ICD-11 Criteria for Autism Spectrum Disorder

ICD-11 Criteria for Autism Spectrum Disorder (6A02)

Autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual’s age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual’s functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.

Inclusions:              

• Autistic disorder

Exclusions:             

• Rett syndrome (LD90.4)

6A02.0     Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language

All definitional requirements for autism spectrum disorder are met, intellectual functioning and adaptive behaviour are found to be at least within the average range (approximately greater than the 2.3rd percentile), and there is only mild or no impairment in the individual's capacity to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires.

6A02.1      Autism spectrum disorder with disorder of intellectual development and with mild or no impairment of functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is only mild or no impairment in the individual's capacity to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires.

6A02.2       Autism spectrum disorder without disorder of intellectual development and with impaired functional language

All definitional requirements for autism spectrum disorder are met, intellectual functioning and adaptive behaviour are found to be at least within the average range (approximately greater than the 2.3rd percentile), and there is marked impairment in functional language (spoken or signed) relative to the individual’s age, with the individual not able to use more than single words or simple phrases for instrumental purposes, such as to express personal needs and desires.

6A02.3      Autism spectrum disorder with disorder of intellectual development and with impaired functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is marked impairment in functional language (spoken or signed) relative to the individual’s age, with the individual not able to use more than single words or simple phrases for instrumental purposes, such as to express personal needs and desires.

6A02.5      Autism spectrum disorder with disorder of intellectual development and with absence of functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is complete, or almost complete, absence of ability relative to the individual’s age to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires

6A02.Y        Other specified autism spectrum disorder

6A02.Z         Autism spectrum disorder, unspecified

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

Psychiatry Board Review: Pearls of Wisdom, Third Edition

Rebecca A. Schmidt

April 18, 2019

• 
  
• Pearls of Wisdom: Third Edition contains more than 2,300 quick-hit questions and answers addressing the most frequently tested topics on psychiatry board and in-service examinations. Only the correct answers are given, so only the correct answers can be memorized. The rapid-fire question-and-answer format with checkboxes to mark which questions to come back to lends itself to studying alone or with a partner. Every question in this edition has been carefully evaluated to make sure it is completely up-to-date. The new edition addresses four sections of major importance on the boards: General Information; Psychopathology (such as eating disorders and sleep disorders); Special Topics (such as substance abuse and child psychiatry); and Treatment Modalities.
• Market: Psychiatry Residents seeking certification in psychiatry (1,200 per year) Recertifying Psychiatrists (750 per year); recertification is required every ten years. Residents preparing for yearly in-service examinations (4,800 per year)
• Unique “flashcards in a book” format allows test-takers to quickly evaluate their knowledge of the content, and complements studying with a partner.
• The format complements other review material and works well with larger course books.

Psychiatry Board Review: Pearls of Wisdom, Third Edition

Publisher: McGraw Hill LLC

ISBN: 9780071549691

About the author (2009)

Rebecca A. Schmidt, MD, is a child and adolescent psychiatry consultant in Omaha, Nebraska.

Superego Cafe

The Critical Appraisal Company

For more than 22 years, healthcare professionals have enjoyed visiting Superego Cafe. Superego Cafe is a medical education startup, that offers online, in-person, and customised training programs for health. Superego Cafe, a trainee psychiatrist website, was launched in 1999. It expanded to include a critical appraisal, ongoing professional development, and MRCPsych exam preparation courses. The webmaster of PsychClub.com's Superego Cafe's MRCPsych Forum was Dr Gurpal Singh Gosall. This website, the top online resource for MRCPsych exam applicants, was created and is now run by him. The website has received positive reviews from the British Medical Journal and Hospital Doctor magazine. To address the demand for our distinctive training method in healthcare organisations and the pharmaceutical business, not just in the UK but also across the rest of Europe, the Middle East, and Australasia, a new subsidiary, The Critical Appraisal Company, was created in 2013.

The critical evaluation assessment has been added to different specialities' training curricula. Now that the company has developed, all medical and dental professionals can take advantage of our training programmes. They now provide virtual training sessions and online courses after launching fresh online content on their website. Please send us an email at office@criticalappraisal.com to learn more about the courses we offer.

The Critical Appraisal Company operates under the trading name Superego Café.

The Doctor’s Guide to Critical Appraisal (5th edition, 2020)

Written by two tutors of The Critical Appraisal Company and published by PasTest, The Doctor’s Guide to Critical Appraisal is a comprehensive and up-to-date review of clinicians' knowledge and skills to appraise clinical research papers.

This new edition expands on the award-winning third edition with a modified structure, new and updated chapters, new figures and scenarios, and more help with difficult topics. Also includes excerpts from real clinical papers to illustrate key concepts.

The Doctor’s Guide to Critical Appraisal is used worldwide by doctors, dentists, nurses, medical students and researchers. The book can help develop the knowledge and skills to appraise clinical research papers effectively. It provides essential reading for a range of postgraduate examinations, including MRCGP, MRCPsych, FCEM, FRCS, MRCOG, ISFE, MFPH and FPM.

This latest edition of the award-winning book is available at all good bookshops. It is also included with the Critical Appraisal Masterclass and Workshop.

MRCPsych CASC Notes

The Royal College of Psychiatrists' Clinical Assessment of Skills and Competencies (CASC) examination was created to evaluate the clinical competencies expected of trainees following 30 months of training. It is the last obstacle to clearing before becoming a full member of the College. This book aims to aid readers in passing what could seem to be a challenging examination by giving them the essential theory.

Reference Type:  Book

Record Number: 511

Author: Dutta, A. and Bhandary, N.M.

Year: 2010

Title: MRCPsych CASC Notes

Publisher: Lulu.com

Short Title: MRCPsych CASC Notes

ISBN: 9781445702032

URL: https://books.google.com.pk/books?id=ySnpAQAAQBAJ

Get Through MRCPsych Part 2: Clinical Exam: Long Case Presentations

"Get Through MRCPsych Part 2: Clinical Exam: Long Case Presentations" is a comprehensive guide to preparing for the clinical component of the MRCPsych exam. This book is specifically designed to help candidates prepare for the long case presentation component of the exam, which is an important aspect of the MRCPsych clinical examination.

Ace the MRCPsych Clinical Exam with 'Get Through MRCPsych Part 2: Clinical Exam: Long Case Presentations.' Your comprehensive guide to preparing for the long case presentation and other key components of the exam. Get ready to showcase your expertise in psychiatry and take your career to the next leve

The book provides a detailed overview of the MRCPsych clinical examination format and covers the key skills and knowledge that candidates need to demonstrate during the exam. The book is well-structured, with clear explanations of the examination process and helpful advice on how to prepare and perform well on the day of the exam.

One of the strengths of this book is its focus on the long case presentation, which is a unique and challenging aspect of the MRCPsych clinical examination. The book provides numerous examples of long case presentations, as well as practical tips on how to structure and present a compelling case study. This makes the book an essential resource for any candidate preparing for the MRCPsych clinical examination.

In addition to its comprehensive coverage of the long case presentation, the book also includes important information on other aspects of the MRCPsych clinical examination, including the short case presentation, the mental state examination, and communication skills. This makes the book an all-in-one resource for MRCPsych candidates, providing everything they need to know to prepare for and succeed on the clinical examination.

Overall, "Get Through MRCPsych Part 2: Clinical Exam: Long Case Presentations" is a well-written, comprehensive guide to the MRCPsych clinical examination. Whether you are a trainee psychiatrist, a consultant psychiatrist, or simply looking to enhance your knowledge and skills in psychiatry, this book is an essential resource for your MRCPsych exam preparation.

New MRCPsych Paper II Mock MCQ Papers

The Royal College of Psychiatrists has recently changed the format of its membership examination to adopt multiple-choice questions (MCQs). The book of mock MCQ papers includes 650 questions and answers covering all subjects of the Paper II curriculum. It is an essential aid for all candidates preparing for the MRCPsych Paper II, and will also be useful for those revising for the related Paper I and Paper III examinations.

Reference Type:  Book

Record Number: 510

Author: Badrakalimuthu, V.

Year: 2009

Title: New MRCPsych Paper II Mock MCQ Papers

Publisher: CRC Press

Short Title: New MRCPsych Paper II Mock MCQ Papers

ISBN: 9781846193958

The New MRCPsych Paper II Practice MCQs and EMIs

Clare Oakley, Oliver White

Published: 2008

The structure of the MRCPsych examination has changed significantly. This book is specifically written for the new exam, providing 250 practice best-of-five multiple choice questions (MCQs) and 100 extended matching item (EMI) questions for Paper II. It contains clear, concise answers to questions, along with explanatory notes and further reading for each topic. It gives practical advice on the format and content of the examination and techniques for answering questions. It is comprehensive and authoritative: both authors are members of the Psychiatric Trainees' Committee of the Royal College of Psychiatrists. This is an essential revision aid for candidates sitting Paper II of the MRCPsych examination.

• Reference Type:  Book
• Record Number: 509
• Author: Oakley, C. and White, O.
• Year: 2008
• Title: The New MRCPsych Paper II Practice MCQs and EMIs
• Publisher: Radcliffe Publishing
• Short Title: The New MRCPsych Paper II Practice MCQs and EMIs
• ISBN: 9781846192852

Cardiff CASC Training

Royal College CASC exam, since its advent in 2008, has posed a challenge for trainees which is evident in low pass percentages. There had been a need for structured and formal training for the CASC exam in Wales.

Cardiff CASC Training (CCT) has been formed in 2012, to lead the CASC training in Wales. It has got seven members, all in different sub specialties of psychiatry.

Training is organizing CASC examination practice sessions in the form of training days every year. The events are designed to boost the confidence of participants by replicating Royal College examination environment.

Cardiff CASC Training is a non-profit organization (Reg.no 08038178). We have links with Wales Deanery in terms of sponsorship and support. We also receive some contribution from pharmaceutical companies.

Contact

2 Narcissus Grove
Rogerstone
Newport
Gwent NP10 9LP

E: contact@cardiffcasctraining.co.uk

CCT Website

MRCPsych Paper I One-Best-Item MCQs: With Answers Explained

The past decade has seen several revisions to the MRCPsych examinations, but the latest changes have been the most radical. It is now a three-part written examination and a clinical assessment of skills and competencies. This has changed the focus of the 'new' MRCPsych Paper I, which now includes two thirds 'one-best-item-from-five' multiple choice questions (MCQs). This collection of 'one-best-item-from-five' style multiple choice questions mirrors the new format for the exam. Its companion volume Extended Matching Items for the MRCPsych Examinations Part 1 by Michael Reilly and Bangaru Raju remains relevant for the new format where EMIs make up one-third of the questions. Together, these two guides thoroughly prepare you for the revised format, incorporating the new areas of study such as basic ethics, philosophy and history of psychiatry, and stigma and culture. With varying degrees of question difficulty, a wide-range of styles and topics, and full explanations of answers overleaf, MRCPsych Paper I One-Best-Item MCQs is ideal for examination preparation and self-study.

Get Through MRCPsych Paper A2: Mock Examination Papers

Get Through MRCPsych Paper A2: Mock Examination Papers

The MRCPsych examinations, conducted by the Royal College of Psychiatrists, are the most important exams for the psychiatric trainees to achieve specialist accreditation.

Written by authors with previous exam experience and edited by the distinguished team behind Revision Notes in Psychiatry, Get Through MRCPsych Paper A: Mock Examination Papers provides candidates with the most realistic and up-to-date MCQ and EMIs, closely matched to themes appearing most often in the Paper A exam.

Get Through MRCPsych Paper A1: Mock Examination Papers

The MRCPsych examinations, conducted by the Royal College of Psychiatrists are the most important exams for psychiatric trainee to achieve specialist accreditation.

Written by authors with previous exam experience and edited by the distinguished team behind Revision Notes in Psychiatry, Get Through MRCPsych Paper A: Mock Examination Papers provides candidates with the most realistic and up-to-date MCQ and EMIs, closely matched to themes appearing most often in the Paper A exam.

Get Through MRCPsych Parts 1 and 2: 1001 EMIQs

Get Through MRCPsych Parts 1 and 2: 1001 EMIQs is an excellent and essential revision guide for all candidates taking the Membership examinations.

This is one of the first EMIQ books for the MRCPsych examinations. The Editor, Albert Michael, has written several successful MRCPsych texts and is a Consultant Psychiatrist. He and his team of 16 international contributors have created a unique selection of 1001 questions spread over the 200 themes which form the MRCPsych syllabus.

Topics featured include:

learning theory * diagnosis of eating disorders * uncommon syndromes * delerium * memory disorders * cognitive function tests * psychometry * couple therapy * drug dosing * mood stabilisers * dynamics of adverse effects * management of schizophrenia * child abuse * developmental syndromes * statistical concepts

Intermittent Explosive Disorder

Intermittent explosive disorder (IED) involved outbursts of impulsive aggression with no persistent mood disruption between the outbursts. It requires only 3 months for the total duration of two episodes every week on, average. There must have been At least three episodes with damage to property or injury to humans/animals within 12 months. It is diagnosed only if age is above 6 years. 

A man with explosive outburst depicted in a painting

See the ICD-11 Criteria for Intermittent explosive disorder here. 

Deficits in the prefrontal cortex on MRI have been associated with impulsivity (can aid diagnosis).¹

Findings of Etiological (but not necessarily diagnostic importance):

• Reduced prefrontal grey matter >> antisocial personality disorder.²
• Reduced amygdala volume has been associated with a lack of empathy.
• Increased amygdala responses to anger stimuli > Intermittent explosive disorder
• Elevated CSF testosterone >> aggressiveness interpersonal violence (men).³
• Low levels of CSF-5HIAA >> impulsive aggression, suicide victim.
• Reduced density of 5-HT transporter sites >> suicide victims.

Treatment

Psychotherapy is difficult; however, group psychotherapy may be helpful and family therapy is useful. A goal of therapy is to have the patient recognize and verbalize the thoughts or feelings that precede the explosive outbursts instead of acting them out. Anticonvulsants have long been used, with mixed results, in treating explosive patients: Lithium works. Carbamazepine, valproate or divalproex, and phenytoin have been reported helpful. Some clinicians have also used other anticonvulsants e.g., gabapentin. Benzodiazepines are sometimes used but have been reported to produce a paradoxical reaction of dyscontrol in some cases. Antipsychotics (e.g., phenothiazines and serotonin-dopamine antagonists) and tricyclic drugs have been effective in some cases. Still, clinicians must then question whether schizophrenia or a mood disorder is the true diagnosis. With a likelihood of subcortical seizure-like activity, medications that lower the seizure threshold can aggravate the situation. Selective serotonin reuptake inhibitors, trazodone, and buspirone are useful in reducing impulsivity and aggression. Propranolol (Inderal) and other β-adrenergic receptor antagonists and calcium channel inhibitors have also been effective in some cases. Some neurosurgeons have performed operative treatments for intractable violence and aggression. No evidence indicates that such treatment is effective. A combined pharmacological and psychotherapeutic approach has the best chance of success.

Bibliography

1. Sadock BJ, Sadock VA, Roiz P. Kaplan & Sadock Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Wolters; 2015:1499.
2. Raine A, Lencz T, Bihrle S, LaCasse L, Colletti P. Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder. Arch Gen Psychiatry. Feb 2000;57(2):119-27; discussion 128-9. doi:10.1001/archpsyc.57.2.119
3. Blair RJ. Neurobiological basis of psychopathy. Br J Psychiatry. Jan 2003;182:5-7. doi:10.1192/bjp.182.1.5

 

Obsession

An obsession is an intrusive thought or impulse that enters the mind despite efforts to exclude them. Most of the time, patients consider them false and totally against their own beliefs. For example, someone might think their hands are dirty and thus repeatedly wash their hands. But notice they clean their hands to reduce the distress of their intrusive thoughts. That is, they know their hands are clean, but due to the intrusive thoughts of dirt, they want to ensure that their hands are clean again. 

Delusion Definition and Types

A delusion is an unshakeable belief (we cannot change it with logical explanations or evidence) that is held on inadequate grounds (they do not have a valid explanation or evidence for their belief, and that is not a conventional belief that the person might be expected to hold given their educational, cultural, and religious background.  

Illusions are mostly but not always normal. Hallucinations are mostly but not always abnormal. But a delusion is something that is always abnormal. So, someone who believes to be possessed by the supernatural is not delusional because it’s a cultural common belief. In the west, many young girls become convinced that they need to be thin and take extreme measures, and their weight may reach life-threatening low levels and continue. And this is still not a delusion because they consider thinness socially desirable and they educate most people about the risks of obesity is dangerous and the need for thinness.

Persecutory delusions are the most common ones, in which they develop a belief that someone wants to harm them.

Common Types of Delusions

• Somatic delusions
• Grandiose delusions
• Bizzare delusion
• Capgras delusion
• Autochthonus delusion
• Cotard delusion
• Delusion of thought broadcasting
• Delusions of being controlled
• Delusions of reference
• Delusions of jealousy 
• Erotomanic delusions
• Foli a deux
• Fregoli delusion

A delusion may be primary or secondary. Primary delusions occur out of the blue, unexplainable by the patient's morbid experiences at the time. Secondary delusions arise occur against a background. For example, a patient with mania and grandiosity develops grandiose delusions. 

A delusional disorder is characterised by a single delusion or delusional system that persists for at least three months. Most of the time, these are persecutory delusions; delusions of jealousy, Foli a deux or Fregoli delusions may also occur.  In schizophrenia, delusions are more likely to be bizarre, primary, multiple and non-systematized. Grandiose delusion is more characteristic of mania. Patients with depression often have cotard delusions, delusions of poverty or hypochondriacal delusions. 

Loosening of Association

A loss of the normal structure of thinking.  The patient’s discourse seems muddled and illogical and does not become clearer with further questioning; there is a lack of general clarity, and the interviewer has the experience that the more he/she tries to clarify the patient’s thinking, the less we understand it.   Loosening of associations occurs mostly in patients with schizophrenia. Earlier psychopathologists have described three kinds of loosening of association:

Knight’s move thinking (Derailment, Entgleisen): 

There is a change in the train of thought. There is retained but misled determining of the objective of thought. There is a disordered intermixture of constituent parts of one complex thought. 

Talking past the point (vorbeireden) 

where the patient gets close to the point of discussion, but skirts around it and never actually reach it

Verbigeration (word salad, schizophasia, paraphrasia) 

where speech is reduced to a senseless repetition of sounds and phrases (this is more of a disorder of thought form)

Three types of loosening of associations. Word salad is the most severe form. 

Disorders of the Form of Thought

Form of thought

Form of thought is the way people experience or express thoughts and the way thoughts proceed one after the other irrespective of their quantity. It helps in the diagnosis of psychiatric disorders.

Normal thinking forms include the following. 

• Dereistic Thinking (daydreams)
• Imaginative thinking
• Rational thinking

Formal Thought Disorder

• The term ‘formal thought disorder’ is a synonym for disorders of conceptual or abstract thinking that are most seen in schizophrenia and organic brain disorders.
• In schizophrenia, disorders in the form of thinking may coexist with deficits in cognition, and these forms of thought disturbance may prove difficult to distinguish in certain cases.
• Cameron used the term ‘Asyndesis’ to describe the lack of adequate connections between successive thoughts.
• Cameron placed particular emphasis on ‘over-inclusion’, which is an inability to narrow down the operations of thinking and bring into action the organized attitudes and specific responses relevant to the task at hand

Perseveration: 

the patient retains a constellation of ideas long after they have ceased to be appropriate, for example, “where do you live?”, “London”, “How old are you”, “London”…

Explanatory concepts for formal thought disorder

• Loss of association (asyndesis)
• Concrete Thinking – inability to think abstractly; unable to differentiate between primary and secondary meanings of words
• Loss of redundancy (Cloze technique)
• Loss of internal monitoring with consequent inability to ‘repair’ thought processes (Frith)
• Impaired semantic memory or impaired access to this.

Schneider named five features of formal thought disorder: 

1. Derailment

2. Substitution

3. Omission

4. Fusion

5. Driveling

Schneider claimed that individuals with schizophrenia complained of three different disorders of thinking that correspond to these three features of normal or non-disordered thinking. 

Transitory thinking

Transitory thinking is characterized by derailments, substitutions, and omissions. An omission is distinguished from desultory thinking because in desultoriness the continuity is loosened but in omission, the intention itself is interrupted and there is a gap. The grammatical and syntactical structures are both disturbed in transitory thinking.

Driveling thinking

With driveling thinking, the patient has a preliminary outline of a complicated thought with all its necessary details but loses the preliminary organization of the thought, so that all the constituent parts get muddled together. A patient with driveling has a critical attitude towards their thoughts, but these are not organized and the inner material relationships between them become obscured and change significance.

Desultory thinking

In desultory thinking, speech is grammatically correct, but sudden ideas force their way in from time to time.

• Verschmelzung: fusion, ‘melting’,
• Faseln: muddling
• Entgleiten: snapping off
• Entgleisen: derailment

Disorders of the form of thought include flight of ideas, loosening of associations, circumstantiality, etc.

Physical Examination in Case of Alcohol Use Disorder

The examination begins with an inspection of the general demeanour and physique. 

General Physical Examination 

On general physical examination, observe signs of agitation, sweating, and bruises and note the respiratory rate. 

• Agitation or restlessness  
• Sweating  
• Bruises 
• Respiratory rate  

Examination of hands and arms

Examine the arms and hands for signs of hepatic disease or cerebellar dysfunction (tremor/dysdiadokokinesia and finger-nose test). 

Inspect for

• Palmar erythema
• Dupuytren’s contracture  
• Clubbing  
• Koilonychia  
• Nicotine stains 

Foundation URI : http://id.who.int/icd/entity/822487798

ICD-11 Criteria For Seasonal Pattern Of Mood Episode Onset

6A80.4 

Description

In the context of recurrent depressive disorder, bipolar type I or bipolar type II disorder, there has been a regular seasonal pattern of onset and remission of at least one type of episode (i.e., depressive, manic, mixed, or hypomanic episodes), with a substantial majority of the relevant mood episodes corresponding to the seasonal pattern. (In bipolar type I and bipolar type II disorder, all types of mood episodes may not follow this pattern.) A seasonal pattern should be differentiated from an episode that is coincidental with a particular season but predominantly related to a psychological stressor that regularly occurs at that time of the year (e.g., seasonal unemployment).

Diagnostic Requirements

This specifier can be applied if:

• In the context of Bipolar Type I or Bipolar Type II Disorder there has been a regular seasonal pattern of onset and remission of at least one type of episode (i.e., Depressive, Manic, Mixed, or Hypomanic Episodes); the other types of Mood Episodes may not follow this pattern; or
• In the context of Recurrent Depressive Disorder there has been a regular seasonal pattern of onset and remission of Depressive Episodes.
• A substantial majority of the relevant Mood Episodes should correspond with the seasonal pattern.
• A seasonal pattern should be differentiated from an episode that is coincidental with a particular season but predominantly related to a psychological stressor that regularly occurs at that time of the year (e.g., seasonal unemployment).

Reference:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

ICD-11 Criteria for Rapid Cycling in Mood Disorder

 6A80.5

Description

In the context of bipolar type I or bipolar type II disorder, there has been a high frequency of mood episodes (at least four) over the past 12 months. There may be a switch from one polarity of mood to the other, or the mood episodes may be demarcated by a period of remission. In individuals with a high frequency of mood episodes, some may have a shorter duration than those usually observed in bipolar type I or bipolar type II disorder. In particular, depressive periods may only last several days. If depressive and manic symptoms alternate very rapidly (i.e., from day to day or within the same day), a mixed episode should be diagnosed rather than rapid cycling.

Diagnostic Requirements

This specifier can be applied if the Bipolar Type I or Bipolar Type II Disorder is characterized by a high frequency of Mood Episodes (at least four) over the past 12 months. There may be a switch from one polarity of mood to the other, or the Mood Episodes may be demarcated by a period of remission.

In individuals with a high frequency of Mood Episodes, some may have a shorter duration than those usually observed in Bipolar Type I or Bipolar Type II Disorder. In particular, depressive periods may only last several days. However, if depressive and manic symptoms alternate very rapidly (i.e., from day to day or within the same day), a Mixed Episode should be diagnosed rather than rapid cycling.

Reference:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

 Foundation URI : http://id.who.int/icd/entity/1906190365

ICD-11 Criteria for Current Depressive Episode Persistent

6A80.2

Description

The diagnostic requirements for a depressive episode are currently met and have been met continuously for at least the past 2 years.

Diagnostic Requirements

This specifier can be applied if the diagnostic requirements for Depressive Episode are currently met and have been met continuously (five or more characteristic symptoms occurring most of the day, nearly every day) for at least the past 2 years.

Reference:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

ICD-11 Criteria for Current Depressive Episode With Melancholia

6A80.3

Description

In the context of a current Depressive Episode, several of the following symptoms have been present during the worst period of the current episode: loss of interest or pleasure in most activities that are normally enjoyable to the individual (i.e., pervasive anhedonia); lack of emotional reactivity to normally pleasurable stimuli or circumstances (i.e., mood does not lift even transiently with exposure); terminal insomnia (i.e., waking in the morning two hours or more before the usual time); depressive symptoms are worse in the morning; marked psychomotor retardation or agitation; marked loss of appetite or loss of weight.

Diagnostic Requirements

This specifier can be applied if, in the context of a current Depressive Episode, several of the following symptoms have been present during the worst period of the current episode:

• Loss of interest or pleasure in most activities that are normally enjoyable to the individual (i.e., pervasive anhedonia).
• Lack of emotional reactivity to normally pleasurable stimuli or circumstances (i.e., mood does not lift even transiently with exposure).
• Terminal insomnia (i.e., waking in the morning 2 hours or more before the usual time).
• Depressive symptoms are worse in the morning.
• Marked psychomotor retardation or agitation.
• Marked loss of appetite or loss of weight.

Reference:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

Foundation URI : http://id.who.int/icd/entity/1383708356

ICD-11 Criteria For Panic Attacks in Mood Episodes

 6A80.1

Description

In the context of a current mood episode (manic, depressive, mixed, or hypomanic), there have been recurrent panic attacks (i.e., at least two) during the past month that occur specifically in response to anxiety-provoking cognitions that are features of the mood episode. If panic attacks occur exclusively in response to such thoughts, panic attacks should be recorded using this qualifier rather than assigning an additional co-occurring diagnosis of panic disorder. If some panic attacks over the course of the depressive or mixed episode have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts, a separate diagnosis of panic disorder should be assigned.

Exclusions

• Panic disorder (6B01)

Diagnostic Requirements

This specifier can be applied if, in the context of a current Episode, there have been panic attacks during the past month that occur specifically in response to depressive ruminations or other anxiety-provoking cognitions. If panic attacks occur exclusively in response to such thoughts, the ‘with panic attacks’ specifier should be applied rather than an additional co-occurring diagnosis of Panic Disorder. If some panic attacks over the course of the Depressive or Mixed Episode have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts and the full diagnostic requirements for Panic Disorder are met, a separate diagnosis of Panic Disorder should be assigned.

Reference:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

ICD-11 Criteria for Prominent Anxiety Symptoms in Mood Episodes

Foundation URI : http://id.who.int/icd/entity/1119039346

Prominent Anxiety Symptoms in Mood Episodes

6A80.0

Description

In the context of a current depressive, manic, mixed, or hypomanic episode, prominent and clinically significant anxiety symptoms (e.g., feeling nervous, anxious or on edge, not being able to control worrying thoughts, fear that something awful will happen, having trouble relaxing, motor tension, autonomic symptoms) have been present for most of the time during the episode. If there have been panic attacks during a current depressive or mixed episode, these should be recorded separately. When the diagnostic requirements for both a mood disorder and an anxiety or fear-related disorder are met, the anxiety or fear-related disorder should also be diagnosed.

Diagnostic Requirements

This specifier can be applied if, in the context of a current Depressive, Manic, Mixed, or Hypomanic Episode, prominent and clinically significant anxiety symptoms (e.g., feeling nervous, anxious or on edge, not being able to control worrying thoughts, fear that something awful will happen, having trouble relaxing, muscle tension, autonomic symptoms) have been present for most of the time during the episode. If there have been panic attacks during the current Depressive or Mixed Episode, these should be recorded separately (see ‘with panic attacks’ specifier). This specifier may be used whether or not the diagnostic requirements for an Anxiety or Fear-Related Disorder are also met, in which case the Anxiety or Fear-Related Disorder should also be diagnosed.

Reference:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

ICD-11 Criteria for Other Specified Depressive Disorders

6A7Y 

Essential (Required) Features:

• The presentation is characterized by mood symptoms that share primary clinical features with other Depressive Disorders (e.g., depressed mood, decreased engagement in pleasurable activities, decreased energy levels, disruptions in sleep or eating).
• The symptoms do not fulfil the diagnostic requirements for any other disorder in the Depressive Disorders grouping.
• The symptoms are not better accounted for by another Mental, Behavioural or Neurodevelopmental Disorder (e.g., Schizophrenia or Other Primary Psychotic Disorder, an Anxiety or Fear-Related Disorder, a Disorder Specifically Associated with Stress).
• The symptoms and behaviours are not a manifestation of another medical condition and are not due to the effects of a substance or medication (e.g., alcohol, benzodiazepine) on the central nervous system, including withdrawal effects (e.g., from cocaine).
• The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/