DSM-Mood disorder

1. Bipolar
• 1 manic episode (often preceded or followed
by hypomania and depressive episodes
• Expansive, or irritable mood AND increase
goal-directed activity
oeither >1 week OR requiring hospitalization
• 3 symptoms of DIGFAST (or 4 if mood is only
irritable)
oDistractible
oIndiscretion
oGrandiose
oFlight of ideas
oActivities
oSleep deficit
oTalkative
• Manic episode that emerges during
antidepressant treatment but persists beyond
the physiological effect is bipolar 1
• Specifiers: See Right Column
Bipolar 2
• Hypomanic episode AND a major depressive
episode
• No manic episode
• Specifiers:
ocurrent or most recent episode: hypomanic,
depressed
• More specifiers:
owith anxious distress
owith mixed features
owith rapid cycling
owith mood congruent psychotic features
owith mood incongruent psychotic
features
owith catatonia
owith peripartum onset
owith seasonal pattern
▪ applies only to the depressive episodes
• More Specifiers:
oin partial remission vs in full remission
• More Specifiers
omild vs moderate vs severe
Substance/Medication Induced
Bipolar and Related Disorder
• bipolar criteria developed during/after
intoxication/withdrawal of
substance/medication that produces
symptoms (not exclusively during delirium)
• Coding:
oalcohol, PCP, hallucinogen, sedative,
amphetamine, cocaine, other
• Specifiers:
owith onset during intoxication vs with onset
during withdrawal
Hypomanic Episode
• Elevated, expansive, or irritable
mood ≥4 days
• 3 (or 4 if irritable) of DIGFAST
• Disturbance in mood/function is
observable by others, is
uncharacteristic, but not severe
enough to cause marked
impairment
oif psychosis or requires
hospitalization, it's
automatically mania without
good prognostic features
• More Specifiers:
owith catatonia
Cyclothymic Disorder
• 2 years (1 year if <18), hypomanic
and depressive symptoms that
never meet criteria for hypomania
or major depression
osymptoms half the time, and
never 2 months without
symptoms
• Specifiers:
owith anxious distress
Bipolar and Related Disorder
Due to Another Medical
Condition
• Bipolar criteria that's the
consequence of another medical
disorder
• not exclusively during delirium
• Coding
• Specify the medical condition
Note: if met prior to onset of
schizophrenia, add "premorbid"
Unspecified Bipolar and
Related Disorder
• symptoms characteristic of
bipolar, causes
distress/impairment, but don't
meet full criteria, and don't want
to specify the reason
Other Specified Bipolar
and Related
• symptoms characteristic of
bipolar, causes
distress/impairment, but don't
meet full criteria, and you want to
specify the reason
Major Depressive Disorder / Episode
• 5 of 9 SIGECAPS for 2 weeks (bereavement
exclusion removed)
oat least one is 1) depressed mood or 2) loss
of pleasure
▪ Depressed mood (in kids: irritable)
▪ sleep
▪ interest
▪ guilt
▪ energy
▪ concentration
▪ appetite
▪ psychomotor activity
▪ suicidal ideation
• Specifiers: See Right Column
Depressive Disorder Due to Another
Medical Condition
• Depressed mood or anhedonia secondary to
another medical condition
• Not better explained by another disorder
oF.e.: adjustment disorder with depressed
mood, in which the stressor is a medical
condition
• Not exclusively during delirium
• Specifiers:
oWith depressive features (full criteria not
met)
oWith major depressive like episode (full
criteria met)
oWith mixed features
Other Specified Depressive Disorder
• Depressive symptoms, clinical impairment,
don’t meet criteria for another disorder, and
you want to communicate the reason
Unspecified Depressive Disorder
• Depressive symptoms, clinical impairment,
don’t meet criteria for another disorder, and
you don’t want to communicate the reason
Persistent Depressive Disorder
(Dysthymia)
• Depressed mood more days than not for ≥2
years (in kids can be irritable mood), requiring
≥2 of the following, never >2 months without
oAppetite
oInsomnia
oEnergy
oSelf-esteem
oConcentration
oHopelessness
• Clinically significant distress or impairment in
function
Disruptive Mood
Dysregulation Disorder
• Severe recurrent temper outbursts
(verbal/behavior) out of proportion to
situation
• Inconsistent with developmental level
• 3 or more times/week
• Mood between outbursts is irritable or
angry
• Present ≥12 months, never ≥3 months
without
• In at least 2 settings
• Can’t be made before 6 or after 18 years
old, but onset of criteria before 10 years
• Can’t have >1 day meeting full
hypomania/mania criteria, and don’t
occur exclusively during MDD or better
explained by another disorder (can’t co-
exist with ODD, IED, or bipolar)
Premenstrual Dysphoric
Disorder
• In most periods, ≥5 symptoms during
last week before starting period, start to
improve a few days after starting period,
and become minimal week after menses
• ≥1 symptom
oLability
oIrritability
oDepressed
oAnxiety
• ≥1 also present to total five including
above
oInterest, concentration, energy,
appetite, sleep, overwhelmed, physical
symptoms
Substance / Medication-Induced
Depressive Disorder
• Depressed mood or anhedonia soon
after substance intoxication or
withdrawal
• Involved substance must be capable of
producing depression
• Not exclusively during delirium
• Specifiers:
oAlcohol, phencyclidine, other
hallucinogen, inhalant, opioid,
sedative/hypnotic/anxiolytic,
amphetamine, cocaine, other
owith onset during intoxication
owith onset during withdrawal
Coding Bipolar &
Depression
• Coding
oBy symptoms: Mild (2) vs
moderate (3), moderate
severe (4 or 5) vs severe (5
with motor agitation)
owith psychotic features
oin partial remission vs in full
remission
ounspecified
• Specifiers:
oex: bipolar 1 disorder, type
of current or most recent
episode,
severity/psychotic/remissio
n specifier and then:
▪ with anxious distress
▪ with mixed features
▪ full criteria for manic or
hypomanic and 3
symptoms of depression
▪ with rapid cycling (bipolar
only)
▪ ≥4 episodes in 1 year
(either switch of polarity
or partial remission of at
least 2 months)
▪ with melancholic features
▪ loss of pleasure OR lack
of reactivity to
pleasurable stimuli
▪ 3 or more of
▪ despair or morose or
empty mood
▪ worse in morning
▪ early morning
awakening (at least 2
hours)
▪ psychomotor agitation
or retardation
▪ anorexia
▪ guilt
▪ with atypical features
▪ with mood congruent
psychotic features
▪ with mood incongruent
psychotic features
▪ with catatonia
▪ with peripartum onset
▪ with seasonal pattern
DSM-5 Mood Disorders