Classification Of Mood Disorders~More Discussion~

Other Mood Disorders
Mood disorder due to a general medical condition is a disturbance characterized by either (or both) depressed mood or elevated or irritable mood as a direct result of a general medical condition. (For example, patients with serious medical conditions may exhibit insomnia, weight loss, and depression.) This disorder is diagnosed when the symptoms are serious enough to cause significant impairment in social or occupational functioning or marked distress. Substance-induced mood disorder is a prominent and persistent disturbance of mood (depression, mania, or both) attributable to the use of a substance or to the cessation of the substance use. Again, it is diagnosed when notable distress and impairment occur.

Symptom Features and Specifiers
To be more precise about the nature of mood disorders, DSM-IV-TR has listed certain characteristics that may be associated with these disorders. They are important symptom features that may accompany the disorders but are not criteria used to determine diagnosis. Specifiers may be used to more precisely describe the major depressive episode. Certain features, such as severity, presence or absence of psychotic symptoms, and remission status may be noted. For example, psychotic features include delusions, hallucinations, and gross impairment in reality testing (an inability to accurately perceive and deal with reality). Their presence tends to predict a relatively poor diagnosis, more chronicity, and impairment. If a person who is diagnosed with a major depressive episode has psychotic symptoms, the person would receive the diagnosis of major depressive episode with psychotic features. Similarly, major depressive episodes for some of the mood disorders may include (1)melancholia (loss of pleasure, lack of reactivity to pleasurable stimuli, depression that is worse in the morning, early morning awakening, excessive guilt, weight loss) and (2)catatonia, which is motoric immobility (taking a posture and not moving), extreme agitation (excessive motor activity), negativism (resistance to changing positions), or mutism.

Course Specifiers
Course specifiers indicate the cyclic, seasonal, postpartum, or longitudinal pattern of mood disorders. In the rapid cycling type, which is applicable to bipolar disorders, the manic or depressive episodes have occurred four or more times during the previous 12 months. The episodes may also appear with periods of relative normality in between. In some cases, there may be only partial remission in between the episodes. One patient was reported to demonstrate manic behaviors for almost exactly 24 hours, immediately followed by depressive behaviors for 24 hours. At the manic extreme, the patient was agitated, demanding, and constantly shouting; the next day, he was almost mute and inactive. The alternating nature of the disorder lasted eleven years (Jenner et al., 1967). Typical manic episodes appear suddenly and last from a few days to months. Depressive episodes tend to last longer.

One of the more interesting course specifiers involves a seasonal pattern. For some people, moods are accentuated during certain times. Lehmann (1985) noted that many depressed people find the morning more depressing than the evening. Many individuals also find winter, when days are shorter and darker, more depressing than summer. In seasonal affective disorder (SAD), serious cases of depression fluctuated according to the season, although the precise reasons for the fluctuation are unclear. Proposed explanations include the possibility that SAD is an abnormal body response to seasonal changes in the length of the day, that the dark days of winter may bring about hormonal changes in the body that somehow affect depression levels, and that disruption of the body's circadian rhythm produces mood fluctuations (T. Lee et al., 1998). SAD appears to be related to the photoperiod (hours from sunrise to sunset) rather than to daily hours of sunshine, average daily temperature, or total daily radiation (M. Young, Meaden, Fogg, Cherin & Eastman, 1997). Interestingly, "light therapy" (exposure to bright light) for several hours a day, especially during winter, appears to be helpful for many individuals with SAD (Oren & Rosenthal, 2001), as may vacations to sunny parts of the country. In some cases of recurrent major depression and bipolar disorder, the onset, end, or change of an episode conincides with a particular time of the year. For example, one man regularly became depressed after Christmas.

Other course specifiers include postpartum onset (if depression or mania in women occurs within four weeks of childbirth) and longitudinal specifiers that indicate the nature of the recurrence and the status of individuals between episodes.

This text is taken from the book 'Understanding Abnormal Behavior',pp. 353-356, written by David Sue, Derald Wing Sue, Stanley Sue, seventh edition, copyright 2003-Houghton Mifflin Company. Used with permission.

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