Mood Disorders

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1. Criteria (Manic A): Distinct period of abnormally persistently elevated,

Episode) expansive, irritable mood, abnormally and increased ele-
vated goal directed activity

B): During the period of mood disturbance and increased

energy or activity and 3 OR MORE OF THE FOLLOWING:
-inflated self esteem or grandiosity
-decreased need for sleep
-more talkative than usual or pressured speech
-flight of ideas
-distractibility
-increase in goal directed activity (socially, sexually) or
psychomotor agitation
-excessive involvement in activities with high risk of painful
consequences

C): Sufficiently severe to cause marked impairment in

social or occupational functioning or to necessitate hos-
pitalization to prevent self harm or psychotic features

D): Not attributable to substance or other medical Condi-

tion

2. Manic Episode at least 1 week

Symptom Dura-
tion for dx

3. Criteria (Hypo- A): Same as Manic Episode

manic Episode) B): Same as Manic Episode
C): Associated with change uncharacteristic of individual
D): Observable by others
E): Not severe enough to cause impairments or hospital-
ization, NO psychotic features
F): Not attributable to substance or other medical condition

4. Duration of Hy- 4 consecutive days, present most of day

pomanic sxs for
dx

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5. Criteria (Ma- A):5 OR MORE OF THE FOLLOWING (ONE MUST BE
jor Depressive DEPRESSED MOOD OR LOSS OF PLEASURE):
Episode) -depressed mood most of day, nearly every day (feels sad,
empty, hopeless)
-** IN children it can be IRRITABLE mood.
-Diminished interest or pleasure in activities
-Significant weight loss or gain or change in appetite (5%
loss or gain)** In children, can be FAILURE TO MEET
weight gain
-Insomnia or hypersomnia
-Psychomotor agitation/retardation
-Fatigue or loss of energy
-Feelings of worthlessness or guilt
-Diminished ability to think or concentrate
-Recurrent thoughts of death, recurrent suicidal ideation,
or suicide attempt

6. Duration of MDE 2 week period

sx for dx

7. Criteria (Bipolar -met at least one manic episode (NOT necessarily depres-
I) sion)
-not better explained by schizo-disorders or psychotic dis-
order
•can have with psychotic features, partial remission
•full remission
•Can also have with:
-anxious distress (feeling unusually stressed/anx-
ious/tense)
-mixed feelings (manic/hypomanic within days of depres-
sion)
-rapid cycling (at least 4 cycles in 12 months)
-melancholic features (does not feel good even with good
event)
-mood-congruent psychotic (consistent with grandiosity)
-mood incongruent psychotic (inconsistent with themes)
-catatonia
-peripartum onset (during or after pregnancy)
-seasonal pattern

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8. Prevalence - .6%/12 months
(Bipolar I) - 1:1, M:F
’ females more likely to develop depressive symptoms,
more likely to have alcohol use disorder

9. Onset (Bipolar I) -18 years (can occur in children and in older adults)
-90% of people with single manic episode develop re-
current mood episodes, 60% manic episodes occur right
before depressive

10. SUI Risk (Bipolar suicide risk: 15 times that of general population. History of
I) suicide attempt/ideation associated with greater risk

11. Rule Out (Bipolar -major depressive disorder

I) -other bipolar disorders
-GAD, panic disorder, PTSD, other anxiety disorder
-Substance induced bipolar
-ADHD
-Personality disorder

12. Comorbidity -co-occurring mental disorders (anxiety disorder, social

(Bipolar I) anxiety disorder, ADHD, specific phobias (3/4 pop has
these), (conduct disorder, explosive disorder), (substance
use disorder’ specifically alcohol)

13. Criteria (Bipolar A.must have recurrent or past hypomanic episode AND
II) past major depressive episode
B.has NEVER had a manic episode (or it is Bipolar I)
C.not better explained by schizo-disorders
D.causing clinical impairment in social, occupational, or
other areas of functioning

14. Prevalence -.3%/12 month

(Bipolar II) -childhood is unknown
-1:1, M:F

15. Onset (Bipolar II) -mid 20s (most begins with depressive

16. SUI (Bipolar II) 1/3 with Bipolar II have suicide attempt

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17. Rule Out (Bipolar -cyclothymic
II) -schizophrenia/psychotic disorders
-panic disorders
-substance use disorders
-ADHD
-Personality disorders
-Bipolar disorders

18. Comorbidity -Anxiety disorders most common

(Bipolar II) - eating disorders
- substance use disorder

19. Criteria (Cy- A.2 years (1 year in children and adolescents). Numerous
clothymic Disor- hypomanic symptoms (not meeting criteria) and numer-
der) ous depressive symptoms (not meeting criteria)
B.during 2 year period (1 year in children and adolescents)
hypomanic and depressive periods present for at least
half the time. Not been without symptoms for more than
2 months.
C.Criteria for manic, depressive, or hypomanic have never
been met
D.Not better explained by schizo-disorders
E.Not attributable to substance or medical condition

20. Prevalence (Cy- -.4/1% (higher in mood disorder)

clothymic Disor- -1:1, M:F
der)

21. Onset (Cy- -begins in adolescence or early adult

clothymic Disor- -persistent course usually
der)

22. Course (Cy- -onset in late adulthood might be due to another medical
clothymic Disor- condition
der) -15%-50% risk that someone with cyclothymic will develop
Bipolar I or Bipolar II.

23. Rule Out (Cy- -bipolar and related disorder due to another medical con-
clothymic Disor- dition
der) -substance induced
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-bipolar I with rapid cycling
-Borderline personality

24. Comorbidity (Cy- -substance related and sleep disorders

clothymic Disor- -pediatric patients ADHD
der)

25. Criteria (Major A): 5 OR MORE SYMPTOMS PRESENT IN 2 WEEK

Depressive Dis- PERIOD AT LEAST ONE IS DEPRESSED MOOD OR
order) LOSS OF INTEREST:
1. Depressed Mood
2. Diminished Interest/pleasure
3.Feelings of worthlessness or guilt
4. Fatigue/loss of energy
5. Diminished ability to think/concentrate or indecisiveness
6. Weight loss or weight gain, decrease in appetite
7. psychomotor agitation or retardation
8. Insomnia or hypersomnia
9. Recurrent thoughts of death, suicidal ideation

B): sxs cause significant distress

C): Episode not attributable to physiologic effects of sub-

stances or AMC

D): Episode not better explained by schizo/delusional or

other psychotic disorder

E): Never been a manic or hypomanic episode

26. Duration of Sx for 5 sxs in 2 week period

Diagnosis (Major
Depressive Dis-
order)

27. Rule Out (Major •Grief/Bereavement

Depressive Dis- •Bipolar
order) •Dysthymia
•Normative Sadness
•Adjustment Disorder
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•Somatization Disorders & Pseudo-dementia
•TBI
•Hypothyroidism
•Diabetes
•MS, Stroke, Epilepsy

28. Prevalence Rates Lifetime: 5.8% - 16.6%; 12 month: 7%;

(Major Depres- Males: 2-3%, Females 5-9%
sive Disorder) 18-29 3x > 60+; Urban/Rural < Industrial

29. Gender Consid- M:F = 1:2 beginning early adolescence

erations (Major
Depressive Dis-
order)

30. Development Onset in 20s = more chronic/malignant course; if onset e 50

and Course y/o, consider medical conditions (SIGNIFICANT variation:
(Major not age dependent diagnosis)
Depressive Course Chronic course = symptoms evident around 14;
Disorder) Lifetime course = symptoms evident in mid 20s

31. Risk Factors (Ma- G

¢ enetic: 1st degree family member = 2-4x higher risk;
jor Depressive Heritability = 35-45%
Disorder) ¢Peripartum: 1st episode happens during pregnancy for
50%
¢SUI!!! 10-30x general population; 15% rate for MDD

32. Special Popula- Psychosis: MDD can be accompanied by psychotic symp-

tions (Major De- toms
pressive Disor- Children/Adolescents: irritable, engage in risky behaviors
der) Elderly: medications/illnesses should be evaluated; may
look like pseudo-dementia
Medically Ill: very common secondary diagnosis; poor ill-
ness management, increases hospital stay/use of medical
services, likelihood of returning & mortality rate; Common
w/vascular illness (stroke, MI) and diabetes/epilepsy

33. Other Notes (Ma- -Male:Female ratio may be due to masculine expressions
jor Depressive of depression (anger, self-destruction, SUDs) not be clas-
Disorder) sified diagnostically as "MDD"
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-Other cultures describe symptoms as somatic symptoms
nerves/hyperactivity, "imbalance" or weakness, problems
with "heart"
-Careful consideration of MDD Dx in response to signifi-
cant loss (Grief v. MDE)

34. Criteria (Uncom- a.Single episode (no prior episodes, none since)
plicated Unipolar b.Less than 6 months to remit
MDD) c.No severe impairment
d.No suicidal ideations, psychomotor retardation or worth-
lessness

35. Criteria (Persis- A.Depressed mood most of the day, more days than not
tent Depressive for at least 2 years
Disorder or Dys- B.Presence of 2+ while depressed:
thymia) i.Poor appetite/overeating
ii.Insomnia/hypersomnia
iii.Low energy/fatigue
iv.Low self-esteem
v.Poor concentration/difficulty making decisions
vi.Feelings of hopelessness

C.No remission periods (absence of Criteria 1-2) >2

months during 2 year period

D.Criteria for MDD may be continuously present for 2

years.

E.No manic/hypomanic episodes; never met criteria for

cyclothymic disorder

F.Not better explained by schizo/delusional or other psy-

chotic disorder

G.Not attributable to phys. effects of substance or medical

condition

H. Sx cause sig. distress in social/occupational or impor-

tant areas of functioning

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36. Duration of sx -Depressed mood for at least 2 years
for dx (Persis- -No remission for more than 2 months during the 2 year
tent Depressive period
Disorder or Dys- -2 depressive sxs
thymia)

37. Rule Out (Persis- •MDD, MDE (indicate with specifiers)

tent Depressive •Chronic Psychotic Disorders (Schizo/delusional disor-
Disorder or Dys- ders)
thymia) •Depressive Disorder due to Medical Condition
•Substance-Induced Depressive Disorder
•Bipolar Disorders
•Normal existential sadness

38. Prevalence Rates 12 month: 2%

(Persistent De-
pressive Disor-
der or Dys-
thymia)

39. Development Onset early childhood, adolescence, early adulthood

and Course Course is chronic; when symptoms rise to level of MDE,
(Persistent likely to subsequently revert to lower level; increased
Depressive severity/chronicity w/comorbid anxiety & conduct disor-
Disorder or ders
Dysthymia)

40. Risk Factors ¢ arental loss/separation in childhood

P
(Persistent De- ¢Early onset = ‘ risk of PDs & SUDs
pressive Disor-
der or Dys-
thymia)

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