Dsm: 06 Mood Disorders

Front 1

What are the different Mood Disorder Episodes

Back 1

Major Depressive episode
Manic episodes
Mixed episode
Hypomanic episodes

Note: Not DSM diagnoses

Front 2

Manic Episode

Back 2

1+ week (or less if hospitalized) of abnormally and persistently elevated, expansive or irritable mood.

3+ additional sx:
inflated self-esteem or gradiosity
decreased need for sleep
pressured speech
flight of ideas
distractibility
increased involvement in goal-directed activities
psychomotor agitation
excessive involvement in pleasurable (dangerous) activities

Front 3

Major Depressive Episode

Back 3

2+ weeks w/ depressed mood or loss of interest in pleasure of all activities

+ 4+ sx:
change in appetite or weight
change in sleep
change in psychomotor activity
decreased energy
feelings of worthlessness or guilt
difficulty thinking
concentrating or
making decisions
recurrent thoughts of death or
suicidal ideation

Front 4

Mixed Episode

Back 4

1+ week in which critere are met for both manic and MD episodes

Front 5

Hypomanic Episode

Back 5

4+ days w/ same features as Manic E

HE is not severe enough to cause marked impairment in social or work or require hospitilation

Front 6

Major Depressive Disorder defined and

Indicators

Back 6

1+ Major Depressive Episode.

MD Episode not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

C. never had a Manic, Mixed, or Hypomanic Episode. (not counting substance induced episodes)

Specify (for current or most recent episode):

Severity/Psychotic/Remission Specifiers
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset

INDICATORS: tearfulness, pasivity, lack of energy, inabiltyt to attend to responsibilities, major decline in most areas of functioning, withdrawal, not caring about anything, somatic symptoms, guilt, irritablity, agitation, behavioral problems, suicidal ideation, stressors

Front 7

Major Depressive Disorder

Base rate?

Re-occurrence rate?

Culture?

Back 7

Base Rate: 10% to 25% women & 5% to 12% Men (m/f = 1:2). twice common in adolescents. prepubertal m/f is =.

Re-occurrence rate: 60% for 2nd, 70% for 3rd, 90% for 4th

Culture effects experience and cummunication of symptoms

Front 8

What are the essential features of dysthymia

Back 8

A. Chronically depressed mood most of the day, more days than not for almost 2 years (1 year for children and adols).

B. Presence, while depressed, of 2+ 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 hopelessness

C. During the 2-year period (1 year for children or adolescents) - never been without the symptoms in Criteria A and B for more than 2 months.

D. No Major Depressive Episode has been present - disturbance is not better accounted for by chronic MD Disorder, or MD In Partial Remission.
Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. Also, after the initial 2 years of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.

E. No Manic Mixed or Hypomanic Episode, and criteria never met for Cyclothymic Disorder.

F. The disturbance does not due to a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.

G. The symptoms are not due to Substances or general medical condition (e.g., hypothyroidism).

H. Symptoms cause clinically significant distress.

Specify if:
Early Onset: if onset is before age 21 years
Late Onset: if onset is age 21 years or older

Front 9

Dysthymic Disorder

Incidators?

Base Rates?

Differential Diagnosis?

Back 9

Indicators: Chronic worthlessness & low self-esteem, interpersonal problems, sensitivity to rejection, isolatoin

BR: lifetime-6%, equal in children but m/f = 1:3

DD: MD disorder, Avoidant Personality D. Anxiety D

Front 10

Essential Features of Bipolar do

What are the indicators?

Back 10

1 or more manic or mixed episodes. MD episodes not required for dx

- shifts in mood, inability to meet responsibility
- bizarre and erratic behavior
- reckless behavior
- legal problems
- irritability
- impatience
- excessive confidence

Front 11

Base rate for bipolar I?

What is the percentage of those that have a manic episode that tend to go one and have more?

Differential Diagnosis?

Back 11

BR: 0.4% to 1.6% , m/f = 1:1; ethincs and kids more likely to be given Schizo

- 90% of those who have a manic episode have another.

DD- psychotic D, Substance A, Personality D (Borderline, Narcissistic or Antisocial), Anxiety Disorder

Front 12

296.0x Bipolar I Disorder, Single Manic Episode

Back 12

A. Only 1 Manic Episode and no past Major Depressive Episodes.

B. Manic Episode not better accounted for by Schizoaffective D and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Specify if:
Mixed: if symptoms meet criteria for a Mixed Episode

Front 13

296.40 Bipolar I Disorder, Most Recent Episode Hypomanic

296.6x Bipolar I Disorder, Most Recent Episode Mixed

296.5x Bipolar I Disorder, Most Recent Episode Depressed

296.7 Bipolar I Disorder, Most Recent Episode Unspecified

Back 13

A. Currently (or most recently) in a "Hypomanic Episode".
Note: Unspecified = not meeting time criteria

B. Hx of 1+ Manic Episode or Mixed Episode.

C. clinically significant distress or impairment in social, occupational.

D. not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

Specify:
Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern (applies only to the pattern of Major Depressive Episodes)
With Rapid Cycling

Front 14

Essential features of Bipolar II?

Indicators?

Base Rate?

Back 14

EF: 1+ MD episode AND 1+ Hypomanic episode (NEVER a Manic E)

BR: 0.5%. m/f 1:2,

Front 15

Manic vs hypomanic

Back 15

- Hypomanic does not cause marked impairment in social or occupational functioning
- does not require hospitalization
- No psychotic features
- Sxs only present for 3 - 4 days

Front 16

296.89 Bipolar II Disorder

Back 16

A. Presence (or history) of 1+ Major Depressive Episodes.

B. Presence (or history) of 1+ Hypomanic Episode.

C.There has never been a Manic Episode or a Mixed Episode.

D. not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. clinically significant distress or impairment in social, occupational.

Specify current or most recent episode:
Hypomanic:
Depressed:

Front 17

301.13 Cyclothymic Disorder

Back 17

A. 2+ years (1+ years for kids) w/ periods of hypomanic sx and periods w/ depressive sx not meeting criteria for Major Depressive Episode.

B. periods w/out sx not lasting longer than 2 mo.

C. No Major Depressive, Manic or Mixed Episodes in 2+ years
Note: After the initial 2 years both Bipolar I (or II) D and Cyclothymic D may be diagnosed.

D. not better accounted for by Schizoaffective and are not superimposed on Schizophrenia, Schizophreniform, Delusional, or Psychotic Disorder Not Otherwise Specified.

E. not substance induced or a general medical condition (e.g., hyperthyroidism).

F. clinically significant distress