeticness, and as a result in increased fatigue and decrease in activity.

Depressive episode continues at least 2 weeks.

Patients note a decrease in the ability to concentrate and attention, which is subjectively perceived as difficulty memorization and reduced success in learning. This is especially noticeable in adolescent and youthful age, as well as persons engaged in intellectual labor. Physical activity is also reduced to the inhibition (up to the stupor), which can be perceived as a tape. In children and adolescents, depression may be accompanied by aggressiveness and conflict, which mask the peculiar hatred of themselves. It is possible to divide all depressive states on syndromes with alarm component and without an alarm component.

The rhythm of mood changes is characterized by a typical improvement in health in the evening. Self-assessment and self-confidence is reduced, which looks like specific nonophobia. The same sensations remove the patient from others and enhance the feeling of its inferiority. With a long flow of depression at the age of 50 years, this leads to deprivation and clinical picture resembling dementia. The ideas of guilt and self-esteem arise, the future is seen in the gloomy and pessimistic colors. All this leads to the emergence of ideas and actions associated with autoagression (self-injury, suicide). Violates sleep / wake rhythm, insomnia is observed or the lack of sleep feeling, dark dreams prevail. In the morning, the patient with difficulty rises from bed. The appetite is reduced, sometimes the patient prefers the carbohydrate food protein, the appetite can be recovered in the evening. The perception of time is changing, which seems endlessly long and durable. The patient ceases to pay attention to himself, it may have numerous hypochondriac and senthenetics experiences, depressive depersonalization appears with a negative idea of \u200b\u200bhis own and body. Depressive Derealization is expressed in the perception of peace in cold and gray colors. We are usually slowed down with a monologue about your own issues and past. The concentration of attention is difficult, and the wording of ideas is slowed.

In case of inspection, patients often look out the window or on the source of light, gesturing with orientation towards their own body, pressing the hands to the chest, with anxious depression to the throat, the pose of submission, in the faith of the Plot of the Veragut, lowered the angles of the mouth. With alarm, accelerated gesture manipulations of objects. The voice is low, quiet, with large pauses between words and low directive.

Endogenous affective component. The endogenous affective component is expressed in the presence of rhythm: the symptoms are enhanced in the morning and compensated in the evening, the presence of critics, in the subjective sensation of the severity of its condition, the connection of gravity with the season, in a positive reaction to tricyclic antidepressants.

The somatic syndrome is a complex of symptoms, indirectly indicating a depressive episode. For its designation, the fifth sign is used, however the presence of this syndrome is not specified for a severe depressive episode, since it is always detected.

To determine the somatic syndrome, four of the following symptoms should be presented on ICD:

Reducing interest and / or reduction of pleasure from activities, usually pleasant for the patient.
The lack of reaction to events and / or activities that are normally called it.
Awakening in the morning for two or more hours until ordinary time.
Depression is harder in the morning.
Objective evidence of noticeable psychomotor inhibition or attachment (marked or described by other persons).
A noticeable decline in appetite:
a) Lower weight (five or more percent of body weight last month).
b) a noticeable decrease in libido.

Nevertheless, many symptoms may include in traditional diagnostics to somatic syndrome: such as the expansion of pupils, tachycardia, constipation, a decrease in skin turgora and increased nail and hair fragility, accelerated invalurative changes (the patient seems older than its years), as well as somato-forming Symptoms: such as psychogenic shortness of breath, syndrome restless legs, Dermatological hypochondria, cardiac and pseudorevmatomatic symptoms, psychogenic dysuria, moisture-forming disorders of the gastrointestinal tract. In addition, when depressed, the weight is sometimes not reduced, but increases due to carbohydrates, the libido may also not decline, but increase, since sexual satisfaction reduces the level of anxiety. Among other somatic symptoms are characterized by uncertain headaches, amenorrhia and dysmenorrhrai, chest pain, and, especially, specific feeling of "stone, gravity on the chest".

The most important features are:

reducing the ability to concentrate and attention;
reducing self-esteem and self-confidence;
ideas of guilt and self-esteem;
gloomy and pessimistic vision of the future;
ideas or actions leading to self-injury or suicide;
sleeping;
reduced appetite.

Depression with initial phenomena in Alzheimer's disease should be differentiated. Depression can really be accompanied by a clinic of pseudo-degeneration described by Wernik. In addition, prolonged depression can lead to a cognitive deficit as a result of secondary deprivation. Pseudo-degeneration in chronic depression is referred to as Puna Wang Winquill syndrome. Anamnistical information is important for distinction, these objective research methods. At depressed patients, there are more often characteristic daily fluctuations in mood and relative success in the evening, they are not so rudely violated. In the faithful of depressive patients, the folds of the veragus, pubescent angles of the mouth are noted and there is no characteristic of Alzheimer's disease, confused amazement and rare blinking. When depressed, gesture stereotypes are also not marked. When depressed, as in Alzheimer's disease, there has been a progressive involution, including a decrease in the leather turgora, dull eyes, an increased nestness of nails and hair, but these disorders in cerebral atrophy are more often ahead of psychopathological disorders, and when depressed, they are noted with a large duration of reduced mood. A weight loss during depression is accompanied by a decrease in appetite, and with Alzheimer's disease, the appetite not only does not decrease, but may increase. Patients with depression more clearly react to antidepressants with an increase in activity, but in Alzheimer's disease, they may increase aspotation and asthenization, creating the impression of the workload of patients. CT, EEG and neuropsychological examination are crucial.

In the treatment, antidepressants are used: mono-, bi-, tri- and tetracyclic, Mao inhibitors, L-tryptophan, thyroid hormones, monolateral EST on unomintently hemisphere, sleep deprivation. The old methods refers to the treatment with increasing euphorizing doses of nitrogen, inhalation of nitrogen. Phototherapy also applies luminescent lamps, Cognitive and group psychotherapy.

F32. 0 Easy depressive episode (up)

In the clinical picture there are a decrease in the ability to concentrate and attention, a decrease in self-esteem and self-confidence, ideas of guilt and self-confidence, a dark and pessimistic attitude to the future; Suicidal ideas and self-injuring, sleep disorders, decline in appetite. These common symptoms of the depressive episode should be combined with such a level of depressive mood, which is perceived by the patient as an abnormal one, while the mood is not an episodic, but covers most of the day and does not depend on reactive moments. The patient is experiencing a distinct reduction in energy and increased fatigue, although it can control its state and often continues to work. Behavioral (Mimic, Communicative, Position and Sign) Signs of bad mood may be present, but are controlled by the patient. In particular, you can see a sad smile, a motor inhibition that is perceived as "thoughtfulness". Sometimes the first complaints are the loss of the meaning of existence, "existential depression".

The fifth sign is used to clarify the availability of somatic syndrome:

Multime two of the following three symptoms:
depressive mood;

Two of the additional symptoms:


sleep disturbance;
change appetite.

Differential diagnosis

Most often, the light depressive episode has to be differentiated with an asthenic state as a result of overwork, organic asthenia, decompensation of asthenic personal traits. At asthenia, suicidal thoughts are not characteristic, and reduced mood and fatigue increase in the evening. With organic asthenia, dizziness, muscle weakness, fatigue at physical exertion are often noted. Anamnesis - cranopy and brain injuries. When decompensating personal features, a psychostenna rod is noticeable in history, subdepression is perceived as a natural person.

In the treatment, benzodiazepines, antidepressants of the type of fluoxetine, pyrazidol, petylin, hefonal, with an alarming component - gold is used. Showing courses of phytotherapy, psychotherapy and nootropics. Sometimes the effect is given 2-3 nitrogen pump sessions, amital-coordinating and intravenous introduction of novocaine.

F32. 1 Moderate Depressive Episode (up)

The main difference between a moderate depressive episode is that the change in the affect affects the level of social activity and interferes with the implementation of the individual. If there is an anxiety, it is clearly manifested in complaints and behavior. In addition, depressed is often found with obsessive-phobic components, with senthenetics. The differences between light and moderate episodes can be purely quantitative.

Diagnostics

1. 2 of 3 symptoms of a light depressive episode, that is, from the following list:

depressive mood;
reducing interest or pleasure from activities that was previously enjoyed to the patient;
energy reduction and increased fatigue.
2. 3-4 other symptoms from the general criteria for depression:

reduction of confidence and self-esteem;
dustless sense of self-selling and guilt;
repetitive thoughts of death or suicide;
complaints on a decrease in the concentration of attention, indecision;
sleep disturbance;
change appetite.
3. The minimum duration is about 2 weeks. The fifth sign indicates somatic syndrome:

1 - with somatic syndrome. Differential diagnosis

It should be differentiated with post-commophric depression, especially in the absence of clear anamnesis. For a moderate depressive episode, an endogenous affective component is characterized, there are no negative emotional and volitional disorders.

In the treatment, the Mao inhibitors are used against the background of a diet, excluding Tiramine (smoked, beer, yogurt, dry wines, sustained cheeses), tricyclic antidepressants (with depression with an alarm component - amitriptyline, with Aergia - Melipramine), tetracyclic antidepressants. With a protracted depression - lithium or carbamazepine carbonate. Sometimes the effect is given 4-6 nitrogen pumping sessions, amital caffeine proceedings and intravenous introduction of novels, as well as treatment with sleep deprivation.

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

In a severe depressive episode clinic, all the symptoms of depression are present. Motorica intensity or significantly slowed down. Suicidal thoughts and behavior are constant, there is always a somatic syndrome. Social activity is subordinate to only disease and is significantly reduced or impossible. All cases require hospitalization due to the danger of suicide. If assessment and inhibition are observed in the presence of other behavioral signs of depression, but it is not possible to obtain additional verbal information about the patient state, this episode also relates to severe depression.

All criteria of a light and moderate depressive episode, that is, there is always a depressive mood; Reducing interest or pleasure from activities that was previously enjoyed to the patient; Energy reduction and increased fatigue.
Optional 4 and more symptoms from the total criteria of the depressive episode, that is, from the list: reduced confidence and self-esteem; Dustless sense of self-selling and guilt; repetitive thoughts of death or suicide, complaints about a decrease in the concentration of attention, indecision; sleep disturbance; Change appetite.
Duration of at least 2 weeks.
Differential diagnosis

It should be differentiated with organic affective symptoms and initial stages of dementia, especially with Alzheimer's disease. Organic affective symptoms allow us to exclude additional neurological, neuropsychological research, EEG and CT. The same methods are used in differential diagnosis with initial stages in Alzheimer's disease.

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

At the height of severe depression, delusional ideas of self-evidence arise, the hypochondriad delusional ideas about the infectiousness of a certain incurable disease and fear (or conviction in infection) infect with this disease of loved ones. The patient entails the sins of all mankind and believes that he must atone them, sometimes at the cost of eternal life. His thoughts can confirm auditory, olfactory deceptions. As a result of these experiences, there are inhibition and depressive stupor.

Complies with the criteria of a severe depressive episode.
The following symptoms must be present:
1) nonsense (depressive nonsense, non-disabilities, nonsense of hypochondriac, nihilistic or percelural content);
2) auditory (accusing and insulting voices) and olfactory (smells of rotting) hallucinations;
3) depressive stupor.

The fifth sign is used to determine the conformity of psychotic symptoms of mood

0 - psychotic symptoms corresponding to the mood (delirium delifferentity, self-esteem, physical illness, impending misfortunes, mocking or condemning auditory hallucinations),
1 - psychotic symptoms that do not match the mood (perceiver nonsense or delusional assignment to itself and hallucinations without affective content).

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

Treatment includes the use of tricyclic and tetracyclic antidepressants, EST and neuroleptics (steplazine, etperazin, haloperidol), as well as benzodiazepines.

F32. 8 Other Depressive Episodes (up)

Episodes are included, which are not suitable for the description of depressive episodes, but the general diagnostic impression indicates their depressive nature.

For example, fluctuations in depressive symptoms in accordance (especially the "somatic" syndrome) with symptoms, such as tensions, anxiety, distress, as well as the complication of "somatic" depressive symptoms of chronic pain or fatigue, which are not caused by organic reasons.

F32. 9 Another depressive episode, unspecified (up)

F33 Recurrent Depressive Disorder (up)

Repeated depressive episodes (light, moderate or heavy). The period between attacks at least 2 months, during which any significant affective symptoms are observed. The duration of episodes is 3-12 months. There is a bowl of women. Usually, the elongation of attacks is noted for late age. Pretty distinct individual or seasonal rhythm. The structure and typology of attacks corresponds to endogenous depression. Additional stress can change the severity of depression. This diagnosis is also placed in this case, the therapy is applied, which reduces the risk of repeated episodes.

Repeated depressive episodes with periods between attacks at least 2 months, during which any affective symptoms are not observed.

F33.0 Recurrent Depressive Disorder, Current Episode Lightweight (up)

Corresponds to the total recurrent depressive disorder.
The current episode corresponds to the criteria for a depressive episode of light gravity.
The fifth point is used to clarify the availability of somatic symptoms in the current episode:

0 - without somatic syndrome.
1 - with somatic syndrome.

F33.1Rext depressive disorder, the current episode of moderate gravity (up)

The current episode corresponds to the criteria for a moderate depressive episode middle severity.
The fifth item is used to assess the availability of somatic symptoms in the current episode:

0 - without somatic syndrome,
1 - with somatic syndrome.

F33.2 Recurrent depressive disorder,
heavy Current Episode without psychotic symptoms (up)

General criteria for recurrent depressive disorder.
The current episode corresponds to the criteria of a severe depressive episode without psychotic symptoms.

F33.3 Recurrent depressive disorder,
heavy Current Episode with Psychotic Symptoms (up)

General criteria for recurrent depressive disorder.

The current episode corresponds to the criteria of a severe depressive episode with psychotic symptoms.

The fifth item is used to determine the compliance of psychotic symptoms mood:

0 - with the appropriate mood psychotic symptoms,
1 - with not relevant mood psychotic symptoms.

F33.4 Recurrent depressive disorder currently remission (up)

The criteria for recurrent depressive disorder.
This state does not correspond to the criteria of the depressive episode of any severity or any other disorder in the F30-F39.

Recurrent depressive disorder should be differentiated with schizoaffective disorder and organic affective disorders. In case of seasoaffective disorders in the structure of productive experiences, symptoms of schizophrenia are present, and with organic affective disorders, the symptoms of depression accompanies the underlying disease (endocrine, brain tumor, the effects of encephalitis).

Therapy

In the treatment, the treatment of exacerbations (antidepressants, EST, sleep deprivation, benzodiazepines and neuroleptics), psychotherapy (cognitive and group therapy) and supporting therapy (lithium, carbamazepine or sodium velproat) are taken into account.

F33.8 Other recurrent depressive disorders (up)

F33.9 Recurrent depressive disorder, not specified (up)

F34 Chronic (Affective) Mood Disorders (up)

We are chronic and usually unstable. Separate episodes are not deep enough to determine them as hypologia or easy depression. Lasts for years, and sometimes throughout the life of the patient. Due to this, they resemble special disorders of the type of constitutional cycloids or constitutionally depressive. Life events and stress can deepen these status.

The cause of chronic mood disorders are both constitutional genetic factors and a special affective background in a family, such as its hedonism orientation or a pessimistic perception of life. When a collision with life events, which from us cannot be dismissed, personality responds with a typical affective state, which originally seems quite adequate and psychologically understandable. This affective state causes the reaction of others and seems adaptive.

Clinic

Often since childhood or adolescence there are fluctuations in seasonal mood. However, this diagnosis is considered adequate only in postpubertach when an unstable mood with subdepress periods and hypologies lasts at least two years. The clinic itself is endogenously perceived only as a period of inspiration, rash actions or a handon. Moderate and severe depressive and manic episodes are absent, but sometimes described in history.

The period of depressive mood grows gradually and perceived as a decrease in energy or activity, the disappearance of the usual inspiration and creativity. This in turn leads to a decrease in self-confidence and the feeling of inferiority, as well as social dedication, density is also manifested in reduced talkativeness. An insomnia appears, pessimism is a steady character. Past and the future is estimated negative or ambivalent. Patients sometimes complain about increased drowsiness and violation of attention, which prevents them from perceiving new information.

An important symptom is Angedonia towards previously pleasant species of the discharge of instinct (food, sex, travel) or pleasant activities. Reducing activity activity is particularly noticeable if it followed after an increased mood. Nevertheless, there are no suicidal thoughts. The episode can be perceived as a period of straight, existential void, and with high duration it is estimated as a characterlike trait.

The opposite state can be stimulated by endogenously and external events and be also attached to the season. With a high mood, energy and activity increases, the need is reduced in a dream. Creative thinking rises or exacerbated, which leads to an increase in self-esteem. The patient tries to demonstrate the mind, wit, sarcasm, the speed of associations. If the patient's profession coincides with the self-removal (actor, lecturer, scientist), its results are assessed as "brilliant", but at a low mind, an increased self-esteem is perceived as inadequate and funny.

Increases interest in sex, and sexual activity increases, increases interest in other types of instinctive activities (food, travel, supervolvested in the interests of their own children, relatives, increased interest in outfits and decorations). The future is perceived optimistic, past achievements are revalued.

More than two years of unstable mood, including alternating periods of both subdepression and hypologia, with or without intermediate periods of normal mood.
Two years there are no moderate and severe manifestations of affective episodes. Observed affective episodes in their level are lower than the lungs.
In depressed, at least three of the following symptoms should be represented:
reducing energy or activity;
insomnia;
reducing confidence or sense of inferiority;
difficulties in the concentration of attention;
social density;
decline in interest or pleasure from sex or pleasant activities;
decline in talkativeness;
pessimistic attitude towards the future and negative assessment of the past.
Increasing the mood is accompanied by at least three of the following symptoms:
increasing energy or activity;
reducing the need for a dream;
increased self-esteem;
aggravated or unusual creative thinking;
increased sociability;
increased talkative or demonstration of the mind;
improving interest in sex and an increase in sexual relations, other activities that are pleasure;
superfluidism and reassessment of past achievements.
Separate antisciplinary actions are possible, usually in a state of alcohol intoxication, which are estimated as "excess fun".

It should be differentiated from light depressive and nanical episodes, bipolar affective disorders leaking with moderate and light affective attacks, the hypomatical states should also be distinguished by the start of the peak disease.

In relation to easy depressive and manic episodes, it is usually possible to do on the basis of the history of the history, since the unstable mood in cyclotimia should be determined for a period of up to two years, suicidal thoughts are also not characterized for cyclotimics, and they are not very harmonious socially more harmonious. Cyclotymic episodes do not reach a psychotic level, it distinguishes them from affective bipolar disorders, in addition, cyclotimics have a unique anamnestic history, the episodes of mood disorders are noted very early in Pubertate, and mood changes in peak disease at late age and are combined with more crude violations social functioning.

Preventing episodes of disturbed mood during cyclotimia is carried out by lithium, carbamazepine or sodium valproat. The same drugs can be used in the treatment of increased mood, although in cases where it is accompanied by increased productivity, it is hardly advisable. With a reduced mood, the prozak is shown, treating sleep deprivation and enotera-pium. Sometimes the effect is given 2-3 nitrogen ointment sessions, amital caffeine milking and intravenous introduction of novocaine.

Etiology

Types of personalities who have Distimia, would correctly be called constitutional depressive. These features are manifested in childhood and push as a reaction to any difficulty, and in the future and endogeneously.

They are crying, thoughtful and not very sociable, pessimistic. Under the influence of minor stresses for at least two years, they have in postpubert the periodicals of a permanent or periodic depressive mood. Intermediate periods of normal mood rarely last longer than a few weeks, all the mood of the person is painted by subdepress. However, the level of depression is lower than with a slight recurrent disorder. It is possible to identify the following symptoms of subdepression: reducing energy or activity; Violation of the rhythm of sleep and insomnia; Reducing confidence or sense of inferiority; difficulties in the concentration of attention and hence the subjectively perceived reduction in memory; Frequent tear and hypersenzitivity; decline in interest or pleasure from sex, other previously pleasant and instinctive forms of activity; a sense of hopelessness or despair in connection with the awareness of helplessness; inability to cope with the routine duties of everyday life; pessimistic attitude to the future and negative assessment of the past; Social density; Reduced talkativeness and secondary deprivation.

At least two years of permanent or recurring depressive mood. Periods of normal mood rarely last longer than a few weeks.
The criteria do not correspond to a light depressive episode, since there are no suicidal thoughts.
During the periods of depression, at least three of the following symptoms should be represented: reducing energy or activity; insomnia; Reducing confidence or sense of inferiority; difficulties in the concentration of attention; Frequent tear; decline in interest or pleasure from sex, other pleasant activities; sense of hopelessness or despair; inability to cope with the routine duties of everyday life; pessimistic attitude to the future and negative assessment of the past; Social density; Reducing the need for communication.
Differential diagnosis

It should be differentiated with a slight depressive episode, the initial stage of Alzheimer's disease. With a slight depressive episode there are suicidal thoughts and ideas. In the initial stages of Alzheimer's disease and other organic depression disorders become protracted, the organic can be identified neuropsychologically and with the help of other objective research methods.

With a reduced mood, the prozak is shown, treating sleep deprivation and eno-therapy. Sometimes the effect is given 2-3 nitrogen ointment sessions, amital caffeine disorders and intravenous introduction of novocaine, as well as the therapy by nootrops.

F34.8 Other Chronic (Affective) Mood Disorders (up)

The category for chronic affective disorders that are not pronounced or long to meet the criteria of cyclotimia or dis-thymia, a light or moderate depressive episode. Included some types of depression, previously called "neurotic". This types of depressions are closely related to stress and together with Distimia organize a circle of endoreactive Distimia.

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

F38 Other (Affective) Mood Disorders (up)

F38.0 Other Single (Affective) Mood Disorders (up)

F38.00 Mixed affective episode (up)

The episode is characterized by a mixed clinical picture or a quick change (for several hours) of hypomanical, manic and depressive symptoms.
And manic and depressive symptoms should be expressed most of the time, for at least a two-week period.
The absence of previously hypomaniacal, depressive or mixed episodes.

F38.1 Other recurrent (affective) mood disorders (up)

F38.10 Recurrent Short Depressive Disorder (up)

Disorders correspond to symptomatic criteria for light, moderate or severe depression.
Depressive episodes arose every month last year.
Separate episodes are less than two weeks (typically - two or three days).
Episodes do not occur due to the menstrual cycle.

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

F39 unspecified (affective) mood disorder (up)

/ F30. - F39 / Mood Disorders (Affective Disorders) The introduction of the relationship between etiology, symptoms, biochemical processes underlying the disease, the reaction to the treatment and outcome of affective disorders is still not well understood and does not allow checking the classification in this form to obtain universal approval. Nevertheless, an attempt to make a classification is necessary and the classification presented below is hoping that it will be at least acceptable for everyone, since it was the result of broad consultations. These are disorders in which the main impairment is to change the affect or mood more often towards oppression (with or without concomitant anxiety) or lifting. This mood change is most often accompanied by a change in the overall level of activity, and most other symptoms are either secondary, or easily understood in the context of these changes in mood and activity. Most of these disorders tend to repeat, and the beginning of individual episodes is often associated with stressful events or situations. This section includes mood disorders in all age groups, including childhood and adolescence. The main criteria for determining mood disorders were elected for practical purposes so that clinical disorders could be well recognized. Single episodes are eliminated from bipolar and other multiple episodes, since a significant part of the patients transfer only one episode. The attention is paid to the severity of the disease, in view of its importance for the treatment and determination of the necessary maintenance. It is recognized that the symptoms that are denoted here as "somatic" could also be called "melancholic", "vital", "biological" or "endogenomorphic". The scientific status of this syndrome is somewhat dubious. However, this syndrome was also included in this section, due to extensive international clinical interest, to exist. We also hope that as a result of the use of this classification, the feasibility of the allocation of this syndrome will receive a critical assessment. The classification is so presented that this somatic syndrome can be recorded by those who would like this, but it can also be ignored without losing other information. It remains a problem as differentiating various severity. Three severity (light, medium (moderate) and severe) are left in classification at the request of many clinicians. The terms "mania" and "severe depression" are used in this classification to designate opposite options for an affective spectrum. "Hyomania" is used to designate the intermediate state without nonsense, hallucinations, without the complete loss of normal activity. Such states often (but not exclusively) can be observed in patients at the beginning or at the exit from mania. It should be noted: Headings encoded by F30.2x, F31.2x, F31.5X, F32.3X and F33.3X "Mood Disorders (Affective Disorders)" are indicated by cases corresponding to a manic-depressive psychosis in the domestic classification. Moreover, the codes of F30.2X and F32.3X are set when the type of flow of manic-depressive psychosis (bipolar or monopolar) is still impossible to establish due to the fact that it is about the first affective phase. When it is clear the type of flow of manic-depressive psychosis, you should use f31.2x codes, F31.5x or F33.3X. It must be borne in mind that cases falling under codes F30.2x, F31.2X, F31.5X, F32.3X and F33.3X, correspond to the diagnosis of manic-depressive psychosis in the event that the existing psychotic disorders are symptoms of the psychotic state (congruent). If psychotic disorders in cases indicated by the same code are not symptoms affective state (not congrused by him), then according to the domestic classification, these cases should be considered as affective-delusional embodiments of the parietal (recurrent) schizophrenia. It should be emphasized that in the picture of the latter, psychotic disorders do not comply with the criteria of schizophrenia specified in the description F20. - on the ICD-10. With the designation of this group of disorders, an additional 5th sign is entered: F30.x3 - with congruent psychotic disorders; F30.H4 - with uncongenant psychotic disorders; F30.H8 - with other psychotic disorders.

/ F30 / Manic Episode

Here are three severity in which there are general characteristics of increased mood and an increase in the amount and pace of physical and mental activity. All subheadings of this category should be used only for a single manic episode. Previous or subsequent affective episodes (depressive, manic or hypomanical) should be encoded in a bipolar affective disorder (F31.-). Turn on: - a manic episode with manic-depressive psychosis; - bipolar disorder, single manic episode.

F30.0 Hyolomania

Golomania is an easy degree of mania (F30.1), when changes in mood and behavior are too long and expressed so that this state can be included in cyclotimia (F34.0), but are not accompanied by nonsense or hallucinations. There is a permanent easy rise in mood (at least for several days), increased energy and activity, feeling of well-being and physical and mental productivity. Also, increased sociability, talkative, excessive familiarity, increased sexual activity and a reduced need for a dream are also often noted. However, they do not lead to serious violations in the work or social rejection of patients. Instead of conventional euphoric sociability, irritability, increased self-conceit and coarse behavior can be observed. Concentration and attention can be upset, thus reducing the possibilities of both work and recreation. However, this state does not prevent the emergence of new interests and active activities or moderate tendam. Diagnostic instructions: Some of the above-mentioned signs of increased or modified mood should be present continuously, at least a few days, to the degree, slightly greater and with a large consistency than described during cyclotimia (F34.0). Significant difficulties in working capacity or social activity is consistent with the diagnosis of hypologia, but in severe or complete violation in these areas, the state should qualify as mania (F30.1 or F30.2x). Differential diagnosis: Golovandania refers to the diagnosis of mood disorders and activity, intermediate between cyclothimia (F34.0) and mania (F30.1 or F30.2x). Increased activity and concern (often and weight loss) should be eliminated from the same symptoms in hypertension and nervous anorexia. The early stages of the "accommodated depression" (especially at middle age) can create superficial similarity with irritable type hypologia. Patients with severe obsessive symptoms can be active during a part of the night, making their home rituals associated with cleanliness, but affect in such cases is usually opposite to the described here. When a short period of hypologia occurs at the beginning or at the output from Mania (F30.1 or F30.2x), should not be allocated to a separate category.

F30.1 Mania without psychotic symptoms

The mood is lifted inadequately circumstances and can vary from careless freight to almost uncontrolled excitation. The rise of the mood is accompanied by an increased energetic, leading to hyperactivity, speech pressure and reduced need for a dream. Normal social braking is lost, attention is not detected, there is a pronounced distraction, increased self-esteem, easily expressed super-optimistic ideas and ideas of greatness. Perceptions may arise, such as the experience of color as a particularly bright (and usually beautiful), concern for small parts of any surface or texture, subjective hyperactus. The patient can take extravagant and impractical steps, thoughtlessly spend money or can become aggressive, in love, humoronic in unsuitable circumstances. With some manic episodes, the mood is rather irritated and suspicious than raised. The first attack more often occurs aged 15-30 years, but may be at any age from children up to 70-80 years. Diagnostic instructions: The episode should last at least 1 week and be such a severity, which leads to a fairly complete violation of ordinary performance and social activities. The change in the mood is accompanied by an increased energeticity with the presence of some symptoms of the above (a particularly speech pressure, a reduced need in a dream, the ideas of magnitude and excessive optimism).

/F30.2/ mania with psychotic symptoms

The clinical picture matches more severe form than F30.1. Increased self-esteem and ideas of greatness can develop in nonsense, and irritability and suspicion - in nonsense prosecution. In severe cases, pronounced delusional ideas of greatness or noble origin are noted. As a result of the racing of thoughts and speech pressure, the patient's speech becomes a low-touch. Heavy and long-lasting physical exertion and excitement can lead to aggression or violence. Neglecting food, drinking and personal hygiene can lead to a dangerous state of dehydration and launch. Brad and hallucinations can be classified as congbents or uncongenant mood. "Uncongenant" include affective neutral delusional and hallucinatory disorders, for example: nonsense relationships without a sense of guilt or charges, or voices that talk with patients about events that do not have emotional significance. Differential diagnosis: One of the most common problems is to deliver from schizophrenia, especially if the stage of the hypomania is skipped and the patient is seen only at the height of the disease, and the magnificent nonsense, nerazonous speech, strong excitement can hide the main mood disorder. Patients with mania, which react well to neuroleptic therapy, can present a similar diagnostic problem at the stage when their physical and mental activity returned to the norm, but still nonsense or hallucinations remain. Periodically arising specific for schizophrenia (F20.XXX) hallucinations or nonsense can also be assessed as non-controvent mood. But if these symptoms are clearly pronounced and long-term, the diagnosis of schizoaffective disorder is more appropriate (F25.-). Turn on: - parietal schizophrenia, manic-delusional state; - Manico-depressive psychosis with a manic-crazy state with an unidentified type of flow. - mania with the appropriate mood psychotic symptoms; - mania with inappropriate mood psychotic symptoms; - Manic stupor. F30.23 Manico-delusional state with Congored Affect Bredom It turns on: - manico-depressive psychosis with a manic-crazy state with an unidentified type of flow. F30.24 Manico-delusional state with uncongenant affect nonsense Turns on: - parotid schizophrenia, manic-delusional state. F30.28 Other mania with psychotic symptoms Turns on: - Manic stupor. F30.8 Other manic episodes F30.9 Manic Episode Uncomfortable Turns on: - Mania BDU. / F31 / bipolar affective disorder Disorder, characterized by repeated (at least two) episodes, in which the mood and level of activity are significantly violated. The CTI changes are that in some cases a mood is noted, increased energy and activity (mania or hypomania), in other reduction in mood, reduced energy and activity (depression). Recovery is usually complete between the attacks (episodes), and the morbidity of both men and women are about the same, unlike other mood disorders. Since patients suffering from repeated episodes of Mania relatively rarely meet and can resemble (on a family history, premature features, the start of the disease and the forecast) of those who also have at least rare depression episodes, these patients should be qualified as bipolar (F31.8) . Manicane episodes usually begin to suddenly and last 2 weeks to 4-5 months (the average duration of the episode is about 4 months). Depressed tend to a longer flow (average duration of about 6 months), although rarely more than a year (excluding senior patients). And those and other episodes are often followed by stressful situations or mental injuries, although their presence is not mandatory for diagnosis. The first episode may arise at any age, starting with childhood and ending old age. The frequency of episodes and the nature of remission and exacerbations are very diverse, but remissions tend to shortening with age, and depression becomes more often more and more than middle age. Although the former concept of "manic-depressive psychosis" included patients who suffered only from depression, the term "TIR" is now used mainly as a synonym for bipolar disorder. Turn on: - Manico-depressive psychosis with a manic-crazy state, bipolar type; - Manico-depressive psychosis with a depressive-bridal state, bipolar type; - manico-depressive disease; - manico-depressive reaction; - parotid schizophrenia with bipolar affect, manic-delusional state; - Top-shaped schizophrenia with bipolar affect, depressive-delusional state. Excluded: - bipolar disorder, single manic episode (F30.-); - cyclotimia (F34.0). F31.0 bipolar affective disorder, the current episode of hypomania Diagnostic instructions: for a reliable diagnosis: a) The current episode meets the criteria of hypologia (F30.0); b) a history was at least another affective episode (depressive or mixed). F31.1 bipolar affective disorder, the current episode of mania without psychotic symptoms Diagnostic instructions: for reliable diagnosis: a) The current episode meets the criteria of mania without psychotic symptoms (F30.1); b) a history was at least another affective episode (depressive or mixed).

/F31.2/ bipolar affective disorder,

current episode with psychotic symptoms

Diagnostic instructions: for a reliable diagnosis: a) the current episode meets the criteria of mania with psychotic symptoms (F30.2x); b) Anamnesis had at least other affective episodes (depressive or mixed). If necessary, nonsense and hallucinations can be defined as "congruent" or "non-controvent" mood (see F30.2x). Turn on: - biporal schizophrenia with bipolar affect, manic-delusional state; - Manico-depressive psychosis with a manic-crazy basis, bipolar type. F31.23 Manico-delirious state, bipolar type, with a bred consumer agent It turns on: - Manico-depressive psychosis with a manic-crazy state, bipolar type. F31.24 Manico-delusional state, bipolar type, with uncongenant affect of nonsense Turns on: - biporal schizophrenia with bipolar affect, manic-delusional state. F31.28 Other Bipolar Affective Disorder, Current Episode Mania /F31.3/ Bipolar affective disorder, the current episode of light or moderate depression Diagnostic instructions: For a reliable diagnosis: a) the current episode must respond to the criteria for a depressive episode or light (F32.0X) or moderate gravity (F32.1X). b) In the past there must be at least one hypomaniacal, manic or mixed affective episode. The fifth sign is used to designate the presence or absence of somatic symptoms in the current episode of depression. F31.30 Bipolar affective disorder, the current episode of light or moderate depression without somatic symptoms F31.31 bipolar affective disorder, the current episode of light or moderate depression with somatic symptoms F31.4 Bipolar affective disorder, the current episode of severe depression without psychotic symptoms Diagnostic instructions: for a reliable diagnosis: a) the current episode meets the criteria of a severe depressive episode without psychotic symptoms (F32.2); b) In the past there must be at least one hypomaniacal, manic or mixed affective episode.

/F31.5/ bipolar affective disorder,

current episode of severe depression

with psychotic symptoms

Diagnostic instructions: for a reliable diagnosis: a) the current episode meets the criteria of a severe depressive episode with psychotic symptoms (F32.3X); b) In the past there must be at least one hypomaniacal, manic or mixed affective episode. If there is a need, nonsense or hallucinations can be defined as congbents or uncongenant moods (see F30.2x). F31.53 Depressive-delusional state, bipolar type, with a congruent affect of nonsense It turns on: - Manico-depressive psychosis with depressive-crazy fortune, bipolar type. F31.54 Depressive-delusional state, bipolar type, with uncongenant affect of nonsense Turns on: - parotid schizophrenia with bipolar affect, depressive-delusional state. F31.58 Other Bipolar Affective Disorder, Current Episode Heavy Depression with other psychotic symptoms F31.6 Bipolar affective disorder, the current episode of a mixed character in the patient should have at least one manic, hypomaniacal, depressive or mixed affective episode in the past. In this episode, either mixed or quickly alternating manic, hypomanical or depressive symptoms are found. Diagnostic instructions: Although the most typical forms of bipolar disorders are characterized by alternating manic and depressive episodes, separated periods of normal mood, often depressive state is accompanied during days or weeks with hyperactivity, speech pressure. Or, the manic mood and ideas of magnitudes can be accompanied by a settling, a decrease in activity and libido. Depressive symptoms, hypologia or mania can also quickly alternate day by day or even within a few hours. The diagnosis of mixed bipolar affective disorder can be delivered if there are 2 sets of symptoms in which both are pronounced for most of the disease, and if this episode lasts at least 2 weeks. Eliminated: - a single affective episode of mixed nature (F38.0x). F31.7 Bipolar affective disorder, current remission The patient must have at least one reliable manic, hypomaniacal, depressive or mixed affective episode in the past and additionally at least another affective episode of hypomania, mania, depression or mixed type, but currently there are no affective disorders. The patient may, however, be on treatment to reduce the risk of the disease in the future. F31.8 Other bipolar affective disorders include: - bipolar disorder, type II; - recurrent (recurrent) manic episodes. F31.9 Bipolar affective disorder Uncomputed / F32 / Depressive Episode In typical cases in all 3 versions described below (light episode F32.0X; Moderate - F32.1X; Heavy - F32.2 or F32.3X), the patient suffers from reduced mood, loss of interests and pleasure, reducing energeticness, which can lead to increased fatigue and reduced activity. There is a pronounced fatigue even with a minor effort. Other symptoms include: a) reduced ability to concentrate and attention; b) reduced self-esteem and sense of self-confidence; c) ideas of guilt and humiliation (even with a light type of episode); d) gloomy and pessimistic vision of the future; e) ideas or actions aimed at self-injury or suicide; e) disturbed sleep; g) reduced appetite. The reduced mood ranges little during days, and often there is no reaction to the surrounding circumstances, but there may be characteristic daily fluctuations. As for manic episodes, clinical picture It discovers individual variability, and in adolescence, atypical paintings are particularly often observed. In some cases, the alarm, despair and motor assessment may be more pronounced than depression, and mood changes can also be masked by additional symptoms: irritability, excessive use of alcohol, hysterical behavior, exacerbation of preceding phobic or obsessive symptoms, and hypochondriad ideas. For depressive episodes of all 3 degrees of gravity, the duration of the episode should be at least 2 weeks, but the diagnosis can be delivered for shorter periods, if the symptoms are unusually heavy and occur quickly. Some of the above symptoms can be pronounced and detect characteristic features that are considered as having a special clinical value. The most typical example is "somatic" (see introduction to this section) Symptoms: the loss of interests and pleasure from activities that normally gives pleasure; The loss of emotional reactivity at the environment and events that are nicked normally; Awakening in the morning for 2 or more hours earlier than in normal time; Depression is hard in the morning hours; Objective data on a clear psychomotor inhibition or an agitation (marked by a stranger); clear decline in appetite; weight loss (it is believed that 5% of weight loss in weight during the last month); severe decline in libido. This somatic syndrome is usually considered to be present in the presence of at least 4 mentioned symptoms. The category of light (F32.0X), moderate (F32.1X) and severe (F32.2 and F32.3X) of the depressive episode should be used for a single (first) depressive episode. Further depressive episodes should be qualified in one of the recurrent depressive disorders (F33.-). Three severity are so designated to turn on a large range clinical conditionswho are found in psychiatric practice. Patients with light shapes of depressive episodes are often found in primary medical and general medical institutions, while stationary branches are mainly dealing with patients who have a more severe depression. Self-accepting actions, most often self-defined by drugs discharged from affective disorders, should be registered with an additional code from class XX MKB-10 (X60 - X84). These codes do not include differentiation between an attempt to suicide and "parasuicide". Both of these categories are included in the general category of self-injunction. The differentiation between a light, moderate and severe degree is based on a complex clinical assessment, which includes the number, type and severity of the symptoms present. Fullness of ordinary social and labor activity can often help in determining the severity of the episode. However, individual social and cultural influences that tear the relationship between the severity of symptoms and social productivity, quite frequent and strong, and therefore it is not advisable to include social productivity as the main criterion of gravity. The presence of dementia (F00.XX - F03.x) or mental retardation (F70.XX - F79.HX) does not exclude the diagnosis of an Kuraboral depressive episode, but due to the difficulties of communication, it is necessary more than in normal cases, rely on objectively observed somatic symptoms , such as psychomotor inhibition, loss of appetite, weight and sleep disorders. Turn on: - Manico-depressive psychosis with a depressive-crazy basis with a continuous type of flow; - depressive episode with manic-depressive psychosis; - parietal schizophrenia, depressive-delusional state; - a single episode of the depressive reaction; - big depression (without psychotic symptoms); - a single episode of psychogenic depression (F32.0; F32.1; F32.2 or F32.38, depending on the severity). - a single episode of reactive depression (F32.0; F32.1; F32.2 or F32.38, depending on the degree of severity). Excluded: - disorder of adaptive reactions (F43.2x); - recurrent depressive disorder (F33.-); - Depressive episode associated with behavioral disorders classified under the headings F91.x or F92.0.

/F32.0/ Depressive Episode of Easy

Diagnostic instructions: reduced mood, loss of interests and ability to enjoy, increased fatigue is usually considered the most typical symptoms of depression. For a reliable diagnosis, at least 2 of these 3-symptoms are needed, plus at least 2 of the other symptoms described above (for F32). None of these symptoms should achieve a deep degree, and the minimum duration of the entire episode is about 2 weeks. A person with a slight depressive episode is usually concerned about these symptoms and it makes it difficult to fulfill the usual work and be socially active, however, it is unlikely to stop fully functioning. The fifth sign is used to designate somatic syndrome. F32.00 Depressive Episode of Light Without Somatic Symptoms The criteria of a lung depressive episode are performed, but not necessarily, only some somatic symptoms. F32.01 The depressive episode of a light degree with somatic symptoms is satisfied with the criteria of a light depressive episode and there are 4 or more somatic symptoms (this category can be used if only 2 or 3 is present, but sufficiently heavy).

/F32.1/ Depressive Episode of Middle Extent

Diagnostic instructions: Must at least 2 of the 3 most typical symptoms should be present for a light degree of depression (F32.0), plus at least 3 (and preferably 4) other symptoms. Several symptoms can be pronounced, but it is optional if there are many symptoms. The minimum duration of the entire episode is about 2 weeks. The patient with a depressive episode of Middle degree is experiencing significant difficulties in fulfilling social duties, homework, in continuing work. The fifth sign is used to determine somatic symptoms. F32.10 Depressive Episode of Middle Extent Without Somatic Symptoms Criteria are satisfied for the depressive episode of moderately, despite the fact that there are only some or there are no somatic symptoms at all. F32.11 The depressive episode of the average degree with somatic symptoms is satisfied with the criteria for the depressive episode of the average degree, despite the fact that there are 4 or more somatic symptoms. (You can use this category if there are only 2 or 3 somatic symptoms, but they are unusually severe). F32.2 A depressive episode of severe without psychotic symptoms with a severe depressive episode of the patient detects considerable concern and coittedness. But there may be a pronounced inhibition. There may be pronounced loss of self-esteem or a sense of worthlessness or guilt. Suicides are undoubtedly dangerous in particularly severe cases. It is assumed that somatic syndrome is almost always present with a severe depressive episode. Diagnostic instructions: There are all 3 of the most typical symptoms characteristic of the mild and moderate degree of depressive episode, plus the presence of 4 and more other symptoms, some of which should be severe. However, if there are symptoms such as assessment or inhibition, the patient may not want or can not describe many other symptoms in detail. In these cases, the qualifications of such a state as a heavy episode can be justified. The depressive episode should last at least 2 weeks. If the symptoms are especially difficult and started very sharp, justified the diagnosis of severe depression and if there is an episode of less than 2 weeks. During a heavy episode, it is unlikely that the patient continued social and homework, performed his work. Such activity can be performed very limited. This category should be used only for a single severe depressive episode without psychotic symptoms; In case of subsequent episodes, a sub-section of a recurrent depressive disorder is used (F33.-). Turn on: - a single episode of the arrangement of depression without psychotic symptoms; - Melancholy without psychotic symptoms; - Vital depression without psychotic symptoms; - Significant depression (a single episode without psychotic symptoms).

/F32.3/ depressive episode of severe

with psychotic symptoms

Diagnostic instructions: a severe depressive episode that meets the criteria F32.2 is complemented by the presence of nonsense, hallucinations or depressive stupor. Chared is more often the following content: sinfulness, impoverishment, threatening unhappiness, for which the responsibility of the patient is responsible. Hearing or olfactory hallucinations, as a rule, accusing and insulting the nature of the "voices", and smells - rotting meat or dirt. Heavy motor inhibition can develop in a stupor. If necessary, nonsense or hallucinations can be defined as congro-or uncongenant moods (see F30.2x). Differential diagnosis: depressive stupor must be differentiated from catatonic schizophrenia (F20.2XX), from dissociative stupor (F44.2) and from organic filling forms. This category should be used only for a single episode of severe depression with psychotic symptoms. For subsequent episodes, it is necessary to use a recurrent depressive disorder (F33.-). Turn on: - Manico-depressive psychosis with a depressive-crazy basis with a continuous type of flow; - parietal schizophrenia, depressive-delusional state; - a single episode of large depressions with psychotic symptoms; - a single episode of psychotic depression; - a single episode of psychogenic depressive psychosis; - a single episode of reactive depressive psychosis. F32.33 Depressive-delusional Condition with Congraent Affect Bredom It turns on: - Manico-depressive psychosis with a depressive-crazy condition with a continuous type of flow. F32.34 Depressive-delusional state with uncongenant affect nonsense It turns on: - parietal schizophrenia, depressive-delusional state. F32.38 Another depressive episode of severe with other psychotic symptoms Turn on: - a single episode of large depression with psychotic symptoms; - a single episode of psychotic depression; - a single episode of psychogenic depressive psychosis; - a single episode of reactive depressive psychosis.

F32.8 Other Depressive Episodes

This includes episodes that do not correspond to the description of depressive episodes in F32.0x - F32.3X, but which give reason to consider the clinical impression that it is depressed by nature. For example, a fluctuating mixture of depressive symptoms (especially a somatic option) with non-diagnostic symptoms, such as voltage, concern or despair. Or a mixture of somatic depressive symptoms with constant pain or depletion, not caused by organic reasons (as it happens in patients who are in general hospitals). Turn on: - Atypical depression; - a single episode "masked" ("hidden") depression BDU.

F32.9 Depressive Episode Uncomfortable

Turn on: - Depression BDA; - Depressive disorder BDA.

/ F33 / Recurrent Depressive Disorder

Disorder, characterized by repeated episodes of depression, as indicated in F32.0x - a depressive episode of a light degree, or F32.1X - a medium degree or F32.2 - a depressive episode of severe, without anamnestic data on individual episodes of high spirits, hyperactivity that could respond Mania criteria (F30.1 and F30.2X). However, this category can be used if there is data on short episodes of lightweight mood and hyperactivity that meet the criteria of hypologia (F30.0) and which follow directly following the depressive episode (sometimes they may be provoked by treating depression). The age of the beginning, the severity, duration and frequency of episodes of depression is very diverse. In general, the first episode arises later than with bipolar depression: on average in the fifth decade of life. The duration of episodes is 3-12 months (average duration - about 6 months), but they tend to rarely repeated. Although the recovery is usually complete in the intergreacy period, a small part of the patients detect chronic depression, especially in old age (this rubric is used for this category of patients). Separate episodes of any gravity often provoke stressful situation And in many culture conditions, 2 times more often in women than in men. The risk that the patient with a recurrent depressive episode will not be an episode with Mania, cannot be completely excluded, no matter how much depressive episodes are in the past. If an episode arises, the diagnosis must be changed to a bipolar affective disorder. The recurrent depressive disorder can be divided, as will be indicated below, by designating the type of the current episode, and then (if there is sufficient information) of the prevailing type of previous episodes. Turn on: - Manico-depressive psychosis, monopolar-depressive type with psychotic symptoms (F33.33); - parotid schizophrenia with monopolar-depressive affect, depressive-delusional state (F33.34); - recurrent episodes of the depressive reaction (F33.0x or F33.1X); - recurrent episodes of psychogenic depression (F33.0x or F33.1X); - recurrent episodes of reactive depression (F33.0x or F33.1X); - seasonal depressive disorder (F33.0x or F33.1); - recurrent episodes of endogenous depression (F33.2 or F33.Z8); - recurrent episodes of manic-depressive psychosis (depressive type) (F33.2 or F33.Z8); - recurrent episodes of vital depression (F33.2 or F33.Z8); - recurrent episodes of large depression (F33.2 or F33.Z8); - recurrent episodes of psychotic depression (F33.2 or F33.Z8); - recurrent episodes of psychogenic depressive psychosis (F33.2 or F33.C8); - recurrent episodes of reactive depressive psychosis (F33.2 or F33.Z8). Excluded: - short-term recurrent depressive episodes (F38.10).

/F33.0/ Recurrente depressive disorder,

current Episode

Diagnostic instructions: For a reliable diagnosis: a) Criteria of recurrent depressive disorder (F33.-) are satisfied, and the current episode meets the criteria for a depth-second Episode of a light degree (F32.0x); b) At least 2 episodes should last at least 2 weeks and should be separated by an interval of several months without any significant mood disorders. Otherwise, it is necessary to use the diagnosis of other recurrent affective disorders (F38.1X). The fifth sign is used to designate the presence of somatic symptoms in the current episode. If necessary, you can designate the prevailing type of previous episodes (light, medium, heavy, indefinite). F33.00 Recurrent Depressive Disorder, Current Episode of Easy without somatic symptoms The criteria of a lung depressive episode are performed, but not necessarily, only some somatic symptoms. F33.01 Recurrent depressive disorder, the current episode of which with somatic symptoms The criteria of a lung depressive episode are satisfied and there are 4 or more somatic symptoms (you can use this category if only 2 or 3 are present, but quite heavy).

/F33.1/ Recurrente depressive disorder,

middle Episode

Diagnostic instructions: For a reliable diagnosis: a) the criteria of the recurrent depressive disorder (F33.-) must be satisfied, and the current episode must respond to the criteria for the depressive episode of the average degree (F32.1x); b) at least 2 episodes should last at least 2 weeks and should be separated by an interval of several months without significant mood disorders; Otherwise, we need to use recurrent affective disorders (F38.1X). The fifth sign is used to denote the presence of somatic symptoms in the current episode: if necessary, it is possible to designate the prevailing type of previous episodes (light, medium, heavy, indefinite). F33.10 Recurrent depressive disorder, the current Episode of Middle Degree without somatic symptoms Criteria are satisfied for the depressive episode of moderately, despite the fact that there are only some or there are no somatic symptoms at all. F33.11 Recurrent depressive disorder, the current Episode of Middle Extent with somatic symptoms Criteria for the depressive episode of the average degree are satisfied, despite 4 or more somatic symptoms. (You can use this category if there are only 2 or 3 somatic symptoms, but they are unusually severe). F33.2 Recurrent depressive disorder, the current episode of severe degree without psychotic symptoms Diagnostic instructions: for a reliable diagnosis: a) Criteria of recurrent depressive disorder (F32.-) are satisfied, and the current episode meets the criteria of a severe depressive episode without psychotic symptoms (F32.2); b) at least 2 episodes should last at least 2 weeks and must be separated by interval of several months without significant mood disorders; Otherwise, it is necessary to encode another recurrent affective disorder (F38.1X). If necessary, you can designate the prevailing type of previous episodes (light, medium, heavy, uncertain). Turn on: - endogenous depression without psychotic symptoms; - significant depression, recurrence without psychotic symptoms; - manic-depressive psychosis, depressive type without psychotic symptoms; - Vital depression, recurrence without psychotic symptoms.

/F33.3/ Recurrente depressive disorder,

the current episode of severe with psychotic symptoms

Diagnostic instructions: For a reliable diagnosis: a) Criteria of recurrent depressive disorder (F33.-) are satisfied, and the current episode meets the criteria of a severe depressive episode with psychotic symptoms (F32.3X); b) at least 2 episodes should last at least 2 weeks and should be separated by an interval of several months without significant mood disorders; Otherwise, it is necessary to diagnose another recurrent affective disorder (F38.1X). If necessary, it is possible to point to a congruent or uncongenant mood character of nonsense or hallucinations. If necessary, you can designate the prevailing type of previous episodes (light, medium, heavy, indefinite). Includes: - parotid schizophrenia with monopolar-depressive affect, depressive-delusional state; - endogenous depression with psychotic symptoms; - Manico-depressive psychosis, monopolar-depressive type with psychotic symptoms; - repeated severe episodes of significant depression with psychotic symptoms; - repeated severe episodes of psychogenic depressive psychosis; - repeated severe episodes of psychotic depression; - repeated severe episodes of reactive depressive psychosis. F33.33 Manico-depressive psychosis, monopolar-depressive type with psychotic symptoms F33.34 Depressive-delusional state, monopolar type with uncongenant affect of nonsense It turns on: - parole schizophrenia with monopolar-depressive affect, depressive-delusional state. F33.38 Other Recurrent Depressive Disorder, Current Episode of Heavy Depression with other psychotic symptoms Turn on:

Endogenous depression with psychotic symptoms;

Repeated severe episodes of significant depression with psychotic symptoms; - repeated severe episodes of psychogenic depressive psychosis; - repeated severe episodes of psychotic depression; - repeated severe episodes of reactive depressive psychosis. F33.4 Recurrent depressive disorder, current state of remission Diagnostic instructions: for a reliable diagnosis: a) the recurrent depressive disorder criteria (F33.-) are satisfied for past episodes, but the current state does not correspond to the criteria for the depressive episode of any extent and does not meet the criteria for other disorders under the heading F30.- - F39; b) at least 2 episodes in the past must be a duration of at least 2 weeks and they must be separated by an interval of several months without any significant mood disorders; Otherwise, another recurrent affective disorder should be encoded (F38.1X). This category can be used if a person is on treatment to reduce the risk of subsequent episodes.

F33.8 Other recurrent depressive disorders

F33.9 Recurrent Depressive Disorder Uncomfortable Turns on: - Monopolar depression BDU.

/ F34 / Sustainable (chronic) mood disorders

(affective disorders)

Disorders included in this category are chronic and usually flushing in nature, where individual episodes are not deep enough so that they can be determined as hypomania or easy depression. Since they last year, and sometimes throughout the life of the patient, they cause anxiety and can lead to a violation of productivity. In some cases, the recurrent or single episodes of manic disorder, light or severe depression can be superimposed on chronic affective disorder. Chronic affective disorders are here, and not in the category of personal disorders, since from family history it becomes known that such patients are genetically associated with relatives who have mood disorders. Sometimes such patients react well to the same therapy as patients with affective disorders. Options for both early and late start cyclotimia and distortimia are described, and if necessary, they must be denoted.

F34.0 cyclotimia

The state of chronic mood instability with numerous episodes of easy depression and lightweight. This instability is usually developing at a young age and takes a chronic course, although at times mood may be normal and stable for many months. Mood changes are usually perceived by a person as not related to life events. To diagnose is not easy if the patient does not have a long time or no good description of behavior in the past. Due to the fact that changes in the mood is relatively lungs, and periods of raisingness delivered pleasure, cyclotimia rarely falls into the field of view of doctors. Sometimes this is due to the fact that changes in mood, although there are less distinct, than cyclical changes in activity, in sense of self-confidence, sociability or in the change of appetite. If necessary, it can be designated when it was started: early (in adolescence or up to 30 years old) or later. Diagnostic instructions: the main feature in the diagnosis is constant, chronic mood instability with numerous periods of easy depression and lightweight, none of which was rather pronounced or long to meet the criteria for bipolar affective disorders (F31.-) or recurrent depressive disorder ( F33.-) This means that individual mood changes are not responding to the criteria of a manicane episode (F30.-) or a depressive episode (F32.-). Differential diagnosis: This disorder is often encountered in relatives of patients with bipolar affective disorder (F31.-). Sometimes some faces with cyclotimia subsequently may suffer from a bipolar affective disorder. Cyclotimia can flow throughout the adult life, temporarily or finally interrupted, or develop in a more severe mood disorder, responding to a description of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). Included: - affective personality disorder; - cycloid personality; - Cyclotymic (cyclotem) personality. F34.1 Distimia This is a chronic depressive mood, which currently does not correspond to the description of the recurrent depressive disorder of light or moderate gravity (F33.0x or F33.1x) or in gravity, nor the duration of individual episodes (although in the past there could be separate episodes that correspond to the criteria for light depressive Episode, especially at the beginning of the disorder). The balance between the individual episodes of light depression and periods relative to the normal state is very variable. These people have periods (days or weeks), which they themselves regard as good. But most of the time (often months) they feel fatigue and reduced mood. Everything becomes difficult and nothing pleasure. They are prone to gloomy reflections and complain that they feel bad and feel uncomfortable, but in general they cope with the basic requirements of everyday life. Therefore, Distimia has a lot in common with the concept of deponsive neurosis or neurotic depression. If necessary, you can note the start time of the disorder as early (in adolescence or up to 30 years) or later. Diagnostic instructions: The main feature is a long-term reduced mood, which is never (or very rare) is not sufficient to meet the criteria for recurrent depressive disorder of light or decay (F33.0x or F33.1x). Usually, this disorder begins at a young age and lasts for several years, sometimes indefinitely long. When such a state occurs later, this is most often the consequence of a depressive episode (F32.-) and is associated with a loss of a loved one or other obvious stress situations. Turn on: - chronic disturbing depression; - depressive neurosis; - depressive personality disorder; - Neurotic depression (for a duration of more than 2 years). Excluded: - alarming depression (light or unstable) (F41,2); - the response of the loss, which lasts less than 2 years (prolonged depressive reaction) (F43.21); - residual schizophrenia (F20.5XX). F34.8 Other Sustainable (Chronic) Mood Disorders (Affective disorders) This residual category includes chronic affective disorders that are not heavy or durable to meet the criteria of cyclotimia (F34.0) or Distimia (F34.1), but at the same time clinically significant. Some types of depression, which were previously called "neurotic", included in this heading in cases where they do not meet the criteria of cyclotimia (F34.0) or Distimia (F34.1), or a depressed episode of light (F32.0x) or moderate (F32.1X). F34.9 Sustainable (chronic) mood disorder (affective disorder) uncomfortable / F38 / Other mood disorders (Affective disorders) /F38.0/ Other single disorders mood (Affective disorders) F38.00 Mixed affective episode Affective episode, which is not less than 2 weeks and characterized either mixed or quickly alternating (usually for several hours) hypomaniacal, manic and depressed symptoms. F38.08. Other single mood disorders (affective disorders) /F38.1/ Other recurrent disorders mood (Affective disorders) Short-term depressive episodes arising about once a month over the past year. All individual episodes lasting 2 weeks (in typical cases - 2-3 days, with complete recovery), but correspond to the criteria of a depressive episode of light, moderate or severe (F32.0x, F32.1X, F32.2). Differential diagnosis: Unlike Distimia (F34.1), patients are not depressed with the bulk of the time. If a depressive episode occurs due to the menstrual cycle, it is necessary to use the heading F38.8, with the second code that caused this condition of the cause (N94.8, pain and other states associated with the female sexual organs and the menstrual cycle). F38.10 Recurrente short-term depressive disorder F38.18 Other recurrent mood disorders (Affective disorders) F38.8 Other refined mood disorders (Affective disorders) This is a residual category for affective disorders that do not meet the criteria of categories F30.0 - F38.18.

F39 Mood Disorder

(Affective disorder)

Used only in the case when there are no other definitions. Turns on: - Affective psychosis BDA. It is excluded: - Mental disorder BDA (F99.9).