DSM4 Mood

Major Depressive Episode

Manic Episode

Mixed Episode

Hypomanic Episode

Note: Mood Episodes are not codable. See specific Mood Disorders.

A. At least five symptoms, differing from previous functioning, present during a two week period. One of the symptoms must be either depressed mood or loss of interest or pleasure.

• B. Not a Mixed Episode.
• C. The symptoms cause distress or impairment in social, occupational, or other important functioning.
• D. Not due to a substance or a general medical condition.
• E. Not Bereavement.

• 1. Depressed mood.
• 2. Decreased interest or pleasure in activities.
• 3. Significant variations in weight or appetite.
• 4. Insomnia or hypersomnia.
• 5. Psychomotor agitation or retardation.
• 6. Daily fatigue or energy loss.
• 7. Feelings of worthlessness or guilt.
• 8. Difficulties in concentration or decisiveness.
• 9. Recurrent thoughts of death or suicidal ideation, plan, or attempt.

A. At least four days of persistently expansive or irritable mood.

• B. At least three (four if only irritable) symptoms persist.
• C. Uncharacteristic change in functioning.
• D. Disturbance in mood and the change in functioning are observable by others.
• E. No marked impairment in social or occupational functioning. Does not require hospitalization. No psychotic features.
• F. Not due to a substance or a general medical condition.

• 1. Inflated self-esteem.
• 2. Reduced need for sleep.
• 3. Unusually talkative.
• 4. Racing thoughts or flight of ideas.
• 5. Distractibility.
• 6. Psychomotor agitation or increase in goal-oriented activities.
• 7. Involvement in activities that give pleasure but are also likely to bring pain.

A. At least one week of unusually and persistently expansive or irritable mood.

• B. At least three symptoms (4 if only irritable) have persisted during the disturbance,
• C. Not a Mixed Episode.
• D. Impairs occupational functioning, social activities or relationships. May require hospitalization to prevent injury to self or others. May include psychotic features.
• E. Not due to a substance or a general medical condition.

• 1. Inflated self-esteem.
• 2. Reduced need for sleep.
• 3. Unusually talkative.
• 4. Racing thoughts or flight of ideas.
• 5. Distractibility.
• 6. Psychomotor agitation or increase in goal-oriented activities.
• 7. Involvement in activities that give pleasure but are also likely to bring pain.

A. Qualifies as both a Manic Episode and a Major Depressive Episode (excepting duration) nearly every day for a week or more.

• B. Impairs occupational functioning, social activities or relationships. May require hospitalization to prevent injury to self or others. May include psychotic features.
• C. Not due to a substance or a general medical condition.

• 1. Major Depressive Disorder, Single Episode
• 2. Major Depressive Disorder, Recurrent
• 3. Dysthymic Disorder
• 4. Depressive Disorder Not Otherwise Specified

A. Presence of one Major Depressive Episode.

• B. The episode is not better accounted for by Schizoaffective Disorder, and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
• C. No Manic Episode, Mixed Episode, or Hypomanic Episode has ever occurred.

A. Presence of at least two Major Depressive Episodes.

• B. The episode is not better accounted for by Schizoaffective Disorder, and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
• C. No Manic Episode, Mixed Episode, or Hypomanic Episode has ever occurred.

A. Depressed mood for most of day, for more days than not for at least 2 years.

• B. At least two neurovegetative symptoms:
• C. Symptoms in Items A and B never disappear for more than 2 months at a time.
• D. No Major Depressive Episode has been present during the first 2 years (or prev. full remission).
• E. Has never been a Manic, Mixed or Hypomanic Episode, or a Cyclothymic Disorder.
• F. Not solely during a chronic Psychotic Disorder.
• G. Not due to a substance or a general medical condition.
• H. Distress or impairment in social, occupational, or other important functioning.

• 1. Overeating or poor appetite.
• 2. Hypersomnia or insomnia.
• 3. Fatigue or low energy.
• 4. Low self-esteem.
• 5. Difficulties with concentration or making decisions.
• 6. Feelings of hopelessness.

• 1. Bipolar I Disorder
• -- Single Manic Episode
• -- Most Recent Episode Hypomanic
• -- Most Recent Episode Manic
• -- Most Recent Episode Mixed
• -- Most Recent Episode Depressed
• -- Most Recent Episode Unspecified

• 2. Bipolar II Disorder
• -- specify if current/recent hypomanic or depressed episode
• -- specify features of MDE if meeting criteria

3. Cyclothymia

4. Bipolar Disorder Not Otherwise Specified

A. One Manic Episode and no previous Major Depressive Episodes.

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

• A. Hypomanic Episode is current or most recent.
• B. A previous Manic or Mixed Episode.
• C. Distress or impairment in social, occupational, or other important functioning.
• D. Neither A nor B above are better accounted for by Schizoaffective Disorder. Neither are they not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

A. Manic Episode is current or most recent.

• B. At least one previous Major Depressive Episode, Manic Episode, or Mixed Episode.
• C. Episodes in A and B are not better accounted for by Schizoaffective Disorder. Neither are they not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

A. Mixed Episode is current or most recent.

• B. At least one previous Major Depressive Episode, Manic Episode, or Mixed Episode.
• C. Episodes in A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

A. Major Depressive Episode is current or most recent.

• B. At least one previous Manic Episode or Mixed Episode.
• C. Episodes in A and B are not better accounted for by Schizoaffective Disorder, and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

A. Other than duration, a Manic, Hypomanic, Mixed, or Major Depressive Episode is current or most recent.

• B. At least one previous Manic Episode or Mixed Episode.
• C. Distress or impairment in social, occupational, or other important functioning.
• D. Symptoms in A and B above are not better accounted for by Schizoaffective Disorder. Neither are they superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
• E. Symptoms in A and B are not due to a substance or a general medical condition.

A. One or more Major Depressive Episodes.

B. At least one Hypomanic Episode.

C. Never a Manic or Mixed Episode.

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

E. Distress or impairment in social, occupational, or other important functioning.

A. Many periods over 2+ years with hypomanic symptoms as well as depressive symptoms (but not a Major Depressive Episode).

B. During the 2 year period, symptoms do not disappear for more than 2 months at a time.

C. No Major Depressive Episode, Manic Episode, or Mixed Episode appears during the first 2 years of the disturbance.

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

E. Not due to a substance or a general medical condition.

F. Distress or impairment in social, occupational, or other important functioning.

Mood Disorder Due to a General Medical Condition

Substance-Induced Mood Disorder

Mood Disorder Not Otherwise Specified

• A. Prominent and persistent mood disturbance that includes either or both:
• -- 1. Depressed mood or decreased interest or pleasure in activities.
• -- 2. Elevated, expansive, or irritable mood.

B. Physiological result of a general medical condition.

C. Not solely during delirium.

D. Distress or impairment in social, occupational, or other important functioning.

• A. Prominent and persistent mood disturbance that includes either or both:
• -- 1. Depressed mood or markedly diminished interest or pleasure in activities.
• -- 2. Elevated, expansive, or irritable mood.

• B. Either:
• -- 1. Symptoms in A above develop during or within one month of Substance Intoxication or Withdrawal.
• -- 2. Medication use relates etiologically to the disturbance.

C. The disturbance cannot be better accounted for by a Mood Disorder not substance induced.

D. Not solely during delirium.

E. Distress or impairment in social, occupational, or other important functioning.