Substance-Induced Mood Disorder
Substance-induced mood disorder is diagnosed when medications, other psychoactive substances, ECT, or phototherapy are proximate events and the likely cause of the mood disturbance. All aforementioned types of mood disorder (e.g., unipolar, bipolar) may occur.
Mood Disorder Due to a General Medical Condition
This category is for mood disturbances apparently caused by a medical illness. Endocrine disorders, such as thyroid and adrenal dysfunction, are common etiologies. Postpartum mood disorders are excluded from the criteria; they are modifiers of unipolar and bipolar mood disorders.
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).
Revision date: June 20, 2011
Last revised: by Jorge P. Ribeiro, MD