The reactions to heavy stress is currently (according to the ICD-10) are divided into the following:

Acute reactions to stress;

Post-traumatic stress disorders;

Adaptation disorders;

Dissociative disorders.

Acute reaction to stress

Transient disorder of significant severity, which develops in individuals without visible mental disorder In response to an exceptional physical and psychological stress and which usually passes within hours or days. Stress can be a strong traumatic experience, including the threat of safety or the physical integrity of an individual or a beloved person (for example, a natural disaster, an accident, battle, criminal behavior, rape) or an unusually sharp and threatening change in the social situation and / or surrounding the patient, for example, Loss of many close or fire in the house. The risk of disorder development increases with physical exhaustion or the presence of organic factors (for example, in elderly patients).

In the emergence and severity of acute reactions to stress play the role of individual vulnerability and adaptive abilities; This is evidenced by the fact that this disorder is not developing in all people who have undergone severe stress.

Symptoms detect a typical mixed and changing picture and include the initial state of "stunning" with some narrowing of the field of consciousness and decline in attention, inability to adequately respond to external incentives, and disorientation. This condition may be accompanied by or further departure from the surrounding situation up to a dissociative stupor or a fitting and hyperactivity (escape or fugance reaction).

Often there are vegetative signs of panic alarms (tachycardia, sweating, redness). Usually symptoms develop within minutes after the impact of stressful stimuli or events and disappear within two or three days (often hours). A partial or complete dissociative amnesia may be present.

Acute reactions to stressthey occur in patients immediately after psychotrambulating impact. They are short, from several hours to 2-3 days. Vegetative violations, as a rule, are mixed in nature: there is an increase in the frequency of heart abbreviations and blood pressure and along with this - the pallor of the skin and the profuse sweat. Motor disorders are manifested either with a sharp excitation (throwing) or intensity. Among them are the affective shock reactions described at the beginning of the 20th century: hyperkinetic and hypokinetic. With a hyperkinetic version, patients are not safely moving, make chaotic unfinished movements. The questions, the more persuasion of the surrounding they do not react, the orientation in the surrounding them is clearly upset. In the hypokinetic version, patients are sharply injected, they do not react to the surrounding, do not answer questions, stunned. It is believed that in the origin of acute reactions to stress play not only a powerful negative impact, but also the personal features of victims - elderly or adolescence, weakening with any somatic disease, such character features as increased sensitivity and vulnerability.

In the ICD-10 concept post-traumatic stress disordersunites disorders that develop not immediately after the impact of the psychotrauming factor (settled) and ongoing weeks, and in some cases a few months. This includes: the periodic appearance of acute fear (panic attacks), heavy sleep disorders, obsessive memories of the psychotracting event, from which the victim can not get rid of the persistent avoidance of places and people associated with the psychotrauming factor. This also includes a long-term preservation of the gloomy-dreary mood (but not to the level of depression) or apathy and emotional inappropriate. Often, people in such a state avoid communicating (children).

Post-traumatic stress disorder is an unexicotic delayed response to traumatic stress that can cause mental disorders from almost any person.

Historical studies in the field of post-traumatic stress developed regardless of stress research. Despite some attempts to bring theoretical bridges between "stress" and post-traumatic stress ", these two areas and today have little in common.

Some of the well-known stress researchers, such as Lazarus, being followers G. Siele, for the most part ignore PTSP, like other disorders, as possible consequences of stress, limiting the field of attention to the research of the singularities of emotional stress.

Stress studies are experimental using special experimental plans under controlled conditions. Studies in the field of post-traumatic stress, on the contrary, are naturalistic, retrospective and for the most part can be attributed to observation.

Criteria of post-traumatic stress disorder (according to ICD-10):

1. The patient must be exposed to the stressful event or situation (both short and long) exclusively threatening or catastrophic nature, which is capable of calling distress.

2. Resistant memories or "revival" of the stressor in obsessive reminiscences, bright memories and repetitive dreams, or re-experience of grief when exposed to situations resembling or associated with stressor.

3. The patient should detect actual avoidance or desire to avoid circumstances resembling either associated with stressor.

4. Any of two:

4.1. Psychogeneic amnesia, or partial or complete, with respect to important periods of the stressor.

4.2. Resistant symptoms of increasing psychological sensitivity or excitability (not observed before the action of the stressor) represented by any two of the following:

4.2.1. Difficulty falling asleep or save sleep;

4.2.2. irritability or outbreak of anger;

4.2.3. difficulty concentration;

4.2.4. raising the level of wakefulness;

4.2.5. reinforced reflex quadcency.

Criteria 2,3,4 occur within 6 months after a stressful situation or at the end of the period of stress.

Clinical symptoms at PTSP (for B.Chodzin)

1. Unmotivated vigilance.

2. "Explosive" reaction.

3. Pump out of emotions.

4. Aggressiveness.

5. Disorders of memory and concentration of attention.

6. Depression.

7. Overall anxiety.

8. Fire attacks.

9. Abuse of narcotic and medicinal substances.

10. Inspected memories.

11. Hallucinatorious experiences.

12. Insomnia.

13. Thoughts about suicide.

14. "Wines of the survivor."

Speaking, in particular, on adaptation disorders, it is impossible not to stop in more detail on such concepts as depression and anxiety. After all, they always accompany stress.

Earlier dissociative disordersdescribes as hysterical psychosis. It is understood that at the same time the experience of the psychotrauming situation is supplanted from consciousness, but is transformed into other symptoms. The emergence of very bright psychotic symptoms and loss of sound in the experiences of transferred psychological impact of a negative plan and marvel dissociation. The same group of experiences include states previously described as hysterical paralysis, hysterical blindness, deafness.

The secondary benefit for patients of manifestations of dissociative disorders is emphasized, that is, they also arise by the mechanism of flight into the disease, when psychotrambulating circumstances are for the fragile nervous system unbearable, super-violent. A common feature of dissociative disorders is the tendency to recurrence.

The following forms of dissociative disorders differ:

1. Dissociative amnesia. The patient forgets about the psychotracting situation, avoids places and people associated with it, a reminder of psychotrame meets violent resistance.

2. Dissociative stupor, often accompanied by the loss of pain sensitivity.

3. Puerylism. Patients in response to psychotrayma show child behavior.

4. Pseudo-degeneration. This disorder flows against the background of light stun. Patients are confused, puzzily look around and show the behavior of the poor and imperfect.

5. Hanzer Syndrome. This state resembles the previous one, but includes miming, that is, patients are not answering the question ("What is your name?" - "far from here"). It is impossible not to mention the neurotic disorders associated with stress. They are always acquired, and not observed constantly from childhood and to old age. In the origin of neuroses, purely psychological causes (overwork, emotional stress) are important, and not organic influences on the brain. Consciousness and self-consciousness in neurosis are not broken, the patient is aware that he is sick. Finally, with adequate treatment, neurosis is always reversible.

Adaptation disorderit is observed during the adaptation period to a significant change in social status (the loss of close or long-term separation with them, the position of the refugee) or the stressful life event (including a serious physical illness). In this case, the temporal connection between stress and the arising disorder should be proven - not Over 3 months from the beginning of the stressor.

For adaptation disordersin the clinical picture are observed:

depressive mood

• anxiety

  feeling inability to cope with the situation, adapt to it

  some reducing productivity in everyday affairs

  dramatic behavior

  flashing aggression.

According to the prevailing attribute, the following adaptation disorders:

short term depressive reaction (no more than 1 month)

prolonged depressive reaction (no more than 2 years)

mixed alarming and depressive reaction, with a predominance of disturbing other emotions

reaction with the predominance of violation of behavior.

Among other reactions to severe stress, there are also noose reactions (develop due to severe somatic disease). Alsamate also acute reactions to stress, which develop as a reaction to an extremely strong, but short-term (within hours, days) a traumatic event that threatens the mental or physical integrity of the individual.

Under the affect, it is customary to understand the short-term strong mental excitement, which is accompanied not only by an emotional reaction, but also by the initiation of all mental activities.

Highlight physiological affectfor example, anger or joy, not accompanied by the permanent of consciousness, automatisms and amnesia. Asthenic Affect- Quickly depleting affect, accompanied by a depressed mood, a decrease in mental activity, well-being and a vital tone.

Stenic affectit is characterized by increased well-being, mental activity, a sense of its own strength.

Pathological Affect- short-term mental disorder arising in response to intensive, sudden mental trauma and expressed in concentration of consciousness on traumatic experiences with subsequent affective discharge, followed by general relaxation, indifference and often deep sleep; It is characterized by partial or complete amnesia.

In some cases, the pathological affect is preceded by a long psychotrauming situation and the pathological affect itself arises as a reaction to some "last drop".

A - the interaction of an exclusively medical or physical stressor.

B - symptoms arise immediately after exposure to the stressor (within 1 hour).

B - two groups of symptoms are distinguished; The reaction to acute stress is divided into:

* Easy, criterion is performed 1.

* Moderate, criterion 1 is performed and there are any two symptoms from the criterion 2.

* Heavy, criterion 1 is performed and there are any four symptoms from criterion 2, or there is a dissociative stupor.

Criterion 1 ( Criteria B, in, G for generalized anxiety disorder).

* There must be at least four symptoms from the following list, and one of them from the list is 1-4:

1) reinforced or rapid heartbeat

2) sweating

3) tremor or trembling

4) dry mouth (but not from drugs and dehydration)

Symptoms related to chest and stomach:

5) breathing difficulties

6) suffocation

7) Pain or discomfort in the chest

8) nausea or abdominal distress (for example, burning in the stomach)

Symptoms related to mental condition:

9) Feeling of dizziness, instability or displacement.

10) Feelings that items are unreal (Derealization) or that their own I moved away and "really not here"

11) Fear of loss of control, madness or upcoming death

12) Fear die

General symptoms:

13) tides and octs

14) numbness or feeling of tingling

Voltage symptoms:

15) muscle tension or pain

16) concern and relaxation inability

17) the feeling of nervousness, "on a platoon" or mental tension

18) Sensation of lump in throat or difficulty in swallowing

Other nonspecific symptoms:

19) reinforced response to small surprises or fright

20) difficulties in focusing or "emptiness in the head" due to anxiety or anxiety

21) constant irritability

22) Difficulties when falling asleep because of anxiety.

* The disorder does not correspond to the criteria of a panic disorder (F41.0), alarming-phobic disorders (F40.-), a compulsive-compulsive disorder (F42-) or a hypochondriatic disorder (F45. 2).

* The most commonly used exception criteria. Anxiety disorder is not due to the physical disease, an organic mental disorder (F00-F09), or a disorder that is not associated with the use of amphetamine-like substances or the abolition of benzodiazepines.

Criterion 2.

a) care from upcoming social interactions

b) narrowing attention.

c) manifestation of disorientation

d) anger or verbal aggression.

e) despair or hopelessness.

e) inadequate or aimless hyperactivity

g) uncontrollable or excessive experiences of grief (considered in accordance with local cultural standards)

G - if the stress is transient or may be facilitated, the symptoms must begin to decrease no more than 8 hours. If the stressor continues to act, the symptoms should begin to decrease no more than 48 hours.

D - the most commonly used exception criteria. The reaction should develop in the absence of other mental or behavioral disorders in the ICD-10 (with the exception of generalized anxiety disorder and personality disorder), and at least three months after the episode is completed by the episode of any other mental or behavioral disorder.

Criteria of post-traumatic stress disorder DSM-IV.:

1. The individual was under the influence of the traumatic event, and both of the following clause must be performed:

1.1. The individual was a member, a witness either ran into an event (events), which include death or the threat of death, or the threat of serious damage, or the threat of the physical integrity of other people (either own).

1.2. Individual reaction includes intensive fear, helplessness or horror. Note: In children, the reaction can be replaced by an aging or disorganized behavior.

2. The traumatic event is persistently repeated in the experience of one (or more) of the following ways:

2.1. Repeating and obsessive reproduction of events, corresponding images, thoughts and perceptions, causing severe emotional experiences. Note: A constantly repeating game may appear in young children, in which themes or aspects of injury manifest.

2.2. Repeating heavy dreams about the event. Note: Children have nightmare nightmares, the content of which is not saved.

2.3. Such actions or sensations as if the traumatic event occurred again (includes the feeling of "bias" experience, illusion, hallucinations and dissociative episodes - "Flashback" - effects, including those that appear in a state of intoxication or in a sample state). Note: Children can appear for injury-specific repeating behavior.

2.4. Intense severe experiences that were caused by an external or internal situation resembling traumatic events or symbolizing them.

2.5. Physiological reactivity in situations that externally or internally symbolize aspects of a traumatic event.

3. Permanent avoidance of incentives associated with injury and numbing.- blocking emotional reactions, stupid (not observed before injury). Determined by the presence of three (or more) from the features listed below.

3.1. Efforts to avoid thoughts, feelings or conversations related to injury.

3.2. Efforts to avoid actions, places or people who awaken memories of injury.

3.3. Inability to recall the important aspects of injury (psychogenic amnesia).

3.4. Noticeably reduced interest or participation in previously significant activities.

3.5. Feeling of removal or separation from other people;

3.6. Reduced expression of affect (inability, for example, to the feeling of love).

3.7. The feeling of lack of perspective in the future (for example, the lack of expectations about career, marriage, children or wishes of long life).

4. Permanent symptoms of increasing arousal (which were not observed before injury). Determined by the presence of at least two of the following symptoms.

4.1. Difficulties with falling asleep or bad sleep (early awakening).

4.2. Irritability or flashes of anger.

4.3. Difficulties with focusing attention.

4.4. Elevated level Possescence, hyperectivity, state of permanent threat.

4.5. Hypertrophized fright reaction.

5. The duration of the flow of disorder (symptoms in criteria in, s and d) more than 1 month.

6. Disorder causes a clinically significant heavy emotional state or violations in social, professional or other important spheres of vital activity.

7. As can be seen from the description of the criterion A, the definition of a traumatic event belongs to the number of paramount when diagnosing PTSD.

This group of disorders differs from other groups by the fact that it includes disorders identified not only on the basis of symptoms and the nature of the flow, but also on the basis of the evidence of the influence of one or even both reasons: an exceptionally unfavorable event in life, which caused an acute stress reaction, or significant Changes in life leading to prolonged unpleasant circumstances and impaired adaptation disorders. Although less severe psychosocial stress (life circumstances) can accelerate the beginning or contribute to the manifestation of a wide range of disorders presented in this class of diseases, its etiological significance is not always clear, and in each case, dependence on the individual will be recognized, often from its hypersensitivity and vulnerability (T .. Life events are not mandatory or sufficient to explain the emergence and form of disorder). Disorders collected in this category, on the contrary, are always considered as a direct consequence of acute severe stress or long-term injury. Stressful events or prolonged unpleasant circumstances are the primary or predominant causal factor and the disorder could not arise without their influence. Thus, the disorders classified in this heading can be considered as perverted adaptive reactions to a heavy or long stress, while they interfere with successfully cope with stress and, therefore, lead to social functioning issues.

Acute reaction to stress

The transient disorder that develops in humans without any other manifestations of mental disorders in response to an unusual physical or mental stress and usually subsides in a few hours or days. In the prevalence and severity of stressful reactions, individual vulnerability and ability to own themselves are important. Symptoms show a typical mixed and changeable picture and include the initial state of "stunning" with some narrowing of the area of \u200b\u200bconsciousness and attention, the inability to fully realize stimuli and disorientation. This condition may be accompanied by subsequent "departure" from the surrounding situation (to the state of dissociative stupor - F44.2) or assestation and superphanitivity (flight reaction or fugue). Usually there are separate features of panic disorder (tachycardia, excessive sweating, redness). Symptoms usually manifests itself a few minutes after the impact of stressful incentives or events and disappears in 2-3 days (often in a few hours). Partial or complete amnesia (F44.0) may be present on the stressful event. If the above symptoms are stable, it is necessary to change the diagnosis. Acute: crisis reaction reaction to stress, nervous demobilization, crisis condition, mental shock.

A. Impact of an exclusively medical or physical stressor.
B. Symptoms arise immediately after exposure to the stressor (within 1 hour).
B. Two groups of symptoms are distinguished; The reaction to acute stress is divided:
F43.00 Light only the following criterion 1)
F43.01 Moderate criterion is performed 1) and there are any two symptoms from the criterion 2)
F43.02 heavy criterion is performed 1) and there are any 4 symptoms from the criterion 2); Or there is a dissociative stupor (see F44.2).
1. Criteria b, B and g are performed for generalized anxiety disorder (F41.1).
2. a) Care from the upcoming social interactions.
b) narrowing attention.
c) manifestation of disorientation.
d) anger or verbal aggression.
d) despair or hopelessness.
e) inadequate or aimless hyperactivity.
g) uncontrollable and excessive experience of grief (considered in accordance with
Local culture standards).
If the stress is transient or may be facilitated, the symptoms should start
It is no more than eight hours to decrease. If the stressor continues to act,
Symptoms should begin to decrease no more than 48 hours.
D. The most commonly used exception criteria. The reaction should develop in
The absence of any other mental or behavioral disorders in the ICD-10 (with the exception of P41.1 (generalized alarming disorders) and F60- (personality disorders)) and at least three months after the episode is completed by any other mental or behavioral disorder.

Post-traumatic stress disorder

It occurs as a delayed or protracted response to a stress event (short or long) exclusively threatening or catastrophic nature, which can cause deep stress in almost everyone. Pre-providing factors, such as personal features (compulsiveness, asthenic) or the nervous disease in history, can reduce the threshold for the development of syndrome or aggravate its course, but they are never necessary or sufficient to explain its occurrence. Typical signs include episodes of repeating experiences of the traumatic event in obsessive memories ("frames"), thoughts or nightmares that appear on a sustainable background of a feeling of stupor, emotional inhibition, alienation from other people, unrequency for the surrounding and avoiding actions and situations that resemble injury. Usually overexcitation and expressed superpost, increased reaction to fright and insomnia. Anxiety and depression are often associated with the aforementioned symptoms, and the ideas of suicide are not rare. The appearance of symptoms of disorder is preceded by a latent period after injury, hesitating from a few weeks to several months. The disorder is different, but in most cases you can expect recovery. In some cases, the state can take the chronic flow for many years with a possible transition to a steady identity change (F62.0). Traumatic neurosis

A. The patient must be exposed to the stressful event or situation (both short and for a long time) exclusively threatening or catastrophic nature, which is able to cause a common distress for almost any individual.
B. Persistent memories or "revival" of the stressor in obsessive reminissates, bright memories or repetitive dreams, or re-experiences grief when exposed to circumstances resembling or associated with stressor.
V. The patient should detect the actual avoidance or the desire to avoid circumstances resembling, or associated with stressor (which was not observed before the impact of the stressor).
G. Any of two:
1. Psychogenic amnesia (F44.0), or partial, or full of important aspects the exposure period of the stressor;
2. Resistant symptoms of increasing psychological sensitivity or excitability (not observed before the action of the stressor) represented by any two of the following:
a) the difficulty of falling asleep or save sleep;
b) irritability or outbreak of anger;
c) difficulty concentration of attention;
d) raising the level of wakefulness;
e) reinforced reflex quadcency.
The criteria B, B, and G arise within six months of a stressful situation or at the end of the period of stress (for some purposes the beginning of the disorder set for more than six months may be included, but these cases must be accurately defined separately).

Adaptive reaction disorder

The state of the subjective distress and emotional disorder, creating difficulties for social activities and actions arising during the adaptation period to a significant change in life or stressful event. Stressful event can disrupt the integrity of social relations of the individual (severe loss, separation) or a wide system of social support and values \u200b\u200b(migration, refugee status) or represent a wide range of changes and fractures in life (admission to school, acquiring parent status, failure in achieving the cherished personality Goals, resignation). Individual predisposition or varying play an important role in the risk of occurrence and form of manifestation of adaptive reactions, however, it is not possible to occur in such disorders without a traumatic factor. Manifestations are very variable and include the depression of mood, alertness or anxiety (or complex of these states), the feeling of the inability to cope with the situation, plan everything in advance or decide to remain in the present situation, and also includes some degree of reduction in the ability to act in everyday life. At the same time, behavior disorders can be joined, especially in youthful age. A characteristic feature can be a brief or long depressive reaction or violation of other emotions and behaviors: cultural shock, grief reaction, hospitalism in children. Excluded: alarming disorder in children caused by separation (F93.0)

A. The development of symptoms should occur within one month after exposure to an identifiable psychosocial stressor, which is not an unusual or catastrophic type.
B. Symptoms or violation of behavior on type detected with other affective disorders (F30-F39) (with the exception of nonsense and hallucinations), any disorders in F40-F48 (neurotic, associated with stress and somatoform disorders) and behavior disorders (F91-) But in the absence of criteria for these specific disorders. Symptoms can be variable in shape and gravity. The prevailing features of symptoms can be determined using the fifth sign:
F43.20 short depressive reaction.
Transient lightweight depressive condition, duration of no more than one month
F43.21 Prolonged depressive reaction.
Easy depressive state resulting from a prolonged action of a stress situation, but a duration of no more than two years.
F43.22 Mixed alarming and depressive reaction.
Symptoms and alarms, and depressed are clearly expressed, but in terms of level not higher than defined for mixed alarm and depressive disorder (F41.2) or other mixed disturbing disorders (F41.3).
F43.23 with the predominance of disorders of other emotions
Symptoms are usually several emotional types, such as anxiety, depression, concern, tensions and anger. The symptoms of alarm and depression can meet the criteria for mixed anxious-depressive disorder (F41.2) or other mixed disturbing disorders (F41.3), but they are not so dominant that other more specific depressive or alarming disorders could be diagnosed. This category should also be used to reactions in children who also have regressive behavior, such as enuresis or sucking fingers.
F43.24 with a predominance of violation of behavior. The main violation affects the behavior, for example, in adolescents, the reaction of grief is manifested by aggressive or asocial behavior.
F43.25 with mixed disorders of emotions and behavior. And emotional symptoms, and behavioral violations are clearly expressed.
F43.28 with other refined predominant symptoms
B. Symptoms do not continue more than six months after the cessation of stress or its consequences, with the exception of F43.21 (prolonged depressive reaction), but this criterion should not prevent the preliminary diagnosis.

This group of disorders differs from other groups by the fact that it includes disorders identified not only on the basis of symptoms and the nature of the flow, but also on the basis of the evidence of the influence of one or even both reasons: an exceptionally unfavorable event in life, which caused an acute stress reaction, or significant Changes in life leading to prolonged unpleasant circumstances and impaired adaptation disorders. Although less severe psychosocial stress (life circumstances) can accelerate the beginning or contribute to the manifestation of a wide range of disorders presented in this class of diseases, its etiological significance is not always clear, and in each case, dependence on the individual will be recognized, often from its hypersensitivity and vulnerability (T .. Life events are not mandatory or sufficient to explain the emergence and form of disorder). Disorders collected in this category, on the contrary, are always considered as a direct consequence of acute severe stress or long-term injury. Stressful events or prolonged unpleasant circumstances are the primary or predominant causal factor and the disorder could not arise without their influence. Thus, the disorders classified in this heading can be considered as perverted adaptive reactions to a heavy or long stress, while they interfere with successfully cope with stress and, therefore, lead to social functioning issues.

Acute reaction to stress

The transient disorder that develops in humans without any other manifestations of mental disorders in response to an unusual physical or mental stress and usually subsides in a few hours or days. In the prevalence and severity of stressful reactions, individual vulnerability and ability to own themselves are important. Symptoms show a typical mixed and changeable picture and include the initial state of "stunning" with some narrowing of the area of \u200b\u200bconsciousness and attention, the inability to fully realize the stimuli and disorientation. This condition may be accompanied by subsequent "departure" from the surrounding situation (to the state of dissociative stupor - F44.2) or assesenixation and supercittivity (flight response or fugth). Usually there are separate features of panic disorder (tachycardia, excessive sweating, redness). Symptoms usually manifests itself a few minutes after the impact of stressful incentives or events and disappears in 2-3 days (often in a few hours). Partial or complete amnesia (F44.0) may be present on the stressful event. If the above symptoms are stable, it is necessary to change the diagnosis.

• crisis reaction
• reaction to stress

Nervous demobilization

Crisis Condition

Mental shock

Post-traumatic stress disorder

It occurs as a delayed or protracted response to a stress event (short or long) exclusively threatening or catastrophic nature, which can cause deep stress in almost everyone. Pre-providing factors, such as personal features (compulsiveness, asthenic) or the nervous disease in history, can reduce the threshold for the development of syndrome or aggravate its course, but they are never necessary or sufficient to explain its occurrence. Typical signs include episodes of repeating experiences of the traumatic event in obsessive memories ("frames"), thoughts or nightmares appearing on a sustainable background of a feeling of stupor, emotional inhibition, alienation from other people, unrequency for the surrounding and avoiding actions and situations that resemble injury. Usually overexcitation and expressed superpost, increased reaction to fright and insomnia. Anxiety and depression are often associated with the aforementioned symptoms, and the ideas of suicide are not rare. The appearance of symptoms of disorder is preceded by a latent period after injury, hesitating from a few weeks to several months. The disorder is different, but in most cases you can expect recovery. In some cases, the state can take the chronic flow for many years with a possible transition to a steady identity change (F62.0).

Traumatic neurosis

Adaptive reaction disorder

The state of the subjective distress and emotional disorder, creating difficulties for social activities and actions arising during the adaptation period to a significant change in life or stressful event. Stressful event can disrupt the integrity of social relations of the individual (severe loss, separation) or a wide system of social support and values \u200b\u200b(migration, refugee status) or represent a wide range of changes and fractures in life (admission to school, acquiring parent status, failure in achieving the cherished personality Goals, resignation). Individual predisposition or varying play an important role in the risk of occurrence and form of manifestation of adaptive reactions, however, it is not possible to occur in such disorders without a traumatic factor. The manifestations are very variable and include the depression of mood, alertness or anxiety (or complex of these states), the feeling of the inability to cope with the situation, to plan everything in advance or decide to remain in the present situation, and also includes some degree of reduction in the ability to act in everyday life. At the same time, behavior disorders can be joined, especially in youthful age. A typical feature can be a brief or long depressive reaction or violation of other emotions and behavior.

/ F40 - F48 / Neurotic, associated with stress and somatoform disorders The introduction of neurotic, associated with stress, and somatoform disorders are combined into one large group due to their historical relationship with the concept of neurosis and communication of the main (although not exactly established) part of these disorders with psychological reasons. As already noted in general introduction to the ICD-10, the concept of neurosis was not preserved as a fundamental principle, but in order to facilitate the identification of the disorders that some experts may still be considered neurotic in their own understanding of this term (see the remark about neuroses in general administration). Often there are combinations of symptoms (the most common is the coexistence of depression and anxiety), especially in cases of less severe disorders commonly found in the field of primary medical care. Despite the fact that it is necessary to strive to allocate the leading syndrome, for those cases of a combination of depression and anxiety, which would be artificially insisting on such a decision, a mixed heading of depression and anxiety is provided (F41.2).

/ F40 / phobic alarm disorders

A group of disorders in which anxiety is called exclusively or mainly certain situations or objects (external to the subject), which are currently not dangerous. As a result, these situations typically are typically avoiding or transferred with a sense of fear. Phobic anxiety is subjective, physiologically and behaviorally not different from other types of alarm and may vary in intensity from light discomfort to horror. The patient's concern can be concentrated on separate symptoms, such as heartbeat or feeling of faintness, and often combined with secondary death fears, loss of self-control or madness. Anxiety does not decrease from consciousness that other people do not consider this situation so dangerous or threatening. It is usually an alignment of anticipation in advance to the phobic situation. The adoption of the criterion that the phobic object or the situation is external with respect to the subject, implies that many fears of the presence of any disease (nosophobia) or deformity (dysmortophobia) are now classified under the heading F45.2 (hypochondriac disorder). However, if the fear of the disease occurs and is repeated mainly with a possible contact with infection or pollution or is simply a fear of medical procedures (injections, operations, etc.), or medical institutions (dental offices, hospitals, etc.), This case will be the appropriate heading F40.- (usually - F40.2, specific (isolated) phobias). Phobic alarm often coexists with depression. The preceding phobic anxiety is almost invariably enhanced during the transient depressive episode. Some depressive episodes are accompanied by temporary phobic alarm, and low mood often accompanies some phobias, especially agoraphobia. How many diagnoses it is necessary to install - two (phobic anxiety and depressive episode) or only one, it depends on whether one disorder has been developed explicitly earlier, and whether one disorder is clearly prevailing at the time of diagnosis. If the criteria for depressive disorder were satisfied before the first appeared phobical symptoms, then the first disorder should be diagnosed as the main one (see the remark in general administration). Most phobic disorders except social phobias are more common in women. In this classification, Panic Attack (F41. 0), which occurs in the established phobic situation, is considered a reflection of the gravity of phobia, which should be encoded primarily as the main disorder. Panic disorder as such must be diagnosed only in the absence of any phobias listed in the F40.

/F40.0/ Agorafobia

The term "agoraphobia" is used here in a broader sense than when it is initially administered or what it is still used in some countries. Now it includes fears of not only open spaces, but also close to them situations, such as the presence of a crowd and the inability to return to safe place (usually - home). Thus, the term includes a whole set of interrelated and usually partially coinciding phobias covering fears from home: enter shops, crowd or public space or traveling one in trains, buses or aircraft. Despite the fact that the intensity of anxiety and the severity of avoiding behavior may be different, this is the most disadapting from phobic disorders, and some patients become fully chained to the house. Many patients are terrified with the thought that they can fall and be left in helpless state in humans. The lack of immediate access and output is one of the key features of many agoraphobic situations. Most patients are women, and the beginning of the disorder usually falls on early ripe age. Depressive and obsessive symptoms and social phobias may also be present, but they do not prevail in the clinical picture. With absence effective treatment Agoraphobia often becomes chronic, although flowing is usually waving. Diagnostic instructions: All of the following criteria should be satisfied for the setting of reliable diagnosis: (a) Psychological or vegetative symptoms should be a primary anxiety expression, and not be secondary to other symptoms, such as nonsense or obsessive thoughts; b) Anxiety should be limited only (or mainly) at least two of the following situations: the crowd, public places, movement outside the house and travel alone; c) avoiding phobic situations is or was a pronounced feature. It should be noted: The diagnosis of agoraphobia involves conjugate with the listed phobias in certain situations the behavior aimed at overcoming fear and / or avoiding phobic situations, leading to a violation of the usual life stereotype and varying degrees of social deadaption (up to a full refusal of any activity outside the house). Differential diagnosis: It must be remembered that some patients with agoraphobia experience only weak anxiety, since they always manage to avoid phobic situations. The presence of other symptoms, such as depression, depersonalization, obsessive symptoms and social phobias do not contradict the diagnosis provided that they do not prevail in the clinical picture. However, if a patient has already been distinct depression by the time of the first appearance of phobic symptoms, a more appropriate main diagnosis may be a depressive episode; This is more often observed in cases with late start of disorder. The presence or absence of panic disorder (F41.0) In most cases, the attacks in agoraphobic situations should be reflected using the fifth sign: F40.00 without panic disorder; F40.01 with panic disorder. Turn on: - agoraphobia without panic disorder in history; - Panic disorder with agoraphobia.

F40.00 Agorafobia without panic disorder

It turns on: - agoraphobia without panic disorder in history.

F40.01 Agorafobia with Panic Disorder

Turns on: - Panic disorder with agoraphobia. F40.1 Social phobias Social phobias often begin in adolescence and concentrated around the fear to experience attention from those surrounding in relatively small groups of people (as opposed to the crowd), which leads to avoiding public situations. Unlike most other phobias, social phobias are equally common in men and women. They can be isolated (for example, limited only to fear of food on humans, public speeches or meetings with opposite sex) or diffuse, including almost all social situations outside the family circle. It may be important to fear of vomiting in society. In some cultures, a direct clash with an eye on the eye can be especially frightening. Social phobias are usually combined with the affected self-esteem and the fear of criticism. They can manifest themselves to redness redness, tremor hands, nausea or imperative urge to urine, while sometimes the patient is convinced that one of these secondary expressions of his anxiety is the main problem; Symptoms can progress up to panic attacks. Often significantly expressed avoiding these situations, which in extreme cases can lead to almost complete social isolation. Diagnostic instructions: All the following criteria should be satisfied for the performance of a reliable diagnosis: a) psychological, behavioral or vegetative symptoms should be a manifestation of primarily anxiety, and not be secondary to other symptoms, such as nonsense or obsessive thoughts; b) anxiety should be limited only or predominantly certain social situations; c) avoiding phobic situations should be a pronounced feature. Differential diagnosis: often pronounced agoraphobia and depressive disorders, and they can contribute to the fact that the patient becomes chained to the house. If the differentiation of social phobia and agoraphobia is difficult, agoraphobia should be encoded primarily as the main disorder; You should not diagnose depression, unless the full depressive syndrome is detected. Turn on: - anthropophobia; - Social neurosis.

F40.2 Specific (isolated) phobia

These are phobias, limited strictly defined situations, such as finding next to some animals, height, thunderstorm, darkness, flights in airplanes, closed spaces, urination or defecation in public toilets, reception of certain food, treatment of a dental doctor, blood type or Damage and fear of subject to certain diseases. Despite the fact that the launcher is isolated, the hit can cause panic as in agoraphobia or social phobia. Specific phobias usually appear as a child or young age and, if they remain untreated, can be maintained for decades. The seriousness of the disorder resulting from reducing productivity depends on how easily the subject can avoid a phobic situation. Fear of phobic objects does not detect trends towards intensity fluctuations, as opposed to agoraphobia. As conventional objects of disease phobias are radiation disease, venereal infections and, from recently, AIDS. Diagnostic instructions: All the following criteria should be satisfied for a reliable diagnosis: a) psychological or vegetative symptoms must be primary manifestations of anxiety, and not secondary to other symptoms, such as nonsense or obsessive thoughts; b) anxiety should be limited to a certain phobic object or situation; c) The phobic situation is avoided when only it is possible. Differential diagnosis: It is usually found that other psychopathological symptoms are absent, in contrast to agoraphobia and social phobias. Phobies of the type of blood and damage differ from the rest of the fact that they lead to bradycardia and sometimes - syncopes, and not to tachycardia. Fears of certain diseases, such as cancer, heart disease or venereal diseases, should be classified under the heading "Heproyondriatic disorder" (F45.2), unless they are associated with specific situations in which the disease can be purchased. If the conviction in the presence of the disease reaches the intensity of nonsense, the rubric "Range disorder" (F22.0) is used. Patients who are convinced of the presence of violations or the deformity of a certain part of the body (often facial), objectively not commemorated others (which is sometimes defined as dysmorphophobia), should be classified as (F22.0X), depending on the strength and perseverance of their conviction. Turn on: - fear of animals; - claustrophobia; - acrofobia; - phobia exams; - Simple phobia. Excluded: - Dysmorphobia (nonsencial) (F45.2); - Fear of getting sick (nosophobia) (F45.2).

F40.8 Other phobic alarm disorders

F40.9 phobic alarm disorder Uncomfortable Turn on: - Phobia BDA; - Fobic states of BDU. / F41 / other disturbing disorders Disorders at which the manifestations of anxiety are the main symptoms are not limited to a special situation. There may also be depressed and obsessive symptoms and even some elements of phobic alarm, but they are clearly secondary and less severe.

F41.0 Panic disorder

(episodic paroxysmal anxiety)

The main feature is repeated seizures of severe alarm (panic) that are not limited to a certain situation or circumstances and therefore unpredictable. As with other alarming disorders, the dominant symptoms vary from different patients, but the generals are unexpectedly emerging heartbeat, chest pain, a feeling of suffocation. Dizziness and sense of unreality (depersonalization or dealelization). The secondary fear of death, self-control or madness loss is also almost inevitable. Usually attacks continue only minutes, although at times and longer; Their frequency and the course of the destruction are quite variable. In panic attack, patients often experience sharply growing fear and vegetative symptoms that lead to the fact that the patients hurriedly leave the place where there are. If this occurs in a specific situation, for example, in a bus or in a crowd, the patient may subsequently avoid this situation. Similarly, frequent and unpredictable panic attacks cause fear to remain one or appear in crowded places. Panic attack often leads to the constant fear of the emergence of another attack. Diagnostic instructions: In this classification, the panic attack arising in the established phobic situation is considered an expression of the gravity of the phobia, which must be taken into account in the diagnosis in the first place. Panic disorder should be diagnosed as a primary diagnosis only in the absence of any of the phobias in F40.-. For a reliable diagnosis, it is necessary that several heavy attacks of vegetative anxiety occurred over the period of about 1 month: a) under circumstances that are not related to an objective threat; b) attacks should not be limited to known or predictable situations; c) between attacks the state must be relatively free from alarming symptoms (although anti-anti-alarm is usual). Differential diagnosis: Panic disorder must be distinguished from panic attacks arising as part of the established phobic disorders, as already noted. Panic attacks can be secondary to depressive disorders, especially in men, and if the criteria for depressive disorder are also detected, the panic disorder should not be established as a primary diagnosis. Turn on: - panic attack; - panic attack; - Panic state. Eliminated: - Panic disorder with agoraphobia (F40.01).

F41.1 Generalized anxiety disorder

The main feature is an alarm that is generalized and persistent, but is not limited to any specific environmental circumstances and does not even arise with an obvious preferred in these circumstances (that is, it is "non-fixed"). As with other alarming disorders, the dominant symptoms are very variable, but frequent are complaints of a feeling of constant nervousness, trembling, muscle tension, sweating, heartbeat, dizziness and discomfort in the epigastric area. Often the fears are expressed that the patient or his relative will soon get sick, or an accident will occur with them, as well as other diverse unrest and bad premonitions. This disorder is more characteristic of women and is often associated with chronic media stress. Different, but there are trends towards wave-like and chime. Diagnostic instructions: The patient must have primary alarm symptoms Most days for a period of at least a few weeks in a row, and usually several months. These symptoms usually include: a) concerns (concern about future failures, sense of excitement, difficulties in concentration, etc.); b) motor tension (fussiness, headaches of stress, trembling, inability to relax); c) Vegetative hyperactivity (sweating, tachycardia or tachipne, epigastric discomfort, dizziness, dry mouth, etc.). Children may have a pronounced need to be soothered and recurrent somatic complaints. The transient appearance (for several days) of other symptoms, especially depression, does not exclude the generalized alarmed disorder as the main diagnosis, but the patient should not correspond to the full criteria for the depressive episode (F32.-), phobic alarm disorder (F40.-), panic disorder (F41 .0), obsessive-compulsive disorder (F42.x). Turn on: - alarming state; - disturbing neurosis; - neurosis anxiety; - alarming reaction. It is excluded: - neurasthenia (F48.0).

F41.2 Mixed anxious and depressive disorder

This mixed category should be used when the symptoms of both anxiety and depression are present, but neither those nor others separately are clearly dominant or expressed so to justify the diagnosis. If there is severe anxiety with a lower degree of depression, one of the other categories for alarming or phobic disorders are used. When depressive and disturbing symptoms are present, and they are quite pronounced for separate diagnostics, then both diagnoses should be encoded, and this category should not be used; If only one diagnosis can be installed from practical considerations, depressed should be preferred. There should be some vegetative symptoms (such as tremor, heartbeat, dry mouth, drilling in the abdomen, etc.), even if they are not permanent; This category is not used if there is only anxiety or excessive concern without vegetative symptoms. If the symptoms that meet the criteria of this disorder occur in close connection with significant life changes or stressful events of life, then the category F43.2x is used, the disorder of adaptive reactions. Patients with such a mixture of relatively light symptoms are often observed during the primary treatment, but they are much more exist in populations that do not enter into doctors. Turns on: - alarming depression (easy or unstable). It is excluded: - chronic anxiety depression (distortium) (F34.1).

F41.3 Other Mixed Alarm Disorders

This category should be used for disorders corresponding to the criteria for F41.1 of generalized anxiety disorder and also have obvious (although often short-term) signs of other disorders in the F40 - F49, while not satisfying the criteria for these other disorders completely. Common examples are obsessive-compulsive disorder (F42.x), dissociative (conversion) disorders (F44.-), somatized disorder (F45.0), undifferentiated somatoform disorder (F45.1) and hypochondriac disorder (F45.2). If the symptoms corresponding to the criteria for this disorder occur in close relationship with significant life changes or stressful events, the category F43.2x is used, the disorder of adaptive reactions. F41.8 Other refined alarming disorders It should be noted: This heading includes phobic conditions in which phobia symptoms are complemented by massive conversion symptoms. Turn on: - alarming hysteria. It is excluded: - dissociative (conversion) disorder (F44.-).

F41.9 Anxiety Disorder Unclean

Turns on: - Anxiety BDA.

/ F42 / obsessive-compulsive disorder

The main feature is repetitive obsessive thoughts or compulsive actions. (For brevity, the term "obsessive" will be used subsequently instead of "obsessive-compulsive" with respect to symptoms). The obsessive thoughts are ideas, images or desection, which in stereotypical form again and again come to the patient's mind. They are almost always painful (because they have an aggressive or obscene content or simply because they are perceived as meaningless), and the patient often tries to resist them unsuccessfully. Nevertheless, they are perceived as their own thoughts, even if they occur involuntarily and unbearable. Combulsive actions or rituals are repeated again and again stereotypical actions. They do not deliver inland pleasure and do not lead to the fulfillment of internal useful tasks. Their meaning is to prevent any objectively unlikely events, damage to the patient or from the patient. Usually, although it is not necessary, such behavior is perceived by the patients as meaningless or fruitless and he repeats the attempts to resist him; With very long states, resistance may be minimal. There are often vegetative symptoms of anxiety, but also characterized by painful sensations of internal or mental stress without obvious vegetative arousal. There is a close relationship between obsessive symptoms, especially obsessive thoughts, and depression. In patients with obsessive-compulsive disorder, depressive symptoms are often observed, and in patients suffering from recurrent depressive disorder (F33.-), obsessive thoughts may develop during depressive episodes. In both situations, increasing or decrease in gravity of depressive symptoms is usually accompanied by parallel changes in the severity of obsessive symptoms. The obsessive-compulsive disorder can equally be in men and women, the basis of the personality is often playing the pellets. The beginning is usually in kindergarten or youthful age. The course is variable and in the absence of pronounced depressive symptoms, its chronic type is likely. Diagnostic instructions: For an accurate diagnosis, obsessive symptoms or compulsive actions, or those and others should take place the greatest number of days for a period of at least 2 weeks in a row and be the source of the distress and violation of activity. Observation symptoms must have the following characteristics: a) they must be regarded as their own thoughts or patient pulses; b) there must be at least one thought or action that the patient is unsuccessfully resisted, even if others are given to which the patient is no longer resisting; c) the idea of \u200b\u200bthe performance should not be in itself pleasant (a simple reduction in tensions or anxiety is not considered pleasant in this sense); d) thoughts, images or impulses should be unpleasant repeating. It should be noted: The performance of compulsive actions does not necessarily relate to specific obsessive concerns or thoughts, and may be aimed at getting rid of the spontaneously emerging sensation of internal discomfort and / or anxiety. Differential diagnosis: Differential diagnosis between obsessive-compulsive disorder and depressive disorder can be difficult, since these 2 types of symptoms often arise together. In an acute episode, preference should be given to the disorder whose symptoms arose first; When both are presented, but none dominates, it is usually better to consider depression primary. In chronic disorders, one of them should be preferred, the symptoms of which are preserved most often in the absence of symptoms of the other. Random panic attacks or light phobic symptoms are not an obstacle to the diagnosis. However, obsessive symptoms developing in the presence of schizophrenia, housing syndrome de la turret, or organic mental disorder should be regarded as part of these states. Although obsessive thoughts and compulsive actions usually coexist, it is advisable to establish one of these types of symptoms as the dominant patients as they can respond to different types of therapy. Turn on: - obsessive-compulsive neurosis; - obsessive neurosis; - Pineapple neurosis. It is excluded: - obsessive-compulsive personality (disorder) (F60.5X). F42.0 predominantly obsessive thoughts or reflections (mental chewing) They can take the form of ideas, mental images or impulses to action. They are very different in content, but almost always unpleasant for the subject. For example, a woman suffers from fear that she may accidentally not resist the impulse to kill the beloved child, or the obscene or blasphemous and alien "I" repetitive images. Sometimes ideas are simply useless, including endless quasi-philosophical arguments on at least alternatives. These not leading to the decision on alternatives are an important part of many other obsessive reflections and are often combined with the inability to make trivial, but necessary in the daily life of the decision. The relationship between obsessive reflections and depression is especially close: the diagnosis of obsessive-compulsive disorder should be preferred only if reflections arise or continue to remain in the absence of depressive disorder.

F42.1 predominantly compulsive action

(obsessive rituals)

Most obsessive actions (compulsions) concerned compliance with the purity (especially hand washing), continuous prevention control potentially dangerous situation or for order and accuracy. The basis of external behavior lies fear, usually hazards for a patient or danger caused by patients, and a ritual action is a fruitless or symbolic attempt to prevent danger. Combulsive ritual actions can occupy a daily clock and sometimes combined with indecisiveness and slowness. They are equally encountered in both sexes, but the rituals of hand washing are more characteristic of women, and slowness without repetition - for men. Compulsive ritual actions are less closely related to depression, rather than obsessive thoughts, and more easily succumb to behavioral therapy. It should be noted: In addition to compulsive actions (obsessive rituals) - actions directly related to intrusive thoughts and / or alarming concerns and aimed at preventing them, this heading should also include compulsive actions performed by patients in order to get rid of spontaneously emerging internal discomfort and / or anxiety.

F42.2 Mixed obsessive thoughts and actions

Most obsessive-compulsive patients have elements of both obsessive thinking and compulsive behavior. This subcategory should be applied if both disorders are equally pronounced, as often happens, but it is advisable to install only one if it clearly dominates, since thoughts and actions can respond to different types of therapy.

F42.8 Other obsessive-compulsive disorders

F42.9 obsessive-compulsive disorder unspecified

/ F43 / Reaction to Heavy Stress and Adaptation Disorders

This category differs from other things that includes disorders that are determined not only on the basis of symptomatology and flow, but on the basis of the presence of one or another of two causal factors: an exceptionally strong stressful life event that causes an acute stress reaction, or a significant change in life leading to continuously continuing unpleasant circumstances, resulting in an adaptation disorder. Choising less severe psychosocial stress ("life event") can provoke the beginning or help manifest a very wide range of disorders classified in other categories of this class, its etiological significance is not always clear and in each case depends on the individual, often special vulnerability. In other words, the presence of psychosocial stress is not necessary and not enough to explain the occurrence and form of disorder. In contrast, the disorders considered in this category apparently always arise as a direct consequence of acute severe stress or prolonged injury. Stressful event or prolonged unpleasant circumstances are primary and the main causal factor, and the disorder would not arise without their influence. This category includes a hard stress reaction and adaptation disorders in all age groups, including children and adolescents. Each of the individual symptoms from which they add up acute reaction For stress and disorders of adaptation, it can also occur with other disorders, but there are some special signs in how these symptoms are manifested, which justifies the unification of these states in the clinical unit. The third state in this subsection post-traumatic stress disorder - has relatively specific and characteristic clinical signs. Disorders in this section can be treated as violated adaptive reactions to severe prolonged stress, in the sense that they impede the action of a successful adaptation mechanism and therefore lead to a violated social functioning. The acts of self-injunction, most often self-defined by drugs, coinciding over time with the beginning of the stress reaction or adaptation disorder, should be observed using an additional code x from class XX MKB-10. These codes do not allow differentiation between a suicide attempt and "parasiside", since both concepts are included in the general category of self-injunction.

F43.0 acute reaction to stress

Transient disorder of significant severity, which develops in individuals without visible mental disorder in response to an exceptional physical and psychological stress and which usually passes within hours or days. Stress can be a strong trauma experience, including the threat of safety or physical integrity of an individual or a beloved person (for example, a natural disaster, an accident, battle, criminal behavior, rape) or an unusually sharp and threatening change in the social situation and / or surrounding the patient, For example, the loss of many close or fire in the house. The risk of disorder development increases with physical exhaustion or the presence of organic factors (for example, in elderly patients). In the emergence and severity of acute reactions to stress play the role of individual vulnerability and adaptive abilities; This is evidenced by the fact that this disorder is not developing in all people who have undergone severe stress. Symptoms detect a typical mixed and changing picture and include the initial state of "stunning" with some narrowing of the field of consciousness and a decrease in attention, inability to adequately respond to external incentives and disorientation. This condition may be accompanied by or further care from the surrounding situation (up to dissociative stupor - F44.2), or a fitting and hyperactivity (the reaction of escape or a fugance). Often there are vegetative signs of panic alarms (tachycardia, sweating, redness). Usually symptoms develop within minutes after the impact of stressful stimuli or events and disappear within two or three days (often hours). A partial or complete dissociative amnesia (F44.0) of the episode may be present. If the symptoms are preserved, then the question of changing the diagnosis (and the maintenance of the patient). Diagnostic instructions: There must be a mandatory and clear temporal connection between the impact of an unusual stressor and the beginning of symptoms; Rocks usually immediate or in a few minutes. In addition, symptoms: a) have a mixed and usually changing picture; In addition to the initial state of stumps, depression, anxiety, anger, despair, hyperactivity and density can be observed, but none of the symptoms prevail for a long time; b) stop quickly (at least within a few hours) in cases where the stressful stress is eliminated. In cases where stress continues or in nature cannot stop, the symptoms are usually started to disappear after 24-48 hours and minimize within 3 days. This diagnosis cannot be used to designate sudden exacerships of symptoms in individuals already having symptoms that meet the criteria of any mental disorder, excluding those in F60.- (specific personality disorders). However, the preceding mental disorder in history does not make the use of this diagnosis inadequate. Turn on: - nervous demobilization; - crisis condition; - acute crisis reaction; - acute reaction to stress; - Combat fatigue; - Mental shock. F43.1 Post-traumatic stress disorder As retraced and / or a prolonged reaction to a stress event or a situation (short or long) exceptionally threatening or catastrophic nature, which, in principle, cause a common distress for almost any person (for example, natural or artificial catastrophes, battles, serious accidents, observation For the violent death of others, the role of the victim of torture, terrorism, rape or other crime). We predictors such as personal features (for example, compulsive, asthenic) or previous neurotic diseases may lower the threshold for the development of this syndrome or drag it, but they are not mandatory and insufficient to explain its occurrence. Typical signs include episodes of re-experiencing injury in the form of obsessive memories (reminiscence), dreams or nightmares arising against the background of chronic feeling of "deceitivity" and emotional sweating, alienation from other people, the lack of reaction to the surrounding, annedonia and evasion of activity and situations reminiscent of injury. Usually the individual is afraid and avoids what he is reminiscent of initial injury. Occasionally there are dramatic, sharp outbreaks of fear, panic or aggression, provoked by incentives, causing an unexpected memory of injury or on the initial reaction to it. Usually there is a condition of increased vegetative excitability with an increase in the level of wakefulness, strengthening the reaction of fright and insomnia. The above symptoms and signs are usually combined with anxiety and depression, it is often a suicidal idea, a complicating factor can be overweight alcohol or drugs. The beginning of this disorder arises after the injury after the latent period, which may vary from a few weeks to months (but rarely more than 6 months). Wavely-shaped current, but in most cases you can expect recovery. In a small part of cases, the condition may detect the chronic course over the years and the transition to a persistent identity change after the Catostrofa experience (F62.0). Diagnostic instructions: This disorder should not be diagnosed if there is no evidence that it originated for 6 months from a serious traumatic event. "Presumable" diagnosis is possible if the gap between the event and the beginning of more than 6 months, but the clinical manifestations are typical and there is no possibility of alternative qualifications of disorders (for example, anxiety or obsessive-compulsive disorder or depressive episode). Evidence of the presence of injury must be supplemented by repeating obsessive memories of the event, fantasies and presentations during the daytime. Noticeable emotional alienation, stuporing of feelings and avoiding incentives that could cause injury memories are often found, but are not necessary for diagnosis. Vegetative disorders, mood disorders and behavioral disorders may be included in the diagnosis, but are not paramount to meaningful. The remote chronic consequences of a devastating stress, that is, those that are manifest after decades after stressful impact, should be classified in F62.0. Turns on: - traumatic neurosis.

/F43.2/ Disorder of adaptive reactions

The states of the subjective distress and emotional disorder, usually prevent social functioning and productivity and arising during the adaptation period to a significant change in life or stressful life event (including the presence or possibility of serious physical illness). The stress factor may affect the integrality of the social network of the patient (loss of loved ones, the experience of separation), a wider system of social support and social values \u200b\u200b(migration, refugee position). Stressor (stress factor) can affect the individual or also its micro-community environment. More important than with other disorders in F43., the role in the risk of occurrence and the formation of manifestations of adaptation disorders is played by an individual predisposition or vulnerability, but it is nevertheless it is believed that the state would not arise without a stress factor. Manifestations are different and include depressive mood, anxiety, anxiety (or mixing them); The feeling of inability to cope, plan or continue to remain in the present situation; And also some degree of reducing productivity in daily matters. The individual may feel a tendency to dramatic behavior and outbreaks of aggressiveness, but they are rare. Nevertheless, additionally, especially in adolescents, behavior disorders (for example, aggressive or dissocial behavior) may be marked. None of the symptoms are so significant or predominant to indicate a more specific diagnosis. Regressive phenomena in children, such as enuresis or children's speech or sucking fingers, are often part of symptoms. When prevailing these features, use F43.23. The beginning is usually within a month after a stressful event or change of life, and the length of symptoms usually does not exceed 6 months (except for F43.21 - a prolonged depressive reaction due to adaptation disorder). When preserving the symptoms, the diagnosis should be changed in accordance with the existing clinical picture, and any continued stress can be encoded using one of the "z" codes of the class XX MKB-10. Contacts with medical and psychiatric services due to normal grief reactions that correspond to the culture level of this person and, usually, do not exceed 6 months, should not be denoted by codes of this class (F), and should be qualified using class XXI COD-10 codes, such as , Z-71.- (consulting) or z73. 3 (stressful state not classified in other categories). The reactions of burning of any duration, assessed as the abnormal due to their shape or content, should be encoded as F43.22, F43.23, F43.24 or F43.25, and those that remain intense and continue over 6 months - F43.21 (Prolonged depressive reaction due to adaptation disorder). Diagnostic instructions: The diagnosis depends on the attentive assessment of the relation between: a) the form, content and severity of symptoms; b) anamnestic data and personality; c) stressful event, situation and vital crisis. The presence of the third factor must be clearly established and must be weighty, although, possibly alleged evidence that the disorder would not appear without it. If the stressor is relatively small and if the temporary connection (less than 3 months) cannot be established, the disorder should be classified elsewhere in accordance with the available features. Turn on: - Cultural shock; - grief reaction; - Hospitalism in children. Excluded:

Anxiety disorder in children caused by separation (F93.0).

In the criteria of adaptation disorders, the clinical form or prevailing features must be refined on the fifth sign. F43.20 short-term depressive reaction due to adaptation disorder Transient soft depressive state, not exceeding 1 month by duration. F43.21 Prolonged depressive reaction due to an adaptation disorder Easy depressive state in response to long-term susceptibility of the stress situation, but continued no more than 2 years. F43.22 Mixed anxious and depressive reaction due to adaptation disorder distinctly expressed disturbing and depressive symptoms, but their level is no more than in a mixed alarm and depressive disorder (F41.2) or in another mixed alarm disorder (F41.3).

F43.23 Adaptation disorder

with the predominance of disturbing other emotions

Usually the symptoms of several types of emotions, such as anxiety, depression, concern, tensions and anger. Symptoms of anxiety and depression can meet the criteria for mixed alarm and depressive disorder (F41.2) or other mixed alarm disorder (F41.3), but they are not so dominant so that other more specific depressive or alarming disorders can be diagnosed. This category should be used in children when there is a regressive behavior, such as enuresis or sucking a finger.

F43.24 Adaptation disorder

with the predominance of violation of behavior

The main disorder is a violation of behavior, that is, the teenage reaction of grief, leading to aggressive or dissocial behavior. F43.25 Mixed disorder of emotions and behavior due to adaptation disorder Explicit characteristics are both emotional symptoms and disorders of behavior. F43.28 Other specific prevailing symptoms due to adaptation disorder F43.8 Other Reactions to Heavy Stress It should be noted: This heading includes non-coined reactions arising in connection. with severe somatic disease (the latter acts as psychotrauming event). Fears and disturbing concerns about their unhealthy and the impossibility of complete social rehabilitation, combined with exacerbate self-observation, hypertrophied assessment of the health effects (neurotic reactions). With protracted reactions to the forefront, the phenomena of rigid hypochondria are acting with a thorough registration of the slightest signs of bodily disadvantaged, the establishment of a sparing "prevention" from possible complications or exacerbations of a somatic mode of regime (diet, the departure of the rest over work, the exclusion of any information perceived as "stressor", tough Regulation physical Loads, Reception of medicines, etc. In some cases, the consciousness of the pathological changes in the body's activities is accompanied by not anxiety and fear, but the desire to overcome the ailment with a sense of bewilderment and resentment ("Hopeondria of Health"). The usual is the question of how a catastrophe might occur, striking the body. The ideas of full recovery "at any cost" of physical and social status are dominated, eliminating the causes of the disease and its consequences. Patients feel the potential opportunities for the effort of the will "reversal" the course of events, positively influence the course and the outcome of the somatic suffering, "upgrade" therapeutic process with increasing loads or exerciseproduced contrary to medical recommendations. The pathological denial syndrome is prevalent mainly in patients with a threatening life of pathology (malignant neoplasms, acute myocardial infarction, tuberculosis with severe intoxication, etc.). The complete denial of the disease, conjugated with the conviction in the absolute preservation of the functions of the body, is relatively rare. More often there is a tendency to minimize the severity of manifestations of somatic pathology. In this case, patients do not deny the disease as such, but only those aspects that have a threatening meaning. So, the possibility of fatal outcome, disability, irreversible changes in the body is excluded. Turns on: - "Heproyondria of health". It is excluded: - is a hypochondriatic disorder (F45.2).

F43.9 Reaction to Heavy Stress Uncomfortable

/ F44 / dissociative (conversion) disorders

General features that characterize dissociative and conversion disorders are partial or complete loss of normal integration between memory for past, realization of identity and immediate sensations, on the one hand, and control the movements of the body, on the other. Usually there is a significant degree of conscious control over memory and sensations that can be selected for direct attention, and on the movements that must be executed. It is assumed that during dissociative disorders, this conscious and elective control is disturbed to such an extent that it may vary from the day to the day and even from an hour to the hour. The degree of loss of a function under conscious control is usually difficult to evaluate. These disorders were usually classified as various forms of "conversion hysteria". This term is undesirable to use its meaningfulness. It is assumed that dissociative disorders described here are "psychogenic" by origin, being closely related to time with traumatic events, insoluble and unbearable problems or disturbed relationships. Therefore, it is often possible to make assumptions and interpretations regarding individual ways to overcome intolerable stress, but the concepts that are outstanding from private theories, such as the "unconscious motivation" and "secondary benefit", are not included in the number of diagnostic instructions or criteria. The term "conversion" is widely used for some of these disorders and implies an unpleasant affect generated by issues and conflicts that an individual cannot resolve and transfucked in symptoms. The beginning and end of dissociative states is often sudden, but they are rarely observed with the exception of specially designed ways of interaction or procedures, such as hypnosis. The change in or disappearance of the dissociative state may be limited to the duration of these procedures. All types of dissociative disorders tend to remit after a few weeks or months, especially if their occurrence was associated with a traumatic life event. Sometimes more gradually and more chronic disorders are also developed, especially paralysis and anesthesia, if the beginning is associated with unsolvable problems or upset interrelations. Dissociative states that persist for 1-2 years before appealing to a psychiatrist, often resistant to therapy. Patients with dissociative disorders usually deny the problems and difficulties that are obvious to others. Any problems that are recognized by them are attributed to the patients with dissociative symptoms. Depersonalization and delinealization are not included here, since they usually violate only limited aspects of personal identity, and there is no loss of productivity in sensations, memory or movements. Diagnostic instructions: For reliable diagnosis, there must be: a) the presence of clinical signs set out for individual disorders in F44.-; b) the absence of any physical or neurological disorder with which the identified symptoms could be related; c) the presence of psychogenic conditionality in the form of a clear connection over time with stressful events or problems or broken relationships (even if it is denied by the patient). Compeced evidence of psychological conditionality can be difficult to find, even if they are reasonably suspected. If there are known disorders of the central or peripheral nervous system, the diagnosis of dissociative disorder should be established with great care. In the absence of data on psychological conditionality, the diagnosis should be temporary, and the study of physical and psychological aspects should be continued. It should be noted: All disorders of this heading when they are persistent, insufficient communication with psychogenic effects, compliance with the characteristics of "catatonia under the mask of hysteria" (persistent Mutism, stupor), identifying signs of increasing asthenia and / or a change in the identity on schizoid type should be classified within the pseudopsychopathic (psychopath-like) schizophrenia (F21.4). Turn on: - conversion hysteria; - conversion reaction; - hysteria; - hysterical psychosis. Excluded: - "Catatonia under the mask of hysteria" (F21.4); - Simulation of the disease (conscious simulation) (Z76.5). F44.0 dissociative amnesia The main feature is a memory loss, usually for recent important events. It is not due to the organic mental illness and is too pronounced to be explained by the usual forgetfulness or fatigue. Amnesia is usually focused on traumatic events, such as accidents or an unexpected loss of loved ones, usually it is partial and selective. The generalization and completeness of Amnesia often vary the day of day and when evaluating various researchers, but the constant general feature is the inability to recall in a state of wakefulness. Complete and generalized amnesia is rare and is usually a manifestation of the state of the Fugue (F44.1). In this case, it must be classified as such. Affective states that are accompanied by amnesia are very diverse, but severe depression is rare. There may be obvious confusion, distress and various degrees of behavior aimed at finding attention, but sometimes the position of calm primacy is striking. Most often fall in young age, and the most extreme manifestations usually take place in men susceptible to the stress of battles. In the elderly, inorganic dissociative states are rare. Aimed vagrancy can be observed, usually accompanied by hygienic nestness and rarely continued for more than one or two days. Diagnostic instructions: For a reliable diagnosis, it is required: a) amnesia, partial or complete, for recent events of traumatic or stressful nature (these aspects can be found out if there are other informants); b) lack of organic brain disorders, intoxication or excessive fatigue. Differential diagnosis: With organic mental disorders, there are usually other signs of impairment of the nervous system, which is combined with obvious and consistent with them signs of consciousness, disorientation and oscillations of awareness. The loss of memory on quite recent events is more characteristic of organic states, whatever in any traumatic events or problems. Alcohol or drug addiction paletmpuses are closely related to the abuse of psychoactive substances, and the lost memory cannot be restored. Loss of short-term memory when amnetic state (Corsakov syndrome), when direct reproduction remains normal, but lost after 2-3 minutes, not detected during dissociative amnesia. Amnesia after concussion or serious brain injury is usually retrograde, although in severe cases there may be an anterograd; Dissociative amnesia is usually predominantly retrograde. Only dissociative amnesia can be modified by hypnosis. Amnesia after seizures in patients with epilepsy and with other states of stupor or mutism, which is sometimes detected in patients with schizophrenia or depression, can usually be differentiated at the expense of other characteristics of the underlying disease. The most difficult to differentiate from conscious simulation, and here may require a repeated and thorough assessment of the premorbium personality. Amnesia's conscious simulation is usually associated with obvious monetary problems, the danger of death in war time or possible imprisonment or death sentence. Excluded: - amnistic disorder caused by alcohol or other psychoactive substances (F10-F19 with total fourth sign); - amnesia BDA (R41.3); - Anterograd amnesia (R41.1); - non-alcoholic organic amnistic syndrome (F04.-); - percental amnesia in epilepsy (G40.-); - Retrograde amnesia (R41.2).

F44.1 Dissociative Fugue

A dissociative fugue has all the signs of dissociative amnesia in combination with externally targeted travels, during which the patient supports care. In some cases, a new identity identity is adopted, usually for several days, but sometimes for long periods and with an amazing degree of completeness. Organized journey can be in places previously known and emotionally significant. Although the period of the Fugue is amnestly, the behavior of the patient at this time for independent observers may be completely normal. Diagnostic instructions: For a reliable diagnosis, there must be: a) the signs of dissociative amnesia (F44.0); b) a targeted journey outside of ordinary everyday life (differentiation between the journey and the walking should be carried out with local specifics); c) Maintaining care (nutrition, washness, etc.) and simple social interaction with unfamiliar people (for example, patients buy tickets or gasoline, ask how to drive, ordered food). Differential diagnosis: differentiation with a post-clay fugue, which is observed mainly after the temporal epilepsy, is usually not difficult when taking the epilepsy in history, the lack of stressful events or problems and less targeted and more fragmented activities and travel in patients with epilepsy. As with dissociative amnesia, there can be very difficult differentiation with a conscious simulation of the Fugue. It is excluded: - Fugue after an attack of epilepsy (G40.-).

F44.2 dissociative stupor

The behavior of the patient meets the criteria of the stupor, but inspection and examination does not reveal its physical conditionality. As with other dissociative disorders, psychogenic necessitability is further detected in the form of recent stressful events or pronounced interpersonal or social problems. The stupor is diagnosed on the basis of a sharp decline or absence of arbitrary movements and normal reactions to external stimuli, such as light, noise, touch. For a long time the patient lies or sits essentially motionless. Fully or almost there are no speech and spontaneous and targeted movements. Although some degree of violation of consciousness, muscular tone, body position, breathing, and sometimes opening eyes and coordinated eye movements are such that it becomes clear that the patient is not in a state of sleep or unconscious. Diagnostic instructions: for reliable diagnosis should be: a) the stupor described above; b) the absence of a physical or mental disorder that could explain the stupor; c) information about recent stressful events or current issues. Differential diagnosis: dissociative stupap should be differentiated from catatonic, depressive or manic. A storium during catatonic schizophrenia is often preceded by symptoms and behavioral signs involving schizophrenia. Depressive and manic stupor develop relatively slowly, therefore, information received from other informants may be crucial. Due to the widespread therapy of affective disease on early stages Depressive and manic stupor meet in many countries more and less. Excluded: - Cattoneic stupup (F20.2-); - stupor depressive (F31 - F33); - Manic stupor (F30.28).

F44.3 Trans and Obsession

Disorders under which there is a temporary loss as a sense of personal identity and complete awareness of the surrounding. In some cases, individual actions are managed by another person, spirit, deity or "force". Attention and awareness can be limited or focused on one or two aspects of the immediate environment and is often a limited, but repeating set of movements, vines and statements. Only those trances that are involuntary or unwanted and make everyday life due to the fact that they arise or are preserved outside the framework of religious or other culturally acceptable situations. These should not include trances, developing during schizophrenia or acute psychosis with nonsense and hallucinations, or multiple personality disorders. This category should not be used in cases where it is assumed that the transmission state is closely connected with any physical disorder (such as temporal epilepsy or cranknaya injury) or intoxication by psychoactive substances. Excluded: - states associated with acute or transient psychotic disorders (F23.-); - states associated with the identity disorder of organic etiology (F07.0x); - states associated with postcontezion syndrome (F07.2); - states associated with intoxication caused by the use of psychoactive substances (F10 - F19) with a total fourth signament. - states associated with schizophrenia (F20.-). F44.4 - F44.7 dissociative disorders of movements and sensations With these disorders there are loss or difficulties of movements or loss of sensations (usually skin sensitivity). Therefore, the patient seems to suffer from physical illness, although such that explains the emergence of symptoms cannot be detected. Symptoms often reflect the presentations of the patient about the physical illness, which may be in contradiction with physiological or anatomical principles. In addition, the assessment of the mental state of the patient and its social situation often suggests that the decrease in productivity flowing from the loss of functions helps him avoid an unpleasant conflict or indirectly express dependence or indignation. Although for other problems or conflicts may be apparent, the patient itself often denies their presence and attributes to symptoms or impaired productivity. In different cases, the degree of productivity disorders arising from all these types of disorders may vary depending on the number and composition of the people present and the emotional state of the patient. In other words, in addition to the main and unchanged loss of sensitivity and movements, which is not under arbitrary control, behavior aimed at attracting attention can be marked. In some patients, symptoms develop in close relationship with psychological stress, others do not detect this link. The calm adoption of severe productivity violations ("beautiful indifference") can rush into the eyes, but is not mandatory; It is found in well-adapted persons facing the problem of an explicit and severe physical disease. Usually premorbid anomalies of personal relationships and individuals are usually found; Moreover, the physical disease, with symptomatics resembling such in the patient, can take place in close relatives and friends. Easy and transient variants of these disorders are often observed in adolescence, especially in girls, but chronic options are usually found at a young age. In some cases, a recurrent type of reaction to stress in the form of these disorders, which can manifest itself in the middle and old age. It turns on the disorders only with loss of sensitivity, while disorders with additional sensations, such as pain, or other complex sensations, in the formation of which is involved in vegetative nervous system, placed in the heading