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Mood disorders

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Mood Disorders

The Mood Disorders section includes disorders that have a disturbance in mood as the predominant feature. The section is divided into three parts. The first part describes mood episodes (Major Depressive Episode, Manic Episode, Mixed Episode, and Hypomanic Episode) that have been included separately at the beginning of this section for convenience in diagnosing the various Mood Disorders. These episodes do not have their own diagnostic codes and cannot be diagnosed as separate entities; however, they serve as the building blocks for the disorder diagnoses. The second part describes the Mood Disorders (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar I Disorder). The criteria sets for most of the Mood Disorders require the presence or absence of the mood episodes described in the first part of the section. The third part includes the specifiers that describe either the most recent mood episode or the course of recurrent episodes.

The Mood Disorders are divided into the Depressive Disorders ("unipolar depression"), the Bipolar Disorders, and two disorders based on etiology-Mood Disorder Due to a General Medical Condition and Substance-Induced Mood Disorder. The Depressive Disorders (i.e., Major Depressive Disorder, Dysthymic Disorder, and Depressive Disorder Not Otherwise Specified) are distinguished from the Bipolar Disorders by the fact that there is no history of ever having had a Manic, Mixed, or Hypomanic Episode. The Bipolar Disorders (i.e., Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Bipolar Disorder Not Otherwise Specified) involve the presence (or history) of Manic Episodes, Mixed Episodes, or Hypomanic Episodes, usually accompanied by the presence (or history) of Major Depressive Episodes.

The specifiers described in the third part of the section are provided to increase diagnostic specificity, create more homogeneous subgroups, assist in treatment selection, and improve the prediction of prognosis. Some of the specifiers describe the clinical status of the current (or most recent) mood episode (i.e., Severity/Psychotic/Remission Specifiers), whereas others describe features of the current episode (or most recent episode if the episode is currently in partial or full remission) (i.e., Chronic, with Catatonic Features, with Melancholic Features, with Atypical Features, with Postpartum Onset). Table 1 (p. 411) indicates which episode specifiers apply to each codable Mood Disorder. Other specifiers describe the course of recurrent mood episodes (i.e., Longitudinal Course Specifiers, with Seasonal Pattern, with Rapid Cycling). Table 2 (p. 424) indicates which course specifiers apply to each codable Mood Disorder. The specifiers that indicate severity, remission, and psychotic features can be coded in the fifth digit of the diagnostic code for most of the Mood Disorders. The other specifiers cannot be coded.

The Mood Disorders section is organized as follows:

Recording Procedures for Major Depressive Disorder and Bipolar I and Bipolar II Disorders

Selecting diagnostic codes.

The diagnostic codes are selected as follows:

For Major Depressive Disorder:

  1. The first three digits are 296.
  2. The fourth digit is either 2 (if there is only a single Major Depressive Episode) or 3 (if there are recurrent Major Depressive Episodes).
  3. The fifth digit indicates the severity of the current Major Depressive Episode if full criteria are met as follows: 1 for Mild severity, 2 for Moderate severity, 3 for Severe Without Psychotic Features, 4 for Severe With Psychotic Features. If full criteria are not currently met for a Major Depressive Episode, the fifth digit indicates the current clinical status of the Major Depressive Disorder as follows: 5 for In Partial Remission, 6 for In Full Remission. If current severity or clinical status is unspecified, the fifth digit is 0.

For Bipolar I Disorder:

  1. The first three digits are also 296.
  2. The fourth digit is 0 if there is a single Manic Episode. For recurrent episodes, the fourth digit indicates the nature of the current episode (or, if the Bipolar I Disorder is currently in partial or full remission, the nature of the most recent episode) as follows: 4 if the current or most recent episode is a Hypomanic Episode or a Manic Episode, 6 if it is a Mixed Episode, 5 if it is a Major Depressive Episode, and 7 if the current or most recent episode is Unspecified.
  3. The fifth digit (except for Bipolar I Disorder, Most Recent Episode Hypomanic, and Bipolar I Disorder, Most Recent Episode Unspecified) indicates the severity of the current episode if full criteria are met for a Manic, Mixed, or Major Depressive Episode as follows: 1 for Mild severity, 2 for Moderate severity, 3 for Severe Without Psychotic Features, 4 for Severe With Psychotic Features. If full criteria are not met for a Manic, Mixed, or Major Depressive Episode, the fifth digit indicates the current clinical status of the Bipolar I Disorder as follows: 5 for In Partial Remission, 6 for In Full Remission. If current severity or clinical status is unspecified, the fifth digit is 0. For Bipolar I Disorder, Most Recent Episode Hypomanic, the fifth digit is always 0. For Bipolar Disorder, Most Recent Episode Unspecified, there is no fifth digit.

For Bipolar II Disorder, the diagnostic code is 296.89.

Recording the name of the diagnosis.

In recording the name of a diagnosis, terms should be listed in the following order:

  1. Name of disorder (e.g., Major Depressive Disorder, Bipolar Disorder)
  2. Specifiers coded in the fourth digit (e.g., Recurrent, Most Recent Episode Manic)
  3. Specifiers coded in the fifth digit (e.g., Mild, Severe With Psychotic Features, In Partial Remission)
  4. As many specifiers (without codes) as apply to the current or most recent episode (e.g., with Melancholic Features, with Postpartum Onset)
  5. As many specifiers (without codes) as apply to the course of recurrent episodes (e.g., with Seasonal Pattern, with Rapid Cycling)

The following examples illustrate how to record a Mood Disorder diagnosis with specifiers:

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text RevisionTM. Copyright 2000 American Psychiatric Association. All Rights Reserved.