Diagnosis ICD-10 F 07.0 Personality and behavioral disorders caused by disease, damage or dysfunction of the brain (treatment of the disease)

What kind of diagnosis is this

Understanding what kind of diagnosis this is is necessary in order to find the right approaches to treatment, rehabilitation and resolve expert issues related to work ability. Common people may be confused between the definition of “organic personality disorder” and “organic asthenic disorder” or any other disease caused by a problem in the brain under the heading F06. The key difference is the change in personality and behavior characteristic of the first and the lack of transformation of a person’s individuality for the second.

Diagnostics

A personality disorder is diagnosed by a doctor.

After reading the above superficial description, some may want to immediately award diagnoses to themselves and their friends. You should refrain from doing this. The diagnosis is made on the basis of psychological examinations, medical history, exclusion of other pathologies, etc. Not every suspicious person is a paranoid psychopath. The names of many personality disorders (“hysterical,” “paranoid,” “schizoid,” and even the term “psychopath”) have gone “to the people” and turned into labels with which we are ready to reward each other. This is still wrong. Or, in any case, you need to understand that using medical terms and making diagnoses are two very different things. By the way, “idiot”, “moron”, “cretin” are all also diagnoses of very specific diseases with their own causes, symptoms, diagnostic criteria, etc.

Personality disorder is not a death sentence.

An important role is played by how socially adapted the subject is. Actually, social adaptation in general is the factor the measure of which helps determine the boundary between normality and pathology in psychiatry. If a person has pronounced character traits, but they do not interfere with his life and social burden (he has friends, family, work, etc.), then it is unlikely that anyone will award him a diagnosis. At most, they will be called an eccentric, eccentric. The problem is that a psychopath usually cannot fully adapt socially. But there are also exceptions. A person with psychopathy can find his niche in society. For example, a hysterical person wants to go to the theater, a schizoid person wants to become a programmer, a paranoid person wants to become a spy, etc. Just God forbid, after reading this, you begin to consider all programmers schizoid. This is, of course, not true.

Etiology

The causes of mental disorder, that is, the etiology, are as follows:

• epilepsy and other pathologies affecting the brain (trauma, tumors);
• toxins;
• hormonal diseases;
• severe somatic diseases;
• vascular disorders.

Often, especially with age, factors can overlap one another.

May be due to disease, injury or dysfunction of the brain

Brain disorders (epilepsy and others)

The appearance of personality changes in connection with epilepsy is individual and primarily depends on the frequency of attacks. The more often seizures occur, the more damage occurs to the cerebral cortex. Accordingly, the more pronounced transformations will occur to a person. Tumor or traumatic brain injury, especially in the frontal lobe, also leads to organic disorder.

Exposure to toxins

Toxic effects on the brain include not only working with harmful substances, but also consuming alcohol or its surrogates, leading to liver cirrhosis and hepatic encephalopathy.

Drug abuse will leave an indelible mark on a person's personality.

Hormone exposure and endocrine disruption

Dishormonal pathologies leading to organic personality changes:

• diabetes mellitus (decompensation leading to encephalopathy);
• thyrotoxicosis;
• pathologies of the adrenal glands;
• diseases of the hypothalamic-pituitary system.

As a result of deteriorating hormonal levels, brain structures, including gray matter, suffer, which further leads to personality changes.

Somatic diseases

Common diseases that decompensate for worsening brain function at the level of cellular damage include:

• liver cirrhosis (hepatic encephalopathy);
• malignant tumors at the last stage;
• chronic renal failure in the terminal stage.

The development of brain pathology is similar to that which occurs under the influence of toxic substances coming from the outside.

Psychosomatic seven, capable of provoking an organic disorder

Vascular origin

Organic personality disorder of vascular origin occurs when the cortex is damaged due to insufficient nutrition.

The reasons may be:

• cerebral infarctions (ischemic, hemorrhagic);
• discirculatory encephalopathy of the third degree.

Mixed genesis

Organic personality disorder of mixed origin occurs when any of the above-described diseases or brain injuries are combined. An example would be dyscirculatory encephalopathy in an epileptic or traumatic brain injury in a drug addict.

Stages and degrees

Organic personality disorder is a pathology that progresses slowly with a gradual deterioration in the general condition of a person.

The disease varies in severity:

• light;
• moderate;
• heavy.

In the early stages of progression, the pathology is manifested by general weakness and decreased performance. The disease is of moderate severity, manifested by physical discomfort, periodic or constant headaches. Severe manifestations of delirium, antisocial behavior and prolonged depression with further progression of the pathology create a threat to the patient’s life.

The stages of development of organic personality disorder vary depending on the form of pathology:

In particular cases, the disease can occur in a mixed form, combining many clinical manifestations of an organic disorder. In the terminal stage, regardless of the type of pathology, in the absence of treatment, vascular dementia and decreased mental activity are observed.

Behavioral symptoms, ICD codes

ICD-10 code for organic personality disorder F07.0. It is used for coding medical records.

Changes in the pattern of emotions and behavior, symptoms of thought disorder, and sexual dysfunction are key to identifying a personality disorder.

These symptoms last for at least six months and include at least three manifestations from the list:

1. A person is unable to carry out his usual daily work, achieve his goal, especially if he needs to do something for a long time.

2. Emotional transformations:

• lability, that is, instability of emotions, mood swings, loss of control;
• euphoric state, flat humor, inappropriate jokes;
• increased irritability, angry outbursts, aggressive behavior;
• lack of desire to do anything (apathy).

Emotional instability
3. Neglect of social rules in pursuit of fulfilling one's needs, leading to antisocial behavior (theft, demonstration of sexual desires in public, gluttony, lack of personal hygiene).

4. Mental pathological symptoms:

• super-dimensional suspicion;
• fixation on one topic (religion, politics, medicine);
• categoricalness in judgment, criticizing any other point of view as absolutely wrong.

5. Changes in speech (its tempo, the appearance of intrusiveness, thoroughness, viscosity, increased detail).

6. Changes in the sexual sphere (change of sexual preference, disinhibition, lack of a sense of distance).

Emotionally labile disorder (asthenic)

Emotionally labile disorder in ICD-10 belongs to category F06 (F06.6) and is characterized by the absence of personal transformations. The main symptoms are:

• emotional instability (mood swings, tearfulness, weakness);
• weakness, fatigue, apathy;
• dizziness, headache, ringing or noise in the head.

All this occurs against the background of a disease directly or indirectly affecting the brain (dyscirculatory encephalopathy, hypertension, hormonal disorders, tumors, head injury).

Symptoms subside when the causative disease is compensated

With mild cognitive impairment

Organic disorder with mild cognitive impairment (F06.7) is manifested by:

• memory loss;
• reduced ability to learn new skills;
• problems with logical sequential thinking;
• difficulty speaking when choosing words or counting;
• poor concentration;
• severe fatigue when performing mental work.

Pathological symptoms must last for at least two weeks against the background of a disease leading to brain dysfunction.

Anxiety disorder

Organic anxiety disorder (F06.4) occurs as a result of brain damage and is characterized by increased anxiety as a leading symptom.

Dissociative disorder

Features of organic dissociative disorder (F06.5) are:

• loss of memory for recent events;
• disturbance of movements in the limbs;
• loss of sensitivity or, conversely, severe discomfort in the body.

Dissociative identity disorder

Affective disorder

Organic mood disorders are associated (F06.3) with brain pathology without transformation of a person’s personality and are characterized by depressive symptoms, as well as, conversely, increased background or phase changes from a decrease in the emotional curve to euphoria.

Delusional schizophrenia-like disorder

Organic delusional disorder (F06.2) is characterized primarily by the presence of delusions, which may be constantly present or occur with varying frequency. Hallucinations are possible. To recognize and distinguish it from schizophrenia, it is necessary to examine a person to identify organic brain damage.

Catotonic state

Organic catatonic disorder (F06.1) is detected when:

• stupor, that is, freezing in one position without movement, speech, reactions to external influences;
• negativism, that is, resistance to changing body position;
• instead of stupor, agitation with chaotic movements is possible;
• the change of the above states is rapid.

Organic hallucinosis

The basis of the pathology coded F06.0 is the presence of hallucinations (visual, auditory) with unchanged consciousness. The person’s criticism is preserved, that is, he understands that the visions are not real.

Visions frighten a person

Possible complications

In the absence of timely treatment of the root cause of the development of pathology and its acute symptoms, the following negative consequences may develop:

• cerebral ischemia;
• hypoxia;
• as a result of prolonged depression, suicidal tendencies may appear;
• dementia;
• decreased cognitive function;
• social maladjustment;
• development of persecution mania, paranoia, phobias of various etiologies.

With the congenital form of the pathology, the child experiences mental retardation and inappropriate behavior.

An organic disorder develops against the background of brain pathologies. A person loses control over his emotions and behavior. As the pathology progresses, his formed personality is erased.

The behavior pattern changes: the patient shows aggression, irritability, suffers from frequent mood swings and migraine attacks. This disorder can develop into dementia and social maladjustment. Treatment combines drug therapy and sessions with a psychotherapist.

Author: Nika Zhuravleva

Treatment

Treatment of an organic disorder consists of the following elements:

1. Symptomatic therapy:

• mood stabilizers for emotional lability (carbamazepine, topiromate);
• anxiolytics for anxiety and irritability (benzodiazepines for no more than 1 month);
• antipsychotics for behavior correction and sedation;
• antidepressants for apathy and reduced emotional background (maprotiline, fluoxetine, sertraline, paroxetine, escitalopram).

2. Etiotropic therapy for an established cause of the disorder (vascular, nootropic, antiepileptic, hormonal and other drugs).

3. Psychotherapy and psychocorrection.

Treatment methods

The goal of treatment is to eliminate the primary cause of the pathological process, adapt the person to the changes in personality that have occurred, and teach him to control his emotional state.

Against the background of severe organic disorders, it is important to remember that it is impossible to completely restore the injured areas of the brain. In this case, drug therapy and sessions with a psychotherapist will help stop the progression of dementia.

Before prescribing medications and physical therapy, the patient must get rid of the provoking factor: tumor, infectious disease, vascular disorder.

Medications

Complex drug therapy is selected depending on the type of organic disorder and the clinical picture of the disease.

It includes the following groups of drugs:

1. Antidepressants: Fluvoxamine, Amitriptyline. Correct the emotional state: prevent the development of apathy, prolonged depression, and help improve mood.

2. Tranquilizers from a number of anxiolytics: Phenazepam, Diazepam. They have a calming effect and cause drowsiness.
3. Neuroleptics: Triftazin, Aminazine, Tizercin. Reduces the level of aggression, paranoia, and persecution mania.
4. Nootropic drugs and antihypoxants: Piracetam, Phezam, Cerebrolysin. They normalize the nutrition of neurons and prevent the development of hypoxia and cerebral ischemia. Thanks to this effect, symptoms are alleviated.
5. Mood stabilizers: lithium preparations, carbamazepine. Taken as part of maintenance therapy. They prevent sudden mood swings and have a sedative effect.
6. Anticonvulsants. Used against the background of an anxiety disorder to relieve spasms and muscle cramps in the abdomen and head.

The duration of drug therapy should not exceed 2 weeks. The daily dosage and type of drug are selected individually for each patient. The doctor's decision is influenced by age, body weight, the presence of chronic pathologies of the patient and the severity of symptoms of an organic disorder.

Traditional methods

Alternative medicine is ineffective in treating the organic disorder. They do not allow you to restore cognitive functions, create a socially acceptable model of behavior, or relieve headache attacks.

Among folk remedies, you can drink chamomile tea to create a calming effect and relieve stress. To prepare it, you need to brew 3-4 tbsp. l. dried plant flowers 500 ml boiling water. You can drink tea every day, but it is worth remembering that it is low in effectiveness.

Other methods

In addition to drug treatment, the patient must undergo classes with a psychotherapist throughout the entire period of complex therapy.

Regular consultations have the following goals:

• improving the patient’s quality of life;
• eliminating depression;
• teaching social norms and new behavior patterns;
• getting rid of sexual disorders;
• therapy for obsessive-compulsive disorders;
• creating psycho-emotional comfort for the patient.

Psychological assistance is provided through regular conversations and a series of exercises.

These include:

1. Artterpia. Patients paint or sculpt with clay. They learn to express themselves, accept criticism and improve themselves. During therapy, irritability is relieved and the person relaxes.

2. Memory improvement. Slows down the development of dementia. The doctor suggests remembering the order of words, numbers or details in the specified image.
3. Trainings. Necessary for getting rid of paranoia and gaining self-confidence.

Treatment can be done individually or in a group. Family therapy is most effective, where the patient learns to build healthy relationships with relatives and receives emotional support from them.

Tests for diagnosing disorders

The test for the presence of a mental disorder reflects different areas of a person’s life.

Psychodiagnostics can be divided into:

• personality research (Minnesota Multidimensional Personality Inventory MMPI or adapted SMIL, Strelyau questionnaire, Eysenck test, Cattell test questionnaire 16PF and others);
• analysis of thinking (Lachins method, exclusion of concepts, analysis of proverbs, etc.);
• memory test (method “10 words”, associations, A. N. Leontiev’s method, Wechsler test and others);
• intelligence tests (Wechsler test, Raven matrices, Guilford matrices and others);
• attention research (Schulte tables, Münsberger test, Kraepelin count and others);
• study of the emotional-volitional background (HADS, Beck, Zang, Hamilton scales).

Causes of organic psychosis

Organic psychoses include mental disorders that were caused by various lesions of the brain tissue of the head. Among such diseases, there are disorders with rapid and acute development, as well as a chronic, protracted version of the development of psychosis; the differences relate to both the nature of the disease and its treatment, and, accordingly, the prognosis. When diagnosing such a disease, the doctor mainly relies on the clinical picture and makes a differential diagnosis with schizophrenia and manic-depressive psychosis.

The cause of organic psychosis can be an infectious disease, alcoholism or drug addiction, which lead to hallucinogenic states, metabolic disorders, poisoning, hormonal pathologies, neurosyphilis, tumors and other diseases affecting the brain. These organic causes provoke changes in the structure and functions of the brain, affect its blood vessels, and can sometimes resemble mental illnesses based on psychological factors.

The reasons why organic psychosis occurs are closely related to three interaction factors: somatic diseases, infections, and intoxications. Their action activates an already existing predisposition in the body for the formation of mental disorders. The conditions for the development of the disease are poorly understood, since the same exposure causes acute and chronic psychoses. Age-related changes in the body aggravate the development of the disease.

Non-organic personality disorders

This group of diseases reflects the pathological character of a person, his emotions and relationships with other people. The disorders are not associated with brain damage.

Personality disorders

Schizoid

A sick person tries to move away from any contact with other people as much as possible and does not accept the rules generally accepted by society. All his emotions are flattened to complete indifference. He is absorbed in his fantasies and is cold.

Schizotypal

Schizotypal disorder (F21) is a separate disorder. It is characterized by:

• alienation, coldness of emotions;
• eccentric behavior or appearance;
• great difficulties in communicating in society;
• oddities in views and beliefs;
• excessive suspicion to the point of paranoia;
• obsessions;
• illusions, a feeling of unreality of the environment and what is happening;
• thoroughness of thinking along with oddities in speech;
• rare attacks of hallucinations and delusional ideas.

To be diagnosed, the condition must have been present for at least two years with at least four of the above symptoms present.

Narcissistic

It is not a disease and requires the exclusion of other personality disorders.

Signs:

• excessive emotionality when communicating with other people;
• abnormal behavior style to attract everyone's attention;
• constant concern about the opinions of others;
• actions aimed at obtaining evidence of one’s rightness and influence, along with hypersensitivity to criticism;
• narcissism;
• egocentrism.

Narcissism is a character trait and can come in varying degrees of severity.

Dissociative

Otherwise known as multiple personality disorder (F44). It is characterized by the presence of several personalities in the patient, replacing each other in his consciousness and never intersecting. Each of them has its own behavioral characteristics and memory.

Bipolar

Bipolar disorder (F31) is manifested by depressive states, alternating with increased energy and the development of activities of varying intensity. The duration of the phases of depression and mania (hypomania) can vary - from several hours to months and even years.

Border

This type of personality disorder is characterized by the following features:

• lack of vision of one’s “I”, goals, preferences and decisions;
• constant involvement in unhealthy relationships that lead to deterioration of the condition;
• fear of being abandoned and making every effort to prevent this from happening;
• self-harm or manipulation through talk of suicide;
• feeling of inner devastation.

Borderline personality states

Symptoms of an organic disorder

Anxious personality disorder

To understand how “unbalanced” a personality is, the doctor determines the criteria for psychopathy. The symptoms of the disease are extensive and do not appear immediately.

Signs of an organic disorder

Gradually, the patient's behavior takes on an antisocial character. Restrictions are disinhibited, the individual becomes hypersexual and prone to gluttony. He develops an aversion to personal hygiene. Those who are aggressive engage in illegal acts.

Emotional instability

To classify a disease as an organic personality disorder, it is necessary to have 2 or more symptoms that are observed for six months. Depending on the combination of criteria, several types of damage are distinguished: disinhibited, apathetic, labile, paranoid, aggressive, mixed.

Basic concept

Mixed personality disorder, mixed personality disorder - what is it?

Mixed personality disorder according to the ICD-10 classification (code F61), is characterized by symptoms that include several definitions included in the heading F60 - F69, for example, schizoid (F60.1), dissocial (F60.2), emotionally unstable (F60 .3) and other specific personality disorders.

Due to the absence of clear symptoms, the decision on diagnosis in this case is made by the specialist observing the patient.

How do they manifest themselves in children and adults?

A tendency towards mixed personality disorder can be detected in childhood , but at this age the diagnosis is not made, since deviations in behavior can manifest themselves in the process of personality development.

Subsequently, less than half of children suffer from a personality disorder during adolescence and adulthood. We can talk about the final diagnosis only after the end of puberty.

At the same time, the child’s behavior is characterized by disobedience to adults, ignoring social norms, and displaying aggression as a reaction to restrictions and prohibitions.

The child may have no interest in communicating with peers or may have pronounced conflict with them, including when defending his opinion against the opinion of the majority. The emotional background of the child is changeable, with a bias towards a gloomy, angry state.

The clinical picture of mixed personality disorder in an adult is a kaleidoscope of symptoms of “pure” classifications of personality disorder - unstable mood, frequent outbursts of anger, a tendency to affective reactions with cruelty or rudeness, after which they are replaced by a gloomy depressed state or high spirits .

Moral weakness, dependence on another person, lack of energy, fatigue, self-doubt and low self-esteem may appear.

At the same time, a person is inclined to check his actions and experience fear of making the wrong decision. A number of patients experience hysterical manifestations , which are replaced by compliance, the need to obey someone, and an awareness of their helplessness in solving life's problems.

In some cases alienation from people , withdrawal into one’s own fantasies, as well as a disorder of desires manifested in the desire to run away from one’s own home, a pathological tendency to set fires and other behavioral disorders are possible.

Certain behavioral features are noted in certain combinations of personality disorders - for example, the presence of symptoms of an emotionally unstable disorder of the impulsive type, along with dissocial and hysterical disorders, is often accompanied by alcoholism or drug addiction.

Combinations of paranoid disorder and emotional instability can manifest themselves in a litigious lifestyle, in which a person is fixated on filing complaints to various authorities, filing lawsuits in court, thus trying to defend an imaginary violation of his rights, since it seems to him that those around him are somehow infringe.

When symptoms that are opposite in quality are combined, for example, hysterical and schizoid personality disorder, careful diagnosis is necessary, since these signs may indicate the development of schizophrenia.

What are the consequences?

The consequences of this mental disorder may be as follows::

1. Suicidal tendencies.
2. Addiction to alcohol and drugs.
3. Inappropriate sexual behavior.
4. Impossibility of integration into society.
5. Inability to perform responsible work.
6. Manifestation of cruelty towards loved ones and relatives, as well as children.
7. Periodic nervous breakdowns, during which there may be no possibility of carrying out any productive activities.

In many ways, the consequences of mixed personality disorder depend on the severity of its course , as well as on the timely provision of medical care to the patient.

Species and types

Mixed personality disorder is diagnosed when a person's behavior exhibits several of the following disorders without the predominance of any one of them:

1. Paranoid. At the same time, the person suspects those around him of conspiring against him with the aim of causing him material or moral harm, perceives statements about himself as offensive, doubts the fidelity of partners, including sexual ones, and delusions of persecution are observed.
2. Dissocial . This disorder is characterized by aggressive behavior of a person, including in relation to family and friends, ignoring social norms, and conflict. Cruelty to animals is also possible. A person does not find a common language with others in a team, does not respect subordination, and behaves provocatively.
3. Schizoid. In this case, a person is characterized by a predisposition to loneliness, a weakly expressed emotional reaction to external stimuli, and alienation.
   A person with schizoid disorder has little interest in sexual contacts or close friendships.

   There is an excessive enthusiasm for one's own fantasies.

4. Emotionally unstable personality disorder of the impulsive and borderline type. It is characterized by an unstable emotional background, sudden changes in mood for minor reasons, outbursts of aggression when others condemn their impulsive behavior. A person is incapable of planning tasks; his activity is largely dependent on his mood.
5. Hysterical . With this disorder, a person is self-centered, requires constant attention to himself, and is inappropriately concerned with the attractiveness of his appearance. Emotions are labile, and there is also a need for constant recognition by others of their merits - physical attractiveness or achievements of various kinds. Characterized by the desire to manipulate other people.
6. Anancast. A person with anancaste disorder is overly cautious, inappropriately concerned with maintaining order and rules, and prone to perfectionism even if this interferes with the completion of the task at hand. There is also a tendency to demand that others adhere to the same standards of behavior.
7. Alarming. Characterized by a constant feeling of anxiety, tension and negative premonitions.
   The individual often experiences low self-esteem and a feeling of worthlessness. A person perceives criticism addressed to him extremely painfully; on this basis, it is possible to avoid society or responsible positions.
8. Dependent personality disorder. A person is incapable of making important independent decisions; even in everyday activities he needs advice and guidance. He experiences a strong fear of being abandoned by the person on whom he is dependent, and transfers all the important decisions in his life to her.

Also, the complex of symptoms of a mixed personality disorder may include infantilism, disinhibition of drives, and narcissism.

In this case, such disorders are classified as follows:

• intermediate _ These mental disorders are caused by pathological processes in the body, as well as the developmental characteristics of a child in early childhood, heredity;
• amalgam . Disorders caused by improper upbringing, as well as stress and other external factors.

With mixed personality disorder, a dominant disorder cannot be identified , so classification and diagnosis of such cases is difficult.

It is characteristic that in more than half of the cases of detection of psychopathologies, they cannot be attributed to any “pure” type.