Mood Disorders

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Mood Disorders
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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
  persons social or occupational functioning.
  

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Definitions

• Depression
• Unusually sad, gloomy, and dejected mood, or
• Markedly diminished interest and pleasure in
  everyday activities that is distinctly different
  from the persons non-depressed state.
• Mania
• Unusually and persistently elevated, expansive,
  or irritable mood that is distinctly different
  from the persons non-manic state
• Marked impairment, requires hospitalization
• Hypomania
• Less severe variant of mania no hospitalization

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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.

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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

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• 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

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Major Depressive Episode p. 349, 356

• For at least two weeks the client feels
• Depressed ( or cannot enjoy life)
• and has
• Problems with eating and sleeping
• Guilt feelings
• Loss of energy
• Trouble concentrating, and
• Thoughts about death

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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

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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.

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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.

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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.

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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

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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

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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.

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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

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2. Bipolar Disorders (cont.)

• a. Bipolar I Disorder
• Must have at least one Manic Episode
• Most Bipolar I clients also have had a Major
  Depressive Episode
• b. Bipolar II Disorder
• At least one Hypomanic Episode, plus
• At least one Major Depressive Episode
• c. 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

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Bipolar Disorders (cont.)

• 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

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3. Other Mood Disorders

• Mood Disorder Due to a General Medical
• Condition.
• Substance-Induced Mood Disorder
• Mood disorder NOS
• For clients who dont fit into any of the mood
  disorder categories mentioned.

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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.

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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

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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)

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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.

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4. Other Causes of Depressive and Manic Symptoms

• 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 Alzheimers Type
  or Vascular Dementia. A delirium can often begin
  with depression anxiety, or other expressions of
  dysphoria.

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4. Other Causes of Depressive and Manic Symptoms
(cont.)

• 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

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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.

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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.

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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.

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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.

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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.

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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.

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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).

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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.

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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.

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