dsm cards - mood.txt

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.

• 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

Bipolar II Disorder

Cyclothymia

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. A Manic, Hypomanic, Mixed, or Major Depressive Episode is current or most recent, but does not meet duration criteria for specifier.

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.

• 1. Severity: mild/moderate/severe +/- psychotic features
• -- only if full criteria for MDE are met

2. Chronic

3. with Catatonic Features

4. with Melancholic Features

5. with Atypical Features

6. with Postpartum Onset

• 7. in Partial/Full Remission
• -- only if full criteria are not met

Mild: just enough symptoms to meet diagnosis; only minor impairment in occupational and social functioning

Moderate: symptoms or functional impairment between "mild" and "severe"

• Severe: several symptoms in excess of requirement; marked interference with occupational and social function
• -- with or without psychotic features
• - - - mood-congruent (depressive themes of personal inadequacy, guilt, disease, death, nihilism, deserved punishment)
• - - - mood-incongruent

Mild: minimum symptom criteria met for Manic Episode

Moderate: extreme increase in activity or impairment in judgment

Severe Without Psychotic Features: almost continual supervision required to prevent physical harm to self/others

• Severe With Psychotic Features: delusions or hallucinations
• -- mood-congruent (inflated worth, power, knowledge, identify, special relationship to deity or famous person)
• -- mood-incongruent

Mild: no more than minimum symptom criteria met for both Manic Episode and MDE

Moderate: symptoms or funtional impairment between "mild" and "severe"

Severe Without Psychotic Features: almost continual supervision required to prevent physical harm to self/others

• Severe With Psychotic Features: delusions or hallucinations
• -- mood-congruent (depressive or manic themes)
• -- mood-incongruent

• In Partial Remission
• - no symptoms for less than 2 months OR
• - symptoms of MDE/Mania/Mixed present but full criteria not met

• In Full Remission
• - no symptoms for at least 2 months

Note: Can be applied to MDE, Manic Episode, Mixed Episode

Full criteria for a MDE have been met continuously for at least 2 years.


Note: Can be applied in any mood disorder if MDE was most recent episode.

• 2 or more:
• -- 1. motoric immobility (catalepsy, waxy flexibility) or stupor
• -- 2. excessive purposeless motor activity
• -- 3. peculiarities of voluntary mvmt (posturing, sterotyped mvmts, mannerisms, grimacing)
• -- 4. echolalia or echopraxia
• -- 5. extreme negativism or mutism

Note: Can be applied to any MDE, Manic or Mixed Episode

• At least one of:
• 1. Loss of pleasure in (almost) all activities
• 2. Lack of reactivity to usually pleasurable stimuli

• Three or more:
• 1. Distinct quality of depressed mood
• 2. Depression worse in morning
• 3. Early morning awakening
• 4. Marked psychomotor agitation or retardation
• 5. Significant weight loss or anorexia
• 6. Excessive or inappropriate guilt

Note: Can be used in any mood disorder if MDE was most recent episode.

Mood reactivity

and

• two or more:
• 1. Hypersomnia
• 2. Hyperphagia or significant weight gain
• 3. Leaden paralysis
• 4. Interpersonal sensitivity (longstanding pattern)

Has never met criteria for Melancholic or Catatonic Features


Note: Can be applied in any mood disorder where these features predominate in most recent 2 weeks of current MDE (or any 2 weeks of past MDE), or if these features predominate in most recent 2 years of Dysthymic Disorder.

Onset of episode within 4 weeks postpartum


Note: Can be applied to most recent MDE, Manic or Mixed Epixsode, or to Brief Psychotic Disorder.

• Longitudinal Course Specifiers
• -- With Full Interepisode Recovery
• -- Without Full Interepisode Recovery

Seasonal Pattern

Rapid Cycling


Note: These specifiers cannot be coded

• With Full Interepisode Recovery
• Without Full Interepisode Recovery

Specify if mood episode is superimposed on Dysthymic Disorder.


Note: Can be applied to recurrent MDD, Bipolar I & II

A. Regular temporal relationship between onset of MDE and a particular time of year.

B. Full remissions (or change from depression to mania or hypomania) occur at characteristic time of year.

C. In last 2 years, two MDEs have occurred in the seasonal pattern defined by A and B, and no nonseasonal MDEs have occured.

D. Seasonal MDEs outnumber the nonseasonal MDEs over the lifetime.


Note: Can be applied to MDE in any recurrent mood disorder

At least four episodes of a mood disturbance in the previous 12 months that meets criteria for MDE, Manic, Mixed or Hypomanic Episode.

Episodes are demarcated by partial or full remission for at least 2 months or a switch to opposite polarity.


Note: Can be applied to Bipolar I & II Disorder

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.