The leading complaint is persistent, severe and psychologically depressing pain that cannot be fully explained by a physiological process or physical disorder and that occurs in combination with emotional conflict or psychosocial problems that may be considered the main cause. The result is usually a clear increase in support and attention from individuals or health professionals.
This does not include pain of presumed psychogenic origin that occurs during a depressive disorder or schizophrenia. Pain that arises from known or suspected psychophysiological mechanisms, such as muscle tension pain or migraine, but which is presumed to have a psychogenic origin, is coded F54 (psychological and behavioral factors associated with disorders or diseases classified elsewhere), plus - additional code from other ICD-10 categories (for example, migraine G43.-).
It should be noted:
In some cases, the state of persistent somatoform pain is accompanied by an overvalued desire to overcome pathological bodily sensations through the development of their own treatment methods, characterized by pretentiousness and brutality, and in severe cases can cause varying degrees of auto-aggression (“limited (circumscripta) hypochondria”).
Differential diagnosis:
Most often it is necessary to differentiate this disorder from hysterical processing of organic pain. Patients with organic pain who do not yet have a specific physical diagnosis may easily become fearful or resentful, which in turn leads to attention-seeking behavior. Various pains are very common in somatization disorder, but they do not stand out in their strength and consistency among other complaints.
Included:
Psychalgia;
Psychogenic back pain;
Psychogenic headache;
“limited (circumscripta) hypochondria”;
Somatoform pain disorder.
Excluded:
Back pain NOS (M54.9);
Pain NOS (R52.9);
The pain is acute (R52.0);
Chronic pain (R52.2);
Unrelieved pain (R52.1);
Tension type headache (G44.2).
2.7.5. F45.8 Other somatoform disorders.
With these disorders, the patients' complaints are not mediated by the autonomic nervous system and are limited to individual systems or parts of the body; this contrasts with
the multiplicity and variability of interpretation of the origin of symptoms and emotional disturbances found in somatization disorder (F45.0) and undifferentiated somatoform disorder (F45.1). There is no tissue damage.
This should also include any other disturbances of sensations that arise outside of organic disorders, which are closely related in time to stressful events and problems or lead to significantly increased attention to the patient either from individuals or physicians. Sensations of swelling, skin movement, and paresthesia (tingling and/or numbness) are common examples.
This should include the following types of disorders:
a) “hysterical lump” (feeling of a lump in the throat causing dysphagia), and also
other forms of dysphagia;
b) psychogenic torticollis and other disorders accompanied by spasmoid
movements (but excluding Gilles de la Tourette syndrome);
c) psychogenic itching (but excluding specific skin disorders such as
alopecia, dermatitis, eczema or urticaria of psychogenic origin (F54));
d) psychogenic dysmenorrhea (but excluding dyspareunia (F52.6) and frigidity
(F52.0);
e) grinding of teeth.
Included:
Psychogenic dysmenorrhea;
Psychogenic dysphagia, including globus hystericus;
Psychogenic itching;
Psychogenic torticollis;
Grinding of teeth.
F45.9 Somatoform disorder, unspecified Includes:
Unspecified psychophysiological disorder;
Psychosomatic disorder NOS.
2.8. F48 Other neurotic disorders
2.8.1. F48.0 Neurasthenia
The presentation of this disorder is subject to considerable cultural variation; There are two main types that have a lot in common.
In the first type, the main symptom is complaints of increased fatigue after mental work, and there is often a decrease in professional productivity or efficiency in everyday activities. Mental fatigue is usually described as the unpleasant interference of distracting associations or memories, an inability to concentrate, and unproductive thinking. With the other type, the main thing is physical weakness and exhaustion after minimal effort, accompanied by a feeling of pain in the muscles and the inability to relax. With both types, other unpleasant physical sensations are common, such as dizziness, tension headaches, and a feeling of general unsteadiness. Concerns about mental and physical ill-being, irritability, anhedonia (loss of feelings of joy, pleasure) and minor degrees of depression and anxiety are also common. The initial and intermediate phases of sleep are often disturbed, but hypersomnia can also be severe.
Diagnostic instructions:
For a reliable diagnosis, the following signs are required:
a) constant complaints of increased fatigue after mental work or
complaints of body weakness and exhaustion after minimal effort;
b) at least two of the following symptoms:
Feeling muscle pain
Dizziness,
Tension headache,
Sleep disturbance,
Inability to relax
Irritability,
Dyspepsia;
c) any existing autonomic or depressive symptoms are not of sufficient duration or severity to meet the criteria for the more specific disorders described in this classification.
Differential diagnosis:
In many countries, the diagnosis of neurasthenia is rarely used. Many similar diagnoses made in the past would have met current criteria for a depressive or anxiety disorder. However, there are also cases that fit the description of neurasthenia more closely than of any other neurotic syndrome, and in some countries such cases seem to occur more often, in others - less often. If a patient is suspected of having neurasthenia, it is first necessary to rule out a depressive illness or anxiety disorder. A distinctive feature of the syndrome is the patient's complaints of fatigue and weakness and his concern about a decrease in mental and physical performance (in contrast to somatoform disorders, where the clinical picture is dominated by complaints about physical illness). If the neurasthenic syndrome appears after a physical illness (especially influenza, viral hepatitis or infectious mononucleosis), the previous diagnosis of neurasthenia should also be noted.
It should be noted:
The identified subtypes in cases of predominance of complaints of mental fatigue and in the presence of objectively detectable signs of decreased mental productivity must be differentiated with pseudoneurasthenic states caused by an affective disorder (asthenic depression), as well as with asthenic manifestations of “symptom-poor” schizophrenia (F21.5).
Included:
Fatigue syndrome.
Excluded:
Asthenia NOS (R53);
Emptyness (state of depletion of vitality) (Z73.0);
Post-viral fatigue syndrome (G93.3);
Malaise and fatigue (R53);
Psychasthenia (F48.8).
2.8.2. F48.1 Depersonalization-derealization syndrome
A disorder in which the patient complains that his mental activity, body and/or environment have changed qualitatively to such an extent that they seem unreal, distant or automatic. He may feel that he no longer thinks, imagines, or remembers himself; that his movements and behavior are, as it were, not his; that his body appears lifeless, distant, or otherwise abnormal; the surroundings have become colorless and lifeless and seem artificial, or like a stage on which people play imaginary roles. In some cases, the patient may feel as if he is seeing himself from the outside or as if he has died. The most common of these various phenomena is the complaint of loss of emotions.
The number of patients in whom this disorder occurs in pure or isolated form is small. The phenomenon of depersonalization most often occurs within the framework of depressive disorder, phobic and obsessive-compulsive disorder.
Elements of this syndrome can also appear in mentally healthy individuals with fatigue,
sensory deprivation, hallucinogenic intoxication, or how
hypnagogic/hypnapompic phenomenon. The depersonalization-derealization syndrome is phenomenologically close to the so-called “near-death states” associated with moments of extreme danger to life.
Diagnostic criteria:
For a reliable diagnosis, the following signs must be present: a) or b) or both, plus c) and d):
a) symptoms of depersonalization, that is, the patient feels that his feelings and/or
actions are torn off from him, removed, not his own, lost, etc.;
b) symptoms of derealization, that is, objects, people and/or the environment seem
unreal, distant, artificial, colorless, lifeless, etc.;
c) understanding that this is a subjective and spontaneous change, and not imposed
external forces or other people (i.e. the presence of criticism),
d) clear consciousness and absence of toxic states of confusion or epilepsy.
Differential diagnosis:
Should be distinguished from other disorders in which a "personality change" is perceived or present, such as schizophrenia (delusions of metamorphosis or sensations of influence), dissociative disorders (in which there is no awareness of a change in state) and some cases of early dementia. As a secondary phenomenon, this syndrome may be present in the preictal aura of temporal lobe epilepsy or some postictal conditions.
If this syndrome is observed as part of depressive, phobic, obsessive-compulsive disorders or schizophrenia, these should be considered the main diagnosis.
It should be noted:
The “involuntariness” of complaints, which is indicated in the introduction to the rubric, should be considered a figurative characteristic. Depersonalization disorder invariably occurs without formal disturbances of consciousness. Even in cases of depressive depersonalization, the observed disorder may not be limited to manifestations of painful mental anesthesia. Disorders of self-awareness extend to all mental activity and, above all, to cognitive functions. The diagnosis is established by belonging to affective disorders (F30 - F39) or to schizotypal disorders (F21.-).
The main feature is the repeated presentation of somatic symptoms simultaneously with persistent demands for medical examinations, despite repeated negative results and assurances from doctors that the symptoms are not of a somatic nature. If the patient has any physical illnesses, they do not explain the nature and severity of the symptoms or the patient's suffering and complaints.
F45.0 Somatization disorder
Epidemiology
Clinic
Diagnosis
Differential diagnosis
Treatment
The main features are numerous, repeated, frequently changing physical symptoms, occurring over a period of at least two years. Most patients have a long and complex history of contact with primary and specialized medical care, during which many inconclusive tests and futile diagnostic manipulations may have been performed. Symptoms can relate to any part of the body or organ system. The course of the disorder is chronic and intermittent and is often associated with disturbances in social, interpersonal and family behavior. Short-term (less than two years) and less severe examples of symptoms should be classified as undifferentiated somatoform disorder (F45.1).
Multiple psychosomatic disorder
Excluded: simulation [conscious simulation] (Z76.5)
F45.1 Undifferentiated somatoform disorder
The diagnosis of undifferentiated somatoform disorder should be made in cases where the patient's complaints are numerous, variable and persistent, but do not satisfy the complete and typical clinical picture of somatization disorder.
Undifferentiated psychosomatic disorder
F45.2 Hypochondriacal disorder
Epidemiology
Etiology
Clinic
Diagnosis
Differential diagnosis
Treatment
The most important feature is the patient's persistent concern about the possibility of having a severe, progressive disease or several diseases. The patient presents persistent somatic complaints or persistent anxiety about their occurrence. Normal, ordinary sensations and signs are often perceived by the patient as abnormal and disturbing; he usually focuses his attention on only one or two organs or systems of the body. Significant depression and anxiety are often present, which may account for additional diagnoses.
A disorder characterized by preoccupation with one's own health
Dysmorphophobia (non-delusional)
Hypochondriacal neurosis
Hypochondria
Nosophobia
F45.3 Somatoform autonomic dysfunction
The symptoms presented by the patient are similar to those that occur when an organ or organ system is damaged, predominantly or completely innervated and controlled by the autonomic nervous system, that is, the cardiovascular, gastrointestinal, respiratory, and genitourinary systems.
Symptoms are usually of two types, neither of which relates to a specific organ or system disorder. The first are complaints based on objective signs of autonomic irritation, such as palpitations, sweating, redness, tremors and expressions of fear and anxiety regarding possible health problems.
The second group of symptoms includes subjective complaints of a nonspecific, variable nature, such as fleeting pain throughout the body, a feeling of heat, heaviness, fatigue, or a feeling of flabby or bloated, which the patient correlates with some organ or organ system.
Cardiac neurosis
Da Costa syndrome
Gastroneurosis
Neurocirculatory asthenia
Psychogenic forms:
- aerophagia
- cough
- diarrhea
- dyspepsia
- dysuria
- flatulence
- hiccups
- deep and frequent breathing
- frequent urination
- irritable bowel syndrome
- pylorospasm
F45.4 Chronic somatoform pain disorder
Epidemiology
Etiology
Clinic
Diagnosis
Differential diagnosis
Treatment
The main complaint is persistent, sharp, excruciating pain that cannot be fully explained by a physiological disorder or physical illness, and which arises in connection with emotional conflict or psychosocial problems, which allows them to be considered as the main etiological cause. The result is usually a noticeable increase in support and attention, either personal or medical.
Pain of a psychogenic nature that occurs during a depressive disorder or schizophrenia cannot be classified under this category.
Psychalgia
Psychogenic:
- backache
- headache
Somatoform pain disorder
Excluded:
back pain NOS (M54.9)
pain:
- NOS (R52.9)
- acute (R52.0)
- chronic (R52.2)
- difficult to treat (R52.1)
tension headache (G44.2)
F45.8 Other somatoform disorders
Any other disorders of sensitivity, function or behavior that do not arise from somatic disorders. Disorders that are not mediated through the autonomic nervous system, that are limited to specific systems or areas of the body, and that have a close temporal relationship with traumatic events or problems.
Psychogenic(s):
- dysmenorrhea
- dysphagia, including globus hystericus
- itching
- torticollis
Teeth grinding
F45.9 Somatoform disorder, unspecified
Psychosomatic disorder NOS
Modern medicine is a constant process of searching for new methods of treatment, diagnosis and prevention of diseases and it is impossible without systematizing previously acquired knowledge. One of the methods for taking into account all accumulated statistical data, which is periodically revised, clarified and supplemented, is the International Classification of Diseases.
This article will talk in more detail about what place bronchitis occupies in ICD 10, depending on the etiology, form and course.
Bronchitis is an inflammatory disease, the development of which damages the mucous membrane and walls of the bronchial tree. This pathology is currently diagnosed in every second inhabitant of the planet. Bronchitis affects people from various age groups, but most often children, the elderly, and patients with weakened natural immune reactivity of the respiratory tract.
According to the classification, there are two main types of bronchitis: acute and chronic. Acute inflammation of the bronchi (J20 - J22) is characterized by the appearance of symptoms of the disease, often against the background of acute respiratory viral infections or acute respiratory infections and complete recovery after 3-4 weeks.
In chronic bronchitis (J40-J47), inflammatory changes are progressive in nature, cover significant areas of the respiratory tree, and periodic exacerbations are observed with aggravation of the patient's condition.
Spicy
Acute bronchitis ICD 10 code depends on the type of pathogen and includes 10 clarifying diagnoses. With the development of inflammation provoked by various bacterial and viral agents with mandatory laboratory clarification of the pathogen, the following codes for acute bronchitis caused by are identified:
- Mycoplasma pneumoniae (J20.0)
- Afanasyev-Pfeiffer wand (J20.1);
- streptococcus (J20.2);
- Coxsackie viruses (J20.3);
- parainfluenza virus (J20.4);
- rhinosyncytial infection virus (J20.5);
- rhinovirus (J20.6);
- echovirus (J20.7).
If the inflammatory process is caused by another specified pathogen not listed in the classification above, acute bronchitis has ICD code J20.8. At the same time, situations often occur when it is not possible to clarify the causative agent of the inflammatory process in the bronchi.
In this case, bronchitis is diagnosed based on the collection of complaints, anamnesis, the presence of clinical symptoms and auscultation patterns (hard breathing, varying degrees of wheezing), the results of laboratory tests and, if necessary, an x-ray examination.
Acute bronchitis according to ICD 10 with an unrefined pathogen has code J20.9.
Chronic
Chronic bronchitis is diagnosed if there is progressive damage to the bronchial tree, and the characteristic manifestations of the disease are constantly present for at least three consecutive months within one year and these signs have been observed over the past two years.
In most cases, irreversible changes in the lower respiratory tract are observed after prolonged exposure to various irritating factors:
- smoking, including passive smoking:
- the constant presence of unfavorable environmental factors;
- long-term indolent infections, somatic diseases with severe intoxication syndrome;
- occupational hazards;
- persistent decrease in immunity.
With chronic inflammation, a restructuring of the secretory apparatus of the bronchi occurs - this causes an increase in the volume and viscosity of sputum, as well as a decrease in the natural protection of the bronchial tree and its cleansing functions.
The main symptom of tracheobronchitis is periodic or constant cough
It is important to remember that in pediatric pulmonology up to the age of three there is no concept of “chronic bronchitis” - this is due to the absence of irreversible changes in the tissues of the bronchi. But at the same time, this pathology is possible in children of an older age group with a progressive course of the inflammatory process and the appearance of signs of hypertrophy, atrophy or hemorrhagic changes in the bronchi, which are clarified by bronchoscopy and tissue biopsy.
In pediatrics, recurrent bronchitis is more often observed - repeated episodes of acute inflammation of the bronchi, which are recorded at least 3-4 times a year, and their duration ranges from 2 weeks to a month. There is no ICD code for recurrent inflammation, and recurrent episodes of the disease are classified as acute bronchitis (J20) or J22 - acute viral lower respiratory tract infection (unspecified).
These children are allocated to a separate group of dispensary observation - FSD (frequently and long-term ill). A pediatrician constantly monitors a child with recurrent bronchitis and prescribes treatment during exacerbations and remission.
Chronic bronchitis (ICB 10)
In adult patients, the following forms of chronic bronchitis are distinguished:
- non-obstructive;
- purulent or mucous-purulent;
- obstructive or asthmatic;
- purulent - obstructive.
Non-obstructive
This form is characterized by catarrhal inflammation of the bronchial mucosa and their walls, without complications such as broncho-obstruction and bronchiectasis.
ICD 10 codes:
- J40 - catarrhal bronchitis with tracheitis, unspecified (both acute and chronic);
- J42 – chronic unspecified bronchitis.
Purulent or mucous-purulent
With this form of the disease, large sections of the bronchi are affected, most often these are infectious types of inflammation caused by bacterial pathogens (Afanasyev-Pfeiffer bacillus, streptococci, pneumococci) with periods of exacerbation and remission. Chronic bronchitis, tracheitis or tracheobronchitis with the release of purulent sputum has ICD code 10 - J41.
Obstructive (asthmatic)
In this form of the disease, against the background of chronic inflammation, there is an increased reactivity of the bronchi, which manifests itself in the form of their spasm and swelling of the mucous membrane. Asthmatic bronchitis code according to ICD 10 (J44).
Purulent-obstructive
This is a mixed form of the disease, in which there are clinical signs of obstruction (bronchial spasm) and purulent sputum. The code for this pathology is selected by the doctor depending on the prevailing component - purulent inflammation or bronchospasm (J41 or J44)
Course and features of therapy
Often chronic forms develop into more severe diseases (asthma, emphysema, cor pulmonale).
Both non-obstructive and obstructive forms of chronic bronchitis have two phases:
- exacerbation;
- remission is a period of weakening or absence of symptoms of the disease.
Patients of any form react sharply to sudden weather fluctuations and often suffer from acute respiratory infections and acute respiratory viral infections.
Therefore, in order to significantly reduce the risk of disease progression, patients should strictly follow the doctor’s recommendations:
- instructions for taking medications, their doses, courses of treatment;
- the use of herbal medicine, physiotherapeutic procedures, massage, exercise therapy, breathing exercises;
- quit smoking and other bad habits;
- lead an active healthy lifestyle.
The video in this article will talk about measures to prevent exacerbations of chronic bronchitis during remission.
The price of an incorrect attitude towards one’s health is the development of respiratory failure and pulmonary arterial hypertension.
The ICD reference book is not only a correct definition of pathology and its etiology, but also a guide for the doctor when prescribing treatment for the disease. The following aspects come first - preventing the deterioration of the patient’s condition, lengthening periods of remission in chronic diseases and reducing the rate of progression of pathological changes in organs and systems.
The first manifestations of the disorder occur at a young age. Symptoms of Briquet syndrome may appear for a few minutes or a few days, or persist for many months. All signs of the syndrome can be divided into four groups: mental, autonomic, sensory and motor. Autonomic symptoms are very diverse and affect various organs and systems. A characteristic feature is the colorful descriptions and dramatic clinical manifestations.
Most often, with Briquet's syndrome, symptoms from the gastrointestinal tract are detected: nausea, vomiting, loss of taste, difficulty swallowing, anorexia, stomach pain, dyspepsia, constipation and diarrhea. A constant symptom is the feeling of a lump in the throat. Less commonly, patients with Briquet syndrome experience heart pain, tachycardia, shortness of breath, imaginary pregnancy and vicarious bleeding. In the literature there are references to urinary retention, polyuria, vaginismus, aerophagia, coughing, hiccups, yawning and sneezing.
Possible movement disorders in Briquet syndrome include paresis, paralysis, contractures, hyperkinesis, seizures, various gait disorders and astasia-abasia. Astasia-abasia is manifested by the inability to maintain balance and walk in the absence of pathological changes in the nervous system and musculoskeletal system. In severe cases, the patient can get up, but falls and cannot take a single step; in mild cases, the patient balances or sways when walking. Gait disturbances in Briquet syndrome may include a zigzag gait, a dragging gait, a stilted gait (with straight legs), a sliding gait (reminiscent of a speed skater), a skipping gait, and walking with the knees constantly bent.
Motor disorders in Briquet syndrome include writer's cramp and other disorders that make it difficult to perform professional duties, as well as voice disorders in the form of hoarseness, whispering and aphonia. In some cases, patients with Briquet syndrome exhibit muteness, stuttering, eyelid paralysis and blepharospasm. Conscripts, especially during combat operations, may exhibit camptocormia - severe flexion of the body in the absence of pathological changes on radiography of the spine.
Hyperkinesis in Briquet syndrome is characterized by variability, instability, dependence on the emotional state and combination with other autonomic or motor symptoms. Unlike epileptic seizures, seizures in Briquet syndrome occur in traumatic circumstances, in the presence of other people. The alternation of clonic and tonic phases is disrupted, the duration of the seizure is increased, consciousness is preserved, and there is no memory loss after the seizure.
Sensory disturbances in Briquet syndrome include pain, decreased, absent, or increased sensitivity. The patient may experience headaches, joint pain, abdominal or back pain. Skin sensitivity is impaired in a stocking or glove pattern, and a discrepancy is revealed between the areas of impaired sensitivity and the areas of innervation. Briquet syndrome sometimes causes deafness or blindness.
The reasons for the development have not been precisely established. Experts suggest that this pathology occurs under the influence of a number of psychological factors, with individual meanings of pain playing a decisive role in the formation of chronic somatoform pain disorder. In childhood, pain may have been perceived as a way of receiving love, atonement for guilt, or protection from future punishment. At an early age, a patient with chronic somatoform pain disorder may feel pain in the process of identifying with a parent who suffered from mental or physical pain.
Pain could also become a kind of symbolic reflection of strong affect (feelings of anger, powerlessness, hopelessness). Each person has his own “set” of meanings of pain, which arose in the process of his individual development. Under unfavorable living conditions and certain characteristics of personal organization, any of these meanings can provoke the development of chronic somatoform pain disorder.
Among the most common causes of this pathology, mental health experts cite the need for care and attention, difficulties in interpersonal relationships, episodes of humiliation, violence and deprivation of important needs in the patient’s personal history. Pain, as a way of receiving attention, appears in cases where the patient, for some reason, cannot openly express his need for sympathy and support.
Pain from problems in interpersonal relationships occurs when a patient suffering from chronic somatoform pain disorder unconsciously tries to manipulate people close to him in order to provide himself with a certain advantage, for example, to regain lost intimacy or gain the devotion of a partner. At the same time, humiliation, violence, or lack of recognition of needs once experienced becomes the reason for an unconscious ban on the open expression of feelings and honest interactions in relationships.
It is important to distinguish chronic somatoform pain disorder from malingering. In malingering, patients deliberately fake the disease in order to achieve certain benefits. With CSBD, needs are realized through pain sensations on an unconscious level; patients with chronic somatoform pain disorder actually suffer from pain, do not understand what caused it and do not realize the connection between the symptom and their psychological problems. Attempts to explain the psychological nature of pain result in sincere resentment, a feeling of helplessness, disappointment in the specialist, and sometimes even aggression towards the doctor.
