Mood Disorders Flashcards
MANIC
Manic episode:
A. A distinct period of elevated, expansive or irritable mood and abnormal and persistently increased energy for > 1 week nearly daily (or less if hospitalized)
B. During that period, 3 or more of the following are noted and represent a significant change in behaviour:
1. grandiosity/inflated self-esteem
2. decreased need for sleep
3. increased/pressured talking
4. flight of ideas or subjective racing thoughts
5. distractible
6. increased goal directed activity (socially, work/school, sexually) or psychomotor agitation
7. risky activities– potential painful consequences
C. Mood disturbance is severe enough to cause marked impairment in social or occupational function or require hospitalization to prevent harm to self/others, or psychotic features/
D. Not due to physiological effects of substance (medication or drug) or another medical condition.
HYPERMANIC EPSIODE
A. Distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently elevated energy/activity, lasting 4 days
B. During this period: 3 or more (4 if mood is irritable) are present and are a change from usual:
1. inflated self-esteem/grandiosity
2. decreased need for sleep
3. more or pressured speech
4. flight of ideas or subjective racing thoughts
5. distractible
6. increased goal directed activity (social, work/school, sex) or psychomotor agitation
7. excessive involvement in risk taking behaviours with potentially painful consequences
C. Symptoms present unequivocal change in functioning that is uncharacteristic when pt is not symptomatic
D. Disturbance in mood and change in function is observable by others.
E. Not severe enough to sue mark impairment in social or occupational function, or to require hospitalization. No psychotic features.
F. Not attributable to physiological effects of substances or another medical condition
PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA)
This disorder represents a consolidation of DSM-IV-defined chronic major depressive dis*
order and dysthymic disorder.
A. Depressed mood for most of the day, for more days than not, as indicated by either
subjective account or observation by others, for at least 2 years.
Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hope essness.
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individ-
ual has never been without the symptoms in Criteria A and B for more than 2 months at a
time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria have
never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder,
schizophrenia, delusional disorder, or other specified or unspecified schizophrenia
spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition (e.g. hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
Note: Because the criteria for a major depressive episode include four symptoms that are
absent from the symptom list for persistent depressive disorder (dysthymia), a very limited
MAJOR DEPRESSIVE ESPISODE
A. Five (or more) of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning; at least one of the symptoms
is either (1) depressed mood or (2) loss of Interest or pleasure.
Note: Do not include symptoms that are clearly attributable to a medcal condition.
- Depressed mood most of the day, nearly every day, as indicated by either subjec-
tive report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g.,
appears tearful). (Note: In children and adolescents, can be irritable mood.) - Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation).
3.Significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease or increase In appetite nearly every
day. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
5.Psychomotor agtation or retardation nearly every day (observable by others; not
merely subjective feelings of restlessness or being slowed down).
6.Fatigue or loss of energy nearly every day.
7.Feelings of worthlessness or excessive or inappropriate guilt (which may be delu-
sional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (ei-
ther by subjective account or as observed by others). - Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with,
out a specific plan, a suicide attempt, or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other Important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another
medical condition.
BIPOLAR 1 DISORDER
Bipolar I Disorder
A. Criteria have been met for at least one manic episode. The Manic episode may have been preceeded by and may be followed by hypomanic or major depressive episodes.
At least 1 lifetime manic episode is required for the diagnosis of bipolar 1 disorder.
BIPOLAR 2 DISORDER
Bipolar Il Disorder
It is necessary to meet criteria for a current or past hypomanic episode AND criteria for current or past major depressive episode.
There has never been manic episode
MAJOR DEPRESSIVE DISORDER:
A. Five (or more) of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning; at least one of the symptoms
is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
- Depressed mood most of the day, nearly every day, as indicated by either subjec-
tive report (e.g., feels sad, empty, hopeless) or observation made by others (e.g.,
appears tearful). (Note: In children and adolescents, can be irritable mood.) - Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as Indicated by either subjective account or observation). - Significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every day.
(Note: In children, consider failure to make expected weight gain.) - Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down). - Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with
out a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode IS not attributable to the physiological effects of a substance or to another
medical condition.
Note: Criteria A—C represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a nat-
ural disaster, a serious medical illness or disability) may include the feelings of Intense sad
ness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A,
which may resemble a depressive episode, Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history
and the cultural norms for the expression of distress in the context of loss.
D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or
other specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes
are substance-induced or are attributable to the physiological effects of another medical condition.
CYCLOTHYMIC DISORDER:
A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic
episode and numerous periods with depressive symptoms that do not meet criteria for
a major depressive episode.
B. During the above 2*year period (1 year in children and adolescents), the hypomanic
and depressive periods have been present for at least half the time and the individual
has not been without the symptoms for more than 2 months ata time.
C. Criteria for a major depressive, manic, or hypomanic episode have never been met.
D. The symptoms in Criterion A are not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder, or other specified or un-
specified schizophrenia spectrum and other psychotic disorder.
E. The symptoms are not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
With anxious distress (see p. 149)
DISRUPTIVE MOOD DYSREGULATION DISORDER (KID ONLY):
A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of
proportion in intensity or duration to the situation or provocation.
B. The temper outbursts are inconsistent with developmental level.
C. The temper outbursts occur, on average, three or more times per week.
D. The mood between temper outbursts is persistently irritable or angry most of the day,
nearly every day, and is observable by others (e.g., parents, teachers, peers).
E. Criteria A—D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the
symptoms in Criteria A—D.
F. Criteria A and D are present in at least two of three settngs (i.e., at home, at school,
with peers) and are severe in at least one of these.
G. The diagnosis should not be made for the first time before age 6 years or after age 1 8
years.
H. By history or observation, the age at onset of Criteria A—E before 10 years.
I. There has never been a distinct period lasting more than 1 day during which the full
symptom criteria, except duration, for a manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs In the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.
J. The behaviors do not occur exclusively during an episode of major depressive disorder
and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive
disorder [dysthymial).
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent ex
plosive disorder, or bipolar disorder, though it can coexist with others, including major
depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and
substance use disorders. Individuals whose symptoms meet criteria for both disruptive
mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation
disorder should not be assigned.
K. The symptoms are not attributable to the physiological effects of a substance or to an-
other medical or neurological condition.
PREMENSTRUAL DYSPHORIC DISORDER
A. In the majority of menstrual cycles, at least five symptoms must be present in the final
week before the onset of menses, start to improve within a few days after the onset of
menses, and become minimal or absent in the week postmenses.
B. One (or more) of the following symptoms must be present:
- Marked affective ‘ability (e.g., mood swings; feeling suddenly sad or tearful, or in-
creased sensitivity to rejection). - Marked irritability or anger or increased interpersonal conflicts.
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
- Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total
of five symptoms when combined with symptoms from Criterion B above.
- Decreased interest in usual activities (e.g., work, school, friends, hobbies).
- Subjective difficulty in concentration.
- Lethargy, easy fatigability, or marked lack of energy.
- Marked change in appetite; overeating; or specific food cravings.
- Hypersomnia or insomnia.
- A sense of being overwhelmed or out of control.
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a
sensation of “bloating,” or weight gain.
Note: The symptoms in Criteria A—C must have been met for most menstrual cycles that
occurred in the preceding year.
D. The symptoms are associated with clinically significant distress or interference with
work, school, usual social activities, or relationships with others (e.g., avoidance of so,
cial activities; decreased productivity and efficiency at work, school, or home).
E. The disturbance is not merely an exacerbation of the symptoms of another disorder,
such as major depressive disorder, panic disorder, persistent depressive disorder
(dysthymia), or a personality disorder (although it may co-occur with any of these dis
orders).
F. Criterion A should be confirmed by prospective daily ratings during at least two symptom-
atic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.)
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication, other treatment) or another medical condition (e.g., hy-
perthyroidlsm).
