1. Mood Disorders
Presented by Erica Vassell

2. Statistics
As per the DSM-IV TR,
15% of people
diagnosised with Major
Depressive Disorder or
Bipolar Disorder
commit suicide
Suicide is the 10th
leading cause of death
in the United States as
per National Institue of
Mental Health
http://www.nimh.nih.gov

3. Mood Disorders
Depressive Disorders
Major Depressive Disorder
Dysthymic Disorder
Depressive Disorder NOS
Bipolar Disorders
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Bipolar NOS
Other Mood Disorders
Mood Disorder Due to General Medical Condition
Substance-Induced Mood Disorder
Mood Disorder NOS

4. • Depressed mood or a loss of interest or pleasure in daily activities for more than two
weeks.
• Mood represents a change from the person's baseline.
• Impaired function: social, occupational, educational.
• Specific symptoms, at least 5 of these 9, present nearly every day:
1.Depressed mood or irritable most of the day, nearly every day, as indicated by
either subjective report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful).
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (5%) or change in appetite
4. Change in sleep: Insomnia or hypersomnia
5. Change in activity: Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
8. Concentration: diminished ability to think or concentrate, or more indecisiveness
9. Suicidality: Thoughts of death or suicide, or has suicide plan
DSM-IV Criteria for Major Depressive Disorder (MDD)
296.XX

5. Single vs. Recurrent
Major depressive disorder,
single episode criterion:
Presence of a single major
depressive episode.
The major depressive episode is
not better accounted for by
schizoaffective disorder and is not
superimposed on schizophrenia,
schizophreniform disorder,
delusional disorder, or psychotic
disorder not otherwise specified.
There has never been a manic
episode, a mixed episode, or a
hypomanic episode.
Major depressive disorder,
recurrent criterion:
Presence of two or more major depressive
episodes (each separated by at least 2
months in which criteria are not met for
a major depressive episode.)
The major depressive episodes are not
better accounted for by schizoaffective
disorder and are not superimposed on
schizophrenia, schizophreniform
disorder, delusional disorder, or psychotic
disorder not otherwise specified.
There has never been a manic episode, a
mixed episode, or a hypomanic episode.

6. Specified Clinical Status
Mild, moderate, severe without psychotic features/severe with
psychotic features
Chronic
Catatonic Features
Melancholic features
Atypical features
Postpartum onset

7. Prevalence
15% of those diagnosed with MDD commit suicide
MDD is twice as common in adolescent and adult female
compared to their male counterparts
MDD may begin at any age but has an average onset in the mid-
20’s
Evidence suggests that MDD has a inherited component

8. Differential Diagnosis
Manic, Mixed or Hypomanic episode
Mood Disorder Due to General Medical Condition
Substance-Induced Mood Disorder
Dysthymic Disorder
Schizoaffective Disorder

9. Background: 300.4 Dysthymic Disorder
Essential feature: Chronically depressed mood for most of the day,
more days than not, for at least 2 years.
Children or adolescents may be irritable rather than depressed
The required minimum here is 1 year
Additional Symptoms:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
American Psychiatric Association. (2000). Dysthymic Disorder. Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.

10. Associated Features and Disorders: 300.4 Dysthymic
Disorder
Within 5 years, up to 75% of individuals with Dysthymic Disorder will develop
Major Depressive Disorder
Dysthymic Disorder may be associated with Borderline, Histrionic, Narcissistic,
Avoidant, and Dependent Personality Disorders
Note: Assessment of features of a Personality Disorder is difficult because
chronic mood symptoms may contribute to interpersonal problems or be
associated with distorted self-perception
American Psychiatric Association. (2000). Dysthymic Disorder. Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.
Associated features of Dysthymic Disorder are similar for a Major Depressive Episode:
Feelings of inadequacy Social Withdrawal Generalized loss of interest or pleasure
Feelings of guilt or brooding about the past Decreased activity effectiveness, or
productivity
Subjective feelings of irritability or excessive anger
Vegetative symptoms (sleep, appetite, weight change, and psychomotor) less common

11. Differential Diagnosis: 300.4 Dysthymic
Disorder
Major Depressive Disorder and Dysthymic Disorder share similar symptoms
Dysthymic Disorder is chronic with less severe depressive symptoms
Can last for many years so mood disturbance can be considered person’s “usual”
functioning
Distinguish a Mood Disorder Due to a General Medical Condition, with Depressive
Feature from Dysthymic Disorder using history, laboratory findings, or physical
examination
A Substance-Induced Mood Disorder can be distinguished from Dysthymic Disorder by
the fact that a substance (e.g., a drug of abuse, etc.) is judged to be related to mood
disturbance
Coexisting personality disorders can exist
This is why it is important to ensure you use the criteria very carefully when making a
diagnosis
Always look for impairment of function 
American Psychiatric Association. (2000). Dysthymic Disorder. Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.

12. Diagnostic Criteria for 300.4 Dysthymic
Disorder
A. Depressed mood for most of the day, for more days than not, as indicated either
by subjective account or observation by others, for at least 2 years. (Note: in
children and adolescents, mood can be irritable and duration must be at least
1 year).
B. Presence, while depressed, of two (or more) of the following:
1) Poor appetite or overeating
2) Insomnia or hypersomnia
3) Low energy or fatigue
4) Low self-esteem
5) Poor concentration or difficulty making decisions
6) Feelings of hopelessness
C. During the 2-year period (1 year for children or adolescents) of the disturbance,
the person has never been without the symptoms in Criteria A and B for more
than 2 months at a time.
American Psychiatric Association. (2000). Dysthymic Disorder. Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.

13. Diagnostic Criteria for 300.4 Dysthymic Disorder
(continued)
D. No Major Depressive Episode (see the Criteria p. 356) has been present during the
first 2 years of the disturbance (1 year for children or adolescents); i.e., the disturbance
is not better accounted for by chronic Major Depressive Disorder, or Major Depressive
Disorder, in Partial Remission. (Note: There may have been a previous Major
Depressive Disorder Depressive Episode provided there was a full remission (no
significant signs or symptoms for 2 months) before developing of the Dysthymic
Disorder. In addition, after the initial 2 years [1 year in children or adolescents) of
Dysthymic Disorder, there may be superimposed episodes of Major Depressive
Disorder, in which case both diagnoses may be given when the criteria are met for a
Major Depressive Episode.
E. There has never been a Manic Episode (see the Criteria p. 362), a Mixed Episode (see
the Criteria p. 365), or a Hypomanic Episode (see the Criteria p. 368), and criteria
have never been met for Cyclothymic Disorder.
American Psychiatric Association. (2000). Dysthymic Disorder. Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.

14. Diagnostic Criteria for 300.4 Dysthymic Disorder
(continued)
F. The disturbance does not occur exclusively during the course of a chronic Psychotic
Disorder, such as Schizophrenia or Delusional Disorder.
G. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug
of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
Specify if:
Early Onset: if onset is before age 21 years
Late Onset: if onset is age 21 years or older
Specify (for most recent 2 years of Dysthymic Disorder):
With Atypical Features (see p. 420)
American Psychiatric Association. (2000). Dysthymic Disorder. Diagnostic and statistical manual of mental disorders
(4th ed., text rev.). Washington, DC: Author.

15. Assessment for 300.4 Dysthymic Disorder
Assessment:
Using the DSM-IV-TR diagnostic criteria and the multiaxial
assessment
Noting comorbidity issues as Dysthymic Disorder is
characteristically associated with high frequencies of
psychiatric comorbidity.
Assessment can be difficult as there is no “pure form” of Dysthymic
Disorder.
Difficulties when diagnosing include:
Sansone R.A. & Sansone L.A. (2009). Dysthymic Disorder: Forlorn and Overlooked? Psychiatry (Edgmont). 6(5): 46–
51.
Soft mood symptoms Comorbidities can be distracting
Lack of patient recognition in
early-onset
Misdiagnosis of symptoms

16. Depressive Disorder NOS (311)
The Depressive disorder NOS category includes disorders with depressive features that do not meet the criteria
for Major Depressive Disorder, Dysthymic disorder, Adjustment Disorder with Depressed Mood or Adjustment
Disorder with Mixed Anxiety and Depressed Mood. Sometimes depressive symptoms can present as part of an
Anxiety Disorder Not otherwise Specified. Examples of Depressive Disorder Not Otherwise Specified include.
Premenstrual Dysphoric Disorder: in most menstrual cycles during the past years, (e.g., markedly depressed
mood, marked anxiety, marked affective lability, or decreased interest in activities) regularly occurred
during the onset of menses. These symptoms must be severe enough to markedly interfere with work,
school, or usual activities and be entirely absent for at least 1 week post menses.
Minor depressive disorder: episodes of at at least 2 weeks of depressive symptoms but with fewer than the
five items required for Major Depressive Disorder.
Recurrent brief depressive disorder: depressive episodes lasting from 2 days up to 2 weeks, occurring at
least once a month for 12 months(not associated with the menstrual cycle)
Post psychotic depressive Disorder of schizophrenia: a Major Depressive Episode that occurs during the
residual phase of schizophrenia
A Major Depressive Episode superimposed on delusional disorder, Psychotic Disorder Not Otherwise
Specified, or the active phase of schizophrenia.
Situations in which the clinician has concluded that a depressive disorder is present but is unable to
determine whether it is primary, due to a general medical condition, or substance induced.

17. Bipolar I Disorder
Bipolar I Disorder is a chronic illness
characterized by manic or rapid cycling
episodes of mania and depression
Rapid cycling occurs when the individual has
four or more episodes of major depression,
mania, and/or mixed episode within one year

18. Signs & Symptoms Manic Phase
Euphoria
Inflated self-esteem
Poor judgment
Rapid speech
Racing thoughts
Aggressive behavior
Agitation or irritation
Increased physical activity
Risky behavior
Spending sprees
Increased drive to perform or achieve goals
Increased sex drive
Decreased need for sleep
Easily distracted
Careless or dangerous use of drugs or alcohol
Delusions or a break from reality (psychosis)
AND impairment in functioning which may result in:
Frequent absences from work or school
Poor performance at work or school
Impaired social relationships

19. Signs & Symptoms Depressive Phase
Suicidal thoughts or behavior- up to
15% of people commit suicide
Sadness
Hopelessness
Anxiety
Guilt
Sleep problems
Low appetite or increased appetite
Loss of interest in activities once
considered enjoyable (anhedonia)
Fatigue
Problems concentrating
Irritability
Chronic pain without a known
cause
Once again these symptoms may cause
impairment of functioning resulting in:
Frequent absences from work or
school
Poor performance at work or
school

20. Prevalence/Risk Factors
 Bipolar I Disorder occurs in about 1% of the population
 Age of onset is usually in the early 20’s
 Men and women are equally affected by bipolar disorder,
however rapid cycling occurs more often in women.
 Women also tend to experience more depressive and mixed
state episodes than men
 Individuals with a parent or sibling suffering from Bipolar I
Disorder have a greater risk of developing the disorder

21. Comorbidity/Differential Diagnosis
Other conditions that commonly occur
with Bipolar I Disorder include :
Attention Deficit Hyperactivity Disorder
(ADHD), Conduct Disorder,
Antisocial Personality Disorder, Borderline
Personality Disorder, Anxiety
Disorders , and Substance Use Disorders.
Physical health problems are also
common.
In order to make an accurate diagnosis,
Bipolar I Disorder must also be
distinguished from:
 Mood Disorder Due to a General Medical
Condition
 Substance-Induced Mood Disorder
 Other Mood Disorders (Major Depressive
Disorder, Dysthymia, Bipolar II Disorder,
Cyclothymic Disorder)
 Schizophrenia, Schizoaffective Disorder,
and Other Psychotic Disorders

22. Diagnosis of Bipolar Disorder requires at least one
Manic or Mixed episode, but there may be episodes of
Hypomania or Major Depression as well
Subtypes for Bipolar I Disorder:
Bipolar I Disorder Single Manic Episode
Bipolar I Disorder Most Recent Episode Hypomanic
Bipolar I Disorder Most Recent Episode Manic
Bipolar I Disorder Most Recent Episode Mixed
Bipolar I Disorder Most Recent Episode Depressed
Bipolar I Disorder Most Recent Episode Unspecified

23. Diagnostic Criteria for 296.0x Bipolar I
Disorder, Single Manic Episode
A. Presence of only one Manic Episode and no past Major
Depressive Episodes.
B. The Manic Episode is not better accounted for by Schizoaffective
Disorder and is not superimposed on Schizophrenia,
Schizophreniform Disorder, Delusional Disorder, or Psychotic
Disorder Not Otherwise Specified.
Specify if:
 Mixed: if symptoms meet criteria for a Mixed Episode
Specify (for current or most recent episode):
 Severity/Psychotic/Remission Specifiers
With Catatonic Features
With Postpartum Onset

24. Diagnostic Criteria for 296.40 Bipolar I
Disorder, Most Recent Episode
Hypomanic
A. Currently (or most recently) in a Hypomanic Episode
B. There has previously been at least one Manic Episode or Mixed
Episode
C. The mood symptoms cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
D. The mood episodes in Criteria A and B are not better accounted for by
Schizoaffective Disorder and is not superimposed on Schizophrenia,
Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder
Not Otherwise Specified.
Specify:
 Longitudinal Course Specifiers (With and Without Interepisode Recovery)
 With Seasonal Pattern
 With Rapid Cycling

25. Diagnostic Criteria for 296.6x Bipolar I
Disorder, Most Recent Episode Mixed
A. Currently (or most recently) in a Mixed Episode
B. There has previously been at least one Major Depressive Episode,
Manic Episode, or Mixed Episode
C. The mood episodes in Criteria A and B are not better accounted for
by Schizoaffective Disorder and is not superimposed on
Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or
Psychotic Disorder Not Otherwise Specified.
Specify (for current or most recent episode):
 Severity/Psychotic/Remission Specifiers
With Catatonic Features
With Postpartum Onset
Specify:
 Longitudinal Course Specifiers (With and Without Interepisode
Recovery)
With Seasonal Pattern (applies only to the pattern of Major Depressive
Episodes)
With Rapid Cycling

26. Diagnostic Criteria for 296.4x Bipolar I
Disorder, Most Recent Episode Manic
A. Currently (or most recently) in a Manic Episode
B. There has previously been at least one Major Depressive Episode ,Manic Episode,
or Mixed Episode
C. The mood episodes in Criteria A and B are not better accounted for by
Schizoaffective Disorder and is not superimposed on Schizophrenia,
Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not
Otherwise Specified.
Specify (for current or most recent episode):
 Severity/Psychotic/Remission Specifiers
With Catatonic Features
With Postpartum Onset
Specify:
 Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern (applies only to the pattern of Major Depressive Episodes)
With Rapid Cycling

27. Diagnostic Criteria for 296.5x Bipolar I
Disorder, Most Recent Episode Depressed
A. Currently (or most recently) in a Major depressive Episode
B. There has previously been at least one Manic Episode or Mixed Episode
C. The mood episodes in Criteria A and B are not better accounted for by Schizoaffective
Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder,
Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
Specify (for current or most recent episode):
 Severity/Psychotic/Remission Specifiers
Chronic
With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset
Specify:
 Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern (applies only to the pattern of Major Depressive Episodes)
With Rapid Cycling

28. Diagnostic Criteria for 296.7 Bipolar I
Disorder, Most Recent Episode
Unspecified
A. Criteria, except for duration, are currently (or most recently) met for a Manic, a
Hypomanic, a Mixed, or a Major Depressive Episode
B. There has previously been at least on Manic Episode or Mixed Episode
C. The mood symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective
Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder,
Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
E. The mood symptoms in Criteria A and B are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g.,
hypothyroidism).
Specify:
 Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern (applies only to the pattern of Major Depressive Episodes)
With Rapid Cycling

29. Bipolar II Disorder
Bipolar II is similar to Bipolar I Disorder, with moods cycling between high
and low over time.
However, in Bipolar II disorder, the “high” moods are less severe and are
referred to as hypomanic episodes, or hypomania.
• Bipolar II Disorder is distinguished from Bipolar I Disorder by the
presence of one or more manic or mixed episode
• If an individual previously diagnosed with Bipolar II Disorder develops
a manic or mixed episode, the diagnosis is changed to Bipolar I
Disorder
• Individuals with Bipolar II Disorder have had at least one hypomanic
episode in life
• Most people with bipolar II disorder also experience depressive episodes

30. Signs & Symptoms
During a hypomanic episode, elevated mood can manifest
itself as either euphoria (feeling "high") or as irritability
Symptoms during hypomanic episodes include:
 Flying suddenly from one idea to the next
 Rapid, "pressured," and loud speech
 Increased energy, with hyperactivity and a decreased need for sleep
While these symptoms may be observable to others, they do
NOT cause the individual significant impairment in social or
occupational areas of functioning

31. Prevalence/Risk Factors
Bipolar II Disorder occurs in about .5% of the
population and is diagnosed more in women
Similarly to Bipolar I, age of onset is in the
early 20’s
Individuals with an immediate family member
are at greater risk

32. Comorbidity/Differential Diagnosis
Other conditions that commonly occur with Bipolar I Disorder include:
ADHD, Substance Use Disorder, and Anxiety Disorders
In order to make an accurate diagnosis, Bipolar II Disorder should also be
distinguished from:
 Mood Disorder Due to a General Medical Condition
 Substance-Induced Mood Disorder
 Major Depressive Disorder
 Bipolar I Disorder
 Cyclothymic Disorder
 Psychotic Disorders

33. Diagnostic Criteria for 296.89 Bipolar II
Disorder
A. Presence (or history) of one or more Major Depressive Episodes.
B. Presence (or history) of at least one Hypomanic Episode.
C. There has never been a Manic Episode or a Mixed Episode.
D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on
Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify current or most recent episode:
 Hypomanic: if currently (or most recently) in a Hypomanic Episode
Depressed: if currently (or most recently) in a Major Depressive Episode
Specify (for current or most recent Major Depressive Episode only if it is the most recent type of mood episode):
 Severity/Psychotic Remission Specifiers
 Chronic
 With Catatonic Features
With Melancholic Features
With Atypical Features
With Postpartum Onset
Specify:
 Longitudinal Course Specifiers (With and Without Interepisode Recovery)
With Seasonal Pattern (applies only to the pattern of Major Depressive Episodes)
With Rapid Cycling

34. Cyclothymic Disorder
Cyclothymic Disorder is a chronic, fluctuating mood
disturbance involving numerous periods of hypomanic
symptoms and numerous periods of depressive
symptoms.
It is a mild form of bipolar disorder in which a person
has mood swings over a period of years that go from
mild depression to euphoria (joy) and excitement.

35. Signs & Symptoms
Episodes of Hypomania occur for at least 2 years.
Mood swings are less severe than in Bipolar Disorder, Major
Depression and Manic. Symptoms are persistent, with no more
than 2 symptom free months in a row.
During a “high“ mood, the person may feel very optimistic
(hopeful) and cheerful.
During a “low“ mood the person has symptoms similar to
depression. Feeling sad and hopeless, losing interest.

36. Prevalence
Cyclothymic disorder usually begins in adolescence or early
adulthood.
The onset is usually insidious and runs a chronic course.
It appears equally in men and in women but women are more
likely to present for treatment than men.
Studies have reported a lifetime prevalence from 0.4% to 1%.
Prevalence in mood disorders clinics may range from 3% to
5%.

37. Causes
The causes are unknown.
It must be distinguished from a mood disorder due to a general
medical condition.
Cyclothymic disorder maybe more common in the first degree
biological relatives of individuals with Bipolar I Disorder.
People with this disorder usually have a family history of
depression, bipolar disorder, suicide, alcohol or drug dependence.
There is a 15%-50% chance that the person will subsequently
develop Bipolar I or II Disorder.

38. Diagnostic criteria for 301.13
Cyclothymic Disorder
A. For at least 2 years, the presence of numerous periods with
hypomanic symptoms (i.e. poor judgment, rapid speech, racing
thoughts, agitation, inability to concentrate) and numerous periods
with depressive symptoms that do not meet criteria for Major
Depressive Episodes. Note: In children and adolescents the
duration must be at least 1 year.
B. During the above 2- year period( 1 year in children and adolescent),
the person has not been without the symptoms in criteria for
more than 2 months at a time.
C. No Major Depressive Episodes ( i.e. feels sad or empty, significant
weight loss, recurrent thoughts of death/ suicide with a plan), Manic
episodes (i.e. grandiosity, decrease need for sleep, distractibility), or
Mixed episodes (criteria for major depressive and manic episodes) has
been present during the first 2 years of the disturbance.

39. Diagnostic criteria for 301.13
Cyclothymic Disorder
Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or
Mixed Episodes ( in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive
Episodes ( in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).
D. The symptoms in the Criterion A are not better accounted for by
Schizoaffective Disorder and are not superimposed on
Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or
Psychotic Disorder Not Otherwise Specified.
E. The symptoms are not due to the direct physiological effects of a
substance (e.g. a drug of abuse, a medication) or general medical
condition (e.g., hyperthyroidism).
F. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.

40. Bipolar NOS
This category includes disorders with bipolar features that do not meet criteria for any specific
Bipolar Disorder.
Very rapid alternation over days between manic symptoms and depressive symptoms that meet
symptom threshold criteria but not minimal duration criteria for Manic, Hypomanic, or Major
Depressive Episodes.
Recurrent Hypomanic Episodes without intercurrent depressive symptoms
A Manic or Mixed Episodes superimposed on Delusional Disorder, residual Schizophrenia, or
Psychotic Disorder Not Otherwise Specified
Hypomanic Episodes, along with chronic depressive symptoms, that are too infrequent to
qualify for a diagnosis of Cyclthoymic Disorder.
Situations in which the clinician has concluded that a Bipolar Disorder is present but is
unable to determine weather its primary, due to a general medical condition or substance
induced

41. Background: 293.83 Mood Disorder
Due to General Medical Condition
Essential feature: Prominent and persistent disturbance in mood due to the
direct physiological effects of a general medical condition
May involve depressed mood, markedly diminished interest or pleasure; or
elevated, expansive, or irritable mood
A variety of general medical condition may cause mood symptoms
American Psychiatric Association. (2000). Mood Disorder Due to a General Medical Condition Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Washington, DC: Author.
Degenerative
conditions
•Parkinson’s Disease
Viral or other
infections
•Hepatitis
Cerebrovascular
disease
•Stroke
Metabolic
conditions
• Vitamin B12 deficiency
Endocrine
conditions
•Hyper- & hypothyroidism
Autoimmune
conditions
•Lupus
Certain cancers •Carcinoma of the pancreas

42. Subtypes and Recording: 293.83 Mood
Disorder Due to General Medical
Condition
One of the following subtypes may be used to indicate
which of the following symptom predominates:
With Depressive Features
With Major Depressive-Like Episode
With Manic Features
When recording diagnosis, clinicians should note
Specific phenomenology of the disturbance, including
appropriate subtype
Identified general medical condition judged to be
causing the disturbance
American Psychiatric Association. (2000). Mood Disorder Due to a General Medical Condition Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Washington, DC: Author.

43. Differential Diagnosis:293.83 Mood Disorder
Due to General Medical Condition
A separate diagnosis of Mood Disorder Due to a General Medical Condition is
not given if the depressive symptoms develop exclusively during the course of
Vascular Dementia
A delirium
If there is evidence of substance use, withdrawal, exposure to a toxin
(a Substance-Induced Mood Disorder should be considered)
Diagnosis can be given in addition to a diagnosis of dementia
Clinicians need to distinguish this disorder from Major Depressive Disorder,
Bipolar I & Bipolar II Disorders, and Adjustment Disorder with Depressed
Mood
Mood Disorder Not Otherwise Specified may be used if clinician cannot
determine cause
American Psychiatric Association. (2000). Mood Disorder Due to a General Medical Condition Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Washington, DC: Author.

44. Diagnostic Criteria for 293.83 Mood
Disorder Due to General Medical
Condition
A. A prominent and persistent disturbance in mood predominates in the clinical picture and is
characterized by either (or both) of the following:
1) Depressed mood or markedly diminished interest or pleasure in all, or almost all,
activities
2) Elevated, expansive, or irritable mood
B. There is evidence from the history, physical examination, or laboratory findings that the
disturbance is the direct physiological consequence of a general medical condition.
C. The disturbance is not better accounted for by another mental disorder (e.g., Adjustment
Disorder with Depressed Mood in response to the stress of having a general medical
condition).
D. The disturbance does not occur exclusively during the course of a delirium.
E. The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
American Psychiatric Association. (2000). Mood Disorder Due to a General Medical Condition Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Washington, DC: Author.

45. Diagnostic Criteria for 293.83 Mood Disorder
Due to General Medical Condition (continued)
Specify type:
With Depressive Features: if the predominant mood is depressed by the full criteria
are not met for a Major Depressive Episode.
With Major Depressive-Like Episode: if the full criteria are met (except Criteria D)
for a Major Depressive Episode (see Criteria on p. 356)
With Manic Features: if the predominant mood is elevated, euphoric, or irritable
With Mixed Features: if the symptoms of both mania and depression are present
but neither predominates
Coding note: Include the name of the general medical condition on Axis I, e.g., 293.83 Mood
Disorder due to Hypothyroidism, With Depressive Features; also code the general medication
condition on Axis III (see Appendix G for the codes).
Coding note: If depressive symptoms occur as part of a preexisting Vascular Dementia, indicate
the depressive symptoms by coding the appropriate subtype, i.e., 290.43 Vascular Dementia,
With Depressed Mood

46. Assessment for 293.83 Mood Disorder
Due to General Medical Condition
Assessment:
Using the DSM-IV-TR diagnostic criteria and the multiaxial
assessment
A careful and comprehensive assessment of multiple factors is
necessary for diagnosis
Laboratory findings, history, and a physical examination can
help make the determination
Other mood disorders must be ruled out
American Psychiatric Association. (2000). Mood Disorder Due to a General Medical Condition Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Washington, DC: Author
Sue, D., Sue, D.W., & Sue, S. (2010). Understanding abnormal behavior (9th ed.). Boston, MA: Wadsworth.

47. Background: Substance-Induced
Mood Disorder
Substance-Induced Mood Disorder is diagnosed when the
clinician believes a drug or other chemical substance or
Withdrawal from a drug causes symptoms suggestive of a
Manic, Mixed, Hyopmanic, or Major Depressive episode
It is defined in DSM-IV-TR as “a prominent and persistent
disturbance of mood . . . that is judged to be due to the
direct physiological effects of a substance (i.e., a drug of
abuse, a medication, or somatic treatment for depression, or
toxin exposure)” (APA, 2000, p. 405). The mood can
manifest as manic (expansive, grandiose, irritable),
depressed, or a mixture of mania and depression.

48. Associated Features and Disorders:
Substance-Induced Mood Disorder
Manic Symptoms in Substance
Induced Mood Disorder
• Elation
• Confidence
• Delusional thinking
• High level of energy
• Loud and rapid speech
• Racing thoughts
• Impulsive behavior
• Overeating
• Fast and reckless driving
• Engaging in wild business
schemes
Depressive Symptoms in
Substance Induced Mood Disorder
• Loss of interest and pleasure
• Irritability and anger
• Changes in appetite
• Sleep problems
• Fatigue
• Slow movement and thinking
• Feelings of worthlessness and
guilt

49. Associated Features and Disorders:
Substance-Induced Mood Disorder
One of the following subtypes may be used to indicate which of the
following symptom presentation predominates:
With Depressive Features: if the predominant mood is depressed
With Manic Features: if the predominant mood is elevated, euphoric, or irritable
With Mixed Features: if symptoms of both mania and depression are present and neither
predominates
The context of the development of the mood symptoms may be indicated by
using one of the following specifiers:
With Onset During Intoxication: if the criteria are met for Intoxication with the substance
and the symptoms develop during the intoxication syndrome
With Onset During Withdrawal: if criteria are met for Withdrawal from the substance and
the symptoms develop during, or shortly after, a withdrawal syndrome
American Psychiatric Association. (2000). Substance-induced Mood Disorder. Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Washington, DC: Author.

50. Differential Diagnosis: Substance-Induced
Mood Disorder
Remember that a substance is judged to be the cause of symptoms, this is untrue with
another mood disorder diagnosis.
Keep in mind that Mood symptoms occur commonly in Substance Intoxication and
Substance Withdrawal
Example: dysphoric mood is a characteristic feature of Cocaine Withdrawal. Cocaine-
Induced Mood Disorder should be diagnosed instead of Cocaine Withdrawal only if
the mood disturbance is substantially more intense than what is usually
encountered with Cocaine Withdrawal and is sufficiently severe to be a separate
focus of attention and treatment.
Substance-induced mood symptoms occurring during delirium are considered to be an
associated feature of the delirium and are not diagnosed separately
Consider Mood Disorder Due to a General Medical Condition when there is a
possibility that the mood symptoms are caused by physiological consequences of general
medical conditions rather than the medication, however these disorders can coexist.
Depressive Disorder Not Otherwise Specified or Bipolar Disorder Not Otherwise
Specified would be indicated when there is insufficient evidence to determine whether
the mood symptoms are due to a substance or general medical condition

51. Diagnostic Criteria for Substance-Induced
Mood Disorder
A. A prominent and persistent disturbance in mood predominates in the clinical picture and is
characterized by either (or both) of the following:
(1) depressed mood markedly diminished interest or pleasure in all, or almost all, activities
(2) elevated, expansive, or irritable mood B.
B. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2):
(1) the symptoms in Criterion A developed during, or within 1 month of, Substance Intoxication or
Withdrawal
(2) medication use is etiologically related to the disturbance
C. The disturbance is not better accounted for by a Mood Disorder that is not substance induced. Evidence
that the symptoms are better accounted for by a Mood Disorder that is not substance induced might
include the following: the symptoms precede the onset of the substance use (or medication use); the
symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute
withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or
amount of the substance used or the duration of use; or there is other evidence that suggests the existence
of an independent non-substance-induced Mood Disorder (e.g., a history of recurrent Major Depressive
Episodes).

52. Diagnostic Criteria for Substance-
Induced Mood Disorder (continued)
D. The disturbance does not occur exclusively during the course of a delirium.
E. The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication or
Substance Withdrawal only when the mood symptoms are in excess of those usually
associated with the intoxication or withdrawal syndrome and when the symptoms are
sufficiently severe to warrant independent clinical attention.
Diagnosis should include Code [Specific Substance]-Induced Mood Disorder:
(291.8 Alcohol; 292.84 Amphetamine [or Amphetamine-Like Substance]; 292.84
Cocaine; 292.84 Hallucinogen; 292.84 Inhalant; 292.84 Opioid; 292.84 Phencyclidine
[or Phencyclidine-Like Substance]; 292.84 Sedative, Hypnotic, or Anxiolytic; 292.84
Other [or Unknown] Substance)
Specify Subtypes and Specifiers
American Psychiatric Association. (2000). Substance-Induced Mood Disorder. Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Washington, DC: Author.

53. Background: 296.90 Mood Disorder
Not Otherwise Specified
The Diagnostic and Statistical Manual of Mental Disorders (DSM-
IV) explains mood disorder not otherwise specified (NOS) as a
mood disorder that impairs an individual but does not meet each
criterion required for the diagnosis of a specific mood disorder.
In other words, it's a disabling illness affecting moods that does
not meet the specification for other affective disorders BUT it is
considered significant enough for it to be defined as an illness.
American Psychiatric Association. (2000). Mood Disorder Not Otherwise Specified Diagnostic and statistical manual of mental
disorders (4th ed., text rev.). Washington, DC: Author.

54. Associated Features and Disorders: 296.90 Mood
Disorder Not Otherwise Specified
Subtypes and Modifiers Various diagnostic specifiers can be applied to specific subtypes of mood disorders. These have
prognostic and treatment implications and may prove to have etiologic implications.
Melancholic: Melancholic depression is a severe form of depression associated with guilt, remorse, loss of pleasure,
and extreme vegetative symptoms. Postpartum: Postpartum depression occurs within 4 weeks of delivery. The
presence of one episode of postpartum mood disorder is strongly predictive of a recurrence.
Seasonal: Seasonal mood disorders show a consistent seasonal pattern of variation. The most common pattern is a
worsening of depression during the fall and winter with improvement in the spring. The reverse is sometimes true.
If the depression is a component of a bipolar disorder, the manic and hypomanic episodes may show a seasonal
association.
Atypical: Atypical depressions show a pattern of hypersomnia, increased appetite or weight gain, mood reactivity,
long-standing rejection sensitivity, anergia, and leaden paralysis.
Rapid Cycling: Patients with bipolar disorder may have frequent (rapid) cycles. To meet criteria for rapid cycling,
four mood disturbances per year must be present. The suicide rate may be higher than in non-rapid cyclers.
Catatonic: The catatonic specifier is applied to mood disorders when there are pronounced movement
abnormalities, including motoric immobility or excessive purposeless motor activity, maintenance of a rigid
posture, mutism, stereotyped movement, echolalia (repetition of a word or phrase just spoken by another person),
or echopraxia (repetition of movements made by another person).
American Psychiatric Association. (2000). Mood Disorder Not Otherwise Specified Diagnostic and statistical manual of mental
disorders (4th ed., text rev.). Washington, DC: Author.

55. Treatment
A mixture of Pharmacotherapy and Psychotherapy
Psychotherapy—A number of psychotherapies have been
advocated including cognitive behavioral therapy,
interpersonal psychotherapy, group therapy, and problem-
solving therapy, Motivational interviewing
Pharmacotherapy—antidepressants or mood stabilizers are
typically are given
Support groups- Community based, AA, NA

56. Common Medications Used
Unipolar
Selective serotonin reuptake inhibitors
(SSRIs)
Prozac, Zoloft, Paxil, Celexa,
Lexapro
Serotonin and norepinephrine reuptake
inhibitors (SNRIs)
Cymbalta, Effexor XR, Pristiq
Norepinephrine and dopamine reuptake
inhibitors (NDRIs)
Wellbutrin
Atypical antidepressants
Oleptro, Remeron, Vibryd
Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOIs)
Parnate, Nardil, Emsam
Other medication strategies
A doctor may choose other drugs
that are not necessarily considered
antidepressants
Bipolar
Mood Stabilizers
Lithium
Anticonvulsants
Depakote
Antidepressants
Antipsychotic
Zyprexa, Abilify, Risperdal,
Geodon, Clorazil
Benzodiazpines