F20-F29 Schizophrenia, schizotypal and delusional disorders

There is no diagnosis of “paranoid schizophrenia”; doctors usually talk about paranoid schizophrenia. In this form, in addition to the symptoms common to schizophrenia, there are also very specific ones. A psychiatrist must understand the nuances of diagnosis and treatment.

The main symptoms of this condition:

• delusional ideas of influence, special purpose, jealousy, damage and the evil eye, persecution, relationships and others;
• the most common hallucinations are auditory, threatening, inciting or imperative (commanding) in nature;
• less often hallucinations of other sense organs, the rarest are visual;
• disturbances of emotions and will (coldness, lack of will) can be hidden by a disorder of thinking in the acute period;
• The onset of the disease is usually 20–25 years.

The ICD-10 code for “paranoid schizophrenia” is F20.0. The manual states that the disease must be differentiated from epilepsy and paranoia, for which specialists resort to clinical, laboratory and instrumental diagnostic methods.

A psychiatrist must understand the nuances of diagnosing and treating paranoid schizophrenia.

The main hallucinatory-paranoid syndrome for this disease is characterized by delusional ideas of persecution, illusions and hallucinations of various senses. Patients feel that they are being talked about on the street and in transport, they are under special surveillance, and pursuers use conventional signs and codes.

Gradually, the delusion becomes more complicated, conspiracy theories appear, and fictitious and real forces and organizations are included in the delirium. Persecutors “cause” unpleasant thoughts, memories, painful sensations and even illnesses in patients, forcing them to act against their will. “Voices” and “visions” appear in the head.

Important

Fleeing from pursuers, “voices” and “visions”, patients can cause harm to themselves and others. Therefore, it is important to regularly see a specialist and take adequate supportive therapy.

Fleeing from hopelessness, patients in this state can cause harm to themselves and others. Therefore, it is important to be observed by a specialist and adhere to an adequate treatment regimen.

Manifestations of paranoid schizophrenia

Manifestations of the disease vary depending on the type of course:

• in an episodic course, the symptoms described above alternate with periods of well-being - remissions. Their quality and duration depend on how adequately the medications and their doses are selected. These periods are: with complete remission, when the person looks completely recovered;
• with incomplete remission, when symptoms do not completely go away;

paranoid schizophrenia of a continuous course develops progressively, without remissions.

When a patient’s decline in willpower and impoverishment of emotions rapidly progress, they speak of paranoid schizophrenia with an increasing defect. This is the simplest option for diagnosis, however, due to the speed at which personality changes increase, you should consult a doctor as early as possible.

Diagnosis of the disease depends on the stage of development of the disease at which the patient first receives psychiatric care. A well-collected life history of the patient and his family (history) and a professionally assessed current mental state (mental status) allow us to confidently suspect the disease. The help of a clinical psychologist, psychometric tests and the exclusion of other causes (psychoactive substances, tumors, cerebral hematomas, epilepsy) confirm the diagnosis. Read more about diagnosing paranoid schizophrenia.

F22 Chronic delusional disorders.

F22.0 Delusional disorder.

A. The presence of a delusion or a system of interrelated delusional ideas other than those that were listed as typical schizophrenic under criteria G(1) b) or d) for F20.0-F20.3 (i.e., excluding those that are completely impossible in content or culturally inadequate). The most common examples are delusions of persecution, grandeur, hypochondriacal, jealousy or erotic.

B. Delirium in criterion A must last for at least 3 months.

B. The general criteria for schizophrenia (F20.0-F20.3) are not met.

D. There should not be chronic hallucinations of any kind (but there may be transient or rare auditory hallucinations in which the patient is not discussed in the third person and which are not commentary in nature).

E. Depressive symptoms (or even a depressive episode (F32-)) may be present from time to time, but delusions persist even when mood disorders are not noted.

E. Most commonly used exclusion criteria. There should be no evidence of a primary or secondary brain disorder as specified in F00-F09 or a substance use disorder (F1x.5).

Indication for identifying possible subtypes.

If desired, the following types can be distinguished:

• persecutory type;
• litigious type;
• type with ideas of relationship;
• the type with ideas of greatness;
• hypochondriacal (somatic) type;
• the type with ideas of jealousy;
• erotomanic type.

F22.8 Other chronic delusional disorders.

This is a residual category for chronic delusional disorders that do not meet the criteria for delusional disorder (F22.0). Disorders in which delusions are accompanied by chronic hallucinatory “voices” or schizophrenic symptoms that do not fully meet the criteria for schizophrenia (F20.-) should be coded here. Delusional disorders lasting less than 3 months should nevertheless be coded at least temporarily in F23.-.

F22.9 Chronic delusional disorder, unspecified.

​

Therapy for paranoid schizophrenia

If we talk about the treatment of paranoid schizophrenia, hallucinatory-paranoid syndrome (acute manifestations of the disease - delusions and hallucinations) must be stopped first. The doctor prescribes drugs from different groups (neuroleptics, antidepressants, nootropics) to alleviate the manifestations of the disease in a particular patient. To increase the effectiveness of therapy, at first the drugs can be administered intramuscularly or intravenously.

Each patient has different manifestations of the disease, so therapy is always prescribed individually.

After recovery from the acute state, the psychiatrist adjusts the neuroleptic therapy - selects the minimum dosage necessary to maintain remission. Psychotherapy improves quality of life and improves social functioning. Rational, cognitive-behavioral psychotherapy is used in individual and family formats. Read more about the treatment of paranoid schizophrenia.

In the case of schizophrenia of the paranoid type with a continuously progressive course, the main task is to slow down the progression of the disease and maintain the level of social life. Against the background of well-chosen therapy and psychotherapeutic training of family members, an improvement often occurs, which is regarded as a relatively high-quality remission.

F21 Schizotypal disorder.

A. At least 4 of the following must be present continuously or periodically for at least two years:

1) inadequate or narrowed affect, the patient looks cold and aloof; 2) oddities, eccentricities or peculiarities in behavior or appearance; 3) impoverishment of contacts and a tendency towards social withdrawal; 4) strange views (beliefs) or magical thinking that influence behavior and are not consistent with subcultural norms; 5) suspiciousness or paranoid ideas; 6) obsessive chewing gum without internal resistance, often with dysmorphophobic, sexual or aggressive content; 7) unusual perceptual phenomena, including somato-sensory (bodily) or other illusions, depersonalization or derealization; amorphous, detailed, metaphorical, hyper-detailed and often stereotypical thinking, manifested in strange speech or in other ways without pronounced discontinuity; 9) rare transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations and delusional ideas, usually occurring without external provocation.

B. The case must never meet the criteria for any disorder in schizophrenia in F20- (schizophrenia).

​

Disease detection

Any type of schizophrenia, regardless of type and form, requires a correct, qualified, and most importantly, timely approach.

This disease does not develop overnight, like the flu or a cold; the first signs of the disorder become noticeable in childhood. Usually these are very “comfortable children”; parents cannot get enough of them. They:

• can play independently for hours without attracting attention;
• invent games on their own, do not need company;
• treat peers coldly;
• do not make a mess in the apartment;
• They don’t pester adults with a million questions per minute.

During adolescence, a teenager's body experiences a hormonal surge. Problems arise one after another: conflicts with parents, difficulties with school, difficult relationships with peers, thoughts of suicide, running away from home, etc. Relatives attribute all behavioral features to a difficult age, the vulnerable psyche of their child, or look for the reason in themselves, attributing some kind of upbringing mistakes.

The general picture of a mental disorder is formed by the age of 20–25, sometimes even earlier. At this age, productive symptoms (delusions, hallucinations) can no longer be hidden from others. The person ends up in a psychiatric ward, where the obvious diagnosis is confirmed.

Treatment of mental retardation

Mental retardation is a chronic disease, so therapeutic measures must be systematic and consistent. The earlier therapy begins, the greater the chance of preserving the psyche and compensating for impaired functions.

Treatment methods for mental retardation:

• Psychological and correctional work.
• Educational and pedagogical work.
• Psychotherapy.
• Psychotherapy and psychoeducation for parents.
• Physiotherapy.
• Drug treatment.
• Exercise therapy, massage, diet therapy.

A psychiatrist, psychologist, speech pathologist or speech therapist, rehabilitation therapist, massage therapist, and neurologist should participate in the treatment process.

Treatment of hebephrenic schizophrenia

Basic treatment methods

1. Neuroleptics;
2. Electroconvulsive therapy;
3. Since it is almost impossible to force such patients to take medications at home, long-term antipsychotics are necessarily prescribed upon discharge from the hospital. And also mood stabilizers - to correct behavior and mood swings.

Treatment takes place in a psychiatric hospital, since the behavior of patients is often socially unacceptable, they cannot care for themselves, and there is a high risk of suicide or aggressive behavior.

Psychiatrists at the private clinic “Preobrazhenie” were able to achieve great success in the treatment of hebephrenic schizophrenia.

Advantages of the clinic

1. We use modern, new generation drugs.
2. We use only original drugs (not cheap substitutes).
3. Experience and professionalism of our staff.
4. Availability of contacts with leading scientific medical institutes around the world.
5. Continuous professional development of employees.
6. The individual characteristics of the formation of the organism are taken into account.
7. We use our own psychotherapeutic techniques.
8. We guarantee complete anonymity.
9. Comprehensive examination and round-the-clock medical assistance.

You can contact the clinic’s specialists by phone in Moscow.

Associated syndromes

In addition to the presence of typical symptoms of the disease, patients with schizophrenia are characterized by manifestations of various syndromes and obsessive mental states. The following deviations can be observed:

1. Capgras syndrome. The patient is convinced that he himself or one of his relatives or friends is periodically replaced by a double. Accordingly, all bad deeds are committed by this same double.
2. Ekbom syndrome. The patient is sure that some kind of parasitic insects live under his skin or in his internal organs. He never tires of telling and showing this to everyone, although the statements may not correspond to the elementary structure of the human body.
3. Lycanthropy. From time to time an individual feels like he is a wolf. As long as the patient feels like a human being, he can be absolutely adequate and completely sane. However, as soon as he “becomes a beast,” everything changes radically - his behavior poses a danger to others. Patients with this type of disorder often howl, bark, crawl on all fours, and attack others.
4. Kandinsky-Clerambault syndrome. It is characterized by delusions of influence and persecution combined with pseudohallucinations. Those suffering from this syndrome consider themselves to be victims of witchcraft, radiation, or believe that their thoughts are in the public domain.
5. Cotard's syndrome. This is the opposite form of megalomania. It is manifested by inadequate formation of reality, perception of oneself as a nonentity, self-flagellation and taking responsibility for all world cataclysms and crimes. The patient thinks that he died a long time ago or that he has no internal organs.

PsyAndNeuro.ru

In addition to the new mental and behavioral disorders in ICD-11 described in the previous part, we are publishing changes made to each of the major disorder groups in the ICD-11 chapter on mental, behavioral and neurodevelopmental disorders. These changes were made based on a review of the available scientific evidence by working groups and expert consultants.

The February issue of World Psychiatry Journal, which described the main changes in ICD-11, was translated by the Council of Young Scientists of the Russian Society of Psychiatrists. This part describes changes in the following groups: neurodevelopmental disorders; schizophrenia and other primary psychotic disorders; mood disorders; disorders caused by anxiety and fear, obsessive-compulsive and related disorders, as well as disorders directly related to stress.

List of diagnostic categories of the chapter on mental, behavioral and neurodevelopmental disorders in ICD-11:

• Neurodevelopmental disorders
• Schizophrenia and other primary psychotic disorders
• Catatonia
• Mood disorders
• Disorders caused by anxiety and fear
• Obsessive-compulsive and related disorders
• Disorders directly related to stress
• Dissociative disorders
• Eating and feeding disorders
• Disorders associated with the excretory system
• Disorders related to bodily self-awareness and bodily discomfort
• Substance use and addictive behavior disorders
• Impulse control disorders
• Defiant and dissocial behavior disorders
• Personality disorders
• Desire disorders
• Factitious disorders
• Neurocognitive disorders
• Mental and behavioral disorders associated with pregnancy, childbirth and the postpartum period
• Psychological and behavioral factors influencing disorders or diseases classified elsewhere
• Secondary mental or behavioral syndromes associated with disorders or diseases from other headings

Neurodevelopmental disorders

Neurodevelopmental disorders are those that are associated with significant difficulties in the acquisition and use of certain intellectual, motor, language and social functions and begin during the developmental period. The ICD-11 group of neurodevelopmental disorders includes such ICD-10 groups as mental retardation, psychological development disorders, and attention deficit hyperactivity disorder (ADHD).

Major changes to ICD-11 include the renaming of mental retardation in ICD-10, which was an outdated and stigmatizing term that did not adequately cover the range of forms and etiologies associated with the condition, as intellectual developmental disorders. Intellectual developmental disorders continue to be defined based on significant limitations in intellectual functioning and behavioral adaptability, ideally defined using standardized, appropriately normed, and individually tailored metrics. Given that different regions of the world have traditionally used different standards of measurement or trained personnel, and because of the importance of determining the severity of the condition for treatment planning, the ICD-11 CDDG provides a comprehensive set of tables with behavioral indicators.

Tables of intellectual functioning and adaptive behavior are separated. Functional areas are divided into three components: conceptual, social, practical; There are three age groups (early childhood, childhood/adolescence and adulthood) and four levels of severity (mild, moderate, severe, profound). Behavioral indicators describe those skills and abilities that are typically observed within each of these categories. Thus, it is expected that the level of confidence in severity profiles will increase and the quality of public health data regarding the burden of intellectual development disorders will improve.

Autism spectrum disorder in ICD-11 includes both childhood autism and Asperger's syndrome in ICD-10 under one category characterized by deficits in social communication and restricted, repetitive and inflexible patterns of behavior, interests or activities. Guidelines for autism spectrum disorder have been substantially updated to reflect current literature, including the life course manifestations of the disorder. The assessment criteria are designed to represent degrees of impairment in intellectual functioning and language skills and cover all aspects of autism spectrum disorder across a broad range of dimensions.

ADHD replaced hyperkinetic disorder in ICD-10 and was moved to the group of neurodevelopmental disorders due to its early onset, characteristic impairments in intellectual, motor and social functioning, and frequent co-occurrence with other neurodevelopmental disorders. This move was also intended to differentiate previously related ADHD from disruptive behavior and dissocial disorders, for the reason that in ADHD, disruptive behavior tends to be unintentional. ADHD in ICD-11 would be characterized as predominantly inattentive, predominantly hyperactive-impulsive, or mixed type and described across the lifespan.

Finally, chronic tic disorders, including Tourette's syndrome, are classified under ICD-11 as Disorders of the Nervous System and overlap with neurodevelopmental disorders due to their high comorbidity (eg, with ADHD) and typical early onset of development.

Schizophrenia and other primary psychotic disorders

In ICD-11, the group of schizophrenia and other primary psychotic disorders replaced the group of schizophrenia, schizotypal and delusional disorders from ICD-10. The term "primary" indicates that psychotic processes are the primary feature, as opposed to psychotic symptoms that may arise as an aspect of other forms of psychopathology (eg, mood disorders).

In ICD-11, the symptoms of schizophrenia remained virtually unchanged compared to ICD-10, although the importance of Schneider's first rank symptoms was reduced. The most significant change is the elimination of all subtypes of schizophrenia (paranoid, hebephrenic, catatonic, etc.) due to their lack of predictive validity or benefit in treatment selection. Instead of subtypes, dimensions were introduced. These include: positive symptoms (delusions, hallucinations, disorganized thinking and behavior, phenomena of mental automatism); negative symptoms (dull or flattened affect, alalia or impoverished speech, abulia, anhedonia); symptoms of depressive mood; symptoms of manic mood; psychomotor symptoms (psychomotor agitation, psychomotor retardation, catatonic symptoms); cognitive symptoms (particularly deficits in processing speed, attention/concentration, orientation, judgment, abstraction, verbal or visual learning, and working memory). These same symptom scales can be applied to other disorders in the group (schizoaffective disorder, acute and transient psychotic disorder, delusional disorder).

The ICD-11 diagnosis of schizoaffective disorder still requires that criteria for schizophrenia and a mood disorder episode be present simultaneously. This diagnosis is intended to qualify the current episode of a disease state and is not considered to be stable over time.

In ICD-11, acute and transient psychotic disorder is characterized by the sudden onset of positive psychotic symptoms that rapidly change in appearance and intensity over a short period of time and persist for no more than three months. This corresponds only to the ICD-10 "polymorphic" form of acute psychotic disorder, which is the most common form, and does not indicate schizophrenia. Non-polymorphic subtypes of acute psychotic disorder (ICD-10) have been excluded and will instead be classified in ICD-11 as “other primary psychotic disorders.” As in ICD-10, schizotypal disorder is classified in this group and is not considered a personality disorder.

Mood disorders

Unlike ICD-10, in ICD-11 episodes are not regarded as independent conditions, but as a basis for making a diagnosis that best matches the clinical picture. Mood disorders are divided into depressive disorders (which include single depressive disorders, recurrent depressive disorder, dysthymic disorder, and mixed depressive-anxiety disorder) and bipolar disorders (which include bipolar I disorder, bipolar II disorder, and cyclothymia). ICD-11 divides bipolar disorder into type I and type II disorders. A separate ICD-10 mood disorder subgroup group consisting of persistent mood disorders (dysthymia and cyclothymia) was removed.

The diagnostic guidelines for a depressive episode are one of the few places in ICD-11 where a minimum number of symptoms is required. This is due to many years of research and clinical tradition of conceptualizing depression in this way. A minimum of five of ten symptoms is required, rather than four of the nine possible symptoms listed in ICD-10, increasing consistency with DSM-5. To help clinicians conceptualize and recall the full spectrum of depressive symptomatology, the ICD-11 CDDG organizes depressive symptoms into three clusters—affective, cognitive, and neurovegetative. Fatigue is part of the neurovegetative cluster of symptoms, but is no longer considered an independent initial-level symptom; more precisely, for diagnosis, a daily low mood or decreased interest in activities must be observed for at least the last two weeks. Hopelessness was added as an additional cognitive symptom due to strong evidence of its predictive value in the diagnosis of depressive disorders. The ICD-11 CDDG provides clear guidance on differentiating culturally normative grief reactions and symptoms that require consideration when diagnosing a depressive episode in the context of bereavement.

To diagnose manic episodes, ICD-11 requires the presence of level 1 symptoms (increased activity, subjective feeling of energy) in addition to euphoria, irritability, or incontinence. This was done to prevent false positive diagnosis cases that correspond to normative mood swings. ICD-11 defines hypomanic episodes as a weakened form of a manic episode without significant loss of functionality. The description of mixed episodes in ICD-11 coincides with ICD-10, because there is evidence of the validity of this approach. The guide contains indications of typical bipolar symptoms when manic or depressive symptoms predominate. The presence of a mixed episode indicates a diagnosis of bipolar disorder, type I.

ICD-11 provides various tools to qualify a current episode of mood disorder or remission (partial or complete). Depressive, manic, and mixed episodes may occur with or without psychotic symptoms. Current depressive episodes in the context of depressive or bipolar disorders can be further characterized by severity (mild, moderate, or severe); melancholic symptoms correspond to somatic manifestations from ICD-10, and a persistent episode (protracted episode) must last more than two years. All mood episodes in the context of depressive or bipolar disorders may be complemented by the use of anxiety symptoms, the presence of panic attacks, and the presence of seasonality. It is also possible to qualify bipolar disorder with rapid cycling.

ICD-11 includes a category of mixed depressive and anxiety disorders due to their importance in primary care settings. Given evidence of shared symptomatology with mood disorders, this ICD-11 diagnosis was moved from the ICD-10 anxiety disorders category to depressive disorders.

Disorders caused by anxiety and fear

ICD-11 groups disorders with anxiety or fear as the main clinical feature in this new group. Consistent with the ICD-11 life course approach, this group includes separation anxiety disorder and selective mutism, both of which were classified as childhood disorders in ICD-10. In ICD-11, the distinction between phobic anxiety disorders and other anxiety disorders that existed in ICD-10 was eliminated in favor of a more clinically useful method of characterizing each anxiety and fear-related disorder according to its perceptual focus, that is, the description of the stimulus that evokes anxiety, excessive physiological reaction or maladaptive behavior.

Generalized anxiety disorder (GAD) is characterized by a general apprehension or worry that is not limited to any specific stimulus. In ICD-11, GAD has a more elaborate set of diagnostic criteria, reflecting advances in understanding its unique phenomenology. In particular, anxiety is added to the general perception as a basic symptom of the disorder. Unlike ICD-10, the ICD-11 CDDG indicates that GAD may co-occur with depressive disorders as long as symptoms are present regardless of mood episodes. Similarly, other hierarchical exclusion rules that were in ICD-10 (GAD cannot be diagnosed with anxiety-phobic disorder or obsessive-compulsive disorder) are also excluded due to better delineation of the phenomenology of the disorder in ICD-11 and evidence that these rules could interfere with the detection and treatment of conditions that require separate, specific clinical attention.

Agoraphobia is defined in ICD-11 as severe and excessive fear or anxiety that occurs in anticipation of, or in the immediate experience of, a situation where help is difficult or unavailable. The difference from ICD-10 is that it was previously described more narrowly as a fear of open spaces and associated situations, such as crowds of people, and may have difficulty leaving the area quickly; now the basis is fear for negative consequences that could lead to negative consequences or be cast in an unsightly light.

Panic disorder is defined in ICD-11 as recurrent, unexpected panic attacks that are not limited to specific stimuli or situations. The ICD-11 CDDG indicates that panic attacks that occur only in response to a specific stimulus or in anticipation of a feared stimulus (eg, public speaking in social anxiety disorder) do not require an additional diagnosis of panic disorder.

Rather, in such cases, the classification “with panic attacks” may be added to the diagnosis of anxiety disorder. The categorization “with panic attacks” may also be applied to other disorders where anxiety may be a prominent but not a defining symptom, such as in some patients with a depressive episode.

Social anxiety disorder in ICD-11 is based on the fear of negative evaluation from others and replaces the ICD-10 diagnosis of “social phobia.” The ICD-11 CDDG specifically describes separation anxiety disorder in adults, which most often occurs in association with a romantic partner or child.

Obsessive-compulsive and related disorders (OCRD)

The introduction of OCRD into ICD-11 represents a significant change from ICD-10. The rationale for creating the OCRD group, as distinct from the anxiety-phobic disorder group, despite phenomenological overlap, was the clinical benefit of grouping the symptoms of recurrent unwanted thoughts and associated repetitive behaviors as a core clinical feature. The diagnostic consistency of this grouping is based on emerging evidence of common validators among the included disorders from neuroimaging, genetic, and neurochemical studies.

ICD-11 OCRD includes obsessive-compulsive disorder, dysmorphia, olfactory disorder, hypochondria (obsessive fear of illness) and pathological hoarding. Equivalent disorders in ICD-10 were located in different groups. OCRD also includes a subgroup of body-focused repetitive behavior disorders that include trichotillomania (hair pulling disorder) and excoriation disorder (skin picking/picking disorder), both of which share the common feature of repetitive behavior patterns without the cognitive aspect of other OCRDs. Tourette's syndrome, in ICD-11, is a disease of the nervous system, but is also included in the OCRD group due to its frequent combination with obsessive-compulsive disorder.

ICD-11 retains the core features of obsessive-compulsive disorder from ICD-10 (persistent obsessions and/or actions), but with some important changes. ICD-11 expands the concept of obsessions beyond obsessive thoughts to include unwanted images and urges/impulses. Moreover, the concept of coercion expands to include, but is not limited to, covert (e.g., counting) as well as overt, repetitive behavior.

Although anxiety is the most common affective experience associated with obsessions, ICD-11 explicitly mentions other phenomena reported by patients, such as disgust, shame, a feeling of “incompleteness,” or anxiety when things don’t look or feel “right.” . OCD subtypes that existed in ICD-10 were removed because most patients reported both obsessions and compulsions and because they had no impact on treatment prognosis. The impossibility of simultaneous diagnosis of OCD and depressive disorder, which existed in ICD-10, was abolished in ICD-11, because this reflects the high incidence of co-occurrence of both disorders, which require different treatments.

Hypochondriasis (obsessive fear of illness), due to its common phenomenology and patterns of common origin, is located in OCRD rather than among the group of anxiety and fear-related disorders, even though health concerns are often associated with anxiety and fear. However, hypochondriasis (obsessive fear of illness) is also listed under the group of anxiety and fear-related disorders, suggesting some phenomenological overlap. Dysmorphic disorder, olfactory disorder and hoarding are new categories that have been included in the ICD-11 group OCRD.

The cognitive component in OCRDs (beliefs) may be expressed with such intensity or persistence that they appear delusional. When these fixed beliefs are fully consistent with the phenomenology of OCRD and there are no other psychotic symptoms, the classification “with weak or absent insight” should be used and a diagnosis of delusional disorder should not be made. This approach is designed to help prevent people with OCRD from being treated for psychosis when they do not need it.

Disorders directly related to stress

The group of disorders specifically related to stress in ICD-11 replaces the ICD-10 group "Reactions to severe stress and adjustment disorders" to emphasize that stress is a necessary but not sufficient component in the etiology of these disorders, and also to distinguish between those included in this group. a group of disorders from various other mental disorders that occur in response to stressors (eg, depressive disorders). In accordance with the ICD-11 approach to considering disorders over the life span, ICD-10 diagnoses such as reactive attachment disorder and disinhibited attachment disorder of childhood are included in this group because these disorder disorders are directly related to attachment stress. ICD-11 includes several important conceptual updates to ICD-10—the introduction of complex PTSD and protracted grief disorder, which have no counterparts in ICD-10.

PTSD is defined by three features that must be present in all cases and must cause significant impairment. These include: re-experiencing the traumatic event in the present (flashbacks), deliberate avoidance of reminders that may trigger the re-experiencing, and a persistent sense of heightened threat in the present. Including a requirement to re-experience cognitive, affective, or physiological aspects of the trauma, rather than simply remembering the event, is expected to address the low diagnostic threshold for PTSD that existed in ICD-10.

Adjustment disorder in ICD-11 is diagnosed if there is an underlying “preoccupation” with a negative life event or its consequences, while in ICD-10 the disorder was diagnosed if symptoms arising in response to a life stressor did not meet certain requirements of another disorders.

Finally, in ICD-11, acute stress reaction is no longer considered a mental disorder, but is understood as a normal reaction to an extreme stressor. And now it is classified in the chapter “Factors influencing or related to health” and is not duplicated in the group of disorders directly related to stress. This is done to facilitate differential diagnosis.

Translation into Russian was organized by the Council of Young Scientists of the Russian Society of Psychiatrists with the support of the World Psychiatric Association.

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Translation: Pikirenya V.I. (Minsk)

Editor: Ph.D. Reznikov M.K. (Voronezh)

Source: Reed GM, First MB, Kogan CS, et al. Innovations and changes in the ICD-11 classification of mental, behavioral and neurodevelopmental disorders. World Psychiatry

. 2019;18(1):3–19. doi:10.1002/wps.20611

Causes

The causes of mental retardation are organic damage to the brain in the early stages of development (in the prenatal period, in the first years of life).

The following factors lead to organic damage to the nervous system:

• Genetic defects.
• Parental abuse of alcohol and drugs.
• Hypoxia and disruption of normal blood supply to the brain.
• Prematurity and premature birth.
• Pathology during childbirth.
• Infections affecting brain tissue
• Mechanical damage to the central nervous system.
• Social isolation (“Mowgli syndrome”), lack of normal conditions for mental development in infancy (lack of nutrition, communication, learning, games and toys, etc.).

F28 Other non-organic psychotic disorders.

Psychotic disorders that do not meet the criteria for schizophrenia (F20.0-F20.3) or psychotic types (affective) mood disorders (F30-F39), and psychotic disorders that do not meet symptomatic criteria for chronic delusional disorder (F22.-) should be coded here. ) (an example is chronic hallucinatory disorder). This also includes combinations of symptoms that are not covered by the previous (F20.- categories (F20.-F25), for example, a combination of delusional ideas other than those listed as typical schizophrenic in F20.0-F20.3, criterion G1.1 b) or d) (i.e., in addition to completely incredible in content or culturally inadequate), with catatonia.