CATEGORIES OF MOOD DISORDERS
The primary mood disorders are major depressive disorder and bipolar disorder (formerly called manic-depressive illness). A major depressive episode lasts at least 2 weeks, during which the person experiences a depressed mood or loss of pleasure in nearly all activities. In addition, four of the following symptoms are present: changes in appetite or weight, sleep, or psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty think-ing, concentrating, or making decisions; or recurrent thoughts of death or suicidal ideation, plans, or attempts. These symptoms must be present every day for 2 weeks and result in significant distress or impair social, occupa-tional, or other important areas of functioning (American Psychiatric Association [APA], 2000). Some people also have delusions and hallucinations; the combination is referred to as psychotic depression.
Bipolar disorder is diagnosed when a person’s mood cycles between extremes of mania and depression (as described previously). Mania is a distinct period during which mood is abnormally and persistently elevated, expansive, or irritable. Typically, this period lasts about 1 week (unless the person is hospitalized and treated sooner), but it may be longer for some individuals. At least three of the following symptoms accompany the manic episode: inflated self-esteem or grandiosity; decreased need for sleep; pressured speech (unrelenting, rapid, often loud talking without pauses); flight of ideas (racing, often unconnected, thoughts); distractibility; increased involvement in goal-directed activity or psy-chomotor agitation; and excessive involvement in plea-sure-seeking activities with a high potential for painful consequences (APA, 2000). Some people also exhibit delusions and hallucinations during a manic episode.
Hypomania is a period of abnormally and persistently elevated, expansive, or irritable mood lasting 4 days and including three or four of the additional symptoms described earlier. The difference is that hypomanic epi-sodes do not impair the person’s ability to function (in fact, he or she may be quite productive), and there are no psychotic features (delusions and hallucinations). A mixed episode is diagnosed when the person experiences both mania and depression nearly every day for at least 1 week. These mixed episodes often are called rapid cycling. For the purpose of medical diagnosis, bipolar disorders are described as follows:
· Bipolar I disorder—one or more manic or mixed episodes usually accompanied by major depressive episodes.
· Bipolar II disorder—one or more major depressive episodes accompanied by at least one hypomanic episode.
People with bipolar disorder may experience a euthy-mic or normal mood and affect between extreme episodes, or they may have a depressed mood swing after a manic episode before returning to a euthymic mood. For some, euthymic periods between extremes are quite short. For others, euthymia lasts months or even years.