TABLE 161 Disorders of Mood

Mood disorders may be either depressive or bipolar. A bipolar disorder includes manic or hypomanic features as well as depressive ones. Four types of episodes, described below, are combined in different ways in diagnosis of mood disorders. A major depressive disorder includes only one or more major depressive episodes. A bipolar I disorder includes one or more manic or mixed episodes, usually accompanied by major depressive episodes. A bipolar II disorder includes one or more major depressive episodes accompanied by at least one hypomanic episode.

Dysthymic and cyclothymic disorders are chronic and less severe conditions that do not meet the criteria of the other disorders. Mood disorders due to general medical conditions or substance abuse are classified separately.

Major Depressive Episode

At least five of the symptoms listed below (including one of the first two) must be present during the same 2-week period. They must also represent a change from the person's previous state.

■ Depressed mood (may be an irritable mood in children and adolescents) most of the day, nearly every day

■ Markedly diminished interest or pleasure in almost all activities most of the day, nearly every day

■ Significant weight gain or loss (not dieting) or increased or decreased appetite nearly every day

Insomnia or hypersomnia nearly every day

■ Psychomotor agitation or retardation nearly every day

■ Fatigue or loss of energy nearly every day

■ Feelings of worthlessness or inappropriate guilt nearly every day

■ Inability to think or concentrate or indecisiveness nearly every day

■ Recurrent thoughts of death or suicide, or a specific plan for or attempt at suicide

The symptoms cause significant distress or impair social, occupational, or other important functions. In severe cases, hallucinations and delusions may occur.

Mixed Episode

A mixed episode, which must last at least 1 week, meets the criteria for both manic and major depressive episodes.

Dysthymic Disorder

A depressed mood and symptoms for most of the day, for more days than not, over at least 2 years (1 year in children and adolescents). Freedom from symptoms lasts no more than 2 months at a time.

Manic Episode

A distinct period of abnormally and persistently elevated, expansive, or irritable mood must be present for at least a week (any duration if hospitalization is necessary). During this time, at least three of the symptoms listed below have been persistent and significant. (Four of the these symptoms are required if the mood is only irritable).

■ Inflated self-esteem or grandiosity

■ Decreased need for sleep (feels rested after sleeping 3 hours)

■ More talkative than usual or pressure to keep talking

■ Flight of ideas or racing thoughts

■ Distractibility

■ Increased goal-directed activity (either socially at work or school, or sexually) or psychomotor agitation

■ Excessive involvement in pleasurable high-risk activities (buying sprees, foolish business ventures, sexual indiscretions)

The disturbance is severe enough to impair social or occupational functions or relationships. It may necessitate hospitalization for the protection of self or others. In severe cases, hallucinations and delusions may occur.

Hypomanic Episode

The mood and symptoms resemble those in a manic episode but are less impairing, do not require hospitalization, do not include hallucinations or delusions, and have a shorter minimum duration—4 days.

Cyclothymic Episode

Numerous periods of hypomanic and depressive symptoms that last for at least 2 years (1 year in children and adolescents). Freedom from symptoms lasts no more than 2 months at a time.

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