Length of major depressive episode
length of manic episode
at least one week. Needs marked social/work impairment, may need hospitalization
MDD will be either _______
recurrent or single episode
Persistent depressive disorder
- No high phases (mania)
- Lasts much longer than typical major depressive disorder.
- Not usually severe enough to be called an episode of major depression (though chronic major depression is now included here)
Disruptive mood dysregulation disorder
A child’s mood is persistently negative between frequent, severe explosions of temper
Premenstrual dysphoric disorder
A few days before her menses, a woman experiences symptoms of depression and anxiety
Depressive disorder due to another medical condition
A variety of medical and neurological conditions can produce depressive symptoms; these need not meet criteria for any of the conditions above
Qhat percent of patients with mood disorders experience manic or hypomanic episodes?
Bipolar I Disorder
At least one manic episode;
most patients with bipolar I have also had a major depressive episode
Bipolar II Disorder
- at least one hypomanic episode plus
- at least one major depressive episode
Patients have had repeated mood swings, but none that are severe enough to be called major depressive episodes or manic episodes
Substance/medication- induced bipolar disorder
Alcohol or other substances (intoxication or withdrawal) can cause manic or hypomanic symptoms; these need not meet criteria for any of the conditions above.
Other causes of manic or depressive symptoms
Schizoaffective disorder. In these patients, symptoms suggestive of schizophrenia coexist with a major depressive or a manic episode (p. 88).
Major and mild neurocognitive disorders with behavioral disturbance. The qualifier with behavioral disturbance can be coded into the diagnosis of major or mild neurocognitive disorder. OK, so mood symptoms don’t sound all that behavioral, but that’s how DSM-5 elects to indicate the cognitive disorders with depression.
Adjustment disorder with depressed mood. This term codes one way of adapting to a life stress (p. 228).
Personality disorders. Dysphoric mood is specifically mentioned in the criteria for borderline personality disorder, but depressed mood commonly accompanies avoidant, dependent, and histrionic personality disorders.
Uncomplicated bereavement. Sadness at the death of a relative or friend is a common experience. Because uncomplicated bereavement is a normal reaction to a particular type of stressor, it is recorded not as a disorder, but as a Z-code [V-code].
Other disorders. Depression can accompany many other mental disorders, including schizophrenia, the eating disorders, somatic symptom disorder, sexual dysfunctions, and gender dysphorias. Mood symptoms are likely in patients with an anxiety disorder (especially panic disorder and the phobic disorders), obsessive– compulsive disorder, and posttraumatic stress disorder.
Specifiers fo mood disorders
These descriptors help characterize the most recent major depressive episode; all but the first two can also apply to a manic episode. (Note that the specifiers for severity and remission are described on p. 158.) With atypical features With melancolic features With anxious distress With catatonic features With mixed features With peripartum onset WIth psychotic features
Specifiers describing course of recurring episodes
These specifiers describe the overall course of a mood disorder, not just the form of an individual episode With rapid cycling With seasonal pattern
With rapid cycling
Within 1 year, the patient has had at least four episodes (in any combination) fulfilling criteria for major depressive, manic, or hypomanic episodes
With seasonal pattern
These patients regularly become ill at a certain time of the year, such as fall or winter
sustained emotion that colors the way we view life
Old term for mood disorders
term affect covers more than just a patient’s statement of emotion. It also encompasses how the patient appears to be feeling, as shown by physical clues such as facial expression, posture, eye contact, and tearfulness
Major depressive episode
Not a codable diagnosis, but important building block
What are the major requirements for a mood episode?
(1) a quality of depressed mood (or loss of interest or pleasure) that (2) has existed for a minimum period of time, (3) is accompanied by a required number of symptoms, (4) has resulted in distress or disability, and (5) violates none of the listed exclusions.
Quality of mood for MDE
Can be subjective, but does patient report feeling sad, do others say they are sad, do they look sad
Duration for MDE
The patient must have felt bad most of the day, almost every day, for at least 2 weeks. This requirement is included to ensure that major depressive episodes are differentiated from the transient “down” spells that most of us sometimes feel.
Symptoms for MDE
To count as a symptom for MDE ____
the behaviors listed above must occur nearly every day. However, thoughts about death or suicide need only be “recurrent.” A single suicide attempt or a specific suicide plan will also qualify.
What are three situations in which you should not count a symptom toward a diagnosis of MDE
1. a symptom is fully explained by another medical condition. For example, you wouldn’t count fatigue in a patient who is recovering from major surgery; in that situation, you expect fatigue. 2. a symptom results from mood- incongruent delusions or hallucinations. For example, don’t count insomnia that is a response to hallucinated voices that keep the patient awake throughout the night. 3. Feelings of guilt or worthlessness that occur because the patient is too depressed to fulfill responsibilities. Such feelings are too common in depression to carry any diagnostic weight. Rather, look for guilt feelings that are way outside the boundaries of what’s reasonable. an extreme example: a woman believes that her wickedness caused the tragedies of 9/11.
Impairment needed for MDE
The episode must be serious enough to cause material distress or to impair the patient’s work (or school) performance, social life (withdrawal or discord), or some other area of functioning, including sex.
MDE Essential Featuers
These people are miserable. Most feel sad, down, depressed, or some equivalent; however, some few will instead insist that they’ve only lost interest in nearly all their once-loved activities. All will admit to varying numbers of other symptoms—such as fatigue, inability to concentrate, feeling worthless or guilty, and wishes for death or thoughts of suicide. In addition, three symptom areas may show either an increase or a decrease from normal: sleep, appetite/weight, and psychomotor activity. (For each of these, the classic picture is a decrease from normal—in appetite, for example—but some “atypical” patients will report an increase.)
MDE fine print
Also, children or adolescents may only feel or seem irritable, not depressed.