In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association 2000), the depressive disorders include major depressive disorder, dysthymic disorder, adjustment disorder with depressed mood, and mood disorder due to a general medical condition. For the last category, the specific condition causing the depressive symptoms must be specified and must be a physical illness known to cause depression. The diagnostic criteria for a major depressive episode, which are the same for all ages, require that 1) five or more of the symptoms of depression be present nearly every day for most of the day during a 2-week period and 2) at least one of the two symptoms of a) depressed or irritable mood or b) markedly diminished interest or pleasure in most activities must be present (see Table 6-1).

According to DSM-IV-TR, manic episodes are characterized as a distinct period lasting at least 1 week during which the individual has an abnormally and persistently elevated, expansive, or irritable mood (American Psychiatric Association 2000). Hypomania is a manic episode in which the disturbance is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization, and no psychotic symptoms are present. Manic episodes may be part of a primary bipolar disorder, but they also may be secondary to a general medical condition or induced by exposure to medications or toxic features. A diagnosis of secondary mania or mood disorder secondary to a general medical condition requires evidence of a prominent and persistently elevated, expansive, or irritable mood, as well as evidence from the history or the physical and laboratory assessments demonstrating that the disturbance is the direct physiological consequence of a physical condition (see Table 6-2).

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