Mood (affective) Patterns/Disorders (DSM IV)

For the purpose of general understanding of these disorders, they will be divided into 2 groups:

1. Mood episodes

2. Mood disorders (depressive, Bipolar, other)

Mood Episodes

Any period of time when a patient feels abnormally happy or sad. Mood episodes are the foundation, or starting point from which many of the identifiable mood disorders are constructed.

Most mood disorder patients will have one or more of these 4 types of episode: major depressive, manic, mixed, and hypomanic. Without additional information, none of these types of mood episodes is an identifiable diagnosis.

Major Depressive Episode: for at least 2 weeks the patient feels depressed or can’t enjoy life, and has problems with eating and sleeping, feelings of guilt, fatigue, trouble concentrating, and thoughts about death.

Manic Episode: For at least 1 week the patient feels elated or sometimes irritable, and may be grandiose, talkative, hyperactive, and distractible. Bad judgment leads to marked social or work impairment. Often these patients must be hospitalized.

Mixed Episode: the patient has fulfilled the symptomatic criteria for both a manic and a major depressive, but it has lasted as briefly as 1 week.

Hypomanic Episode: much like a manic episode but it is briefer and less severe.

Mood Disorders

A pattern of illness due to an abnormal mood. Nearly every patient who has a mood disorder experiences depression at some time, but some also have ‘highs’ of mood.

Many, but not all, mood disorders are diagnosed on the basis of a mood episode. Most patients with mood disorders will fit into one of the identifiable categories ed below. They are divided into 3 groups: depressive, bipolar, other.

Depressive

Major Depressive Disorder: these patients have never had manic or hypomanic episodes but have had one or more major depressive episodes. Major Depressive Disorder will be either recurrent or single episode.

Dysthymic Disorder: not severe enough to be called a major depressive episode. This disorder lasts much longer then major depressive disorder, and there are no ‘high’ phases.

Depressive Disorder not otherwise specified: when a patient has depressive symptoms that do not meet the criteria for the depressive diagnoses above or for any other diagnosis in which depression is a feature.

Bipolar

Bipolar I Disorder: there must be at least 1 manic episode. Most Bipolar I patients have also had a major depressive episode.

Bipolar II Disorder: at least 1 hypomanic episode plus at least 1 major depressive episode.

Cyclothymic Disorder: have had repeated mood swings, but none that are severe enough to be called major depressive episodes or manic episodes.

Bipolar Disorder not otherwise specified: has bipolar symptoms that do not meet the criteria for the bipolar diagnoses above.

Other

Mood Disorder due to a general medical condition: ‘highs’ and ‘lows’ can be caused by various types of physical illness.

Substance-Induced Mood Disorder: Alcohol or other substances can cause ‘high’ or ‘low’ moods that may not meet criteria for any of the above mentioned episodes or disorders.

Mood Disorder not otherwise specified: do not fit neatly into any of the mood disorder categories mentioned above.

Schizoaffective Disorder: symptoms of Schizophrenia coexist with a major depressive or manic episode.

Cognitive Disorders with depressed mood: could show with dementia or Alzheimer’s. Delerium may also start with depression, anxiety, or other expressions of dysphoria.

Adjustment Disorder with depressed mood: can only adjust to a life stress one way.

Personality Disorders: may be present in avoidant, dependant, histrionic, but most notably in borderline.

Bereavement: when symptoms last more than 2 months following the death of a loved one.

Misc: Schizophrenia, eating disorders, somatization, sexual and gender identity disorders, anxiety, panic disorder, obsessive-compulsive, phobic disorder, and post traumatic stress disorder.

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