TABLE 12 Criteria for

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.

Note: Do not include symptoms that are clearly due to a general medical

: of the day, nearly every day, as indicated by either . or empty) or observation by others (e.g., . Note; In adolescents, can be irritable mood. 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day (as indicated by cither subjective account oi observation made by others).

3. Significant weight loss when not dieting or weight gain (e.g., a change of i than 5% of body weight in a month), or decrease or increase in ; nearly every day. Note: In children, consider failure to i

4. Insomnia or hypersomnia nearly every day.

5. Psychomotor agitation or retardation nearly every day (observable by

6. Fatigue or loss of energy nearly every day."

7. Feelings of worthlessness or excessive or'inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach about being sick).

8. Diminished ability to think or concentrate, or indecisiveness, nearly < day (either by subjective account or as observed by others).

9. Recurrent thoughts of death (not just fear of dying), recurra ideation without a specific plan, or a suicide attempt or specific plan for

occupational, or other important areas of i

D. The symptoms are not due to the direct physiological . (e.g., drug of abuse or medication) or a general medical hypothyroidism).

E. The symptoms are not better accounted for by bereavement (i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or ; by suicidal ideation, psychotic :

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

empty, slowed down, irritable, or angry. Often one's perception of self and others becomes distorted. One may feel inadequate or experience an unwar-

Depressive episodes in manic-depressive disorder are indistinguishable from those in major depressive disorder. About half of persons with manic-

TABLE 1.3 Criteria i

period of period of

B, During the period of mood disturbance, three (or more) of the following ; have persisted (four if the mood is only irritable) and have been : to a : *

sexually) or i in pleasurable activities that 1

; do not meet criteria for a mixed episode (sec Table 1.4).

; or in usual social activities or j hospitalization to prevent harm to self or others, or there a

E. The symptoms are not due to me direct pnysioiogicai effects of a ยก

(e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant

: (e.g., medication, electroconvulsive therapy, or light therapy) should not < of bipolar disorder type I.

B, During the period of mood disturbance, three (or more) of the following ; have persisted (four if the mood is only irritable) and have been : to a : *

; toward a

Copyright 2000,.

depressive disorder experience depressive episodes characterized by decreased sleep and appetite, and about half experience more atypical symptoms of increased sleep and appetite. Recall that the differential diagnosis between major depressive and manic-depressive disorders is made not by cross-sectional symptom analysis but by longitudinal course. The diagnostic decision tree for manic-depressive disorder is outlined in Figure 1.1.

Manic episodes are defined by discrete periods of abnormally elevated, expansive, or irritable mood accompanied by marked impairment in judgment and social and occupational function. These symptoms are often accompanied by unrealistic grandiosity, excess energy, and increases in goal-directed activity that frequently have a high potential for damaging conse-

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