| Diagnostic criteria for a manic episode
|
|
A. One or more distinct periods with a predominantly elevated, expansive, or irritable mood. The elevated mood must be a prominent part of the illness and relatively persistent, although it may alternate or intermingle with a depressive mood.
|
|
B.Duration of at least one week [or any duration if hospitalization is necessary], during which, for the most of the time, at least three of the following symptoms have persisted [four if the mood is only irritable] and have been present to a significant degree:
[1] increase in activity [either socially, at work, or sexually] or physical restlessness
[2] more talkative than usual or pressure to keep talking
[3] flight of ideas or subjective experience that thoughts are racing
[4] inflated-self esteem [grandiosity, which may be delusional]
[5] decreased need for sleep
[6] distractibility, i.e., attention is too easily drawn to unimportant or irrelevant external stimuli
[7] excessive involvement in activities that have a high potential for painful consequences which is not recognized, e.g., buying sprees, sexual indiscretions, foolish business investments, reckless driving
|
|
C. Neither of the following dominate the clinical picture when an affective syndrome [i.e., criteria A and B above] is not present, that is, before it developed or after it has remitted:
[1] preoccupation with a mood-incongruent delusion or hallucination [see definition below]
[2] bizarre behavior
|
|
D. Not superimposed on either Schizophrenia, Schizophreniform Disorder, or a Paranoid Disorder.
|
|
E. Not due to any Organic Mental Disorder, such as Substance Intoxication.
[Note: A hypomanic episode is a pathological disturbance similar to, but not as severe as, a manic episode. See Atypical Bipolar Disorder…]
|
|
Fifth-digit code numbers and criteria for subclassification of manic episode
6- In Remission…
4- With Psychotic Features…
Mood-congruent Psychotic Features:…
Mood-incongruent Psychotic Features:…
2- Without Psychotic Features…
0- Unspecified.
|
| Diagnostic criteria for a major depressive episode
|
|
A. Dysphoric mood or loss of interest or pleasure in all or almost all usual activities and pastimes. The dysphoric mood is characterized by symptoms such as the following: depressed, sad, blue, hopeless, low, down in the dumps, irritable. The mood disturbance must be prominent and relatively persistent, but not necessarily the most dominant symptom, and does not include momentary shifts from one dysphoric mood to another dysphoric mood, e.g. anxiety to depression to anger, such are seen in states of acute psychotic turmoil [For children under six, dysphoric mood may have to be inferred from a persistently sad expression.]
|
|
B.At least four of the following symptoms have each been present nearly every day for a period of at least two weeks [in children under six, at least three of the first four].:
[1] poor appetite or significant weight loss [when not dieting] or increased appetite or significant weight gain [in children under six, consider failure tomake expected weight gains]
[2] insomnia or hypersomnia
[3] psychomotor agitation or retardation [not merely subjective feelings of restlessness or being slowed down][in children under six, hypoactivity]
[4] loss of interest or pleasure in usual activities, or decrease in sexual drive not limited to a period when delusional or hallucinating [in children under six, signs of apathy]
[5] loss of energy; fatigue
[6] feelings of worthlessness, self reproach, or excessive or inappropriate guilt [either may be delusional]
[7] complaints or evidence of diminished ability to think or concentrate, such as slowed thinking, or indecissiveness not associated with marked loosening of association or incoherence
[8] recurrent thoughts of death, suicide ideation, wishes to be dead, or suicide attempt
|
|
C. Neither of the following dominate the clinical picture when an affective syndrome [i.e., criteria A and B above] is not present, that is, before it developed or after it has remitted:
[1] preoccupation with a mood-incongruent delusion or hallucination [see definition below]
[2] bizarre behavior
|
|
D. Not superimposed on either Schizophrenia, Schizophreniform Disorder, or a Paranoid Disorder.
|
|
E. Not due to any Organic Mental Disorder or Uncomplicated Bereavement.
|
|
Fifth-digit code numbers and criteria for subclassification of major depressive episode
6- In Remission…
4- With Psychotic Features…
Mood-congruent Psychotic Features:…
Mood-incongruent Psychotic Features:…
3- With Melancholia
A. Loss of pleasure in all or almost all activities
B. Lack of reactivity to usually pleasurable stimuli [doesn’t feel much better, even temporarily, when something good happens].
C. At least three of the following: [a] distinct quality of depressed mood, i.e. the depressed mood is perceived as distinctly different from the kind of feeling experience following the death of a loved one
[b] the depression is regularly worse in the morning
[c] early morning awakening [at least two hours before usual time of awakening]
[d] marked psychomotor retardation or agitation
[e] significant anorexia or weight loss
[f] excessive or inappropriate guilt
2- Without Melancholia
0- Unspecified.
|
| Diagnostic criteria for a Cyclothymic Disorder
|
|||
|
A. During the last two years, numerous periods during which some symptoms characteristic of both the depressive and the manic syndromes were present, but were not of sufficient severity and duration to meet the criteria for a major depressive or manic episode.
|
|||
|
B. The depressive periods and hypomanic periods may be separated by periods of normal mood lasting as long as months at a time, they may be intermixed, or they may alternate.
|
|||
|
C. During depressive periods there is repressed mood or loss of interest or pleasure in all or almost all, usual activities and pastimes, and at least three of the following:
[1] insomnia or hypersomnia
[2] low energy or chronic fatigue
[3] feelings of inadequacy
[4] decreased effectiveness or productivity at school, work, or home
[5] decreased attention, concentration, or ability to think clearly
[6] social withdrawal
[7] loss of interest or enjoyment of sex
[8] restriction of involvement in pleasurable activities; guilt over past activities
[9] feeling slowed down
[10] less talkative than usual
[11] pessimistic attitude toward the future, or brooding about past events
[12] tearfulness or crying
|
During hypomanic periods there is an elevated, expansive, or irritable mood and at least three of the following:
[1] decreased need for sleep
[2] more energy than usual
[3] inflated self-esteem
[4] increased productivity, often associated with unusual and self-imposed working hours
[5] sharpened and unusually creative thinking
[6] uninhibited people-seeking [extreme gregariousness]
[7] hypersexuality without recognition of possibility of painful consequences
[8] excessive involvement in pleasurable activities with lack of concern for the high potential for painful consequences, e.g., buying sprees, foolish business investments, reckless driving
[9] physical restlessness
[10] more talkative than usual
[11] overoptimism or exaggeration of past achievements
[12] inappropriate laughing joking punning
|
||
|
D. Absence of psychotic features such as delusions. hallucinations, incoherence, or loosening of associations.
|
|||
|
E. Not due to any other mental disorder, such as partial remission of Bipolar Disorder. However, Cyclothymic Disorder may precede Bipolar Disorder.
|
|||
| Diagnostic criteria for a Dysthymic Disorder
|
|
A. During the past two years [or one year for children and adolescents] the individual has been bothered most or all the time by symptoms characteristic of the depressive syndrome but are not of sufficient severity and duration to meet the criteria for a major depressive episode [although a major depressive episode may be superimposed on Dysthymic Disorder].
|
|
B. The manifestations of the depressive syndrome may be relatively persistent or separated by periods of normal mood lasting a few days to a few weeks, but no more than a few months at a time.
|
|
C. During the depressive periods there is either prominent depressed mood [e.g., sad, blue, down in the dumps, low] or marked loss of interest or pleasure in all, or almost all, usual activities and pastimes.
|
|
D. During depressive periods at least three of the following are present:
[1] insomnia or hypersomnia
[2] low energy level or chronic tiredness
[3] feelings of inadequacy, loss of self esteem, or self-deprication
[4] decreased effectiveness or productivity at school, work, or home
[5] decreased attention, concentration, or ability to think clearly
[6] social withdrawal
[7] loss of interest or enjoyment of pleasurable activities
[8] irritability or excessive anger [in children, expressed towards parents or caretakers]
[9] inability to respond with apparent pleasure to praise or rewards
[10] less active or talkative than usual, or feels slowed down or restless
[11] pessimistic attitude toward the future, brooding about past event, or feeling sorry for self
[12] tearfulness or crying
[13] recurrent thoughts of death or suicide
|
|
E. Absence of psychotic features, such as delusions, hallucinations, or incoherence, or loosening of associations..
|
|
F. If the disturbance is superimposed on a preexisting mental disorder, such as Obsessive Compulsive Disorder or Alcohol Dependence, the depressed mood, by virtue of its intensity or effect on functioning, can be clearly distinguished from the individual’s usual mood.
|
| Diagnostic criteria for Atypical Bipolar Disorder
|
|
This is a residual category for individuals with manic features that cannot be classified as Bipolar Disorder or as Cyclothymic Disorder. For example, an individual who previously had a major depressive episode and now has an episode of illness with some manic features [hypomanic episode], but not of sufficient severity and duration to meet the criteria for a manic episode. Such cases have been referred to as "Bipolar II."
|
| Diagnostic criteria for Atypical Depression
|
|
This is a residual category for individuals with depressive symptoms who cannot be diagnosed as having a Major or Other Specific Affective Disorder or Adjusment Disorder. Examples include the following:
[1] A distinct and sustained episode of the full depressive syndrome in an individual with Schizophrenia, Residual Type, that develops without an activation of the psychotic symptoms.
[2] A disorder that fulfills the criteria for Dysthymic Disorder; however there have been intermittent periods of normal mood lasting more than a few months.
[3] A brief episode of depression that does not meet the criteria for a Major Affective Disorder and that is apparently not reactive to psychosocial stress, so that it cannot be classified as an Adjustment Disorder.
|
| Diagnostic criteria for a Adjustment Disorder
|
|
A. A maladaptive reaction to an identifiable stressor that occurs within three months of the onset of the stressor.
|
|
B. The maladaptive nature of the reaction is indicated by either of the following:
[1] impairment in social or occupational functioning
[2] symptoms that are in excess of normal and expectable reaction to the stessor
|
|
C. The disturbance is not merely one instance of a pattern of overreaction to stress or an exacerbation of one of the mental disorders previously described.
|
|
D. It is assumed that the disturbance will eventually remitafter the stressor ceases, or if the stressor persists, when a new level of adaptation is achieved.
|
|
E. The disturbance does not meet the criteria for any of the specific disorders listed previously or for Uncomplicated Bereavement.
|