Chapter V
Mental and behavioural disorders
(F00-F99)

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.

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 Hypomania
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 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.
F30.2 Mania with psychotic symptoms
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 Other manic episodes
F30.9 Manic episode, unspecified
Mania NOS

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.
Includes: manic-depressive:
· illness
· psychosis
· reaction
Excludes: bipolar disorder, single manic episode ( F30.- )
cyclothymia ( F34.0 )
F31.0 Bipolar affective disorder, current episode hypomanic
The patient is currently hypomanic, and has had at least one other affective episode (hypomanic, manic, depressive, or mixed) in the past.
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 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 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 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 Bipolar affective disorder, current episode severe depression with psychotic symptoms
The patient is currently depressed, as in severe depressive episode with psychotic symptoms (F32.3), and has had at least one authenticated hypomanic, manic, or mixed affective episode in the past.
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 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 Other bipolar affective disorders
Bipolar II disorder
Recurrent manic episodes NOS
F31.9 Bipolar affective disorder, unspecified

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 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.
Includes: single episodes of:
· depressive reaction
· psychogenic depression
· reactive depression
Excludes: adjustment disorder ( F43.2 )
recurrent depressive disorder ( F33.- )
when associated with conduct disorders in F91.- ( F92.0 )
F32.0 Mild depressive episode
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 Moderate depressive episode
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 Severe depressive episode without psychotic symptoms
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
Major depression
Vital depression
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single episode without psychotic symptoms
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 Other depressive episodes
Atypical depression
Single episodes of "masked" depression NOS
F32.9 Depressive episode, unspecified
Depression NOS
Depressive disorder NOS

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 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 antidepressant 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.-).
Includes: recurrent episodes of:
· depressive reaction
· psychogenic depression
· reactive depression
seasonal depressive disorder
Excludes: recurrent brief depressive episodes ( F38.1 )
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 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 without any history of mania.
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.
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 Recurrent depressive disorder, current episode severe with psychotic symptoms
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.
Endogenous depression with psychotic symptoms
Manic-depressive psychosis, depressed type with psychotic symptoms
Recurrent severe episodes of:
· major depression with psychotic symptoms
· psychogenic depressive psychosis
· psychotic depression
· reactive depressive psychosis
F33.4 Recurrent depressive disorder, currently in remission
The patient has had two or more depressive episodes as described in F33.0-F33.3, in the past, but has been free from depressive symptoms for several months.
F33.8 Other recurrent depressive disorders
F33.9 Recurrent depressive disorder, unspecified
Monopolar depression NOS

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 Cyclothymia
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 Dysthymia
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 Other persistent mood [affective] disorders
F34.9 Persistent mood [affective] disorder, unspecified

F38 Other mood [affective] disorders
Any other mood disorders that do not justify classification to F30-F34, because they are not of sufficient severity or duration.
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 Unspecified mood [affective] disorder
Affective psychosis NOS