Mood Disorders in Specific Physical Illnesses

Depression co-occurring with physical illness worsens the prognosis of many general medical conditions. The presence of depression is associated with higher morbidity and mortality rates in many adult physical illnesses (Evans et al. 2005a). In this section, we briefly review specific illness conditions for

Table 6-10. Confounding overlaps between DSM-IV-TR symptoms of depression and symptoms of physical illness and/or its treatment

Weight loss and/or decreased appetite

Cancer

Diabetes mellitus

Malabsorption

Cancer chemotherapy agents

Infection (e.g., HIV, tuberculosis)

Renal failure

Cystic fibrosis

Inflammatory bowel diseases

Vitamin deficiencies

Weight gain and/or increased appetite

Anticonvulsant medications

Cushing's disease

Hypothyroidism

Antihistamine medications

Hypogonadism

Insulinoma

Corticosteroids

Hypothalamic lesions

Polycystic ovary disease

Insomnia

Alcohol

Duodenal ulcers

Psychostimulant medications

Asthma

Hyperthyroidism

Restless legs syndrome

Caffeine

Nocturia

Sleep apnea

Corticosteroids

Pain

Sympathomimetic amines

Hypersomnia

Brain tumors

Hypercapnia

Opiates

Diabetic ketoacidosis

Hypothyroidism

Sleep apnea (daytime hypersomnia)

Encephalitis

Liver failure

Uremia

Fatigue and/or loss of energy

Addison's disease

Heart failure

Narcolepsy

Anemia

Hepatitis

Poliomyelitis

Anticonvulsant medications

Mononucleosis

Rheumatoid arthritis

Chronic physical illnesses

Motor neuron disease

Tumors

Endocarditis

Multiple sclerosis

Uremia

Guillain-Barre syndrome

Muscular dystrophy

Vitamin B12 deficiency

Difficulty with thinking or concentration

Cirrhosis

Lead poisoning

Opiates

Dementia

Marijuana

Huntington's disease

Metachromatic leukodystrophy

Loss of interest in sex

Cirrhosis

Hormonal disorders

Hemochromatosis

Substance abuse

Psychomotor agitation

Hypercalcemia

Reye's syndrome

Wernicke-Korsakoff syndrome

Psychostimulant medications

Substance withdrawal or abuse

Table 6-11. DSM-IV-TR diagnostic criteria for substance-induced mood disorder

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 of either (1) or (2):

(1) the symptoms in Criterion A developed during, or within a month of, substance intoxication or withdrawal

(2) medication use is etiologically related to the disturbance

C. The disturbance is not better accounted for by a mood disorder that is not substance induced. Evidence that the symptoms are better accounted for by a mood disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced mood disorder (e.g., a history of recurrent major depressive episodes).

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.

Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the mood symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.

Code [Specific Substance]-Induced Mood Disorder:

(291.89 Alcohol; 292.84 Amphetamine [or Amphetamine-Like Substance]; 292.84 Cocaine; 292.84 Hallucinogen; 292.84 Inhalant; 292.84 Opioid; 292.84 Phencyclidine [or Phencyclidine-Like Substance]; 292.84 Sedative, Hypnotic, or Anxiolytic; 292.84 Other [or Unknown] Substance)

Specify type:

With Depressive Features: if the predominant mood is depressed With Manic Features: if the predominant mood is elevated, euphoric, or irritable With Mixed Features: if symptoms of both mania and depression are present and neither predominates Specify if:

With Onset During Intoxication: if the criteria are met for Intoxication with the substance and the symptoms develop during the intoxication syndrome

With Onset During Withdrawal: if criteria are met for withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal syndrome which the relationships between mood disorders and general medical conditions have been well established. We include discussions of cancer, epilepsy, diabetes mellitus, end-stage renal disease, and HIV disease. Detailed discussion of these illnesses can be found in other chapters of this text.

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