A Working Clinical Psychiatry Reference

Psychotic mania, severe risk-taking, exhaustion/dehydration, aggression. Exclude substance-induced (stimulants, steroids) and organic mania (frontal lesion, hyperthyroidism).

Screen any depression for past (hypo)mania before an antidepressant — missed bipolarity risks switch/cycling. Red flags: mixed features (high suicide risk), rapid cycling, psychotic episodes, postpartum onset.

Bipolar depression (screen for past hypomania), dysthymia (F34.1), adjustment disorder, organic/secondary mood disorder (thyroid, steroids, anaemia, B12), substance-related. Red flags: suicidality, psychotic features, catatonia, severe self-neglect, postpartum onset.

Recurrence drives maintenance-treatment decisions; document episode count and inter-episode recovery. Always re-screen for emergent bipolarity at each new episode.

Panic disorder (F41.0), GAD, PTSD-related avoidance, autistic social difficulty vs social phobia, and physical mimics (see F41 card). First-line treatment is exposure-based CBT.

Exclude hyperthyroidism, arrhythmia, phaeochromocytoma, caffeine/stimulant or substance withdrawal, and depression with anxious distress. Red flags: first panic at older age, exertional symptoms, focal neurology → investigate medically.

Distinguish primary OCD from obsessive–compulsive (anankastic) personality disorder (F60.5 — ego-syntonic, no true obsessions/compulsions), from GAD's worry, from depressive ruminations, and from the stereotypies of autism or tic disorders. Absent-insight/delusional OCD is not schizophrenia. First-line: ERP-based CBT; pharmacologically, OCD often needs higher-dose, longer-trial SSRIs (or clomipramine).

DSM-5 makes acute stress disorder a standalone diagnosis in the Trauma- & Stressor-Related chapter: exposure to actual/threatened death, serious injury or sexual violence, then ≥ 9 symptoms across five categories (intrusion, negative mood, dissociation, avoidance, arousal) lasting 3 days to 1 month. So the same clinical window is a transient near-normal reaction in ICD-10 but an operationalised diagnosis in DSM-5; DSM no longer treats it as a predictor of PTSD. (ICD-11 moves acute stress reaction out of its disorders grouping entirely.)

Adjustment disorder (sub-threshold, no trauma criterion), acute stress reaction/disorder (early window), depression, panic, and dissociative disorders. Screen for comorbid substance use and suicidality. First-line: trauma-focused CBT or EMDR.

Normal, proportionate stress responses (not a disorder); major depression or an anxiety disorder when full threshold is met; PTSD when the stressor is traumatic and re-experiencing dominates; uncomplicated bereavement.

DSM-5 keeps dissociative amnesia (with a fugue specifier), dissociative identity disorder (ICD-10's "multiple personality", F44.81 in US ICD-10-CM / under F44.8 in WHO), and depersonalisation/derealisation disorder in a standalone Dissociative Disorders chapter — but moves conversion out, renaming it Functional Neurological Symptom Disorder and placing it among the somatic-symptom disorders, with criteria emphasising positive incompatibility findings on neurological exam rather than a presumed psychological cause.

Always exclude genuine neurological/medical disease first (conversion is not a diagnosis of exclusion alone — it needs positive incompatibility signs). Consider epilepsy vs non-epileptic attacks, malingering and factitious disorder (intentional production — different intent), and organic amnesia.

DSM-5 collapsed most of F45: somatization, undifferentiated somatoform, hypochondriasis and pain disorder were deleted as separate diagnoses. Most map to somatic symptom disorder (≥ 1 distressing somatic symptom + excessive thoughts/feelings/behaviours, typically ≥ 6 months — note DSM no longer requires the symptom to be medically unexplained). Health anxiety without prominent somatic symptoms becomes illness anxiety disorder. Dysmorphophobia / body dysmorphic disorder leaves this group entirely in DSM-5 — it sits in the OCD & Related chapter (see the OCD section). (ICD-11 replaces the lot with a single "bodily distress disorder.")

Underlying organic disease (re-evaluate over time); depression/anxiety presenting somatically; panic disorder; factitious disorder and malingering (intentional). Manage with a single coordinating clinician, limited investigations, and a focus on function rather than symptom eradication.

Exclude substance-induced psychosis, delirium, mood disorder with psychotic features, and organic causes (autoimmune/limbic encephalitis, temporal-lobe epilepsy, CNS lesion) — especially with rapid onset, fluctuating consciousness, or neurological signs. First-episode psychosis → prompt assessment, early-intervention pathway.

Schizophrenia (F20), mood disorder with psychotic features, delusional presentations of OCD/body-dysmorphic disorder, organic and substance causes; assess dangerousness in persecutory/jealous types.

Schizophrenia with post-psychotic depression, mood disorder with psychotic features, schizophrenia plus comorbid mood disorder. Longitudinal history (timing of psychosis vs mood) is what makes the call.

DSM-5 groups these as Communication Disorders — language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering — note ICD-10 files stuttering separately at F98.5), and social (pragmatic) communication disorder (a DSM-5 addition with no ICD-10 equivalent).

Exclude hearing loss (H90–H91), intellectual disability (F70–F79), autism (F84), and elective/selective mutism (F94.0). Acquired aphasia routes to R47.0 unless the Landau-Kleffner picture applies.

DSM-5 merges the lot into one specific learning disorder with coded specifiers (with impairment in reading / written expression / mathematics) and severity — replacing ICD-10's separate reading/spelling/arithmetic categories with a single dimensional diagnosis.

DSM-5 keeps this as developmental coordination disorder within the motor-disorders group of the Neurodevelopmental chapter (alongside stereotypic movement disorder and the tic disorders).

Diagnosis rests on developmental history + cross-setting observation; structured tools (e.g. ADOS/ADI-R) support but don't replace clinical assessment. Screen comorbidity (intellectual disability — code F70–F79 additionally; ADHD; anxiety; epilepsy). Differentiate from intellectual disability without ASD, selective mutism, and receptive language disorder.

Adult ADHD diagnosis rests on developmental history + current cross-setting impairment; rating scales support, not replace, assessment. Screen common comorbidities (mood, anxiety, substance use). Confirm stimulant scheduling/availability in Romania before planning treatment.

Distinguish from specific learning disorder (F81 — circumscribed, normal global intelligence), autism (F84 — can co-occur; code additionally), and acquired cognitive decline (dementia, F00–F03). ICD-10 invites an additional code for associated autism, epilepsy, conduct or physical disorder.

Exclude mood/affective disorder, ADHD (F90 — frequently comorbid; F90.1 codes the combination in ICD-10), autism, and adjustment reactions. When emotional symptoms co-occur prominently, see F92 mixed.

DSM-5 has no single "mixed conduct and emotions" category. The same clinical picture is captured by coding the conduct disorder and the co-occurring depressive or anxiety disorder as separate comorbid diagnoses.

DSM-5 moved separation anxiety disorder into the main Anxiety Disorders chapter — no longer restricted to childhood onset (adults can be diagnosed). The childhood phobic and social-anxiety presentations map onto the general specific-phobia and social-anxiety disorders. See also the Anxiety & phobic section's "where it lives" note on F41 for how ICD-10 routes adult-type anxiety.

DSM-5 moves selective mutism into the Anxiety Disorders chapter, and places the two attachment disorders — reactive attachment disorder and disinhibited social engagement disorder — in the Trauma- & Stressor-Related Disorders chapter, reflecting their basis in social neglect.

DSM-5 places tic disorders in the Neurodevelopmental chapter (motor disorders) with closely parallel categories — provisional, persistent (chronic) motor or vocal, and Tourette's disorder — keeping the > 1-year and onset-before-18 framing.

Distinguish from stereotyped movement disorder (F98.4), chorea/dystonia and other organic movement disorders (G20–G25), and OCD (frequently comorbid). Trichotillomania is coded F63.3, not here.

DSM-5 scatters these: enuresis and encopresis become a dedicated Elimination Disorders chapter; feeding disorder of infancy maps largely onto ARFID and rumination disorder lands in Feeding & Eating (see that section); pica likewise; stereotypic movement disorder and stuttering (childhood-onset fluency disorder) move to the Neurodevelopmental chapter. Note ICD-10's F98.8 "attention deficit disorder without hyperactivity" is the inattentive-only presentation that DSM ADHD recognises but ICD-10 hyperkinetic disorder (F90) does not.

Distinguish trait from state (mood/psychotic episode), and from organic personality change (F07 — see Organic section). EUPD/borderline: structured psychological therapy (DBT, MBT) is first-line; medication is adjunctive and targets comorbidity, not the disorder itself.

F62.0 is the historical precursor of ICD-11 complex PTSD (see the Stress section), which superseded it. DSM-5 has no direct equivalent — such presentations fold into its broadened PTSD. (Placed here, in the personality block, because that is where WHO ICD-10 codes it.)

DSM scatters these: gambling disorder moved to Substance-Related & Addictive Disorders (a behavioural addiction; ICD-11 agrees); trichotillomania moved to the OCD & Related chapter (see OCD); pyromania and kleptomania sit in DSM's Disruptive, Impulse-Control & Conduct chapter, which also holds intermittent explosive disorder (no neat ICD-10 home).

ICD-11 removed gender-identity diagnoses from the mental-disorders chapter entirely. It renamed them gender incongruence (of adolescence/adulthood; of childhood) and moved them to a new chapter, Conditions related to sexual health — explicitly to reflect that trans and gender-diverse identities are not mental illness and to reduce stigma, while retaining a code to preserve access to healthcare. ICD-11 requires no distress or dysfunction. DSM-5 took a middle path: it renamed gender identity disorder to gender dysphoria and kept it in the manual, but reframed the diagnosis around clinically significant distress/impairment — so gender variance alone is explicitly not a disorder. Use current, person-centred terminology in practice.

Risk framing: where the interest involves non-consenting others, use a structured risk assessment — history of acting on urges, access to potential victims, insight, treatment engagement. Differentials: sexual behaviour better explained by a manic or psychotic episode, intoxication, a neurocognitive disorder or other disinhibition, intellectual disability, or ego-dystonic intrusive sexual thoughts of OCD (unwanted, not desired). Duty considerations: confidentiality is not absolute — a credible risk of serious harm to an identifiable other (especially a child) may engage safeguarding/disclosure duties; know your jurisdiction's reporting law. Paedophilic disorder is handled strictly at the level of diagnosis and risk management: attraction is not the same as offending, not everyone who offends against children has it, and recognised assessment/treatment pathways exist.

Psychological therapy is first-line — CBT on offence-supportive cognitions, self-regulation, victim awareness. Pharmacology is adjunctive where distress or risk is high: SSRIs (milder end) and, for high-risk cases, anti-androgen / testosterone-lowering agents (cyproterone acetate; GnRH analogues) under specialist forensic/endocrine governance and consent. See forensic-psychiatry sources and your local pathway.

DSM-5 moves factitious disorder into the Somatic Symptom & Related Disorders chapter (imposed on self, or on another). Malingering is not a mental disorder in either system.

Distinguish from mood/anxiety disorders driving use. Withdrawal can be lethal — assess with a structured scale, treat with a benzodiazepine regimen, and give parenteral thiamine to prevent Wernicke's. Tools: AUDIT, breath/blood alcohol.

= Major (or mild) neurocognitive disorder due to Alzheimer's disease. Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine are symptomatic; confirm clinical detail in your licensed source.

Antipsychotics in dementia carry increased stroke and mortality risk — reserve for severe distress/risk, lowest dose, shortest time, documented review. Always exclude delirium first.

Always exclude delirium before diagnosing a primary psychiatric disorder in an acutely disturbed patient — hypoxia, sepsis, metabolic derangement, intoxication/withdrawal, intracranial events. Investigate and treat the cause; antipsychotics are symptomatic only.

DSM disperses these as "… due to another medical condition" diagnoses within the matching chapters (e.g. psychotic disorder due to another medical condition, mood disorder due to another medical condition). F06.1 organic catatonic ≈ DSM catatonia due to another medical condition / catatonia specifier — cross-referenced from the Psychotic section. F06.7 mild cognitive disorder roughly parallels DSM mild neurocognitive disorder.

= DSM personality change due to another medical condition. Distinguish from a primary personality disorder (lifelong pattern, no organic cause) — see the Personality & adult-behaviour section.

Eating disorders carry the highest mortality in psychiatry. Watch bradycardia, hypotension, electrolyte derangement, and refeeding syndrome (hypophosphataemia) on re-nutrition. Manage medical risk first; use a risk framework (e.g. MEED / local protocol) and involve medicine early.

ICD-10 routes organic sleep disorders to G47.- in the neurology chapter: G47.0 insomnia, G47.1 hypersomnia, G47.2 sleep-wake schedule, G47.4 narcolepsy, sleep apnoea, etc. F51 is reserved for the emotionally-driven, nonorganic presentations only. DSM-5 abandons this organic/nonorganic split entirely — its single Sleep–Wake Disorders chapter covers insomnia, hypersomnolence, narcolepsy, breathing-related, circadian, NREM/REM parasomnias and restless legs together, and explicitly allows a sleep diagnosis to coexist with a medical or psychiatric one rather than being subordinated to it.

Depression and anxiety (sleep change is a core symptom — code F51 only if it dominates), substance/medication effects and withdrawal, primary organic sleep disorders (apnoea, narcolepsy, restless legs), and shift-work / jet-lag circadian causes.

DSM-5 keeps all sexual dysfunctions in one chapter and drops the ICD-10 organic/nonorganic distinction, instead requiring ≈ 6 months' duration and a frequency threshold and tagging each as lifelong/acquired and generalised/situational. It merged some ICD-10 entries — female desire and arousal became female sexual interest/arousal disorder; vaginismus and dyspareunia became genito-pelvic pain/penetration disorder. DSM places excessive sexual drive / "hypersexuality" outside this chapter (no formal diagnosis), whereas ICD-11 introduces compulsive sexual behaviour disorder under impulse-control.

Always exclude organic causes first (vascular, endocrine, neurological, pelvic pathology — these route to the relevant somatic chapter, e.g. N48.4 organic impotence, N94.1–.2 organic dyspareunia/vaginismus), plus medication effects (SSRIs, antihypertensives, antipsychotics), depression, and relationship factors.

DSM-5 has no equivalent residual category. Instead it codes the underlying mood, psychotic, or other episode and appends a "with peripartum onset" specifier (onset in pregnancy or within four weeks postpartum) — note the four-week DSM window versus ICD-10's six weeks. This reflects a deliberate stance that postpartum illness is the same disorder with a timing modifier, not a distinct entity.

Puerperal psychosis is a psychiatric emergency (rapid onset, fluctuating course, infanticide/suicide risk) — urgent assessment and usually admission, ideally to a mother-and-baby unit. Screen for bipolar disorder, the strongest risk factor.

DSM-5 keeps this as psychological factors affecting other medical conditions, sitting in the Somatic Symptom & Related Disorders chapter. The concept is closely aligned with ICD-10 F54 — a genuine medical condition is present, and psychological/behavioural factors adversely affect its course, treatment, or outcome.