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抑郁症诊断标准-给力心理
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抑郁症诊断标准

抑郁症诊断标准
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发表时间:2015-06-18 16:37:26 325 0 2

抑郁症又称抑郁障碍,以显著而持久的心境低落为主要临床特征,是心境障碍的主要类型。临床可见心境低落与其处境不相称,情绪的消沉可以从闷闷不乐到悲痛欲绝,自卑抑郁,甚至悲观厌世,可有自杀企图或行为;甚至发生木僵;部分病例有明显的焦虑和运动性激越;严重者可出现幻觉、妄想等精神病性症状。每次发作持续至少2周以上、长者甚或数年,多数病例有反复发作的倾向,每次发作大多数可以缓解,部分可有残留症状或转为慢性。

抑郁发作ICD-10()诊断标准

在ICD-10中,抑郁发作不包括发生于双相情感障碍中的抑郁状态。因此,抑郁发作只包括首次发作抑郁症或复发性抑郁症。ICD-10规定的抑郁发作一般标准有3条:
  G1.抑郁发作须持续至少2周。
  G2.在病人既往生活中,不存在足以符合轻躁狂或躁狂(F30.-)标准的轻躁狂或躁狂发作。
  G3.需除外的最常见情况:此种发作不是由于精神活性物质使用(F10-F19)或任何器质性精神障碍(F00-F09)所致。抑郁发作的症状分为两大类,可以粗略地将之分别称为核心症状和附加症状。抑郁发作的核心症状有3条:
  (1)抑郁心境,对个体来讲肯定异常,存在于一天中大多数时间里,且几乎每天如此,基本不受环境影响,持续至少2周;
  (2)对平日感兴趣的活动丧失兴趣或愉快感;
  (3)精力不足或过度疲劳;
  抑郁发作的附加症状有7条:
  (1)自信心丧失和自卑;
  (2)无理由的自责或过分和不适当的罪恶感;
  (3)反复出现死或自杀想法,或任何一种自杀行为;
  (4)主诉或有证据表明存在思维或注意能力降低,例如犹豫不决或踌躇;
  (5)精神运动性活动改变,表现为激越或迟滞  

(6)任何类型的睡眠障碍;

(7)食欲改变(减少或增加),伴有相应的体重变化。

轻度抑郁发作(F32.0):具有核心症状中的至少两条,核心与附加症状共计至少四条。
  中度抑郁发作(F32.1):具有核心症状中的至少两条,核心与附加症状共计至少六条。ICD-10中还列举了一系列所谓躯体综合征症状,在含义上与DSM-IV的伴忧郁或经典分类中的内源性抑郁症类似。这些症状包括:
  (1)对平日感兴趣的活动丧失兴趣或失去乐趣;
  (2)对正常时能产生情感反应的事件或活动缺乏反应;
  (3)比通常早醒2小时以上;
  (4)早晨抑郁加重;
  (5)具有明显的精神运动性迟滞或激越的客观证据(他人的观察或报告);
  (6)食欲明显丧失;
  (7)体重减轻(上月体重的5%以上);
  (8)性欲明显丧失。要符合躯体性综合征的条件,上述症状必须有其四。
  重度抑郁发作分为不伴精神病性症状(F32.2)和伴有精神病性症状(F32.3)两型。其抑郁表现需具有全部三条核心症状,核心与附加症状共计八条。伴有精神病性症状者需存在:
  (1)妄想和幻觉,但不应有典型精神分裂症性的幻觉和妄想(即:不应有完全不可能或与文化不相适应的妄想,不应有对病人进行跟踪性评论的幻听或第三人称的幻听)。常见的情况为带有抑郁、自罪、虚无、自我援引及被害内容的妄想.
  (2)抑郁性木僵。伴有精神病性症状者又分为与心境相协调的和与心境不协调的两类。与心境相协调的精神病性症状包括罪恶妄想、无价值妄想、躯体疾病或大祸临头(灾难)妄想、嘲弄性或谴责性的听幻觉;与心境不协调的精神病性症状包括被害或自我援引妄想,没有情感色彩的幻听。 

 

按照ICD-10划分标准抑郁症分为以下几类:

 

F32.0轻度抑郁发作:求助者有患病感,并有寻求医生帮助的意愿。只要还能掌握生活的规律,就还可以胜任工作并处理日常生活,只是处理得有些困难。

F32.1中度抑郁发作:无法胜任工作或处理自己的生活,或者情况有波动,有时可以有时不行。

F32.2重度抑郁发作,不伴有精神病症状:病人需要持续的照顾;如果不能确定其危险性,需要住院治疗。

F32.3重度抑郁发作,伴有精神病症状:病人需要持续的照顾;如果不能确定其危险性,需要住院治疗。并带有妄想,如荒谬的负罪感,对疾病的恐惧。

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