V.  MENTAL DISORDERS


This section of the Classification differs from the others in that it includes
a glossary, prepared after consultation with experts from many different
countries, defining the contents of the rubrics.  This difference is
considered to be justified because of the special problems posed for
psychiatrists by the relative lack of independent laboratory information upon
which to base their diagnoses.  The diagnosis of many of the most important
mental disorders still relies largely upon descriptions of abnormal experience
and behavior, and without some guidance in the form of a glossary that can
serve as a common frame of reference, psychiatric communications easily become
unsatisfactory at both clinical and statistical levels.

Many well-known terms have different meanings in current use.  It is important
for the user to use the glossary descriptions and not merely the category
titles when searching for the best fit for the condition he is trying to code.
This is particularly important if a separate national glossary also exists.

The instructions "Use additional code to identify..." are important because
of the nature of many psychiatric conditions in which two or more codes are
necessary to describe the condition and the associated or causal factors.
It should be used whenever possible.


PSYCHOSES (290-299)

Mental disorders in which impairment of mental function has developed to a
degree that interferes grossly with insight, ability to meet some ordinary
demands of life or to maintain adequate contact with reality.  It is not an
exact or well defined term.  Mental retardation is excluded.


ORGANIC PSYCHOTIC CONDITIONS (290-294)

Syndromes in which there is impairment of orientation, memory, comprehension,
calculation, learning capacity and judgement.  These are the essential
features but there may also be shallowness or lability of affect, or a more
persistent disturbance of mood, lowering of ethical standards and exaggeration
or emergence of personality traits, and diminished capacity for independent
decision.

Psychoses of the types classifiable to 295-298 and without the above features
are excluded even though they may be associated with organic conditions.

The term "dementia" in this glossary includes organic psychoses as just
specified, of a chronic or progressive nature, which if untreated are usually
irreversible and terminal.

The term "delirium" in this glossary includes organic psychoses with a short
course in which the above features are overshadowed by clouded consciousness,
confusion, disorientation, delusions, illusions and often vivid
hallucinations.

                          ICD-9/Ch05.TXT - pg. 1

Includes:    psychotic organic brain syndrome

Excludes:    nonpsychotic syndromes of organic etiology (see 310.-)
             psychoses classifiable to 295-298 and without the above
                  features but associated with physical disease, injury, or
                  condition affecting the brain [e.g., following childbirth]
                  code to 295-298 and use additional code to identify the
                  associated physical condition.

290     Senile and presenile organic psychotic conditions

Excludes:    psychoses classifiable to 295-298.8 occurring in the senium
                  without dementia or delirium (295.0-298.8)
             transient organic psychotic conditions (293.-)
             dementia not classified as senile, presenile, or arterio-
                  sclerotic (294.1)

290.0   Senile dementia, simple type

Dementia occurring usually after the age of 65 in which any cerebral pathology
other than that of senile atrophic change can be reasonably excluded.

Excludes:    mild memory disturbances, not amounting to dementia, associated
                  with senile brain disease (310.1)
             senile dementia:
                 depressed or paranoid type (290.2)
                 with confusion and/or delirium (290.3)

290.1   Presenile dementia

Dementia occurring usually before the age of 65 in patients with the
relatively rare forms of diffuse or lobar cerebral atrophy.  Use additional
code to identify the associated neurological condition.

Brain syndrome with presenile brain disease
Circumscribed atrophy of the brain
Dementia in:
    Alzheimer's disease
    Pick's disease of the brain

Excludes:    arteriosclerotic dementia (290.4)
             dementia associated with other cerebral conditions (294.1)

290.2   Senile dementia, depressed or paranoid type

A type of senile dementia characterized by development of advanced old age,
progressive in nature, in which a variety of delusions and hallucinations of a
persecutory, depressive and somatic content are also present.  Disturbance of
the sleep/waking cycle and preoccupation with dead people are often
particularly prominent.

Senile psychosis NOS

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Excludes:    senile dementia:
                  NOS (290.0)
                  with delirium and/or confusion (290.3)

290.3   Senile dementia with acute confusional state

Senile dementia with a superimposed reversible episode of acute confusional
state

Excludes:    senile:
                  dementia NOS (290.0)
                  psychosis NOS (290.2)

290.4   Arteriosclerotic dementia

Dementia attributable, because of physical signs [on examination of the
central nervous system] to degenerative arterial disease of the brain.
Symptoms suggesting a focal lesion in the brain are common.  There may be a
fluctuating or patchy intellectual defect with insight, and an intermittent
course is common.  Clinical differentiation from senile or presenile dementia,
which may coexist with it, may be very difficult or impossible.  Use
additional code to identify cerebral atherosclerosis (437.0).

Excludes:   suspected cases with no clear evidence of arteriosclerosis (290.9)

290.8   Other

290.9   Unspecified

291     Alcoholic psychoses

Organic psychotic states due mainly to excessive consumption of alcohol;
defects of nutrition are taught to play an important role.  In some of these
states, withdrawal of alcohol can be of aetiological significance.

Excludes:    alcoholism without psychosis (303)

291.0   Delirium tremens

Acute or subacute organic psychotic states in alcoholics, characterized by
clouded consciousness, disorientation, fear, illusions, delusions,
hallucinations of any kind, notably visual and tactile, and restlessness,
tremor and sometimes fever.

Alcoholic delirium

291.1   Korsakoff's psychosis, alcoholic

A syndrome of prominent and lasting reduction of memory span, including
striking loss of recent memory, disordered time appreciation and
confabulation, occurring in alcoholics as the sequel to an acute alcoholic
psychosis [especially delirium tremens] or, more rarely, in the course of

                          ICD-9/Ch05.TXT - pg. 3

chronic alcoholism.  It is usually accompanied by peripheral neuritis and may
be associated with Warnicke's encephalopathy.

Alcoholic polyneuritic psychosis

Excludes:    Korsakov's psychosis:
                  NOS (294.0)
                  nonalcoholic (294.0)

291.2   Other alcoholic dementia

Nonhallucinatory dementias occurring in association with alcoholism but not
characterized by the features of either delirium tremens or Korsakov's
psychosis.

Alcoholic dementia NOS
Chronic alcoholic brain syndrome

291.3   Other alcoholic hallucinosis

A psychosis usually of less than six months' duration, with slight or no
clouding of consciousness and much anxious restlessness in which auditory
hallucinations, mostly of voices uttering insults and threats, predominate.

Excludes:    schizophrenia (295.-) and paranoid states (297.-) taking the
                  form of chronic hallucinosis with clear consciousness in
                  an alcoholic

291.4   Pathological drunkenness

Acute psychotic episodes induced by relatively small amounts of alcohol.
These are regarded as individual idiosyncratic reactions to alcohol, not due
to excessive consumption and without conspicuous neurological signs of
intoxication.

Excludes:    simple drunkenness (305.0)

291.5   Alcoholic jealousy

Chronic paranoid psychosis characterized by delusional jealousy and associated
with alcoholism.

Alcoholic paranoia

Excludes:    nonalcoholic paranoid states (297.-)
             schizophrenia, paranoid type (295.3)

291.8   Other

Alcohol withdrawal syndrome

Excludes:    delirium tremens (291.0)

                          ICD-9/Ch05.TXT - pg. 4

291.9   Unspecified

Alcoholic:                        Alcoholism (chronic) with psychosis
    mania NOS
    psychosis NOS

292     Drug psychoses

Syndromes that do not fit the descriptions given in 295-298 (nonorganic
psychoses) and which are due to consumption of drugs [notably
amphetamines, barbiturates and the opiate and LSD groups] and solvents.
Some of the syndromes in this group are not as severe as most conditions
labelled "psychotic" but they are included here for practical reasons.
Use additional E code to identify the drug and also code drug dependence
(304.-) if present.

292.0   Drug withdrawal syndrome

States associated with drug withdrawal ranging from severe, as specified
for alcohol under 291.0 (delirium tremens) to less severe states
characterized by one or more symptoms such as convulsions, tremor,
anxiety, restlessness, gastrointestinal and muscular complaints, and
mild disorientation and memory disturbance.

292.1   Paranoid and/or hallucinatory states induced by drugs

States or more than a few days but not usually of more than a few months
duration, associated with large or prolonged intake od drugs, notably of
the amphetammine and LSD groups.  Auditory hallucinations usually
predominate, and there maybe anxiety and restlessness.

Excludes:    the described conditions with confusion or delirium (293.-)
             states following LSD or other hallucinogens, lasting only a
                  few days or less ["bad trips"] (305.3)

292.2   Pathological drug intoxication

Individual idiosyncratic reactions to comparatively small quantities of
a drug, which take the form of acute, brief psychotic states of any
type.

Excludes:    expected brief psychotic reactions to hallucinogens
                  ["bad trips"] (305.3)
             physiological side-effects of drugs (e.g., dystonias)

292.8   Other

292.9   Unspecified

293     Transient organic psychotic conditions

States characterized by clouded consciousness, confusion, disorientation,
illusions and often vivid hallucinations.  They are usually due to some intra-
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or extracerebral toxic, infectious, metabolic or other systemic disturbance
and are generally reversible.  Depressive and paranoid symptoms may also be
present but are not the main feature.  Use additional code to identify the
associated physical or neurological condition.

Excludes:    confusional state or delirium superimposed on senile dementia
                  (290.3)
             dementia due to:
                  alcohol (291.-)
                  arteriosclerosis (290.4)
                  senility (290.0)

293.0   Acute delirium

Short-lived states, lasting hours or days, of the above type.

Acute:                            Acute:
    delirium                           psychosis associated with endocrine,
    infective psychosis                     metabolic, or cerebrovascular
    organic reaction                        disorder
    post-traumatic organic        Epileptic:
         psychosis                    confusional state
    psycho-organic syndrome           twilight state

293.1   Subacute confusional state

States of the above type in which the symptoms, usually less florid, last for
several weeks or longer, during which they may show marked fluctuations in
intensity.

Subacute:                         Subacute:
    delirium                          psycho-organic syndrome
    infective psychosis               psychosis associated with endocrine or
    organic reaction                       metabolic disorder
    post-traumatic organic psychosis

293.8   Other

293.9   Unspecified

294     Other organic psychotic conditions (chronic)

294.0   Korsakoff's psychosis or syndrome (nonalcoholic)

Syndromes as described under 291.1 but not due to alcohol.

294.8   Other

States that fulfill the criteria of an organic psychosis but do not take the
form of a confusional state (293.-), a nonalcoholic Korsakov's psychosis
(294.0) or a dementia (294.1).


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Epileptic psychosis NOS           Mixed paranoid and affective organic
    (code also 345.-)                 psychotic states

Excludes:   mild memory disturbances, not amounting to dementia (310.1)

294.9   Unspecified


                         OTHER PSYCHOSES (295-299)

295     Schizophrenic disorders

A group of psychoses in which there is a fundamental disturbance of
personality, a characteristic distortion of thinking, often a sense of being
controlled by alien forces, delusions which may be bizarre, disturbed
perception, abnormal affect out of keeping with the real situation, and
autism.  Nevertheless, clear consciousness and intellectual capacity are
usually maintained.  The disturbance of personality involves its most basic
functions which give the normal person his feeling of individuality,
uniqueness and self-direction.  The most intimate thoughts, feelings and acts
are often felt to be known to or shared by others and explanatory delusions
may develop, to the effect that natural or supernatural forces are at work to
influence the schizophrenic person's thoughts and actions in ways that are
often bizarre.  He may see himself as the pivot of all that happens.
Hallucinations, especially of hearing, are common and may comment on the
patient or address him.  Perception is frequently disturbed in other ways;
there may be perplexity, irrelevant features may become all-important and,
accompanied by passivity feelings, may lead the patient to believe that
everyday objects and situations possess a special, usually sinister, meaning
intended for him.  In the characteristic schizophrenic disturbance of
thinking, peripheral and irrelevant features of a total concept, which are
inhibited in normal directed mental activity, are brought to the forefront and
utilized in place of the elements relevant and appropriate to the situation.
Thus thinking becomes vague, elliptical and obscure, and its expression in
speech sometimes incomprehensible.  Breaks and interpolations in the flow of
consecutive thought are frequent, and the patient may be convinced that his
thoughts are being withdrawn by some outside agency.  Mood may be shallow,
capricious or incongruous.  Ambivalence and disturbance of volition may appear
as inertia, negativism or stupor.  Catatonia may be present.  The diagnosis
"schizophrenia" should not be made unless there is, or has been evident during
the same illness, characteristic disturbance of thought, perception, mood,
conduct, or personality--preferably in at least two of these areas.  The
diagnosis should not be retricted to conditions running a protracted,
deteriorating, or chronic course.  In addition to making the diagnosis on the
criteria just given, effort should be made to specify one of the following
subdivisions of schizophrenia, according to the predominant symptoms.

Includes:    schizophrenia of the types described in 295.0-295.9 occurring
                  in children

Excludes:    childhood type schizophrenia (299.9)
             infantile autism (299.0)

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295.0   Simple type

A psychosis in which there is insidious development of oddities of conduct,
inability to meet the demands of society, and decline in total performance.
Delusions and hallucinations are not in evidence and the condition is less
obviously psychotic than are the hebephrenic, catatonic and paranoid types of
schizophrenia.  With increasing social impoverishment vagrancy may ensue and
the patient becomes self-absorbed, idle and aimless.  Because the
schizophrenic symptoms are not clear-cut, diagnosis of this form should be
made sparingly, if at all.

Schizophrenia simplex

Excludes:    latent schizophrenia (295.5)

295.1   Hebephrenic type

A form of schizophrenia in which affective changes are prominent, delusions
and hallucinations fleeting and fragmentary, behaviour irresponsible and
unpredictable and mannerisms common.  The mood is shallow and inappropriate,
accompanied by giggling or self-satisfied, self-absorbed smiling, or by a
lofty manner, grimaces, mannerisms, pranks, hypochondriacal complaints and
reiterated phrases.  Thought is disorganized.  There is a tendency to remain
solitary, and behaviour seems empty of purpose and feeling. This form of
schizophrenia usually starts between the ages of 15 and 25 years.

Hebephrenia

295.2   Catatonic type

Includes as an essential feature prominent psychomotor disturbances often
alternating between extremes such as hyperkinesis and stupor, or automatic
obedience and negativism.  Constrained attitudes may be maintained for long
periods:  if the patient's limbs are put in some unnatural position they may
be held there for some time after the external force has been removed. Severe
excitement may be a striking feature of the condition.  Depressive or
hypomanic concomitants may be present.

Catatonic:                        Schizophrenic:
    agitation                         catalepsy
    excitation                        catatonia
    stupor                            flexibilitas cerea

295.3   Paranoid type

The form of schizophrenia in which relatively stable delusions, which may be
accompanied by hallucinations, dominate the clinical picture.  The delusions
are frequently of persecution but may take other forms [for example of
jealousy, exalted birth, Messianic mission, or bodily change].  Hallucinations
and erratic behavior may occur; in some cases conduct is seriously disturbed
from the outset, thought disorder may be gross, and affective flattening with
fragmentary delusions and hallucinations may develop.

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Paraphrenic schizophrenia

Excludes:    paraphrenia, involutional paranoid state (297.2)
             paranoia (297.1)

295.4   Acute schizophrenic episode

Schizophrenic disorders, other than those listed above, in which there is a
dream-like state with slight clouding of consciousness and perplexity.
External things, people and events may become charged with personal
significance for the patient.  There may be ideas of reference and emotional
turmoil.  In many such cases remission occurs within a few weeks or months,
even without treatment.

Oneirophrenia
Schizophreniform:
    attack
    psychosis, confusional type

Excludes:    acute forms of schizophrenia of:
                  catatonic type (295.2)
                  hebephrenic type (295.1)
                  paranoid type (295.3)
                  simple type (295.0)

295.5   Latent schizophrenia

It has not been possible to produce a generally acceptable description for
this condition.  It is not recommended for general use, but a description is
provided for those who believe it to be useful:  a condition of eccentric or
inconsequent behavior and anomalies of affect which give the impression of
schizophrenia though no definite and characteristic schizophrenic anomalies,
present or past, have been manifest.  The inclusion terms indicate that this
is the best place to classify some other poorly defined varieties of
schizophrenia.

Latent schizophrenic reaction
Schizophrenia:
    borderline
    prepsychotic
    prodromal
    pseudoneurotic
    pseudopsychopathic

Excludes:    schizoid personality (301.2)

295.6   Residual schizophrenia

A chronic form of schizophrenia in which the symptoms that persist from the
acute phase have mostly lost their sharpness.  Emotional response is blunted
and thought disorder, even when gross, does not prevent the accomplishment of
routine work.

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Chronic undifferentiated          Restzustand (schizophrenic)
    schizophrenia                 Schizophrenic residual state

295.7   Schizo-affective type

A psychosis in which pronounced manic or depressive features are intermingled
with schizophrenic features and which tends towards remission without
permanent defect, but which is prone to recur.  The diagnosis should be made
only when both the affective and schizophrenic symptoms are pronounced.

Cyclic schizophrenia              Schizo-affective psychosis
Mixed schizophrenic and           Schizophreniform psychosis, affective type
    affective psychosis

295.8   Other

Schizophrenia of specified types not classifiable under 259.0-295.7.

Acute (undifferentiated)          Atypical schizophrenia
    schizophrenia                 Cenesthopathic schizophrenia

Excludes:    infantile autism (299.0)

295.9   Unspecified

To be used only as a last resort.

Schizophrenia NOS                 Schizophreniform psychosis NOS
Schizophrenic reaction NOS

296     Affective psychoses

Mental disorders, usually recurrent, in which there is a severe disturbance of
mood [mostly compounded of depression and anxiety but also manifested as
elation and excitement] which is accompanied by one or more of the following:
delusions, perplexity, disturbed attitude to self, disorder of perception and
behavior; these are all in keeping with the patient's prevailing mood [as are
hallucinations when they occur].  There is a strong tendency to suicide.  For
practical reasons, mild disorders of mood may also be included here if the
symptoms match closely the descriptions given; this applies particularly to
mild hypomania.

Excludes:    neurotic depression (300.4)
             reactive depressive psychosis (298.0)
             reactive excitation (298.1)

296.0   Manic-depressive psychosis, manic type

Mental disorders characterized by states of elation or excitement out of
keeping with the patient's circumstances and varying from enhanced liveliness
[hypomania] to violent, almost uncontrollable excitement.  Aggression and
anger, flight of ideas, distractibility, impaired judgement, and grandiose
ideas are common.
                          ICD-9/Ch05.TXT - pg. 10

Hypomania NOS                     Manic psychosis
Hypomanic psychosis               Manic-depressive psychosis or reaction:
Mania (monopolar) NOS                  hypomanic
Manic disorder                         manic

Excludes:    circular type, if there was a previous attack of depression
                  (296.4)

296.1   Manic-depressive psychosis, depressed type

An affective psychosis in which there is a widespread depressed mood of gloom
and wretchedness with some degree of anxiety.  There is often reduced activity
but there may be restlessness and agitation.  There is a marked tendency to
recurrence; in a few cases this may be at regular intervals.

Depressive psychosis              Manic-depressive psychosis or reaction
Endogenous depression             Monopolar depression
Involutional melancholia          Psychotic depression

Excludes:    circular type, if previous attack was of manic type (296.3)
             depression NOS (311)

296.2   Manic-depressive psychosis, circular type but currently manic

An affective psychosis which has appeared in both the depressive and the manic
form, either alternating or separated by an interval of normality, but in
which the manic form is currently present.  [The manic phase is far less
frequent than the depressive.]

Bipolar disorder, now manic

Excludes:    brief compensatory or rebound mood swings (296.8)

296.3   Manic-depressive psychosis, circular type but currently depressed

Circular type (see 296.2) in which the depressive form is currently present.

Bipolar disorder, now depressed

Excludes:    brief compensatory or rebound mood swings (296.8)

296.4   Manic-depressive psychosis, circular type, mixed

An affective psychosis in which both manic and depressive symptoms are present
at the same time.

296.5   Manic-depressive psychosis, circular type, current condition not
        specified

Circular type (see 296.2) in which the current condition is not specified as
either manic or depressive.


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296.6   Manic-depressive psychosis, other and unspecified

Use this code for cases where no other information is available, except the
unspecified term, manic-depressive psychosis, or for syndromes corresponding
to the descriptions of depressed (296.1) or manic (296.0) types but which for
other reasons cannot be classified under 296.0-296.5.

Manic-depressive:                 Manic-depressive psychosis:
    reaction NOS                      NOS
    syndrome NOS                      mixed type

296.8   Other

Excludes:    psychogenic affective psychoses (298.-)

296.9   Unspecified

Affective psychosis NOS
Melancholia NOS

297     Paranoid states

Excludes:    acute paranoid reaction (298.3)
             alcoholic jealousy (291.5)
             paranoid schizophrenia (295.3)

297.0   Paranoid state, simple

A psychosis, acute or chronic, not classifiable as schizophrenia or affective
psychosis, in which delusions, especially of being influenced, persecuted or
treated in some special way, are the main symptoms. The delusions are of a
fairly fixed, elaborate and systematized kind.

297.1   Paranoia

A rare chronic psychosis in which logically constructed systematized delusions
have developed gradually without concomitant hallucinations or the
schizophrenic type of disordered thinking.  The delusions are mostly of
grandeur [the paranoiac prophet or inventor], persecution or somatic
abnormality.

Excludes:    paranoid personality disorder (301.0)

297.2        Paraphrenia

Paranoid psychosis in which there are conspicuous hallucinations, often in
several modalities. Affective symptoms and disordered thinking, if present, do
not dominate the clinical picture and the personality is well preserved.

Involutional paranoid state
Late paraphrenia


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297.3   Induced psychosis

Mainly delusions psychosis, usually chronic and often without florid features,
which appears to have developed as a result of a close, if not dependent,
relationship with another person who already has an established similar
psychosis.  The delusions are at least partly shared.  The rare cases in which
several persons are affected should also be included here.

Folie  deux
Induced paranoid disorder

297.8   Other

Paranoid states which, though in many ways akin to schizophrenic or affective
states, cannot readily be classified under any of the preceding rubrics, nor
under 298.4.

Paranoia querulans
Sensitiver Beziehungswahn

Excludes:    senile paranoid state (297.2)

297.9   Unspecified

Paranoid:
    psychosis NOS
    reaction NOS
    state NOS

298     Other nonorganic psychoses

Categories 298.0-298.8 should be restricted to the small group of psychotic
conditions that are largely or entirely attributable to a recent life
experience.  They should not be used for the wider range of psychoses in which
environmental factors play some [but not the major] part in aetiology.

298.0   Depressive type

A depressive psychosis which can be similar in its symptoms to
manic-depressive psychosis, depressed type (296.1) but is apparently provoked
by saddening stress such as a bereavement, or a severe disappointment or
frustration.  There may be less diurnal variation of symptoms than in 296.1,
and the delusions are more often understandable in the context of the life
experiences.  There is usually a serious disturbance of behavior, e.g., major
suicidal attempt.

Psychogenic depressive psychosis
Reactive depressive psychosis

Excludes:    manic-depressive psychosis, depressed type (296.1)
             neurotic depression (300.4)


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298.1   Excitative type

An affective psychosis similar in its symptoms to manic-depressive psychosis,
manic type, but apparently provoked by emotional stress.

Excludes:    manic-depressive psychosis, manic type (296.0)

298.2   Reactive confusion

Mental disorders with clouded consciousness, disorientation [though less
marked than in organic confusion] and diminished accessibility often
accompanied by excessive activity and apparently provoked by emotional stress.

Psychogenic confusion             Psychogenic twilight state

Excludes:    acute confusional state (293.0)

298.3   Acute paranoid reaction

Paranoid states apparently provoked by some emotional stress.  The stress is
often misconstrued as an attack or threat.  Such states are particularly prone
to occur in prisoners or as acute reactions to a strange and threatening
environment, e.g., in immigrants.

Bouffe dlirante

Excludes:    paranoid states (297.-)

298.4   Psychogenic paranoid psychosis

Psychogenic or reactive paranoid psychosis of any type which is more
protracted than the acute reactions covered in 298.3.  Where there is a
diagnosis of psychogenic paranoid psychosis which does not specify "acute"
this coding should be made.

Protracted reactive paranoid psychosis

298.8   Other and unspecified reactive psychosis

Hysterical psychosis              Psychogenic stupor
Psychogenic psychosis NOS

298.9   Unspecified psychosis

To be used only as a last resort, when no other term can be used.

Psychosis NOS

299     Psychoses with origin specific to childhood

This category should be used only for psychoses which always begin before
puberty.  Adult type psychoses such as schizophrenia or manic-depressive
psychoses when occurring in childhood should be coded elsewhere under the
appropriate heading--i.e., 295 and 296 for the examples given.
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299.0   Infantile autism

A syndrome present from birth or beginning almost invariably in the first 30
months.  Responses to auditory and sometimes to visual stimuli are abnormal
and there are usually severe problems in the understanding of spoken language.
Speech is delayed and, if it develops, is characterized by echolalia, the
reversal of pronouns, immature grammatical structure and inability to use
abstract terms.  There is generally an impairment in the social use of both
verbal and gestural language.  Problems in social relationships are most
severe before the age of five years and include an impairment in the
development of eye-to-eye gaze, social attachments, and cooperative play.
Ritualistic behavior is usual and may include abnormal routines, resistance to
change, attachment to odd objects and stereotyped patterns of play.  The
capacity for abstract or symbolic thought and for imaginative play is
diminished.  Intelligence ranges from severely subnormal to normal or above.
Performance is usually better on tasks involving rote memory or visuospatial
skills than on those requiring symbolic or linguistic skills.

Childhood autism                  Kanner's syndrome
Infantile psychosis

Excludes:    disintegrative psychosis (299.1)
             Heller's syndrome (299.1)
             schizophrenic syndrome of childhood (299.9)

299.1   Disintegrative psychosis

A disorder in which normal or near-normal development for the first few years
is followed by a loss of social skills and of speech, together with a severe
disorder of emotions, behavior and relationships. Usually this loss of speech
and of social competence takes place over a period of a few months and is
accompanied by the emergence of overactivity and of stereotypies.  In most
cases there is intellectual impairment, but this is not a necessary part of
the disorder.  The condition may follow overt brain disease--such as measles
encephalitis--but it may also occur in the absence of any known organic brain
disease or damage.  Use additional code to identify any associated
neurological disorder.

Heller's syndrome

Excludes:    infantile autism (299.0)
             schizophrenic syndrome of childhood (299.9)

299.8   Other

A variety of atypical infantile psychoses which may show some, but not all, of
the features of infantile autism.  Symptoms may include stereotyped repetitive
movements, hyperkinesis, self-injury, retarded speech development, echolalia
and impaired social relationships.  Such disorders may occur in children of
any level of intelligence but are particularly common in those with mental
retardation.

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Atypical childhood psychosis

Excludes:    simple stereotypies without psychotic disturbance (307.3)

299.9   Unspecified

Child psychosis NOS
Schizophrenia, childhood type NOS
Schizophrenic syndrome of childhood NOS

Excludes:    schizophrenia of adult type occurring in childhood (295.0-295.8)



        NEUROTIC DISORDERS, PERSONALITY DISORDERS,
      AND OTHER NONPSYCHOTIC MENTAL DISORDERS (300-316)

300      Neurotic disorders

The distinction between neurosis and psychosis is difficult and remains
subject to debate.  However, it has been retained in view of its wide use.

Neurotic disorders are mental disorders without any demonstrable organic basis
in which the patient may have considerable insight and has unimpaired reality
testing, in that he usually does not confuse his morbid subjective experiences
and fantasies with external reality.  Behaviour may be greatly affected
although usually remaining within socially acceptable limits, but personality
is not disorganized.  The principal manifestations include excessive anxiety,
hysterical symptoms, phobias, obsessional and compulsive symptoms, and
depression.

300.0   Anxiety states

Various combinations of physical and mental manifestations of anxiety, not
attributable to real danger and occurring either in attacks or as a persisting
state.  The anxiety is usually diffuse and may extend to panic.  Other
neurotic features such as obsessional or hysterical symptoms may be present
but do not dominate the clinical picture.

Anxiety:                          Panic:
    neurosis                          attack
    reaction                          disorder
    reaction                          state
    state (neurotic)

Excludes:
    neurasthenia (300.5)
    psychophysiologic disorders (306.-)

300.1      Hysteria

Mental disorders in which motives, of which the patient seems unaware, produce
either a restriction of the field of consciousness or disturbances of motor or
                          ICD-9/Ch05.TXT - pg. 16

sensory function which may seem to have psychological advantage or symbolic
value.  It may be characterized by conversion phenomena or dissociative
phenomena.  In the conversion form the chief or only symptoms consist of
psychogenic disturbance of function in some part of the body, e.g., paralysis,
tremor, blindness, deafness, seizures.  In the dissociative variety, the most
prominent feature is a narrowing of the field of consciousness which seems to
serve an unconscious purpose and is commonly accompanied or followed by a
selective amnesia.  There may be dramatic but essentially superficial changes
of personality sometimes taking the form of a fugue [wandering state].
Behavior may mimic psychosis or, rather, the patient's idea of psychosis.

Astasia-abasia, hysterical        Dissociative reaction of state
Compensation neurosis             Ganser's syndrome, hysterical
Conversion hysteria               Hysteria NOS
Conversion reaction               Multiple personality

Excludes:    adjustment reaction (309.-)
             anorexia nervosa (307.1)
             gross stress reaction (308.-)
             hysterical personality (301.5)
             psychophysiologic disorders (306.-)

300.2   Phobic state

Neurotic states with abnormally intense dread of certain objects or specific
situations which would not normally have that effect.  If the anxiety tends to
spread from a specified situation or object to a wider range of circumstances,
it becomes akin to or identical with anxiety state, and should be classified
as such (300.0)

Agoraphobia                       Claustrophobia
Animal phobias                    Phobia NOS
Anxiety-hysteria

Excludes:    anxiety state (300.0)
             obsessional phobias (300.3)

300.3   Obsessive-compulsive disorders

States in which the outstanding symptom is a feeling of subjective
compulsion--which must be resisted--to carry out some action, to dwell on an
idea, to recall an experience, or to ruminate on an abstract topic.  Unwanted
thoughts which intrude, the insistency of words or ideas, ruminations or
trains of thought are perceived by the patient to be inappropriate or
nonsensical. The obsessional urge or idea is recognized as alien to the
personality but as coming from within the self.  Obsessional actions may be
quasi-ritual performances designed to relieve anxiety, e.g., washing the hands
to cope with contamination.  Attempts to dispel the unwelcome thoughts or
urges may lead to a severe inner struggle, with intense anxiety.

Anankastic neurosis               Compulsive neurosis

Excludes:    obsessive-compulsive symptoms occurring in:
                          ICD-9/Ch05.TXT - pg. 17

                  endogenous depression (296.1)
                  schizophrenia (295.-)
                  organic states (e.g., encephalitis)

300.4   Neurotic depression

A neurotic disorder characterized by disproportionate depression which has
usually recognizably ensued on a distressing experience; it does not include
among its features delusions or hallucinations, and there is often
preoccupation with the psychic trauma which preceded the illness, e.g., loss
of a cherished person or possession.  Anxiety is also frequently present and
mixed states of anxiety and depression should be included here.  The
distinction between depressive neurosis and psychosis should be made not only
upon the degree of depression but also on the presence or absence of other
neurotic and psychotic characteristics and upon the degree of disturbance of
the patient's behaviour.

Anxiety depression                Reactive depression
    Depressive reaction
    Neurotic depressive state

Excludes:    adjustment reaction with depressive symptoms (309.0)
             depression NOS (311)
             manic-depressive psychosis, depressed type (296.1)
             reactive depressive psychosis (298.0)

300.5   Neurasthenia

A neurotic disorder characterized by fatigue, irritability, headache,
depression, insomnia, difficulty in concentration, and lack of capacity for
enjoyment [anhedonia].  It may follow or accompany an infection or exhaustion,
or arise from continued emotional stress.  If neurasthenia is associated with
a physical disorder, the latter should also be coded.

Nervous debility

Excludes:    anxiety state (300.0)
             neurotic depression (300.4)
             psychophysiological disorders (306.-)
             specific nonpsychotic mental disorders following organic brain
                  damage (310.-)

300.6   Depersonalization syndrome

A neurotic disorder with an unpleasant state of disturbed perception in which
external objects or parts of one's own body are experienced as changed in
their quality, unreal, remote or automatized.  The patient is aware of the
subjective nature of the change he experiences.  Depersonalization may occur
as a feature of several mental disorders including depression, obsessional
neurosis, anxiety and schizophenia; in that case the condition should not be
classified here but in the corresponding major category.

Derealization (neurotic)
                          ICD-9/Ch05.TXT - pg. 18

300.7   Hypochondriasis

A neurotic disorder in which the conspicuous features are excessive concern
with one's health in general or the integrity and functioning of some part of
one's body, or, less frequently, one's mind.  It is usually associated with
anxiety and depression.  It may occur as a feature of severe mental disorder
and in that case should not be classified here but in the corresponding major
category.

Excludes:    hysteria (300.1)
             manic-depressive psychosis, depressed type (296.1)
             neurasthenia (300.5)
             obsessional disorder (300.3)
             schizophrenia (295.-)

300.8   Other neurotic disorders

Neurotic disorders not classified elsewhere, e.g., occupational neurosis.
Patients with mixed neuroses should not be classified in this category but
according to the most prominent symptoms they display.

Briquet's disorder                Psychasthenia
Occupational neurosis,            Psychasthenic neurosis
    including writer's cramp

300.9   Unspecified

To be used only as a last resort.

Neurosis NOS                      Psychoneurosis NOS

301     Personality disorders

Deeply ingrained maladaptive patterns of behaviour generally recognizable by
the time of adolescence or earlier and continuing throughout most of adult
life, although often becoming less obvious in middle or old age.  The
personality is abnormal either in the balance of components, their quality and
expression or in its total aspect. Because of this deviation or psychopathy
the patient suffers or others have to suffer and there is an adverse effect
upon the individual or on society.  It includes what is sometimes called
psychopathic personality, but if this is determined primarily by
malfunctioning of the brain, it should not be classified here but as one of
the nonpsychotic organic brain syndromes (310).  When the patient exhibits an
anomaly of personality directly related to his neurosis or psychosis, e.g.,
schizoid personality and schizophenia or anankastic personality and obsessive
compulsive neurosis, the relevant neurosis or psychosis which is in evidence
should be diagnosed in addition.

Character neurosis



                          ICD-9/Ch05.TXT - pg. 19

301.0   Paranoid personality disorder

Personality disorder in which there is excessive sensitiveness to setbacks or
to what are taken to be humiliations and rebuffs, a tendency to distort
experience by misconstruing the neutral or friendly actions of others as
hostile or contemptuous, and a combative and tenacious sense of personal
rights.  There may be a proneness to jealousy or excessive self-importance.
Such persons may feel helplessly humiliated and put upon; others, likewise
excessively sensitive, are aggressive and insistent.  In all cases there is
excessive self-reference.

Fanatic personality               Paranoid traits
Paranoid personality (disorder)

Excludes:    acute paranoid reaction (298.3)
             alcoholic paranoia (291.5)
             paranoid schizophrenia (295.3)
             paranoid states (297.-)

301.1   Affective personality disorder

Personality disorder characterized by lifelong predominance of a pronounced
mood which may be persistently depressive, persistently elated, or alternately
one then the other.  During periods of elation there is unshakeable optimism
and an enhanced zest for life and activity, whereas periods of depression are
marked by worry, pessimism, low output of energy and a sense of futility.

Cycloid personality               Depressive personality
Cyclothumic personality

Excludes:    affective psychoses (296.-)
             cyclothymia(296.2-296.5)
             neurasthenia (300.5)
             neurotic depression (300.4)

301.2   Schizoid personality disorder

Personality disorder in which there is withdrawal from
affectional, social and other contacts with autistic
preference for fantasy and introspective reserve.  Behaviour
may be slightly eccentric or indicate avoidance of
competitive situations.  Apparent coolness and detachment may
mask an incapacity to express feeling.

Excludes:    schizophrenia (295.-)

301.3   Explosive personality disorder

Personality disorder characterized by instability of mood with liability to
intemperate outbursts of anger, hate, violence or affection.  Aggression may
be expressed in words or in physical violence.  The outbursts cannot readily
be controlled by the affected persons, who are not otherwise prone to
antisocial behaviour.

                          ICD-9/Ch05.TXT - pg. 20

Aggressive:                       Emotional instability
    personality                       (excessive)
    reaction                      Pathological emotionality
Aggressiveness                    Quarrelsomeness

Excludes:    dyssocial personality (301.7)
             hysterical neurosis (300.1)

301.4   Anankastic personality disorder

Personality disorder characterized by feelings of personal insecurity, doubt
and incompleteness leading to excessive conscientiousness, checking,
stubbornness and caution.  There may be insistent and unwelcome thoughts or
impulses which do not attain the severity of an obsessional neurosis.  There
is perfectionism and meticulous accuracy and a need to check repeatedly in an
attempt to ensure this.  Rigidity and excessive doubt may be conspicuous.

Compulsive personality            Obsessional personality

Excludes:    obsessive-compulsive disorder (300.3)
             phobic state (300.2)

301.5   Histerical personality disorder

Personality disorder characterized by shallow, labile affectivity, dependence
on others, craving for appreciation and attention, suggestibiltiy and
theatricality.  There is often sexual immaturity, e.g., frigidity and over-
responsiveness to stimuli.  Under stress hysterical symptoms [neurosis] may
develop.

Psychoinfantile personality       Histrionic personality

Excludes:    hysterical neurosis (300.1)

301.6   Asthenic personality disorder

Personality disorder characterized by passive compliance with the wishes of
elders and others and a weak inadequate response to the demands of daily life.
Lack of vigour may show itself in the intellectual or emotional spheres; there
is little capacity for enjoyment.

Dependent personality             Passive personality
Inadequate personality

Excludes:    neurasthenia (300.5)

301.7   Personality disorder with predominantly sociopathic or asocial
        manifestation

Personality disorder characterized by disregard for social obligations, lack
of feeling for others, and impetuous violence or callous unconcern.  There is
a gross disparity between behaviour and the prevailing social norms.

                          ICD-9/Ch05.TXT - pg. 21

Behaviour is not readily modifiable by experience, including punishment.
People with this personality are often affectively cold and may be abnormally
aggressive or irresponsible.  Their tolerance to frustration is low; they
blame others or offer plausible rationalizations for the behaviour which
brings them into conflict with society.

Amoral personality
Asocial personality
Antisocial personality

Excludes:    disturbance of conduct without specifiable personality disorder
                  (312.-)
             explosive personality (301.3)

301.8   Other personality disorders

Personality:
    eccentric
    "haltlose" type
    immature
    passive-aggressive
    psychoneurotic

Excludes:    psychoinfantile personality (301.5)

301.9   Unspecified

Pathological personality NOS      Psychopathic:
Personality disorder NOS              constitutional state
                                      personality (disorder)

302      Sexual deviations and disorders

Abnormal sexual inclinations or behaviour which are part of a referral
problem. The limits and features of normal sexual inclination and behaviour
have not been stated absolutely in different societies and cultures but are
broadly such as serve approved social and biological purposes.  The sexual
activity of affected persons is directed primarily either towards people not
of the opposite sex, or towards sexual acts not associated with coitus
normally, or towards coitus performed under abnormal circumstances.  If the
anomalous behaviour becomes manifest only during psychosis or other mental
illness the condition should be classified under the major illness.  It is
common for more than one anomaly to occur together in the same individual; in
that case the predominant deviation is classified.  It is preferable not to
include in this category individuals who perform deviant sexual acts when
normal sexual outlets are not available to them.

302.0   Homosexuality

Exclusive or predominant sexual attraction for persons of the same sex with or
without physical relationship.  Code homosexuality here whether or not it is
considered as a mental disorder.

                          ICD-9/Ch05.TXT - pg. 22

Lesbianism

Excludes:    homosexual paedophilia (302.2)

302.1   Bestiality

Sexual or anal intercourse with animals.

302.2   Paedophilia

Sexual deviations in which an adult engages in sexual activity with a child of
the same or opposite sex.

302.3   Transvestism

Sexual deviation in which sexual pleasure is derived from dressing in clothes
of the opposite sex.  There is no consistent attempt to take on the identity
or behaviour of the opposite sex.

Excludes:    trans-sexualism (302.5)

302.4   Exhibitionism

Sexual deviation in which the main sexual pleasure and gratification is
derived from exposure of the genitals to a person of the opposite sex.

302.5   Trans-sexualism

Sexual deviation centered around fixed beliefs that the overt bodily sex is
wrong.  The resulting behaviour is directed towards either changing the sexual
organs by operation or completely concealing the bodily sex by adopting both
the dress and behaviour of the opposite sex.

Excludes:    transvestism (302.3)

302.6   Disorders of psychosexual identity

Behaviour occurring in preadolescents of immature psychosexuality which is
similar to that shown in the sexual deviations described under transvestism
(302.3) and trans-sexualism (302.5).  Cross-dressing is intermittent, although
it may be frequent, and identification with the behaviour and appearance of
the opposite sex is not yet fixed.  The commonest form is feminism in boys.

Gender-role disorder

Excludes:    homosexuality (302.0)
             trans-sexualism (302.5)
             transvestism (302.3)

302.7   Frigidity and impotence

Frigidity--dislike of or aversion to sexual intercourse, of
psychological origin, of sufficient intensity to lead, if
                          ICD-9/Ch05.TXT - pg. 23

not to active avoidance, to marked anxiety, discomfort or pain
when normal sexual intercourse takes place.  Less severe
degrees of this disorder that also give rise to consultation
should also be coded here.

Impotence--sustained inability, due to psychological causes,
to maintain an erection which will allow normal heterosexual
penetration and ejaculation to take place.

Dyspareunia, psychogenic

Excludes:    impotence of organic origin
             normal transient symptoms from ruptured hymen
             transient or occasional failures of erection due to fatigue,
                  anxiety, alcohol or drugs

302.8   Other

Fetishism                         Sadism
Masochism

302.9   Unspecified

303     Alcohol dependence syndrome

A state, psychic and usually also physical, resulting from taking alcohol,
characterized by behavioural and other responses that always include a
compulsion to take alcohol on a continuous or periodic basis in order to
experience its psychic effects, and sometimes to avoid the discomfort of its
absence; tolerance may or may not be present.  A person may be dependent on
alcohol and other drugs; if so also make the appropriate 304 coding.  If
dependence is associated with alcoholic psychosis or with physical
complications, both should be coded.

Acute drunkenness in              Chronic alcoholism
    alcoholism                    Dipsomania

Excludes:    alcoholic psychoses (291.-)
             drunkenness NOS (305.0)
             physical complications of alcohol, such as:
                  cirrhosis of liver (571.2)
                  epilepsy (345.-)
                  gastritis (535.3)

304     Drug dependence

A state, psychic and sometimes also physical, resulting from taking a drug,
characterized by behavioural and other responses that always include a
compulsion to take a drug on a continuous or periodic basis in order to
experience its psychic effects, and sometimes to avoid the discomfort of its
absence.  Tolerance may or may not be present.  A person may be dependent on
more than one drug.

                          ICD-9/Ch05.TXT - pg. 24

Excludes:    nondependent abuse of drugs (305.-)

304.0   Morphine type

Heroin                            Opium alkaloids and their derivatives
Methadone                         Synthetics with morphine-like effect
Opium

304.1   Barbiturate type

Barbiturates
Nonbarbiturate sedatives and tranquilizers with a similar effect:
    chlordiazepoxide
    diazepam
    glutethimide
    meprobamate

304.2   Cocaine

Coca leaves and derivatives

304.3   Cannabis

Hashish                           Marijuana
Hemp

304.4   Amphetamine type and other psychostimulants

Methylphenidate                   Phenmetrazine

304.5   Hallucinogens

LSD and derivatives               Psilocybin
Mescaline

304.6   Other

Absinthe addiction                Glue sniffing

Excludes:    tobacco dependence (305.1)

304.7   Combinations of morphine type drug with any other

304.8   Combinations of drug dependence excluding morphine type drug

304.9   Unspecified

Drug addiction NOS                Drug dependence NOS

305      Nondependent abuse of drugs

Includes cases where a person, for whom no other diagnosis is possible, has
come under medical care because of the maladaptive effect of a drug on which
                          ICD-9/Ch05.TXT - pg. 25

he is not dependent (as defined in 304.-) and that he has taken on his own
initiative to the detriment of his health or social functioning.  When drug
abuse is secondary to a psychiatric disorder, code the disorder.

Excludes:    alcohol dependence syndrome (303)
             drug dependence (304.-)
             drug withdrawal syndrome (292.0)
             poisoning by drugs or medicinal substances (960-979)

305.0   Alcohol

Cases of acute intoxication or "hangover" effects.
    Drunkenness NOS
    Excessive drinking of alcohol NOS
    "Hangover" (alcohol)
    Inebriety NOS

Excludes:    alcoholic psychoses (291.-)
             physical complications of alcohol, such as:
                  cirrhosis of liver (571.2)
                  epilepsy (345.-)
                  gastritis (535.3)

305.1   Tobacco

Cases in which tobacco is used to the detriment of a person's health or social
functioning or in which there is tobacco dependence. Dependence is included
here rather than under 304.- because tobacco differs from other drugs of
dependence in its psychotoxic effects.

Tobacco dependence

305.2   Cannabis

305.3   Hallucinogens

Cases of acute intoxication or "bad trips".

LSD reaction

305.4   Barbiturates and tranquillizers

Cases where a person has taken the drug to the detriment of his health or
social functioning, in doses above or for periods beyond those normally
regarded as therapeutic.

305.5   Morphine type

305.6   Cocaine type

305.7   Amphetamine type

305.8   Antidepressants
                          ICD-9/Ch05.TXT - pg. 26

305.9   Other, mixed, or unspecified

"Laxative habit"                  Nonprescribed use of drugs or
Misuse of drugs NOS                   patent medicinals

306     Physiological malfunction arising from mental factors

A variety of physical symptoms or types of physiological malfunction of mental
origin, not involving tissue damage and usually mediated through the autonomic
nervous system.  The disorders are grouped according to body system.  Codes
306.0-306.9 should not be used if the physical symptom is secondary to a
psychiatric disorder classifiable elsewhere.  If tissue damage is involved,
code under 316.

Excludes:    hysteria (300.1)
             psychic factors associated with physical conditions involving
                  tissue damage classified elsewhere (316)
             specific nonpsychotic mental disorders following organic brain
                  damage (310.-)

306.0   Musculoskeletal

Psychogenic torticollis

Excludes:    Gilles de la Tourette's syndrome (307.2)
             tics (307.2)

306.1   Respiratory

Air hunger                        Psychogenic cough
Hiccough (psychogenic)            Yawning
Hyperventilation

Excludes:    psychogenic asthma (316 and 493.9)

306.2   Cardiovascular

Cardiac neurosis                  Neurocirculatory asthenia
Cardiovascular neurosis           Psychogenic cardiovascular disorder

Excludes:    psychogenic paroxysmal tachycardia (316 and 427.9

306.3   Skin

Psychogenic pruritus

Excludes:    psychogenic:
                  alopecia (316 and 704.0)
                  dermatitis (316 and 692.-)
                  eczema (316 and 691.9 or 692.-)
                  urticaria (316 and 708.-)


                          ICD-9/Ch05.TXT - pg. 27

306.4   Gastrointestinal

Aerophagy                         Cyclical vomiting, psychogenic

Excludes:    cyclical vomiting NOS (536.2)
             globus hystericus (300.11)
             mucous colitis (316 and 564.1)
             psychogenic:
                  cardiospasm (316 and 530.0)
                  duodenal ulcer (316 and 532.-)
                  gastric ulcer (316 and 531.-)
                  peptic ulcer (316 and 533.-)

306.5   Genitourinary

Psychogenic dysmenorrhoea

Excludes:    dyspareunia (302.7)
             enuresis (307.6)
             frigidity (302.7)
             impotence (302.7)

306.6   Endocrine

306.7   Organs of special sense

Excludes:    hysterical blindness or deafness (300.1)

306.8   Other

Teeth grinding

306.9   Unspecified

Psychophysiologic disorder NOS    Psychosomatic disorder NOS

307     Special symptoms or syndromes, not elsewhere classified

Conditions in which an outstanding symptom or group of symptoms is not
manifestly part of a more fundamental classifiable condition.

Excludes:    when due to mental disorders classified elsewhere
             when of organic origin

307.0   Stammering and stuttering

Disorders in the rhythm of speech, in which the individual knows precisely
what he wishes to say, but at the time is unable to say it because of an
involuntary, repetitive prolongation or cessation of a sound.

Excludes:    dysphasia (784.5)
             lisping or lalling (307.9)
             retarded development of speech (315.3)
                          ICD-9/Ch05.TXT - pg. 28

307.1   Anorexia nervosa

A disorder in which the main features are persistent active refusal to eat and
marked loss of weight.  The level of activity and alertness is
characteristically high in relation to the degree of emaciation.  Typically
the disorder begins in teenage girls but it may sometimes begin before puberty
and rarely it occurs in males.  Amenorrhoea is usual and there may be a variety
of other physiological changes including slow pulse and respiration, low body
temperature and dependent oedema. Unusual eating habits and attitudes toward
food are typical and sometimes starvation follows or alternates with periods
of overeating.  The accompanying psychiatric symptoms are diverse.

Excludes:    eating disturbance NOS (307.5)
             loss of appetite (783.0)
                  of nonorganic origin (307.5)

307.2   Tics

Disorders of no known organic origin in which the outstanding feature consists
of quick, involuntary, apparently purposeless, and frequently repeated
movements which are not due to any neurological condition.  Any part of the
body may be involved but the face is most frequently affected.  Only one form
of tic may be present, or there may be a combination of tics which are carried
out simultaneously, alternatively or consecutively.  Gilles de la Tourette's
syndrome refers to a rare disorder occurring in individuals of any level of
intelligence in which facial tics and tic-like throat noises become more
marked and more generalized and in which later, whole words or short sentences
[often with an obscene content] are ejaculated spasmodically and
involuntarily.  There is some overlap with other varieties of tic.

Excludes:    nail-biting or thumb-sucking (307.9)
             stereotypies occurring in isolation (307.3)
             tics of organic origin (333.3)

307.3   Stereotyped repetitive movements

Disorders in which voluntary repetitive stereotyped movements, which are not
due to any psychiatric or neurological condition, constitute the main feature.
Includes head-banging, spasmus nutans, rocking, twirling, finger-flicking
mannerisms and eye poking.  Such movements are particularly common in cases of
mental retardation with sensory impairment or with environmental monotony.

Stereotypies NOS

Excludes:    tics:
                  NOS (307.2)
                  of organic origin (333.3)

307.4   Specific disorders of sleep

This category should only be used when a more precise medical or psychiatric
diagnosis cannot be made.

                          ICD-9/Ch05.TXT - pg. 29

Of nonorganic origin:             Of nonorganic origin:
    Hypersomnia                       Nightmares
    Insomnia                          Night terrors
    Inversion of sleep rhythm         Sleepwalking

Excludes:    narcolepsy (347)
             when of unspecified cause (780.5)

307.5   Other and unspecified disorders of eating

This category should only be used when a more precise medical or psychiatric
diagnosis cannot be made.

Of nonorganic origin:             Of nonorganic origin:
    Infantile feeding                 Overeating
         disturbances                 Pica
    Loss of appetite                  Psychogenic vomiting

Excludes:    anorexia:
                  nervosa (307.1)
                  of unspecified cause (783.0)
             overeating of unspecified cause (783.6)
                  vomiting:
                       NOS (787.0)
                       cyclical (536.2)
                       psychogenic (306.4)

307.6   Enuresis

A disorder in which the main manifestation is a persistent involuntary voiding
of urine by day or night which is considered abnormal for the age of the
individual.  Sometimes the child will have failed to gain bladder control and
in other cases he will have gained control and then lost it. Episodic or
fluctuating enuresis should be included. The disorder would not usually be
diagnosed under the age of four years.

Enuresis (primary) (secondary) of nonorganic origin

Excludes:    enuresis of unspecified cause (788.3)

307.7   Encopresis

A disorder in which the main manifestation is the persistent voluntary or
involuntary passage of formed motions of normal or near-normal consistency
into places not intended for that purpose in the individual's own
sociocultural setting. Sometimes the child has failed to gain bowel control,
and sometimes he has gained control but then later again became encopretic.
There may be a variety of associated psychiatric symptoms and there may be
smearing of faeces.  The condition would not usually be diagnosed under the
age of four years.

Encopresis (continuous) (discontinuous) of nonorganic origin

                          ICD-9/Ch05.TXT - pg. 30

Excludes:    encopresis of unspecified cause (787.6)

307.8   Psychalgia

Cases in which there are pains of mental origin, e.g., headache or backache,
when a more precise medical or psychiatric diagnosis cannot be made.

Psychogenic backache              Tension headache

Excludes:    migraine (346.-)
             pains not specifically attributable to a psychological cause
                  (in):
                       back (784.5)
                       headache (784.0)
                       joint (719.4)
                       limb (729.5)
                       lumbago (724.2)
                       rheumatic (729.0)

307.9   Other and unspecified

The use of this category should be discouraged.  Most of the items listed in
the inclusion terms are not indicative of psychiatric disorder and are
included only because such terms may sometimes still appear as diagnoses.

Hair plucking                     Masturbation
Lalling                           Nail-biting
Lisping                           Thumb-sucking

308     Acute reaction to stress

Very transient disorders of any severity and nature which occur in individuals
without any apparent mental disorder in response to exceptional physical or
mental stress, such as natural catastrophe or battle, and which usually sub-
side within hours or days.

Catastrophic stress               Exhaustion delirium
Combat fatigue

Excludes:    adjustment reaction (309.-)

308.0   Predominant disturbance of emotions

Panic states, excitability, fear, depressions and anxiety fulfilling the above
criteria.

308.1   Predominant disturbance of consciousness

Fugues fulfilling the above criteria.

308.2   Predominant psychomotor disturbance

Agitation states, stupor fulfilling the above criteria.
                          ICD-9/Ch05.TXT - pg. 31

308.3   Other

Acute situational disturbance

308.4   Mixed

Many gross stress reactions include several elements but whenever possible a
specific coding under .0, .1, .2, or .3 should be made according to the
preponderant type of disturbance.  The category of mixed disorders should only
be used when there is such an admixture that this cannot be done.

308.9   Unspecified

309     Adjustment reaction

Mild or transient disorders lasting longer than acute stress reactions (308.-)
which occur in individuals of any age without any apparent pre-existing mental
disorder.  Such disorders are often relatively circumscribed or situation-
specific, are generally reversible, and usually last only a few months.  They
are usually closely related in time and content to stresses such as bereave-
ment, migration or separation experiences.  Reactions to major stress that
last longer than a few days are also inclluded here.  In children such
disorders are associated with no significant distortion of development.

Excludes:    acute reaction to major stress (308.-)
             neurotic disorders (300.-)

309.0   Brief depressive reaction

States of depression, not specifiable as manic-depressive, psychotic or
neurotic, generally transient, in which the depressive symptoms are usually
closely related in time and content to some stressful event.

Grief reaction

Excludes:    affective psychoses (296.-)
             neurotic depression (300.4)
             prolonged depressive reaction (309.1)
             psychogenic depressive psychosis (298.0)

309.1   Prolonged depressive reaction

States of depression, not specifiable as manic-depressive, psychotic or
neurotic, generally long-lasting; usually developing in association with
prolonged exposure to a stressful situation.

Excludes:    affective psychoses (296.-)
             brief depressive reaction (309.0)
             neurotic depression (300.4)
             psychogenic depressive psychosis (298.0)



                          ICD-9/Ch05.TXT - pg. 32

309.2   With predominant disturbance of other emotions

States, fulfilling the general criteria for adjustment reaction, in which the
main symptoms are emotional in type [anxiety, fear, worry, etc.] but not
specifically depressive.

Abnormal separation anxiety       Culture shock

309.3   With predominant disturbance of conduct

Mild or transient disorders, fulfilling the general criteria for adjustment
reaction, in which the main disturbance predominantly involves a disturbance
of conduct.  For example, an adolescent grief reaction resulting in aggressive
or antisocial disorder would be included here.

Excludes:    disturbance of conduct NOS (312.-)
             personality disorder with predominantly sociopathic or asocial
                  manifestations (301.7)

309.4   With mixed disturbance of emotions and conduct

Disorders fulfulling the general definition in which both
emotional disturbance and disturbance of conduct are prominent
features.

309.8   Other

Adjustment reaction with elective mutism
Hospitalism in children NOS

309.9   Unspecified

Adaptation reaction NOS           Adjustment reaction NOS

310     Specific nonpsychotic mental disorders following organic brain damage

Note:  This category should be used only for conditions where the form of the
       disorder is determined by the brain pathology.

Excludes:    neuroses, personality disorders, or other nonpsychotic conditions
                  occurring in a form similar to that seen with functional
                  disorders but in association with a physical condition; code
                  to 300.-, 300.-, etc., and use additional code to identify
                  the physical condition

310.0   Frontal lobe syndrome

Changes in behaviour following damage to the frontal areas of the brain or
following interference with the connections of those areas. There is a general
diminution of self-control, foresight, creativity and spontaneity, which may
be manifest as increased irritability, selfishness, restlessness and lack of
concern for others. Conscientiousness and powers of concentration are often

                          ICD-9/Ch05.TXT - pg. 33

diminished, but measurable deterioration of intellect or memory is not
necessarily present. The overall picture is often one of emotional dullness,
lack of drive andd slowness; but, particularly in persons previously with
energetic, restless or aggressive characteristics, there may be a change
towards impulsiveness, boastfulness, temper outbursts, silly fatuous humour,
and the development of unrealistic ambitions; the direction of change usually
depends upon the previous personality.  A considerable degree of recovery is
possible and continue over the course of several years.

Lobotomy syndrome                 Postleucotomy syndrome [state]

Excludes:    postcontusional syndrome (310.2)

310.1   Cognitive or personality change of other type

Chronic, mild states of memory disturbance and intellectual deterioration,
often accompanied by increased irritability, querulousness, lassitude and
complaints of physical weakness.  These states are often associated with old
age, and may precede more severe states due to brain damage classifiable under
dementia of any type (290.-,and  294.-) or any condition in 293.-(Transient
organic psychotic conditions).

Mild memory disturbance
Organic psychosyndrome of nonpsychotic severity

310.2   Postconcussional syndrome

States occurring after generalized contusion of the brain, in which the
symptom picture may resemble that of the frontal lobe syndrome (310.0) or that
of any of the neurotic disorders (300.0-300.9), but in which in addition,
headache, giddiness, fatigue, insomnia and a subjective feeling of impaired
intellectual ability are usually prominent.  Mood may fluctuate, and quite
ordinary stress may produce exaggerated fear and apprehension.  There may be
marked intolerance of mental and physical exertion, undue sensitivity to
noise, and hypochondriacal preoccupation.  The symptoms are more common in
persons who have previously suffered from neurotic or personality disorders or
when there is a possibility of compensation.  This syndrome is particularly
associated with the closed type of head injury when signs of localized brain
damage are slight or absent, but it may also occur in other conditions.

Postcontusional syndrome (encephalopathy)
Post-traumatic brain syndrome, nonpsychotic
Status postcommotio cerebri

Excludes:    frontal lobe syndrome (310.0)
             postencephalitic syndrome (310.8)
             any organic psychotic conditions following head injury
                  (290.- to 294.0)

310.8   Other

Include here disorders resembling the postcontusional syndrome(310.2),
associated with infective or other diseases of the brain or surrounding
tissues.
                          ICD-9/Ch05.TXT - pg. 34

Other focal (partial) organic psychosyndromes

310.9   Unspecified

311     Depressive disorder, not elsewhere classified

States of depression, usually of moderate but occasionally of marked
intensity, which have no specifically manic-depressive or other psychotic
depressive features and which do not appear to be associated with stressful
events or other features specified under neurotic depression.

Depressive disorder NOS
Depressive state NOS
Depression NOS

Excludes:    acute reaction to major stress with depressive symptoms (308.0)
             affective personality disorder (301.1)
             affective psychoses (296.-)
             brief depressive reaction (309.0)
             disturbance of emotions specific to childhood and adolescence,
                  with misery and unhappiness (313.1)
             mixed adjustment reaction with depressive symptoms (309.4)
             neurotic depression (300.4)
             prolonged depressive adjustment reaction (309.1)
             psychogenic depressive psychosis (298.0)

312     Disturbance of conduct, not elsewhere classified

Disorders mainly involving aggressive and destructive behaviour and disorders
involving delinquency.  It should be used for abnormal behaviour, in
individuals of any age, which gives rise to social disapproval but which is
not part of any other psychiatric condition.  Minor emotional disturbances may
also be present. To be included, the behaviour--as judged by its frequency,
severity and type of associations with other symptoms--must be abnormal in its
context.  Disturbances of conduct are distinguished from an adjustment
reaction by a longer duration and by a lack of close relationship in time and
content to some stress.  They differ from a personality disorder by the
absence of deeply ingrained maladapative patterns of behaviour present from
adolescence or earlier.

Excludes:     adjustment reaction with disturbance of conduct (309.3)
              drug dependence (304.-)
              personality disorder with predominantly sociopathic or
                asocial manifestations (301.7)
              sexual deviations (302.-)

312.0   Unsocialized disturbance of conduct

Disorders characterized by behaviours such as defiance, disobedience,
quarrelsomeness, aggression, destructive behaviour, tantrums, solitary
stealing, lying, teasing, bullying and disturbed relationships with others.
The defiance may sometimes take the form of sexual misconduct.
                          ICD-9/Ch05.TXT - pg. 35

Unsocialized aggressive disorder

312.1   Socialized disturbance of conduct

Disorders in individuals who have acquired the values or behaviour of a
delinquent peer group to whom they are loyal and with whom they
characteristically steal, play truant, and stay out late at night. There may
also be promiscuity.

Group delinquency

312.2   Compulsive conduct disorder

Disorder of conduct or delinquent act which is specifically compulsive in
origin.

Kleptomania

312.3   Mixed disturbance of conduct and emotions

Disorders involving behaviours listed for 312.0 and 312.1 but in which there
is also considerable emotional disturbance as shown for example by anxiety,
misery or obsessive manifestations.

Neurotic delinquency

Excludes:    compulsive conduct disorder (312.2)

312.8   Other

312.9   Unspecified

313     Disturbance of emotions specific to childhood and adolescence

Less well differentiated emotional disorders characteristic of the childhood
period.  Where the emotional disorder takes the form of a neurotic disorder
described under 300.-, the appropriate 300.- coding should be made.  This
category differs from category 308.- in terms of longer duration and by the
lack of close relationship in time and content to some stress.

Excludes:    adjustment reaction (309.-)
             masturbation, nail-biting, thumb-sucking, and other isolated
                  symptoms (307.-)

313.0   With anxiety and fearfulness

Ill-defined emotional disorders characteristic of childhood in which the main
symptoms involve anxiety and fearfulness.  Many cases of school refusal or
elective mutism might be included here.

Overanxious reaction of childhood and adolescence


                          ICD-9/Ch05.TXT - pg. 36

Excludes:    abnormal separation anxiety (309.2)
             anxiety states (300.0)
             hospitalism in children (309.8)
             phobic state (300.2)

313.1   With misery and unhappiness

Emotional disorders characteristic of childhood in which the main symptoms
involve misery and unhappiness.  There may also be eating and sleep
disturbances.

Excludes:    depressive neurosis (300.4)

313.2   With sensitivity, shyness, and social withdrawal

Emotional disorders characteristic of childhood in which the main symptoms
involve sensitivity, shyness, or social withdrawal. Some cases of elective
mutism might be included here.

Withdrawing reaction of childhood or adolescence

Excludes:    infantile autism (299.0)
             schizoid personality (301.2)
             schizophrenia (295.-)

313.3   Relationship problems

Emotional disorders characteristic of childhood in which the main symptoms
involve relationship problems.

Sibling jealousy

Excludes:    relationship problems associated with aggression, destruction,
                  or other forms of conduct disturbance (312.-)

313.8   Other or mixed

Many emotional disorders of childhood include several elements but whenever
possible a specific coding under .0, .1, .2 or .3 should be made according to
the preponderant type of disturbance.  The category of mixed disorders should
only be used when there is such an admixture that this cannot be done.

313.9   Unspecified

314     Hyperkinetic syndrome of childhood

Disorders in which the essential features are short attention-span and
distractibility. In early childhood the most striking symptom is disinhibited,
poorly organized and poorly regulated extreme overactivity but in adolescence
this may be replaced by underactivity.  Impulsiveness, marked mood fluctua-
tions and aggression are also common symptoms.  Delays in the development of
specific skills are often present and disturbed, poor relationships are

                          ICD-9/Ch05.TXT - pg. 37

common.  If the hyperkinesis is symptomatic of an underlying disorder, code
the underlying disorder instead.

314.0   Simple disturbance of activity and attention

Cases in which short attention span, distractibility, and overactivity are the
main manifestations without significant disturbance of conduct or delay in
specific skills.

Overactivity NOS

314.1   Hyperkinesis with developmental delay

Cases in which the hyperkinetic syndrome is associated with speech delay,
clumsiness, reading difficulties or other delays in specific skills.

Developmental disorder of hyperkinesis

Use additional code to identify any associated neurological disorder

314.2   Hyperkinetic conduct disorder

Cases in which the hyperkinetic syndrome is associated with marked conduct
disturbance but not developmental delay.

Hyperkinetic conduct disorder

Excludes:    hyperkinesis with significant delays in specific skills (314.1)

314.8   Other

314.9   Unspecified

Hyperkinetic reaction of childhood or adolescence NOS
Hyperkinetic syndrome NOS

315     Specific delays in development

A group of disorders in which a specific delay in development is the main
feature.  In each case development is related to biological maturation but it
is also influenced by nonbiological factors and the coding carries no
aetiological implications.

Excludes:    when due to a neurological disorder (320-389)

315.0   Specific reading retardation

Disorders in which the main feature is a serious impairment in the development
of reading or spelling skills which is not explicable in terms of general
intellectual retardation or of inadequate schooling.  Speech or language
difficulties, impaired right-left differentiation, perceptuo-motor problems,
and coding difficulties are frequently associated.  Similar problems are often

                          ICD-9/Ch05.TXT - pg. 38

present in other members of the family.  Adverse psychosocial factors may be
present.

Developmental dyslexia            Specific spelling difficulty

315.1   Specific arithmetical retardation

Disorders in which the main feature is a serious impairment in the development
of arithmetical skills which is not explicable in terms of general
intellectual retardation or of inadequate schooling.

Dyscalculia

315.2   Other specific learning difficulties

Disorders in which the main feature is a serious impairment in the development
of other learning skills which are not explicable in terms of general
intellectual retardation or of inadequate schooling.

Excludes:    specific arithmetical retardation (315.1)
             specific reading retardation (315.0)

315.3   Developmental speech or language disorder

Disorders in which the main feature is a serious impairment in the development
of speech or language [syntax or semantics] which is not explicable in terms
of general intellectual retardation.  Most commonly there is a delay in the
development of normal word-sound production resulting in defects of
articulation.  Omissions or substitutions of consonants are most frequent.
There may also be a delay in the production of spoken language.  Rarely, there
is also a developmental delay in the comprehension of sounds.  Includes cases
in which delay is largely due to environmental privation.

Developmental aphasia             Dyslalia

Excludes:    acquired aphasia (784.3)
             elective mutism (309.8, 313.0, 313.2)
             lisping and lalling (307.9)
             stammering and stuttering (307.0)

315.4   Specific motor retardation

Disorders in which the main feature is a serious impairment in the development
of motor coordination which is not explicable in terms of general intellectual
retardation.  The clumsiness is commonly associated with perceptual
difficulties.

Clumsiness syndrome               Dyspraxia syndrome

315.5      Mixed development disorder

A delay in the development of one specific skill [e.g., reading, arithmetic,
speech or coordination] is frequently associated with lesser delays in other
                          ICD-9/Ch05.TXT - pg. 39

skills.  When this occurs the coding should be made according to the skill
most seriously impaired.  The mixed category should be used only where the
mixture of delayed skills is such that no one skill is preponderantly
affected.

315.8   Other

315.9   Unspecified

Developmental disorder NOS

316     Psychic factors associated with diseases classified elsewhere

Mental disturbances or psychic factors of any type thought to have played a
major part in the aetiology of physical conditions, usually involving tissue
damage, classified elsewhere.  The mental disturbance is usually mild and
nonspecific and psychic factors [worry, fear, conflict, etc.] may be present
without any overt psychiatric disorder. Use an additional code to identify the
physical condition.  In the rare instance that an overt psychiatric disorder
is thought to have caused a physical condition, use a second additional code
to record the psychiatric diagnosis.

Examples of the use of this category are:

    psychogenic:
         asthma (316 and 493.9)
         dermatitis (316 and 692.-)
         eczema (316 and 691.-, or 692.-)
         gastric ulcer (316 and 531.-)
         mucous colitis (316 and 564.1)
         ulcerative colitis (316 and 556)
         urticaria (316 and 708.-)
    psychosocial dwarfism (316 and 259.4)

Excludes:    physical symptoms and physiological malfunctions, not involving
                  tissue damage, of mental origin (306.-)



                       MENTAL RETARDATION (317-319)

A condition of arrested or incomplete development of mind which is especially
characterized by subnormality of intelligence.  The coding should be made on
the individual's current level of functioning without regard to its nature or
causation such as psychosis, cultural deprivation, Down's syndrome etc.
Where there is a specific cognitive handicap, such as in speech, the
four-digit coding should be based on assessments of cognition outside the area
of specific handicap.  The assessment of intellectual level should be based on
whatever information is available, including clinical evidence, adaptive
behaviour and psychometric findings.  The IQ levels given are based on a test
with a mean of 100 and a standard deviation of 15-such as the Wechsler scales.
They are provided only as a guide and should not be applied rigidly.  Mental

                          ICD-9/Ch05.TXT - pg. 40

retardation often involves psychiatric disturbances and may often develop as a
result of some physical disease or injury.  In these cases, an additional code
or codes should be used to identify any associated condition, psychiatric or
physical.  The Impairment and Handicap codes should also be consulted.

317     Mild mental retardation

Feeble-minded                     Mild mental subnormality
High-grade defect                 Moron
IQ 50-70

318     Other specified mental retardation

318.0   Moderate mental retardation

Imbecile
IQ 35-49
Moderate mental subnormality

318.1   Severe mental retardation

IQ 20-34                          Severe mental subnormality

318.2   Profound mental retardation

Idiocy                            Profound mental subnormality
IQ under 20

319     Unspecified mental retardation

Mental deficiency NOS             Mental subnormality NOS






















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