Certain infectious and parasitic diseases
Certain infectious and parasitic diseases Certain infectious and parasitic diseases
due to organic mental disorder, and is too great to be explained by ordinary forgetfulness or fatigue. The amnesia is usually centred on traumatic events, such as accidents or unexpected bereavements, and is usually partial and selective. Complete and generalized amnesia is rare, and is usually part of a fugue (F44.1). If this is the case, the disorder should be classified as such. The diagnosis should not be made in the presence of organic brain disorders, intoxication, or excessive fatigue. Excludes: alcohol- or other psychoactive substance-induced amnesic disorder ( F10-F19 with common fourth character .6) amnesia: · NOS ( R41.3 ) · anterograde ( R41.1 ) · retrograde ( R41.2 ) nonalcoholic organic amnesic syndrome ( F04 ) postictal amnesia in epilepsy ( G40.- ) F44.1 Dissociative fugue Dissociative fugue has all the features of dissociative amnesia, plus purposeful travel beyond the usual everyday range. Although there is amnesia for the period of the fugue, the patient's behaviour during this time may appear completely normal to independent observers. Excludes: postictal fugue in epilepsy ( G40.- ) F44.2 Dissociative stupor Dissociative stupor is diagnosed on the basis of a profound diminution or absence of voluntary movement and normal responsiveness to external stimuli such as light, noise, and touch, but examination and investigation reveal no evidence of a physical cause. In addition, there is positive evidence of psychogenic causation in the form of recent stressful events or problems. Excludes: organic catatonic disorder ( F06.1 ) stupor: · NOS ( R40.1 ) · catatonic ( F20.2 ) · depressive ( F31-F33 ) · manic ( F30.2 ) F44.3 Trance and possession disorders Disorders in which there is a temporary loss of the sense of personal identity and full awareness of the surroundings. Include here only trance states that are involuntary or unwanted, occurring outside religious or culturally accepted situations. Excludes: states associated with: · acute and transient psychotic disorders ( F23.- ) · organic personality disorder ( F07.0 ) · postconcussional syndrome ( F07.2 ) · psychoactive substance intoxication ( F10-F19 with common fourth character .0) · schizophrenia ( F20.- ) F44.4 Dissociative motor disorders In the commonest varieties there is loss of ability to move the whole or a part of a 196 WHO’s ICD-10
limb or limbs. There may be close resemblance to almost any variety of ataxia, apraxia, akinesia, aphonia, dysarthria, dyskinesia, seizures, or paralysis. Psychogenic: · aphonia · dysphonia F44.5 Dissociative convulsions Dissociative convulsions may mimic epileptic seizures very closely in terms of movements, but tongue-biting, bruising due to falling, and incontinence of urine are rare, and consciousness is maintained or replaced by a state of stupor or trance. F44.6 Dissociative anaesthesia and sensory loss Anaesthetic areas of skin often have boundaries that make it clear that they are associated with the patient's ideas about bodily functions, rather than medical knowledge. There may be differential loss between the sensory modalities which cannot be due to a neurological lesion. Sensory loss may be accompanied by complaints of paraesthesia. Loss of vision and hearing are rarely total in dissociative disorders. Psychogenic deafness F44.7 Mixed dissociative [conversion] disorders Combination of disorders specified in F44.0-F44.6 F44.8 Other dissociative [conversion] disorders Ganser's syndrome Multiple personality Psychogenic: · confusion · twilight state F44.9 Dissociative [conversion] disorder, unspecified F45 Somatoform disorders The main feature is repeated presentation of physical symptoms together with persistent requests for medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupation of the patient. Excludes: dissociative disorders ( F44.- ) hair-plucking ( F98.4 ) lalling ( F80.0 ) lisping ( F80.8 ) nail-biting ( F98.8 ) psychological or behavioural factors associated with disorders or diseases classified elsewhere ( F54 ) sexual dysfunction, not caused by organic disorder or disease ( F52.- ) thumb-sucking ( F98.8 ) tic disorders (in childhood and adolescence) ( F95.- ) Tourette's syndrome ( F95.2 ) trichotillomania ( F63.3 ) Version for 2007 197
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limb or limbs. There may be close resemblance to almost any variety of ataxia,<br />
apraxia, akinesia, aphonia, dysarthria, dyskinesia, seizures, or paralysis.<br />
Psychogenic:<br />
· aphonia<br />
· dysphonia<br />
F44.5 Dissociative convulsions<br />
Dissociative convulsions may mimic epileptic seizures very closely in terms of<br />
movements, but tongue-biting, bruising due to falling, <strong>and</strong> incontinence of urine<br />
are rare, <strong>and</strong> consciousness is maintained or replaced by a state of stupor or<br />
trance.<br />
F44.6 Dissociative anaesthesia <strong>and</strong> sensory loss<br />
Anaesthetic areas of skin often have boundaries that make it clear that they are<br />
associated with the patient's ideas about bodily functions, rather than medical<br />
knowledge. There may be differential loss between the sensory modalities which<br />
cannot be due to a neurological lesion. Sensory loss may be accompanied by<br />
complaints of paraesthesia. Loss of vision <strong>and</strong> hearing are rarely total in<br />
dissociative disorders.<br />
Psychogenic deafness<br />
F44.7 Mixed dissociative [conversion] disorders<br />
Combination of disorders specified in F44.0-F44.6<br />
F44.8 Other dissociative [conversion] disorders<br />
Ganser's syndrome<br />
Multiple personality<br />
Psychogenic:<br />
· confusion<br />
· twilight state<br />
F44.9 Dissociative [conversion] disorder, unspecified<br />
F45<br />
Somatoform disorders<br />
The main feature is repeated presentation of physical symptoms together with<br />
persistent requests for medical investigations, in spite of repeated negative<br />
findings <strong>and</strong> reassurances by doctors that the symptoms have no physical basis.<br />
If any physical disorders are present, they do not explain the nature <strong>and</strong> extent of<br />
the symptoms or the distress <strong>and</strong> preoccupation of the patient.<br />
Excludes: dissociative disorders ( F44.- )<br />
hair-plucking ( F98.4 )<br />
lalling ( F80.0 )<br />
lisping ( F80.8 )<br />
nail-biting ( F98.8 )<br />
psychological or behavioural factors associated with disorders or<br />
<strong>diseases</strong> classified elsewhere ( F54 )<br />
sexual dysfunction, not caused by organic disorder or disease ( F52.- )<br />
thumb-sucking ( F98.8 )<br />
tic disorders (in childhood <strong>and</strong> adolescence) ( F95.- )<br />
Tourette's syndrome ( F95.2 )<br />
trichotillomania ( F63.3 )<br />
Version for 2007 197
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