Real-Life Communication
The World Health Organization has a coding system used by health-care
providers around the world. The codebook is called the International Classifications
of Disease (ICD). Of course, the book is continually updated. The newest version
of the book is just being adopted by many countries, including yours.
That
means you'll have to get up to speed on any changes that have been made in
the current edition. It's time to get reading!
"Reading and writing
skills are crucial in this field," says Shirley Davis. She is a professor
of health information management and medical coding. "Comprehension is extremely
important."
Below is an excerpt from the clinical descriptions and diagnostic
guidelines. Read it and answer the questions to make sure you understand the
codes and guidelines.
F32 Depressive Episode
In
typical depressive episodes of all three varieties -- mild (F32.0), moderate
(F32.1), and severe (F32.2 and F32.3) -- the individual usually suffers from
depressed mood, loss of interest and enjoyment, and reduced energy, leading
to increased fatigability and diminished activity. Marked tiredness after
only slight effort is common. Other common symptoms are:
- Reduced concentration and attention
- Reduced self-esteem and self-confidence
- Ideas of guilt and unworthiness (even in a mild type of episode)
- Bleak and pessimistic views of the future
- Ideas or acts of self-harm or suicide
- Disturbed sleep
- Diminished appetite
The lowered mood varies little from day to day and is often unresponsive
to circumstances, yet may show a characteristic diurnal variation as the day
goes on.
As with manic episodes, the clinical presentation shows marked
individual variations, and atypical presentations are particularly common
in adolescence. In some cases, anxiety, distress and motor agitation may be
more prominent at times than the depression, and the mood change may also
be masked by added features such as irritability, excessive consumption of
alcohol, histrionic behavior and exacerbation of pre-existing phobic or obsessional
symptoms, or by hypochondriacal preoccupations.
For depressive episodes
of all three grades of severity, a duration of at least two weeks is usually
required for diagnosis, but shorter periods may be reasonable if symptoms
are unusually severe and of rapid onset.
(From the World Health Organization: http://www.who.int/en)
Questions:
- What are the three degrees of depression and what are the accompanying
codes?
- If a patient says she has difficulty sleeping, could this be a symptom
of depression? Why?
- Atypical presentations of depression are particularly common in what age
group of the population?