第五章　精神[心智]與行為疾患

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1 行 (F00-F99) Chapter V Mental and behavioural disorders (F00-F99) 理 ( ) 狀臨異類 (R00-R99) Includes:disorders of psychological development Excludes: symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) 列 ( ) This chapter contains the following blocks: F00-F09 ( 狀 ) 精神 [ ] ( ) F00-F09 Organic, including symptomatic, mental disorders F10-F19 精神精神 [ ] 行 ( ) F10-F19 Mental and behavioural disorders due to psychoactive substance use F20-F29 精神裂 ( ) 精神裂 ( ) ( ) F20-F29 Schizophrenia, schizotypal and delusional disorders F30-F39 [ ( )] ( ) F30-F39 Mood [affective] disorders F40-F48 精神力 ( ) F40-F48 Neurotic, stress-related and somatoform disorders F50-F59 ( ) 理 ( 亂 ) 行 F50-F59 Behavioural syndromes associated with physiological disturbances and physical factors F60-F69 行 ( ) F60-F69 Disorders of adult personality and behaviour F70-F79 不 F70-F79 Mental retardation F80-F89 理 ( ) F80-F89 Disorders of psychological development F90-F98 ( ) 年行 ( ) F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence F99 精神 [ ] ( ) F99 Unspecified mental disorder 311

2 類 Asterisk categories for this chapter are provided as follows: F00* ( ) ( ) ( ) F02* 類 ( ) ( ) F00* Dementia in Alzheimer's disease F02* Dementia in other diseases classified elsewhere ( 狀 ) ( ) (F00-F09) 精神 ( ) 不良 ( ) 不良 ( ) ( ) ( ) (F00-F03) ( ) 行 ( ) ( 亂 ) ( ) 理力力力識狀 ( 不 ) ( ) 行更 ( ) ( ) Organic, including symptomatic, mental disorders (F00-F09) This block comprises a range of mental disorders grouped together on the basis of their having in common a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively; or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or systems of the body that are involved. Dementia (F00-F03) is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation. This syndrome occurs in Alzheimer s disease, in cerebrovascular disease, and in other conditions primarily or secondarily affecting the brain. Use additional code, if desired, to identify the underlying disease. 312

3 F00* ( ) ( ) ( ) (G30.- ) ( ) 不 ( ) 神理神不不數年行 F00* Dementia in Alzheimer s disease (G30.- ) Alzheimer s disease is a primary degenerative cerebral disease of unknown etiology with characteristic neuropathological and neurochemical features. The disorder is usually insidious in onset and develops slowly but steadily over a period of several years. F00.0* ( ) ( ) ( ) (G30.0 ) ( ) ( ) ( ) 65 惡 ( ) ( ) ( ) F00.0* Dementia in Alzheimer s disease with early onset (G30.0 ) Dementia in Alzheimer s disease with onset before the age of 65, with a relatively rapid deteriorating course and with marked multiple disorders of the higher cortical functions. ( ) Alzheimer s disease, type 2 老 ( ) ( ) ( ) ( ) 老 Presenile dementia, Alzheimer s type Primary degenerative dementia of the Alzheimer s type, presenile onset F00.1* ( ) ( ) ( ) (G30.1 ) ( ) ( ) 臨 ( 不 ) F00.1* Dementia in Alzheimer s disease with late onset (G30.1 ) Dementia in Alzheimer s disease with onset after the age of 65, usually in the late 70s or thereafter, with a slow progression, and with memory impairment as the principal feature. ( ) Alzheimer s disease, type 1 ( ) ( ) 老年老年 ( ) ( ) Primary degenerative dementia of the Alzheimer s type, senile onset Senile dementia, Alzheimer s type F00.2* ( ) ( ) ( ) (G30.8 ) ( ) ( ) F00.9* ( ) ( ) ( ) (G30.9 ) F00.2* Dementia in Alzheimer s disease, atypical or mixed type (G30.8 ) Atypical dementia, Alzheimer s type F00.9* Dementia in Alzhelmer s disease unspecified (G30.9 ) F01 ( ) F01 Vascular dementia 313

4 塞塞 ( ) 累來年 ( ) Vascular dementia is the result of infarction of the brain due to vascular disease, including hypertensive cerebrovascular disease. The infarcts are usually small but cumulative in their effect. Onset is usually in later life. Includes: arteriosclerotic dementia F01.0 ( ) 連塞數塞 F01.0 Vascular dementia of acute onset Usually develops rapidly after a succession of strokes from cerebrovascular thrombosis, embolism or haemorrhage. In rare cases, a single large infarction may be the cause. F01.1 塞 ( ) F01.1 Multi-infarct dementia 度塞累 ( ) Gradual in onset, following a number of transient ischaemic episodes which produce an accumulation of infarcts in the cerebral parenchyma. Predominantly cortical dementia F01.2 ( ) F01.2 Subcortical vascular dementia ( ) ( ) 臨狀 Includes cases with a history of hypertension and foci of ischaemic destruction in the deep white matter of the cerebral hemispheres. The cerebral cortex is usually preserved and this contrasts with the clinical picture which may closely resemble that of dementia in Alzheimer s disease. F01.3 ( ) F01.3 Mixed cortical and subcortical vascular dementia F01.8 ( ) F01.8 Other vascular dementia F01.9 ( ) F01.9 Vascular dementia, unspecified F02* 類 ( ) ( ) 來 ( ) ( ) F02* Dementia in other diseases classified elsewhere Cases of dementia due, or presumed to be due, to causes other than Alzheimer s disease or cerebrovascular disease. Onset 314

5 老年 may be at any time in life, though rarely in old age. F02.0* Pick( ) ( ) ( ) (G31.0 ) ( ) 年 [* 50~60 ] 行力 ( ) 路 ( ) F02.0* Dementia in Pick s disease (G31.0 ) A progressive dementia, commencing in middle age, characterized by early, slowly progressing changes of character and social deterioration, followed by impairment of intellect, memory, and language functions, with apathy, euphoria and, occasionally, extrapyramidal phenomena. F02.1* Creutzfeldt-Jakob( ) ( ) ( ) (A81.0 ) ( ) 神 ( ) 神理 [ ] 年更年 F02.1* Dementia in Creutzfeldt-Jakob disease (A81.0 ) A progressive dementia with extensive neurological signs, due to specific neuropathological changes that are presumed to be caused by a transmissible agent. Onset is usually in middle or later life, but may be at any adult age. The course is subacute, leading to death within one to two years. F02.2* Huntington ( ) ( ) ( ) (G10 ) 狀 10~15 年 Huntington ( ) ( ) ( ) F02.2* Dementia in Huntington s disease (G10 ) A dementia occurring as part of a widespread degeneration of the brain. The disorder is transmitted by a single autosomal dominant gene. Symptoms typically emerge in the third and fourth decade. Progression is slow, leading to death usually within 10 to 15 years. Dementia in Huntington s chorea F02.3* 金 ( ) ( ) ( ) (G20 ) 立金 ( ) [ 度 ] 臨列 ( ) ( ) F02.3* Dementia in Parkinson s disease (G20 ) A dementia developing in the course of established Parkinson s disease. No particular distinguishing clinical features have yet been demonstrated. Dementia in: 315

6 金 ( ) paralysis agitans parkinsonism F02.4* 類 [HIV] ( ) ( ) (B22.0 ) 類 [HIV] 了 HIV 臨 F02.4* Dementia in human immunodeficiency virus [HIV] disease (B22.0 ) Dementia developing in the course of HIV disease, in the absence of a concurrent illness or condition other than HIV infection that could explain the clinical features. F02.8* 類 ( ) ( ) F02.8* Dementia in other specified diseases classified elsewhere 列 ( ) ( ) ( 類 ) ( 沈沈 (E75.- ) (G40.- ) Dementia in: cerebral lipidosis (E75.- ) epilepsy (G40.- ) 狀 ( ) (E83.0 ) hepatolenticular degeneration (E83.0 ) (E83.5 ) hypercalcaemia (E83.5 ) 狀 (E01, E03.- ) hypothyroidism, acquired (E01,E03.- ) (T36-T65 ) intoxications (T36-T65 ) ( ) (G35 ) multiple sclerosis (G35 ) 神 (A52.1 ) neurosyphilis (A52.1 ) ( )[ ] (E52 ) niacin deficiency [pellagra] (E52 ) (M30.0 ) 狼 ( ) (M32.- ) ( ) ( B56.- B57.- ) ( )B 12 ( ) (E53.8 ) polyarteritis nodosa (M30.0 ) systemic lupus erythcmatosus (M32.- ) trypanosomiasis (B56.-, B57.- ) vitamin B12 deficiency (E53.8 ) F03 ( ) F03 Unspecified dementia *[ ( ) 類 ( ) (F00.0-F02.9) ( ) ] ( 列 ) 老 Presenile: ( ) dementia NOS 精神 ( ) psychosis NOS ( ) Primary degenerative dementia NOS ( 列 ) 老年 ( 列 ) ( ) Senile: dementia: 316

7 NOS depressed or paranoid type 精神 ( ) 老年 ( ) ( ) 亂狀 (F05.1) 老 [ 老 ] (R54) psychosis NOS Excludes: senile dementia with delirium or acute confusional state (F05.1) senility NOS (R54) F04 精精神力力降 ( ) Korsakov ( ) 精神 ( ) 精 ( 列 ) (R41.3) 行 (R41.1) 離 (F44.0) 行 (R41.2) Korsakov ( ) 精 [ 精 ] (F10.6) 精神 (F11-F ) F04 Organic amnesic syndrome, not induced by alcohol and other psychoactive substances A syndrome of prominent impairment of recent and remote memory while immediate recall is preserved, with reduced ability to learn new material and disorientation in time. Confabulation may be a marked feature, but perception and other cognitive functions, including the intellect, are usually intact. The prognosis depends on the course of the underlying lesion. Korsakov s psychosis or syndrome, nonalcoholic Excludes: amnesia: NOS (R41.3) anterograde (R41.1) dissociative (F44.0) retrograde (R41.2) Korsakov s syndrome: alcohol-induced or unspecified (F10.6) induced by other psychoactive substances (F11-F19 with common fourth character.6) F05 精精神識力精神行 ( 亂 ) 不度不 F05 Delirium, not induced by alcohol and other psychoactive substances An etiologically nonspecific organic cerebral syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake schedule. The duration is variable and the 317

8 degree of severity ranges from mild to very severe. ( 列 ) Includes: acute or subacute: brain syndrome ( 精 ) 亂狀 confusional state (nonalcoholic) 精神 ( ) infective psychosis organic reaction 精神 psycho-organic syndrome 精 (F10.4) Excludes: delirium tremens, alcohol-induced or unspecified (F10.4) F05.0 ( ) ( ) F05.0 Delirium not superimposed on dementia, so described F05.1 ( ) ( ) F05.1 Delirium superimposed on dementia ( ) ( ) (F00-F03) ( ) Conditions meeting the above criteria but developing in the course of a dementia (F00-F03). F05.8 ( ) F05.8 Other delirium ( ) Delirium of mixed origin F05.9 ( ) F05.9 Delirium, unspecified F06 ( ) 不良 ( 異 ) 精神 ( ) 類 ( ) ( ) ( ) ( ) 泌 F06 Other mental disorders due to brain damage and dysfunction and to physical disease Includes miscellaneous conditions causally related to brain disorder due to primary cerebral disease, to systemic disease affecting the brain secondarily, to exogenous toxic substances or hormones, to endocrine disorders, or to other somatic illnesses. ( 列 ) Excludes: associated with: ( ) (F05.-) delirium (F05.-) 類 F00-F03 ( ) dementia as classified in F00-F03 ( ) 精精神 (F10-F19) resulting from use of alcohol and other psychoactive substances (F10-F19) F06.0 F06.0 Organic hallucinosis 318

9 識狀識識不臨識 ( 精 ) 狀精 (F10.5) 精神裂 ( ) (F20.-) A disorder of persistent or recurrent hallucinations, usually visual or auditory, that occur in clear consciousness and may or may not be recognized by the subject as such. Delusional elaboration of the hallucinations may occur, but delusions do not dominate the clinical picture; insight may be preserved. Organic hallucinatory state (nonalcoholic) Excludes: alcoholic hallucinosis (F10.5) schizophrenia (F20.-) F06.1 F06.1 Organic catatonic disorder 精神 ( ) ( ) 狀兩精神 ( ) A disorder of diminished (stupor) or increased (excitement) psychomotor activity associated with catatonic symptoms. The extremes of psychomotor disturbance may alternate. 精神裂 ( ) (F20.2) ( 列 ) (R40.1) 離 (F44.2) Excludes: catatonic schizophrenia (F20.2) stupor: NOS (R40.1) dissociative (F44.2) F06.2 [ 精神裂 ] ( ) 臨 ( ) 精神裂 ( ) 例異 F06.2 Organic delusional [schizophrenia-like] disorder A disorder in which persistent or recurrent delusions dominate the clinical picture. The delusions may be accompanied by hallucinations. Some features suggestive of schizophrenia, such as bizarre hallucinations or thought disorder, may be present. 狀 ( ) 類精神裂 ( ) 精神 ( ) ( 列 ) 精神 (F23.-) 319 Paranoid and paranoid-hallucinatory organic states Schizophrenia-like psychosis in epilepsy Excludes: disorder: acute and transient psychotic (F23.-) (F22.-) persistent delusional (F22.-) 精神 [ 精神 ] (F11-F19 4 psychotic drug-induced (F11-F19 with common fourth

10 .5 ) character.5) 精神裂 ( ) (F20.-) schizophrenia (F20.-) F06.3 [ ] ( ) F06.3 Organic mood [affective] disorders ( ) 量 ( 參 F30-F32) [ ] (F30-F39) Disorders characterized by a change in mood or affect, usually accompanied by a change in the overall level of activity, depressive, hypomanic, manic or bipolar (see F30-F32), but arising as a consequence of an organic disorder. Excludes: mood disorders, nonorganic or unspecified (F30-F39) F06.4 ( ) (F41.1) (F41.0) 兩 [ ] ( ) (F41.-) F06.4 Organic anxiety disorder A disorder characterized by the essential descriptive features of a generalized anxiety disorder (F41.1), a panic disorder (F41.0), or a combination of both, but arising as a consequence of an organic disorder. Excludes: anxiety disorders, nonorganic or unspecified (F41.-) F06.5 離 ( ) F06.5 Organic dissociative disorder 識 ( 參 F44.-) [ ] 離 [ ] ( ) (F44.-) A disorder characterized by a partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements (see F44.-), but arising as a consequence of an organic disorder. Excludes: dissociative [conversion] disorders, nonorganic or unspecified (F44.-) F06.6 不 [ ] F06.6 Organic emotionally labile [asthenic] disorder 不易累不 ( 例暈 ) [ ] A disorder characterized by emotional incontinence or lability, fatigability, and a variety of unpleasant physical sensations (e.g.dizziness) and pains, but arising as a consequence of an organic disorder. ( ) Excludes: somatoform disorders, nonorganic 320

11 (F45.-) or unspecified (F45.-) F06.7 度 ( ) F06.7 Mild cognitive disorder ( 不 ) 力力 ( 力 ) 不狀不 ( ) (F00-F03) ( )(F05.-) 連若 F10-F99 精神不不 ( ) (F07.1) (F07.2) 不狀度 A disorder characterized by impairment of memory, learning difficulties, and reduced ability to concentrate on a task for more than brief periods. There is often a marked feeling of mental fatigue when mental tasks are attempted, and new learning is found to be subjectively difficult even when objectively successful. None of these symptoms is so severe that a diagnosis of either dementia (F00-F03) or delirium (F05.-) can be made. This diagnosis should be made only in association with a specified physical disorder, and should not be made in the presence of any of the mental or or behavioural disorders classified to F10-F99. The disorder may precede accompany, or follow a wide variety of infections and physical disorders, both cerebral and systemic, but direct evidence of cerebral involvement is not necessarily present. It can be differentiated from postencephalitic syndrome (F07.1) and postconcussional syndrome (F07.2) by its different etiology, more restricted range of generally milder symptoms, and usually shorter duration. F06.8 ( ) 不良 ( 異 ) 精神精神 ( ) F06.8 Other specified mental disorders due to brain damage and dysfunction and to physical disease Epileptic psychosis NOS F06.9 ( ) 不良 ( 異 ) 精神 ( ) ( 列 ) 精神 ( ) F06.9 Unspecified mental disorder due to brain damage and dysfunction and to physical disease Organic: brain syndrome NOS mental disorder NOS 321

12 F07 ( ) 不良 ( 異 ) 行 ( ) 行 ( ) 不良 ( 異 ) F07 Personality and behavioural disorders due to brain disease, damage and dysfunction Alteration of personality and behaviour can be a residual or concomitant disorder of brain disease, damage or dysfunction. F07.0 ( ) F07.0 Organic personality disorder 臨 ( 列 ) 精神 ( 列 ) 葉葉葉切切 A disorder characterized by a significant alteration of the habitual patterns of behaviour displayed by the subject premorbidly, involving the expression of emotions, needs and impulses. Impairment of cognitive and thought functions, and altered sexuality may also be part of the clinical picture. Organic: pseudpsychopathic personality pseudoretarded personality Syndrome: frontal lobe limbic epilepsy personality lobotomy postleucotomy ( 列 ) Excludes: enduring personality change after: 歷 (F62.0) catastrophic experience (F62.0) 精神 ( 不 ) (F62.1) psychiatric illness (F62.1) (F07.2) postconcussional syndrome (F07.2) (F07.1) postencephalitic syndrome (F07.1) ( ) specific personality disorder (F60.-) (F60.-) F07.1 F07.1 Postencephalitic syndrome 來復行不復 ( ) 322 Residual nonspecific and variable behavioural change following recovery from either viral or bacterial encephalitis. The principal difference between this disorder and the organic personality disorders is that it is reversible. Excludes: organic personality disorder (F07.0)

13 (F07.0) F07.2 F07.2 Postconcussional syndrome ( 識 ) 不狀諸暈 ( 暈 ) 力精力 A syndrome that occurs following head trauma (usually sufficiently severe to result in loss of consciousness) and includes a number of disparate symptoms such as headache, dizziness, fatigue, irritability, difficulty in concentration and performing mental tasks, impairment of memory, insomnia, and reduced tolerance to stress, emotional excitement, or alcohol. ( ) Postcontusional syndrome (encephalopathy) 精神 Post-traumatic brain syndrome, nonpsychotic F07.8 ( ) 不良 ( 異 ) 行 ( ) ( ) F07.9 ( ) 不良 ( 異 ) 行 ( ) 精神 F07.8 Other organic personality and behavioural disorders due to brain disease, damage and dysfunction Right hemispheric organic affective disorder F07.9 Unspecified organic personality and behavioural disorder due to brain disease, damage and dysfunction Organic psychosyndrome F09 狀精神 ( ) ( 列 ) 精神 ( ) 狀精神 ( ) (F29) F09 Unspecified organic or symptomatic mental disorder Psychosis: organic NOS symptomatic NOS Excludes: psychosis NOS (F29) [ ] 行 ( ) (F10-F19) 了不度臨更精神精神類 3 4 臨狀來 Mental and behavioural disorders due to psychoactive substance use (F10-F19) This block contains a wide variety of disorders that differ in severity and clinical form but that are all attributable to the use of one or more psychoactive substances, which may or may not have been medically prescribed. The third character of the code identifies the substance involved, and the 323

14 來 4 都 ( ) 精神臨來料狀臨行 ( ) 不臨狀 ( 類 ) 類精神量 ( 4.0 ) ( 4.1 ) ( 4.2 ) ( ) 精神亂不精神精神精神 (F19.-) 濫 (F55) fourth character specifies the clinical state. The codes should be used, as required, for each substance specified, but it should be noted that not all fourth-character codes are applicable to all substances. Identification of the psychoactive substance should be based on as many sources of information as possible. These include self-report data, analysis of blood and other body fluids, characteristic physical and psychological symptoms, clinical signs and behaviour, and other evidence such as a drug being in the patient's possession or reports from informed third parties. Many drug users take more than one type of psychoactive substance. The main diagnosis should be classified, whenever possible, according to the substance or class of substances that has caused or contributed most to the presenting clinical syndrome. Other diagnoses should be coded when other psychoactive substances have been taken in intoxicating amounts (common fourth character. 0) or to the extent of causing harm (common fourth character.1), dependence (common fourth character.2) or other disorders (common fourth character.3-.9). Only in cases in which patterns of psychoactive substance-taking are chaotic and indiscriminate, or in which the contributions of different psychoactive substances are inextricably mixed, should the diagnosis of disorders resulting from multiple drug use (F19.-) be used. Excludes: abuse of non-dependence-producing substances (F55) 列 4 類 F10-F19 類 The following fourth-character subdivisions are for use with categories F10-F19:.0 精神 ( 亂 ) 識行理理理 ( 亂 ) 復.0 Acute intoxication A condition that follows the administration of a psychoactive substance resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses. The disturbances are directly related to the acute pharmacological effects of the substance and resolve with time, with complete 324

15 ( ) 療精神理類 ( ) ( ) 旅 ( ) 精神 ( ) ( ) recovery, except where tissue damage or other complications have arisen. Complications may include trauma, inhalation of vomitus, delirium, coma, convulsions, and other medical complications. The nature of these complications depends on the pharmacological class of substance and mode of administration. Acute drunkenness in alcoholism "Bad trips" (drugs) Drunkenness NOS Pathological intoxication Trance and possession disorders in psychoactive substance intoxication.1.1 Harmful use 精神 ( 精神 ) 精神 [ ] ( 量 ( ) ) A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected psychoactive substances) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol). 精神濫 Psychoactive substance abuse.2 ( ).2 Dependence syndrome 精神行理烈精神精神力狀 ( ) 精神 ( 精 diazepam) 類 ( 類 ) 更理 ( ) 精神 A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state. The dependence syndrome may be present for a specific psychoactive substance (e.g. tobacco, alcohol, or diazepam), for a class of substances (e.g. opioid drugs), or for a wider range of pharmacologically different psychoactive substances. 325

16 [ 精 ] [ ] Chronic alcoholism Dipsomania Drug addiction.3 狀.3 Withdrawal state 精神不不度狀狀精神類 ( ) 量狀 ( ) A group of symptoms of variable clustering and severity occurring on absolute or relative withdrawal of a psychoactive substance after persistent use of that substance. The onset and course of the withdrawal state are time-limited and are related to the type of psychoactive substance and dose being used immediately before cessation or reduction of use. The withdrawal state may be complicated by convulsions..4 ( ) 狀.4 Withdrawal state with delirium 4.3 狀 F05.- ( ) 若列類 F05.8 ( 精精 ) ( ) A condition where the withdrawal state as defined in the common fourth character.3 is complicated by delirium as defined in F05.-. Convulsions may also occur. When organic factors are also considered to play a role in the etiology, the condition should be classified to F05.8. Delirium tremens (alcohol-induced).5 精神 ( ).5 Psychotic disorder 精神精神 ( ) 狀 ( 不 ) ( ) 精神 ( ) 異 ( 度 ) 度識不亂 A cluster of psychotic phenomena that occur during or following psychoactive substance use but that are not explained on the basis of acute intoxication alone and do not form part of a withdrawal state. The disorder is characterized by hallucinations (typically auditory, but often in more than one sensory modality), perceptual distortions, delusions(often of a paranoid or persecutory nature), psychomotor disturbances (excitement or stupor), and an abnormal affect, which may range from intense fear to ecstasy. The sensorium is usually clear but some degree of clouding of consciousness, though not severe confusion, may be present. 326

17 ( 列 ) 精 Alcoholic: hallucinosis jealousy paranoia 精神 ( ) psychosis NOS 精精神留精神 ( ) (F10-F ) Excludes: alcohol- or other psychoactive substance-induced residual and late-onset psychotic disorder (F10-F19 with common fourth character.7).6.6 Amnesic syndrome 更不都更 ( ) 精精神 Korsakov ( ) 精神 ( ) 精精神精 Korsakov ( ) 精神 ( ) (F04) A syndrome associated with chronic prominent impairment of recent and remote memory. Immediate recall is usually preserved and recent memory is characteristically more disturbed than remote memory. Disturbances of time sense and ordering of events are usually evident, as are difficulties in learning new material. Confabulation may be marked but is not invariably present. Other cognitive functions are usually relatively well preserved and amnesic defects are out of proportion to other disturbances. Amnesic disorder, alcohol- or drug-induced Korsakov's psychosis or syndrome, alcohol- or other psychoactive substance-induced or unspecified Excludes: nonalcoholic Korsakov's psychosis or syndrome (F04).7 精神 ( ).7 Residual and late-onset psychotic disorder 精精神行精神更精神類精神例烈 327 A disorder in which alcohol- or psychoactive substance-induced changes of cognition, affect, personality, or behaviour persist beyond the period during which a direct psychoactive substance-related effect might reasonably be assumed to be operating. Onset of the disorder should be directly related to

18 精神類類精神狀精精神 the use of the psychoactive substance. Cases in which initial onset of the state occurs later than episode(s) of such substance use should be coded here only where clear and strong evidence is available to attribute the state to the residual effect of the psychoactive substance. Flashbacks may be distinguished from psychotic state partly by their episodic nature, frequently of very short duration, and by their duplication of previous alcohol- or other psychoactive substance-related experiences. 精 ( ) 精 ( ) ( 不 ) 精神精神 ( ) ( ) ( 列 ) ( ) 行 ( ) 精精神 Korsakov ( ) (F10-F ) 精神狀 (F10-F ) Alcoholic dementia NOS Chronic alcoholic brain syndrome Dementia and other milder forms of persisting impairment of cognitive functions Flashbacks Late-onset psychoactive substance-induced psychotic disorder Posthallucinogen perception disorder Residual: affective disorder disorder of personality and behaviour Excludes: alcohol- or psychoactive substance-induced: Korsakov's syndrome (F10-F19 with common fourth character.6) psychotic state (F10-F19 with common fourth character.5).8 精神 [ ] 行 ( ).8 Other mental and behavioural disorders.9 精神 [ ] 行 ( ).9 Unspecified mental and behavioural disorder F10.- 精精神 [ ] 行 ( ) F10.- Mental and behavioural disorders due to use of alcohol [ 參 324~328 類 ] [See pages 324~328 for subdivisions] 328

19 F11.- 類精神 [ ] 行 ( ) F11.- Mental and behavioural disorders due to use of opioids [ 參 324~328 類 ] [See pages 324~328 for subdivisions] F12.- 類精神 [ ] 行 ( ) F12.- Mental and behavioural disorders due to use of cannabinoids [ 參 324~328 類 ] [See pages 324~328 for subdivisions] F13.- ( ) ( ) 精神 [ ] 行 ( ) F13.- Mental and behavioural disorders due to use of sedatives or hypnotics [ 參 324~328 類 ] [See pages 324~328 for subdivisions] F14.- 精神 [ ] 行 ( ) F14.- Mental and behavioural disorders due to use of cocaine [ 參 324~328 類 ] [See pages 324~328 for subdivisions] F15.- ( ) [ ] 精神 [ ] 行 ( ) F15.- Mental and behavioural disorders due to use of other stimulants, including caffeine [ 參 324~328 類 ] [See pages 324~328 for subdivisions] F16.- [ ] 精神 [ ] 行 ( ) F16.- Mental and behavioural disorders due to use of hallucinogens [ 參 324~328 類 ] [See pages 324~328 for subdivisions] F17.- 精神 [ ] 行 ( ) F17.- Mental and behavioural disorders due to use of tobacco [ 參 324~328 類 ] [See pages 324~328 for subdivisions] F18.- 精神 [ ] 行 ( ) F18.- Mental and behavioural disorders due to use of volatile solvents [ 參 324~328 類 ] [See pages 324~328 for subdivisions] F19.- 精神精神 [ ] 行 ( ) F19.- Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances [ 參 324~328 類 ] [See pages 324~328 for subdivisions] 類精神 ( ) 329 This category should be used when two or more psychoactive substances are known to be involved, but it is impossible to assess which

20 精神諸精神不 substance is contributing most to the disorders. It should also be used when the exact identity of some or even all the psychoactive substances being used is uncertain or unknown, since many multiple drug users themselves often do not know the details of what they are taking. Includes: misuse of drugs NOS 裂 ( ) 裂 ( ) ( ) (F20-F29) 精神裂 ( )( 類 ) 精神裂 ( ) ( ) 更精神 ( ) 裂 ( ) 論留類 Schizophrenia, schizotypal and delusional disorders (F20-F29) This block brings together schizophrenia, as the most important member of the group, schizotypal disorder, persistent delusional disorders, and a larger group of acute and transient psychotic disorders. Schizoaffective disorders have been retained here in spite of their controversial nature. F20 精神裂 ( ) 精神裂 ( ) ( ) 不來識力精神理論 ( ) 狀 F20 Schizophrenia The schizophrenic disorders are characterized in general by fundamental and characteristic distortions of thinking and perception, and affects that are inappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained although certain cognitive deficits may evolve in the course of time. The most important psychopathological phenomena include thought echo; thought insertion or withdrawal; thought broadcasting; delusional perception and delusions of control; influence or passivity; hallucinatory voices commenting or discussing the patient in the third person; thought disorders and negative symptoms. 精神裂 ( ) ( ) 行 ( ) 不若狀精神裂狀不精神裂 ( ) 若 ( ) The course of schizophrenic disorders can be either continuous, or episodic with progressive or stable deficit, or there can be one or more episodes with complete or incomplete remission. The diagnosis of schizophrenia should not be made in the presence of extensive depressive or manic symptoms unless it is clear that schizophrenic symptoms antedate the 330

21 不精神裂 ( ) 若類類 F06.2 精神類 F10-F 精神裂 ( ) ( ) (F23.2) (F25.2) 精神裂 ( ) (F23.2) 精神裂 ( ) (F21) affective disturbance. Nor should schizophrenia be diagnosed in the presence of overt brain disease or during states of drug intoxication or withdrawal. Similar disorders developing in the presence of epilepsy or other brain disease should be classified under F06.2, and those induced by psychoactive substances under F10-F19 with common fourth character.5. Excludes: schizophrenia: acute (undifferentiated) (F23.2) cyclic (F25.2) schizophrenic reaction (F23.2) schizotypal disorder (F21) F20.0 精神裂 ( ) F20.0 Paranoid schizophrenia 精神裂 ( ) 臨狀不若不老年精神裂 ( ) 更年狀 (F22.8) (F22.0) Paranoid schizophrenia is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition and speech, and catatonic symptoms, are either absent or relatively inconspicuous. Paraphrenic schizophrenia Excludes: involutional paranoid state (F22.8) paranoia (F22.0) F20.1 精神裂 ( ) F20.1 Hebephrenic schizophrenia 精神裂 ( ) 不行不不零亂狀力不年 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, thought is disorganized, and speech is incoherent. There is a tendency to social isolation. Usually the prognosis is poor because of the rapid development of "negative" symptoms, particularly flattening of affect and loss of volition. Hebephrenia should normally be diagnosed only in adolescents or young adults. 331

22 精神裂 ( ) 精神裂 ( ) Disorganized schizophrenia Hebephrenia F20.2 精神裂 ( ) F20.2 Catatonic schizophrenia 臨精神狀兩不度暴力狀 ( ) 狀 Catatonic schizophrenia is dominated by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. Constrained attitudes and postures may be maintained for long periods. Episodes of violent excitement may be a striking feature of the condition. The catatonic phenomena may he combined with a dream-like (oneiroid) state with vivid scenic hallucinations. Catatonic stupor 精神裂 Schizophrenic: ( ) catalepsy catatonia 蠟 flexibilitas cerea F20.3 精神裂 ( ) F20.3 Undifferentiated schizophrenia 精神裂 ( ) 精神 ( 參 F20) 類 F Psychotic conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the subtypes in F20.0-F20.2, or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics. 精神裂 ( ) 類精神裂 ( ) 精神 (F23.2) 精神裂 ( ) (F20.5) Atypical schizophrenia Excludes: acute schizophrenia-like psychotic disorder (F23.2) chronic undifferentiated schizophrenia (F20.5) 精神裂 ( ) (F20.4) post-schizophrenic depression (F20.4) F20.4 精神裂 ( ) F20.4 Post-schizophrenic depression 精神裂 ( ) 精神裂狀不 ( ) A depressive episode, which may he prolonged, arising in the aftermath of a schizophrenic illness. Some schizophrenic 332

23 殺若精神裂狀 ( ) (F32.-) 若精精神裂狀類精神裂 (F20.0-F20.3) symptoms, either "positive" or "negative", must still be present but they no longer dominate the clinical picture. These depressive states are associated with an increased risk of suicide. If the patient no longer has any schizophrenic symptoms, a depressive episode should be diagnosed (F32.-). If schizophrenic symptoms are still florid and prominent, the diagnosis should remain that of the appropriate schizophrenic subtype (F20.0-F20.3). F20.5 留精神裂 ( ) F20.5 Residual schizophrenia 精神裂不不復狀臨精神量神料 A chronic stage in the development of a schizophrenic illness in which there has been a clear progression from an early stage to a later stage characterized by long-term, though not necessarily irreversible, "negative" symptoms, e.g. psychomotor slowing; underactivity; blunting and lack of initiative; poverty of quantity or content of speech; poor nonverbal communication by facial expression, eye contact, voice modulation and posture; poor self-care and social performance. 精神裂 ( ) ( 精神裂 ) 留狀精神裂留狀 Chronic undifferentiated schizophrenia Restzustand (schizophrenic) Schizophrenic residual state F20.6 精神裂 ( ) F20.6 Simple schizophrenia 精神行異行切力降留 ( 力 ) 精神狀 A disorder in which there is an insidious but progressive development of oddities of conduct, inability to meet the demands of society, and decline in total performance. The characteristic negative features of residual schizophrenia (e.g. blunting of affect and loss of volition) develop without being preceded by any overt psychotic symptoms. F20.8 精神裂 ( ) F20.8 Other schizophrenia 精神裂 ( ) Cenesthopathic schizophrenia ( 列 ) 精神裂 ( ) Schizophreniform: 333

24 ( ) 精神 ( ) 精神裂 ( ) (F23.2) disorder NOS psychosis NOS Excludes: brief schizophreniform disorders (F23.2) F20.9 精神裂 ( ) F20.9 Schizophrenia, unspecified F21 精神裂 ( ) 異行異精神裂 ( ) 見類精神裂異狀不樂異行 ( ) 異離念見精神類刺類 ( ) F21 Schizotypal disorder A disorder characterized by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies occur at any stage. The symptoms may include a cold or inappropriate affect; anhedonia; odd or eccentric behaviour; a tendency to social withdrawal; paranoid or bizarre ideas not amounting to true delusions; obsessive ruminations; thought disorder and perceptual disturbances; occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation. There is no definite onset and evolution and course are usually those of a personality disorder. ( ) 精神裂 ( ) Latent schizophrenic reaction ( 列 ) 精神裂 ( ) Schizophrenia: ( ) borderline latent 精神 [ ] prepsychotic prodromal 精神 pseudoneurotic 精神 pseudopsychopathic 精神裂 ( ) ( ) Schizotypal personality disorder Asperger ( ) (F84.5) Excludes: Asperger's syndrome (F84.5) 裂 ( ) (F60.1) schizoid personality disorder (F60.1) F22 ( ) F22 Persistent delusional disorders Includes a variety of disorders in which 334

25 臨類精神裂 ( ) 類 F23.- ( ) long-standing delusions constitute the only, or the most conspicuous, clinical characteristic and which cannot be classified as organic, schizophrenic or affective. Delusional disorders that have lasted for less than a few months should be classified, at least temporarily, under F23.-. F22.0 ( ) F22.0 Delusional disorder 若 ( ) 精神裂狀 ( ) 不老年精神裂 ( ) 臨不 Paranoia ( 列 ) ( ) Paranoid: 精神 ( ) psychosis 狀 state ( ) 精神 ( ) Paraphrenia (late) [* 老年精神 ( )] A disorder characterized by the development either of a single delusion or of a set of related delusions that are usually persistent and sometimes lifelong. The content of the delusion or delusions is very variable. Clear and persistent auditory hallucinations (voices), schizophrenic symptoms such as delusions of control and marked blunting of affect, and definite evidence of brain disease are all incompatible with this diagnosis. However, the presence of occasional or transitory auditory hallucinations, particularly in elderly patients, does not rule out this diagnosis, provided that they are not typically schizophrenic and form only a small part of the overall clinical picture. Sensitiver Beziehungswahn ( ) Excludes: paranoid: ( ) (F60.0) personality disorder (F60.0) 精神 ( ) (F23.3) psychosis, psychogenic (F23.3) (F23.3) reaction (F23.3) 精神裂 ( ) (F20.0) schizophrenia (F20.0) F22.8 ( ) F22.8 Other persistent delusional disorders 狀 ( ) 精神裂狀不立精神裂 ( )(F20.-) 335 Disorders in which the delusion or delusions are accompanied by persistent hallucinatory voices or by schizophrenic symptoms that do not justify a diagnosis of schizophrenia

26 更年 ( ) 狀 (F20.-). Delusional dysmorphophobia Involutional paranoid state Paranoia querulans F22.9 F22.9 Persistent delusional disorder, unspecified F23 精神 ( ) 類度異精神狀行異臨類狀不立 (F05.-) 復若狀類不力 F23 Acute and transient psychotic disorders A heterogeneous group of disorders characterized by the acute onset of psychotic symptoms such as delusions, hallucinations, and perceptual disturbances, and by the severe disruption of ordinary behaviour. Acute onset is defined as a crescendo development of a clearly abnormal clinical picture in about two weeks or less. For these disorders there is no evidence of organic causation. Perplexity and puzzlement are often present but disorientation for time, place and person is not persistent or severe enough to justify a diagnosis of organically caused delirium (F05.-). Complete recovery usually occurs within a few months, often within a few weeks or even days. If the disorder persists, a change in classification will be necessary. The disorder may or may not be associated with acute stress, defined as usually stressful events preceding the onset by one to two weeks. F23.0 精神 ( ) ( ) 精神裂狀 F23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia 精神 ( ) 都不不烈樂 ( ) 不臨異精神不立精神裂 ( )(F20.-) 336 An acute psychotic disorder in which hallucinations, delusions or perceptual disturbances are obvious but markedly variable, changing from day to day or even from hour to hour. Emotional turmoil with intense transient feelings of happiness or ecstasy, or anxiety and irritability, is also frequently present. The polymorphism and instability are characteristic for the overall

27 不復若狀 (* 例 ) 更 (F22.-) clinical picture and the psychotic features do not justify a diagnosis of schizophrenia (F20.-). These disorders often have an abrupt onset, developing rapidly within a few days, and they frequently show a rapid resolution of symptoms with no recurrence. If the symptoms persist the diagnosis should be changed to persistent delusional disorder (F22.-). Bouffée délirante ( ) ( ) 精神裂 ( ) 狀精神 ( ) ( ) 精神裂 ( ) 狀 Bouffée délirante without symptoms of schizophrenia or unspecified Cycloid psychosis without symptoms of schizophrenia or unspecified F23.1 精神 ( ) ( ) 精神裂狀精神 ( ) 不臨 F23.0 不精神裂狀若精神裂狀 (* 例 ) 更精神裂 ( )(F20.-) F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia An acute psychotic disorder in which the polymorphic and unstable clinical picture is present, as described in F23.0; despite this instability, however, some symptoms typical of schizophrenia are also in evidence for the majority of the time. If the schizophrenic symptoms persist the diagnosis should be changed to schizophrenia (F20.-). Bouffée délirante ( ) ( ) 精神裂 ( ) 狀精神 ( ) ( ) 精神裂 ( ) 狀 Bouffée délirante with symptoms of schizophrenia Cycloid psychosis with symptoms of schizophrenia F23.2 類精神裂 ( ) 精神 ( ) 精神 ( ) 精神狀立精神裂 ( ) F23.0 不臨若精神裂狀更精神裂 ( )(F20.-) ( ) 精神裂 ( ) ( 列 ) 精神裂 F23.2 Acute schizophrenia-like psychotic disorder An acute psychotic disorder in which the psychotic symptoms are comparatively stable and justify a diagnosis of schizophrenia, but have lasted for less than about one month; the polymorphic unstable features, as described in F23.0, are absent. If the schizophrenic symptoms persist the diagnosis should be changed to schizophrenia (F20.-). Acute (undifferentiated) schizophrenia Brief schizophreniform: 337

28 ( ) disorder 精神 ( ) psychosis 精神 ( ) 精神裂 [ 類精神裂 ( ) ] ( ) (F06.2) 精神裂 ( ) (F20.8) Oneirophrenia Schizophrenic reaction Excludes: organic delusional [schizophrenia -like] disorder (F06.2) schizophreniform disorder NOS (F20.8) F23.3 精神 ( ) 精神 ( ) 臨不立精神裂 ( )(F20.-) 若狀更 (F22.-) F23.3 Other acute predominantly delusional psychotic disorders Acute psychotic disorders in which comparatively stable delusions or hallucinations are the main clinical features, but do not justify a diagnosis of schizophrenia (F20.-). If the delusions persist the diagnosis should be changed to persistent delusional disorder (F22.-). 精神 ( ) Paranoid reaction Psychogenic paranoid psychosis F23.8 精神 ( ) 類 F23.0-F23.3 精神 ( ) F23.8 Other acute and transient psychotic disorders Any other specified acute psychotic disorders for which there is no evidence of organic causation and which do not justify classification to F23.0-F23.3. F23.9 精神 ( ) 精神 ( ) 精神 ( ) F23.9 Acute and transient psychotic disorder, unspecified Brief reactive psychosis NOS Reactive psychosis F24 ( ) 連罹 ( ) 精神 ( ) 來離 F24 Induced delusional disorder A delusional disorder shared by two or more people with close emotional links. Only one of the people suffers from a genuine psychotic disorder; the delusions are induced in the other(s) and usually disappear when the people are separated. 狀 Folie à deux 338

29 ( 列 ) ( ) ( ) Induced: paranoid disorder 精神 ( ) psychotic disorder F25 裂 ( ) ( ) 精神裂狀不立精神裂 ( ) ( ) 若狀精神裂 ( ) 類 F20-F29 不精神狀若不立裂 ( ) F25 Schizoaffective disorders Episodic disorders in which both affective and schizophrenic symptoms are prominent but which do not justify a diagnosis of either schizophrenia or depressive or manic episodes. Other conditions in which affective symptoms are superimposed on a pre-existing schizophrenic illness, or co-exist or alternate with persistent delusional disorders of other kinds, are classified under F20-F29. Mood-incongruent psychotic symptoms in affective disorders do not justify a diagnosis of schizoaffective disorder. F25.0 裂 ( ) F25.0 Schizoaffective disorder, manic type ( ) 精神裂狀不精神裂 ( ) 類復 ( ) 數裂 ( ) A disorder in which both schizophrenic and manic symptoms are prominent so that the episode of illness does not justify a diagnosis of either schizophrenia or a manic episode. This category should be used for both a single episode and a recurrent disorder in which the majority of episodes are schizoaffective, manic type. 裂精神 ( ) 精神裂精神 ( ) Schizoaffective psychosis, manic type Schizophreniform psychosis, manic type F25.1 裂 ( ) F25.1 Schizoaffective disorder, depressive type ( ) 精神裂 ( ) 狀不立精神裂 ( ) 類復 ( ) 裂 ( ) 裂精神 ( ) 339 A disorder in which both schizophrenic and depressive symptoms are prominent so that the episode of illness does not justify a diagnosis of either schizophrenia or a depressive episode. This category should be used for both a single episode and a recurrent disorder in which the majority of episodes are schizoaffective, depressive type. Schizoaffective psychosis, depressive type 精神裂精神 ( ) Schizophreniform psychosis, depressive type

30 F25.2 裂 ( ) 精神裂 ( ) 精神裂精神 ( ) F25.2 Schizoaffective disorder, mixed type Cyclic schizophrenia Mixed schizophrenic and affective psychosis F25.8 裂 ( ) F25.8 Other schizoaffective disorders F25.9 裂 ( ) 裂精神 ( ) F25.9 Schizoaffective disorder, unspecified Schizoaffective psychosis NOS F28 精神 ( ) ( ) 臨不立精神裂 ( )(F20.-) (F22.-) 精神 (F23.-) 精神 (F30.2) 度 (F32.3) 精神 ( ) F28 Other nonorganic psychotic disorders Delusional or hallucinatory disorders that do not justify a diagnosis of schizophrenia (F20.-), persistent delusional disorders (F22.-), acute and transient psychotic disorders (F23.-), psychotic types of manic episode (F30.2), or severe depressive episode (F32.3). Chronic hallucinatory psychosis F29 精神 ( ) 精神 ( ) 精神 [ ] (F99) F29 Unspecified nonorganic psychosis Psychosis NOS Excludes: mental disorder NOS (F99) 狀精神 ( ) (F09) organic or symptomatic psychosis NOS (F09) [ ( )] ( ) (F30-F39) ( 亂 ) ( ) ( ) 量數狀都來易了數復力 Mood [affective] disorders (F30-F39) This block contains disorders in which the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity; most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations. 340

31 F30 類類罹若 ( ) ( ) 都類 ( ) (F31.-) ( ) ( ) F30 Manic episode All the subdivisions of this category should be used only for a single episode. Hypomanic or manic episodes in individuals who have had one or more previous affective episodes (depressive, hypomanic, manic, or mixed) should be coded as bipolar affective disorder (F31.-). Includes: bipolar disorder, single manic episode F30.0 F30.0 Hypomania ( ) ( 數 ) 力量切都利力良說度度不易怒行見樂行行 ( ) A disorder characterized by a persistent mild elevation of mood, increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency. Increased sociability, talkativeness, over-familiarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability. The disturbances of mood and behaviour are not accompanied by hallucinations or delusions. F30.1 ( ) 精神狀不樂 ( ) 狀力度說力不易力率魯不不行 F30.1 Mania without psychotic symptoms Mood is elevated out of keeping with the patient's circumstances and may vary from carefree joviality to almost uncontrollable excitement. Elation is accompanied by increased energy, resulting in overactivity, pressure of speech, and a decreased need for sleep. Attention cannot be sustained, and there is often marked distractibility. Self-esteem is often inflated with grandiose ideas and overconfidence. Loss of normal social inhibitions may result in behaviour that is reckless, foolhardy, or inappropriate to the circumstances, and out of character. 341

32 F30.2 ( ) 精神狀 F30.2 Mania with psychotic symptoms 了 F30.1 臨 ( ) ( 說 ) ( ) 度度念理 ( ) ( ) 精神狀 ( ) 不精神狀 In addition to the clinical picture described in F30.1, delusions (usually grandiose) or hallucinations (usually of voices speaking directly to the patient) are present, or the excitement, excessive motor activity, and flight of ideas are so extreme that the subject is incomprehensible or inaccessible to ordinary communication. Mania with: mood-congruent psychotic symptoms mood-incongruent psychotic symptoms Manic stupor F30.8 ( ) F30.8 Other manic episodes F30.9 ( ) F30.9 Manic episode, unspecified Mania NOS F31 ( ) ( ) ( ) 量量力 ( ) 量力降 ( ) 類 (F31.8) F31 Bipolar affective disorder A disorder characterized by two or more episodes in which the patient's mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression). Repeated episodes of hypomania or mania only are classified as bipolar (F31.8). ( 不 ) Includes: manic-depressive: illness 精神 ( ) psychosis reaction ( ) ( ) (F30.-) Excludes: bipolar disorder, single manic episode (F30.-) ( ) (F34.0) cyclothymia (F34.0) F31.0 ( ) ( ) F31.0 Bipolar affective disorder, current episode hypomanic ( ) 342 The patient is currently hypomanic, and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in

33 the past. F31.1 ( ) ( ) ( ) 精神狀 ( ) 精神狀 (F30.1) ( ) F31.1 Bipolar affective disorder, current episode manic without psychotic symptoms The patient is currently manic, without psychotic symptoms (as in F30.1), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past. F31.2 ( ) ( ) ( ) 精神狀精神 (F30.2) ( ) F31.2 Bipolar affective disorder, current episode manic with psychotic symptoms The patient is currently manic, with psychotic symptoms (as in F30.2), and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past. F31.3 ( ) ( ) ( ) 度度 ( ) 度度 ( ) (F32.0 F32.1) F31.3 Bipolar affective disorder, current episode mild or moderate depression The patient is currently depressed, as in a depressive episode of either mild or moderate severity (F32.0 or F32.1), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past. F31.4 ( ) ( ) ( ) 精神狀度 ( ) ( ) 精神狀度 (F32.2) F31.4 Bipolar affective disorder, current episode severe depression without psychotic symptoms The patient is currently depressed, as in severe depressive episode without psychotic symptoms (F32.2), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past. F31.5 ( ) ( ) ( ) 精神狀度 ( ) ( ) 精神狀度 F31.5 Bipolar affective disorder, current episode severe depression with psychotic symptoms The patient is currently depressed, as in severe depressive episode with psychotic 343

34 (F32.3) symptoms (F32.3), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past. F31.6 ( ) ( ) ( ) 狀 ( ) (F38.0) F31.6 Bipolar affective disorder, current episode mixed The patient has had at least one authenticated hypomanic, manic, depressive, or mixed affective episode in the past, and currently exhibits either a mixture or a rapid alteration of manic and depressive symptoms. Excludes: single mixed affective episode (F38.0) F31.7 ( ) ( ) ( ) ( 亂 ) 療 F31.7 Bipolar affective disorder, currently in remission The patient has had at least one authenticated hypomanic, manic, or mixed affective episode in the past, and at least one other affective episode (hypomanic, manic, depressive, or mixed) in addition, but is not currently suffering from any significant mood disturbance, and has not done so for several months. Periods of remission during prophylactic treatment should be coded here. F31.8 ( ) ( ) F31.8 Other bipolar affective disorders ( ) Bipolar disorder ( ) Recurrent manic episodes F31.9 ( ) ( ) F31.9 Bipolar affective disorder, unspecified F32 ( ) 度度度 ( ) 落力降降樂力惡念 F32 Depressive episode In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and 344

35 不不 ( ) 狀更來精神狀數度 ( ) 度度度 appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present. The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called "somatic" symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours before the usual time, depression worst in the morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido. Depending upon the number and severity of the symptoms, a depressive episode may be specified as mild, moderate or severe. 列 Includes: single episodes of: ( ) depressive reaction ( ) psychogenic depression ( ) reactive depression ( ) (F43.2) Excludes: adjustment disorder (F43.2) ( ) ( ) (F33.-) recurrent depressive disorder (F33.-) ( )F91.- 行 ( ) (F92.0) when associated with conduct disorders in F91.- (F92.0) F32.0 度 ( ) F32.0 Mild depressive episode 狀狀行 Two or three of the above symptoms are usually present. The patient is usually distressed by these but will probably be able to continue with most activities. F32.1 度 ( ) F32.1 Moderate depressive episode 狀更行 Four or more of the above symptoms are usually present and the patient is likely to have great difficulty in continuing with ordinary activities. F32.2 度 ( ) ( ) 精神狀 F32.2 Severe depressive episode without psychotic symptoms 345

36 ( ) 狀狀惡殺念行見狀 An episode of depression in which several of the above symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt. Suicidal thoughts and acts are common and a number of "somatic" symptoms are usually present. ( ) ( ) Agitated depression ( ) 精神狀 Major depression ( ) Vital depression single episode without psychotic symptoms F32.3 ( ) 精神狀度 ( ) F32.2 ( ) 精神狀行殺不列 ( ) ( ) 精神狀 ( ) 精神 ( ) 精神 ( ) ( ) 精神 ( ) F32.3 Severe depressive episode with psychotic symptoms An episode of depression as described in F32.2, but with the presence of hallucinations, delusions, psychomotor retardation, or stupor so severe that ordinary social activities are impossible; there may be danger to life from suicide, dehydration, or starvation. The hallucinations and delusions may or may not be mood-congruent. Single episodes of: major depression with psychotic symptoms psychogenic depressive psychosis psychotic depression reactive depressive psychosis F32.8 ( ) F32.8 Other depressive episodes ( ) Atypical depression 匿 ( ) Single episodes of "masked" depression NOS F32.9 ( ) F32.9 Depressive episode, unspecified ( ) Depression NOS ( ) ( ) Depressive disorder NOS F33 ( ) ( ) ( ) ( ) (F32.-) ( ) 力 ( ) F33 Recurrent depressive disorder A disorder characterized by repeated episodes of depression as described for depressive episode (F32.-), without any history of independent episodes of mood 346

37 ( ) 立度 ( ) 療 ( ) 類 (F33.2 F33.3) ( ) ( ) 念 ( ) 老年年論歷 ( ) ( ) 不若了更 ( ) (F31.-) elevation and increased energy (mania). There may, however, be brief episodes of mild mood elevation and overactivity (hypomania) immediately after a depressive episode, sometimes precipitated by anti-depressant treatment. The more severe forms of recurrent depressive disorder (F33.2 and F33.3) have much in common with earlier concepts such as manic-depressive depression, melancholia, vital depression and endogenous depression. The first episode may occur at any age from childhood to old age, the onset may be either acute or insidious, and the duration varies from a few weeks to many months. The risk that a patient with recurrent depressive disorder will have an episode of mania never disappears completely, however many depressive episodes have been experienced. If such an episode does occur, the diagnosis should be changed to bipolar affective disorder (F31.-). 列 ( ) ( ) ( ) ( ) ( ) ( ) ( ) (F38.1) Includes: recurrent episodes of: depressive reaction psychogenic depression reactive depression seasonal depressive disorder Excludes: recurrent brief depressive episodes (F38.1) F33.0 ( ) ( ) 度 ( ) ( ) 度 F32.0 ( ) F33.0 Recurrent depressive disorder, current episode mild A disorder characterized by repeated episodes of depression, the current episode being mild, as in F32.0, and without any history of mania. F33.1 ( ) ( ) 度 ( ) ( ) 度 F32.1 ( F33.1 Recurrent depressive disorder, current episode moderate A disorder characterized by repeated episodes of depression, the current episode being of moderate severity, as in F32.1, and 347

38 ) without any history of mania. F33.2 ( ) ( ) ( ) 精神狀度 ( ) ( ) 度 ( ) 精神狀 F32.2 ( ) F33.2 Recurrent depressive disorder, current episode severe without psychotic symptoms A disorder characterized by repeated episodes of depression, the current episode being severe without psychotic symptoms, as in F32.2, and without any history of mania. ( ) ( ) 精神狀 ( ) ( ) ( ) 精神狀精神 ( ) ( ) 精神狀 ( ) ( ) ( ) 精神狀 Endogenous depression without psychotic symptoms Major depression, recurrent without psychotic symptoms Manic-depressive psychosis, depressed type without psychotic symptoms Vital depression, recurrent without psychotic symptoms F33.3 ( ) ( ) ( ) 精神狀度 F33.3 Recurrent depressive disorder, current episode severe with psychotic symptoms ( ) ( ) ( ) 精神狀度 F32.3 A disorder characterized by repeated episodes of depression, the current episode being severe with psychotic symptoms, as in F32.3, and with no previous episodes of mania. ( ) ( ) 精神狀精神 ( ) ( ) 精神狀 Endogenous depression with psychotic symptoms Manic-depressive psychosis, depressed type with psychotic symptoms 列度 Recurrent severe episodes of: ( ) ( ) 精神 major depression with psychotic symptoms 狀 ( ) 精神 ( ) psychogenic depressive psychosis 精神 ( ) ( ) 精神 ( ) psychotic depression reactive depressive psychosis F33.4 ( ) ( ) F33.0-F33.3 F33.4 Recurrent depressive disorder, currently in remission The patient has had two or more depressive 348

39 ( ) ( ) 狀 episodes as described in F33.0-F33.3, in the past, but has been free from depressive symptoms for several months. F33.8 ( ) ( ) F33.9 ( ) ( ) ( ) F33.8 Other recurrent depressive disorders F33.9 Recurrent depressive disorder, unspecified Monopolar depression NOS F34 [ ( )] ( ) ( ) 數度 ( ) 數年年例 ( ) ( ) F34 Persistent mood [affective] disorders Persistent and usually fluctuating disorders of mood in which the majority of the individual episodes are not sufficiently severe to warrant being described as hypomanic or mild depressive episodes. Because they last for many years, and sometimes for the greater part of the patient's adult life, they involve considerable distress and disability. In some instances, recurrent or single manic or depressive episodes may become superimposed on a persistent affective disorder. F34.0 ( ) F34.0 Cyclothymia 不 ( ) 度度都不立 ( )(F31.-) ( ) ( )(F33.-) 見 ( )(F31.-) ( ) ( ) A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). This disorder is frequently found in the relatives of patients with bipolar affective disorder. Some patients with cyclothymia eventually develop bipolar affective disorder. ( ) Affective personality disorder Cycloid personality Cyclothymic personality F34.1 ( ) F34.1 Dysthymia 349

40 數年度不立度度度 ( ) ( )(F33.-) ( 列 )( ) 精神 ( ) 精神 ( ) [* 年 ] ( ) ( 度不 ) (F41.2) A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder (F33.-). Depressive: neurosis personality disorder Neurotic depression Persistent anxiety depression Excludes: anxiety depression (mild or not persistent) (F41.2) F34.8 [ ( )] ( ) F34.9 [ ( )] ( ) F34.8 Other persistent mood [affective] disorders F34.9 Persistent mood [affective] disorder, unspecified F38 [ ( )] ( ) F38 Other mood [affective] disorders 度不類 F30- F34( 類 ) ( ) ( ) Any other mood disorders that do not justify classification to F30-F34, because they are not of sufficient severity or duration. F38.0 [ ( )] ( ) ( ) F38.1 [ ( )] ( ) ( ) ( ) F38.8 [ ( )] ( ) F38.0 Other single mood [affective] disorders Mixed affective episode F38.1 Other recurrent mood [affective] disorders Recurrent brief depressive episodes F38.8 Other specified mood [affective] disorders F39 [ ( )] ( ) 精神 ( ) F39 Unspecified mood [affective] disorder Affective psychosis NOS 力 ( ) (F40-F48) Neurotic, stress-related and somatoform disorders (F40-F48) 350

41 ( )F91.- 行 ( ) (F92.8) Excludes: when associated with conduct disorders in F91.- (F92.8) F40 ( )[ ] ( ) ( ) 諸狀 ( ) ( ) ( ) ( ) 兩兩兩療量 F40 Phobic anxiety disorders A group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous. As a result these situations are characteristically avoided or endured with dread. The patient's concern may be focused on individual symptoms like palpitations or feeling faint and is often associated with secondary fears of dying, losing control, or going mad. Contemplating entry to the phobic situation usually generates anticipatory anxiety. Phobic anxiety and depression often coexist. Whether two diagnoses, phobic anxiety and depressive episode, are needed, or only one, is determined by the time course of the two conditions and by therapeutic considerations at the time of consultation. F40.0 F40.0 Agoraphobia ( ) 離車車 ( ) ( ) 狀 ( ) [ ] A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes. Panic disorder is a frequent feature of both present and past episodes. Depressive and obsessional symptoms and social phobias are also commonly present as subsidiary features. Avoidance of the phobic situation is often prominent, and some agoraphobics experience little anxiety because they are able to avoid their phobic situations. Agoraphobia without history of panic disorder [ ] ( ) Panic disorder with agoraphobia F40.1 F40.1 Social phobias 尿 351 Fear of scrutiny by other people leading to avoidance of social situations. More pervasive social phobias are usually associated with low self-esteem and fear of ii i h l i

42 狀 criticism. They may present as a complaint of blushing, hand tremor, nausea, or urgency of micturition, the patient sometimes being convinced that one of these secondary manifestations of their anxiety is the primary problem. Symptoms may progress to panic attacks. ( ) ( ) 精神 Anthropophobia Social neurosis F40.2 ( 立 ) F40.2 Specific (isolated) phobias 雷便療見流連 Phobias restricted to highly specific situations such as proximity to particular animals, heights, thunder, darkness, flying, closed spaces, urinating or defecating in public toilets, eating certain foods, dentistry, or the sight of blood or injury. Though the triggering situation is discrete, contact with it can evoke panic as in agoraphobia or social phobia. ( ) Acrophobia Animal phobias ( ) Claustrophobia Simple phobia ( ) (F45.2) Excludes: dysmorphophobia (nondelusional) (F45.2) (F45.2) nosophobia (F45.2) F40.8 ( )[ ] F40.9 ( )[ ] 狀 F40.8 Other phobic anxiety disorders F40.9 Phobic anxiety disorder, unspecified Phobia NOS Phobic state NOS F41 ( )[ ] F41 Other anxiety disorders 狀 ( ) 不狀 352 Disorders in which manifestation of anxiety is the major symptom and is not restricted to any particular environmental situation.

43 狀不 Depressive and obsessional symptoms, and even some elements of phobic anxiety, may also be present, provided that they are clearly secondary or less severe. F41.0 ( )[ ] ( ) 不不狀暈不 ( ) ( ) 若 ( ) ( ) 不 ( ) F41.0 Panic disorder [episodic paroxysmal anxiety] The essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable. As with other anxiety disorders, the dominant symptoms include sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization). There is often also a secondary fear of dying, losing control, or going mad. Panic disorder should not be given as the main diagnosis if the patient has a depressive disorder at the time the attacks start; in these circumstances the panic attacks are probably secondary to depression. ( ) Panic: attack 狀 state ( ) ( ) (F40.0) Excludes: panic disorder with agoraphobia (F40.0) F41.1 ( ) ( ) [ ] F41.1 Generalized anxiety disorder 353

44 不 ( ) 狀異神暈不 Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances (i.e. it is "free-floating"). The dominant symptoms are variable but include complaints of persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort. Fears that the patient or a relative will shortly become ill or have an accident are often expressed. ( ) Anxiety: 精神 neurosis reaction 狀 state 神 (F48.0) Excludes: neurasthenia (F48.0) F41.2 ( ) ( ) 類狀若來度立 ( ) 狀立兩都列不類 ( 度不 ) ( ) F41.2 Mixed anxiety and depressive disorder This category should be used when symptoms of anxiety and depression are both present, but neither is clearly predominant, and neither type of symptom is present to the extent that justifies a diagnosis if considered separately. When both anxiety and depressive symptoms are present and severe enough to justify individual diagnoses, both diagnoses should be recorded and this category should not be used. Anxiety depression (mild or not persistent) F41.3 ( ) F41.3 Other mixed anxiety disorders 狀 F42-F48( 類 ) 若類狀不立 Symptoms of anxiety mixed with features of other disorders in F42-F48. Neither type of symptom is severe enough to justify a diagnosis if considered separately. F41.8 ( )[ ] F41.8 Other specified anxiety disorders 354

45 里 F41.9 ( ) [ ] ( ) Anxiety hysteria F41.9 Anxiety disorder, unspecified Anxiety NOS F42 ( )[ ] ( ) ( ) 念 ( ) 都惡念行行不不令不不行屢若更 F42 Obsessive-compulsive disorder The essential feature is recurrent obsessional thoughts or compulsive acts. Obsessional thoughts are ideas, images, or impulses that enter the patient's mind again and again in a stereotyped form. They are almost invariably distressing and the patient often tries, unsuccessfully, to resist them. They are, however, recognized as his or her own thoughts, even though they are involuntary and often repugnant. Compulsive acts or rituals are stereotyped behaviours that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks. Their function is to prevent some objectively unlikely event, often involving harm to or caused by the patient, which he or she fears might otherwise occur. Usually, this behaviour is recognized by the patient as pointless or ineffectual and repeated attempts are made to resist. Anxiety is almost invariably present. If compulsive acts are resisted the anxiety gets worse. 精神精神 ( ) (F60.5) Includes: anankastic neurosis obsessive-compulsive neurosis Excludes: obsessive-compulsive personality (disorder) (F60.5) F42.0 F42.0 Predominantly obsessional thoughts or ruminations 念 These may take the form of ideas, mental ( images, or impulses to act, which are nearly ) 念 always distressing to the subject. Sometimes the ideas are an indecisive, endless consideration of alternatives, ( ) associated with an inability to make trivial 連切 ( but necessary decisions in day-to-day ) ( ) living. The relationship between 不 obsessional ruminations and depression is particularly close and a diagnosis of 355

46 obsessive-compulsive disorder should be preferred only if ruminations arise or persist in the absence of a depressive episode. F42.1 ( )[ ] 數 ( ) 都 ( ) 不行 ( ) 了 F42.1 Predominantly compulsive acts [obsessional rituals] The majority of compulsive acts are concerned with cleaning (particularly handwashing), repeated checking to ensure that a potentially dangerous situation has not been allowed to develop, or orderliness and tidiness. Underlying the overt behaviour is a fear, usually of danger either to or caused by the patient, and the ritual is an ineffectual or symbolic attempt to avert that danger. F42.2 ( ) F42.2 Mixed obsessional thoughts and acts F42.8 ( ) F42.8 Other obsessive-compulsive disorders F42.9 ( ) F42.9 Obsessive-compulsive disorder, unspecified F43 力 ( ) 類不不狀兩 ( ) 力力不 ( ) 不理力 ( ) 類不朗異不不 ( ) 來力 ( ) 力不不力不良 F43 Reaction to severe stress, and adjustment disorders This category differs from others in that it includes disorders identifiable on the basis of not only symptoms and course but also the existence of one or other of two causative influences: an exceptionally stressful life event producing an acute stress reaction, or a significant life change leading to continued unpleasant circumstances that result in an adjustment disorder. Although less severe psychosocial stress ("life events") may precipitate the onset or contribute to the presentation of a very wide range of disorders classified elsewhere in this chapter, its etiological importance is not always clear and in each case will be found to depend on individual, often idiosyncratic, vulnerability, i.e. the life events are neither necessary nor sufficient to explain the occurrence and form of the disorder. In contrast, the disorders brought together here are thought to arise always as a direct consequence of acute severe stress or continued trauma. The stressful 356

47 events or the continuing unpleasant circumstances are the primary and overriding causal factor and the disorder would not have occurred without their impact. The disorders in this section can thus be regarded as maladaptive responses to severe or continued stress, in that they interfere with successful coping mechanisms and therefore lead to problems of social functioning. F43.0 力 F43.0 Acute stress reaction 精神精神力數數力力度臨狀識領力理刺力來 ( 離狀度 F44.2) 度 [ ( ) 離 ( 神 )] 神 ( ) 狀力刺數 ( 數 ) ( 參 F44.0) 若狀 A transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days. Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions. The symptoms show a typically mixed and changing picture and include an initial state of "daze" with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, and disorientation. This state may be followed either by further withdrawal from the surrounding situation (to the extent of a dissociative stupor-f44.2), or by agitation and over-activity (flight reaction or fugue). Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are commonly present. The symptoms usually appear within minutes of the impact of the stressful stimulus or event, and disappear within two to three days (often within hours). Partial or complete amnesia (F44.0) for the episode may be present. If the symptoms persist, a change in diagnosis should be considered. ( 列 ) 力狀精神 Acute: crisis reaction reaction to stress Combat fatigue Crisis state Psychic shock 357

48 F43.1 力 ( )[PTSD] F43.1 Post-traumatic stress disorder 力力來類異 ( ) 精神 ( ) 臨降惡不不 [ (flashbacks)] 離樂 ( 聯 ) 神度狀 ( ) 度易狀殺念不見數數 (* 六 ) 都復不年 (F62.0) Arises as a delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. Predisposing factors, such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness, may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence. Typical features include episodes of repeated reliving of the trauma in intrusive memories ("flashbacks"), dreams or nightmares, occurring against the persisting background of a sense of "numbness" and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situations reminiscent of the trauma. There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety and depression are commonly associated with the above symptoms and signs, and suicidal ideation is not infrequent. The onset follows the trauma with a latency period that may range from a few weeks to months. The course is fluctuating but recovery can be expected in the majority of cases. In a small proportion of cases the condition may follow a chronic course over many years, with eventual transition to an enduring personality change (F62.0). 精神 Traumatic neurosis F43.2 ( )[ ] F43.2 Adjustment disorders 狀力力 358 States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant

49 路狀 ( 離 ) 更 ( 狀 ) ( ) 力不臨 ( ) 例行度行 ( 行 ) 連年行 ( 行 ) life change or a stressful life event. The stressor may have affected the integrity of an individual's social network (bereavement, separation experiences) or the wider system of social supports and values (migration, refugee status), or represented a major developmental transition or crisis (going to school, becoming a parent, failure to attain a cherished personal goal, retirement). Individual predisposition or vulnerability plays an important role in the risk of occurrence and the shaping of the manifestations of adjustment disorders, but it is nevertheless assumed that the condition would not have arisen without the stressor. The manifestations vary and include depressed mood, anxiety or worry (or mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some degree of disability in the performance of daily routine. Conduct disorders may be an associated feature, particularly in adolescents. The predominant feature may be a brief or prolonged depressive reaction, or a disturbance of other emotions and conduct. ( ) ( ) ( ) 離 (F93.0) Culture shock Grief reaction Hospitalism in children Excludes: separation anxiety disorder of childhood (F93.0) F43.8 力 F43.8 Other reactions to severe stress F43.9 力 F43.9 Reaction to severe stress, unspecified F44 離 ( )[ ] ( ) [ 離 ] 離論類 F44 Dissociative [conversion] disorders The common themes that are shared by dissociative or conversion disorders are a partial or complete loss of the normal integration between memories of the past, 359

50 離狀數數復切連類不類里離連狀念療神說類狀理力神類 (F45.0) 精神 awareness of identity and immediate sensations, and control of bodily movements. All types of dissociative disorders tend to remit after a few weeks or months, particularly if their onset is associated with a traumatic life event. More chronic disorders, particularly paralyses and anaesthesias, may develop if the onset is associated with insoluble problems or interpersonal difficulties. These disorders have previously been classified as various types of "conversion hysteria". They are presumed to be psychogenic in origin, being associated closely in time with traumatic events, insoluble and intolerable problems, or disturbed relationships. The symptoms often represent the patient's concept of how a physical illness would be manifest. Medical examination and investigation do not reveal the presence of any known physical or neurological disorder. In addition, there is evidence that the loss of function is an expression of emotional conflicts or needs. The symptoms may develop in close relationship to psychological stress, and often appear suddenly. Only disorders of physical functions normally under voluntary control and loss of sensations are included here. Disorders involving pain and other complex physical sensations mediated by the autonomic nervous system are classified under somatization disorder (F45.0). The possibility of the later appearance of serious physical or psychiatric disorders should always be kept in mind. ( ) Includes: conversion: ( ) 里 hysteria ( ) reaction 里 hysteria 里精神 ( ) hysterical psychosis [ 識 ] (Z76.5) Excludes: malingering [conscious simulation] (Z76.5) 360

51 F44.0 離 ( ) F44.0 Dissociative amnesia 度力不勞來不見 (F44.1) 列 ( F44.1) 若精神不 The main feature is loss of memory, usually of important recent events, that is not due to organic mental disorder, and is too great to be explained by ordinary forgetfulness or fatigue. The amnesia is usually centred on traumatic events, such as accidents or unexpected bereavements, and is usually partial and selective. Complete and generalized amnesia is rare, and is usually part of a fugue (F44.1). If this is the case, the disorder should be classified as such. The diagnosis should not be made in the presence of organic brain disorders, intoxication, or excessive fatigue. 精精神 [F10-F19 ( ) 4.6 ] ( 列 ) ( ) (R41.3) 行 (R41.1) 行 (R41.2) 精 (F04) ( ) (G40.-) Excludes: alcohol- or other psychoactive substance-induced amnesic disorder (F10-F19 with common fourth character.6) amnesia: NOS (R41.3) anterograde (R41.1) retrograde (R41.2) nonalcoholic organic amnesic syndrome (F04) postictal amnesia in epilepsy (G40.-) F44.1 離 ( ) F44.1 Dissociative fugue 離立來行 ( ) ( ) (G40.-) Dissociative fugue has all the features of dissociative amnesia, plus purposeful travel beyond the usual everyday range. Although there is amnesia for the period of the fugue the patient's behaviour during this time may appear completely normal to independent observers. Excludes: postictal fugue in epilepsy (G40.-) F44.2 離 ( ) F44.2 Dissociative stupor 361

52 離 ( ) 刺力理 ( ) Dissociative stupor is diagnosed on the basis of a profound diminution or absence of voluntary movement and normal responsiveness to external stimuli such as light, noise, and touch, but examination and investigation reveal no evidence of a physical cause. In addition, there is positive evidence of psychogenic causation in the form of recent stressful events or problems. ( ) (F06.1) ( 列 ) stupor: Excludes: organic catatonic disorder (F06.1) (R40.1) NOS (R40.1) (F20.2) catatonic (F20.2) ( ) (F31-F33) depressive (F31-F33) (F30.2) manic (F30.2) F44.3 ( ) F44.3 Trance and possession disorders 類識力不狀 ( ) 列狀精神 ( ) (F23.-) ( ) (F07.0) (F07.2) Disorders in which there is a temporary loss of the sense of personal identity and full awareness of the surroundings. Include here only trance states that are involuntary or unwanted, occurring outside religious or culturally accepted situations. Excludes: states associated with: acute and transient psychotic disorders (F23.-) organic personality disorder (F07.0) postconcussional syndrome (F07.2) 精神 [F10-19 ( ) 4.0 ] psychoactive substance intoxication (F10-F19 with common fourth character.0) 精神裂 ( ) (F20.-) schizophrenia (F20.-) F44.4 離 ( ) F44.4 Dissociative motor disorders 見力類列類 ( ) 不 ( ) 不不良 ( ) In the commonest varieties there is loss of ability to move the whole or a part of a limb or limbs. There may be close resemblance to almost any variety of ataxia, apraxia, akinesia, aphonia, dysarthria, dyskinesia, seizures, or paralysis. 362

53 ( 列 ) Psychogenic: aphonia dysphonia F44.5 離 ( ) F44.5 Dissociative convulsions 離 ( )[ ] 離 ( ) 尿不識 Dissociative convulsions may mimic epileptic seizures very closely in terms of movements, but tongue-biting, bruising due to falling, and incontinence of urine are rare, and consciousness is maintained or replaced by a state of stupor or trance. F44.6 離 ( ) F44.6 Dissociative anaesthesia and sensory loss 念識神來異離聾 Anaesthetic areas of skin often have boundaries that make it clear that they are associated with the patient's ideas about bodily functions, rather than medical knowledge. There may be differential loss between the sensory modalities which cannot be due to a neurological lesion. Sensory loss may be accompanied by complaints of paraesthesia. Loss of vision and hearing are rarely total in dissociative disorders. Psychogenic deafness F44.7 離 ( )[ ] ( ) *[ 離 ( ) ] F44.0-F44.6 類 ( 聯 ) ( ) F44.7 Mixed dissociative [conversion] disorders Combination of disorders specified in F44.0-F44.6 F44.8 離 ( )[ ] ( ) F44.8 Other dissociative [conversion] disorders Ganser ( ) Ganser's syndrome Multiple personality ( 列 ) Psychogenic: 亂 confusion 狀 twilight state F44.9 離 ( )[ ] ( ) F44.9 Dissociative [conversion] disorder, unspecified 363

54 F45 ( )[ ] 狀療不什狀度 F45 Somatoform disorders The main feature is repeated presentation of physical symptoms together with persistent requests for medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupation of the patient. 離 ( ) (F44.-) Excludes: dissociative disorders (F44.-) ( ) (F98.4) hair-plucking (F98.4) [ ] 不 (F80.0) lalling (F80.0) [ ] 不 (F80.8) lisping (F80.8) (F98.8) nail-biting (F98.8) ( ) 類理行 (F54) psychological or behavioural factors associated with disorders or diseases classified elsewhere (F54) ( ) 不良 ( ) sexual dysfunction, not caused by organic disorder or disease (F52.-) (F52.-) (F98.8) thumb-sucking (F98.8) [ ( ) 年 ] ( ) (F95.-) tic disorders (in childhood and adolescence) (F95.-) Tourette ( ) (F95.2) Tourette's syndrome (F95.2) ( ) (F63.3) trichotillomania (F63.3) F45.0 ( )[ ] F45.0 Somatization disorder 364

55 兩年狀數療異都狀不 ( ) ( 例兩年 ) 狀不類類 ( ) (F45.1) The main features are multiple, recurrent and frequently changing physical symptoms of at least two years' duration. Most patients have a long and complicated history of contact with both primary and specialist medical care services, during which many negative investigations or fruitless exploratory operations may have been carried out. Symptoms may be referred to any part or system of the body. The course of the disorder is chronic and fluctuating, and is often associated with disruption of social, interpersonal, and family behaviour. Short-lived (less than two years) and less striking symptom patterns should be classified under undifferentiated somatoform disorder (F45.1). Briquet ( ) ( )[ ] ( )[ ] ( )[ ] (Z76.5) Briquet s disorder Multiple psychosomatic disorder Excludes: malingering [conscious simulation] (Z76.5) F45.1 ( )[ ] 臨 F45.1 Undifferentiated somatoform disorder When somatoform complaints are multiple, varying and persistent, but the complete and typical clinical picture of somatization disorder is not fulfilled, the diagnosis of undifferentiated somatoform disorder should be considered. ( )[ ] Undifferentiated psychosomatic disorder F45.2 ( )[ ] F45.2 Hypochondriacal disorder 365

56 了更益惡念不不來不令 The essential feature is a persistent preoccupation with the possibility of having one or more serious and progressive physical disorders. Patients manifest persistent somatic complaints or a persistent preoccupation with their physical appearance. Normal or commonplace sensations and appearances are often interpreted by patients as abnormal and distressing, and attention is usually focused upon only one or two organs or systems of the body. Marked depression and anxiety are often present, and may justify additional diagnoses. ( ) 精神 (F22.8) 狀 (F22.-) Body dysmorphic disorder Dysmorphophobia (nondelusional) Hypochondriacal neurosis Hypochondriasis Nosophobia Excludes: delusional dysmorphophobia (F22.8) fixed delusions about bodily functions or shape (F22.-) F45.3 神 ( ) 不良 ( 異 )( ) 狀神例泌尿狀兩 ( ) 神狀 ( ) 狀沈 F45.3 Somatoform autonomic dysfunction Symptoms are presented by the patient as if they were due to a physical disorder of a system or organ that is largely or completely under autonomic innervation and control, i.e. the cardiovascular, gastrointestinal, respiratory and urogenital systems. The symptoms are usually of two types, neither of which indicates a physical disorder of the organ or system concerned. First, there are complaints based upon objective signs of autonomic arousal, such as palpitations, sweating, flushing, tremor, and expression of fear and distress about the possibility of a physical disorder. Second, there are subjective complaints of a nonspecific or changing nature such as fleeting aches and pains, sensations of burning, heaviness, tightness, and feelings of being bloated or distended, which are referred by the patient 366

57 to a specific organ or system. ( ) 精神 Da Costa ( ) 精神神 ( 列 ) 痢不良尿度尿 ( ) 類理行 (F54) Cardiac neurosis Da Costa's syndrome Gastric neurosis Neurocirculatory asthenia Psychogenic forms of: aerophagy cough diarrhoea dyspepsia dysuria flatulence hiccough hyperventilation increased frequency of micturition irritable bowel syndrome pylorospasm Excludes: psychological and behavioural factors associated with disorders or diseases classified elsewhere (F54) F45.4 ( ) 理來理療 ( ) 精神裂 ( ) 不 F45.4 Persistent somatoform pain disorder The predominant complaint is of persistent, severe, and distressing pain, which cannot be explained fully by a physiological process or a physical disorder, and which occurs in association with emotional conflict or psychosocial problems that are sufficient to allow the tconclusion that they are the main causative influences. The result is usually a marked increase in support and attention, either personal or medical. Pain presumed to be of psychogenic origin occurring during the course of depressive disorders or schizophrenia should not be included here. ( 列 ) ( ) 367 Psychalgia Psychogenic: backache headache Somatoform pain disorder

58 (M54.9) Excludes: backache NOS (M54.9) ( 列 ) pain: (R52.9) NOS (R52.9) (R52.0) acute (R52.0) (R52.2) chronic (R52.2) (R52.1) intractable (R52.1) (G44.2) tension headache (G44.2) F45.8 ( )[ ] ( ) 行狀神力切聯 ( 列 ) ( ) 里 ( ) F45.8 Other somatoform disorders Any other disorders of sensation, function and behaviour, not due to physical disorders, which are not mediated through the autonomic nervous system, which are limited to specific systems or parts of the body, and which are closely associated in time with stressful events or problems. Psychogenic: dysmenorrhoea dysphagia, including "globus hystericus" pruritus torticollis Teeth-grinding F45.9 ( )[ ] ( ) F45.9 Somatoform disorder, unspecified Psychosomatic disorder NOS F48 精神 ( ) ( ) [ 精神 ] F48 Other neurotic disorders F48.0 神 ( ) F48.0 Neurasthenia ( 異 ) 兩類類精神 ( ) ( ) 率精神狀不不聯力率來類 ( ) 兩類 Considerable cultural variations occur in the presentation of this disorder, and two main types occur, with substantial overlap. In one type, the main feature is a complaint of increased fatigue after mental effort, often associated with some decrease in occupational performance or coping efficiency in daily tasks. The mental fatiguability is typically described as an unpleasant intrusion of distracting associations or recollections, difficulty in 368

59 ( ) 不暈降易怒樂度都見度 concentrating, and generally inefficient thinking. In the other type, the emphasis is on feelings of bodily or physical weakness and exhaustion after only minimal effort, accompanied by a feeling of muscular aches and pains and inability to relax. In both types a variety of other unpleasant physical feelings is common, such as dizziness, tension headaches, and feelings of general instability. Worry about decreasing mental and bodily well-being, irritability, anhedonia, and varying minor degrees of both depression and anxiety are all common. Sleep is often disturbed in its initial and middle phases but hypersomnia may also be prominent. 勞 ( 不 ) Fatigue syndrome Use additional code, if desired, to identify previous physical illness. ( 力 ) (R53) Excludes: asthenia NOS (R53) ( 勞 ) (Z73.0) burn-out (Z73.0) 不勞 (R53) malaise and fatigue (R53) ( ) 勞 (G93.3) postviral fatigue syndrome (G93.3) 精神 ( ) (F48.8) psychasthenia (F48.8) F48.1 [ ] 見精神狀離識 [ ] 狀 ( ) 精神裂 ( ) 列 F48.1 Depersonalization-derealization syndrome A rare disorder in which the patient complains spontaneously that his or her mental activity, body, and surroundings are changed in their quality, so as to be unreal, remote, or automatized. Among the varied phenomena of the syndrome, patients complain most frequently of loss of emotions and feelings of estrangement or detachment from their thinking, their body, or the real world. In spite of the dramatic nature of the experience, the patient is aware of the unreality of the change. The sensorium is normal and the capacity for emotional expression intact. Depersonalization-derealization symptoms may occur as part of a diagnosable schizophrenic, depressive, phobic, or 369

60 obsessive-compulsive disorder. In such cases the diagnosis should be that of the main disorder. F48.8 精神 ( ) [ 精神 ] F48.8 Other specified neurotic disorders Briquet ( ) ( ) Dhat ( ) 精神精神 ( ) 精神精神暈 Briquet s disorder Dhat syndrome Occupational neurosis, including writer's cramp Psychasthenia Psychasthenic neurosis Psychogenic syncope F48.9 精神 ( )[ 精神 ] 精神 F48.9 Neurotic disorder, unspecified Neurosis NOS ( ) 理 ( 亂 ) 行 (F50-F59) Behavioural syndromes associated with physiological disturbances and physical factors (F50-F59) F50 ( ) ( ) F50 Eating disorders ( ) (R63.0) Excludes: anorexia NOS (R63.0) ( 列 ) ( ) feeding: 理不 (R63.3) difficulties and mismanagement (R63.3) ( ) ( ) (F98.2) disorder of infancy or childhood (F98.2) (R63.2) polyphagia (R63.2) F50.0 神 [ ] ( ) F50.0 Anorexia nervosa 年女年年女年年年 ( ) 年年女精神理念度不度不良 ( 370 A disorder characterized by deliberate weight loss, induced and sustainedby the patient. It occurs most commonly in adolescent girls and young women, but adolescent boys and young men may also be affected, as may children approaching puberty and older women up to the menopause. The disorder is associated with a specific psychopathology whereby a dread of fatness and flabbiness of body contour persists as an intrusive overvalued idea, and

61 ) 泌 ( ) 狀度利尿 the patients impose a low weight threshold on themselves. There is usually undernutrition of varying severity with secondary endocrine and metabolic changes and disturbances of bodily function. The symptoms include restricted dietary choice, excessive exercise, induced vomiting and purgation, and use of appetite suppressants and diuretics. (R63.0) (F50.8) Excludes: loss of appetite (R63.0) psychogenic (F50.8) F50.1 神 [ ] ( ) 神 [ ] ( ) 說來臨不神 [ ] ( ) 例行狀例 ( ) 降不 F50.1 Atypical anorexia nervosa Disorders that fulfil some of the features of anorexia nervosa but in which the overall clinical picture does not justify that diagnosis. For instance, one of the key symptoms, such as amenorrhoea or marked dread of being fat, may be absent in the presence of marked weight loss and weight-reducing behaviour. This diagnosis should not be made in the presence of known physical isorders associated with weight loss. F50.2 神 [ ] 暴 ( ) F50.2 Bulimia nervosa 暴來神 [ ] ( ) 理度神 [ ] ( ) 神 [ ] 暴 ( ) 年不暴 ( ) 神度 ( ) ( ) A syndrome characterized by repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or use of purgatives. This disorder shares many psychological features with anorexia nervosa, including an overconcern with body shape and weight. Repeated vomiting is likely to give rise to disturbances of body electrolytes and physical complications. There is often, but not always, a history of an earlier episode of anorexia nervosa, the interval ranging from a few months to several years. Bulimia NOS Hyperorexia nervosa 371

62 F50.3 神 [ ] 暴 ( ) F50.3 Atypical bulimia nervosa 神 [ ] 暴 ( ) 臨 ( ) 神 [ ] 暴 ( ) 例度狀 Disorders that fulfil some of the features of bulimia nervosa, but in which the overall clinical picture does not justify that diagnosis. For instance, there may be recurrent bouts of overeating and overuse of purgatives without significant weight change, or the typical overconcern about body shape and weight may be absent. F50.4 ( ) 理 ( 亂 ) 暴 ( ) 力度 ( ) 例度 ( ) ( ) (E66.-) F50.4 Overeating associated with other psychological disturbances Overeating due to stressful events, such as bereavement, accident, childbirth, etc. Psychogenic overeating Excludes: obesity (E66.-) F50.5 ( ) 理 ( 亂 ) ( ) 離 (F44.-) (F45.2) 不類 O21.-( 度 ) F50.5 Vomiting associated with other psychological disturbances Repeated vomiting that occurs in dissociative disorders (F44.-) and hypochondriacal disorder (F45.2), and that is not solely due to conditions classified outside this chapter. This subcategory may also be used in addition to O21.- (excessive vomiting in pregnancy) when emotional factors are predominant in the causation of recurrent nausea and vomiting in pregnancy. Psychogenic vomiting (R11) Excludes: nausea (R11) (R11) vomiting NOS (R11) F50.8 ( ) ( ) F50.8 Other eating disorders 年異 ( ) ( ) 異 ( ) (F98.3) F50.9 ( ) ( ) Pica in adults Psychogenic loss of appetite Excludes: pica of infancy and childhood (F98.3) F50.9 Eating disorder, unspecified 372

63 F51 ( ) 例論精神 ( 亂 ) 狀不論類論臨療臨來說 F51 例精神理理類類 ( ) ( ) (G47.-) F51 Nonorganic sleep disorders In many cases, a disturbance of sleep is one of the symptoms of another disorder, either mental or physical. Whether a sleep disorder in a given patient is an independent condition or simply one of the features of another disorder classified elsewhere, either in this chapter or in others, should be determined on the basis of its clinical presentation and course as well as on the therapeutic considerations and priorities at the time of the consultation. Generally, if the sleep disorder is one of the major complaints and is perceived as a condition in itself, the present code should be used along with other pertinent diagnoses describing the psychopathology and pathophysiology involved in a given case. This category includes only those sleep disorders in which emotional causes are considered to be a primary factor, and which are not due to identifiable physical disorders classified elsewhere. Excludes: sleep disorders (organic) (G47.-) F51.0 ( ) F51.0 Nonorganic insomnia 量精神狀臨類 A condition of unsatisfactory quantity and/or quality of sleep, which persists for a considerable period of time, including difficulty falling asleep, difficulty staying asleep, or early final wakening. Insomnia is a common symptom of many mental and physical disorders, and should be classified here in addition to the basic disorder only if it dominates the clinical picture. ( ) ( ) (G47.0) Excludes: insomnia (organic) (G47.0) F51.1 ( ) F51.1 Nonorganic hypersomnia 373

64 ( ) ( 不 ) 來不精神 Hypersomnia is defined as a condition of either excessive daytime sleepiness and sleep attacks (not accounted for by an inadequate amount of sleep) or prolonged transition to the fully aroused state upon awakening. In the absence of an organic factor for the occurrence of hypersomnia, this condition is usually associated with mental disorders. ( ) (G47.1) Excludes: hypersomnia (organic) (G47.1) (G47.4) narcolepsy (G47.4) F51.2 律 ( ) ( 律 ) ( 律 ) 不 F51.2 Nonorganic disorder of the sleep-wake schedule A lack of synchrony between the sleep-wake schedule and the desired sleep-wake schedule for the individual's environment, resulting in a complaint of either insomnia or hypersomnia. 列 Psychogenic inversion of: circadian ( 理 ) 律 nyctohemeral rhythm sleep ( ) 律 (G47.2) Excludes: disorder of the sleep-wake schedule (organic) (G47.2) F51.3 ( ) F51.3 Sleepwalking [somnambulism] 識狀度力 ( 度 ) 來 ( ) A state of altered consciousness in which phenomena of sleep and wakefulness are combined. During a sleepwalking episode the individual arises from bed, usually during the first third of nocturnal sleep, and walks about, exhibiting low levels of awareness, reactivity, and motor skill. Upon awakening, there is usually no recall of the event. F51.4 ( )[ ( )] F51.4 Sleep terrors [night terrors] 度烈力神度來 374 Nocturnal episodes of extreme terror and panic associated with intense vocalization, motility, and high levels of autonomic discharge. The individual sits up or gets up, usually during the first third of nocturnal

65 離離切 ( 精神理 ) sleep, with a panicky scream. Quite often he or she rushes to the door as if trying to escape, although very seldom leaves the room. Recall of the event, if any, is very limited (usually to one or two fragmentary mental images). F51.5 ( )[ ( )] F51.5 Nightmares 度神復 Dream experiences loaded with anxiety or fear. There is very detailed recall of the dream content. The dream experience is very vivid and usually includes themes involving threats to survival, security, or self-esteem. Quite often there is a recurrence of the same or similar frightening nightmare themes. During a typical episode there is a degree of autonomic discharge but no appreciable vocalization or body motility. Upon awakening the individual rapidly becomes alert and oriented. ( ) Dream anxiety disorder F51.8 ( ) F51.8 Other nonorganic sleep disorders F51.9 ( ) ( ) F51.9 Nonorganic sleep disorder, unspecified Emotional sleep disorder NOS F52 ( ) 不良 ( ) ( ) 不良 ( ) 不參行參 ( ) 不良 ( ) 理 F52 Sexual dysfunction, not caused by organic disorder or disease Sexual dysfunction covers the various ways in which an individual is unable to participate in a sexual relationship as he or she would wish. Sexual response is a psychosomatic process and both psychological and somatic processes are usually involved in the causation of sexual dysfunction. Dhat ( ) (F48.8) Excludes: Dhat syndrome (F48.8) F52.0 ( ) F52.0 Lack or loss of sexual desire 375

66 不冷 ( ) ( ) Loss of sexual desire is the principal problem and is not secondary to other sexual difficulties, such as erectile failure or dyspareunia. Frigidity Hypoactive sexual desire disorder F52.1 樂 ( ) F52.1 Sexual aversion and lack of sexual enjoyment 類 [ ] [ 樂 ] Either the prospect of sexual interaction produces sufficient fear or anxiety that sexual activity is avoided (sexual aversion) or sexual responses occur normally and orgasm is experienced but there is a lack of appropriate pleasure (lack of sexual enjoyment). ( ) Anhedonia (sexual) F52.2 F52.2 Failure of genital response ( 度行 ) 女滑 The principal problem in men is erectile dysfunction (difficulty in developing or maintaining an erection suitable for satisfactory intercourse). In women, the principal problem is vaginal dryness or failure of lubrication. 女 ( )[ 女 ] ( )[ ] [ ] [ ] (N48.4) Female sexual arousal disorder Male erectile disorder Psychogenic impotence Excludes: impotence of organic origin (N48.4) F52.3 ( ) 不良 ( 異 )[ ] 不 ( ) ( )( 女 ) [ ] F52.3 Orgasmic dysfunction Orgasm either does not occur or is markedly delayed. Inhibited orgasm (male)(female) Psychogenic anorgasmy F52.4 ( ) F52.4 Premature ejaculation 376

67 精樂 The inability to control ejaculation sufficiently for both partners to enjoy sexual interaction. F52.5 ( ) F52.5 Nonorganic vaginismus 塞不 ( ) ( ) ( ) (N94.2) Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening. Penile entry is either impossible or painful. Psychogenic vaginismus Excludes: vaginismus (organic) (N94.2) F52.6 ( ) F52.6 Nonorganic dyspareunia ( ) 女 ( ) 理狀理切類類 ( ) 不良 ( ) ( ) ( ) (N94.1) Dyspareunia (or pain during sexual intercourse) occurs in both women and men. It can often be attributed to local pathology and should then properly be categorized under the pathological condition. This category is to be used only if there is no primary nonorganic sexual dysfunction (e.g. vaginismus or vaginal dryness). Psychogenic dyspareunia Excludes: dyspareunia (organic) (N94.1) F52.7 ( ) 度 ( ) F52.7 Excessive sexual drive 女 ( ) Nymphomania ( ) Satyriasis F52.8 ( ) 不良 ( 異 ) F52.9 ( ) 不良 ( 異 ) F52.8 Other sexual dysfunction, not caused by organic disorder or disease F52.9 Unspecified sexual dysfunction, not caused by organic disorder or disease F53 ( ) 精神 [ ] 行 ( ) 類類 ( ) ( 六 ) 精神 ( ) 不類 ( ) 料不 377 F53 Mental and behavioural disorders associated with the puerperium, not elsewhere classified This category includes only mental disorders associated with the puerperium (commencing within six weeks of delivery) that do not meet the criteria for disorders

68 臨類不 classified elsewhere in this chapter, either because insufficient information is available, or because it is considered that special additional clinical features are present that make their classification elsewhere inappropriate. F53.0 度精神 [ ] 行 ( ) 類 ( 列 )( ) F53.0 Mild mental and behavioural disorders associated with the puerperium, not elsewhere classified Depression: postnatal NOS postpartum NOS F53.1 ( ) 度精神 [ ] 行 ( ) 類精神 ( ) F53.8 ( ) 精神 [ ] 行 ( ) 類 F53.9 精神 [ ] ( ) F53.1 Severe mental and behavioural disorders associated with the puerperium, not elsewhere classified Puerperal psychosis NOS F53.8 Other mental and behavioural disorders associated with the puerperium, not elsewhere classified F53.9 Puerperal mental disorder, unspecified F54 ( ) 類 ( ) 理行類錄理行 ( ) ( ) 類 (ICD-10) ( ) 精神 ( 理 ) ( 亂 ) ( ) 不類 F54 Psychological and behavioural factors associated with disorders or diseases classified elsewhere This category should be used to record the presence of psychological or behavioural influences thought to have played a major part in the etiology of physical disorders which can be classified to other chapters. Any resulting mental disturbances are usually mild, and often prolonged (such as worry, emotional conflict, apprehension) and do not of themselves justify the use of any of the categories in this chapter. 理類例 Psychological factors affecting physical conditions Examples of the use of this category are: F54 J45.- asthma F54 and J

69 F54 L23-L25 dermatitis F54 and L23-L25 F54 K25.- gastric ulcer F54 and K25. - F54 K58.- mucous colitis F54 and K58. - F54 K51.- lcerative colitis F54 and K51. - F54 L50.- urticaria F54 and L50. - (G44.2) Use additional code, if desired, to identify the associated physical disorder. Excludes: tension-type headache (G44.2) F55 ( ) 濫類 (a) 不 ( ) 精神 ( ) (b) (c) 不靈 (aspirin) (paracetamol) 類療 ( ) ( ) 不 ( ) ( ) 不良 ( 異 ) 不烈不 F10-F19 精神 ( ) 狀 F55 Abuse of non-dependence-producing substances A wide variety of medicaments and folk remedies may be involved, but the particularly important groups are: (a) psychotropic drugs that do not produce dependence, such as antidepressants, (b) laxatives, and (c) analgesics that may be purchased without medical prescription, such as aspirin and paracetamol. Persistent use of these substances often involves unnecessary contacts with medical professionals or supporting staff, and is sometimes accompanied by harmful physical effects of the substances. Attempts to dissuade or forbid the use of the substance are often met with resistance; for laxatives and analgesics this may be in spite of warnings about (or even the development of) physical harm such as renal dysfunction or electrolyte disturbances. Although it is usually clear that the patient has a strong motivation to take the substance, dependence or withdrawal symptoms do not develop as in the case of the psychoactive substances specified in F10-F19. 列濫類 Abuse of: antacids herbal or folk remedies steroids or hormones 379

70 ( ) 精神濫 (F10-F19) vitamins Laxative habit Excludes: abuse of psychoactive substances (F10-F19) F59 ( ) 理 ( 亂 ) 行理不良 ( 異 ) F59 Unspecified behavioural syndromes associated with physiological disturbances and physical factors Psychogenic physiological dysfunction NOS 行 ( ) (F60-F69) 了臨行 ( ) 行說論 ( )(F60.-) ( )(F61.-) 異 (F62.-) 行離行行理 ( 不 ) 不度 ( ) Disorders of adult personality and behaviour (F60-F69) This block includes a variety of conditions and behaviour patterns of clinical significance which tend to be persistent and appear to be the expression of the individual's characteristic lifestyle and mode of relating to himself or herself and others. Some of these conditions and patterns of behaviour emerge early in the course of individual development, as a result of both constitutional factors and social experience, while others are acquired later in life. Specific personality disorders (F60.-), mixed and other personality disorders (F61.-), and enduring personality changes (F62.-) are deeply ingrained and enduring behaviour patterns, manifesting as inflexible responses to a broad range of personal and social situations. They represent extreme or significant deviations from the way in which the average individual in a given culture perceives, thinks, feels and, particularly, relates to others. Such behaviour patterns tend to be stable and to encompass multiple domains of behaviour and psychological functioning. They are frequently, but not always, associated with various degrees of subjective distress and problems of social performance. F60 ( ) 行 ( 亂 ) F60 Specific personality disorders These are severe disturbances in the personality and behavioural tendencies of 380

71 ( ) 精神 ( ) 數 ( ) 裂 ( ) 年來年 the individual; not directly resulting from disease, damage, or other insult to the brain, or from another psychiatric disorder; usually involving several areas of the personality; nearly always associated with considerable personal distress and social disruption; and usually manifest since childhood or adolescence and continuing throughout adulthood. F60.0 ( )[ ] 度行利度度 F60.0 Paranoid personality disorder Personality disorder characterized by excessive sensitivity to setbacks, unforgiveness of insults; suspiciousness and a tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous; recurrent suspicions, without justification, regarding the sexual fidelity of the spouse or sexual partner; and a combative and tenacious sense of personal rights. There may be excessive self-importance, and there is often excessive self-reference. ( 列 ) ( )[ ] ( ) ( ) (F22.0) ( ) [ 易怒 ] (F22.8) ( ) Personality (disorder): expansive paranoid fanatic querulant paranoid sensitive paranoid Excludes: paranoia (F22.0) querulans (F22.8) paranoid: 精神 ( ) (F22.0) psychosis (F22.0) 精神裂 ( ) (F20.0) schizophrenia (F20.0) 狀 (F22.0) state (F22.0) F60.1 類精神裂 ( )[ 類精神裂 ] 類精神裂 F60.1 Schizoid personality disorder Personality disorder characterized by withdrawal from affectional, social and 381

72 寧省露力 other contacts with preference for fantasy, solitary activities, and introspection. There is a limited capacity to express feelings and to experience pleasure. Asperger ( ) (F84.5) ( ) (F22.0) ( ) 類精神裂 ( ) (F84.5) 精神裂 ( ) (F20.-) 精神裂 ( ) (F21) Excludes: Asperger's syndrome (F84.5) delusional disorder (F22.0) schizoid disorder of childhood (F84.5) schizophrenia (F20.-) schizotypal disorder (F21) F60.2 異 ( )[ 異 ] 異行異行不不利 ( ) 易力刺暴力行行理 F60.2 Dissocial personality disorder Personality disorder characterized by disregard for social obligations, and callous unconcern for the feelings of others. There is gross disparity between behaviour and the prevailing social norms. Behaviour is not readily modifiable by adverse experience, including punishment. There is a low tolerance to frustration and a low threshold for discharge of aggression, including violence; there is a tendency to blame others, or to offer plausible rationalizations for the behaviour bringing the patient into conflict with society. ( 列 ) ( )[ ] ( ) ( ) ( ) 精神 ( ) ( ) 行 ( 行 ) ( ) (F91.-) 不 ( )[ 不 ] (F60.3) Personality (disorder): amoral antisocial asocial psychopathic sociopathic Excludes: conduct disorders (F91.-) emotionally unstable personality disorder (F60.3) F60.3 不 ( )[ 不 ] F60.3 Emotionally unstable personality disorder 382

73 不行不 ( ) 不易行力行兩類 (impulsive type) 不 (borderline type) ( 亂 ) 烈不殺行 Personality disorder characterized by a definite tendency to act impulsively and without consideration of the consequences, the mood is unpredictable and capricious. There is a liability to outbursts of emotion and an incapacity to control the behavioural explosions. There is atendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored. Two types may be distinguished: the impulsive type, characterized predominantly by emotional instability and lack of impulse control, and the borderline type, characterized in addition by disturbances in self-image, aims,and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gestures and attempts. ( 列 ) ( )[ ] ( ) ( ) ( ) 異 ( )[ 異 ] (F60.2) Personality (disorder): aggressive borderline explosive Excludes: dissocial personality disorder (F60.2) F60.4 ( )[ ] 易不易不易刺 F60.4 Histrionic personality disorder Personality disorder characterized by shallow and labile affectivity, self-dramatization, theatricality, exaggerated expression of emotions, suggestibility, egocentricity, self-indulgence, lack of consideration for others, easily hurt feelings, and continuous seeking for appreciation, excitement and attention. ( 列 ) ( )[ ] 里精神 Personality (disorder): hysterical psycoinfantile 383

74 F60.5 ( ) ( )[ ( ) ] ( ) 良度不不 ( ) 度 ( 列 ) ( )[ ] ( )[ ] (F42.-) F60.5 Anankastic personality disorder Personality disorder characterized by feelings of doubt, perfectionism, excessive conscientiousness, checking and preoccupation with details, stubbornness, caution, and rigidity. There may be insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disorder. Personality (disorder): compulsive obsessional obsessive-compulsive Excludes: obsessive-compulsive disorder (F42.-) F60.6 [ ] ( ) [ ] [ ] 不度了來 F60.6 Anxious [avoidant] personality disorder Personality disorder characterized by feelings of tension and apprehension, insecurity and inferiority. There is a continuous yearning to be liked and accepted, a hypersensitivity to rejection and criticism with restricted personal attachments, and a tendency to avoid certain activities by habitual exaggeration of the potential dangers or risks in everyday situations. F60.7 ( )[ ] 力力精力 F60.7 Dependent personality disorder Personality disorder characterized by pervasive passive reliance on other people to make one's major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life. Lack of vigour may show itself in the intellectual or emotional spheres; there is often a tendency to transfer responsibility to others. 384

75 ( 列 ) ( )[ ] 力不 Personality (disorder): asthenic inadequate passive self-defeating F60.8 ( )[ ] ( 列 ) ( )[ ] 離 [ ] 不戀神 F60.8 Other specific personality disorders Personality (disorder): eccentric "haltlose" type immature narcissistic passive-aggressive psychoneurotic F60.9 ( )[ ] 精神 [ 神 ] F60.9 Personality disorder, unspecified Character neurosis NOS Pathological personality NOS F61 ( ) ( ) 類令不 F60.- 類狀類 F60.- 更例 F60.- 狀更不類列 F60.- F62.- F61 Mixed and other personality disorders This category is intended for personality disorders that are often troublesome but do not demonstrate the specific pattern of symptoms that characterize the disorders described in F60.-. As a result they are often more difficult to diagnose than the disorders in F60.-. Examples include: mixed personality disorders with features of several of the disorders in F60.- but without a predominant set of symptoms that would allow a more specific diagnosis. troublesome personality changes, not classifiable to F60.- or F62.-, and 385

76 ( ) ( ) (Z73.1) regarded as secondary to a main diagnosis of a coexisting affective or anxiety disorder. Excludes: accentuated personality traits (Z73.1) F62 [ 異 ] ( ) 暴露度力度精神 ( 不 ) 年行 ( ) 不良行不精神 ( ) 臨精神狀 ( ) ( ) 不良 ( ) 行 ( ) (F07.-) F62 Enduring personality changes, not attributable to brain damage and disease Disorders of adult personality and behaviour that have developed in persons with no previous personality disorder following exposure to catastrophic or excessive prolonged stress, or following a severe psychiatric illness. These diagnoses should be made only when there is evidence of a definite and enduring change in a person's pattern of perceiving, relating to, or thinking about the environment and himself or herself. The personality change should be significant and be associated with inflexible and maladaptive behaviour not present before the pathogenic experience. The change should not be a direct manifestation of another mental disorder or a residual symptom of any antecedent mental disorder. Excludes: personality and behavioural disorder due to brain disease, damage and dysfunction (F07.-) F62.0 [ 異 ] 歷力暴露兩年力不來力 ( ) 不度不離類力 (F43.1) F62.0 Enduring personality change after catastrophic experience Enduring personality change, present for at least two years, following exposure to catastrophic stress. The stress must be so extreme that it is not necessary to consider personal vulnerability in order to explain its profound effect on the personality. The disorder is characterized by a hostile or distrustful attitude towards the world, social withdrawal feelings of emptiness or hopelessness, a chronic feeling of "being on edge" as if constantly threatened, and estrangement. Post-traumatic stress disorder (F43.1) may precede this type of personality change. ( 列 ) 386 Personality change after:

77 歷 concentration camp experiences disasters prolonged: captivity with an imminent possibility of 暴露力 ( ) (F43.1) being killed exposure to life-threatening situations such torture as being a victim of terrorism Excludes: post-traumatic stress disorder (F43.1) F62.1 精神 ( 不 ) [ 異 ] 罹精神歷兩年來留精神裂 ( ) 精神 [ ] 復狀 ( ) 度度立切立 ( 離 ) 參落不罹罹行落不精神 [ ] 精神 [ ] ( ) 留 ( ) 狀 F62.1 Enduring personality change after psychiatric illness Personality change, persisting for at least two years, attributable to the traumatic experience of suffering from a severe psychiatric illness. The change cannot be explained by a previous personality disorder and should be differentiated from residual schizophrenia and other states of incomplete recovery from an antecedent mental disorder. This disorder is characterized by an excessive dependence on and a demanding attitude towards others; conviction of being changed or stigmatized by the illness, leading to an inability to form and maintain close and confiding personal relationships and to social isolation; passivity, reduced interests, and diminished involvement in leisure activities; persistent complaints of being ill, which may be associated with hypochondriacal claims and illness behaviour; dysphoric or labile mood, not due to the presence of a current mental disorder or antecedent mental disorder with residual affective symptoms; and longstanding problems in social and occupational functioning. F62.8 [ 異 ] F62.8 Other enduring personality changes Chronic pain personality syndrome F62.9 [ 異 ] F62.9 Enduring personality change, unspecified F63 ( ) F63 Habit and impulse disorders 387

78 類類類行 ( ) 理不利益行行烈不了類度精精神 (F10-F19) 行 ( ) (F65.-) This category includes certain disorders of behaviour that are not classifiable under other categories. They are characterized by repeated acts that have no clear rational motivation, cannot be controlled, and generally harm the patient's own interests and those of other people. The patient reports that the behaviour is associated with impulses to action. The cause of these disorders is not understood and they are grouped together because of broad descriptive similarities, not because they are known to share any other important features. Excludes: habitual excessive use of alcohol or psychoactive substances (F10-F19) impulse and habit disorders involving sexual behaviour (F65.-) F63.0 ( ) F63.0 Pathological gambling 行念 The disorder consists of frequent, repeated episodes of gambling that dominate the patient's life to the detriment of social, occupational, material, and family values and commitments. ( ) 度行 (F30.-) (Z72.6) 異 ( )[ 異 ] 行 (F60.2) Compulsive gambling Excludes: excessive gambling by manic patients (F30.-) gambling and betting NOS (Z72.6) gambling in dissocial personality disorder (F60.2) F63.1 ( )[ ] F63.1 Pathological fire-setting [pyromania] 行烈度力度 Disorder characterized by multiple acts of, or attempts at, setting fire to property or other objects, without apparent motive, and by a persistent preoccupation with subjects related to fire and burning. This behaviour is often associated with feelings of increasing tension before the act, and intense excitement immediately afterwards. 388

79 ( ) 行 Excludes: fire-setting (by)(in): 異 ( )[ 異 ] (F60.2) adult with dissocial personality disorder (F60.2) 精精神 (F10-F ) alcohol or psychoactive substance intoxication (F10-F19, with common fourth character.0) 精神 ( ) 理 (Z03.2) 行 ( 行 ) ( as the reason for observation for suspected mental disorder (Z03.2) conduct disorders (F91.-) ) (F91.-) 精神 ( ) (F00-F09) organic mental disorders (F00-F09) 精神裂 ( ) (F20.-) schizophrenia (F20.-) F63.2 ( )[ ] F63.2 行了來力度 ( ) ( ) ( ) ( ) ( ) (F31-F33) 精神 ( ) (F00-F09) 精神 ( ) 行 (Z03.2) Pathological stealing [kleptomania] Disorder characterized by repeated failure to resist impulses to steal objects that are not acquired for personal use or monetary gain. The objects may instead be discarded, given away, or hoarded. This behaviour is usually accompanied by an increasing sense of tension before, and a sense of gratification during and immediately after, the act. Excludes: depressive disorder with stealing (F31-F33) organic mental disorders (F00-F09) shoplifting as the reason for observation for suspected mental disorder (Z03.2) F63.3 ( ) F63.3 Trichotillomania 力度 ( ) 若 ( ) 不立 A disorder characterized by noticeable hair-loss due to a recurrent failure to resist impulses to pull out hairs. The hair-pulling is usually preceded by mounting tension and is followed by a sense of relief or gratification. This diagnosis should not be made if there is a pre-existing inflammation of the skin, or if the hair-pulling is in response to a delusion or a hallucination. 389

80 ( ) ( ) (F98.4) Excludes: stereotyped movement disorder with hair-plucking (F98.4) F63.8 ( ) F63.8 Other habit and impulse disorders 類不良行精神行 ( ) Other kinds of persistently repeated maladaptive behaviour that are not secondary to a recognized psychiatric syndrome, and in which it appears that the patient is repeatedly failing to resist impulses to carry out the behaviour. There is a prodromal period of tension with a feeling of release at the time of the act. 暴 ( ) Intermittent explosive disorder F63.9 ( ) F63.9 Habit and impulse disorder, unspecified F64 ( ) F64.0 烈異不不療 F64 Gender identity disorders F64.0 Transsexualism A desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex. F64.1 異 F64.1 Dual-role transvestism 了異異異異異 ( ) The wearing of clothes of the opposite sex for part of the individual's existence in order to enjoy the temporary experience of membership of the opposite sex, but without any desire for a more permanent sex change or associated surgical reassignment, and without sexual excitement accompanying the cross-dressing. 年年 ( ) 戀異 (F65.1) Gender identity disorder of adolescence or adulthood, nontranssexual type Excludes: fetishistic transvestism (F65.1) 390

81 F64.2 ( ) ( F64.2 ) ( ) ( ) ( 露 ) 烈 ( ) 異 ( ) 異度 ( 亂 ) 若女不 ( ) 不類類 F66.- Gender identity disorder of childhood A disorder, usually first manifest during early childhood (and always well before puberty), characterized by a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual's own sex. The diagnosis requires a profound disturbance of the normal gender identity; mere tomboyishness in girls or girlish behaviour in boys is not sufficient. Gender identity disorders in individuals who have reached or are entering puberty should not be classified here but in F66.-. 不 (F66.1) ( ) (F66.0) Excludes: egodystonic sexual orientation (F66.1) sexual maturation disorder (F66.0) F64.8 ( ) F64.8 Other gender identity disorders F64.9 ( ) F64.9 Gender identity disorder, unspecified ( ) Gender-role disorder NOS F65 ( )[ ] F65 Disorders of sexual preference ( ) Includes: paraphilias F65.0 戀 F65.0 Fetishism 利刺戀 ( ) 見例 ( ) 不戀來 ( ) 391 Reliance on some non-living object as a stimulus for sexual arousal and sexual gratification. Many fetishes are extensions of the human body, such as articles of clothing or footwear. Other common examples are characterized by some particular texture such as rubber, plastic or leather. Fetish objects vary in their importance to the individual. In some cases they simply serve to enhance sexual excitement achieved in ordinary ways (e.g. having the partner wear a particular

82 garment). F65.1 戀異 F65.1 Fetishistic transvestism 異異異便烈戀異 The wearing of clothes of the opposite sex principally to obtain sexual excitement and to create the appearance of a person of the opposite sex. Fetishistic transvestism is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines. It can occur as an earlier phase in the development of transsexualism. 異戀 Transvestic fetishism F65.2 暴露 F65.2 Exhibitionism ( 異 ) 暴露切暴露行行 A recurrent or persistent tendency to expose the genitalia to strangers (usually of the opposite sex) or to people in public places, without inviting or intending closer contact. There is usually, but not invariably, sexual excitement at the time of the exposure and the act is commonly followed by masturbation. F65.3 F65.3 Voyeurism 行 ( 更 ) 行行行行 A recurrent or persistent tendency to look at people engaging in sexual or intimate behaviour such as undressing. This is carried out without the observed people being aware, and usually leads to sexual excitement and masturbation. F65.4 戀女兩 ( ) 年 F65.4 Paedophilia A sexual preference for children, boys or girls or both, usually of prepubertal or early pubertal age. F65.5 若 F65.5 Sadomasochism A preference for sexual activity which involves the infliction of pain or 392

83 樂刺 (masochism) (sadism) 兩 ( ) humiliation, or bondage. If the subject prefers to be the recipient of such stimulation this is called masochism; if the provider, sadism. Often an individual obtains sexual excitement from both sadistic and masochistic activities. Masochism Sadism F65.6 ( ) F65.6 Multiple disorders of sexual preference 異見戀異 ( 聯 ) Sometimes more than one abnormal sexual preference occurs in one person and there is none of first rank. The most common combination is fetishism, transvestism and sadomasochism. F65.8 ( )[ ] 類刺行勒 [ ( ) ] F65.8 Other disorders of sexual preference A variety of other patterns of sexual preference and activity, including making obscene telephone calls, rubbing up against people for sexual stimulation in crowded public places, sexual activity with animals, and use of strangulation or anoxia for intensifying sexual excitement. 戀 Frotteurism Necrophilia F65.9 ( )[ ] F65.9 Disorder of sexual preference, unspecified Sexual deviation NOS F66 ( ) 理行 ( ) 不 ( ) F66 Psychological and behavioural disorders associated with sexual development and orientation Note: Sexual orientation by itself is not to be regarded as a disorder. F66.0 ( )[ ] F66.0 Sexual maturation disorder The patient suffers from uncertainty about 393

84 異不年 ( ) his or her gender identity or sexual orientation, which causes anxiety or depression. Most commonly this occurs in adolescents who are not certain whether they are homosexual, heterosexual or bisexual in orientation, or in individuals who, after a period of apparently stable sexual orientation (often within a longstanding relationship), find that their sexual orientation is changing. F66.1 不 ( 異 ) 理行 ( ) 療 F66.1 Egodystonlc sexual orientation The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it. F66.2 ( )[ ] ( 異 ) ( 立 ) F66.2 Sexual relationship disorder The gender identity or sexual orientation (heterosexual, homosexual, or bisexual) is responsible for difficulties in forming or maintaining a relationship with a sexual partner. F66.8 理 ( ) [ 理 ] F66.9 理 ( )[ 理 ] F66.8 Other psychosexual development disorders F66.9 Psychosexual development disorder, unspecified F68 行 ( ) F68 Other disorders of adult personality and behaviour F68.0 理 ( ) 狀 F68.0 Elaboration of physical symptoms for psychological reasons 394

85 狀理狀 Physical symptoms compatible with and originally due to a confirmed physical disorder, disease or disability become exaggerated or prolonged due to the psychological state of the patient. The patient is commonly distressed by this pain or disability, and is often preoccuped with worries, which may be justified, of the possibility of prolonged or progressive disability or pain. 精神 Compensation neurosis F68.1 理狀 [ ( ) ] 理狀了狀不行 ( ) F68.1 Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder] The patient feigns symptoms repeatedly for no obvious reason and may even inflict self-harm in order to produce symptoms or signs. The motivation is obscure and presumably internal with the aim of adopting the sick role. The disorder is often combined with marked disorders of personality and relationships. [ ] Münchausen ( ) ( ) ( ) (L98.1) [ ]( ) (Z76.5) Hospital hopper syndrome Münchhausen's syndrome Peregrinating patient Excludes: factitial dermatitis (L98.1) person feigning illness (with obvious motivation) (Z76.5) F68.8 行 ( ) ( )[ ] ( )[ ] F68.8 Other specified disorders of adult personality and behaviour Character disorder NOS Relationship disorder NOS F69 行 ( ) F69 Unspecified disorder of adult personality and behaviour 395

86 不 (F70-F79) ( ) 不 ( ) 不 ( ) ( 不 ) ( ) 了力 ( ) 不 ( ) ( ) ( 精神 ) ( ) 不度來量來量不度練 ( ) ( ) 不理練復來 Mental retardation (F70-F79) A condition of arrested or incomplete development of the mind, which is especially characterized by impairment of skills manifested during the developmental period, skills which contribute to the overall level of intelligence, i.e. cognitive, language, motor, and social abilities. Retardation can occur with or without any other mental or physical condition. Degrees of mental retardation are conventionally estimated by standardized intelligence tests. These can be supplemented by scales assessing social adaptation in a given environment. These measures provide an approximate indication of the degree of mental retardation. The diagnosis will also depend on the overall assessment of intellectual functioning by a skilled diagnostician. Intellectual abilities and social adaptation may change over time, and, however poor, may improve as a result of training and rehabilitation. Diagnosis should be based on the current levels of functioning. 列 4 類 F70-F79 類行 ( 不 ) 度 The following fourth-character subdivisions are for use with categories F70-F79 to identify the extent of impairment of behaviour:.0 行 ( 不 ).1 行 ( 不 ) 療.0.1 With the statement of no, or minimal, impairment of behaviour Significant impairment of behaviour requiring attention or treatment.8 行 ( 不 ).8 Other impairments of behaviour.9 行 ( 不 ).9 Without mention of impairment of behaviour ( ) 行 ( 行 ) ( ) ( ) Use additional code, if desired, to identify associated conditions such as autism, other developmental disorders, epilepsy, conduct disorders, or severe physical handicap. 396

87 F70 度不 F70 Mild mental retardation 50~69 ( 年 9~12 ) 年 ( ) 良 Approximate IQ range of 50 to 69 (in adults, mental age from 9 to under 12 years). Likely to result in some learning difficulties in school. Many adults will be able to work and maintain good social relationships and contribute to society. Includes: feeble-mindedness 度 mild mental subnormality F71 度不 F71 Moderate mental retardation 35~49 ( 年 6~9 ) ( ) 數度立力切 ( ) 年 ( ) 不度度 Approximate IQ range of 35 to 49 (in adults, mental age from 6 to under 9 years). Likely to result in marked developmental delays in childhood but most can learn to develop some degree of independence in self-care and acquire adequate communication and academic skills. Adults will need varying degrees of support to live and work in the community. Includes: moderate mental subnormality F72 度不 20~34 ( 年 3~6 ) 不度力 F72 Severe mental retardation Approximate IQ range of 20 to 34 (in adults, mental age from 3 to under 6 years). Likely to result in continuous need of support. Includes: severe mental subnormality F73 ( ) 度不 F73 Profound mental retardation 20( 年 3 ) ( 便 ) 力力 ( ) 度 IQ under 20 (in adults, mental age below 3 years). Results in severe limitation in self-care, continence, communication and mobility. Includes: profound mental subnormality F78 不 F78 Other mental retardation F79 不 F79 ( ) Unspecified mental retardation Includes: mental: 397

88 deficiency NOS subnormality NOS 理 ( ) (F80-F89) (F80-F89) 列 ( ) 列 (a) 律都年都 ( ) (b) ( 不 ) 神度切 (c) 復 [* 精神復 ] 數 ( )( 不 ) 來留 ( 不 ) ( ) ( 不 ) Disorders of psychological development (F80-F89) The disorders included in this block have in common: (a) onset invariably during infancy or childhood; (b) impairment or delay in development of functions that are strongly related to biological maturation of the central nervous system; and (c) a steady course without remissions and relapses. In most cases, the functions affected include language, visuo-spatial skills, and motor coordination. Usually, the delay or impairment has been present from as early as it could be detected reliably and will diminish progressively as the child grows older, although milder deficits often remain in adult life. F80 ( ) 類 ( ) 力神異不讀讀 ( ) 異行 F80 Specific developmental disorders of speech and language Disorders in which normal patterns of language acquisition are disturbed from the early stages of development. The conditions are not directly attributable to neurological or speech mechanism abnormalities, sensory impairments, mental retardation, or environmental factors. Specific developmental disorders of speech and language are often followed by associated problems, such as difficulties in reading and spelling, abnormalities in interpersonal relationships, and emotional and behavioural disorders. F80.0 ( ) F80.0 ( ) 力年 ( ) ( ) ( 列 ) Specific speech articulation disorder A specific developmental disorder in which the child's use of speech sounds is below the appropriate level for its mental age, but in which there is a normal level of language skills. Developmental: ( ) phonological disorder 398

89 ( ) ( ) [ ] 列 ( ) ( 不 ) ( ) (R47.0) ( ) ( R48.2) ( 力 ) (H90-H91) 不 (F70-F79) ( ) ( ) (F80.1) (F80.2) speech articulation disorder Dyslalia Functional speech articulation disorder Lalling Excludes: speech articulation impairment (due to): aphasia NOS (R47.0) apraxia(r48.2) hearing loss (H90-H91) mental retardation (F70-F79) with language developmental disorder: expressive (F80.1) receptive (F80.2) F80.1 ( ) F80.1 Expressive language disorder ( ) 力年 ( ) 理力異 A specific developmental disorder in which the child's ability to use expressive spoken language is markedly below the appropriate level for its mental age, but in which language comprehension is within normal limits. There may or may not be abnormalities in articulation. ( ) ( ) ( ) [ 藍勒 (Landau-Kleffner)( ) ] (F80.3) ( ) (F80.2) ( ) (R47.0) 不 ( ) (F94.0) Developmental dysphasia or aphasia, expressive type Excludes: acquired aphasia with epilepsy [Landau-Kleffner] (F80.3) developmental dysphasia or aphasia, receptive type (F80.2) dysphasia and aphasia NOS (R47.0) elective mutism (F94.0) 不 (F70-F79) mental retardation (F70-F79) ( ) (F84.-) pervasive developmental disorders (F84.-) F80.2 ( ) F80.2 Receptive language disorder ( ) 了力 A specific developmental disorder in 399

90 年 ( ) 異見 which the child's understanding of language is below the appropriate level for its mental age. In virtually all cases expressive language will also be markedly affected and abnormalities in word-sound production are common. ( 力 ) 不良 Congenital auditory imperception Developmental: ( ) dysphasia or aphasia, receptive type Wernicke ( ) ( ) Wernicke's aphasia 聾 Word deafness ( ) ( ) Excludes: acquired aphasia with epilepsy [ 藍勒 [Landau-Kleffner] (F80.3) (Landau-Kleffner)( ) ] (F80.3) ( ) (F84.0-F84.1) autism (F84.0-F84.1) ( ) dysphasia and aphasia: (R47.0) NOS (R47.0) (F80.1) expressive type (F80.1) 不 ( ) (F94.0) elective mutism (F94.0) 聾 language delay due to deafness (H90-H91) (H90-H91) 不 (F70-F79) mental retardation (F70-F79) F80.3 ( ) ( ) [ 藍勒 (Landau-Kleffner) ( ) ] F80.3 Acquired aphasia with epilepsy [Landau-Kleffner] ( ) 來 ( ) 力 ( ) (EEG) 異數都 ( ) 3~7 ( ) ( ) 連異數兩年 ( ) ( ) ( 不 ) A disorder in which the child, having previously made normal progress in language development, loses both receptive and expressive language skills but retains general intelligence; the onset of the disorder is accompanied by paroxysmal abnormalities on the EEG, and in the majority of cases also by epileptic seizures. Usually the onset is between the ages of three and seven years, with skills being lost over days or weeks. The temporal association between the onset of seizures and loss of language is variable, with one preceding the other (either way round) by a few months to two years. An inflammatory encephalitic process has been suggested as a possible cause of this 400

91 disorder. About two-thirds of patients are left with a more or less severe receptive language deficit. ( ) (R47.0) ( ) (F84.0-F84.1) ( ) ( ) (F84.2-F84.3) Excludes: aphasia (due to): NOS(R47.0) autism(f84.0-f84.1) disntegrative disorders of childhood (F84.2-F84.3) F80.8 ( ) F80.8 Other developmental disorders of speech and language 濫 F80.9 ( ) ( ) Lisping F80.9 Developmental disorder of speech and language, unspecified Language disorder NOS F81 ( ) ( ) 類 ( ) ( ) ( ) ( 亂 ) ( ) F81 Specific developmental disorders of scholastic skills Disorders in which the normal patterns of skill acquisition are disturbed from the early stages of development. This is not simply a consequence of a lack of opportunity to learn, it is not solely a result of mental retardation, and it is not due to any form of acquired brain trauma or disease F81.0 讀 ( ) 讀 ( 不 ) 年力不來讀理讀 ( 識 ) 朗讀 ( ) 參讀力都讀 ( ) 讀 ( ) 了年讀力讀 ( ) 讀 ( ) F81.0 Specific reading disorder The main feature is a specific and significant impairment in the development of reading skills that is not solely accounted for by mental age, visual acuity problems, or inadequate schooling. Reading comprehension skill, reading word recognition, oral reading skill, and performance of tasks requiring reading may all be affected. Spelling difficulties are frequently associated with specific reading disorder and often remain into adolescence even after some progress in reading has been made. Specific 401

92 ( ) 行 ( 亂 ) " 讀 " 讀 ( ) 讀讀不 ( ) (R48.0) 讀 ( ) (R48.0) ( ) 讀 (F93.-) developmental disorders of reading are commonly preceded by a history of disorders in speech or language development. Associated emotional and behavioural disturbances are common during the school age period. "Backward reading" Developmental dyslexia Specific reading retardation Excludes: alexia NOS (R48.0) dyslexia NOS (R48.0) reading difficulties secondary to emotional disorders (F93.-) F81.1 讀 ( ) ( ) 讀 ( ) ( ) ( 不 ) 讀 ( ) 年力不來讀 ( ) 力兩 F81.1 Specific spelling disorder The main feature is a specific and significant impairment in the development of spelling skills in the absence of a history of specific reading disorder, which is not solely accounted for by low mental age, visual acuity problems, or inadequate schooling. The ability to spell orally and to write out words correctly are both affected. 讀 ( ) [ 讀 ( )] 不 ( ) (R48.8) 讀 ( ) ( ) 讀 ( ) 讀 ( ) (F81.0) 不讀 ( ) (Z55.8) Specific spelling retardation (without reading disorder) Excludes: agraphia NOS (R48.8) spelling difficulties: associated with a reading disorder (F81.0) due to inadequate teaching (Z55.8) F81.2 ( ) ( ) 不不來 ( ) ( ) ( 不 ) F81.2 Specific disorder of arithmetical skills Involves a specific impairment in arithmetical skills that is not solely explicable on the basis of general mental retardation or of inadequate schooling. The 402

93 力數 ( ) 數數不 deficit concerns mastery of basic computational skills of addition, subtraction, multiplication, and division rather than of the more abstract mathematical skills involved in algebra, trigonometry, geometry, or calculus. ( 列 ) ( ) 不 ( ) ( ) ( ) Gerstmann ( ) ( ) 不 ( ) (R48.8) ( ) ( ) 讀讀 ( ) ( ) (F81.3) Developmental: acalculia arithmetical disorder Gerstmann's syndrome Excludes: acalculia NOS (R48.8) arithmetical difficulties: associated with a reading or spelling disorder (F81.3) 不 (Z55.8) due to inadequate teaching (Z55.8) F81.3 ( ) ( ) 不類 ( ) 力讀讀 ( ) ( ) 不不來類 ( ) ( ) F81.2 F81.0 F81.1 兩 F81.3 Mixed disorder of scholastic skills An ill-defined residual category of disorders in which both arithmetical and reading or spelling skills are significantly impaired, but in which disorder is not solely explicable in terms of general mental retardation or of inadequate schooling. It should be used for disorders meeting the criteria for both F81.2 and either F81.0 or F81.1. ( ) ( ) ( ) (F81.2) 讀 ( ) (F81.0) 讀 ( ) ( ) (F81.1) Excludes: specific: disorder of arithmetical skills (F81.2) reading disorder (F81.0) spelling disorder (F81.1) F81.8 ( ) ( ) ( ) F81.8 Other developmental disorders of scholastic skills Developmental expressive writing disorder F81.9 ( ) ( ) F81.9 Developmental disorder of scholastic skills, unspecified 403

94 識 ( 不 ) ( ) ( ) Knowledge acquisition disability NOS Learning: disability NOS disorder NOS F82 ( ) F82 Specific developmental disorder of motor function ( 不 ) 神 ( ) 來 ( ) 數臨神不 ( ) 狀精 [ ] A disorder in which the main feature is a serious impairment in the development of motor coordination that is not solely explicable in terms of general intellectual retardation or of any specific congenital or acquired neurological disorder. Nevertheless, in most cases a careful clinical examination shows marked neurodevelopmental immaturities such as choreiform movements of unsupported limbs or mirror movements and other associated motor features, as well as signs of impaired fine and gross motor coordination. ( ) ( ) 不良力 [ ] 異 (R26.-) [ ] (R27.-) 不 (F70-F79) Clumsy child syndrome Developmental: coordination disorder dyspraxia Excludes: abnormalities of gait and mobility (R26.-) lack of coordination (R27.-) secondary to mental retardation (F70-F79) F83 ( ) ( ) ( ) 類 ( ) ( ) 類度 F83 Mixed specific developmental disorders A residual category for disorders in which there is some admixture of specific developmental disorders of speech and language, of scholastic skills, and of motor function, but in which none predominates sufficiently to constitute the prime diagnosis. This mixed category should be used only when there is a major overlap 404

95 不不良 ( 異 ) F80.- F81.- F82( 類 ) 兩兩 between each of these specific developmental disorders. The disorders are usually, but not always, associated with some degree of general impairment of cognitive functions. Thus, the category should be used when there are dysfunctions meeting the criteria for two or more of F80.-, F81.- and F82. F84 ( ) 異 ( ) 異療不 F84 Pervasive developmental disorders A group of disorders characterized by qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by a restricted, stereotyped, repetitive repertoire of interests and activities. These qualitative abnormalities are a pervasive feature of the individual's functioning in all situations. Use additional code, if desired, to identify any associated medical condition and mental retardation. F84.0 ( ) F84.0 Childhood autism ( ) 類 (a) 異 (b) 異見精神理行行列 ( ) ( 亂 ) 亂 ( ) ( ) ( ) A type of pervasive developmental disorder that is defined by: (a) the presence of abnormal or impaired development that is manifest before the age of three years, and (b) the characteristic type of abnormal functioning in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behaviour. In addition to these specific diagnostic features, a range of other nonspecific problems are common, such as phobias, sleeping and eating disturbances, temper tantrums, and (self-directed) aggression. Autistic disorder Infantile: autism 精神 ( ) psychosis Kanner ( ) 精神 (F84.5) Kanner's syndrome Excludes: autistic psychopathy (F84.5) F84.1 F84.1 Atypical autism 405

96 ( ) 類 ( ) 不年類異 ( 不 ) 3 異精神理 ( 行 ) 異類 ( ) 度 [ 不 ] 度 ( ) A type of pervasive developmental disorder that differs from childhood autism either in age of onset or in failing to fulfil all three sets of diagnostic criteria. This subcategory should be used when there is abnormal and impaired development that is present only after age three years, and a lack of sufficient demonstrable abnormalities in one or two of the three areas of psychopathology required for the diagnosis of autism (namely, reciprocal social interactions, communication, and restricted, stereotyped, repetitive behaviour) in spite of characteristic abnormalities in the other area(s). Atypical autism arises most often in profoundly retarded individuals and in individuals with a severe specific developmental disorder of receptive language. ( ) 精神 ( ) Atypical childhood psychosis 不 ( ) Mental retardation with autistic features (F70-F79) 不 Use additional code (F70-F79), if desired, to identify mental retardation. F84.2 Rett( ) F84.2 Rett's syndrome 女 ( ) ( ) 7 24 度留 4 ( ) 不 ( ) ( ) (choreoathetoid) 不 A condition, so far found only in girls, in which apparently normal early development is followed by partial or complete loss of speech and of skills in locomotion and use of hands, together with deceleration in head growth, usually with an onset between seven and 24 months of age. Loss of purposive hand movements, hand-wringing stereotypies, and hyperventilation are characteristic. Social and play development are arrested but social interest tends to be maintained. Trunk ataxia and apraxia start to develop by age four years and choreoathetoid movements frequently follow. Severe mental retardation almost invariably results. F84.3 ( ) ( ) F84.3 Other childhood disintegrative disorder 406

97 ( ) 類了 ( ) 類異行來 A type of pervasive developmental disorder that is defined by a period of entirely normal development before the onset of the disorder, followed by a definite loss of previously acquired skills in several areas of development over the course of a few months. Typically, this is accompanied by a general loss of interest in the environment, by stereotyped, repetitive motor mannerisms, and by autistic-like abnormalities in social interaction and communication. In some cases the disorder can be shown to be due to some associated encephalopathy but the diagnosis should be made on the behavioural features. ( ) Dementia infantilis 精神 ( ) Disintegrative psychosis Heller ( ) Heller's syndrome 精神 ( ) Symbiotic psychosis 聯神 ( ) Use additional code, if desired, to identify any associated neurological condition. Rett ( ) (F84.2) Excludes: Rett's syndrome (F84.2) F84.4 ( ) 不 ( )[ ] 不類 ( ) 類力不行度不 ( ) ( 50 ) 療不 ( 不 ) 落惡劣 ( 精神 ) 年 ( ( ) 不見 ) 行 ( ) F84.4 Overactive disorder associated with mental retardation and stereotyped movements An ill-defined disorder of uncertain nosological validity. The category is designed to include a group of children with severe mental retardation (IQ below 50) who show major problems in hyperactivity and in attention, as well as stereotyped behaviours. They tend not to benefit from stimulant drugs (unlike those with an IQ in the normal range) and may exhibit a severe dysphoric reaction (sometimes with psychomotor retardation) when given stimulants. In adolescence, the overactivity tends to be replaced by underactivity (a pattern that is not usual in hyperkinetic children with normal intelligence). This syndrome is also often associated with a variety of developmental delays, either 407

98 specific or global. The extent to which the behavioural pattern is a function of low IQ or of organic brain damage is not known. F84.5 Asperger ( ) F84.5 Asperger's syndrome 類 ( ) 類異 ( ) 不異年年年見精神 ( ) A disorder of uncertain nosological validity, characterized by the same type of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities. It differs from autism primarily the fact that there is no general delay or retardation in language or in cognitive development. This disorder is often associated with marked clumsiness. There is a strong tendency for the abnormalities to persist into adolescence and adult life. Psychotic episodes occasionally occur in early adult life. 精神 ( ) ( ) 類精神裂 ( ) Autistic psychopathy Schizoid disorder of childhood F84.8 ( ) F84.8 Other pervasive developmental disorders F84.9 ( ) F84.9 Pervasive developmental disorder, unspecified F88 理 ( ) 識不 ( ) F88 Other disorders of psychological development Developmental agnosia F89 理 ( ) ( ) F89 Unspecified disorder of psychological development Developmental disorder NOS ( ) 年行 ( ) (F90-F98) Behavioural and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98) F90 ( )[ ] ( 5 ) ( ) 408 F90 Hyperkinetic disorders A group of disorders characterized by an early onset (usually in the first five years of

99 參行 ( ) ( ) 不良異 ( ) 易不年不不 ( ) 立不例 ( 異 ) 行 ( )[ ] (F41.-) [ ( )] ( ) (F30-F39) ( ) (F84.-) 精神裂 ( ) (F20.-) life), lack of persistence in activities that require cognitive involvement, and a tendency to move from one activity to another without completing any one, together with disorganized, ill-regulated, and excessive activity. Several other abnormalities may be associated. Hyperkinetic children are often reckless and impulsive, prone to accidents, and find themselves in disciplinary trouble because of unthinking breaches of rules rather than deliberate defiance. Their relationships with adults are often socially disinhibited, with a lack of normal caution and reserve. They are unpopular with other children and may become isolated. Impairment of cognitive functions is common, and specific delays in motor and language development are disproportionately frequent. Secondary complications include dissocial behaviour and low self-esteem. Excludes: anxiety disorders (F41.-) mood [affective] disorders (F30-F39) pervasive developmental disorders (F84.-) schizophrenia (F20.-) F90.0 量力 ( 亂 ) ( 列 ) 力 ( ) ( ) 度 ( )[ ] ( ) 度 ( )[ ] ( ) 行 ( 行 ) ( ) (F90.1) F90.0 Disturbance of activity and attention Attention deficit: disorder with hyperactivity hyperactivity disorder syndrome with hyperactivity Excludes: hyperkinetic disorder associated with conduct disorder (F90.1) F90.1 行 ( 行 ) ( F90.1 ) ( ) 行 ( 行 ) ( ) ( )[ ] Hyperkinetic conduct disorder Hyperkinetic disorder associated with conduct disorder 409

100 F90.8 ( )[ ] F90.8 Other hyperkinetic disorders F90.9 ( )[ ] ( ) 年 F90.9 Hyperkinetic disorder, unspecified Hyperkinetic reaction of childhood or adolescence NOS Hyperkinetic syndrome NOS F91 行 ( 行 ) ( ) 行行 ( 行 ) ( ) 類行年 ( ) 年行類 ( 6 ) 行 ( 行 ) 精神狀 [* ( 異 ) 行 ] F91 Conduct disorders Disorders characterized by a repetitive and persistent pattern of dissocial, aggressive, or defiant conduct. Such behaviour should amount to major violations of age-appropriate social expectations; it should therefore be more severe than ordinary childish mischief or adolescent rebelliousness and should imply an enduring pattern of behaviour (six months or longer). Features of conduct disorder can also be symptomatic of other psychiatric conditions, in which case the underlying diagnosis should be preferred. 類行例度 ( ) ( ) 說亂不行若狀若立行不 [ ( )] ( ) (F30-F39) ( ) (F84.-) 精神裂 ( ) (F20.-) 列 ( ) (F92.-) ( )[ ] (F90.1) Examples of the behaviours on which the diagnosis is based include excessive levels of fighting or bullying, cruelty to other people or animals, severe destructiveness to property, fire-setting, stealing, repeated lying, truancy from school and running away from home, unusually frequent and severe temper tantrums, and disobedience. Any one of these behaviours, if marked, is sufficient for the diagnosis, but isolated dissocial acts are not. Excludes: mood [affective] disorders (F30-F39) Pervasive developmental disorders (F84.-) schizophrenia (F20.-) when associated with: emotional disorders (F92.-) hyperkinetic disorders (F90.1) 410

101 F91.0 行 ( 行 ) F91.0 Conduct disorder confined to the ( ) family context ( 異 ) 行 ( 立行 ) 行 ( 行 ) ( ) 異行 F91.- ( 亂 ) 不 Conduct disorder involving dissocial or aggressive behaviour (and not merely oppositional, defiant, disruptive behaviour), in which the abnormal behaviour is entirely, or almost entirely, confined to the home and to interactions with members of the nuclear family or immediate household. The disorder requires that the overall criteria for F91.- be met; even severely disturbed parent-child relationships are not of themselves sufficient for diagnosis. F91.1 行 ( 行 ) ( F91.1 Unsocialized conduct disorder ) ( 異 ) 行行 ( 行 ) ( )( F91.- 立行 ) ( ) ( ) 異 Disorder characterized by the combination of persistent dissocial or aggressive behaviour (meeting the overall criteria for F91.- and not merely comprising oppositional, defiant, disruptive behaviour) with significant pervasive abnormalities in the individual's relationships with other children. 行 ( 行 ) ( ) ( ) Conduct disorder, solitary aggressive type Unsocialized aggressive disorder F91.2 行 ( 行 ) ( ) ( 異 ) 行 ( F91.- 立行 ) F91.2 Socialized conduct disorder Disorder involving persistent dissocial or aggressive behaviour (meeting the overall criteria for F91.- and not merely comprising oppositional, defiant, disruptive behaviour) occurring in individuals who are generally well integrated into their peer group. 行 ( 行 ) ( ) Conduct disorder, group type Group delinquency Offences in the context of gang membership Stealing in company with others Truancy from school 411

102 F91.3 立 ( ) F91.3 Oppositional defiant disorder 類行 ( 行 ) ( ) 年 ( ) [* ] 不行益更 ( 異 ) 行 F91.- 行不類年 ( ) 臨行 ( 行 ) ( 異 ) 行不行 Conduct disorder, usually occurring in younger children, primarily characterized by markedly defiant, disobedient, disruptive behaviour that does not include delinquent acts or the more extreme forms of aggressive or dissocial behaviour. The disorder requires that the overall criteria for F91.- be met; even severely mischievous or naughty behaviour is not in itself sufficient for diagnosis. Caution should be employed before using this category, especially with older children, because clinically significant conduct disorder will usually be accompanied by dissocial or aggressive behaviour that goes beyond mere defiance, disobedience, or disruptiveness. F91.8 行 ( 行 ) ( ) F91.8 Other conduct disorders F91.9 行 ( 行 ) ( ) ( 列 ) ( ) F91.9 Conduct disorder, unspecified Childhood: 行 ( ) behavioural disorder NOS 行 ( 行 ) ( ) conduct disorder NOS F92 行 ( 行 ) ( ) ( ) ( 異 ) 行 ( ) ( ) 不良狀 ( ) 行 ( 行 ) (F91.-) ( ) (F93.-) 精神 (F40-F48) (F30 -F39) F92 Mixed disorders of conduct and emotions A group of disorders characterized by the combination of persistently aggressive, dissocial or defiant behaviour with overt and marked symptoms of depression, anxiety or other emotional upsets. The criteria for both conduct disorders of childhood (F91.-) and emotional disorders of childhood (F93.-) or an adult-type neurotic diagnosis (F40-F48) or a mood disorder (F30-F39) must be met. F92.0 行 ( 行 ) ( ) 類 ( ) 行 ( 行 ) (F91.-) F92.0 Depressive conduct disorder This category requires the combination of conduct disorder (F91.-) with persistent and 412

103 (F32.-) 度樂 ( 亂 ) marked depression of mood (F32.-), as demonstrated by symptoms such as excessive misery, loss of interest and pleasure in usual activities, self-blame, and hopelessness; disturbances of sleep or appetite may also be present. ( )F32.-( 類 ) ( ) ( ) F91.- ( 類 ) 行 ( 行 ) ( ) Conduct disorder in F91.- associated with depressive disorder in F32.- F92.8 行 ( 行 ) ( ) 類 ( ) 行 ( 行 ) (F91.-) 狀行 [ ] [ ] ( ) ( ) F92.8 Other mixed disorders of conduct and emotions This category requires the combination of conduct disorder (F91.-) with persistent and marked emotional symptoms such as anxiety, obsessions or compulsions, depersonalization or derealization, phobias, or hypochondriasis. ( ) 列列 F91.- 行 ( 行 ) ( ) Conduct disorder in F91.- associated with: 列 F93.- ( ) emotional disorder in F93. - 列 F40-F48 精神 ( ) neurotic disorder in F40-F48 F92.9 行 ( 行 ) ( 聯 ) ( ) F92.9 Mixed disorder of conduct and emotions, unspecified F93 ( ) ( ) F93 Emotional disorders with onset specific to childhood 異 ( ) ( ) 精神 ( )(F40-F48) Mainly exaggerations of normal developmental trends rather than phenomena that are qualitatively abnormal in themselves. Developmental appropriateness is used as the key diagnostic feature in defining the difference between these emotional disorders, with onset specific to childhood, and the neurotic disorders. (F40-F48) ( ) 行 (F92.-) Excludes: when associated with conduct disorder (F92.-) 413

104 F93.0 ( ) 離 ( )[ ( ) 離 ] 離 ( ) ( ) 離離 ( ) ( ) 度不 ( 離 ( ) 異了年 ) F93.0 Separation anxiety disorder of childhood Should be diagnosed when fear of separation constitutes the focus of the anxiety and when such anxiety first arose during the early years of childhood. It is differentiated from normal separation anxiety when it is of a degree (severity) that is statistically unusual (including an abnormal persistence beyond the usual age period), and when it is associated with significant problems in social functioning. [ ( )] ( ) (F30-F39) 精神 ( )[ 精神 ] (F40-F48) ( ) ( ) (F93.1) ( ) ( ) (F93.2) Excludes: mood [affective] disorders (F30-F39) neurotic disorders (F40-F48) phobic anxiety disorder of childhood (F93.1) social anxiety disorder of childhood (F93.2) F93.1 ( ) ( )[ ( ) ] 數 ( 度不 ) ( ) 異度 ( ) 理 ( ) F40-F48 類 F93.1 Phobic anxiety disorder of childhood Fears in childhood that show a marked developmental phase specificity and arise (to some extent) in a majority of children, but that are abnormal in degree. Other fears that arise in childhood but that are not a normal part of psychosocial development (for example agoraphobia) should be coded under the appropriate category in section F40-F48. ( )[ ] (F41.1) Excludes: generalized anxiety disorder (F41.1) F93.2 ( ) ( )[ ( ) ] ( ) ( ) 類 F93.2 Social anxiety disorder of childhood In this disorder there is a wariness of strangers and social apprehension or anxiety when encountering new, strange, or socially threatening situations. This category should 414

105 ( ) (* 六 ) 不度 ( ) ( ) 年 ( ) be used only where such fears arise during the early years, and are both unusual in degree and accompanied by problems in social functioning. Avoidant disorder of childhood or adolescence F93.3 ( ) 數年 ( ) ( ) 都度 ( 亂 ) 度 ( ) 異 ( ) F93.3 Sibling rivalry disorder Some degree of emotional disturbance usually following the birth of an immediately younger sibling is shown by a majority of young children. A sibling rivalry disorder should be diagnosed only if the degree or persistence of the disturbance is both statistically unusual and associated with abnormalities of social interaction. Sibling jealousy F93.8 ( ) ( F93.8 Other childhood emotional disorders ) [ ( ) ] ( ) Identity disorder 度 ( ) Overanxious disorder ( ) ( Excludes: gender identity disorder of childhood ) (F64.2) (F64.2) F93.9 ( ) ( )[ ( ) ] F93.9 Childhood emotional disorder, unspecified F94 ( ) 年 ( ) ( ) 異 ( ) 異領 ( 不 ) 例塞 415 F94 Disorders of social functioning with onset specific to childhood and adolescence A somewhat heterogeneous group of disorders that have in common abnormalities in social functioning which begin during the developmental period, but which (unlike the pervasive developmental disorders) are not primarily characterized by an apparently constitutional social incapacity or deficit that pervades all areas of functioning. In many instances, serious environmental distortions or privations

106 probably play a crucial role in etiology. F94.0 不 ( ) F94.0 Elective mutism 說力 ( ) 不 Characterized by a marked, emotionally determined selectivity in speaking, such that the child demonstrates a language competence in some situations but fails to speak in other (definable) situations. The disorder is usually associated with marked personality features involving social anxiety, withdrawal, sensitivity, or resistance 不 ( ) ( )[ ] (F84.-) 精神裂 ( ) (F20.-) ( )[ ] (F80.-) 年 ( ) 離不 ( ) (F93.0) Selective mutism Excludes: pervasive developmental disorders (F84.-) schizophrenia (F20.-) specific developmental disorders of speech and language (F80.-) transient mutism as part of separation anxiety in young children (F93.0) F94.1 ( ) 戀 ( ) [ 戀 ] 5 ( ) 異 ( ) ( 亂 ) ( 度不良度 ) 來不良 F94.1 Reactive attachment disorder of childhood Starts in the first five years of life and is charactcrizcd by persistent abnormalities in the child's pattern of social relationships that are associated with emotional disturbance and are reactive to changes in environmental circumstances (e.g. fearfulness and hypervigilance, poor social interaction with peers, aggression towards self and others, misery, and growth failure in some cases). The syndrome probably occurs as a direct result of severe parental neglect, abuse, or serious mishandling. Asperger ( ) (F84.5) Use additional code, if desired, to identify any associated failure to thrive or growth retardation. Excludes: Asperger's syndrome (F84.5) 416

107 ( ) 戀 ( )[ 戀 ] (F94.2) 不 (T74.-) 戀異 ( ) 理 (Z61.4-Z61.6) disinhibited attachment disorder of childhood (F94.2) maltreatment syndromes (T74.-) normal variation in pattern of selective attachment sexual or physical abuse in childhood, resulting in psychosocial problems (Z61.4-Z61.6) F94.2 ( ) 戀 ( ) 5 異不例戀行不行不理行 ( 亂 ) 精神 Asperger ( ) (F84.5) ( ) (F43.2) ( )[ ] (F90.-) ( ) 戀 ( )[ 戀 ] (F94.1) F94.2 Disinhibited attachment disorder of childhood A particular pattern of abnormal social functioning that arises during the first five years of life and that tends to persist despite marked changes in environmental circumstances, e.g. diffuse, nonselectively focused attachment behaviour, attention-seeking and indiscriminately friendly behaviour, poorly modulated peer interactions;depending on circumstances there may also be associated emotional or behavioural disturbance. Affectionless psychopathy Institutional syndrome Excludes: Asperger's syndrome (F84.5) hospitalism in children (F43.2) hyperkinetic disorders (F90.-) reactive attachment disorder of childhood (F94.1) F94.8 ( ) ( ) F94.8 Other childhood disorders of social functioning F94.9 ( ) ( ) F94.9 Childhood disorder of social functioning, unspecified F95 ( )[ ] F95 Tic disorders 不 ( ) 不力惡 417 Syndromes in which the predominant manifestation is some form of tic. A tic is an involuntary, rapid, recurrent, nonrhythmic motor movement (usually involving circumscribed muscle groups) or vocal production that is of sudden onset and that

108 力惡見見見來見說不 ( ) ( ) ( ) serves no apparent purpose. Tics tend to be experienced as irresistible but usually they can be suppressed for varying periods of time, are exacerbated by stress, and disappear during sleep. Common simple motor tics include only eye-blinking, neck-jerking, shoulder-shrugging, and facial grimacing. Common simple vocal tics include throat-clearing, barking, sniffing, and hissing. Common complex tics include hitting oneself, jumping, and hopping. Common complex vocal tics include the repetition of particular words, and sometimes the use of socially unacceptable (often obscene) words (coprolalia), and the repetition of one's own sounds or words (palilalia). F95.0 ( )[ ] 不 12 F95.0 Transient tic disorder Meets the general criteria for a tic disorder but the tics do not persist longer than 12 months. The tics usually take the form of eye-blinking, facial grimacing, or head-jerking. F95.1 ( )[ ] ( 都 ) ( ) 年 F95.1 Chronic motor or vocal tic disorder Meets the general criteria for a tic disorder, in which there are motor or vocal tics (but not both), that may be either single or multiple (but usually multiple), and last for more than a year. F95.2 ( 聯 ) ( )[de la Tourette ( ) ] 不 ( ( ) ) 年惡年說行 ( 行 ) 418 F95.2 Combined vocal and multiple motor tic disorder [de la Tourette] A form of tic disorder in which there are, or have been, multiple motor tics and one or more vocal tics, although these need not have occurred concurrently. The disorder usually worsens during adolescence and tends to persist into adult life. The vocal tics are often multiple with explosive repetitive vocalizations, throat-clearing, and grunting, and there may be the use of obscene words or phrases. Sometimes there is associated

109 gestural echopraxia which may also be of an obscene nature (copropraxia). F95.8 ( )[ F95.8 Other tic disorders ] F95.9 ( )[ ] ( ) F95.9 Tic disorder, unspecified Tic NOS F98 ( ) 年行 ( ) ( ) 異 ( ) 年不狀見理 (R06.8) ( ) ( ) (F64.2) Kleine-Levin ( ) [ ] (G47.8) ( )[ ] (F42.-) ( ) ( ) (F51.-) F98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence A heterogeneous group of disorders that share the characteristic of an onset in childhood but otherwise differ in many respects. Some of the conditions represent well-defined syndromes but others are no more than symptom complexes that need inclusion because of their frequency and association with psychosocial problems, and because they cannot be incorporated into other syndromes. Excludes: breath-holding spells (R06.8) gender identity disorder of childhood (F64.2) Kleine-Levin syndrome (G47.8) obsessive-compulsive disorder (F42.-) sleep disorders due to emotional causes (F51.-) F98.0 尿 ( ) F98.0 Nonorganic enuresis 不尿理年異神 ( ) 泌尿異尿 ( ) 來尿 ( ) ( ) ( ) A disorder characterized by involuntary voiding of urine, by day and by night, which is abnormal in relation to the individual's mental age, and which is not a consequence of a lack of bladder control due to any neurological disorder, to epileptic attacks, or to any structural abnormality of the urinary tract. The enuresis may have been present from birth 419

110 行 ( )( ) 尿 ( ) 尿 ( ) 尿 ( ) 尿尿 ( ) (R32) or it may have arisen following a period of acquired bladder control. The enuresis may or may not be associated with a more widespread emotional or behavioural disorder. Enuresis (primary)(secondary) of nonorganic origin Functional enuresis Psychogenic enuresis Urinary incontinence of nonorganic origin Excludes: enuresis NOS (R32) F98.1 ( ) F98.1 不便 ( 便異 ) 不來便理便不狀 (F93.-) 行 ( 行 ) (F91.-) Nonorganic encopresis Repeated, voluntary or involuntary passage of faeces, usually of normal or near-normal consistency, in places not appropriate for that purpose in the individual's own sociocultural setting. The condition may represent an abnormal continuation of normal infantile incontinence, it may involve a loss of continence following the acquisition of bowel control, or it may involve the deliberate deposition of faeces in inappropriate places in spite of normal physiological bowel control. The condition may occur as a monosymptomatic disorder, or it may form part of a wider disorder, especially an emotional disorder (F93.-) or a conduct disorder (F91.-). ( ) 便 ( ) Functional encopresis Incontinence of faeces of nonorganic origin Psychogenic encopresis 便 ( ) ( ) (R15) Use additional code, if desired, to identify the cause of any coexisting constipation. Excludes: encopresis NOS (R15) F98.2 ( ) ( ) ( ) ( ) F98.2 Feeding disorder of infancy and childhood A feeding disorder of varying manifestations usually specific to infancy 420

111 理狀不 ( 不 ) ( ) 神 [ ] ( ) ( ) ( ) (F50.-) ( 列 ) 理不 (R63.3) (P92.-) ( ) 異 ( ) (F98.3) and early childhood. It generally involves food refusal and extreme faddiness in the presence of an adequate food supply, a reasonably competent caregiver, and the absence of organic disease. There may or may not be associated rumination (repeated regurgitation without nausea or gastrointestinal illness). Rumination disorder of infancy Excludes: anorexia nervosa and other eating disorders (F50.-) feeding: difficulties and mismanagement (R63.3) problems of newborn (P92.-) pica of infancy or childhood (F98.3) F98.3 ( ) 異 ( ) F98.3 ( 泥料 ) 更精神 ( ) 狀立精神行類類見不 ( ) 若不 F70-F79 Pica of infancy and childhood Persistent eating of non-nutritive substances (such as soil, paint chippings, etc.). It may occur as one of many symptoms that are part of a more widespread psychiatric disorder (such as autism), or as a relatively isolated psychopathological behaviour; only the latter is classified here. The phenomenon is most common in mentally retarded children and, if mental retardation is also present, F70-F79 should be selected as the main diagnosis. F98.4 ( ) F98.4 Stereotyped movement disorders ( ) 不精神神 ( ) 狀都類捻行 ( ) 不 ( 兩 ) 若力 ( 不 ) ( ) 類力 ( 力 ) 421 Voluntary, repetitive, stereotyped, nonfunctional (and often rhythmic) movements that do not form part of any recognized psychiatric or neurological condition. When such movements occur as symptoms of some other disorder, only the overall disorder should be recorded. The movements that are of a non self-injurious variety include: body-rocking, head-rocking, hair-plucking, hair-twisting, finger-flicking mannerisms, and hand-flapping. Stereotyped self-injurious behaviour includes repetitive head-banging, face-slapping, eye-poking, and biting of hands, lips or other body parts. All the stereotyped movement disorders occur most frequently in association with

112 類力 ( 力 ) mental retardation (when this is the case, both should be recorded). If eye-poking occurs in a child with visual impairment, both should be coded: eye-poking under this category and the visual condition under the appropriate somatic disorder code. ( ) 異不 (R25.-) ( ) (G20-G25) (F98.8) (F98.8) 精神 (F00-F95) (F98.8) [ ] (F95.-) ( ) (F63.3) Stereotype/habit disorder Excludes: abnormal involuntary movements (R25.-) movement disorders of organic origin (G20-G25) nail-biting (F98.8) nose-picking (F98.8) stereotypies that are part of a broader psychiatric condition (F00-F95) thumb-sucking (F98.8) tic disorders (F95.-) trichotillomania (F63.3) F98.5 ( ) 說拉了說律 [* 說流度 ] 度流度類 F98.5 Stuttering [stammering] Speech that is characterized by frequent repetition or prolongation of sounds or syllables or words, or by frequent hesitations or pauses that disrupt the rhythmic flow of speech. It should be classified as a disorder only if its severity is such as to markedly disturb the fluency of speech. ( ) (F98.6) ( )[ ] (F95.-) Excludes: cluttering (F98.6) tic disorders (F95.-) F98.6 ( ) 說了流度說不律 ( ) (98.5) ( )[ ] (F95.-) 422 F98.6 Cluttering A rapid rate of speech with breakdown in fluency, but no repetitions or hesitations, of a severity to give rise to diminished speech intelligibility. Speech is erratic and dysrhythmic, with rapid jerky spurts that usually involve faulty phrasing patterns. Excludes: stuttering (F98.5) tic disorders (F95.-)

113 F98.8 ( ) 年行 ( ) 力 ( ) ( ) ( ) 度 ( ) F98.8 Other specified behavioural and emotional disorders with onset usually occurring in childhood and adolescence Attention deficit disorder without hyperactivity Excessive masturbation Nail-biting Nose-picking Thumb-sucking F98.9 ( ) 年行 ( ) F98.9 Unspecified behavioural and emotional disorders with onset usually occurring in childhood and adolescence ( ) (F99) Unspecified mental disorder (F99) F99 精神 [ ] ( ) 精神 [ ] ( 不 ) 精神 [ ] ( ) (F06.9) F99 Mental disorder, not otherwise specified Mental illness NOS Excludes: organic mental disorder NOS (F06.9) 423

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