MOOD DISORDERS

OVERVIEW
 Classification
• DSM-IV-TR :
MOOD DISORDERS

• DSM-5 :
-BIPOLAR AND RELATED DISORDERS
-DEPRESSIVE DISORDERS
 MOOD vs AFFECT
• MOOD – pervasive and sustained emotion or feeling
tone experienced internally
 influences a person’s behavior
 colors his or her perception the world
(Kaplan & Sadock, 11th ed)

• AFFECT – the external expression of the internal

feeling tone
- the immediate experience of emotion attached to
ideas or mental representations of objects (Kaplan & Sadock, 10 th

ed)
 MOOD AFFECT
depressed flat/flattened
sad restricted
melancholic blunted
distressed
irritable broad
labile
euphoric appropriate
manic inappropriate
gleeful
 DSM-IV-TR  DSM-5
DSM-IV-TR :
Mood Disorders

DSM-5
 Bipolar and Related Disorders
 Depressive Disorders
 Mood Episodes
• Major Depressive episode

• Manic episode

• Hypomanic episode
 Mood episodes for Dx
• Major depressive episode ONLY
 Major Depressive Disorder (MDD)

• Manic episode
 Bipolar I Disorder

• Hypomanic episode
 Bipolar II Disorder
MAJOR DEPRESSIVE EPISODE
 Major depressive episode
• Fulfills criterion A to C of Major Depressive Disorder
A. At least 5 symptoms in the same 2-wk period; at
least 1 is either (1) or (2)

B. Clinically significant distress/functional impairment

C. Not due to substance/medication or AMC

 Common in Bipolar I Disorder but not required for the diagnosis

of Bipolar I Disorder
 Depressive symptoms
1. Depressed mood (subjective/objective)
2. Diminished interest or pleasure in all activities (anhedonia)

3. Fatigue / loss of energy

4. Feelings of worthlessness / excessive guilt
5. Recurrent thoughts of death / suicidal ideation*
6. Psychomotor retardation/agitation

7. Weight loss/gain * or increase/decrease in appetite

8. Insomnia or hypersomnia

9. Diminished ability to think / concentrate or indecisiveness

 Depressive symptoms
(mnemonics)

SIG : E CAPS

Sleep ↓↑ Concentration ↓
Interest ↓ Appetite ↓↑
Guilt Psychomotor
Activity ↓↑
Suicidal ideation
Energy ↓
E CAPS
 Depressive symptoms
(mnemonics)

SIG : E CAPS

Sleep ↓↑ Concentration ↓
Interest ↓ Appetite ↓↑
Guilt Psychomotor
Activity ↓↑
Suicidal ideation
Energy ↓
 MAJOR DEPRESSIVE DISORDER
DSM-5 criteria

A. At least 5 of the symptoms* in the same 2-wk

period ; at least 1 is either (1) or (2)
B. Clinically significant distress/functional
impairment
C. Not due to substance/medication or AMC
D. Not better explained by any Schizophrenia
spectrum disorder
E. Absence of manic/hypomanic episode
MANIC EPISODE
 Manic Episode
A. Distinct period of abnormally and persistently
elevated, expansive, or irritable mood
and persistently increased goal-directed
activity or energy lasting at least 1 week,
present most of the day, nearly everyday
B. Presence of at least 3 (or 4) of the symptoms*
C. Impaired functioning
D. Not attributable to a substance or AMC
 *Manic symptoms
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (insomnia)
3. More talkative than usual or pressure to keep
talking
4. Flight of ideas (“thoughts are racing”)
5. Distractibility
6. Psychomotor agitation or increase in activity
7. Excessive involvement in activities that have a high
potential for painful consequences
 Manic Symptoms
mnemonics

DIG FAST

Distractability Flight of ideas

Insomnia Activity / agitation
Grandiosity Speech (pressured)
Thoughtlessness
 *Manic symptoms
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (insomnia)
3. More talkative than usual or pressure of speech
4. Flight of ideas (“thoughts are racing”)
5. Distractibility
6. Psychomotor agitation or increase in activity
7. Excessive involvement in activities that have a high
potential for painful consequences (thoughtlessness)
HYPOMANIC EPISODE
 Hypomanic Episode
A. Elevated mood for at least 4 days
B. At least 3 (or 4) of the manic symptoms
C. Unequivocal change in functioning
D. A, B, and C are observable by others
E. No marked impairment in functioning, no
need for hospitalization, no psychotic
features
F. Not due to a substance or medication
 Episodes Diagnosis
(+) Major depressive episode
(-) Manic/hypomanic episode 
MAJOR DEPRESSIVE DISORDER

(+) Manic episode

BIPOLAR I DISORDER

(+) Hypomanic episode

BIPOLAR II DISORDER
 Diagnosis
DYSTHYMIA (Persistent Depressive Disorder)
– Depressed mood for at least 2 years
(-) major depressive episode
(-) manic/hypomanic episode

CYCLOTHYMIA (Cyclothymic Disorder)

– Alternating periods of hypomanic episodes and
mild/moderate depressive symptoms
(-)major depressive episode
Thank you