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1. MAJOR DEPRESSIVE DISORDER
Major Depressive Episode:
A. Five (or more) of the following symptoms have been present
during the same 2-week period and represent a change from
previous functioning; at least one of the symptoms is either (1)
depressed mood or (2) loss of interest or pleasure:
(1) depressed mood
(2) loss of interest or pleasure
(anhedonia)
(3) significant weight loss when not dieting or
weight gain, or decrease or increase in appetite
(4) insomnia or
hypersomnia
(5) psychomotor agitation or retardation
(6) fatigue
or loss of energy
(7) feelings of worthlessness or
inappropriate/excessive guilt
(8) diminished ability to think or
concentrate, or indecisiveness
(9) recurrent thoughts of death
or suicide
B. The symptoms do not meet criteria for a mixed episode.
C. The symptoms cause significant distress or impairment in
social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological
effects of a substance (eg, drug of abuse) or a general medical
condition (eg, hypothyroidism).
E. The symptoms are not better accounted for by bereavement
(ie, depressive/grief symptoms lasting less than 2 months).
2. DYSTHYMIC DISORDER
A. Depressed mood for most of the day, for more days than
not, as indicated either by subjective account or observation
made by others, for at least 2 years.
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.
D. No major depressive episode has been present during the
first 2 years of the disturbance (1 year for children and
adolescents); ie, the disturbance is not better accounted for by
chronic major depressive disorder, or major depressive disorder,
in partial remission.
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Note: There may have been a previous major depressive episode
provided there was a full remission (no significant signs or
symptoms for 2 months) before development of the dysthymic
disorder. In addition, after the initial 2 years (1 year in
children and 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, a mixed episode, or
a hypomanic episode, and criteria have never been met for
cyclothymic disorder.
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 effects of a
substance (eg, drugs of abuse, a medication) or a general
medical condition (eg, hypothyroidism).
H. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
3. BIPOLAR DISORDERS
Hypomanic Episode:
A. A distinct period of abnormally and persistently elevated,
expansive, or irritable mood lasting at least 1 week (or any
duration if hospitalization is necessary).
B. During the period of mood disturbance, three (or more) of
the following symptoms have persisted (four if the mood is only
irritable) and have been present to a significant degree:
(1) inflated self-esteem or grandiosity
(2) decreased need
for sleep (eg, feels rested after only 3 hours of sleep)
(3)
more talkative than usual or pressure to keep talking
(4) flight
of ideas or subjective experience that thoughts are racing
(5)
distractibility (ie, attention too easily drawn to unimportant
or irrelevant external stimuli)
(6) increase in goal-directed
activity (either socially, at work or school, or sexually) or
psychomotor agitation
(7) excessive involvement in pleasurable
activities that have a high potential for painful consequences
(eg, engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)
C. The symptoms do not meet the criteria for a mixed episode.
D. The mood disturbance is sufficiently severe to cause
marked impairment in occupational functioning or in usual social
activities or relationships with others, or to necessitate
hospitalization to prevent harm to self or others, or there are
psychotic features.
E. The symptoms are not due to the direct physiological
effects of a substance (eg, a drug of abuse, a medication, or
other treatment) or a general medical condition (eg,
hyperthyroidism).
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*Note: Manic-like episodes that are clearly caused by somatic
antidepressant treatment (eg, medication, electroconvulsive
treatment, light therapy) should not count toward a diagnosis of
bipolar I disorder.
4. CYCLOTHYMIC DISORDER
A. For at least 2 years, the presence of numerous periods
with hypomanic symptoms and numerous periods with depressive
symptoms that do not meet criteria for a major depressive
episode.
B. During the above 2-year period (1 year in children and
adolescents), the person has not been without the symptoms in
Criterion A for more than 2 months at a time.
C. No major depressive episode, manic episode, or mixed
episode has been present during the first 2 years of the
disturbance.
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 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 (eg, drugs of abuse, a medication) or a
general medical condition (eg, hyperthyroidism).
F. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
5. MOOD DISORDER DUE TO A 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 accounted for by another mental
disorder (eg, 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. |