F33.8 Most recurrent depressive problems

/ F30 - F39 / Rozladi mood (affective rosladi) The introduction of Inconsideration between ethiological, symptoms, biochemical processes, but lie at the basis of an illness, a reaction to treatment and the result of affective problems to a lack of immunization, and does not allow the conversion of the classification into such a problem On the other hand, in order to create a classification, it is necessary, and on the presented below the classification, we should lay down the hope, as if you would like to be accepted for everyone, it was the result of extensive consultations. Tse discord, for which the main deterioration of the field in the change of the affect or the mood is often in the bic of rottenness (for lack of supportive anxiety) or else. The change in the mood is most often supported by the change in the backward level of activity, and the greater the number of symptoms, or second, or it is easy to understand in the context of the changes in the mood and activity. Most of the number of problems may tend to repeat, and the ear of some of them is often tied to stressful situations or situations. At the end of the day, there are included mood adjustments for all groups, including children and adults. The main criteria for determining the mood of the boules were selected for practical purposes, but the most important ones could be well-defined. Some of them are divided into bipolar and other bagatorazic epizodes, as it is a part of the sick to endure only one episode. Pay attention to the gravity of the illness, with a glance at the importance for the treatment and the designation of the necessary service. To recognize that the symptoms, which are called "somatic" here, could also be called "melancholy", "vital", "biological" or "endogenomorphic". The scientific status of the tsy syndrome is cheap. Protective syndrome also includes inclusions in the Danish razdіl, zvazhayuchi on a wide international clinical interest before it wins. We also support that, as a result of the assessment of this classification, the degree to which the syndrome is seen is critically assessed. The classification is presented in the following way, as a general somatic syndrome of short-term fixations of those, who want to be bi-tsiy, albeit also can be forecasted without losing information. To be overwhelmed by the problem of differentiation new steps gravity. Three degrees of gravity (light, middle (pomirna) and important) are superfluous in the classification for the bazhannya of bagatokh clinitsists. The terms "mania" and "importance of depression" are vikoristic to be included in the classifications, in order to identify the opposite options for the effective spectrum. "Hypomania" is victorious for the designated industrial camp without madder, hallucinations, without ever losing normal activity. Such stanes often (albeit not viciously) can be spared from ailments on the cob, or on the way out of mania. Slid mean: The headings coded F30.2x, F31.2x, F31.5x, F32.3x and F33.3x "Regard the mood (affective problems)" refer to the type of manic-depressive psychosis in the last classifications. Moreover, the codes F30.2x and F32.3x should be placed only, if the type of interruption of maniacal-depressive psychosis (bipolar or monopolar) is more difficult to get through those, which are already known about the first affective phase. If there is a clear type of interruption of manic-depressive psychosis, then vikoristovuvati code F31.2x, F31.5x or F33.3x. It is necessary to have a mother on uvaz, so vipadays F30.2x, F31.2x, F31.5x, F32.3x and F33.3x, lead to the diagnosis of manic-depressive psychosis in the same way as the manifest psychotic disorder є symptoms of a psychotic stance (congruence). It seems that psychotic problems in those who are identified by the same code, not symptoms of an affective camp (NOT congruent to you), then according to the prevailing classification, the symptoms of guilt are seen as a recurrent affective attack. Slid of adherence, but in the picture of the last psychotic problems do not meet the criteria of schizophrenia, meaning in the inventory F20.- according to ICD-10. At the designated number of groups, the additional 5th sign is introduced: F30.x3 - with congruent psychotic dispositions; F30.х4 - s Inconsistency by psychotic breakdowns; F30.x8 - with the same psychotic distribution.

/ F30 / Maniacal epizod

There are three grades of severity here, with certain characteristics inspired by the mood and improvement in society and pace of physical and mental activity. All the categories of the category of guilt of the vicarists are only for the one maniac epizode. Prior to the onset of affective epizodia (depressive, maniacal or hypomanic), they are guilty of koduvatsya in the rubric of bipolar affective disorder (F31.-). Chi vklyuchayutsya: - maniac episode with manic-depressive psychosis; - bipolar rozladi, a single maniac epizod.

F30.0 Hypomania

Hypomania is an easy step of mania (F30.1), if the mood and behavior change, it’s possible to include the camp in cyclothymia (F34.0), but not be supervised by madders, but hallucinations. It is a sign of a long-term light mood (take several days for a long time), an increase in energy and activity, in view of well-being and physical and mental productivity. It is also often attributed to increased sociability, balacuability, overwhelming familiarity, increased sexual activity and decreased demand for sleep. However, the stench does not lead to serious damage in the robot or socially unacceptable ailments. Replacing the savage euphoricity of socialism can be promoted by the increased urgency, increased intelligence and rude behavior. Well-being and respect can be tortured, lowering the rank of humility as a robot, and so on. However, such a country did not overstep the appearance of new interests and active activity, or even more gracefulness to vitrates. Diagnostic indications: Deyaki zgadani vische are signs of a person who is guilty of being present without interruption, taking a few days, in a step often more and more, during a great period of time. Significant difficulties in the protractedness of social efficiency are used to diagnose hypomania, even if there is an important deterioration in these spheres, the country is poorly qualified as a mania (F30.1 or F30.2x). Differential diagnosis: Hypomania is carried out before the diagnosis of mood and activity, intermediate cyclothymic (F34.0) and manin (F30.1 or F30.2x). Increased activity and lateness (often loss in vases) are responsible for the same symptoms in hyperthyroidism and anorexia nervosa. The early stages of "agitated depression" (especially in the middle one) can create a superficial similarity to the addictive type of hypomania. Ailments with severe obsessive symptoms can be an active stretch of a part of the night, here you go your home rituals, tied up with goodness, but in such cases, you can call the other ones described here. If there is a short period of time on the cob or on entries from mania (F30.1 or F30.2x), do not see it in the same heading.

F30.1 Mania without psychotic symptoms

The mood is inadequate to the surroundings and can vary from turbulent gaiety to uncontrolled excitement. With the help of the mood, supervise to increase the energy, to bring to the hyperactivity, the mass pressure and the decrease in consumption in sleep. It is normal for social galmu to get involved, respect does not get lost, it means that there is volatility, self-assessment is changed, it is easy to catch up on optimistic ideas and ideas of greatness. There may be a breakdown in the appearance, such as experiencing a color that is especially bright (and inviting beauty), preoccupation with other details, be it a surface or texture, sub-active hyperacusis. Sickness can kill extravagant and impractical crocs, mindlessly turn a penny or become aggressive, in love, hot in unprecedented circumstances. In case of good maniacal episodes, the mood is better spent and underwhelmed, and under no circumstances. The first attack is often found in children of 15-30 rockies, but it can also be in any event from a child up to 70-80 rockets. Diagnostic indications: Epizod is guilty of a triviality of 1 tier and of such a vagi, to bring to the end of the general destruction of the great pride and social performance. It is a change in the mood of supervising the increase in energy due to the manifestation of symptoms in the meanings of the disease (especially by the pressure, the reduced need for sleep, the ideas of greatness and the overwhelming optimism).

/F30.2/ Mania with psychotic symptoms

A clear picture of an important form, below F30.1. Self-assessment and ideas of greatness can develop into madder, and gratitude and tolerance - into madder. In important cases, the bends of the lighthouse ideas of greatness and noble promenade are considered. As a result, the jumps of the thoughts and the high pressure of the sick grows with little noise. Important and trivial physical measures and excitement can lead to aggression or violence. Znevaga to їzhі, pitva and special hygiene can be brought to will not be without bake dehydration and injury. Marennya and hallucinations can be classified as congruence or incongruous mood. "Non-congruence" includes affectively neutral lighthouse and hallucinatory razlady, for example: maddening without any guilt, or annoying, or voices, like talking about podiatry, as not to obscure the moral meaning. Differential diagnosis: One of the most frequently encountered problems is that there are no problems with schizophrenia, especially as the stage of hipomania is missed, and it’s possible to get sick, there can be a lot of sickness, but not smart Ailments from manin, as they react kindly to neuroleptic therapies, may reveal an analogous diagnostic problem at this stage, if their physical and mental activity has turned to normal, but there is still a lot of madness or hallucinations. Periodically, there are specificities for schizophrenia (F20.xxx) hallucinations, for madder can also be judged as incongruous mood. Allegedly, the symptoms are clearly flare-up and overwhelming, a greater pre-river diagnosis of schizoaffective disorder (F25.-). Chi vklyuchayutsya: - paroxysmal schizophrenia, manic-looming stun; - manic-depressive psychosis with manic-looming camps with unrecoverable type of leak. - a mania with a mood of psychotic symptoms; - a mania with unacceptable mood of psychotic symptoms; - manic stupor. F30.23 Maniac-lighthouse camp with congruence to madder affection It turns on: - manic-depressive psychosis with manic-looming camps with unrecoverable type of leak. F30.24 Maniac-lighthouse c Inconsistency with the attack of madders Chi is included: - paroxysmal schizophrenia, manic-looming stun. F30.28 Inshaction of psychotic symptoms Chi turns on: - manic stupor. F30.8 Insect maniacal epizodi F30.9 Maniac episode of unspecified Chi turn on: - mania NOS. / F31 / Bipolar affective disorder Rozlad, which is characterized by repeated (accept two) epizodes, with certain attitudes and levels of activity, are significantly damaged. These changes are in the fact that in some cases it is determined by the mood, the increase in energy and activity (mania or hypomania), in the lower the decrease in the mood, the decrease in the energy. Oduzhannya zvvychay outside of the attacks (epizodes), and the incidence of both the choloviks, and the women, are approximately the same, to the mind of the others in the mood. Oskіlki hvorі, SSMSC strazhdayut re epіzodami manії porіvnyano rіdko zustrіchayutsya i mozhut nagaduvati (on sіmeynomu anamnezі, premorbіdnim Especially, cob hour forecast zahvoryuvannya i) quiet, in yakih buvayut takozh Hoch b rіdkіsnі epіzodi depresії, tsі hvorі povinnі kvalіfіkuvatisya yak bіpolyarnі (F31.8 ). Maniacal epizodes are encouraged to repair raptus and three months from 2 months to 4-5 months (the average time of an episode is close to 4 months). Depressions may tend to be more tricky (the middle triviality is close to 6 months), I want a little more fate (the sick people are sick). First and foremost episodes often follow stressful situations such as mental trauma, if they do not seem to be necessary for diagnosing. The first episode can be found in any occasion, repairing from childhood and ending old age. The frequency of episodes and the nature of remissions and fire-fighting are of great development, altogether the remissions tend to be shortened in a row, and depression is more often and more trivial in the middle. Would like the kolishnaya concept of "manic-depressive psychosis" included ailments, as they suffered only from depression, the term "MDP" is now victorious in the main way as synonymous with bipolar distribution. Chi vklyuchayutsya: - manic-depressive psychosis with manic-looming stuns, bipolar type; - manic-depressive psychosis with depressive-looming camp, bipolar type; - manic-depressive illness; - manic-depressive reaction; - paroxysmal schizophrenia with a bipolar affection, manic-looming stun; - paroxysmal schizophrenia with bipolar affection, depressive-looming stun. Viklyuchayutsya: - bipolar rozladi, single maniac epizod (F30.-); cyclothymia (F34.0). F31.0 Bipolar affective disorder, current episode of hypomania Diagnostic tests: For a reliable diagnosis: a) the current test of hypomania criteria (F30.0); b) in the anamnesis, there was one affective episode (depressive abnormalities). F31.1 Bipolar affective disorder, current episode of mania without psychotic symptoms Diagnostic indications: For a reliable diagnosis: a) a current test according to the criteria of mania without psychotic symptoms (F30.1); b) in the anamnesis, there was one affective episode (depressive abnormalities).

/F31.2/ Bipolar affective disorder,

persistent episode of mania with psychotic symptoms

Diagnostic indications: For a reliable diagnosis: a) the current test of the criteria for psychotic symptoms (F30.2x); b) in the anamnesis of bully, they were aware of the fact that they were not effective (depressive or depressive). It is necessary, madder and hallucination can be of value like "congruence" or "incongruence" mood (marvel at F30.2x). Chi vklyuchayutsya: - paroxysmal schizophrenia with a bipolar affection, manic-looming stun; - manic-depressive psychosis with manic-looming stuns, bipolar type. F31.23 Manic-lighthouse camp, bipolar type, with congruence to madder affection Chi is included: - manic-depressive psychosis with manic-looming camps, bipolar type. F31.24 Manic-lighthouse stun, bipolar type, s Inconsistency with madder affection It turns on: - paroxysmal schizophrenia with a bipolar affection, a manic-looming camp. F31.28 Insha bipolar affective disorder, current episode of mania /F31.3/ Bipolar affective discord, current epizod of easy or peaceable depression Diagnostic indications: For a reliable diagnosis: a) the current test is guilty of the criteria of a depressive test of either lightness (F32.0x), or of an internal degree of severity (F32.1x). b) the last one is guilty of being responsible for one hypocrisy, a manic or negative affective episode. P'yuyu a sign of viciousness, to mean the appearance of or the appearance of somatic symptoms in the flow episode of depression. F31.30 Bipolar affective disorder, current episode of mild or moderate depression without somatic symptoms F31.31 Bipolar affective disorder, current episode of mild or moderate depression with somatic symptoms F31.4 Bipolar affective disorder, current episode of important depression without psychotic symptoms Diagnostic indications: For a reliable diagnosis: a) the current test according to the criteria of an important depressive episode without psychotic symptoms (F32.2); b) the last one is guilty of being responsible for one hypocrisy, a manic or negative affective episode.

/F31.5/ Bipolar affective disorder,

psychotic symptoms

Diagnostic indications: For a reliable diagnosis: a) the current test according to the criteria of an important depressive episode with psychotic symptoms (F32.3x); b) the last one is guilty of being responsible for one hypocrisy, a manic or negative affective episode. Iakshcho є need, madding or hallucination can be seen as congruence or incongruence in mood (marvel at F30.2x). F31.53 Depressive lighthouse stun, bipolar type, with congruence to madder affection Chi is included: - manic-depressive psychosis with depressive-looming camp, bipolar type. F31.54 Depressive-lighthouse stun, bipolar type, s incongruity to madder affection Chi is included: - paroxysmal schizophrenia with bipolar affection, depressive-looming stun. F31.58 Insha bipolar affective disorder, current episode of important depression with other psychotic symptoms F31.6 Bipolar affective disorder, current episodic affective character. In general, epizodia appear either for changes, or for rapidly alternating maniacal, hypomanic or depressive symptoms. Diagnostic indications: Wanting the most types of forms of bipolar disorders are characterized by manic and depressive episodes, which are divided by periods of normal mood, an unreasonably depressive stampede, which is superfluous during the day. For the maniacal attitude and ideas of values ​​can be supervised by agitation, decreased activity and libido. Depressive symptoms, hypomania, or mania, can also be quickly worn out on a skin day, or for a stretch of years. Diagnosis of a low bipolar affective disorder can be set at least 2 symptoms, in case of any offense, a large part of the disease is spreading, and at least 2 cases are affected. Viklyuchatsya: - lonely affective episode of low character (F38.0x). F31.7 Bipolar affective disorder, in-line repair The sick person is guilty, but they took one reliable maniacal, hypomanic, depressive or negative affective episodes in the last but also one more affective episodes of hypomania, mania, and depression in some cases. Sickness can, however, be transferred to lykuvanni, to reduce risik to mayybutny. F31.8 Інші bipolar failures Chi are included: - bipolar drives, type II; - recurrent (recurrent) maniacal episodes. F31.9 Bipolar affective disorder, unspecified / F32 / Depressive episode In typical cases in all 3 options, described below (light episode F32.0x; pomirny - F32.1x; important - F32.2 or F32.3x), ailments are suffering from a low mood, lose interest and contentedness, which can lead to increased stomatomy and decreased activity. It is evident that there is a swelling of the nausea with a slight zusilli. The following are considered to be the following: a) the health is reduced to the level of improvement and respect; b) a decrease in self-assessment and a feeling of performance in one's own; c) ideas of wine and humiliation (to win with a light type of epizode); d) frowning and pesimistic behavior of the maybutny; e) іdeї аbо dії direct to self-education or suicide; f) sleep disturbances; g) decreased appetite. There is little decrease in the mood for a stretch of days, and often there is no reaction to the current situation, but it may be more characteristic of additional communication. However, there are maniacal epizodes, then the classic picture is of individual variability, and in the midst of life, atypical paintings are especially often referred to. In deyakih vipadkah trivoga, vіdchay i Ruhov azhitatsіya hour mozhut Buti bіlsh virazhenimi, nіzh depresіya and zmіni mood takozh mozhut Buti maskuvati dodatkovimi symptoms: dratіvlivіstyu, nadmіrnim vzhivanie alcohol іsterichnim povedіnkoyu, zagostrennyam poperednіh fobіchnih abo nav'yazlivih simptomіv, іpohondrichnimi іdeyami. For depressive episodes of all 3 degrees of severity, the triviality of the episode is not less than 2 conditions, but the diagnosis can be made for more short periods, as the symptoms are not surprisingly important and come. Deyakі from vishchevkannyh symptoms can be swerve and appear characteristic signs, such as vvazhayutsya as such, which is of special importance. The most typical butt є "somatic" (marvel at the introduction to a whole lot) symptoms: loss of interest and satisfaction from performance, as in the norm to bring satisfaction; loss of emotional reactivity on the adjustment of the basis, which is in the norm of acceptance; the awakening of the vrant is 2 or more years earlier, less at the earliest hour; depression is more important in the rankings; ob'ktivnі data about the reading of psychomotor balmovanosti or agitation (denoted by outside people); read the decrease in appetite; waste at the vase (vvazhaєtsya, which will add 5% of the waste at the vase in the last month); turn around the decrease in libido. Tsey somatic syndrome becomes addicted to being present when there is a desire for 4 symptoms. The category of lung (F32.0x), moderate (F32.1x) and important (F32.2 and F32.3x) depressive episode is guilty of a single (first) depressive episode. Subsequent depressive episodes are qualified in one of the cases of recurrent depressive disorder (F33.-). Three degrees of severity are so significant, so you can turn on the great range key stations, I am learning in psychiatric practice. sick s light forms depressive episodes are often seen in primary medical and foreign medical institutions At that hour, as a stationary appearance, in the main, I will be right with ailments, for those who have depression of a greater degree. Self-damaging children, most often self-destructing by typed names of defective disorders, guilty of restructuring with an additional code from Class XX ICD-10 (X60 - X84). This code does not include the differentiation between the breakout and the "parasite". The offense of the category is included in the home category of self-education. Differentiation between easy, amid and important steps to ground on the folding clinical assessment, Yaka includes the number, type and severity of present symptoms. Social welfare labor activity often you can help with the seriousness of the epizode. However, individual social and cultural is injected, as they develop in one and the same number of symptoms and social productivity, to reach parts and strengths, in connection with not-critically include the basis of social productivity. Detection of dementia (F00.хх - F03.х) or pinkness (F70.хх - F79.хх) does not lead to the diagnosis of a susceptible dementia episode, but in connection with difficult cases, it is necessary Somatic symptoms, such as psychomotor malnutrition, loss of appetite, vagi and sleep disturbance, are actively promoted. Chi vklyuchayutsya: - manic-depressive psychosis with a depressive-lighthouse camp with an uninterrupted type of interruption; - depressive epizod with manic-depressive psychosis; - paroxysmal schizophrenia, depressive-looming stun; - lonely episode of depressive reaction; - great depression (without psychotic symptoms); - a single episode of psychogenic depression (F32.0; F32.1; F32.2 or F32.38 in the presence of the degree of severity). - a single episode of reactive depression (F32.0; F32.1; F32.2 or F32.38 in the presence of the severity level). Viklyuchayutsya: - Disorder of predisposing reactions (F43.2x); - recurrent depressive disorder (F33.-); - depressive episode, dressings with behavioral patterns, classified in the headings F91.x or F92.0.

/F32.0/ Depressive episode of light step

Diagnostic indications: Decreases in mood, loss of interest and health, and satisfaction, increased obesity is caused by the most typical symptoms of depression. For a reliable diagnosis, it is necessary to take 2 of 3 symptoms, plus more than 2 of other symptoms described for the disease (for F32). Due to the significant symptoms, it is not guilty of reaching a high level, and the least triviality of the whole episode is about 2 times. Lyudin with a mild depressive episode, as the rule of stabbing with symptoms and it is impossible for the robot to be socially active, however, it is unlikely that it will increase the function. P'yuchi is a sign of vicariousness for the identification of somatic syndrome. F32.00 Depressive episode of mild degree without somatic symptoms Vykonuyutsya criterion of mild depressive episode, presence, but not necessarily, depriving deyaki somatic symptoms. F32.01 Depressive episode of mild degree with somatic symptoms.

/F32.1/ Depressive episode of the middle stage

Diagnostic indications: At least 2 of the 3 most common symptoms for mild depression (F32.0), plus 3 (and more than 4) symptoms, were present. Some of the symptoms can be butt bends of the feet, but sometimes it is not necessary, but there are many symptoms. The minimum triviality of the whole episode is close to 2 types. Ailment with a depressive episode of the middle stage is conceited of significant difficulties in the viconnia of social conditions, at home, in advanced robots. P'yuchi is a sign of vicariousness for the identification of somatic symptoms. F32.10 Depressive episode of the middle stage without somatic symptoms Satisfied with the criteria for a depressive episode of the middle stage, despite the fact that there are no more or less somatic symptoms. F32.11 Depressive episode of the middle stage with somatic symptoms The criteria for depressive episode of the middle stage are satisfied with the presence of 4 or more somatic symptoms. (You can choose the heading for the presence of only 2 or 3 somatic symptoms, albeit the stench of an uninvitedly important step). F32.2 Depressive episode of an important stage without psychotic symptoms. A little bit of a glamor is evident. You can be a twist in the vrata of samopovagi or almost no fault or guilt. Suicide is insanely insecure in especially important issues. Transmission, somatic syndrome may even be present in the presence of an important depressive episode. Diagnostic indications: Present all 3 of the most typical symptoms characteristic of a mild and moderate degree of a depressive episode, plus the appearance of 4 or more symptoms, some of which are due to a serious degree. However, even if such symptoms are present, such as agitation or malnutrition, ailment may not want to, or it is impossible to describe in detail the abundant symptoms. In cich vipadkah, the qualification of such a person will become an important episode can be justified. Depressive episodus is guilty of trivati ​​shonaymenshe 2 tyzhny. Also, the symptoms are especially important and the ear is even worse than the gostre; The hour of something important to the epizode is small, so the ailments will continue to socially and at home, and will visit your robot. This activity can be further enclosed. Quite a category of need for vikoristovuvati only for a single important depressive episode without psychotic symptoms; at the onset of episodes, the subheading of recurrent depressive breakdown (F33.-) should be entered. Chi vklyuchayutsya: - single episode of agitated depression without psychotic symptoms; - melancholy without psychotic symptoms; - vital depression without psychotic symptoms; - signified depression (single episode without psychotic symptoms).

/F32.3/ Depressive episode of an important stage

psychotic symptoms

Diagnostic indications: An important depressive episode, which is similar to the criteria of F32.2, is supplemented by the appearance of madder, hallucination or depressive stupor. Delirium is more often than not such a wickedness: shitness, teeth, how to obstruct the misery, for which there is no evidence of ailments. Rumors, or smelling hallucinations, as a rule, call out and imitate the character of "voices", and smells - of rotten meat or brude. The importance of rukhova can become a stupor. It is necessary, madder or hallucination may appear as congruence or incongruence in mood (marvel at F30.2x). Differential diagnosis: Depressive stupor is necessary to differentiate from catatonic schizophrenia (F20.2xx), from dissociative stupor (F44.2) and from organic forms of stupor. Quite a category of need for vicoristovuvati only for a single episode of important depression with psychotic symptoms. For the more recent episodes, you need to use the headings of recurrent depressive breakdown (F33.-). Chi vklyuchayutsya: - manic-depressive psychosis with a depressive-lighthouse camp with an uninterrupted type of interruption; - paroxysmal schizophrenia, depressive-looming stun; - lonely episodic great depression with psychotic symptoms; - lonely episode of psychotic depression; - single episode of psychogenic depressive psychosis; - single episode of reactive depressive psychosis. F32.33 Depression-lighthouse stun with congruence to madder affection Chi is included: - manic-depressive psychosis with a depressive-looming camp with an uninterrupted type of interruption. F32.34 Depression-lighthouse stan Chi is included: - paroxysmal schizophrenia, depressive-looming stun. F32.38 Major depressive episode with major psychotic symptoms Chi vklyuchayutsya: - single episode of great depression with psychotic symptoms; - lonely episode of psychotic depression; - single episode of psychogenic depressive psychosis; - single episode of reactive depressive psychosis.

F32.8 Insensitive epizodia

They are included in the episodes, which do not give a description of the depressive episodes in F32.0x - F32.3x, even if they give a glimpse of respect for the enemy, which is a depression for its nature. For example, a fluctuating sum of depressive symptoms (especially a somatic variant) does not appear diagnostic value symptoms, such as a spill, when you are still or see. Abo the sum of somatic depressive symptoms last pain abo visnazhennyam, not obumovlenie organic reasons (like the tse buvaє in ailments, scho to be found in the lіkarnya zalnogo profile). Chi vklyuchayutsya: - atypical depression; - a single episode of "masked" ("prikhovanoi") depression of the BDU.

F32.9 Depressive episode of unspecified

Chi vklyuchayutsya: - depression NOS; - depressive disorder NOS.

/ F33 / recurrence depressive disorder

Rozlad, which is characterized by repeated episodes of depression, which is indicated in F32.0x - depression episode of an easy step, or F32.1x - a middle step, or F32.2 - a depressive episode of an important step, without anamnestic episodes of anxiety according to the criteria of mania (F30.1 and F30.2x). However, this category can be victorious, as well as information about short episodes of mild mood and hyperactivity, which show the criteria for hypomania (F30.0) and how to go without a median deprivation. The ear, the severity, the triviality and the frequency of depression are even worse. In general, the first epizod of winyk piznishe, lower in bipolar depression: in the middle in the fifth ten years of life. The triviality of the episodes is 3-12 months (the middle triviality is close to 6 months), but the stink may seem to be a tendency to a greater repetition. If you want to grow up in the middle of the population, a small part of the ailments is chronically depressed, especially in the summer (this is a heading for the general category of ailments). Outside of being difficult, often provoked by a stressful situation, and in many cultural minds, it is twice as common among women, but not among choloviks. Rizik, a sick person with recurrent depressive episodes will not have an episode of mania, there can be no more failures, since no depressive episodes have been in the past. Yakshko vinikak epizod mania, the diagnosis is guilty of changes in bipolar affective disorder. Recurrent depressive breakdown can be subtle, as it will be shown below, by way of the type of flowing epizode, and sometimes (as well as sufficient information) to the type of large number of cases. Chi vklyuchayutsya: - manic-depressive psychosis, monopolar-depressive type with psychotic symptoms (F33.33); - paroxysmal schizophrenia with monopolar-depressive affection, depressive-luminous stun (F33.34); - recurrent depressive reactions (F33.0x or F33.1x); - recurrent episodes of psychogenic depression (F33.0x or F33.1x); - recurrent epizodi of reactive depression (F33.0x or F33.1x); - seasonal depressive breakdown (F33.0x or F33.1x); - recurrent endogenous depression (F33.2 or F33.Z8); - recurrent epizodia of manic-depressive psychosis (depressive type) (F33.2 or F33.Z8); - recurrent episodic depression (F33.2 or F33.Z8); - recurrent episodes of great depression (F33.2 or F33. Z8); - recurrent episodes of psychotic depression (F33.2 or F33.Z8); - recurrent episodic psychogenic depressive psychosis (F33.2 or F33.Z8); - recurrent episodic reactive depressive psychosis (F33.2 or F33.Z8). Vylyuchayutsya: - short-time recurrent depressive episodi (F38.10).

/F33.0/ recurrence depressive disorder,

streaming episode of the light step

Diagnostic indications: For a reliable diagnosis: a) the criteria of recurrent depressive disorder (F33.-) are satisfied, and the current test is based on the criteria of a mild stage of depression (F32.0x); b) I would like to be guilty of two times as small as two times and at intervals in the month of the month without any significant changes in the mood. It is also necessary to diagnose other recurrent affective disorders (F38.1x). P'yatiy is a sign of vicariousness for the meaning of the manifestation of somatic symptoms in a flow epizodi. While it is necessary, it is possible to mean a perevazhayushchiy type of the frontal epizodes (light, middle, important, non-significant). F33.00 recurrence depressive breakdown, streaming episode of light step no somatic symptoms Vykonuyutsya criterion of mild depressive episode, presence, but not necessarily, depriving deyaki somatic symptoms. F33.01 recurrence depressive breakdown, flowing stage with somatic symptoms Satisfied with the criterion of mild depressive episode and presence of 4 or more somatic symptoms (you can choose the category, if only 2 or 3 are present, please note the important ones).

/F33.1/ recurrence depressive disorder,

streaming episode of the middle stage

Diagnostic indications: For a reliable diagnosis: a) you are guilty of being satisfied with the criterion of recurrent depressive disorder (F33.-), and the current episode is guilty of determining the criteria for a depressive episode of the F32.1 stage; b) less than 2 times to be guilty of triviality yak minimum 2 times and guilty to be distributed at intervals in the month of the month without significant changes in the mood; in the first category of demand, be sure to refer to the rubric of recurrent affective problems (F38.1x). It is a sign of vicariousness for the meaning of the manifestation of somatic symptoms in a flow episode: It is necessary, it is possible to identify the prevailing type of anterior episodes (light, middle, important, non-significant). F33.10 recurrence depressive disorder, flowing episode of the middle stage no somatic symptoms Satisfied with the criteria for a depressive episode of the middle stage, despite the fact that there are no more or less somatic symptoms. F33.11 recurrence depressive disorder, flowing episode of the middle stage with somatic symptoms Satisfied with the criteria for a depressive episode of the middle stage, with the presence of 4 or more somatic symptoms. (You can choose the heading for the presence of only 2 or 3 somatic symptoms, albeit the stench of an uninvitedly important step). F33.2 recurrence depressive disorder, fluent episode of important steps without psychotic symptoms Diagnostic cues: For a reliable diagnosis: a) the criteria of recurrent depressive disorder (F32.-) are satisfied, and the current episode is based on the criteria of an important depressive episode without psychotic symptoms (F32.2); b) less than 2 times to be guilty of triviality yak minimum 2 times and guilty but to be distributed at intervals in the decilka of months without significant damage to the mood; In the first place, there is a need for coduvati and a recurrent affective disorder (F38.1x). While it is necessary, it is possible to mean the prevailing type of coli's epizodes (easy, medium, important, non-significant). Chi vklyuchayutsya: - endogenous depression without psychotic symptoms; - depression is significant, recurrent without psychotic symptoms; - manic-depressive psychosis, depressive type without psychotic symptoms; - vital depression, recurrent without psychotic symptoms.

/F33.3/ recurrence depressive disorder,

acute episode of an important step with psychotic symptoms

Diagnostic cues: For a reliable diagnosis: a) the criteria of recurrent depressive disorder (F33.-) are satisfied, and the current episode is based on the criteria of an important depressive episode with psychotic 3 symptoms); (F32 b) less than 2 times to be guilty of a triviality not less than 2 times and not to be dispensed at intervals in a month without significant damage to the mood; In the first case, it is necessary to diagnose a recurrent affective disorder (F38.1x). If necessary, it is possible to take into account the congruence or the incongruence of the mood, the character of the madder or the hallucinations. While it is necessary, it is possible to mean the prevailing type of the preceding epizodes (easy, middle, important, non-significant). Chi vklyuchayutsya: - paroxysmal schizophrenia with monopolar-depressive affection, depressive-looming stun; - endogenous depression with psychotic symptoms; - manic-depressive psychosis, monopolar-depressive type with psychotic symptoms; - repeated important episodic depression with psychotic symptoms; - repeated important episodes of psychogenic depressive psychosis; - repeated importance of the episode of psychotic depression; - repeated important episodes of reactive depressive psychosis. F33.33 Manic-depressive psychosis, monopolar-depressive type with psychotic symptoms F33.34 Depressive lighthouse stun, monopolar type Chi turns on: - paroxysmal schizophrenia with monopolar-depressive affection, depressive-luminous stun. F33.38 Insha recurrent depressive disorder, current episode of important depression with other psychotic symptoms Chi turns on:

Endogenous depression with psychotic symptoms;

Repeated important episodic depression with psychotic symptoms; - repeated important episodes of psychogenic depressive psychosis; - repeated importance of the episode of psychotic depression; - repeated important episodes of reactive depressive psychosis. F33.4 recurrence depressive breakdown, continuous production line Diagnostic tests: For a reliable diagnosis: a) criteria for recurrent depressive problems (F33.-) are acceptable for past patients, but the current state does not meet the criteria for depressive problems. b) for the last 2 days in the last guilt, I’m trivial for not less than 2 times and the smell of guilt, but I’ll be dispensed at intervals in the month without any kind of deterioration; In the first place, there is a recurrent affective disorder (F38.1x). This category can be victorious, as people are on the list to change the risk of the onset of the coming episodes.

F33.8 Other recurrent depressive problems

/ F34 / Stiyki (chronic) adjust the mood

(Affective rozladi)

Rozlad, which should be included in the whole category, have a chronic and fluctuating character, and sometimes there is a lack of glory, but it can be very important in the form of hypomania or mild depression. The stench smells like rock, and if you stretch out the sickly life, the stink can overwhelm the restless and can lead to the deterioration of productivity. In some cases of recurrent or even episodic disorder, mild or important depression may overlap with chronic affective disorder. Chronic affective problems are found here, and not in the category of special problems, as from the family anamnesis it is obvious that such ailments are genetically linked to relatives who are in the mood for a family. In some cases such ailments respond kindly to the same therapy, as well as ailments with affective treatment. Describes the options for the early, so i on the cob cyclothymia and dysthymia, and if necessary, the stench and guilt so start.

F34.0 Cyclothymia

The stagnation of chronic instability of the mood with the numerical episodes of easy depression and easy adolescence. Qia instability to develop in a young vice and reception chronic overrun, I would like an hour to set up a normal and stable stretch of bagatokh miscellaneous. Wake up to the mood, inviting you to sleep with people as they are not tied to life's pod. It is not easy to make a diagnosis, as the patient is not in a hurry to achieve a good description of behavior in the past. At the same time, the changes in the mood are visibly easy, and during the period of pregnancy they bring satisfaction, the cyclothymia is rarely consumed in the field. Some of them are tied to the time, so there is a change in mood, if you want to be present, there are few changes in activity, in a sense of change in your activity, in a sense of being in your own mind, socially, or in a change of appetite. It is necessary, it is possible to mean, if there is a cob: early (in the middle of the year, up to 30 years) or more. Diagnostic tests: The main rice when making a diagnosis post-life, chronic instability of the mood with the number of periods of mild depression and easy fatigue, due to those who do not have a sufficient risk of depression and .-) This means that the environment does not meet the criteria for a maniac episode (F30.-) but a depressive episode (F32.-). Differential diagnosis: A disorder often occurs in relatives of ailments with a bipolar affective disorder (F31.-). In some cases individuals with cyclothymic age can suffer from a bipolar affective disorder. Cyclothymia can pass through a stretch of a grown-up life, for an hour or even a residual break, or develop into a more important disposition of the mood, giving a description of a bipolar affective disposition (F31.-) F33- or recurrent depressive. Chi vklyuchayutsya: - Affective disorder of specialness; - cycloidal specialty; - Cyclothymic (cyclothymic) specialty. F34.1 Dysthymia Chronic depressive mood, as in Danish hour I will not be able to describe a recurrent depressive disorder of easy or even severe depressive epizodus, especially on the cob of food). The balance between the conditions of mild depression and periods of the normal will become even more variable. There are many people who have a period of time (for a day), as the stench itself is good. For a little more than an hour (often in months), the stench can be seen in this and the decrease in mood. All are important and do not bring satisfaction. The stench is strong to frowning thoughts and skarzhayutsya, how disgusting to sleep and see yourself uncomfortable, but in general cope with the main vimogs of the haunted life. That is why dysthymia is not very strong in the concept of depression neurosis or neurotic depression. If it is necessary, it is possible to pick up an ear of food early (in the middle of the day, up to 30 years) or more. Diagnostic tests: Basic rice є trivially lowered mood, as nikoli (or even worse) is not enough to satisfy the criteria of recurrent depressive disorder of easy or lazy level (F33.0x) or F33.1x. Zvvychay the goal of repentance in a young life and triumph with a stretch of decilkoh rocky, in some cases unassigned. If such a camp is victorious, it is most often the inheritance of a depressive episode (F32.-) and is not tied with the second close people for some obvious stressful situations. Chi vklyuchayutsya: - chronic anxiety depression; - depressive neurosis; - depressive disorder of specialness; - neurotic depression (triviality more than 2 rocks). Viklyuchayutsya: - anxiety depression (easy or nasty) (F41.2); - reaction at the expense of less than 2 rocky (prolonged depression reaction) (F43.21); - residual schizophrenia (F20.5xx). F34.8 Intrinsic (chronic) mood adjustments (affective rozladi) Prior to the residual category, chronic affective problems should be considered, which are not important or trivial, in order to meet the criteria for cyclothymia (F34.0) or dysthymia (F34.1), but at the same time they are critically significant. Deyaky types of depression, which were previously called "neurotic", are included in the whole heading in quiet cases, if the stench does not meet the criteria for cyclothymia (F34.0) or dysthymia (F34.1), or mild depressive episode) (F32.0 (F32.1x). F34.9 Steel (chronic) mood disorder (affective rozlad) unspecified / F38 / Інші rozladi tune (affective rozladi)/F38.0/ Інші one-by-one rozladi mood (affective rozladi) F38.00 Affective epizode Affective epizode, which is not less than 2 types of symptoms and is characterized either by a change or by a swell (as a rule, by stretching out for a period of time) by hypomanic, depressive symptoms. F38.08 Іnshi one at a time change the mood (affective rozladi) /F38.1/ Інші recurrent problems set up (affective rozladi) Short-hour depressive episodes, which occur approximately once a month, stretching out the rest of the rock. All of them are less than 2 types (in typical cases - 2-3 days, with more days), but they meet the criteria of a depressive episode of easy, medium or important level (F32.0x, F32.2). Differential diagnosis: On the basis of dysthymia (F34.1), the main part of the disease is not depressive. Also, there is a depressive episode of the disease in connection with the menstrual cycle, you need to use the heading F38.8, with a different code for the cause (N94.8, more and more cases, tied with the female body organs and menstrual organs). F38.10 Recurrence of short-hourly depressive disorder F38.18Inshi recurrent adjustments (affective rozladi) F38.8 Inspection adjustments (affective rozladi) This is a residual category for affective disorders that do not meet the criteria for categories F30.0 - F38.18.

F39 Rozlad tune

(affective rozlad)

Vikoristovuєtsya only in the same way, if there are no values. Chi turn on: - affective psychosis NOS. Viklyuchatsya: - psychotic disorder NOS (F99.9).

Rozlad is characterized by repeated episodes of depression, similar to the description of a depressive episode (F32.-), without a history of self-reliant episodes in the mood and surge of energy (mania). However, it can be a short episode of mild mood and hyperactivity (hypomania) at the same time as a depressive episode, one of the reactions to antidepressants. The most important form of recurrent depressive breakdown (F33.2 and F33.3) may be rich in spirits with many people, such as maniac-depressive depression, melancholy, mental depression and endogenous depression. The first episode can be found in any occasion, repaired from the childhood and up to the elder. The ear of this can be hospitable or uncomfortable, and the triviality is from the past to the bagatokh miscellaneous. I am not aware of the fact that a person who is ill with recurrent depressive disorder is not guilty of a maniacal episode. As soon as it becomes, the diagnosis is guilty of changes in bipolar affective disorder (F31.-).

included:

• repeated episodi:
  • depressive reaction
  • psychogenic depression
  • reactive depression
• seasonally depressive discord

Victims: recurrent short depressive episodes (F38.1)

Rozlad, which is characterized by repeated episodes of depression. Streamy episode of easy bending (as described in section F32.0) and without a history of mania.

Rozlad, which is characterized by repeated episodes of depression. Streaming episode along with bends (as described in section F32.1) and without a history of mania.

Rozlad, which is characterized by repeated episodes of depression. A streaky episode of significant rotations, without psychotic symptoms (as described in section F32.2) and without a history of mania.

Endogenous depression without psychotic symptoms

Significant depression, recurrent without psychotic symptoms

Manic-depressive psychosis, depressive type without psychotic symptoms

Vital depression, recurrent without psychotic symptoms

Rozlad, which is characterized by repeated episodes of depression. The current episode of meaningful bends, is supervised by psychotic symptoms, as described in section F32.3, albeit without caveats in the forefront.

Endogenous depression with psychotic symptoms

Manical-depressive psychosis, depressive type with psychotic symptoms

Repeat important episodi:

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

The patient last had two more depressive episodes (as described in sections F33.0-F33.3), or, for a long time, depressive symptoms of the day.

Bipolar affective disorder of the individual

It is also ambiguous, until the end of the day it wasn’t vivcheniye and not quite clearly reinforced by the cordons of mental illness, like a bipolar process, which was seen in psychiatry in the middle of the 19th century. Yak only yogo did not call their own hour, і to gods in two forms, і circular psychosis. Buv period, since they are abnormal, such as schizophrenia, were respected as a manifestation of genality. In the end of the 19th century, the famous psychiatrist Emil Krepelin, I will name it - maniacally-depressive psychosis (MDP), and only through the centuries it has been changed to a greater degree of correctness. Same tse naymenuvannya presence in the ICD-10. What is a BAR, like living with it and how to uniqueness invalidity?

In ICD-10, Bipolarny affective distribution is included in the block F30-F39 Rozladi mood [affective distribution] i maє code:

F31 Bipolar affective disorder

• F31.0 Bipolar affective disorder, current episode of hypomania
• F31.1 Bipolar affective disorder, current episode of mania without psychotic symptoms
• F31.2 Bipolar affective disorder, current episode of mania with psychotic symptoms
• F31.3 Bipolar affective disorder, current episode of mild or moderate depression
• F31.4 Bipolar affective disorder, current episode of important depression without psychotic symptoms
• F31.5 Bipolar affective disorder, current episode of important depression with psychotic symptoms
• F31.6 Bipolar affective disorder
• F31.7 Bipolar affective disorder, in-line repair
• F31.8 Insti bipolar affective disorder
• F31.9 Bipolar affective disorder, unspecified

Brief description of bipolar affective syndrome



Yak zrozumіlo і is it possible to describe the TIR in foreign rice? A bipolar discord can be achieved, as it is more accurate to change the mood from one to one by the phases of depression and mania (or hypomania). However, the criteria for diagnostics are wide, but there are many options for overcoming the forms of an affective syndrome - impaired, from epizodic hypomania to an attack-like manic-divine schizophrenia. The difference between different variations in the range of polygons in the frequency of episodes and the nature of the fire. The triviality of these chi іnshіy phases can also reach the level of versatility (from the middle to two rockies), or, in the middle, a maniacal attack is trivial, and the depressive - pivrok. A change of symptoms of mania on the camp of depression is seen as a rapt. In some types of episodes, one follows one sleep, in others - through intermissions, which are also called "light" periods of mental health, so as in all the times of power, the specialties are practically updated. The triviality of intermissions can be from three to seven rockets. I will be able to meet both different and flexible changes. It is noteworthy that all the patients from the TIR may have a pre-existing mental breakdown in their character.

How much wider are you getting sick?



Objectively assess the breadth of such an ambiguous position of psychiatrists becoming ill, as a bipolar depression, to finish smoothly. The evaluation criteria are even more profitable, and that means the process of diagnostics is not sub'activities. Data from foreign statistics show that signs of a bipolar change appear in 5-8 individuals per thousand inhabitants, and for the last time they show that I will fall ill in all 1 out of 2000 people. The prevalence of seizure is the same for all older adults, it’s not a matter of status, cultural, ethnical accessories and become 4%. It is easy to accurately assess, how often bipolar discord is developed in children, even to small children it is unfortunate in the world of stasis to be used for older diagnostics criteria. As soon as a cob of ailment occurs, it seems that about half of it falls on the period 25-44. Moreover, bipolar types move to the main month in a young age (up to 25 years), and unipolar types are more often developed even after 30 years.

Ethiology and pathogenetic mechanisms

Until the end of the day, the exact reasons Winning and Mechanism for TIR Development. The greatest interest is to become those, as the most bipolar discharges are transmitted in recessions, and as the development of the syndrome infuse biochemical processes in the brain. I don’t care for those who are responsible for the blame given to the situation, I don’t see it until the end, but show a lot of science, that the most decline in etiology may be the most declining bureaucrats, and the middle ranks are deprived of 20-30%. Biological bases of the bipolar affective syndrome of the accumulation of pathological processes to the body. The following officials pour into the BAR outlet:

• special features of the constitution;
• genetic damage, which is transmitted during recessions;
• pathology of the biological year of the people (changes in biological processes in the fallowness every hour of the day);
• change of water-electrolyte exchange process;
• damage to endocrine systems;
• destruction of the robotic neuromediator systems.



Those that BAR are transmitted in the downturns, yet not a guarantee of the development of the decline by 100%. Yak with schizophrenia, genetic schizophrenia can spratsyuvaty deprived of the incessant singing factors of the middle, especially the family ones. The evolving process and the atmosphere of the building are integrated into the chances of capturing the BAR by 20% more. Such factors, how to become and more, infuse not on the development of the syndrome in older adults, but on the nature of their interruption, types of psychosis and key symptoms.

Dodatkovi factories riziku

Due to the inflow of endocrine processes on the development of BAR є the fact that manic-depressive psychosis in women is not easy to get sick during the vaginal period, as well as before the hour of menstruation. Rizik development of BAR is also increased among women who have suffered postnatal depression or psychotic without the need for mid-range travel and canopy. On the ear of manifestation syndrome, it is often infused with psychogenic and somatogenic causes. Before them are brought up against mental breakdown, physiological illness and injury, alcohol malignancy, loss of close people, severe stress and development of psychological traumatic situations. Primarily, those with more bends are the most manic component, the less inflamed factor is the exogenous character. Todi as a bipolar depression, which is opposed to weakly swiveling attacks by mania, or even without them, is strongly to lay down all of the most common factors, so that it is possible to prevent the spread of all ailments.

big high risik Conquer the BAR to tie in with the features of the specialties. As a rule, the price is melancholy, based on the attitude, stability and order of people. I am aware of the understanding, like maniac-depressive pedantry, like I will play a role in the formulated affective episodes of the very peculiarities of particularity. Promote the development of the BAR and also the character, such as emotional instability, conservatism, monotony, the visibility of the rootedness. Such officials can provoke a relapse of the syndrome, such as a change in the wicked way of life, especially sleep, stay, alcohol, hospitality stress. Dani, a high level of intelligence in the course of developing the MIR development, this means that the geniality of people can be the cause of this God.

Classification



For the key manifestations of BAR, the development of common symptomatology has been taken. Maniacal depression can be approximately equal to the turn of the episodes, either from the dominant abnormal or depressive phases. In addition, they see unipolar MDPs with epizodes of more than one type. Uninvolved on the development of the presence in the ICD-10 diagnoses, you can see a few options in excess of the BAR:

• Circular psychosis. The attack of mania and depression is to be blamed clearly one by one without intermission episodes.
• Rozlad sub-type. Two opposing phases are opposed to sleep, and when the infusion is infused, there is intermission.
• Overbig wrong-interleaved type. Depressive and maniacal episodes are scared through intermissions without a clear consistency, for example, when an attack is likely to occur, maniacal syndrome may occur.
• The bipolar distribution is correct to the type. Phases of mania and depression alternately change one to one through intermission.
• Overbig unipolar type. Until the end of the day, I am in the mood to admit periodic maniacal attacks, as well as regular depressive episodes (there is a type of syndromic insurance in ICD-10 before recurrent depression).

manic phase

How is it against manic psychosis? Classical symptoms, which indicate an ear of mania - the chain of mood changes, mental and motor excitement. Lyudin started to show abnormal activity for an hour at a manic phase. The development of an attack can be distributed at the singing stage. Hypomaniacal psychosis - everything should be repaired. Proceedingly, the mood grows, there is a sign of bad growth, people start talking more and more, often agree. Sleep of a hundred and three is shorter, and appetite is more beautiful. Far away from the stage of reverberating mania, however, in case of some variants, the psychosis will not become overwhelmed by hypoxia. The appearance of a rotated manic phase of the field is in the fact that the main symptoms are more hospitable and yaskravі. Mova a sick old zbudzhenoy, guilt steadily, even about the geniality of their ideas, consuming the last of the mission and sleep deprived of chotira years. Distant manic psychosis reaches the level of pranks. At this stage, the main symptoms in the region of the state of rotation, the activity of the rukhova appears to be disorderly, and the movement becomes similar to burmatism. Called tse can nagaduvati show schizophrenia. Further on, the phase of lowering the roc's excitement is underway, while the mood is still going on. At the last, reactive stage, the normalization of symptoms occurs, when bipolar changes go either into the depressive phase, or into intermissions.



Depressive psychosis, symptoms and development

What is the difference in the development of the depressive phases? Bipolar affective discord is often manifested by people of this type. Symptoms that are spontaneous in a sick person in a depressive character are found at the other pole in a condition of mania. The mood of the decrease, the activity of the rukhova, and the misinterpretation are worn out. All people, who are going through a depressive phase, will see an easier social life. In the process of the aging of the patient, all the more and more we will grow the anxiety component of depression. The phase is given. simple depression, And maybe a mother is hypochondriac, agitated abo, yak with schizophrenia, haze ugil. Overbig depressive phase also add up to the stage. On the cob stage, Lyudin sees little difficult sleep, when we grow older, we’ll have a frown. At the onset of the stage, symptoms of depression build up, there is a feeling of anxiety, a sharp decrease in activity, rate of movement and missedness, loss of sleep. Next is the phase of a rotated depressive camp. The key signs reach the maximum, there is a pain in tightness, ailments are severely consumed in vases, they become sick to the point of suicidal desires, so that the sense of life should not be given away. Lyudin can lie without a ruck and think about his nothingness. At the last reactive stage, the patient's state gradually normalizes, the symptoms disappear, and the maniacal depression enters the first phase.

Atypical options override

Epizodi MIR often, especially in young patients, is of a low type, if one of the key symptoms of the phase is protracted. For example, with agitated abnormal depression, Rukhova's activity is not gagged, but is encouraged. An unproductive mania is perceived to become a wicked character, when one is encouraged to trust, as well as a mania with a motor nagging and dysphoric moods. This is such a variant of an affective attack of a small type, if the symptoms of depression and mania change one more quickly - literally in a couple of years. Some of the patients can be easily diagnosed and liable, such patients are not often unattractive to pharmacotherapy, which can lead to invalidity. Difficult in staging a diagnosis of possible viciousness and circular psychosis, changes in a fast cycle. Such maniacal depression can be counteracted by a choter and more affective episodes in rick. Situations also occur, if circular psychosis protested through a sharp snake of phases - over and over again. The prognosis for people with a disorder of this type, as a rule, is unpleasant, and invalidity is practically inevitable.

diagnostic methods



Bipolar discord is important to the recognition of yakomog earlier, since then, as a result of the accident, as a result of a manifest manic attack, more effective, less therapy for the experienced series of affective phases. To establish a diagnosis, the psychotherapist is guilty of a great number of factors. And because of the fact that in the ICD-10, manic-depressive psychosis has no form, it is not easy for patients to be given a pardon diagnosis. American preschool agendas, about a third of people who are hunting for help, can diagnose the correct diagnosis without having gone through ten years to debut the mood. In order to unify pardons on the stage of diagnostics, it is necessary to know that the bipolar affective disorder is not often susceptible to mental illness.

Accurate diagnosis is important for the correct choice of tactics for treatment in general, especially for the adequate recognition of symptoms (lithium, convulex, antidepressants or pills). It also helps to diagnose differential diagnostics, to the nature of the causes of neurodepression, special problems, schizophrenia, neurosis, injecting psychoactive speech disorders (alcohol, narcotic diseases), pathology of thyroid disorders Most differentiated maniacal-depressive psychosis from schizophrenia and recurrent depressive syndrome. Pomilkovo diagnostics of schizophrenia replace the BAR in the absence of incomparable inheritance from non-primed signs of antipsychotics or even to the incapacitation of the patient.

Lіkuvannya bipolar rozlad



TIR traces for the specialness and psyche of the people can be easily transferred, which is often and correctly chosen, allowing the reduction of the risk for the patient to take into account the indispensability. Bipolar disagreement is carried out to get sick, likuvati yaki to finish smoothly. It is especially important to correctly take a drink (be it lithium, convulex, antidepressant or other tablets). It is important to correctly determine the dose, to take psychotic symptoms, and not to allow an abrupt transition to the opposite phase through an overdose. It is also a low dose of drugs, for example, it can become a resistant camp, and then an active intake of antidepressants can lead to an inversion in the maniacal phase, so that the patient is ill and the prognosis as a whole. The most popular drugs for stabilization of the mood - normotimics (drugs for lithium, atypical antipsychotics, convulex and other antiepileptic drugs) are most popular in drug BAR.

It has been reported that the drugs reduce the degree of suicide, as well as the degree of impulsiveness and aggressiveness in the patient. Litiy, konvuleks and іnshi antiepileptic tablets are also even more effective in terms of prophylactic drugs, allowing to reduce the risk of relapse of both phases. Konvuleks, which is dispensed in tablets, drops or capsules, along with other valproates, has increased its effectiveness in the treatment of maniacal treatment. For depressive periods, certain tablets are not particularly helpful in combining antidepressants with antidepressants. For a short hour for the neutralization of maniacal symptoms, a drug may indicate an antipsychotic drug. However, during the pre-construction period, the symptoms will be stronger than antipsychotics. Bipolar affective disorder in the second depressive phase, seek for additional antidepressants, which is necessary in a general order, one after the other, convulsions or other norms. Antidepressants are picked up in the fallow because of the direct depressive phase. It is important to reason, as antidepressants are indispensable, without urahuvannya їkh sedative or stimulating directness, so it can destroy the psychomotor nerve of the patient or overcome the discomfort and anxiety.



The main meta in choosing the tactics of pharmacotherapy for the skin psychiatrist, or the psychotherapist, is in order to maximize the promptness of the remission. The effectiveness of the disease and the incidence of relapses is due to the fact that there are more affective phases from the illness, which is more, the prognosis is less friendly, and the incidence of more symptoms. In the case of designated patients, the drug is guilty but not overdone. It is not recommended to immediately consume more than three types of drugs, but to admit to different categories, as well as the designation of several types of tablets of the same pharmacological group (for example, one-hour convulex of the second type of drug). In this position, the optimal pharmacotherapy scheme is approximately the following: antidepressant plus antipsychotic plus lithium or konvuleks.

In the case of bipolar problems, specialties have an incomparable inheritance for a sick person. People with such a diagnosis of the decal foldably adhere to the work and by-beat mode, as well as to the end of their life. To that, maniacal-depressive syndrome of vimag of the use of psychotherapeutic techniques at all stages of treatment. The treatment of bipolar disorder with the help of psychotherapy allows people to manage the symptoms of ailments, after taking the drug regime, seeking an acceptable level of functioning in the society. Writing robots with a psychologist or a psychotherapist, the patient becomes more resistant to stress factors, it is easy to cope with them, as well as a prophylactic warning. Good, as these people are experiencing manic-depressive syndrome, my brother is actively involved in family psychotherapy. Tse allow all relatives to correctly put to ailments and help a sick person to cope with their camp.

So zhvoryuvannya, like a bipolar disorder of the psyche, ill-fated vilikuvati shvidko. In addition, since the signs of defective damage are becoming uncomfortable, we need to try to adapt the therapy with the use of prophylaxis for Convulex in tablets, and for some other norms. Zvychano, life on pills to bring little joy, albeit with BAR tsogo not unique. A lot of people are not missed, what does it mean to live with such a person? Tse means that in be-like a sick person, your help and assistance can be known. You will be able to steadily quest for keeping the balance between the ailing ailments and the special space.

What a slid of the nobility, how is it that someone's relatives have diagnosed a manic-depressive syndrome? People, who are bipolar depression, are sensitive to the snake of a ringtone, especially tied to sleep and sleep. This means that it is necessary to create everything possible, in order to adapt it to the usual sleep and life as a whole.

Do not overwhelm yourself, remember that the people from the BAR are subtly aware of the mood of their loved ones, so your razdratuvannya is definitely not to be sick of the sick. Do not get stuck up to such people, yak to the reckless. Navigate as soon as possible if you are experiencing a period of time, let it be as simple as possible. Follow the syndrome for an overrun, and you can immediately recover, if you think you have a gostry attack. Monitor the dosage regimen for taking drugs (antidepressants, drugs in lithium, convulex and other pills), in which case your additional help will be simply necessary. I’ll look at those who have a manic-depressive psychosis transmitted in recessions, it’s impossible to consult with geneticists at the stage of planning the vagina, so that you can start developing BAR. Obviously, living with an affective syndrome is not easy, and it’s not easy to fall into the face, Isaac Newton was suffering from one hour at once from a bipolar discord, and because of schizophrenia, however, it’s unlikely that some people in the world can become confused.

Bipolar affective disorder, flowing episodic change in character

Viznennya and zagalny vіdomosti [ed]

Often it is that the TIR is a tense camp, with a period of overwhelming, boisterous joy and happiness, with periods of recession, rottenness, and impairment. For the sake of it, it is also more correct to delineate attacks, or phases, not to occur so often: depressive attacks are found more than 6 times more often than maniacal ones. Maniacal and depressive stanes will come back a little more, however, the TIR has been described earlier in the middle of the 19th century in robots Falre ("circular psychosis") and Bayyarzhe ("subordinate psychosis"). Former Krepelin saw the TIR as an independent unit, as a result of the differentiation of schizophrenia at the time of the periodicity of the current and redefined in the classic picture of the modern era Mayzhe 60 rocky by that, in 1957, Leonard poured the TIR on bipolar (with manic and depressive attacks) and monopolar (only with depressive or only with manic attacks) types

Ethiology and pathogenesis [ed]

Klinichny show [ed]

Bipolar affective disorder, flowing epizod of changeable character: Diagnostics [ed]

A. Typical manic-depressive problems.

1. МДП with manic attacks - tse option of МДП, with which a sick person would have one maniacal attack. At the same hour, viglyadi viglyadly maniacal attacks (without depressive, hypocritical, or misbehaving maniacal-depressive) develop in the edge of the world; All the problems of such a change, with the author stuck, can quickly be brought to an attack-like paranoia.

2. TIR with hypomanic attacks - the tsevariant of the TIR, with which there would be one depressive and one hypomanic attack, or altogether maniacal abnormally manic-depressive. Mania, depression or hypomania can be provoked by organic diseases (for example, rosy sclerosis for thyrotoxicosis), drug addicts (for example, implantation of amphetamines or cocaine), antidepressants (for example, MAO inhibitors), sympathomimetics (including cases of non-life), and corticosteroids In cich vipadkah inodі put the diagnosis "bipolar breakdown without additional clarifications". For those with such ailments (for example, with prednisone addiction or implantation of cocaine), they can be attacked by the paranoid.

Diagnostic criteria for a depressive attack (div. Table 22.1) with monopolar depression and TIR, however. At the same hour, a lot of people are told that depressive attacks when there are two cases of problems, trochas come up. The reason for this is the effectiveness of other methods of treatment; zokrema, lіtіy more effective at MDP. Depressive attacks at TIR are often subject to charges and fees. An important pislyapologova depression is a trigger for an attack of TIR.

Diagnostic criteria for a maniac attack on guidance in the table. 23.1. The variability of symptoms is significant in one sick person, as well as in children with ailments. The attack can be done with a gostro (for a few years or a dib) or a pidgostro (for a few years). The most frequent attack is to win the attachment. Oh, the triviality is probably not, but due to the current criteria, it is not guilty of being less tough. before you come effective methods lіkuvannya stench could be trivial 4-13 mіs, and not without a stretch of ten rockіv meant a chotiri of such an attack. Sometimes the stench is provoked by certain factors (for example, the death of a loved one), or it can develop for no apparent reason.

Up to 50% of maniacal attacks are accompanied by psychotic symptoms. For deyakim danimi, we will be able to develop the company, which should be repaid to the TIR earlier. Delirium and destruction of behavior can be like holotimny, so that they are aware of an affliction (for example, "I am Mesia"), and not hollow (for example, "God blessed me with his gift"). It is important to bear in mind the nature of the madder to the affect, because it is important to know about those who are born with the help of God, it can be like a looming new age, and because of the overwhelming sensation of vibrancy. If there are also thoughts of ailments to schizophrenia or a psychotic form of depression, they are not tied to them with religious feelings.

With a maniacally sick sickness, they are sick until hot. Most often, it is humor contagious, ale buvak ikim and evil. If you are sick, you are persistent, assertive and unstable in your mood, actions are aggressive. Aggression, as a rule, is spared in case of a particular variability of symptoms in non-congenital ailments, or as a result of an incorrect assessment of the situation (pardon of taking away the thoughts of those who are living in galasliv, richly populated situations, and not very uncomfortable)

Diagnostic criteria for hypomanic attack on the target in table. 23.2. On the off chance I’m going to be in a position to be grateful in the whole camp not to bend, like at mania; Possibly, the very behavior of a sick man is permanently and transferred. Deyaki vvazhayut, but in the country of hypocrisy try suicide more often, less in the country of mania. Likuvannya is not very successful. Greater ailments befitting a hypocritical camp - wakefulness, a sense of freedom, a creative mind, increased productivity, and their behavior is rather unbearable or not without food, the food was put on a waste of food.

Before any maniacally-depressive attacks, they must be sent to the countries that meet the criteria of mania, as well as depression, and last more than 7 days. Bagato hto vvazhaє, scho tsi sti are similar to the so-called angry mania. For the tribute of one look around, there is a repulsive mania to be seen at a third of the ailments from the TIR. In the same place, it is possible to find out that the appearance of vicious attacks is possible on any stage of getting sick and the forecast (like a short-hour, so it is a very short-term one) with a number of attacks.

The form with frequent attacks (“with quick cycles”) is seen in the DSM-IV as a special option for overcoming both types of TIR (with manic and hypomanic attacks), for any attacks they win more than three times on the risk. The Danish option is spared from about 20% of the ills with the TIR, however, the figure is varied, which is often linked to the witnesses in the minds of the triviality of attacks, and in some cases - to the reports to the whole group of ills from the cyclothymic. Mabut, TIR with frequent attacks is not a uniform pidgroup: in some of the attacks, some of the attacks are considered from the ear itself, in others - because of the bagatech rock ailments without abuse. You can, in deyaky vipadkah such interruption with a reception of antidepressants.

Recession, width and overrun. On the part of the TIR, 20% of all affective distributions are brought. In most cases, the first attack develops in 15-24 rockies; the average rate of illness is 21 rubles (with monopolar depression - 27 rubles). The list of articles is roughly the same (as long as in the past, the TIR is shown to be much wider in women). Nawpaki, monopolar depression women suffer 2-3 times more often. As soon as the TIR develops for 60 years, then win the second (for example, early part). The prevalence of being caught up in life is 1.2% (for monopolar depression - 4.4%). According to the data of international reports, the whole indicator rises from 0.6 to 3.3%. Deyakі danі to apply for three more widening of the TIR with maniacal attacks in the occasion of the IoR with hіpomaniac attacks (0.8% and 0.5% altogether). The frequency of manic and hypomanic attacks becomes 3% in ric.

Substantiate the genetic strength before the TIR. In identical twins, the concordance becomes 65-80%, and in twins - approximately 20%. Genealogical predictions may also confirm the declining character of the TIR: among the relatives of the ailing TIR of the first stage of the dispute, the problem is being developed more often, but the quiet, who does not have the TIR in the current case The vivchennya of foster children did not give overconstitutional results.

It meant something, the importance of psychotic depression and psychosis are the attacks of the TIR. The breadth of such attacks is approximately 1 per 1000 species. In 3-4% of vipadkіv every hour the attack is dіtovat. In case of psychoanalytic attacks, the MIR effectively very pleasant: Litiy, protisudomnі and benzodiazepinovye drugs with normotimіchny dієyu, neuroleptics and electroconvulsive therapy.

Between the first and another attack of TIR, the remissions of up to 3-5 rockets are not often carried out, and the stench becomes short. In the Danish hour, there are a lot of TIR ailments with manic attacks or they are evil drugs, It’s wrong to live їх.

Differential diagnosis [ed]

Bipolar affective disorder, current epizod of changeable character: Likuvannya [ed]

Most of the TIR patients are treated on an outpatient basis. For a successful treatment, it is often necessary to get close relatives or friends. Oscillations of great ailments befits a period of being in a state of mind, the stench does not go to waste for help when maniacal symptoms appear. In connection with the cycle of the members of the family, they are close to guilty of being in the course of that, as against the TIR and as the principle of its love. It is important that the stench knew about the death of a sick person and a plan to neutralize the uncomfortable inheritance. For example, if from a sick person, it is possible to ochіkuvati overworldly penny vitrates, to completely enclose the amount of available ones. Guilty is the plan for the primus hospital in the event of destruction, aggression or suicidal behavior. With the mania of criticism, before and after learning of their inheritance for those who want to grow up in the daytime, and also information about good changes in the behavior of a sick person, take away from relatives and friends. In addition, the stench itself can often be ignored by the licenses of licars. Family and individual psychotherapy is especially corny, if the attack is provoked by certain factors or supervised behavior, unbearable for the members of the family.

At the height of a maniac attack, hospitalization is often required. Superbly brown can be a change in the number of popular ones, especially since the last few days. For those who are sick, they will be accommodated in the spokiynu ward or in the isolator (div. Ch. 7). In order to prevent self-harm and violence, one must be brought to the point of fixation (Div. Ch. 8).

Golovniy zasib at TIR - lit. In case of depressive attacks, vikoristovuyut also antidepressant. Imipramine is often, below the antidepressant, the transition from a depressive attack to a manic. Іngіbіtori MAO victories not so often, і a lot of wіth thаt, іt smelt especially in the case of depression attacks of the TIR. Ingіbіtorі vorotnyh drowning serotonіnu і amfebutamone, mabut, vicious manіacal attack more and more.

Even with a manic attack, lithium is not effective, because it is not allowed to chew, as long as it is not a problem, then it is necessary to add antipsychotics (for example, haloperidol, mesoridazin, pimozide) or benzodiazepin (for example, clonamazepine). In case of stiffness until lithium, it is necessary to stasis and benzodiazepine drugs with normotimic dosage (for example, carbamazepin or valproic acid); with forms with frequent attacks and small manic-depressive attacks, ci-cost (or clozapine) can be more beautiful than lithium.

1. Litiy. Tsikavo, in 1949, when Cade described the carbonate of lithia during mania, in the journal of the American Medical Association (J.A.M.A.) he published a spit about the important, one of the deadly, poisonous chlorides. However, the value of Cade's robot was estimated by the Danish scholar Shu. At the same time, our spirits have been actively involved in the development of carbonate lithium at the MIR. As a result, in 1970, the carbonate lithium became official in the United States for the prevention of manic attacks, and in 1974, it was used for the prevention of others. Potentially depressive attacks are recommended by the FDA on a daily basis.

Mechanisms for litigation under TIR are superbly flexible until the end of the accident. They include: 1) in addition, altogether, serotoninergic action, including sensitization of postsynaptic serotonin receptors in the hippocampus (field CA 3); 2) promoting the synthesis and promotion of acetylcholine in the cortex great pіvkul; 3) smothering the wikid with norepinephrine from presynaptic ends; 4) driving of circadian rhythms; 5) acting on systems and other in between, including the control of the exchange of phosphoinositol and ingibuvannya of adenylate cyclase, with mediators.

a. Preparations, pharmacokinetics and doses. Carbonate lithium quickly soaks into the intestinal tract, the maximum concentration of lithium is reached in 1-6 years after receiving. The citrate of lithium is getting wet more shvid: it’s getting wet more outside in 8 years. Litiy concentrate in slines, thyroid glands and cysts, in cyst tissues, which can be covered by rocks. The change of lithium in erythrocytes is rather rare, I want the indicator to be stronger in the course of the day, lower in concentration. 3-5% of the years are seen in later, as soon as one of the victories develops a child, and may be especially unacceptable in psoriasis.

Vyhodyachi from pharmacokinetics lіtіyu, yogo invoke priznachayut 2 times for doba. However, it’s danny, you take 1 time for nothing to change the degree of nephrotoxicity. It is important to vrahovuvati when high doses are recognized (besides, take 1 time at a minimum for a sick person). Deyakі lykarі vvazhayut for more beautiful prolonged preparations. At the same time, according to our suspicion, the frequency of intestinal disorders and tremors is less, so the lower is the maximum syrovatkov concentration of lithium; at the same hour, pour the drug into the nirki for an hour. To that, we are imperative for the better sign of prolonged preparation only if high doses are required - from 450 to 900 mg / add all the way.

Table. 23.3 hovering trade name, Dozi i lykarski formi carbonate and citrate of lithium, allowed until consumption in the United States. Syrovatkov concentration lithium is meaningfully varied, it is fallen into the stagnant preparation, which, mabut, begins with the size of particles and the type of napovnyuvach.

Monitoring. Before stabilization, I will become the frequency, from which I start the concentration of lithium, lie in the form of a turn of a positive effect from one side, and side reactions - from the other side. It is possible to achieve a stabilization interval between analyzes up to 3 msec. Therapeutic concentration of lithium is significant for children with ailments. In a large amount of vapors for an hour, the attack will become 0.3-1.2 mmol / l. Concentration, based on the lower boundary (0.3-0.5 meq / l), can be effective in summer and in some people with a stable camp. In cich vipadkah, the initial concentration of the skin lithium is 6-12 ms. If it is necessary to adjust the concentration of food to 1.2 mmol / l, then the reasons for the change of the extra doses are due to the image in the history of the ailment.

Until the time of day and night, it’s time to change the function of the thyroid gland and nyrok. For a wide range of viznachayut level TSH, T 4, antithyroid antibodies, AMK and creatinine. Regardless of the importance of the poor, the analysis can be carried out more often. Deyaki vvazhayut sufficient vznachennya klіrence creatine.

Vidmina. With the correct intake of individual dose, a greater number of ailments are good to endure trivial, one time for ten years, with a lithium. Approximately half of the ailments had recurrent attacks in between 6 months after the last minute of the attack. As long as the lithium lithium has led to a relapse, the renewal of the therapy lithium does not expect a positive result. Moreover, sensitivity can be reduced to some of the other drugs. To that deyakі fakhіvtsі, including the author, I do not recommend to interrupt the treatment of lіtієm with its harmony of efficiency and portability. It takes a while to pay for it for an hour, however, it seems to be a lot of people who have healthy children among women who have adopted lithias. By the end of the first trimester of vaginosity it is possible to experience Ebstein's anomaly, but not so often, as it was before.

Most widened side effects- boredom, drip, polydipsia, polyuria, metalevium in roti, headache and tremor, absorbed by propranolol, 20-80 mg / day in the middle, or atenolol, 25-50 mg / day in the middle. Possibly pogirshennya rozumovoy pracezdatnosti. There are more side effects when the dose is changed. Oskіlki a lot of them are found on the smallest maximum concentration of lithium, their tolerance is observed when the writing is recognized, or for nothing, as well as when the prolonged forms are victorious. Citrate lithium before wiklikak slurry-intestinal debris, low carbonate.

Hypothyroidism is diagnosed in 5-30% of ailments, who are constantly taking lithium for 6-18 months, more often in women and in the form of frequent attacks. Litiy can get sick, or to promote hypothyroidism in chronic lymphocytic thyroiditis (Hasimoto's thyroiditis).

At toxic concentrations, lithium often spares the confusion of symptoms, restlessness, drowsiness and non-virulence of movement; Potent development of Sopor and Komi. Particularly sensitive to overdose of lithuania. Lіkuvannya lіtієvoї іntoksikatsії look in Ch. 14, item V.E.3.

Vzaєmodia with інshi lіkarskiy zasob. In case of severe depression of lithiasis, it is not easy to co-ordinate with the ingibitors of the vortex accumulation of serotonin, as well as ininodi viclikal serotonin syndrome (Div. Ch. 22, item VIII.B.1.G.7). However, it is still not safe to add thiazidnimidiuretics (for example, hydrochlorothiazide). At the same time, there is a decrease in the amount of lithium and the growth of its concentration, which can lead to lithuania of intoxication. Greater safe diuretics (for example, amiloride or triamteren). Data on the second line with loop diuretics (for example, furosemide) and with carbonic anhydrazi (for example, acetazolamide) superintensives. On one occasion, take a high blood pressure or thiazide diuretic for the reduction of illnesses in polyuria and nephrogenic non-bloody diabetes. You can also go to the prototype or benzodiazepine normotensive care. The interaction of the lithium with the other preparations is looked at in Ch. 16, pp. II.E, V.I, VI.

2. Protisudomnі and benzodiazepіnovie normoіmіmicheskoe koshty

a. Carbamazepin is carried to iminostilbenam. Vin is structurally close to tricyclic antidepressants, ale is a little carbamyl lancer, which is known to have a protisdominal effect. Mabut, carbamazepin is important on the structure of the limb system. Unimportant for those carbamazepine, although not recommended by the FDA, as anti-manic and normative, it is widely used in the case of MIR, especially for the prevention of attacks in the case of persistence up to lithium and in forms with frequent attacks. On one occasion, take a lithium and other drugs.

The ratio between the concentration of carbamazepine and its effect in the case of MDP has not been sufficiently established, the protein in the greater amount of the therapeutic concentration becomes 4-12 μg / ml. Make sure to reach it at a dose of 100-1000 mg / day. When you take all the carbamazepin in the middle, get wet all over the place, as it is rotten at the water. Most of the secondary effects - ataxia, head bill, Zapamorochennya, visip and sedative effect. To deliver often carbamazepine in a mild neutropenia, however, there are descriptions and fatal effects of agranulocytosis and aplastic anemia. The incidence of hematopoiesis is often more susceptible to susceptibility to problems with other protisudomal diseases. It is recommended to regularly initiate a synovial concentration of carbamazepine and conduct a blood test.

Carbamazepin inducing cytochrome P450 IID6 (and, besides, reducing the concentration of haloperidol). In its own cell, the cob stage of its metabolism, obviously, is galvanized by drugs, in the metabolism of those who take care of the fate of cytochrome P450 IIIA4 (verapamil, erithromicin, alprazolam). The head active metabolite of carbamazepin is 10,11-epoxide, and the toxicity of the drug is associated with the accumulation in the world. The concentration of the metabolite can be increased, for example, when carbamazepine is combined with phenobarbital (as a result of enzyme induction). Valproic acid drives epoxyhydroxylase and also increases the concentration of epoxy metabolite carbamazepin.

b. Valproic acid (2-propylvaleric acid) - increases the effect of GABA, increases potassium penetration and reduces depolarization, mediates glutamate NMDA receptors and enriches calcification. It is found that the resistance to carbamazepine and valproic acid is perekrylnoy with lodged vessel activity in the amygdala. Є Data on the desensitization of GABA presynaptic receptors with valproic acid. It is not clear yet, how the anti-manic action of valproic acid is tied to these chi іnshih clitinny mechanisms.

Valproic acid is effective for controlling manic attacks and for reducing them (if it is not FDA-approved as anti-manic). Mabut, vona is especially crimson with forms with frequent attacks and with small attacks (and angry mania). Table. 23.4 Re-insured trade name of the preparation of valproic acid. Sirovatkov concentration - 50-125 mcg / ml; I won’t have much interest in the therapeutic work. The pochatkova dose in the fallowness of the severity will become 500-1500 mg / dob (in the case of the deciduous), and the accepted dose is 1000-2000 mg / day.

The most common side effects - nudota, anorexia, іnshі slunk-intestinal damage, sedation, ataxia and tremor, are absorbed by propranolol. Bagato hto viddaє perevagu Depakot is a drug in obolontsi, rozchinnoi in the intestine, and that is why it is more pronounced in the intestinal tract. It is often necessary to give the werewolves no symptoms of an increase in the activity of liver aminotransferases, a description of the lethal symptoms of liver damage (by the type of idiosyncrasy). You can increase your appetite and hair growth. Є Data on the adolescence of valproic acid analysis with the annual intake of polyvinylamine preparations, which is to take revenge on selenium and zinc.

v. Clonazepam і lorazepam (div. Soozh ch. 12, ch. 14, ch. 21, ch. 25, p. IV.G.2.y.2). If all benzodiazepines want to activate the GABA type A receptor and are sedative and powerful, clonazepam and lorazepam are more likely to become stagnant with mania. The stench is oddly weakly interrelated with the likarskiye zasobas, for the blame deprived of the strength of the sedative effect. Neither, nor is there any active metabolites. Benzodiazepini often appear more beautifully in secondary mania (somatogenic, drug or narcotic), as well as in cases of extrapyramidal disorders, vicious with neuroleptics. T 1/2 (18-50 years) and the triviality of clonazepam is less than lorazepam (T 1/2: 8-24 hours). The maximum concentration of clonazepam sirovatkov is reached more quickly than lorazepam (1-2 hours and 1-6 hours as appropriate). Dozi: clonazepam - 1.5-20 mg / dob in the middle, lorazepam - 2-10 mg / dob in the middle. Clonazepam and lorazepam can be taken with lithium, the effect of both drugs being infused with two drugs is higher, or with other anti-manic drugs. Lorazepam is also used intramuscularly, 2 mg of skin for 2 years, once in the day with haloperidol, 1-5 mg intramuscularly. The most common side effect of clonazepam and lorazepam is sedative; clonazepam is more often sleepy through more triviality. High doses of both drugs, which can be stagnant for the abatement of maniacal anesthesia, do not often get anterograde amnesia.

3. Antipsychotics. With a manic attack, all groups of neuroleptics become stagnant. To get involved, she is surrounded by a blockade of D 2 receptors.

a. Haloperidol mesoridazin. The most common antipsychotic - haloperidol. Yogo priznachayut in the middle i / m at a dose of 2-40 mg / dobu; T 1/2: close to 18. In case of severe deterioration, one hour is given to haloperidol, 1-5 mg i / m skin 2-6 years, and lithium: haloperidol is rapidly assimilated, and lithium is more severe, a little more. Haloperidol can be given a dose of zlorazepam to improve the sedative effect. Haloperidol viclikє extrapyramidnі rosladi (div. Takozh ch. 27, item VI.B.5.c).

Often, mesoridazin is consumed - a drug that is one hour the main active metabolite of thioridazine. At the end of the last mesoridazin, it is not only stagnant (75-300 mg / dose), but ale and / m (12.5-50 mg of skin for 6 years). T 1/2 in the edge is variable (1-3 dB). Mesoridazin, such as haloperidol, is often combined with lithium in the first days of treatment. Extrapiracy is very rare, but there is no evidence of pigmentary retinopathy, which can be promoted with high doses of thioridazine. Mesoridazine may be more active than thioridazine.

b. Pimozide (div. Takozh Ch. 26, item X.B.2, і table. 27.8 і table. 27.9) is an atypical neuroleptic, which is not only a block of D 2 receptors, ale and a calcium channel. Deyakіlіkі, especially in Europe, confirm its effectiveness in case of manic attack, however, the FDA as an anti-manic because of not hardening. Pimozide has sedative and M-cholinoblocking side effects; vin wiklikє also changes the EKG, with a dose-dependent increase in the QT interval. Є Regarding the broken rhythm of the heart, including about the fibrillation of shlunochkiv. In connection with the cym, it is necessary to restore the EKG before the first hour of the test, but in case of a manic attack it is important. The maximum concentration of sirovatkova can be reached everywhere, in the same way; T 1/2: 1.5-2.5 days. The dose is 2-20 mg / add vseredin.

v. Clozapine (div. Takozh ch. 27, item VI.B.1.b.1) is an atypical antipsychotic. For lonely occasional visits and viprobuvan on small vibrations, it is effective with an angry mania (FDA for storing with no hardening). Dozi - 250-800 mg / add all the way. T 1/2: close to 8 years. In some form of clozapine monotherapy, in some cases of it you can use them (for example, with valproic acid or lithium). It is necessary to follow the number of leukocytes, since granulocytopenia is possible, especially when given with other drugs, which is injected into the blood.

4. Heart-Sudinni normotimicheskoe koshty

a. Kolindians stimulate the central alpha 2 adrenergic receptors, by themselves reducing the tone of the sympathetic nervous system (Div. Sozh Ch. 13, p. III.B.7). The breeders of the whole wine are ineffective in mania (the FDA is for storing with a lot of non-hardening). In addition, it stimulates peripheral presynaptic alpha 2 adrenergic receptors, which by itself changes norepinephrine from presynaptic ends; tse suprovodzhutsya reduction of arterial grip. Kolindians quickly get wet and quickly reach the necessary concentration in the tissue of the brain. Dozi - 0.2-1.2 mg / add all the way. At higher doses, it is more possible to move the arterial vise. The main side effects of the hypotensive are dryness in the roti, zamorochennya, more powerful depression. Kolindians priznachayut deprivation with the ineffectiveness of the special methods of treatment and for real visibility.

b. Antagonism of calcium. Verapamil, 240-400 mg / day, in the middle, and diltiazem, 150-300 mg / day in the middle, can be changed to show mania (FDA is not to be hardened for a long time). The grunting of the intake of these drugs is confirmed by the time, so that the concentration of calcium in the spinal cord decreases from the hour of manic attacks and the growth of the hour of the depressive. The offense of the preparation p_dvischuyut instead of calcium in synaptic endings. Verapamil maє weakly turns protisdomnuyu; not that one, not one who does not є a preparation of a vibor for mania, and it only recognizes the ineffectiveness of conventional methods. Inodi verapamil due to depression and anxiety.

V. Elektroudomna therapy (div. Ch. 15). Lots of people and sick people drug treatment, However, there is a change in the data about the greater efficiency of the ECT in some cases from the literature on early stages important mania. Heads of safety and efficiency of electroconvulsive therapy in the form of a buoy and a single method of treatment of MDP in case of vaginosis.

Prevention [ed]

Inshe [ed]

Unimportant to the lesser extent of the TIR in the context of psychoses and social inheritance. On one side, they are rich in creative, productive, energy and achieve great success in mystery, politics, science and business. On the other hand, the greatness of the school is applied to the suspension through the dilemma of missed talent and cost, trivial inconvenience, and suicide, hospitalization and many of those who have lost their inheritance. In a given hour, not more than a quarter of the TIR ailments will get the correct treatment. A great robot is needed, so that you can understand the names of the doctor. Necessary more effective and non-baked preparations... Nareshty, demanding more vividness and intelligence, as there is a misconception of attacks (for that reason) and the use of likars' attacks on the turn, frequency, triviality of the onset and attack before therapy.

Dzherela (posilannya) [ed]

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19. McElroy, S. L., Keck, P. E., et al. Valproate in the treatment of bipolar disorder: Literature review and clinical guidelines. J. Clin. Psychopharmacol. 12: 42S-52S, 1992.

20. McElroy, S. L., Keck, P. E., et al. Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. Am. J. Psychiatry 149: 1633-1644,1992.

21. Modell, J. G., Lenox, R. H., Weiner, S. Inpatient clinical trial of lorazepam in the management of manic agitation. J. Clin. Psychopharmacol. 5: 109-113, 1985.

22. Post, R. M., Leverich, G. S., et al. Lithium discontinuation-induced refractoriness: Preliminary observations. Am. J. Psychiatry 149: 1727-1729,1992.

23. Post, R. M., Weiss, S. R. B., Chuang, D. M. Mechanisms of action of anticonvulsants in affective disorders: Comparisons with lithium. J. Clin. Psychopharmacol. 12: 23S-35S, 1992.

24. Santos, A. B., Morton, W. A. ​​More on clonazepam in manic agitation. J. Clin. Psychopharmacol. 7: 439-440, 1987.

25. Schou, M. Normothymics, “mood-normalizers”: are lithium and the imipramine drugs specific for affective disorders? Br. J. Psychiatry 109: 803-809,1964.

26. Shader, R. I., Jackson, A. H., Dodes, L. M. The antiaggressive effects of lithium in man. Psychopharmacologia 40: 17-24, 1974.

27. Small, J. G., Klapper, M. H., et al. Electroconvulsive treatment compared with lithium in the management of manic states. Arch. Gen. Psychiatry 45: 727-732, 1988.

28. Suppes, T., McElroy, S. L., et al. Clozapine in the treatment of dysphoric mania. Biol. Psychiatry 32: 270-280,1992.

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

Bipolar affective disorder (F31)

Rozlad, which is characterized by two or more epizodes, for which attitudes and levels of activity of the patient are significant. A decrease in mood, a surge of energy and an increase in activity (hypomania abnormal), and a decrease in mood and a sharp decrease in energy and activity (depression). Repeated episodes of hypomania are classified as bipolar (F31.8).

included: manic-depressive
- getting sick
- psychosis
- reaction

F31.0 Bipolar affective disorder, current episode of hypomania

In a patient in Denmark, the moment is hypocritical, and for the last time, for the last time, it is assumed that one-time affective episode (hypomanic, manic, depressive or depressing in character).

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

In a patient in Denmark the moment of maniac manifestation without psychotic symptoms (similar to the category F30.1), and for the last time, taken one-time, the lowest affective episode (hypomanic, maniacal, depressive)

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

In a patient in Denmark the moment is a maniac manifestation with psychotic symptomatology (similar to the category F30.2), and for the last time, taken one-time, the least affective episode (hypomanic, depressed)

F31.3 Bipolar affective disorder, current episode of mild or moderate depression

In a patient in Denmark, the moment of the appearance of depression, such as with a depressive episode of mild or moderate severity (F32.0 or F32.1), and for the last time, took a one-time, suspicious of mannequal symptoms.

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

A patient in Denmark has a moment of depression, as with an important depressive episode without psychotic symptoms (F32.2), and, for the last time, taken as a one-time affirmation of hypomanic, psychotic symptoms.

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

In a patient in Denmark, the moment of manifestation of depression, as with an important depressive episode of psychotic symptoms (F32.3), and, for the last time, assumed, once, for confirmation of hypomaniacal aphysiological, maniac anxiety.

F31.6 Bipolar affective disorder

Patients in the last mav, taken one-time, are susceptible to hypomanic, depressive, depressive, or depressive affective episodes, and the rolling mill is a one-time symptom.

F31.7 Bipolar affective disorder, in-line repair

Patient in the last mav, taken one-time, suspicion of hypocritical, maniac, for the change of affective episode and for the addition I would like to have one affective episode (hypocritical, depressive, depressive) on the day is still stretching out the decilkokh months. Period of remission with a prophylactic treatment of guilt by coduvating the whole section.

F31.8 Insti bipolar affective disorder

Bipolar II Razlad

Recurrent maniacal epizodi

F31.9 Bipolar affective disorder, unspecified

Bipolar affective disorder

Bipolar affective disorder (BAR) - mentally ill with phases of inadequately advanced (mania, manic phase) and greatly reduced (depression, depressive phase) mood. On the basis of a change in the mood of a healthy people, or even an emotional lability of bipolar discord - a disease with an inadequate assessment of the daunting, unhappiness of praction and the threat of life in the mind. The diagnosis and treatment is carried out by a doctor-psychiatrist or a doctor-psychotherapist.

The life of the people from the BAR is subdivided into "smogs": the smog of the masses is the dark smog of the impenetrable tug and depression, and the smut of the smug of the mania, euphoria, and safety. And so to nessinchnosti, as not to turn for help.

The reasons and mechanisms for the development of ailments to cich pir unavailable. I know only that, bipolar discord is often seen in people, among relatives, who also have patients with BAR, or because of those affective disorders (depression, dysthymia, cyclothymia). Tobto in the development of ailments take the fate of genetic and decline officials.

Bipolar disagreement is the endogenous disease. Tse means that you can develop without an apparent reason. Navit yakshcho first epizod buv dressing z zovnishnim injected(Stress, physical or overexertion, infectious or infectious) - the trigger factor for the whole process is better, which has shown a craving for it.

Patients, some of them have a depressive phase (bipolar depression), they tell me: in the evening everything is fine, but I don’t want life on the next wound.

For the first attack, the role of the called officials will change, but the new attack will be "on an empty mission". So the children, who have felt a depressive phase (bipolar depression), tell them: in the evening everything is going well, but they don't want to live on the next wound. If you want to cleanse people from stress and overwhelm, you will not get ailments - you need to use it.

Bipolar affective distribution of ICD-10 (International classification of ailments) is described in the section "Rozladi nostiu" (synonymic - affective distribution). Options for the development of ailments and symptoms are described in the onset of the part.

Symptoms of a bipolar affective disorder

The old name for bipolar affective disorder is manic-depressive psychosis (MPP). Infections of those who are vvazhayut are inaccurate, so as a BAR do not expect to be supervised by gross damage to mental processes, as in psychosis.

Bipolar affective distribution in ICD-10 is classified under the heading F31, which includes:

The very word "bipolar" is spoken, but before the hour is sick, the social camp of the people is changing between two poles - from the mania to the depression.

The maniacal phase is characterized by three main symptoms:

This is also typical:

• decrease in demand for sleep - people sleep for a while (2-3) or for a whole hour to sleep;
• to advance sexually and sexual activity;
• In some cases, the gratitude and lack of eyesight, even to the point of aggression;
• reevaluation of the power of power - people can be more overdzhuvati, like volodin overheads, like winays "like from all sickness", or, for sure, a relative of the family, high-ranking people.

The depressive phase of a bipolar affective disorder is more than maniac (without treatment in the middle, close to 6 months) and is characterized by signs of endogenous depression of the aggravated stage of severity:

• decrease, adjustments of mood;
• trusting the misinterpretation - there are few thoughts in the head, such people are commonly used to say when there is a pause;
• rukhova zagalmovan_st - ruku povіlna, the patient can lie in a cage in a single position;
• disturbed sleep - an unsettled sleep, the feeling of being felt like a hiccup or a persistent sleepiness;
• lowering or wasting appetite;
• anhedonia - a waste of the building of a feeling of satisfaction, a waste of interest before drowning, hobbies, sharing with friends and old people;
• in especially important vipadki - suicidal thoughts and namiri.

Successful in all the senses of a lyudin - family, friends, kar'ara - through the ailment, he ceases to bach in everyone's sense, zabuvaє, as a joy to life, and constantly thinking, as to pin up his countrymen.

In addition, there can be a spontaneous change in affective episodes, if the sick person immediately has signs of mania and depression. For example, lowering of moods, tight and self-deprecating thoughts can be unified with ruffled unconsciousness, euphoric camp - with ruffled pangs.

People have grown up in the daytime criticism to their own extent, it is not a good idea to adequately assess the inheritance of their actions. It’s an hour, whether it’s a BAR episode, right away from its polarity, people’s mothers can take on rashness and character, pose a threat to the life and health of the very same people.

As the hour is depressive, so at the hour of the manic phase, the patient will need professional medical assistance.

The diagnosis of bipolar affective disorder is dealt with by a psychotherapist or psychiatrist, mentally with a clinical psychologist. The limit of clinical and anamnestic treatment in a fakhivtsya (besida with a likarem) with an opportunity and an obvious indication of a vicious laboratory instrumental methods(Blood analysis, EEG, MRI / CT, Neurotest, Neurophysiological test system). More details about the diagnosis of bipolar affective disorder.

Bipolar depressive disorder: prognosis

Bipolar affective disorder (manic-depressive psychosis) with a free-for-all treatment and a favorable prognosis. BAR therapy includes three main areas:

1. The purchase of a hospitable camp is an outpatient or stationary medication, if indicated, indicated before the hospital.
2. Adopting patient therapy with the method of rehabilitation and prevention of relapses - including psychotherapy, drug therapy, additional general therapeutic procedures for indications (physiotherapy, massage, physiotherapy).
3. Robot with relatives and close friends of the patient for their rehabilitation and advising on the specialties of the disease.

The effectiveness of the test is based on the accuracy of diagnostics of illness, which is often foldable through trivial intermissions (period of "lull" between attacks). As a result, the phase of the ailment is taken for an okremia problem, or for the debut of the first psychotic illness (for example, schizophrenia). A reliable differential diagnosis can be carried out only by fahivets - lykar-psychiatr.

With the appearance of the political process, the triviality of the "light" processes will change, and the affective phases, navpaks, will increase, while the effect may be monopolar. Affective disagreement in the general vipad of the nature of the lingering depression of abo mania.

Bipolar affective discord in the time of hourly brutalization for medical aid to the good is given to liking. BAR therapy has its own particularity in the presence of individual clinical picture and flow phase and congestion. You will be prompted for an hour of in-line affective epizode or for an hour of interphase, in fact, it is indicated that you are allowed to reach the stiff and trivial remission of new innovations and social adaptations. More details about the treatment of bipolar affective distribution.

Bipolar affective disorder - not very important for the psyche, the very "dictating" to the ailing one, both the form of behavior and the child. It is important for people close to me to think, but the stench may not be rotten, I am driven by the fiery character of a member of the family, but by the manifestations of severe ailment, as for an hour I will take control of the specialness and torment the sick people no less than the least.

Bipolar affective disorder, unspecified

Viznennya and zagalny vіdomosti [ed]

The width of the middle of the population becomes 0.3-1.5% (0.8% - for bipolar type I; 0.5% - for type II). The number of men and women who are hungry for bipolar breakdown is approximately the same: type I is more often developed in children, type II and shvidky cycles - in women.

In the debut of a bipolar breakdown (especially type I), among people who are overwhelmed, mania (hypomania), among women - a depressed stun. Bipolar roslad Make the winnings from 15 to 50 rockets and more. The peak of congestion is recognized by the children of the 21st rock.

Ethiology and pathogenesis [ed]

The main role in the diagnosis of sickness is to follow the genetic factors. The development of sickness among the closest relatives of the sick in the present development, lower in the average in the population, and to become 10-15%. In children, one of the fathers of those who have a bipolar distribution, the rizik becomes close to 50%. At the same time, they can experience bipolar, schizoaffective discord, and schizophrenia. Concordance for monozygotic twins is 33-90%, for dizygotic twins it is close to 23%.

Neurotransmitters (norepinephrine, dopamine, serotonin) are received in the development and extension of the bipolar distribution. Glucocorticoid and stress hormones are also taken into account before development.

Among other hypotheses, to explain the nature of bipolar distribution, crazy interest is the concept of "Kindling" (English Kindling), formed by R.M. Post i S.R. Weiss (1989). Apparently, the main role in the diagnosis of bipolar disorder is to follow cerebral pathophysiological mechanisms close to paroxysmal. The reasons for this are the number of stimulants and other couples, severe physiological damage, stress factors. The stench is to produce until the first episode of the disease is diagnosed from the outside. Such a breakdown of ailments is similar to the development of epilepsy. There is no hypothesis of vinicle in conjunction with the antiepileptic drugs - carbamazepine and valproates - as thymostabilizers (in conjunction with the treatment and prevention of bipolar rose).

Klinichny show [ed]

Manical, depressive and affective symptoms and power syndromes are not only affective disorders. They often occur in schizophrenia, disorders of the schizophrenic spectrum, early symptomatic psychoses, such as superficially somatic (heart-shaped, endocrinous) and organic traumatic, intoxic cerebral. At the same time, there is a comorbidity of depression and somatic ailments. Stagnation of steroid hormones and psychostimulants is not a frequent provocation of development of maniacal and hypochondriacal conditions. This kind of "secondary" affective breakdowns of power and laws, less bipolar breakdowns and recurrent depression.

Bipolar affective disorder of unspecified: Diagnostics [ed]

Diagnostic criteria for hypomania, mania, depressive episode and recurrent depressions, victories in ICD-10, provide a formal basis for diagnosing an affective disorder. In the ICD-10, as in the DSM-IV, the need for inclusion in the inclusion of exogenous factors, mental, important somatic and organic ailments, is especially admitted, so that the declarative nature of the affective clauses is recognized, bit by bit.

The phenomenology of hypochondriacal and maniacal stances is represented by a characteristic complex of emotional, vegetative-somatic, sensory, ruddy, conate (motivational-wolf, pulling down), cognitive and backward behavioral damage.

Emotional changes hunt all kinds of gimmicks - because of the inadequate joyfulness in terms of positive tone of emotional reactions, unbearable for a pity, easy tolerance of the mood, and overwhelming inadequate excitement of joy It can also be euphoria and hypertimia with a benevolent viewer, if it is not typical for a bipolar distribution and in order to organically and somatically change the soil (Zhislin S.G., 1965). Likewise, dysphoric reactions and dysphoric reactions can also be seen.

The only hyperthermic phenomenon that goes beyond the diagnosis of bipolar disposition and prostate endogenomorphic mania is Morya.

Vegetative changes are nonspecific: they relate signs of an increase in the tone of a sympathetic nervous system, a discussion of shortened sleep and early awakenings. The changes of vegetative regulation are often similar to those in depressive camps, the protestal tone of alterations, the energy of the day. Ailments may not be common, the demand for food is reduced. One hundred percent to the tsikh signifies rightly to say not only about vegetative, but about general somatic changes: adjustment of physical and mental tone; somewhat depressive, a little more opposed to the sign of goodness with the greatest turn of activity (right up to destruction) in the first half of the day, start immediately after a rank awakening; deyake calmness insisted in the middle of the day, at the evening of the year there is a mighty repetition of activity, and a little more quiet.

Sensory damage with maniacal camps is not necessary, loss of health is not damaged (for the fault of a sensitive tone of a child - a special sensitiveness, an enemy of the poor and sentient). You can have sensory hyperesthesia, call on to organically change the soil. Some ailments talk about the specialty of sleepiness, sensation, hearing, scent, especially in contrast to the general level of perceptual functions in case of anterior depression. Mabut, here there is also a significant increase in mental tone, not in the inclusion and positive destruction of vegetative-trophic functions in the order of a positive sub-active assessment of the external self-feeling, self-perception and perception. Physiological changes (psychic, vegetative, endocrine) in case of maniacal conditions of mensh vivcheni in normal conditions with such in depression. The price can be explained by the singular difficulties in organizing control over the behavior of patients, the incompatibility of the ailments (it is necessary to have a recommendation) in case of maniacal and hypocritical camps.

Rukhovo zbudzhennya of the risky step of turn - characteristic sign maniacal and hypochondriacs. In case of hypomania, hesitate to see not only psychotic excitement, ale and beyond the strength of activity, decay, manifesting a special spriteness and accuracy of ruins, uncomfortable for a drug user who knows a sick person. With the improvement of symptoms of maniacal problems, all the more obvious are the deterioration of coordination, the appearance of plasticity, the frequency, the incompleteness of the process and the surrounding collapse. The extreme form of rukhovoy zbujennya is “shalena mania” (mania furibunda). Spontaneous aggressiveness is spontaneously spontaneous, albeit during the turn of mania, it is necessary to provide active support to those who are intercourse, as well as during medical visits to the primus character.

The accelerated pace of movement, overwhelming balacuchism, superbly robust for the given patient (an hour before the hoarse, voices can be heard) supervised overwhelming motivation of activity and ruddiness.

Constantial debility (motivation of activity, manifest volition, sphere of pulling) to reach the hundred and not least important, not the emotional symptoms of debility. The motivation of performance in patients with hypomaniacal and maniacal camps is resilient and spontaneous, unrepentant, disorganized character. The inclination, the overbearing, the overwhelmedness of something (often extraordinary) can easily be changed by being active. Those who are sick to extravagant vchinki, irrational tastes of education, non-turbulent vitamins, unnecessary purchases, distribution of pennies and gifts. One does not smell the stench of one's professional, family dressings, hesitates thoughtless trips, and wanders. It’s still up to the goal of directing free-will and control of your actions only for a short hour: the progress is made to the completion of the day and the health of the mind.

An important sign of hypomania and mania is the promotion of sexual cravings (not often with a romantic kind) right up to the unsettledness in sexual intercourse. Changes in appetite are not uniform - from their admission to a greater characteristic decrease or irregularity of intake. Ailments often forget about їzhu, which leads to a decrease in masi tila. During the prodromal period and the cob stage, the development of hypomania masa tila, navpaki, grows.

Cognitive problems with Hypomania, maniacal mills and affective problems with distribution at the office (functional), change (ideator) and systemic. Among the pathological functions of the visitor (respect, memory, pace, lulling, sensibility and after-life associations), the most characteristic is the deterioration of the concentration of respect and the most frequent switching (up to hypothermic supernatural), In the case of hypomania of the world stage of the turn, it means a clear "saw", the appearance of particular details and the day of the appearances. The ease of mixing up respect in the same way at the same accelerated rate of misdirection and improvement of the association can celebrate the hostile bliss and hospitality. The nature of the chicks is ailing, it appears in the surface of the sujen, it is not the world of splendor to the heat, puns. With maniacal camps, hyperprosexia in the same place with a continuous change in the course of the current, the associatio accept the character of a "leap of ideas", so that between the incoherence of misunderstanding and movement, I want to turn around for a short time. For the most part, in the context of changes, there is an obvious dependence on the elements of modern stereotypes, which depend on the possible supportive asthenizing influx.

Memories of non-uniform memory: from hypermnesia, ease of memory and revival to alarmingly passing destructions of operational memory, connected with overworldly distraction. To navigate during the bends of the dovgostrokov's mania, the memory of the sufferer is insignificant.

Zmіstovnі (іdeatornі) kognіtivnі torn down toil Pevnyi "optimіstichno-ekspansivnu" spryamovanіst: od overvalued reєstratsії svoїh dosyagnen, pіdkreslennya i perebіlshennya real mozhlivostey i perevag, optimіstichnoyu otsіnki obstavin, gotovnostі priynyati on itself nezvichnu role without vіdpovіdnih zdіbnostey i navichok to yavnoї pereotsіnki svoєї osobistostі. Mabut, followed by vvvazati vypadkovuyu pity the riddle in the ICD-10 podosrilosti middle signs of maniacal stanіv. Those who are sick sooner are good and kind; I respect balacuchism on myself, scho between nastirlivistyu, swings up to non-tactlessness. In the world of the development of a maniacal camp, we are sick all the more power overworld comradeship, praise for our dignity, participation in our own podiatry, knowledge of pseudo people, obviously enhancing ourselves by means of zeal. Call the price of ruin not to go beyond the delusional fantasies, minimal and accessible corrections. Affective delusions of maniacal type (ideals of magnitude) with bipolar dislocation are not characterized by the characteristic structural features of a systematized interpretative madder with the establishment of pathological ligaments in the presence of real and transmucosal pests. You can have ideas of wine, especially a mission, ale the misunderstanding of a misnomer, "jumps of ideas" transcend the completeness of a divine storyline and a style concept. In besіdі with lіkarem ailments, you easily reduce the scale of ideas of greatness to the weekday rіvnya. The megalomaniac madder, which was previously respected by the familiar twisted mania, does not look within the framework of a bipolar distribution at this hour. Persecutory paranoid ideas for a bipolar breakdown are not characteristic and guilty of being on the alert, due to the schizophrenic nature of being ill or paranoid psychoses close to schizophrenia. Gostriy chuttuviy madder can also be superfluous in the diagnosis of bipolar distribution, as it is for good health and rumors of deceit. Foldable diagnostics are found in cases of congruence and symptoms in maniacal affections. It is also foldable for assessing the young at the height of the development of a manic camp of pseudo-remnant scenes with a plot of high-profile performances by celebrities, honor to historical events and inn. Є Give respect, that the phenomena are close to special phenomena such as wahneinfall in case of schizoaffective dislocations. With mania within the framework of a bipolar disposition, it is possible to correct such experiences from the ailments of the realities of fantastic podias, to the knowledge of them in a vigorous and full of imagination.

The signs of systemic cognitive dyyalnosti rotate in the defeated criticism, so that it is perceived to sub'active well-being, to see the strength. The knowledge of the pathological nature of the people is a sign of hypomania abo mania (for example, sleep deprivation, wickedness) є ailing, ale criticism. The productivity of mental activity can be high in case of hypomania, but inevitably decrease in the world of transformation, I will become in the maniacal. The identification of the authority's specialty is not damaged. In some cases, the price is not obvious due to the peculiarities of behavior, the large production of ailments, and in the case of a patient, it is necessary to establish a valid biographical vision of oneself and one's real social development. Orієntuvannya in navkolishny is practically not ruined (to wind on the height of the development of a maniacal camp), but in spontaneous behavior of ailments do not start a real situation. The excess of a bipolar breakdown, which breaks down in the form of a manic or a hypomanic episode, is often unpleasant. Up to 15% of hypomania nadali swell the structure of manic stuns and mental illness until protracted. Slid vrahovuvati also cure ailments from food visits. With the passage of the ailment, it is early to see the development of the depressive episodes (phases), and it is worthwhile to serve one of the arguments, as to cross the sick in need of treatment. Unipolar maniacal variations of bipolar distribution become an insignificant part of mid-affective disorders, especially in cases of unipolar recurrent depressions.

Differential diagnosis [ed]

Bipolar affective disorder of unspecified: Likuvannya [ed]

The most frequent use of affective disorders is based on the decline and onset of active stopping (shaving), stabilizing and susceptible therapy and prevention of relapses.

The final stages of treatment and prevention of recurrence of affective disorders allow for the establishment of non-biological therapy, but also psychosocial visits that are focused on the social and psychological improvement of mental health problems. Remaining is not necessary for prophylaxis, but for the stage of active therapy: systematic therapeutic activities At the beginning of the treatment stage, the phase (epizode), with the regular recommendations and possible control of the concentration of the drug in the blood, it is allowed to infuse into the second world in order to change the course of complications of chronic diseases, in the length of the period of complications cutaneous offensive phase.

In the cupping therapy of maniac and hypochondriacal conditions, such as in the prevention of bipolar distribution, by means of the first choice є salt lithium.

Yak stopping a cat in case of a turn of mania with signs of psychomotor disturbance; However, with a "pure" mania of lithiasis from a pathogenetic point of view and in the perspective of a given one in the capacity of a temporal stabilizer - in order to prevent affective phasic coliforms. A shortage of the most advanced lithium preparation - lithium carbonate - is the appearance of one of these forms.

According to the efficiency of the infusion in the mania and the preponderance of maniacal and depressive relapses within the framework of the bipolar disorder of type I, it is possible to change the salts of valproic acid (valproate), widely stagnate in epileptology. dobova dose Sodium valproate in the capacity of a stopping cat should be 500-1000 mg, for an additional therapy and prophylaxis I do not overtake 500 mg.

With bipolar type II, cyclothymia, as well as with fast cycles, carbamazepin is the most common anticonvulsant for the duration of valproate and salt lithium. Slid means that in case of unipolar recurrent depression, carbamazepin itself is a drug of the first choice when prompting prophylactic tactics.

For an extraordinary reduction of antipsychotics (persh for all chlorpromazine, clozapin, zuclopenthixol, and also haloperidol) in the form of a drug, without sum, it is more effective and effective: it doesn’t take a lot of sedation. However, it’s better for everything, only symptomatic: neuroleptics are practically not injected on the basis of clinical symptoms and transmission of phase flow mechanisms. When pinching їkh stasosuvannya in zychaynykh vypadkah turn around the symptoms. The addition of neuroleptics with lithium intake can lead to the appearance of neurotoxic effects (tremor, akathisia), vegetative lability, which is difficult to discomfort, and sometimes lead to a hostile development of anxiety.

In the end of the rock, there is more and more robustness, for the stagnation of mania and hypocrisy of such acute antipsychotics, for example, quetiapine, olanzapine, aripiprazole and other drugs.

Klіnіchnі efekta neyroleptikіv mozhut sluzhiti diferentsіyno-dіagnostichnimi Find our nature to z'yasuvannya manіakalnih abo gіpomanіakalnih stanіv: Yakscho pid vplivom neyroleptikіv redukuєtsya not tіlki Ruhov i movne zbudzhennya, ale i harakternі іdeatornі torn down (napriklad, іdeї velichі), you can not pripustiti affective and schizoaffective nature of impairment, and as the phenomenon of expansive delusion occurs as a reduction of powerlessly affective disorders, then a greater diagnosis of schizophrenia. On the other hand, as if salts were stagnant, or if anticonvulsants were reduced to a harmonious reduction of emotional, vegetative-somatic, ruddy and cognitive impairments, then it’s more important to say about the suitability of the disease.

Іn'єktsіyne administration benzodіazepіnіv (dіazepam, phenazepam, lorazepam, clonazepam) bіlsh Bezpieczne (in addition to chislі poєdnannі of drugs lіtіyu) Yogo mozhna vikoristovuvati on pershit Etap aktivnoї terapії tіmostabіlіzatoramі in yakostі for pathogenetic background of obgruntovanoї terapії away profіlaktikoyu preparations lіtіyu abo anticonvulsants ...

Bipolar Affective Products ICD-10

F30 Maniacal epizode(Up)

Tim was amazed by the affection and the mood, so that in the case of the affection he was thinking about how he was being played, how to be aware of the image in behavior, because of how he could be thinking about the singing promiscuously during the hour, I often don't expect To the number of affective disorders, there are such syndromes, such as seasonal changes in vagina, evening cravings for carbohydrates, premenstrual syndromes, and a part of adolescent aggressiveness.

Ethiology and pathogenesis

Emotion is manifested in behavior, for example, the mind, posture, gesture, particularity of social communities, misleading and sub'actively described in the structure of the experience. If control is involved over it, it’s within the reach of a step, and it can lead to self-destruction (suicide, self-destruction) or destruction (aggression). Affective problems (bipolar, recurrent, distimic) may cause some etiology and pathogenesis:

The genetic cause of the disease can be a gene in the 11th chromosome, in order to understand the theory of genetic variation in affective disorders. Transferred to the dominant, recessive and polygenic forms of distribution.
The biochemical reason is the deterioration of the activity of the exchange of neurotransmitters, the number decreases with depression (serotonin) and the development of mania, as well as catecholamines: deficiency of catecholamines is attributed to depressions.
Neuroendocrine causes appear in the disturbed rhythm of the functioning of the hypothalamic-hypophysis, lymbic system and epiphysis, as well as to be aware of the rhythm of the wikidre of releasing hormones and melatonin. The price is infused bit by bit into the whole rhythm of the body, the growth of the rhythm of sleep / sleep, sexual activity, їzhі. The rhythms are systematically destroyed in case of affective disorders.
Theories of the loss of social contacts include cognitive and psychoanalytic interpretation. The cognitive interpretation is based on the adaptation of the fixation of depressogenic schemes of the type: foul moods - I cannot take anything - my energy is falling - I am marniy - the mood is to go down. The qia scheme is based on a special and social level. The stylistics of the depressive targeting of the transmission of the vision to the plan of the future. Psychoanalytic concepts explain the depression of regression to narcissism and the form of hatred to oneself, narcissistic elements appear in self-presentation and eksgibitsionizm also during mania.
Negative (distress) and positive (eustress) stress can be the cause of affective discord. Serii of stresses to produce up to overwork, and then the rest of the phase of the main adaptive syndrome and development of depression in constitutionally schilous specialties. The most significant stressors - death of a man / squad, child, welding and loss of economic status.
The basis of the psychobiology of affective disorders is the breakdown of regulation in the spectrum of aggressive - auto-aggressive behavior. Selectively experiencing depression є stimulating altruism in a group and family, an obvious challenge in group and individual perceptions of hypomania. We will explain the stipulation of the number of schliness of defective disorders among the population.
wideness

The frailty of defective wives becomes 1%, the rate of maturity of people and women is approximately the same. Children have a stench of growing up to a maximum of 30-40 years.

Basically, the deterioration of the field in the change of the affect or the mood, the level of motor activity, the activity of social function. Іnshі symptoms, for example, changing the rate of targeting, psychosensory problems, lingering self-referencing or re-evaluating, secondarily according to the rate of change. Klinika manifests itself in viglyadi epizodes (maniacal, depressive), bipolar (biphasic) and vivorous disorders, as well as in the form of chronic disorders in mood. Intermission without psychopathological symptoms is indicated as psychoses. Effective problems may be perceived in the somatic sphere (physiological direction, vaga, turgor shkiri, etc.).

The head signs are the change to the affect or the mood, the symptoms of the disease from the cycle of change and second.

Effective problems are recognized in case of bagatio endocrine disabilities(Thyrotoxicosis and hypothyroidism), Parkinson's ailments, forensic pathology of the brain. In case of organic affective disorders, the presence of symptoms of cognitive deficiency and loss of svidomosty is not typical for endogenous affective disorders. A bit of differentiation in schizophrenia, however, in the presence of a large number of characteristic productive or negative symptoms, in addition, maniacal and depressive conditions develop atypical and near-apologetic The most difficult and super-strands occur when differential diagnostics with schizoaffective disorders, as well as in the structure of affective disorders there are secondary ideas of revaluation or self-denial. However, in case of true affective discouragements, the stench is aware of how normal it is to enter into a normal affect, and not to start a clichéd picture.

The therapy is based on the lack of depression and mania, as well as prophylactic therapy. Therapy of depression includes in the fallowness of the glibini wide range drugs - from fluoxetine, lerivone, zoloft to tricyclic antidepressants and ECT. Therapy maniy is based on the therapy with increasing doses of lithium under the control of the blood, the intake of antipsychotics, such as carbamazepin, and some beta-blockers. Acceptable therapy is healthy with lithium carbonate, carbamazepine or sodium valpate.

F30 Maniacal epizode

It is easy to step mania, when there is a change in mood and behavior, it didn’t go overboard and it’s not supervised by madmen and hallucinations. Inspiration of attitudes is manifested in the sphere of emotional as a result of lack of feeling, dullness, in the spheres of movement, in the sphere of movement, as a result of latency and surface convulsions, in relation to contact. In the sphere of increased motivation, it is meant to increase appetite, sexuality, volatility, decrease in consumption, okremia vchinka, overstep the bounds of morality. Sub'actively perceives the ease of association, promotion of praise and creative productivity. The number of social contacts and success is growing actively.

Particular symptoms of the addicted mania can be monosymptoms of the offensive type: retardation in a child and an adult, a decrease in consumption in a child, in the absence of an increase in creative productivity due to the experience of a mental illness, excessive

The main criteria are:

1. Any changes in mood that are abnormal for the whole individual and take about 4 days.
2. The guilty ones are presented not less than 3 symptoms from the number of the offensive:

the life of the physically unconscious is increased;
balacuchity has been improved;
difficult in zooseredzhennі respect or volіkannya;
reduced demand for food;
promotion of sexual energy;
an episode of reckless or unaware behavior;
friendliness or familiarity has been added.
Differential diagnosis

Hypomanic episodes of hyperthyroidism, in the case of hyperthyroidism, may experience autonomic reactions, temperature changes, Graefe's symptom, exophthalmos, tremor. Patients mean "internal tremty". Hypomania can also be found in the phase of grubbing with anorexia, or in case of stagnation of hunger. With true hipomania, appetite, navpaki, pidvisheniya. Hypomania is also characteristic of the intoxication with psychoactive speech, for example, amphetamines, alcohol, marijuana, cocaine, and, in general, the presence of some signs of intoxication: changes in the development of vegetative reactions.

The therapy stagnates small and medium doses of lithium carbonate, small doses of carbamazepin.

F30.1 Mania without psychotic symptoms(Up)

The head idea of ​​hypocrisy is those who, as a result of changes in attitudes, are recognized on the changes in the norms of social functioning, manifest themselves in inadequate changes, and the onslaught of efforts to drive activity is not controlled. Self-assessment is advancing, and there are some ideas of great significance and greatness. The winners are subjectively aware of the lightness of the association, due to the volatility, the farsi navkolishnogo light is taken with more bright and contrasting, more subtle sounds are perceived. The pace will accelerate for an hour, and the demand will speed up. Tolerance and demand for alcohol, sexual energy and appetite, cravings for higher prices and suitable for the increase. Permanently fear of being infected with venereal diseases and those caught in history with non-transferring inheritance. The managers of the streak іdey winnіkє without lіch plans, the implementation of whichever licenses are inevitable. The patient is pragmatic to a sweet and sweet dress, to speak in a husky and hoarse voice, to rob the helpless borgs and give pennies of ice to the people who know them. It’s easy to get lost in love and love for yourself. Seeking helpless vipadkovyh people, vіn vlashtovuє is sacred in borg.

Head symptoms of mania and onset:

Adjustments, emotsiyne, drativlive (obscene) or suspicious of attitudes, like є unprecedented for this individual. The mood is guilty, but we are flexible and take hold of the tension.
They are guilty of being present at least three from the number of onset symptoms (and even if the setting is only drastic, then chotiri):
1) p_advishennya activity, or physical napodennya;
2) balacuchism has been adjusted (“push”);
3) accelerated flow of thoughts or sub'actively perceived "leaps of ideas";
4) a decrease in normal social control, leading to inadequate behavior;
5) reduced demand for SNI;
6) self-assessment has been adjusted for the idea of ​​greatness (grandeur);
7) allowance for any post-change in progress or plans;
8) there is no need for any kind of careless behavior, the inheritance of something we have a problem with, for example, gulny, bad attitude, carelessness in driving a car;
9) not to promote sexual energy or sexual impatience.

Visibility of hallucinations or maddens, if you want to be able to get rid of them (for example, sub-active hyperactivity, to get rid of them, especially yaskravikh).
Differential diagnosis

A slid of differentiation of mania with affective disorders in case of ailments of fallowness (euphoria with implantation of cocaine, marijuana), with organic affective disorders and from manic-hebephrenic disorders in schizophrenia and schizophrenia In case of intoxication as a result of cocaine treatment, the order of somatic symptoms of manic damage is indicated: headaches, stiffness before the trial, rhinitis, arterial pain, tachycardia, hypertension With intoxicating euphoria as a result of implantation of marijuana, mania can contradict nonviolent myo, caused by dry mucous membranes, tachycardia, depersonalization, extended zinits.

Organizational mania against the change of evidence, neurological and somatic damage appear, as well as components of the psychoendocrine syndrome, for example, cognitive decline. Manic-gebephrenic stance on the mind of manic is characterized by non-infectious joyfulness, formal misery (rosiness, amorphousness, paralogical misinterpretation), stupid, symptoms of instinctive sexual regression (cold re-creative)

In therapy, vikoristovuyut great neuroleptics (tisercin, aminazine), carbonate lithium in adult doses with control of the level of lithium in plasma, as well as carbamazepin.

F30.2 Mania of psychotic symptoms(Up)

The mania of the bright leaping ideas and maniacal excitements is swirled, to the point of adhering to the second lighthouse ideas of greatness, high walking, hypereroticism, value. The hallucinatory hail, which confirms the significance of the specialness.

P'yatiy a sign in the whole diagnostic group vikoristovuyutsya for the designation of the visibility of madder or hallucination mood:

0 - with psychotic symptoms, attributable to the mood (madder is great or "voice", it seems to someone who is sick about his superhuman forces);
1 - with psychotic symptoms, but they do not show the mood (“voice” to tell a sick person about emotionally neutral speeches, or maddening meaning or peresliduvannya).

The epizod is based on the criteria of mania, albeit against psychotic symptoms, which are both common and old due to an impulsive mood.
Epizod does not conform to the criteria of schizophrenia but schizoaffective discord.
Delirium (greatness, meaning, erotic abo persecutory snake) abo hallucination.

The most difficult ones to polarize in differential diagnostics with schizoaffective discharges, however, in the case of multiple discharges, the symptoms are characteristic of schizophrenia, and the luminous ideas are characteristic of schizophrenia in the men of the world. However, the diagnosis can be made to look at the cob for the assessment of schizoaffective problems (first epizod).

Therapy of transferring carbonate to lithium and antipsychotics (triftazin, haloperidol, tizercin) immediately.

F30.8 Insect maniacal epizodi(Up)

F30.9 Maniacal epizode, unspecified(Up)

F31 Bipolar affective disorder(Up)

Rozlad, previously qualified as a manic-depressive psychosis. Anxiety is characterized by repeated (not less than two) episodes, with certain moods and levels of motor activity significant impairment - from manic hyperactivity to depressive impairment. Exogenous factors are practically not infused with rhythm. Between the stages of the transition to the stage of the opposite polarity, or the change in polarity, or in the intermissions (remission). Attack may be the path until the seasons, more often the spring and the main fire, if you want more individual rhythms. Triviality of intermissions from 6 months to 2-3 rocky. The triviality of maneuvers from month to 4 months, extending the dynamics of ailments, the triviality of depression from month to 6 months. A relapse can be approximately the same triviality, or you can podovzhuvatisya with short remissions. Depressions have a clearly endogenous character: add to the mood, elements of vitality. At the outset of therapy, attack the tendency to spontaneous shaving, wanting the stench and more protracted.

In the event of a breakdown, one is encouraged to become socially deprived.

Diagnostics is based on the detection of repeated episodes of changes in mood and level of motor activity in the coming clinical options:

F31.0 Bipolar affective disorder, current hypomaniacal epizodes(Up)

Episodic criteria for hypomania.
In the last I would like to have one affective episode with the criteria for hypomanic abnormal episode, depressive epizode and negative affective episode.

F31.1 Bipolar affective disorder, current episode of mania without psychotic symptoms(Up)

Epizod with the criteria of mania.
In the last one I want to have one or another affective episode, which is similar to the criteria for hypomanic abnormal episode, depressive episode or negative affective episode.

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

Streaming episode with criteria of mania with psychotic symptoms.
In the last few years, I would like to have one or another affective episode, which is similar to the criteria for a hypomanic abnormal episode, a depressive episode or a negative affective episode.
P'yuyu sign zvvychay vikorystyutsya for the value of indications of psychotic symptoms in the mood:

0 - psychotic symptoms, attributable to mood;

F31.3 Bipolar affective disorder, current episode of moderate or easy depression(Up)

Epizod with the criteria of a depressive episode, easy or altogether heavy.
Accepted one affective episode in the last with the criteria of hypomanic abnormal epizode, or less affective episode.
P'yatiy the sign of vicories for the value of the representation of somatic symptoms in the flow episode of depression:

0 - no somatic symptoms,
1 - somatic symptoms.

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

Episode with criteria of severe depressive episode without psychotic symptoms.
In the last year I would like to have one maniac or hypomanic episodic or altered affective episodic.

F31.5 Bipolar affective disorder,
acute episode of important depression with psychotic symptoms(Up)

Episode with criteria of severe depressive episode with psychotic symptoms.
In the last year I would like to have one hypomanic or an affective episode or an affective episode.
P'yuchi is a sign of victoriousness for referring to the likelihood of psychotic symptoms in the mood:

0 - psychotic symptoms, attributable to mood,
1 - psychotic symptoms, which do not correspond to the mood.

F31.6 Bipolar affective disorder, current changes in epizodes(Up)

Episodes are characterized by either a small or a quick snake (for a few years) of hypomaniacal, maniacal and depressive symptoms.
The first maniac, and the depressive symptoms of guilt but flare up took two problems.
At the last I took one hypomanic abnormal episode, depressive abnormal affective episode.

F31.7 Bipolar affective disorder, remission(Up)

The camp does not meet the criteria for depression, for mania be it hard, or in those who have a mood disorder (perhaps in conjunction with preventive therapy).
In the last I want to have one hypomaniacal abnormalities and at least one more affective episodes (hypomania abnormalities), depressive abnormalities.
Differential diagnosis

Bipolar affective disorder is often differentiated from schizoaffective disorder. Shizoaffective disorder is a time-dependent endogenous functional disorder, as it is also practical not to suffer from a defect and in any way affective damage to superficial treatment and to prevent more, less productive symptoms of schizophrenia (F20). Symptoms are not typical for bipolar affective disorder.

The development of depression, mania and prophylactic therapy of attacks. The peculiarities of the therapy are manifested by a glimpse of affective damage and the manifestation of other productive symptoms. In case of depressive episodes of vikoristovuyuet more often tricyclic antidepressant, EST, treatment deprivation sleep, dissolve with nitrous oxide. In case of maniacal epizodes, the addition of carbonate to lithium and neuroleptics. In the form of adaptive therapy: carbamazepin, sodium valproate and lithium carbonate.

F31.8 Insti bipolar affective disorder(Up)

F31.9 Bipolar affective disorder, unspecified(Up)

F32 Depressive episode(Up)

Riziku factories

Factors in the development of depression in 20-40 years, decrease in social class, separation among children, family history of suicides, loss of relatives in 11 years, especially in sexual quality with respect to homosexuality , especially among self-contained women.

The class is based on emotional, cognitive and somatic damage, in the number of additional symptoms, as well as the presence of second ideas of self-repudiation, depersonalization and derealization. Depression is manifested in a low mood, loss of interest and satisfaction, low energy, and as a result, in increased stomatization and decreased activity.

Depressive episode of triviality is not less than 2 types.

Patients mean a decrease in building up to a level of improvement and respect, so that one can sub-actively get rid of it like a folding camp, a memory and a decrease in success in the modern world. It is especially useful in an adult and youthful life, as well as for individuals who are engaged in intellectual practice. Physical activity it is also reduced to gallmovanosti (even to a stupor); Children and adolescents in depression can be super-aggressive and confrontational, as they can mask their hatred to themselves. It is intellectually possible to divide all depressive conditions into syndromes with a trivial component and without a trivial component.

The rhythm of the mood changes is characterized by typical self-respect until evening. Decrease in self-assessment and performance in a person who sees a specific neophobia. The way to see the distance of the patient from the desperate and feel the sense of his disagreement. In case of a trivial overload of depression at the time of 50 years of age, it can lead to a deprivation and a classic picture, which is just a dementia. Winning ideas of wines and self-abasement, maybutting in frowning and pesimistic tones. Everything should be brought to the conclusion of ideas and ideas, tied to auto-aggression (self-harm, suicide). The rhythm of sleep / non-sleep breaks down, the rhythm of sleep / sleep breaks down, the sleeplessness is felt, or the daytime feels like a dream, it gets over the gloomy dreams. Vrantzi patient forcibly got up from the sled. Appetite goes down, one patient gets overwhelmed by carbohydrates, the appetite can be seen at evening hours. For an hour to sleep, it’s like being built indefinitely and hard. The patient ceases to bear the beasts of self respect, he may have numerous hypochondriac and senestopathic experiences, there is a depressive depersonalization with negative submissions about the powerful Self and Til. Depressive derealization rolls around in the light in cold and gray tones. Mova is very special, with a monologue about problems and past. Concentration of respect is difficult, and the formulation of ideas is trustworthy.

When looking around the patient, one often marvels at the back of the eye, or at the dzherelo light, gestures from the organization right up to the hairy body, pressing the hands to the breasts, with anxiety depression to the throat, the posture of ordering, in the place of mind. With three quickened gestures of manipulating objects. The voice is low, quiet, with great pauses between words and low directives.

Endogenous affective component. The endogenous affective component rotates in the presence of rhythm: the symptomatology will be tolerated and compensated for in the evening, the manifestation of criticism, in the sub-active perception of the severity of one's camp, the severity of the seasons, in the positive triple reaction

The somatic syndrome is a complex of symptoms, which, one by one, is related to a depressive episode. For the first time, it’s a sign, but the presence of this syndrome is not specified for an important depressive episode;

For the somatic syndrome of guilt, it is presented according to the ICD 10 chotiri of the onset symptoms:

Decrease of interests and / for depletion of satisfaction in virtue of performance, call for a welcome for the sick.
The prevalence of the reaction on the basis of that / or the activity, which is in the norm of the week.
The awakening of the vrant is two or more years before the hour.
Depression is more important than vrance.
About'єktivnі evidence pіtnoy psychomotor gallmovanstі or agitation (as seen or described by the persons).
Note the decrease in appetite:
a) a decrease in the amount of money (five or more times in the last month).
b) remember the decrease in libido.

Protest in the traditional diagnosis of a somatic syndrome, there may be a lot of symptoms: such as an increase in the age, tachycardia, constipation, a decrease in the age of a child, and a lag of niggaz and hair, to accelerate : such as psychogenic sluggishness, trouble-free syndrome, dermatological hypochondria, cardiac and pseudo-rheumatic symptoms, psychogenic dysuria, somatoform disorders shlunkovo-intestinal tract... Moreover, in case of depression, one does not go down, but move into the connection with the cravings for carbohydrates, it can go down, but it can go down, but it’s more sexually satisfied with the trip. Among the other somatic symptoms are characteristic unimportant headaches, amenorrhea and dysmenorrhea, chest pains, especially, specifically, the appearance of "stone, heavyness on the breasts."

Naybilsh important signs є:

reduction of building up to average and respect;
a decrease in self-assessment and performance in one's own;
ideas of wine and self-abasement;
a frown and a pesimistic bachelor of the maybut;
іdeї abo dії, scho to self-educate abo suicide;
sleep disturbances;
decreased appetite.

Slid differentiation of depression with cob ulcers in Alzheimer's ailments. Depression can be supervised by the clinker of pseudodementia described by Vernika. In addition, trivial depression can lead to cognitive deficiency as a result of secondary deprivation. Pseudo-dementia in chronic depression is associated with Puna van Winkl's syndrome. For the interconnection, the values ​​of the anamnestic views, the data of the active methods of preliminaries may be considered. Depressive children often have a characteristic good mood and good success at the evening hour, they have not rudely ruined respect. Among the mimic depressive patients, the fold of the Veragut, the pubescence of the kuti rota and the mute characteristic of Alzheimer's ailment, the decayed health and the brilliant flicker are considered. Depression also does not mean sign stereotypes. When depresії, yak at hvorobі Alzheimer vіdznachaєtsya Progressive іnvolyutsіya, in addition chislі znizhennya turgor shkіri, tmyanі ochі, pіdvischena lamkіst nіgtіv i hair ale zaznachenі rozladi at mozkovoї atrofії chastіshe viperedzhayut psihopatologіchnі rozladi, while depresії stink vіdznachayutsya at velikіy trivalostі znizhenogo mood. Decreased vagi in case of depression leads to decreased appetite, and with Alzheimer's ailment, the appetite does not decrease only, but perhaps it does not decrease. Patients with depression respond more readily to antidepressant activity, but with Alzheimer's ailments, the stench may cause spontaneity and asthenization, leading to hostile entanglement of ailments. All the data of CT, EEG and neuropsychological conditions are of great importance.

Antidepressants stagnate in lykuvanna: mono-, bi-, tri- and tetracyclic, ingibitorium MAO, L-tryptophan, thyroid hormone, monolateral ECT for nondominant sleep, sleep deprivation. Prior to the old methods, it was introduced into / in the treatment with high doses of novokain, ingalyation with nitrous oxide. Phototherapy with fluorescent lamps, cognitive and group psychotherapy is also stagnant.

F32. 0 Mild depression epizod(Up)

In the classy picture, there is a decrease in building up to average and respect, a decrease in self-esteem and self-esteem in one's own, the idea of ​​winniness and self-defiance, a gloom and a pessimistic setting to a mighty; suicidal ideas that self-conscious, ruining sleep, decreasing appetite. The main symptoms of a depressive episode of guilt will come to an end with such a level of depressive mood, as it is abnormal to sleep as a patient, while the mood is not epizodically, but would like to spend more of the day and not reactivate the moment. The patient is experiencing a decrease in energy and increased obesity, if he wants to control his condition and often prodolzhuvat. Behavior (mimic, communicative, cognitive and gestures) signs of a filthy mood can be present, but not controlled by a patient. In the morning, I can remember a little laugh, a motor naughty, how to sleep like "thoughtful". Inodі first skargami є vrata sensu іsnuvannya, "existential depression".

P'yuyu sign vikoristovuyutsya to clarify the visibility of the somatic syndrome:

Minimum two from the onset of three symptoms:
depressive mood;

Two additional symptoms:


disturbed sleep;
a sign of appetite.

Differential diagnosis

Most often, a mild depressive episode is brought about by differentiation with an asthenic camp as a result of overturning, organic asthenia, decompensation of asthenic particular rice. With asthenia, not typical suicidal thoughts, but decreases in mood and stamina, will be accepted until evening. In case of organic asthenia, it is often indicated that there is a lack of frost, myazova weakness, and stomachache in case of physical nascence. Anamnesis - craniocerebral trauma. In case of decompensation of special rice, psychasthenic shearing is discolored in the anamnesis, subdepression is lost as a specialty as natural.

In lykuvanny vikoristovuyt benzodiazepini, antidepressants such as fluoxetine, pyrazidol, Petilia, gerfonal, with anxiety components - zoloft. Shown courses of phytotherapy, psychotherapy and natrapiv. Inodіeffect gives 2-3 sessions of nitrous oxide, amytal-koffeіin rezhalmovannya and internal introduction of new laws.

F32. 1 Pomirny depressive epizod(Up)

The head view of the depressive depressive epizode is those who, on the basis of an affection, are recognized on the basis of equal social activity and the realization of special features. With the manifestation of triviality, it is clearly manifested in skargs and behavior. In addition, depression often appears with obsessive-phobic components, with senestopathies. In the light of the light and in the middle of the way, they can be just and purely short.

diagnostics

1.2 out of 3 symptoms of a mild depressive episode, so that from an offensive transition:

depressive mood;
a decrease in interest, for the satisfaction of the performance, as before, it was accepted by the patients;
Reduced energy and increased urgency.
2. 3-4 of those symptomatic of the outlying criteria of depression:

decrease in performance and self-assessment;
for no reason to accept self-justice and almost guilt;
repeating thoughts about death or suicide;
skargi for a decrease in the concentration of respect, nonsense;
disturbed sleep;
a sign of appetite.
3. Minimum triviality is close to 2 types. P'yatie sign in case of somatic syndrome:

1 - somatic syndrome. Differential diagnosis

A slight differentiation from post-schizophrenic depression, especially when there is a clear anamnesis. For the depressive epizode, the characteristic endogenous affective component, the negative emotional-volitional changes in the daytime.

In lіkuvannі vikoristovuyut іngіbіtori MAO on tlі children, yaka viclyuchaє tiramіn (smoked meats, beer, yoghurt, dry wines, vitrimanі siri), tricyclic antidepressants (in case of depression with the component of trivia - antipyrine With prolonged depression - carbonate lithium or carbamazepin. In some cases, they give 4-6 sessions of nitrous oxide, amytal-coffee breeding and internal introduction of new medicine, as well as reducing sleep deprivation.

F32. 3 Major depressive episode without psychotic symptoms(Up)

In the class of an important depressive episode, all symptoms of depression are present. The motor skills are agitiryrovaya abo meaningfully galvanized. Suicidal thoughts and behavior have a permanent character, due to the presence of a somatic syndrome. Social activity is ordered only by ailments and is significantly reduced, or even sickly. All vimagayut hospitalization in connection with unsafe suicide. I also want to encourage agitation and flirting with the presence of other behavioral signs of depression, but not to discard the additional verbal information about the patient's age, and it is important for the period to be presented as well.

All criteria of light and peaceful depressive episode, so that depressive mood is present; a decrease in interest, for the satisfaction of the performance, as before, it was accepted by the patients; Reduced energy and increased urgency.
Dodatkovo 4 and more symptoms from general criteria of a depressive episode, tobto from the interchange: decrease in performance and self-judgment; for no reason to accept self-justice and almost guilt; repeating thoughts about death or suicide, mischief on lowering the concentration of respect, nonsense; disturbed sleep; a sign of appetite.
Triviality is not less than 2 types.
Differential diagnosis

A slid of differentiation with organic affective symptomatology and cob stages of dementia, especially with Alzheimer's ailments. Organic affective symptomatology is allowed to include additional neurological, neuropsychological dosages, EEG and CT. This method is used for differential diagnosis of cob stages in Alzheimer's ailments.

F32. 3 Important depressive episode of psychotic symptoms(Up)

At the most important depression, there are luminous ideas of self-incrimination, hypochondriacal ideas about infection and fear (or, in other words, becoming infected) of infecting cymbals to those close to them. The patient pays for himself the sin of all people and vvazhaє, who is guilty of spokutuvati, inodi price life... Yogo thoughts can support rumors, scent deceptions. As a result of their experience, they become gloomy and depressive stupor.

Based on the criteria of an important depressive episode.
The blame for the presence of onset symptoms:
1) delirium (depressive madder, self-styled madder, hypochondriacal madder, nigilistic or persecutory madder);
2) rumors (sounds and sounds) and smells (smells of grit) hallucinations;
3) depressive stupor.

P'yati sign vikorystyutsya for the value of the appearance of psychotic symptoms in the mood

0 - psychotic symptoms, attributable to mood (maddening wine, self-degradation, physical ailments, how to get sick of unhappiness, laughing or hearing rumors of hallucinations),
1 - psychotic symptoms, which do not reflect the mood (persecutory madder or looming attention to oneself and hallucinations without affective wisdom).

The main differential diagnosis of dressings with a group of schizoaffective disorders. For the sake of the important depressive episodes, you can see how the manifestation of schizoaffective disorders. Until then, with affective disorders of the day, symptoms of the first rank, characteristic of schizophrenia.

Treatment includes the intake of tricyclic and tetracyclic antidepressants, ECT and neuroleptics (stelazine, etaperazine, haloperidol), as well as ben-zodiazepines.

F32. 8 Інші depressive episodi(Up)

They are included in the episode, as they do not go to describe the depressive episodes, but the more diagnostically hostile case is in the case of their depressive nature.

For example, the number of depressive symptoms is indicative (especially of the "somatic" syndrome) with symptoms such as stress, anxiety, distress, as well as the acceleration of "somatic" depressive symptoms due to chronic pain, but not because of the reasons.

F32. 9 Second depressive episode, unspecified(Up)

F33 recurrence depressive disorder(Up)

Repeated depressive episodi (light, moderate or important). The period between attacks is at least 2 months, which cannot be spared any significant affective symptoms. The triviality of episodes is 3-12 months. Learn more often with women. Call the attackers up until the end of the day. Deliver a clear individual or seasonal rhythm. The structure and typology of attacks in the form of endogenous depressions. Additional stress can reduce the degree of gravity of depression. The Danish diagnosis is put in a wide range, the therapy stagnates, as it reduces the risk of repeated episodes.

Repeated depressive episodes from periods of at least 2 months of attacks, which do not lead to any kind of affective symptoms.

F33.0 recurrence depressive disorder, current episode of light severity(Up)

Resulting in a general recurrent depressive breakdown.
The current episode is based on the criteria of the depressive episode of lightness.
The following paragraph is to be considered to clarify the manifestation of somatic symptoms in the flow epizodi:

0 - no somatic syndrome.
1 - somatic syndrome.

F33.1 Recurrent depressive disorder(Up)

The current episode is based on the criteria for a depressive episode average gravity.
Understanding the point of vikoristany for assessing the manifestation of somatic symptoms in the flow epizodi:

0 - no somatic syndrome,
1 - somatic syndrome.

F33.2 recurrence depressive disorder,
important current episode without psychotic symptoms(Up)

General criteria of recurrent depressive breakdown.
The current episode responds to the criteria of an important depressive episode without psychotic symptoms.

F33.3 recurrence depressive disorder,
an important current episode of psychotic symptoms(Up)

General criteria of recurrent depressive breakdown.

The current episode responds to the criteria of an important depressive episode with psychotic symptoms.

The following paragraph is victorious for determining the appearance of psychotic symptoms in the mood:

0 - due to the mood of psychotic symptoms,
1 - do not show the mood with psychotic symptoms.

F33.4 recurrence depressive breakdown, in the Danish hour of remission(Up)

General criteria for recurrent depressive breakdown.
The fair camp is not in accordance with the criteria for a depressive episode, be it hard, or whatever it is in F30-F39.

Recurrent depressive disorder followed by differentiation from schizoaffective disorders and organic affective disorders. With schizoaffective disorders in the structures of productive, experiencing the presence of symptoms of schizophrenia, and with organic affective disorders, the symptoms of depression are mainly sick (endocrine, cerebral swelling, traces of encephalitis).

therapy

In case of elimination of hypersensitivity therapy (antidepressants, ECT, sleep deprivation, benzodiazepines and neuroleptics), psychotherapy (cognitive and group therapy) and adaptive therapy (lithium, carbamasepathy)

F33.8 Other recurrent depressive problems(Up)

F33.9 recurrence depressive disorder, not specified(Up)

F34 Chronic (affective) mood changes(Up)

Wear a chronic and develop an unstable character. Okremia sometimes lack of gliboki, but it may cause hipomania or mild depression. Trivial rock, but inodi and stretching the sick life of the sick. The bosses of the whole nagaduyut special problems of the type of constitutional cycloids or constitutional depressive ones. Life and stress can take a toll on the future.

The reason for the chronic discord in the mood is both constitutional and genetic factors, as well as a special affective background in the family, for example, the idea of ​​hedonism or pessimistic way of thinking about life. In case of confusion with living conditions, for which no one of us can be unique, the specialness of us responds with a typical affective camp, as a chance to be created completely adequate and psychologically intelligent. The goal of becoming more adaptive is the reaction of those who feel comfortable.

clinika

Often times, children’s homes are based on seasonal moods. However, the diagnosis is adequate to be adequately deprived in post-puberty, if the unstable mood during the periods of subdepression and hypomania is not less than two rocky. The clinker itself endogenously siphon off as a period of natkhnennya, thoughtless vchinkiv or blues. Somewhat importantly, depressive and manic about every day, but only when described in anamnesis.

The period of depressive mood virosta step-by-step and take off as a decrease in energy or activity, a development of a vicious attitude and creative potential. It’s worthwhile to bring to a decline in performance in one's own capacity and for a bit of disingenuousness, as well as in social awareness, because the city should also manifest itself in a reduced balance. Sleeplessness, pesimism is a strong power character. Have passed and may be evaluated negatively or ambivalently. Patients skip in some way to increase sleepiness and deterioration of respect, which will add new information to them.

An important symptom is anhedonia, according to the admission to the earlier of the accepted types of distribution of the instinct (їzha, sex, traffic) or the accepted types of activity. Decrease in activity activity is especially helpful, as long as you take it in an adjusted mood. There is no protest of suicidal thoughts. Episodic can occur as a period of inconvenience, existential emptying, and in case of great triviality, it can be appreciated as characterological rice.

Prototype camp can be stimulated by endogenous and inviting podiatny and but also tied to the season. With an adjusted mood, energy and activity increase, the demand for people decreases. Creative misinterpretations are promoted or stricken, scho to produce self-assessment before advancing. The patient will be able to demonstrate the intelligence, completeness, sarcasm, speed of association. As the profession of the patient is self-demonstrating (actor, lecturer, teachings), then the results are evaluated as "blisky", however, with a low reason, the self-evaluation of self-evaluation is inadequate and inappropriate.

To get interested in sex, to gain sexual activity, to get interested in the other types of instinctive activity (іzhі, high prices, winners of over-involvement in the interests of family, power Maybut will be optimistic;

There are more than two rockets of unstable mood, which includes the tempering of periods such as subdepression, as well as hypomania, for example, without intermediate periods of the normal mood.
Two rockets on the day are reconciled and important to show affective episodes. Sparing an affective episode of his own lower, lower lungs.
In depression, there are no less than three onset symptoms:
decrease in energy and activity;
sleeplessness;
a decrease in performance in one's own, for a bit of disregard;
difficult in the concentration of respect;
social services;
a decrease in interest or satisfaction in sex or in other types of activity;
reduction of balakuchostі;
Pesimistic positioning to the future and negative assessment of the past.
Adjusted for the mood of supervising not less than three in the onset of symptoms:
adjustment of energy abo activity;
decrease in consumer goods;
self-assessment has been adjusted;
sharpened or unwittingly creative mission;
added comradeship;
balacuchity has been introduced, or a demonstration of the rosum;
promotion of interest in sex and improvement of sexual intercourse, one of the types of activity, to bring satisfaction;
superoptimism and reevaluation have passed until the end.
You can okremі antidіstsіplіnarnye dії, wake up in the camp of alcoholic sp'yanіnnya, which evaluate as "overly cheerful".

A class of differentiation from mild depressive and manic epizodes, bipolar affective disorders, when I fight against moderate and mild affective attacks, I will also become hypomanic as soon as I see a bad ear.

As a result of being up to mild depressive and manic episodes, you want to think about the development of your anamnesis, some instability of mood during cyclothymia may start with a line to two harmony, for cyclotymics, but they are not typical for them. Tsiklotimіchny epіzodi not dosyagayut psychotic rіvnya, tse vіdrіznyaє їh od afektivnih bіpolyarnih rozladіv, krіm of cyclothymic toil unіkalnu anamnestichnu іstorіyu, epіzodi torn down mood they vіdznachayutsya duzhe early in puberty, and zmіni mood at hvorobі Pіka in pіznomu vіtsі i poєdnuyutsya of bіlsh rudely torn down social function.

Zapobіgannya epizodіv ruptured mood during cyclothymia, lіtієm, carbamazepine or sodium valproate. The preparation can be stagnant when you are in a mood that is in a state of flux, if you want it to be quiet, if it’s supervised to increase your productivity, it’s hardly worth it. With a low mood, Prozac is shown, the treatment of deprivation to sleep and Onotera-Pia. Inodіeffect give 2-3 sessions of nitrous oxide, amytal-caffeinated food and internal introduction of new drugs.

Ethiology

Typical features, such as dysthymia, are correctly called constitutional-depressive. As they see them, they appear in childhood and puberty as a reaction to be difficult, but in the case of others it is endogenous.

The stench of crying, mercy and no worse than comrade, pesimistic. In the aftermath of insignificant stress, not less than two rock times, they are in the postpubertal period of a permanent or periodic depressive mood. During the period of normal attitudes, they are usually better than decimals; However, the level of depression is lower, lower with a slight recurrent breakdown. There are some symptoms of subdepression: decreased energy abo activity; disruption to the rhythm of sleep and sleeplessness; a decrease in performance in one's own, for a bit of disregard; it is difficult in the concentration of respect and stars to sub-actively recover from the decrease in memory; frequent slack and hypersensitivity; a decrease in interest or satisfaction in sex, which were previously accepted and instinctive forms of activity; Feeling hopelessness or dispensing at the connection with assimilation of lack of hope; lack of dignity to cope with the routine requirements of the haunted life; pesimistic positioning to the future and negative assessment of the past; social services; Reducing balacuchost and secondary deprivation.

Not less than two rock_v post_ayny or repeated depressive mood. Period of a normal mood, it is rather difficult to get better than decilkoh tizhniv.
The criteria are not indicative of a mild depressive episode, some of the daily suicidal thoughts.
During periods of depression, there are no less than three of the onset symptoms: decreased energy and activity; sleeplessness; a decrease in performance in one's own, for a bit of disregard; difficult in the concentration of respect; frequent slackness; a decrease in interest or satisfaction in sex, in those of their own kind; Feeling hopelessness or dispensing; lack of dignity to cope with the routine requirements of the haunted life; pesimistic positioning to the future and negative assessment of the past; social services; reduction in consumption in spilkuvanni.
Differential diagnosis

Slid differentiation with mild depressive epizode, cob stage of Alzheimer's ailment. With a slight depressive episode of the presence of suicidal thoughts and ideas. At the cob stages of Alzheimer's ailment and the largest organic depressions of depression become protracted, the organ can evolve neuropsychological and with the help of the second active methods of delay.

With a low mood of indications of Prozac, treatment of sleep deprivation and Eno-therapy. In some cases, they give 2-3 sessions of nitrous oxide, amytal-coffee therapy and internal administration of new drugs, as well as therapy with nootropics.

F34.8 Chronic (affective) mood disorders(Up)

Category for chronic affective disorders, such as lack of rotation or triviality, to meet the criteria for cyclothymia, or dis-thymіі, mild or less depressive to an epizode. Inclusion of deyaki type of depression, previously called "neurotic". The type of depression is tightly coupled with stress and at the same time with dysthymia to organize coloendoreactive dysthymia.

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

F38 Inshi (affective) adjustment of the mood(Up)

F38.0 Lonely (affective) mood adjustments(Up)

F38.00 Sense of affective episode(Up)

Epizodes are characterized by a changeable clinical picture, or a quick change (stretching out for decades) of hypomaniacal, maniacal and depressive symptoms.
The first maniac and depressive symptoms are guilty but rotate more than an hour, stretching out for a two-month period.
The prevalence of earlier hypomaniacal, depressive or negative episodes.

F38.1Inshi recurrent (affective) adjustment of mood(Up)

F38.10 recurrence short depressive disorder(Up)

Rozladi admit symptomatic criteria of easy, in addition to important depression.
Depressive episodes were diagnosed in the last week.
Okremi epizodi are less, less than two (typically - two or three days).
Epizodi does not have a problem with the menstrual cycle.

F38.8 Inspection (affective) adjustment of mood(Up)

F39 unspecified (affective) mood disorder(Up)