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The DSM IV TR Classification
The DSM IV TR describes the essential features of theses disorders as a disturbance of mood, characterized by full or partial manic or depressive syndrome that cannot be attributed to another mental disorder. Mood disorders are classified into under two major categories :depressive disorder and bipolar disorders.
Major depressive disorder
This disorder is characterized by depressed mood or loss of interest or pleasure in usual activities. Evidence will show impaired social and occupational functioning that has existed for at least two weeks ,no history of manic behavior ,and symptoms that cannot be attributed to use of substances or a general medical condition.
Major depressive disorder may be further classified as follows :
1. Single episodic or recurrent : a single episode specifier is used for an individual's first diagnosis of depression. Recurrent is specified when the history reveals two or more episodes of depression.
2. Mild, moderate or severe: These categories are identified by the number and severity of symptoms.
3. With psychotic features : the impairment of reality testing is evident . the individual experiences delusions or hallucinations.
4. With catatonic features : this category identifies the presence of psychomotor disturbances such as severe psychomotor retardation ,with or without the presence of waxy flexibility or stupor or excessive motor activity. The individual may also manifest symptoms of negativism, mutism, echolalia or echopraxia.
5. With melancholic features : this is a typically severe form of major depressive episode. Symptoms are exaggerated. Even temporary reactivity to usually pleasurable stimuli is absent. History reveals a good respose to antidepressant or other somatic therapy.
6. Chronic: this classification applies when the current episode of depressed mood has been evident continuously for at least the pat two years.
7. With seasonal patterns: this diagnosis indicates the presence of depressive symptoms during the fall or winter month. This diagnosis is made when the number of seasonal depressive episode is substantially higher than the number of nonseasonal depressive episodes that have occurred over the individuals lifetime.
8. With postpartum onset : this specifier is used when symptoms of major depression occur within 4weeks of postpartum.
Individuals with dysthymic disorder describe the mood as sad or "down in the dumps". There is no evidence of psychotic symptoms. The essential feature is a chronically depressed mood for most of the day, more days than not ,for at least 2 years . It is classified into:
1. Early onset : identifies cases of dysthymic disorder when the onset occurs before age 21 years
2. Late onset : identifies cases of dysthymic disorder when the onset occurs at age 21 years or older.
Premenstrual dysphoric disorder
The DSM IV TR does not include premenstrual dysphoric disorder as an official diagnostic category ,but provides a set of research criteria to promote further study of the disorder. The essential feature include markedly depressed mood ,marked anxiety ,mood swings and decreased interest in activities during the week prior to menses and subsiding shortly after the onset of menstruation.
The bipolar disorder is characterized by mood swings from profound depression to extreme euphoria with intervening periods of normalcy. Delusions or hallucinations may or may not be part of the clinical picture and onset of symptoms may reflect a seasonal pattern.
Bipolar I disorder it is diagnosis given to an individual who is experiencing or has experienced ,a full syndrome of manic and mixed symptoms. The client also may have experienced episodes of depression.
Bipolar II disorders
This diagnostic category is characterized by recurrent bouts of major depression with episodic occurrence of hypomania. The client has never experienced an episode that meets the full criteria for mania or mixed symptomatology.
Cyclothymic disorder
The essential feature of cyclothymic disorder is a chronic mood disorder is a chronic mood disturbance of at least 2years duration involving numerous episodes of hypomania and depressed mood of insufficient severity or duration to meet the criteria for either bipolar I or II disorder.
Mood disorders due to a general medical condition
This disorder is characterized by a prominent and persistent disturbance in mood that is judged to be the result of direct physiological effects of a general of a general medical condition. The mood disturbance may involve depression or elevated ,expansive or irritable mood and causes clinically significant distress or impairment in social ,occupational or other important areas of functioning.
Substance induced mood disorders
The disturbance of mood associated with this disorder is considered to be the direct result of physiological effects of a substance. The mood disturbance may involve depression or elevated ,expansive or irritable mood and cause clinically significant distress or impairment in social ,occupational or other areas of functioning.
ICD 10 classification of mood disorders
The mood disorders are classified as follows :
1. manic episode
2. depressive episode
3. bipolar mood disorders
4. recurrent depressive disorders
5. persistent mood disorders( including cyclothymia and dysthymia).
6. other mood disorders (including mixed affective episode and recurrent brief depressive disorders )
Depression is also linked to morbidity and mortality when it is associated with other illnesses such as cardiovascular disease. As a result of these serious consequences, there has been ongoing research about the etiology, clinical course and outcomes and treatment modalities for mood disorders.
References :
  1. Carson V B. Mental Health Nursing :The Nurse Patient Journet.2nd ed.Philadelphia : W.B. Suanders Company;2000
  2. Fortinash KM, Worret PA .Psychiatric Mental Health Nursing.4th ed. Philadelphia : W.B. Suanders Company;2008
  3. Shives LR .Basic Concepts of Psychiatric -Mental Health Nursing.7th ed.Philadelphia : Lippincott publications; 2008
  4. Sreevani R. A Guide to Mental Health and Psychiatric Nursing. New Delhi:Jaypee Medical Publications ;2004.
  5. Mary TC. Psychiatric Mental Health Nursing -Concept of Care 3rd ed. Philadelphia :F.A. Davis Publishers ;2002
  6. Ahuja N .A Short Text Book of Psychiatry 5th ed. New Delhi: Jayee Medical Brothers Publishers .2002.
  7. Kaplan HI, Sadock BJ. Synopsis of Psychiatry , Behavioral Sciences/ Clinical Psychiatry .9th ed. Hong Kong :William and Wilkinson Publishers ;1998.
  8. Sadock BJ ,Sadock VA. Synopsis of psychiatry :Behavioral Sciences/ Clinical Psychiatry.10th ed. Philadelphia :William and Wilkinson Publishers;2007.
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