30 A practical guide to the Istanbul Protocol – for psychologists [http://www.who.int/classifications/apps/icd/icd10online] INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS 10TH REVISION – (ICD-10) – VERSION FOR 2007 MOOD [AFFECTIVE] DISORDERS (F30-F39) F32 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. Includes: Excludes: 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 ) F32.0 Mild 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. F32.1 Moderate 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.