Depressive Disorders (Unipolar depression) and Bipolar Disorders

Depressive Disorders (Unipolar depression)

a. Major depressive Disorder

The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypo manic Episodes.

b. Dysthymic Disorder

The essential feature of Dysthymic Disorder is a chronically depressed mood that occurs for most of the days during the first 2 years. Patients usually describe their mood as sad or ‘down in the dumps’. The diagnosis of Dysthymic Disorder can be made only if the initial 2-year period of dysthymic symptoms is free of Major Depressive Episodes.The most commonly encountered symptoms in Dysthymic Disorder may be feelings of inadequacy; generalized loss of interest or pleasure; social withdrawal; feelings of guilt or brooding about the past; subjective feelings of irritability or excessive anger; and decreased activity, effectiveness,or productivity. In children,Dysthymic Disorder seems to occur equally in both sexes and often results in impaired school performance and social interaction. Children and adolescents with Dysthymic Disorder are usually irritable and cranky as well as depressed. They have low self-esteem and poor social skills and are pessimistic. In adulthood, women are two to three times more likely to develop Dysthymic Disorder than are men.

Bipolar Disorders

This includes Bipolar I Disorder, Bipolar II Disorder, Cyclothymia, and Bipolar Disorder Not Otherwise Specified.

a. Bipolar I disorder

Bipolar I disorder is characterized by one or more Manic or Mixed Episodes, usually accompanied by Major Depressive Episodes.

There are six separate criteria sets for Bipolar I Disorder: Single Manic Episode,Most Recent Episode Hypomanic, Most Recent Episode Manic, Most Recent Episode Mixed,Most Recent Episode Depressed, and Most Recent Episode Unspecified Diagnostic Criteria Bipolar I is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes.Often the individuals have also had one or more Major Depressive Episodes.

Bipolar I Disorder, single Manic Episode, isused to describe individuals who are having a first episode of mania.The remaining criteria sets are used to specify the nature of the current (or most recent) episode in individuals who have had recurrent mood episodes which is shown in the table.

b. Bipolar II disorder

The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode. The presence of a Manic or Mixed Episode precludes the diagnosis of Bipolar II Disorder. Patients with Bipolar II disorder may not view the Hypomanic Episodes as pathological, although others maybe troubled by the patient’s erratic behaviour.Often patients, particularly when in the midst of a Major Depressive Episode, do not recall periods of hypomania without reminders from close friends or relatives. Information fro mother informants is often critical in establishing the diagnosis of Bipolar II Disorder. This is also known as Recurrent Major Depressive Episodes With Hypomanic Episodes.

Diagnostic Criteria For Bipolar II Disorder

A. Presence (or history) of one or more Major Depressive Episodes.
B. Presence (or history) of at least one Hypomanic Episode.

C. There has never been a manic Episode or a Mixed Episode.
D. The mood symptoms in Criteria A and B are not better accounted for by Schizo affective Disorder and are not superimposed on Schizophrenia, Schizophreni form Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

E. The Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify current or most recent episode:

Hypomanic.This specifier isused if the current (or most recent) episode is a Hypomanic Episode.

Depressed. This specifier is used if the current (or most recent) episode is a Major Depressive Episode.
The following specifiers maybe used to describe the current Major Depressive Episode in Bipolar II Disorder (or the most recent Major Depressive Episode if currently in remission only if it is the most recent type of mood episode):

Mild,Moderate, Severe Without Psychotic Features, Severe With Psychotic Features,
In Partial Remission, In Full Remission Chronic With Catatonic Features or With Melancholic Features or With A typical Features or With Postpartum Onset

c. Cyclothymic disorder

The essential feature of Cyclothymic Disorder is a chronic, fluctuating mood disturbance involving at least 2 years of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms that do not meet criteria for a Major Depressive  Episode.The hypomanic symptoms are of insufficient number, severity, pervasiveness, or  duration to meet full criteria for a ManicEpisode, and the depressive symptoms are of insufficient number, severity, pervasiveness, or duration to meet full criteria for a Major Depressive Episode.The diagnosis of Cyclothymic Disorder is made only if the initial 2-year period of cyclothymic symptoms is free of Major Depressive,Manic, and Mixed Episodes.

d. Bipolar Disorder Not Otherwise Specified

It includes disorders with bipolar features that do not meet criteria for any specific Bipolar Disorder