MOOD DISORDERS
Core Concept

People with this diagnosis have an
abnormal mood characterized by:
 Depression
 Mania,
or
 Both symptoms in alternating fashion

The abnormal mood may or may not
impair the person’s social or
occupational functioning.
Definitions



Depression
 Unusually sad, gloomy, and dejected mood, or
 Markedly diminished interest and pleasure in everyday
activities that is distinctly different from the person’s nondepressed state.
Mania
 Unusually and persistently elevated, expansive, or irritable
mood that is distinctly different from the person’s non-manic
state
 Marked impairment, requires hospitalization
Hypomania
 Less severe variant of mania; no hospitalization
Quick Guide: Four Criteria Sets
I. Mood Episodes, pgs. 349, 357, 362, and
365.
II. Mood Disorders, pgs. 369 - 410
III. Specifiers, describing most recent
mood episode, pgs. 410- 422.
IV. Specifiers, describing course of recurrent
episodes. pgs. 423-428.
I. Mood Episodes (Quick Guide)


Similar to the two criteria sets we used to determine if a client
met the criteria for Panic Attack or Agoraphobia.
 Remember that these were not codable
 Also they were not diagnoses; i.e., they were not anxiety
disorders
Mood Episodes are:

Not codable – not diagnoses.
The “building blocks” from which many of the codable mood
disorders are constructed.
 Most mood disorder clients will have one or more of the four
types of mood episode:

The four types of Mood Episodes are:
Major Depressive Episode, p. 349,
356
Manic Episode, p. 357, 362
Mixed Episode, p, 362, 365
Hypomanic Episode, p. 365, 368
Major Depressive Episode p. 349, 356
For at least two weeks the client feels:
 Depressed
 and
( or cannot enjoy life)
has:
 Problems
with eating and sleeping
 Guilt feelings
 Loss of energy
 Trouble concentrating, and
 Thoughts about death
Manic Episode p. 357, 362
For at least one week, the client feels:
 Elated
(or sometimes only irritable) and
 May be grandiose, talkative, hyperactive, and
distractible
 Bad judgment leads to marked social or work
impairment
 Often client must be hospitalized
Mixed Episode p. 362, 365
The client has fulfilled the symptomatic criteria for
both a Manic and a Major Depressive Episode.
But episode has lasted as briefly as one week.
Hypomanic Episode p. 365, 368
A Hypomanic Episode is much like a Manic Episode;
however, it is:
 Briefer
and
 Less severe
Hospitalization is not required.
Four Criteria Sets
I. Mood Episodes, p. 349, 357, 362, and 365.
II. Mood Disorders, p. 369 - 410
III. Specifiers, describing most recent
mood episode, p. 410- 422.
IV. Specifiers, describing course of recurrent
episodes, p. 423-428.
II. Mood Disorders




A mood disorder is a pattern of illness due to an
abnormal mood.
Nearly every client with a mood disorder
experience depression at some time
But some clients also have highs of mood
Many, but not all, mood disorders are diagnosed on
the basis of a mood episode
Most clients with Mood Disorders fit into
one of the following codable categories




Depressive Disorders
Bipolar Disorders
Other Mood Disorders
Other Causes of Depressive and Manic
Symptoms
Depressive Disorders
a. Major Depressive Disorder:
296.2x Major Depressive Disorder, Single Episode
296.3x Major Depressive Disorder, Recurrent Type
 Client has no Manic or Hypomanic Episodes,
 But has had one or more Major Depressive Episodes
b. 300.4 Dysthymic Disorder
 Not severe enough to be call a Major Depressive Episode
 Lasts much longer than Major Depressive Disorder
 No high phases
c. 311 Depressive Disorder Not Otherwise Specified (NOS)
 Client has depressive symptoms that do not meet criteria
for the a. or b. (above) or any other diagnosis in which
depression is a feature.
Bipolar Disorders



Approximately 25% of mood disorder clients
experience Manic or Hypomanic Episodes.
Nearly all of these clients also have episodes of
depression.
The severity and duration of the highs and lows
determine the specific mood disorder
2. Bipolar Disorders (con’t.)
a.
Bipolar I Disorder


b.
Bipolar II Disorder


c.
Must have at least one Manic Episode
Most Bipolar I clients also have had a Major Depressive Episode
At least one Hypomanic Episode, plus
At least one Major Depressive Episode
Cyclothymic Disorder


Repeated mood swings, but
None severe enough to be called Major Depressive Episodes or
Manic Episode
d. Bipolar Disorder NOS

Client has bipolar symptoms that do not meet the criteria for the
bipolar diagnoses above
Bipolar Disorders (con’t.)
a. 296.xx Bipolar I Disorder
(1) 296.0x Bipolar I Disorder, Single Manic
Episode
(2) 296.40 Bipolar I Disorder, Most Recent Episode
Hypomanic
(3) 206.4x Bipolar I Disorder, Most Recent Episode
Manic
(4) 296.6x Bipolar I Disorder, Most Recent Episode
Mixed
(5) 296.5x Bipolar I Disorder, Most Recent Episode
Depressed
(6) 296.7 Bipolar I Disorder, Most Recent Episode Unspecified
b. 296.89 Bipolar II Disorder
c. 301.13 Cyclothymic Disorder
d. 296.80 Bipolar Disorder NOS
3. Other Mood Disorders
a.
b.
c.
Mood Disorder Due to a General Medical
Condition.
Substance-Induced Mood Disorder
Mood disorder NOS
For clients who don’t fit into any of the mood
disorder categories mentioned.
Four Criteria Sets
I. Mood Episodes, pgs. 349, 357, 362, and 365.
II. Mood Disorders, pgs. 369 - 410
III. Specifiers, describing most recent
mood episode, pgs. 410- 422.
IV. Specifiers, describing course of
recurrent
episodes. pgs. 423-428.
Specifiers
Two sets of descriptions can be applied to a number
of the mood episodes and mood disorders.
 III. Specifiers Describing Most Recent Episode
 IV. Specifiers Describing Course of Recurrent
Episodes
III. Specifiers
for Most Recent Episode

With Atypical Features
Clients eat a lot, gain weight, sleep excessively, feel leaden, &
sensitive to rejection. (D, only)

With Melancholic Features
Clients awake early and feel worse early in day, lose
appetite and weight, feel guilty, slowed down or
agitated. (D, only)

With Catatonic Features
Motor hyperactivity or inactivity (D or/& M episode)

With Postpartum Onset
Within month of having a baby (D & M episode)
IV. Specifiers for Course
of Recurrent Episodes

With or Without Full Interepisode Recovery. That is the
presence (of absence) of symptoms between Manic,
Hypomanic, Mixed, or Major Depressive Episodes

With Rapid Cycling. Within one year, the client has had at
least four episodes (in any combination) meeting criteria for
Major Depression, Mania, Mixed, and/or Hypomanic episodes

With Seasonal Pattern. Client becomes ill at certain times
of the year, e.g., fall or winter.
4. Other Causes of Depressive and Manic
Symptoms
a.
b.
Schizoaffective Disorder
Schizophrenia can co-exist with a Major Depressive
or a Manic Episode.
Cognitive disorders with depressed mood. The
qualifier “With Depressed Mood” can be coded
into the diagnosis of Dementia of the Alzheimer’s
Type or Vascular Dementia. A delirium can often
begin with depression anxiety, or other expressions
of dysphoria.
4. Other Causes of Depressive and Manic
Symptoms (con’t.)




Adjustment Disorder With Depressed Mood.
Personality disorders. A mood disorder can
accompany Borderline, Avoidant, Dependent and
Histrionic Personality Disorders
Bereavement. Common event, but when symptoms
last longer than two months, a mood disorder might
be present
Other Disorders:
4. Other Causes of Depressive and Manic
Symptoms (cont.)
Depression can also accompany:
 Schizophrenia
 Eating Disorders
 Somatization Disorder, and
 Sexual and Gender Identity disorders.
Mood symptoms can also be present in:
 Anxiety Disorders, especially Panic Disorder,
Obsessive-Compulsive Disorder, Phobic Disorder,
and PTSD.
Depression and Children



Children can have depression - more likely than
adults to manifest itself as somatic complaints,
irritability, phobias, school problems, acting out,
social withdrawal.
Children/Teens with a combination of depressed
mood and self-deprecatory ideation are
particularly likely to have a mood disorder.
Bipolar disorders are rare in children.
Depression and Elderly


Depression occurs for the first time in10% to 20% of
population over the age of 60 years.
Mood disorder is different in later life:





Melancholia seems more prevalent among the elderly than other ages.
Mood disorders seem to worsen with age.
Psychomotor agitation, delusions, loss of appetite, memory loss,
distractibility, and disorientation are common symptoms.
Depression is often missed in the elderly, because behavior is
often attributed erroneously to somatic concerns, cognitive
deficits, medication side effects, or expectable changes of old
age.
One way to tell if depression is causing the symptoms:
Depression has a more rapid onset than above disorders.
Depression and Children



Children can have depression - more likely than
adults to manifest itself as somatic complaints,
irritability, phobias, school problems, acting out,
social withdrawal.
Children/Teens with a combination of depressed
mood and self-deprecatory ideation are
particularly likely to have a mood disorder.
Bipolar disorders are rare in children.
Depression and Elderly


Depression occurs for the first time in10% to 20% of
population over the age of 60 years.
Mood disorder is different in later life:





Melancholia seems more prevalent among the elderly than other ages.
Mood disorders seem to worsen with age.
Psychomotor agitation, delusions, loss of appetite, memory loss,
distractibility, and disorientation are common symptoms.
Depression is often missed in the elderly, because behavior is
often attributed erroneously to somatic concerns, cognitive
deficits, medication side effects, or expectable changes of old
age.
One way to tell if depression is causing the symptoms:
Depression has a more rapid onset than above disorders.
Gender Differences




Depression is far more common among women than
men.
Women are also more prone than men to experience
recurrent depressive episodes.
Both biological and social factors play a part in these
patterns. For example, women who experience severe
premenstrual mood changes are more vulnerable to
other mood disorders including postpartum
depression.
For bipolar disorder, men and woman are equally
represented. About 25% of people who are
depressed are also bipolar.
Culture Differences


Depression may differ from culture to culture with
regard to age of onset, symptoms, course, etc.
For example, in many non-Western cultures,
depression is more likely to be experienced in
somatic (through not feeling well in the body),
rather than affective terms (feelings emotionally
low).
One Possible Cause
of Depression



Seems to have genetic basis.
Does run in families. See statistics in DSM-IV-TR.
Article in Science magazine, May 1997
Found one portion of the brain is significantly smaller and
less active in people suffering from hereditary depression. A
tiny, thimble-size nodule of the brain, located about 2-1/2
inches behind the bridge of the nose, called the subgenera
prefrontal cortex, plays a part in controlling emotions.
The study found that in depressed people, this part,
according to PET scans, was less active in depressed individuals
than in non-depressed people. So researchers scanned using
MRI. They found that, on the average, 39% to 48% less brain
tissue in the affected region of the brain of depressed patients.
Treatment


It appears that therapy alone is as good, if not
better, than medication alone.
Using both medication and therapy, outcome may
even be better.