AFFECTIVE
DISORDERS
F30
- F39 MOOD (AFFECTIVE) DISORDERS
Hypomania
The
mood is elevated or irritable to a degree that is definitely abnormal for the
individual concerned and sustained for AT LEAST FOUR CONSECUTIVE DAYS
-
So
patients who come and complain of mood swings on daily basis or within hours do
not qualify for the diagnosis of manic or hypomanic disorder.
At
least three of the following must be present, leading to disruption of work and
social activity:
increased activity or physical restlessness;
increased talkativeness;
difficulty in concentration or distractibility;
decreased need for sleep;
increased sexual energy;
mild spending sprees, or other types of reckless or
irresponsible behaviour;
increased sociability or over-familiarity.
The
disorder does not meet the criteria for mania (F30.l and F3O.2)
bipolar
affective disorder (F31.-)
depressive
episode (F32.-)
cyclothymia
(F34.O)
anorexia
nervosa (F50.O).
The
episode is not attributable to substance abuse, endocrine disorder, drug treatment
or any organic mental disorder.
Mania
without psychotic symptoms
A
mood which is predominantly elevated, expansive, irritable or suspicious and
definitely abnormal for the individual concerned. This mood change must be prominent and sustained for AT
LEAST A WEEK (unless it is severe enough to require hospital
admission) though it may alternate or intermingle with depression.
Note: Note that mild and transient upswings of
mood and activity that fulfill the symptomatic criteria for hypomania that
occur at the end of a depressive episode apparently as a reaction to treatment
should be ignored from the point of view of diagnosis, unless they last for at
least four consecutive days.
At
least three of the following must be present (FOUR if the mood is merely
irritable or suspicious), leading to severe disruption of work and social
activity:
Increased activity or physical restlessness;
Increased talkativeness ('pressure of speech');
Flight of ideas or the subjective experience of
thoughts racing;
loss of normal social inhibitions resulting in
behaviour which is inappropriate to the circumstances and out of character:
Decreased need for sleep;
Inflated self-esteem or grandiosity;
Distractibility or constant changes in activity or
plans;
Behaviour which is foolhardy or reckless and whose
risks the subject does not recognize e.g. spending sprees, foolish enterprises,
reckless driving;
Marked sexual energy or sexual indiscretions.
The
absence of hallucinations or delusions, although perceptual disorders may occur
(e.g. subjective hyperacusis, appreciation of colours as specially vivid,
etc.).
The
episode is not attributable to alcohol or drug abuse, endocrine disorder, drug
treatment or any organic mental disorder.
Mania with
psychotic symptoms
The
episode meets the criteria for mania without psychotic symptoms with exception
of criterion C.
The
episode does not simultaneously fulfill the criteria for schizophrenia or
schizo-affective disorder, manic type.
Delusions or hallucinations are present,
which do not fulfill the criteria for F20 Schizophrenia
Note: The most common qualifying symptoms here are
delusions of persecution or reference.
A fifth character should be used to specify whether
the hallucinations or delusions are congruent or incongruent with the mood:
F30.20 mania
with mood congruent psychotic Symptoms
F30.21 mania with mood incongruent psychotic
symptoms (such as voices speaking to the subject about affectively neutral
topics, or delusions of reference, jealousy, or delusions of general influence
from other planets, aliens, Computers, etc.)
BIPOLAR
AFFECTIVE DISORDER
Bipolar affective disorder,
current episode hypomanic
The current episode fulfills the criteria for
hypomania.
There has been at least one other affective episode in
the past, fulfilling the criteria for hypomanic or manic episode, depressive
episode or mixed affective episode.
Bipolar affective disorder,
current episode manic without psychotic symptoms
The current episode fulfills the criteria for mania
without psychotic symptoms.
There has been at least one other affective episode
in the past; fulfilling the criteria for hypomanic or manic episode, depressive
episode or mixed affective episode.
Bipolar affective disorder,
current episode manic with psychotic symptoms
The current episode fulfills the criteria for mania
with psychotic symptoms.
.
There has been at least one other affective episode
in the past, fulfilling the criteria for hypomanic or manic episode, depressive
episode or mixed affective episode.
A fifth character, should be used to specify whether
the psychotic symptoms are congruent or incongruent with the mood:
with
mood congruent psychotic symptoms
with
mood incongruent psychotic symptoms
Bipolar affective disorder,
current episode moderate or mild depression
The current episode fulfills the criteria for a depressive
episode of either mild or moderate severity.
There has been at least one other affective episode
in the past, fulfilling the criteria for hypomanic or manic episode, or mixed
affective episode.
A fifth character should be used to specify the
presence of somatic symptoms, in the current episode of depression:
without
somatic symptoms
with
somatic symptoms
Bipolar
affective disorder, current episode severe depression without psychotic
symptoms
The
current episode fulfills the criteria for a severe depressive episode without
psychotic symptoms There has been at least one well authenticated hypomanic or
manic episode (F30. -) or mixed affective episode in the past.
Bipolar
affective disorder, current episode severe depression with psychotic symptoms
The
current episode fulfills the criteria for a severe depressive episode with
psychotic symptoms . There has been at least one well authenticated hypomanic
or manic episode or mixed affective episode in the past.
A fifth character should be used to specify whether
the psychotic symptoms are congruent or incongruent with the mood.
with mood
congruent psychotic symptoms
with mood
incongruent psychotic symptoms
Bipolar
affective disorder, current episode mixed
The
current episode is characterized by either a mixture or a rapid alternation
(i.e. within a few hours) of hypomanic, manic and depressive symptoms.
Both
manic and depressive symptoms must be prominent most of the time during a
period of at least two weeks.
There
has been at least one well authenticated hypomanic or manic episode, depressive
or mixed affective episode in the past.
Bipolar
affective disorder, currently in remission
The
current state does not fulfil the criteria for depressive or manic episode in
any severity, or for any other mood disorder.
There
has been at least one well authenticated hypomanic or manic episode in the past
and in addition at least one other affective episode (hypomanic or manic, depressive
or mixed.
NB: Receiving treatment to reduce the risk of future
episodes is no bar to this diagnosis.
DEPRESSIVE
EPISODE
The following general criteria apply
to all subcategories :
The depressive episode should last for at least two
weeks.
Absence
of hypomanic or manic symptoms sufficient to meet the criteria for hypomanic or
manic episode at any time in the subject's life.
Depressive
episode. mild severity
The
general criteria of Depressive episode are fulfilled.
At
least two of the following three symptoms:
Depressed
mood to a degree that is definitely abnormal for the subject. present for most
of the day and almost every day, largely uninfluenced by circumstances, and
sustained for at least TWO WEEKS.
Marked
loss of interest or pleasure in activities, which are normally pleasurable.
Decreased
energy or increased fatigability.
An
additional symptom or symptoms from the following to give a total of at
least FOUR:
loss of confidence, and self-esteem.
Unreasonable feelings of self-reproach or excessive
and inappropriate guilt.
Recurrent thoughts of death or suicide, or any
suicidal behaviour.
Complaints or evidence of diminished ability to think
or concentrate, such as indecisiveness or vacillation.
Change in psychomotor activity, with agitation or
retardation.
Sleep disturbance of any type.
Change
in appetite (decrease or increase) with corresponding weight change.
A
fifth character should be used to specify the presence of the "somatic
syndrome" as defined below:
without
somatic symptoms
with
somatic symptoms
Depressive
episode, moderate severity
The
general criteria of Depressive episode are fulfilled.
At
least two of the three symptoms in B
Additional
symptoms from C, to give a total of at least six symptoms.
A
fifth character should be used to specify the presence of the
"somatic syndrome" as defined
below:
without
somatic symptoms
with
somatic symptoms
Severe
depressive episode without psychotic symptoms
The
general criteria of Depressive episode are fulfilled.
All three
of the symptoms in B.
Additional
symptoms from C, to give a total of at least EIGHT symptoms
The
absence of hallucinations, delusions or depressive stupor.
The warning in the diagnostic guidelines about the
effect of severe retardation or agitation upon the reporting of symptoms should
be taken into account.
Severe
depressive episode with psychotic symptoms
The
general criteria of Depressive episode are fulfilled.
The
criteria for severe depressive episode without psychotic symptoms are met with
the exception of criterion D.
The
criteria for schizophrenia (F20) or schizo-affective disorder, depressive type,
either severe or moderate are not met.
Either
(I) Hallucinations or delusions are
present which do not fulfill the criteria for any of the symptom groups in Schizophrenia.
or (2)
Depressive stupor.
** The most common qualifying symptoms here are
delusions of persecution or reference.
A fifth character should be used to specify whether
the psychotic symptoms are congruent or incongruent with the mood:
with
mood congruent psychotic symptoms (i.e. delusions of guilt, worthlessness,
bodily disease or impending disaster, derisive or condemnatory auditory
hallucinations)
with mood incongruent psychotic symptoms
SOMATIC
SYNDROME
Some depressive symptoms are widely regarded as
having special clinical significance, and are called here "somatic"
(terms such as biological, vital, melancholic or endogenomorphic are used for
this syndrome in other classifications).
A fifth character may be used to specify the presence
or absence of the somatic syndrome. To
qualify for the somatic syndrome, four of the following symptoms should be
present:
loss of interest or loss of pleasure in activities
which are normally pleasurable;
lack
of reactivity to events or activities that normally produce a response;
waking in the morning two hours or more before the
usual time;
depression worse in the morning;
objective evidence of marked psychomotor retardation or
agitation (remarked on or reported by other persons);
marked
loss of appetite;
weight loss
marked loss of libido.
RECURRENT
DEPRESSIVE DISORDER
The
current episode fulfills the criteria for a depressive episode either mild
(F32.O), moderate (F32.l) or severe.
There has been in the past at least one depressive
episode, either mild, moderate, or severe, lasting a minimum of two weeks and
separated by a period of SIX MONTHS without any significant mood disturbance.
At
no time in the past has there been an episode fulfilling the criteria for hypomanic
or manic episode.
It is recommended to specify the predominant type of
previous episodes (mild, moderate, severe, uncertain).
Current episode of mild
severity
The
general criteria for recurrent depressive disorder are fulfilled.
B. The current episode fulfills the criteria for
depressive episode, mild severity.
A fifth character should be used to specify the
presence of somatic symptoms in the current episode:
without
somatic symptoms
with
somatic symptoms
Current episode of moderate
severity
The
general criteria for recurrent depressive disorders (P33) are fulfilled.
The current episode fulfills the criteria for
depressive episode, moderate severity (F32.l).
A fifth character should be used to specify the
presence of somatic symptoms in the current episode:
without somatic symptoms
with somatic symptoms
Current
episode severe, without psychotic symptoms
The general criteria for recurrent depressive
disorders are fulfilled.
The current episode fulfills the criteria for severe depressive
episode without psychotic symptoms.
Current
episode severe with psychotic symptoms
The general criteria for recurrent depressive
disorders are fulfilled.
The current episode fulfills the criteria for severe
depressive episode with psychotic symptoms.
A fifth character should be used to specify whether
the psychotic symptoms are congruent or incongruent with the mood:
with mood congruent psychotic symptoms
with mood incongruent psychotic symptoms
Currently
in remission
The general criteria for recurrent depressive
disorder have been fulfilled in the past.
The current state does not fulfill the criteria for a
depressive episode of any severity, or for any other disorder.
N.B. Receiving treatment to reduce the risk of
further episodes is no bar to this diagnosis.
persistent MOOD (AFFECTIVE) DISORDERS
Cyclothvmia
A
period of AT LEAST TWO YEARS of instability of mood involving several periods
of both depression and hypomania, with or without intervening periods of
normal mood.
None
of the manifestations of depression or hypomania during such a two-year period
should be sufficiently severe or long lasting to meet criteria for manic episode
or depressive episode (moderate or severe);
however, manic or depressive episode(s) may have occurred before, or may
develop after, such a period of persistent mood instability.
During
at least some of the periods of depression at least three of the following
should be present:
A
reduction in energy or activity;
Insomnia;
loss
of self confidence or feelings of inadequacy;
Difficulty
concentrating:
Social withdrawal;
loss
of interest or enjoyment in sex and other pleasurable activities
Less talkative than normal;
Pessimistic
about the future or brooding over the past.
During
at least some of the periods of mood elevation at least three of the following
should be present:
Increased
energy or activity;
Decreased
need for sleep;
Inflated
self esteem;
Sharpened
or unusually creative thinking;
More gregarious than normal;
More talkative or witty than normal;
Increased interest and involvement in sexual and
other pleasurable activities;