Why diagnosis needs an agreed list of symptoms

1. The ICD is published by the World Health Organization and sets out the symptoms a doctor checks before naming a condition.
2. Working from an agreed list means two different doctors should reach the same conclusion about the same person.

Symptoms of unipolar depression

1. The ICD splits the symptoms into three core symptoms and a longer list of other common symptoms.
2. Persistent low mood is present for most of the day, on most days, and does not lift for long even when something good happens.
3. Loss of interest and enjoyment means activities the person used to look forward to no longer give them any pleasure.
4. Reduced energy leaves the person tired after only small amounts of effort, so activity drops as well.
5. The other common symptoms in the ICD list fill out the picture, and a doctor also weighs how long the low mood has lasted and how far it disrupts everyday life.
   1. Concentration and attention are reduced, so reading, revising or following a conversation becomes hard work.
   2. Self-esteem and self-confidence fall, and the person may hold ideas of guilt and unworthiness that are out of proportion to anything they have done.
   3. The person may hold a bleak and pessimistic view of the future.
   4. Sleep is disturbed, either through waking early and being unable to get back to sleep or through sleeping far more than usual.
   5. Appetite changes, most often falling, and weight may change with it.
   6. Thoughts of self-harm may occur, which is one reason depression is treated as a serious condition that needs proper support.

Features of addiction in the ICD

1. Addiction is a recognised medical condition, so avoid writing about it as a lack of willpower or a bad habit someone could simply drop.
2. The ICD does not use the everyday word addiction and records the condition as dependence syndrome instead.
3. Dependence is recognised from a pattern of features that show up together in the way a person uses the substance.
4. No single feature settles it on its own, so what matters is the pattern taken as a whole.

The features of dependence

1. Impaired control over use, meaning the person struggles with when their use starts, how often it happens, how heavy it gets and how long it goes on.
2. Increasing importance, meaning the substance takes precedence over other aspects of life, so work, friends and interests get pushed aside.
3. Tolerance, meaning larger amounts are needed to get the effect that a smaller amount once produced.
4. A withdrawal state, meaning unpleasant physical and psychological effects appear when use stops or is cut down, or the substance is taken again to relieve them.
5. A strong desire, sometimes felt as a compulsion, to take the substance.
6. Persisting use despite clear harm, meaning use continues even though the person knows it is damaging their health, work or relationships.

Turning this into marks

1. When two symptoms are asked for, make them genuinely separate rather than one symptom rephrased.
2. Name the ICD, because a description that could have come from any manual does not secure the knowledge mark.
3. The mark most often lost is covering only depression or only addiction when the question names both.