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Showing posts with label Mood Disorders. Show all posts
Showing posts with label Mood Disorders. Show all posts

ICD-10 - Mood/Affective Disorders

Posted by Dr.K@meleon Labels:

[From World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Copyright, World Health Organization, Geneva, 1993.] ...

Manic episode
Hypomania
  1. The mood is elevated or irritable to a degree that is definitely abnormal for the individual concerned and sustained for at least 4 consecutive days.
  2. At least three of the following signs must be present, leading to some interference with personal functioning in daily living:
    1. increased activity or physical restlessness;
    2. increased talkativeness;
    3. distractibility or difficulty in concentration;
    4. decreased need for sleep;
    5. increased sexual energy;
    6. mild overspending, or other types of reckless or irresponsible behavior;
    7. increased sociability or overfamiliarity.
  3. The episode does not meet the criteria for mania, bipolar affective disorder, depressive episode, cyclothymia, or anorexia nervosa.
  4. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
Mania without psychotic symptoms
  1. Mood must be predominantly elevated, expansive, or irritable, and definitely abnormal for the individual concerned. The mood change must be prominent and sustained for at least 1 week (unless it is severe enough to require hospital admission).
  2. At least three of the following signs must be present (four if the mood is merely irritable), leading to severe interference with personal functioning in daily living:
    1. increased activity or physical restlessness;
    2. increased talkativeness (“pressure of speech”);
    3. flight of ideas or the subjective experience of thoughts racing;
    4. loss of normal social inhibitions, resulting in behavior that is inappropriate to the circumstances;
    5. decreased need for sleep;
    6. inflated self-esteem or grandiosity;
    7. distractibility or constant changes in activity or plans;
    8. behavior that is foolhardy or reckless and whose risks the individual does not recognize, e.g., spending sprees, foolish enterprises, reckless driving;
    9. marked sexual energy or sexual indiscretions.
  3. There are no hallucinations or delusions, although perceptual disorders may occur (e.g., subjective hyperacusis, appreciation of colors as especially vivid).
  4. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
Mania with psychotic symptoms
  1. The episode meets the criteria for mania without psychotic symptoms with the exception of Criterion C.
  2. The episode does not simultaneously meet the criteria for schizophrenia or schizoaffective disorder, manic type.
  3. Delusions or hallucinations are present, other than those listed as typically schizophrenic in Criterion G1(1)b, c, and d for schizophrenia (i.e., delusions other than those that are completely impossible or culturally inappropriate, and hallucinations that are not in the third person or giving a running commentary). The commonest examples are those with grandiose, self-referential, erotic, or persecutory content.
  4. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
Specify whether the hallucinations or delusions are congruent or
incongruent with the mood:
With mood-congruent psychotic symptoms (such as grandiose delusions or voices telling the individual that he or she has superhuman powers)
With mood-incongruent psychotic symptoms (such as voices speaking to the individual about affectively neutral topics, or delusions of reference or persecution)
Other manic episodes
Manic episode, unspecified
Bipolar affective disorder
Note. Episodes are demarcated by a switch to an episode of opposite mixed polarity or by a remission.
Bipolar affective disorder, current episode hypomanic
  1. The current episode meets the criteria for hypomania.
  2. There has been at least one other affective episode in the past, meeting the criteria for hypomanic or manic episode, depressive episode, or mixed affective episode.
Bipolar affective disorder, current episode manic without psychotic symptoms
  1. The current episode meets the criteria for mania without psychotic symptoms.
  2. There has been at least one other affective episode in the past, meeting the criteria for hypomanic or manic episode, depressive episode, or mixed affective episode.
Bipolar affective disorder, current episode manic without psychotic symptoms
  1. The current episode meets the criteria for mania without psychotic symptoms.
  2. There has been at least one other affective episode in the past, meeting the criteria for hypomanic or manic episode, depressive episode, or mixed affective episode.
Specify whether the psychotic symptoms are congruent or incongruent with the mood:
With mood-congruent psychotic symptoms
With mood-incongruent psychotic symptoms
Bipolar affective disorder, current episode moderate or mild depression
  1. The current episode meets the criteria for a depressive episode of either mild or moderate severity.
  2. There has been at least one other affective episode in the past, meeting the criteria for hypomanic or manic episode, depressive episode, or mixed affective episode.
Specify the presence of the “somatic syndrome” in the current episode of depression:
Without somatic syndrome
With somatic syndrome
Bipolar affective disorder, current episode severe depression without psychotic symptoms
  1. The current episode meets the criteria for a severe depressive episode without psychotic symptoms.
  2. There has been at least one well-authenticated hypomanic or manic episode or mixed affective episode in the past.
Bipolar affective disorder, current episode severe depression with psychotic symptoms
  1. The current episode meets the criteria for a severe depressive episode without psychotic symptoms.
  2. There has been at least one well-authenticated hypomanic or manic episode or mixed affective episode in the past.
Specify whether the psychotic symptoms are congruent or incongruent with the mood:
With mood-congruent psychotic symptoms
With mood-incongruent psychotic symptoms
Bipolar affective disorder, current episode mixed
  1. The current episode is characterized by either a mixture or a rapid alternation (i.e., within a few hours) of hypomanic, manic, and depressive symptoms.
  2. Both manic and depressive symptoms must be prominent most of the time during a period of at least 2 weeks.
  3. There has been at least one well-authenticated hypomanic or manic episode, depressive episode, or mixed affective episode in the past.
Bipolar affective disorder, currently in remission
  1. The current state does not meet the criteria for depressive or manic episode of any severity or for any other mood [affective] disorder (possibly because of treatment to reduce the risk of future episodes).
  2. There has been at least one well-authenticated hypomanic or manic episode in the past and in addition at least one other affective episode (hypomanic or manic, depressive, or mixed).
Other bipolar affective disorders
Bipolar affective disorder, unspecified
Depressive episode
G1. The depressive episode should last for at least 2 weeks.
G2. There have been no hypomanic or manic symptoms sufficient to meet the criteria for hypomanic or manic episode at any time in the individual's life.
G3. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
Somatic syndrome
Some depressive symptoms are widely regarded as having special clinical significance and are here called “somatic.” (Terms such as biological, vital, melancholic, or endogenomorphic are used for this syndrome in other classifications.)
A fifth character may be used to specify the presence or absence of the somatic syndrome. To qualify for the somatic syndrome, four of the following symptoms should be present:
  1. marked loss of interest or pleasure in activities that are normally pleasurable;
  2. lack of emotional reactions to events or activities that normally produce an emotional response;
  3. waking in the morning 2 hours or more before the usual time;
  4. depression worse in the morning;
  5. objective evidence of marked psychomotor retardation or agitation (remarked on or reported by other people);
  6. marked loss of appetite;
  7. weight loss (5% or more of body weight in the past month);
  8. marked loss of libido.
In The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines, the presence or absence of the somatic syndrome is not specified for severe depressive episode, since it is presumed to be present in most cases. For research purposes, however, it may be advisable to allow for the coding of the absence of the somatic syndrome in severe depressive episode.
Mild depressive episode
  1. The general criteria for depressive episode must be met.
  2. At least two of the following three symptoms must be present:
    1. depressed mood to a degree that is definitely abnormal for the individual, present for most of the day and almost every day, largely uninfluenced by circumstances, and sustained for at least 2 weeks;
    2. loss of interest or pleasure in activities that are normally pleasurable;
    3. decreased energy or increased fatigability.
  3. An additional symptom or symptoms from the following list should be present, to give a total of at least four:
    1. loss of confidence or self-esteem;
    2. unreasonable feelings of self-reproach or excessive and inappropriate guilt;
    3. recurrent thoughts of death or suicide, or any suicidal behavior;
    4. complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation;
    5. change in psychomotor activity, with agitation or retardation (either subjective or objective);
    6. sleep disturbance of any type;
    7. change in appetite (decrease or increase) with corresponding weight change.
A fifth character may be used to specify the presence or absence of the “somatic syndrome”:
Without somatic syndrome
With somatic syndrome
Moderate depressive episode
  1. The general criteria for depressive episode must be met.
  2. At least two of the three symptoms listed for Criterion B above must be present.
  3. Additional symptoms from depressive episode, Criterion C, must be present, to give a total of at least six.
A fifth character may be used to specify the presence or absence of the “somatic syndrome”:
Without somatic syndrome
With somatic syndrome
Severe depressive episode without psychotic symptoms
Note: If important symptoms such as agitation or retardation are marked, the patient may be unwilling or unable to describe many symptoms in detail. An overall grading of severe episode may still be justified in such a case.
  1. The general criteria for depressive episode must be met.
  2. All three of the symptoms in Criterion B, depressive episode, must be present.
  3. Additional symptoms from depressive episode, Criterion C, must be present, to give a total of at least eight.
  4. There must be no hallucinations, delusions, or depressive stupor.
Severe depressive episode with psychotic symptoms
  1. The general criteria for depressive episode must be met.
  2. The criteria for severe depressive episode without psychotic symptoms must be met with the exception of Criterion D.
  3. The criteria for schizophrenia or schizoaffective disorder, depressive type, are not met.
  4. Either of the following must be present:
    1. delusions or hallucinations, other than those listed as typically schizophrenic in Criterion G1(1)b, c, and d for general criteria for paranoid, hebephrenic, catatonic, and undifferentiated schizophrenia (i.e., delusions other than those that are completely impossible or culturally inappropriate and hallucinations that are not in the third person or giving a running commentary), the commonest examples are those with depressive, guilty, hypochondriacal, nihilistic, self-referential, or persecutory content
    2. depressive stupor
A fifth character may be used to specify whether the psychotic symptoms are congruent or incongruent with mood:
With mood-congruent psychotic symptoms (i.e., delusions of guilt, worthlessness, bodily disease, or impending disaster, derisive or condemnatory auditory hallucinations)
With mood-incongruent psychotic symptoms (i.e., persecutory or self-referential delusions and hallucinations without an affective content)
Other depressive episodes
Episodes should be included here which do not fit the descriptions given for depressive episodes, but for which the overall diagnostic impression indicates that they are depressive in nature. Examples include fluctuating mixtures of depressive symptoms (particularly those of the somatic syndrome) with nondiagnostic symptoms such as tension, worry, and distress, and mixtures of somatic depressive symptoms with persistent pain or fatigue not due to organic causes (as sometimes seen in general hospital services).
Depressive episode, unspecified
Recurrent depressive disorder
G1. There has been at least one previous episode, mild, moderate, or severe, lasting a minimum of 2 weeks and separated from the current episode by at least 2 months free from any significant mood symptoms.
G2. At no time in the past has there been an episode meeting the criteria for hypomanic or manic episode.
G3. Most commonly used exclusion clause. The episode is not attributable to psychoactive substance use or to any organic mental disorder.
It is recommended that the predominant type of previous episodes is specified (mild, moderate, severe, uncertain).
Recurrent depressive disorder, current episode mild
  1. The general criteria for recurrent depressive disorder are met.
  2. The current episode meets the criteria for mild depressive episode.
A fifth character may be used to specify the presence or absence of the “somatic syndrome,” in the current episode:
Without somatic syndrome
With somatic syndrome
Recurrent depressive disorder, current episode moderate
  1. The general criteria for recurrent depressive disorder are met.
  2. The current episode meets the criteria for moderate depressive episode.
A fifth character may be used to specify the presence or absence of the “somatic syndrome.” in the current episode:
Without somatic syndrome
With somatic syndrome
Recurrent depressive disorder, current episode without psychotic symptoms
  1. The general criteria for recurrent depressive disorder are met.
  2. The current episode meets the criteria for severe depressive episode without psychotic symptoms.
Recurrent depressive disorder, current episode severe with psychotic symptoms
  1. The general criteria for recurrent depressive disorder are met.
  2. The current episode meets the criteria for severe depressive episode with psychotic symptoms.
A fifth character may be used to specify whether the psychotic symptoms are congruent or incongruent with the mood:
With mood-congruent psychotic symptoms
With mood-incongruent psychotic symptoms
Recurrent depressive disorder, currently in remission
  1. The general criteria for recurrent depressive disorder have been met in the past.
  2. The current state does not meet the criteria for a depressive episode of any severity or for any other disorder in mood [affective] disorders.
Comment
This category can still be used if the patient receives treatment to reduce the risk of further episodes.
Other recurrent depressive disorders
Recurrent depressive disorder, unspecified
Persistent mood [affective] disorders
Cyclothymia
  1. There must have been a period of at least 2 years of instability of mood involving several periods of both depression and hypomania, with or without intervening periods of normal mood.
  2. None of the manifestations of depression or hypomania during such a 2-year period should be sufficiently severe or long-lasting to meet criteria for manic episode or depressive episode (moderate or severe); however, manic or depressive episode(s) may have occurred before, or may develop after, such a period of persistent mood instability.
  3. During at least some of the periods of depression at least three of the following should be present:
    1. reduced energy or activity;
    2. insomnia;
    3. loss of self-confidence or feelings of inadequacy;
    4. difficulty in concentrating;
    5. social withdrawal;
    6. loss of interest in or enjoyment of sex and other pleasurable activities;
    7. reduced talkativeness;
    8. pessimism about the future or brooding over the past.
  4. During at least some of the periods of mood elevation at least three of the following should be present:
    1. increased energy or activity;
    2. decreased need for sleep;
    3. inflated self-esteem;
    4. sharpened or unusually creative thinking;
    5. increased gregariousness;
    6. increased talkativeness or wittiness;
    7. increased interest and involvement in sexual and other pleasurable activities;
    8. overoptimism or exaggeration of past achievements.
Note. If desired, time of onset may be specified as early (in late teenage or the 20s) or late (usually between age 30 and 50 years, following an affective episode).
Dysthymia
  1. There must be a period of at least 2 years of constant or constantly recurring depressed mood. Intervening periods of normal mood rarely last for longer than a few weeks, and there are no episodes of hypomania.
  2. None, or very few, of the individual episodes of depression within such a 2-year period should be sufficiently severe or long-lasting to meet the criteria for recurrent mild depressive disorder.
  3. During at least some of the periods of depression at least three of the following should be present:
    1. reduced energy or activity;
    2. insomnia;
    3. loss of self-confidence or feelings of inadequacy;
    4. difficulty in concentrating;
    5. frequent tearfulness;
    6. loss of interest in or enjoyment of sex and other pleasurable activities;
    7. feeling of hopelessness or despair;
    8. a perceived inability to cope with the routine responsibilities of everyday life;
    9. pessimism about the future or brooding over the past;
    10. social withdrawal;
    11. reduced talkativeness.

Note. If desired, time of onset may be specified as early (in late teenage or the 20s) or late (usually between age 30 and 50 years, following an affective episode).
Other persistent mood [affective] disorders
This is a residual category for persistent affective disorders that are not sufficiently severe or long-lasting to fulfill the criteria for cyclothymia or dysthymia but that are nevertheless clinically significant. Some types of depression previously called “neurotic” are included here, provided that they do not meet the criteria for either cyclothymia or dysthymia or for depressive episode of mild or moderate severity.
Persistent mood [affective] disorder, unspecified Other mood [affective] disorders
There are so many possible disorders that could be listed that no attempt has been made to specify criteria, except for mixed affective episode and recurrent brief depressive disorder. Investigators requiring criteria more exact than those available in Clinical Descriptions and Diagnostic Guidelines should construct them according to the requirements of their studies.
Other single mood [affective] disorders
Mixed affective episode
  1. The episode is characterized by either a mixture or a rapid alternation (i.e., within a few hours) of hypomanic, manic, and depressive symptoms.
  2. Both manic and depressive symptoms must be prominent most of the time during a period of at least 2 weeks.
  3. There is no history of previous hypomanic, depressive, or mixed episodes.
Other recurrent mood [affective] disorders
Recurrent brief depressive disorder
  1. The disorder meets the symptomatic criteria for mild, moderate, or severe depressive episode.
  2. The depressive episodes have occurred about once a month over the past year.
  3. The individual episodes last less than 2 weeks (typically 2–3 days).
  4. The episodes do not occur solely in relation to the menstrual cycle.
Other specified mood [affective] disorders
This is a residual category for affective disorders that do not meet the criteria for any other categories above.
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DSM-IV - Mood Disorder Not Otherwise Specified

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

This category includes disorders with mood symptoms that do not meet the criteria for any specific mood disorder and in which it is difficult to choose between depressive disorder not otherwise specified and bipolar disorder not otherwise specified (e.g., acute agitation).
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DSM-IV - Substance-Induced Mood Disorder

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

  1. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
    1. depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
    2. elevated, expansive, or irritable mood
  2. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2):
    1. the symptoms in Criterion A developed during, or within a month of, substance intoxication or withdrawal
    2. medication use is etiologically related to the disturbance
  3. The disturbance is not better accounted for by a mood disorder that is not substance induced. Evidence that the symptoms are better accounted for by a mood disorder that is not substance-induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non–substance-induced mood disorder (e.g., a history of recurrent major depressive episodes).
  4. The disturbance does not occur exclusively during the course of a delirium.
  5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the mood symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention. Code [Specific substance]-induced mood disorder:
Alcohol; amphetamine [or amphetamine-like substance]; cocaine; hallucinogen; inhalant; opioid; phencyclidine [or phencyclidine-like substance]; sedative, hypnotic, or anxiolytic; other [or unknown] substance
Specify type:
With depressive features: if the predominant mood is depressed
With manic features: if the predominant mood is elevated, euphoric, or irritable
With mixed features: if symptoms of both mania and depression are present and neither predominates
Specify if:
With onset during intoxication: if the criteria are met for intoxication with the substance and the symptoms develop during the intoxication syndrome
With onset during withdrawal: if criteria are met for withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal syndrome
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DSM-IV - Mood Disorder Due to a General Medical Condition

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

  1. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
    1. depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
    2. elevated, expansive, or irritable mood
  2. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
  3. The disturbance is not better accounted for by another mental disorder (e.g., adjustment disorder with depressed mood in response to the stress of having a general medical condition).
  4. The disturbance does not occur exclusively during the course of a delirium.
  5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify type:
With depressive features: if the predominant mood is depressed but the full criteria are not met for a major depressive episode
With major depressive-like episode: if the full criteria are met (except Criterion D) for a major depressive episode
With manic features: if the predominant mood is elevated, euphoric, or irritable
With mixed features: if the symptoms of both mania and depression are present but neither predominates
Coding note: Include the name of the general medical condition on Axis I, e.g., mood disorder due to hypothyroidism, with depressive features; also code the general medical condition on Axis III.
Coding note: If depressive symptoms occur as part of a preexisting vascular dementia, indicate the depressive symptoms by coding the appropriate subtype, i.e., vascular dementia, with depressed mood.
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DSM-IV - Mixed Anxiety-Depressive Disorder

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

  1. Persistent or recurrent dysphoric mood lasting at least 1 month.
  2. The dysphoric mood is accompanied by at least 1 month of four (or more) of the following symptoms:
    1. difficulty concentrating or mind going blank
    2. sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
    3. fatigue or low energy
    4. irritability
    5. worry
    6. being easily moved to tears
    7. hypervigilance
    8. anticipating the worst
    9. hopelessness (pervasive pessimism about the future)
    10. low self-esteem or feelings of worthlessness
  3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
  5. All of the following:
    1. criteria have never been met for Major Depressive Disorder, Dysthymic Disorder, Panic Disorder, or Generalized Anxiety Disorder
    2. criteria are not currently met for any other Anxiety or Mood Disorder (including an Anxiety or Mood Disorder, In Partial Remission)
    3. the symptoms are not better accounted for by any other mental disorder
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Sunday, August 17, 2008 | 2 Comments

DSM-IV - Bipolar Disorder Not Otherwise Specified

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

The bipolar disorder not otherwise specified category includes disorders with bipolar features that do not meet criteria for any specific bipolar disorder. Examples include
  1. Very rapid alternation (over days) between manic symptoms and depressive symptoms that meet symptom threshold criteria but not minimal duration criteria for manic, hypomanic, or major depressive episodes
  2. Recurrent hypomanic episodes without intercurrent depressive symptoms
  3. A manic or mixed episode superimposed on delusional disorder, residual schizophrenia, or psychotic disorder not otherwise specified
  4. Hypomanic episodes, along with chronic depressive symptoms, that are too infrequent to qualify for a diagnosis of cyclothymic disorder
  5. Situations in which the clinician has concluded that a bipolar disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced
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DSM-IV - Postpsychotic Depressive Disorder of Schizophrenia

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

  1. Criteria are met for a major depressive episode.
    Note: The major depressive episode must include Criterion A1: depressed mood. Do not include symptoms that are better accounted for as medication side effects or negative symptoms of schizophrenia.
  2. The major depressive episode is superimposed on and occurs only during the residual phase of schizophrenia.
  3. The major depressive episode is not due to the direct physiological effects of a substance or a general medical condition.
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DSM-IV - Recurrent Brief Depressive Disorder

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

  1. Criteria, except for duration, are met for a major depressive episode.
  2. The depressive periods in Criterion A last at least 2 days but less than 2 weeks.
  3. The depressive periods occur at least once a month for 12 consecutive months and are not associated with the menstrual cycle.
  4. The periods of depressed mood cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  5. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
  6. There has never been a major depressive episode, and criteria are not met for dysthymic disorder.
  7. There has never been a manic episode, a mixed episode, or a hypomanic episode, and criteria are not met for cyclothymic disorder. Note: This exclusion does not apply if all of the manic-, mixed-, or hypomanic-like episodes are substance or treatment induced.
  8. The mood disturbance does not occur exclusively during schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, or psychotic disorder not otherwise specified.
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DSM-IV - Minor Depressive Disorder

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

  1. A mood disturbance, defined as follows:
    1. at least two (but less than five) 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 (a) or (b):
      1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
      2. 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 made by others)
      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 gains.
      4. insomnia or hypersomnia nearly every day
      5. psychomotor agitation 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 delusional) nearly every day (not merely self-reproach or guilt about being sick)
      8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
      9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
    2. the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
    3. the symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)
    4. the symptoms are not better accounted for by bereavement (i.e., a normal reaction to the death of a loved one)
  2. There has never been a major depressive episode, and criteria are not met for dysthymic disorder.
  3. There has never been a manic episode, a mixed episode, or a hypomanic episode, and criteria are not met for cyclothymic disorder. Note: This exclusion does not apply if all of the manic-, mixed-, or hypomanic-like episodes are substance or treatment induced.
  4. The mood disturbance does not occur exclusively during schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, or psychotic disorder not otherwise specified.
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DSM-IV - Depressive Disorder Not Otherwise Specified

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

The depressive disorder not otherwise specified category includes disorders with depressive features that do not meet the criteria for major depressive disorder, dysthymic disorder, adjustment disorder with depressed mood, or adjustment disorder with mixed anxiety and depressed mood. Sometimes depressive symptoms can present as part of an anxiety disorder not otherwise specified. Examples of depressive disorder not otherwise specified include
  1. Premenstrual dysphoric disorder: in most menstrual cycles during the past year, symptoms (e.g., markedly depressed mood, marked anxiety, marked affective lability, decreased interest in activities) regularly occurred during the last week of the luteal phase (and remitted within a few days of the onset of menses). These symptoms must be severe enough to markedly interfere with work, school, or usual activities and be entirely absent for at least 1 week postmenses.
  2. Minor depressive disorder: episodes of at least 2 weeks of depressive symptoms but with fewer than the five items required for major depressive disorder.
  3. Recurrent brief depressive disorder: depressive episodes lasting from 2 days up to 2 weeks, occurring at least once a month for 12 months (not associated with the menstrual cycle).
  4. Postpsychotic depressive disorder of schizophrenia: a major depressive episode that occurs during the residual phase of schizophrenia.
  5. A major depressive episode superimposed on delusional disorder, psychotic disorder not otherwise specified, or the active phase of schizophrenia.
  6. Situations in which the clinician has concluded that a depressive disorder is present but is unable to determine whether it is primary, due to a general medical condition, or substance induced.
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Sunday, August 17, 2008 | 0 Comments

DSM-IV - Cyclothymic Disorder

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

  1. For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. Note: In children and adolescents, the duration must be at least 1 year.
  2. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.
  3. No major depressive episode, manic episode, or mixed episode has been present during the first 2 years of the disturbance.
    Note: After the initial 2 years (1 year in children and adolescents) of cyclothymic disorder, there may be superimposed manic or mixed episodes (in which case both bipolar I disorder and cyclothymic disorder may be diagnosed) or major depressive episodes (in which case both bipolar II disorder and cyclothymic disorder may be diagnosed).
  4. The symptoms in Criterion A are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
  5. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
  6. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
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Sunday, August 17, 2008 | 0 Comments

DSM-IV - Dysthymic Disorder

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

  1. Depressed mood for most of the day, for more days than not, as indicated either by 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.
  2. 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 hopelessness
  3. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
  4. No major depressive episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic major depressive disorder, or major depressive disorder, 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. In addition, after the initial 2 years (1 year in children or adolescents) 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.
  5. There has never been a manic episode, a mixed episode, or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
  6. The disturbance does not occur exclusively during the course of a chronic psychotic disorder, such as schizophrenia or delusional disorder.
  7. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
  8. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
Early onset: if onset is before age 21 years
Late onset: if onset is age 21 years or older
Specify (for most recent 2 years of dysthymic disorder) if
With atypical features
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Sunday, August 17, 2008 | 1 Comments

DSM-IV - Longitudinal Course Specifiers

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

Specify if (can be applied to recurrent major depressive disorder or bipolar I or II disorder):
With full interepisode recovery: if full remission is attained between the two most recent mood episodes
Without full interepisode recovery: if full remission is not attained between the two most recent mood episodes
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Saturday, August 16, 2008 | 0 Comments

DSM-IV - Seasonal Pattern Specifier

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

Specify if:
With seasonal pattern (can be applied to the pattern of major depressive episodes in bipolar I disorder, bipolar II disorder, or major depressive disorder, recurrent)
  1. There has been a regular temporal relationship between the onset of major depressive episodes in bipolar I or bipolar II disorder or major depressive disorder, recurrent, and a particular time of the year (e.g., regular appearance of the major depressive episode in the fall or winter).
    Note: Do not include cases in which there is an obvious effect of seasonal-related psychosocial stressors (e.g., regularly being unemployed every winter).
  2. Full remissions (or a change from depression to mania or hypomania) also occur at a characteristic time of the year (e.g., depression disappears in the spring).
  3. In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationships defined in Criteria A and B, and no nonseasonal major depressive episodes have occurred during that same period.
  4. Seasonal major depressive episodes (as described above) substantially outnumber the nonseasonal major depressive episodes that may have occurred over the individual's lifetime.
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Saturday, August 16, 2008 | 1 Comments

DSM-IV - Rapid-Cycling Specifier

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

Specify if:
With rapid cycling (can be applied to bipolar I disorder or bipolar II disorder)
At least four episodes of a mood disturbance in the previous 12 months that meet criteria for a major depressive, manic, mixed, or hypomanic episode.
Note: Episodes are demarcated either by partial or full remission for at least 2 months or a switch to an episode of opposite polarity (e.g., major depressive episode to manic episode).
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Saturday, August 16, 2008 | 0 Comments

DSM-IV - Chronic Specifier

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

Specify if:
Chronic (can be applied to the current or most recent major depressive episode in major depressive disorder and to a major depressive episode in bipolar I or II disorder only if it is the most recent type of mood episode)
Full criteria for a major depressive episode have been met continuously for at least the past 2 years.
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Saturday, August 16, 2008 | 0 Comments

DSM-IV - Postpartum Onset Specifier

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

Specify if:
With postpartum onset (can be applied to the current or most recent major depressive, manic, or mixed episode in major depressive disorder, bipolar I disorder, or bipolar II disorder; or to brief psychotic disorder)
Onset of episode within 4 weeks postpartum
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Saturday, August 16, 2008 | 0 Comments

DSM-IV - Catatonic Features Specifier

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

Specify if:
With catatonic features (can be applied to the current or most recent major depressive episode, manic episode, or mixed episode in major depressive disorder, bipolar I disorder, or bipolar II disorder)
The clinical picture is dominated by at least two of the following:
  1. motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
  2. excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
  3. extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
  4. peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
  5. echolalia or echopraxia
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Saturday, August 16, 2008 | 0 Comments

DSM-IV - Atypical Features Specifier

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

Specify if:
With atypical features (can be applied when these features predominate during the most recent 2 weeks of a current major depressive episode in major depressive disorder or in bipolar I or bipolar II disorder when a current major depressive episode is the most recent type of mood episode, or when these features predominate during the most recent 2 years of dysthymic disorder; if the major depressive episode is not current, it applies if the feature predominates during any 2-week period)
  1. Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
  2. Two (or more) of the following features:
    1. significant weight gain or increase in appetite
    2. hypersomnia
    3. leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
    4. long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
  3. Criteria are not met for with melancholic features or with catatonic features during the same episode.
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Saturday, August 16, 2008 | 0 Comments

DSM-IV - Melancholic Features Specifier

Posted by Dr.K@meleon Labels:

[From American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association; copyright 2000.] ...

Specify if:
With melancholic features (can be applied to the current or most recent major depressive episode in major depressive disorder and to a major depressive episode in bipolar I or bipolar II disorder only if it is the most recent type of mood episode)
  1. Either of the following, occurring during the most severe period of the current episode:
    1. loss of pleasure in all, or almost all, activities
    2. lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)
  2. Three (or more) of the following:
    1. distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)
    2. depression regularly worse in the morning
    3. early morning awakening (at least 2 hours before usual time of awakening)
    4. marked psychomotor retardation or agitation
    5. significant anorexia or weight loss
    6. excessive or inappropriate guilt
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Saturday, August 16, 2008 | 0 Comments

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