Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Friday, May 24, 2013


Here's some good news for anyone who doesn't want to buy, read,
or use the DSM-5.

The World Health Organizatio (WHO) provides free online ICD-10 access, and free online ICD-10 training. I worked through most of the training, and it's a bit dull, but pretty intuitive.

Fittingly, Mental and Behavioral Disorders are in chapter V.

Here's a peak at how depression is described, ICD-10 style:

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.
single episodes of:
  • depressive reaction
  • psychogenic depression
  • reactive depression
adjustment disorder (F43.2)
recurrent depressive disorder (F33.-)
when associated with conduct disorders in F91.- (F92.0)
F32.0Mild 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.
F32.1Moderate 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.
F32.2Severe 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
  • single episode without psychotic symptoms

Who-Hoo! No more Chinese menu!

ICD-10 codes are very different from ICD-9 codes, which are structured like DSM codes. Will insurance companies accept them? Looks like they will, starting October 1, 2014. Until then, ICD-9 will have to do.

Thanks, WHO.


  1. ICD 11 will be launched by World Health Organization in 2015. Interestly, the rest of the world has been using ICD 9 since 1990 when it was launched.

  2. I read somewhere that, as you say, ICD 11 will be launched in 2015, but won't be in use in the US until 2020. I do use ICD 9 codes from time to time. I like that they involve clinical judgement on my part. Makes me feel like a doctor, not a clerk.