MOOD EPISODES

Major depressive episodes Manic episode Mixed episode Hypomanic episode A. 5 of following symptoms present d same A. A distinct period of abnormally & A. D criteria r met BOTH for Manic episode & A. A distinct period of abnormally & 2-wk period & represent a from prev fx; at persistently , expansive, or irritable mood MDE (except for duration) nearly every day persistently , expansive, or irritable mood least either (1) depressed mood OR (2) loss lasting 1 wk (or any duration if 1 wk lasting 4 d that is clearly different from of interest or pleasure hospitalization is necessary) usual nondepressed mood 1. Depressed mood most of d day, nearly B. During d period of mood disturbance, 3 every day as indicated by subjectives symptoms persist (4 if d mood is ONLY report OR observations by others irritable) & hv been present to a significant Note : in children & adolescent, can B irritable degree : mood 1. Inflated self esteem or grandiosity 2. Markedly diminish interest or pleasure in 2. need to sleep (feels rested aftr only 3 all, almost all, activities most of d day, hr of sleep) nearly every day (as indicated by 3. Talkative than usual or pressure to keep subjectives report OR observations by talking others) 4. Flight or ideas or subjective experiences 3. Significant LOW (w/out dieting) or wt that thought r racing gain, or / appetite nearly every day. 5. Distractibility Note : in children, consider failure to make 6. in goal-directed actvt (social, work, expected weight gains. school, sexually) or psychomotor agitation 4. Insomnia or hypersomnia nearly every 7. Xs involvement in pleasurable actvt that day hv potential for painful consequences 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjectives feelings of restlessns or being slowed down) 6. Fatigue or loss of energy nearly every day 7. Feeling of worthlsns or xs or inappropriate guilt (which may B delusional) nearly every day (not merely self reproach or guilt about being sick) 8. Diminished ability to think or concentrate or indecisivens, nearly every dat (either by subjective account or as observed by others) 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation w/out
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B. During d period of mood disturbance, 3 symptoms persist (4 if d mood is ONLY irritable) & hv been present to a significant degree : 1. Inflated self esteem or grandiosity 2. need to sleep (feels rested aftr only 3 hr of sleep) 3. Talkative than usual or pressure to keep talking 4. Flight or ideas or subjective experiences that thought r racing 5. Distractibility 6. in goal-directed actvt (social, work, school, sexually) or psychomotor agitation 7. Xs involvement in pleasurable actvt that hv potential for painful consequences C. Episode is a/w unequivocal in functioning that is uncharacteristic of d person when not symptomatic D. D disturbance in mood & in functioning r observable by other

specific plan or a suicidal attempt or a specific plan for commiting suicide

B. D symptoms does not meet criteria for C. D symptoms does not meet criteria for mixed episode mixed episode C. Symptoms cause clinically significant D. Mood disturbance is sufficiently severe to B. Mood disturbance is sufficiently severe to E. Episode is NOT SEVERE ENUF to caused distress or impairment in social, cause marked impairment in occupational fx cause marked impairment in occupational fx marked impairment in occupational fx OR in occupational or other important areas of fx OR in usual social actvt OR r/ship w others OR in usual social actvt OR r/ship w others usual social actvt OR r/ship w others OR to OR to necessitate hospitalization to prevent OR to necessitate hospitalization to prevent necessitate hospitalization to prevent harm harm to self or others, OR there r psychotic harm to self or others, OR there r psychotic to self or others, OR there r NO psychotic features features features D. D symptoms r X d/t direct physiological E. D symptoms r X d/t direct physiological C. D symptoms r X d/t direct physiological F. D symptoms r X d/t direct physiological effect of a substance or GMC effect of a substance or GMC effect of a substance or GMC effect of a substance or GMC E. Symptoms r X better accounted by bereavement

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MDD, single episode A. Presence of single MDE

MDD, recurrrent A. Presence of 2 MDE Note : to be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria r not met for MDE B. D MDE is not bttr accounted by Schizoaffective d/o & is not superimposed on Schizophrenia, Schizophreniform d/o, Delusional d/o, or Psychotic d/o NOS C. There has never been a Manic episode, a Mixed episode OR Hypomanic episode Note: this exclusion does x apply if all o d mniklike, mixed-like, OR hypomanic-like episodes r substance OR tx induced OR r d/t GMC If the FULL criteria r currently MET for MDE, specify its current clinical status &/or features : Mild, Moderate, Severe w/out Psychotic Features/ Severe w Psychotic Features Chronic With Catatonic Features With Melancholic Features With Atypical Features With Postpartum Onset If d FULL criteria r NOT currently MET for MDE, specify the current clinical status of MDD or features of most RECENT episode : In partial Remission, In Full Remission Chronic With Catatonic Features With Melancholic Features With Atypical Features With Postpartum Onset Specify : Longitudinal Course Specifiers (with & w/out Interepisode recovery) With Seasonal Pattern

Dysthymic d/o A. Depressed mood for most of d day for more days that not, as indicated either by subjective account or observation by others for at least 2 yrs Notes : in children & adolescent mood can b irritable & duration must be at least 1 yr B. Presence, while depressed 2 of following : Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self esteem Poor [ ] or difficulty making decision Feeling hopeless C. During d 2 yr period (1 yr for children & adolescent) o disturbance d person nvr bin w/out d sympts of criteria A & B for 2/12 at a time D. No MDE has been present during 1st 2 yrs o disturbance (1 yr for children & adolescent) e:g disturbance is not bttr accounted for by chronic MDD or MDD, In Partial Remission Note : they may hv been a prev MDE provided there was FULL remission (x significant s&s for 2/12) b4 dvlpmnt of Dysthymic d/o. In addition, aftr initial 2 yrs (1 yr for children & adolescent) of Dysthymic dz there may B superimposed episodes o MDD, in which case both dx may be given when d criteria r met for MDE E. There nvr hv been Manic epi.,Mixed epi., Hypomanic epi. & criteria nvr hv met Cyclothymic dz F. D disturbance does X occur exclusively during course of chronic Psychotic dz e:d schizo or delusional dz G. Sx r not d/t substance or GMC H. Sx cause clinically significant distress or impairment in social, occupational or other important areas of fx

Cyclothymic d/o A. For at least 2 yrs, d presence of numerous periods of hypomanic sx & numerous periods w depressive sx that do x meet criteria for MDD Note : in children & adolescents, d duration must be at least 1 yr

B. D MDE is not bttr accounted by Schizoaffective d/o & is not superimposed on Schizophrenia, Schizophreniform d/o, Delusional d/o, or Psychotic d/o NOS C. There has never been a Manic episode, a Mixed episode OR Hypomanic episode Note: this exclusion does x apply if all o d mniklike, mixed-like, OR hypomanic-like episodes r substance OR tx induced OR r d/t GMC If the FULL criteria r currently MET for MDE, specify its current clinical status &/or features : Mild, Moderate, Severe w/out Psychotic Features/ Severe w Psychotic Features Chronic With Catatonic Features With Melancholic Features With Atypical Features With Postpartum Onset If d FULL criteria r NOT currently MET for MDE, specify the current clinical status of MDD or features of most RECENT episode : In partial Remission, In Full Remission Chronic With Catatonic Features With Melancholic Features With Atypical Features With Postpartum Onset

B. During d 2 yr period ( 1 yr for children & adolescent) of disturbance d person nvr bin w/out the sympts of criteria A for 2/12 at a time C. No MDE, Manic episode, or Mixed episode has been present during 1st 2 yrs of disturbance Note : aftr initial 2 yrs (1yr in children & adolescents) of Cyclothymic d/o, there may be superimposed Manic or Mixed Episodes (in ahich case both Bipolar I d/o & Cyclothymic d/o may be dx) OR MDE ( in which case both Bipolar II & Cyclothymic d/o may b dx)

D. Sympt in criterion A x bttr accounted for Schizoaffective d/o & r NOT SUPERIMPOSED on Schizo, Schizophreniform d/o, Delusional d/o or Psychotic d/o NOS

E. Sx r not d/t substance or GMC F. Sx cause clinically significant distress or impairment in social, occupational or other important areas of fx

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Bipolar I
Most recent Epi. Most Recent Epi. Manic Most Recent Epi. Mixed Most Recent Epi. Mixed Most Recent Epi. Hypomanic Unspecified A. Presence of only 1 Manic A. Currently (or most A. Currently (or most A. Currently (or most A. Currently (or most A. Criteria, xcept for duration, Epi & no past MDE recently) in Hypomanic Epi. recently) in Manic Epi. recently) in Mixed Epi. recently) in MDE. r currently (or most Note : recurrence is defined recently) met for Manic, as either a in polarity from Hypomanic, Mixed or MDE depression or an interval of at least 2/12 w/out manic sx B. Prevly been at least 1 B. Prevly been at least 1 B. Prevly been at least 1 B. Prevly been at least 1 B. Prevly been at least 1 Manic Epi or Mixed Epi. MDE, Manic Epi., or Mixed MDE, Manic Epi., or Mixed Manic Epi., or Mixed Epi. Manic Epi., or Mixed Epi. Epi. Epi. C. D moof sx cause clinically C. D moof sx cause clinically significant distress or significant distress or impairment in social, impairment in social, occupational or other occupational or other important areas of fx important areas of fx B. Manic Epi is X bttr D. Mood epi. is X bttr C. Mood epi. In criteria A & B C. Mood epi. In criteria A & B C. Mood epi. In criteria A & B D. Mood epi. In criteria A & B accounted for accounted for is X bttr accounted for is X bttr accounted for is X bttr accounted for is X bttr accounted for Schizoaffective d/o & r NOT Schizoaffective d/o & r NOT Schizoaffective d/o & r NOT Schizoaffective d/o & r NOT Schizoaffective d/o & r NOT Schizoaffective d/o & r NOT SUPERIMPOSED on SUPERIMPOSED on SUPERIMPOSED on SUPERIMPOSED on SUPERIMPOSED on SUPERIMPOSED on Schizo, Schizophreniform Schizo, Schizophreniform Schizo, Schizophreniform Schizo, Schizophreniform Schizo, Schizophreniform Schizo, Schizophreniform d/o, Delusional d/o or d/o, Delusional d/o or d/o, Delusional d/o or d/o, Delusional d/o or d/o, Delusional d/o or d/o, Delusional d/o or Psychotic d/o NOS Psychotic d/o NOS Psychotic d/o NOS Psychotic d/o NOS Psychotic d/o NOS Psychotic d/o NOS E. Mood sx in criteria A & B r X d/t substance or GMC Single Manic Epi

Bipolar II (Recurrent Major Depressive Episode with Hypomanic Episode)

A. B. C. D. E. Presence (or hx) of 1 MDE Presence (or hx) of Hypomanic Episode Never hv been Manic Episode or Mixed Episode Mood epi. In criteria A & B is X bttr accounted for Schizoaffective d/o & r NOT SUPERIMPOSED on Schizo, Schizophreniform d/o, Delusional d/o or Psychotic d/o NOS D moof sx cause clinically significant distress or impairment in social, occupational or other important areas of fx

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Severity/Psychotic/Remission Specifiers for current (or most recent) MDE Mild, Moderate, Severe w/out Psychotic features, & Severe with Psychotic Features can B applied ONLY if criteria CURRENTLY met MDE In Partial Remission & In Full Remission can B applied to d MOST recent MDE in MDD & to MDE in Bipolar I or II d/o ONLY if it is d MOST recent type of mood episode

Severity/Psychotic/Remission Specifiers for current (or most recent) Manic Episode Mild, Moderate, Severe w/out Psychotic features, & Severe with Psychotic Features can B applied ONLY if criteria CURRENTLY met Manic episode In Partial Remission & In Full Remission can B applied to a Manic Episode in Bipolar I d/o ONLY if it is d MOST recent type of mood episode

Severity/Psychotic/Remission Specifiers for current (or most recent) Mixed Episode Mild, Moderate, Severe w/out Psychotic features, & Severe with Psychotic Features can B applied ONLY if criteria CURRENTLY met Mixed episode In Partial Remission & In Full Remission can B applied to a MMixed Episode in Bipolar I d/o ONLY if it is d MOST recent type of mood episode Mild : No more than minimum sx criteria r met for BOTH Manic Epi & MDE Moderate :Sx OR functional impairment btwn mild & severe

Mild : Few, if any, sx in xs of those required to make dx & sx Mild : Minimum sx criteria r met for a Manic Episode results in only minor impairment in occupational fx or in usual social actvt or r/ship with others Moderate : Sx & fx impairment btwn mild & severe Moderate : Extreme in actvt OR impairment in judgement

Severe w/out Psychotic features: several sx in xs of those Severe w/out Psychotic features : almost continual Severe w/out Psychotic features : almost continual required to make dx, & sx markedly interefe occupational fx or supervision required to prevent physical harm to self or others supervision required to prevent physical harm to self or others with usual social actvt or r/ship with others Severe with Psychotic Features : Delusions OR hallucinations. Severe with Psychotic Features : Delusions OR hallucinations. Severe with Psychotic Features : Delusions OR hallucinations. If possible, specify whether d psychotic features r mood- If possible, specify whether d psychotic features r mood- If possible, specify whether d psychotic features r moodcongruent or mood-Incongruent congruent or mood-Incongruent congruent or mood-Incongruent Mood-Congruent Psychotic Features: Delusion OR hallucination whose content is ENTIREly consistent with typical depressive theme of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment Mood-Incongruent Psychotic Features: Delusion OR hallucination whose content does NOT involve typical depressive theme of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. Included r such sx as persecutory delusions (not directly related to depressive themes), thought insertion, thought broadcasting & delusions of control Mood-Congruent Psychotic Features: Delusion OR hallucination whose content is ENTIREly consistent with typical manic theme of inflated worth, power, knowledge, identity, or special r/ship to a deity or famous person. Mood-Incongruent Psychotic Features: Delusion OR hallucination whose content does NOT involve typical manic theme of inflated worth, power, knowledge, identity, or special r/ship to a deity or famous person. Included r such sx as persecutory delusions (not directly related to depressive themes), thought insertion, thought broadcasting & delusions of control Mood-Congruent Psychotic Features: Delusion OR hallucination whose content is ENTIREly consistent with typical manic OR depressive theme. Mood-Incongruent Psychotic Features: Delusion OR hallucination whose content does NOT involve typical manic OR depressive theme. Included r such sx as persecutory delusions (not directly related to depressive themes), thought insertion, thought broadcasting & delusions of control

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In Partial Remission : Sx of MDE r present but full criteria r NOT met, OR there is perios w/out any significant sx of MDE lasting <2/12 following end of MDE (IF MDE was superimposed on Dysthymic d/o, d dx of Dysthymic d/o alone is given once full criteria for MDE r no longer met)

In Partial Remission : Sx of Manic Episode r present but full criteria r NOT met, OR there is perios w/out any significant sx of Manic Episode lasting < 2/12 following end of Manic Episode

In Partial Remission : Sx of Mixed Episode r present but full criteria r NOT met, OR there is perios w/out any significant sx of Mixed Episode lasting < 2/12 following end of Mixed Episode

In Full Remission : during past 2/12, no significant s&s of In Full Remission : during past 2/12, no significant s&s of In Full Remission : during past 2/12, no significant s&s of disturbance were present disturbance were present disturbance were present Unspecified Unspecified Unspecified

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Specifier
Chronic Specifier Catatonic Features Specifier Melancholic Features Specifier Specify if : Specify if : Specify if : With Catatonic Features (can With Melancholic features (can Chronic (can B applied to be applied to d current OR most B applied to current OR most current OR most recent MDE in recent MDE, Manic Epi, OR recent MDE in MDD & to a MDE MDD & to a MDE in Bipolar I Mixed Epi in MDD, Bipolar I or II in Bipolar I OR II d/o ONLY if it is OR II d/o ONLY if it is d most d/o) d most recent type of mood recent type of mood episode) episode) Full criteria for MDE hv been A. Either of d following occurring met continuously for at least D clinical features is dominated by 2 of following : during d most severe period of past 2 yrs current episode: 1) Motoric immobility as evidenced 1) Loss of pleasure in all, or by catalepsy (including waxy almost all, activities flexibility) OR stupor 2) Lack of reactivity to usually pleasurable stimuli (does X 2) Xs motor actvt (that is apparently feel much bttr, even purposels & X influenced by temporarily, when something Xternal stimuli) good happen) Atypical Features Specifier Specify if : With Atypical Features (can B apllied when thse features predominate during most recent 2 wks of current MDE in MDD or in Bipolar I or II when current MDE is MOST recent type of mood epi, OR when these features predominate during most recent 2 yrs if Dysthymic d/o; if d MDE is X current, it applies if d feature predominate during any 2 wk period) A. Mood reactivity (i:e, mood brightens in response to actual OR potential +ve events) Postpartum Onset Specifier Specify if : With Postpartum Onst (can be applied to current OR most recent MDE, Manic, Mixed Episode in MDD, Bipolar I, OR II OR to Brief Psychotic d/o) Onset of episode w/in 4 wks postpartum

3) Xtreme negativism (an B. 3 : B. 2 : apparently motivels resistance to 1) Distinct quality of depressed 1) Significant wt gain OR all instructions OR maintenance of mood (i:e, d depressed mood appetite rigid posture against attempt to be is xperienced as distinctly 2) Hypersomnia moved) or mutism different from d kind of feeling 3) Leaden paralysis (i:e, heavy, experienced astr death of laeden feelings in arms OR 4) Peculiarities of voluntary mvmnt loved one) legs) as evidenced by posturing 2) Depression regularly worse in 4) Long standing pattern of (voluntary assumption of d morning interpersonal rejection inappropriate OR bizzare 3) Early morning awakening (at sensitivity (X limited to episodes postures), stereotyped mvmnts, least 2 hrs b4 usual time of of mood disturbance) that prominent mannerism, OR awakening) results in significant social, prominent grimacing 4) Marked psychomotor occupational impairment) retardation or agitation 5) Criteria r NOT met With 5) Echolalia OR echopraxia 5) Significant anorexia or weight Melancholic Features OR With loss Catatonic Features during same 6) Xs or inappropriate guilt periods
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