F39 Diagnostic Criteria

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Unspecified mood (affective) disorder

296.90 Mood disorders NOS

criteria. As an affective experience of sadness, it is common to all humans; as a symptom, it is present in several mental and physical illnesses and, as a syndrome, it is associated with specific mental and physical disorders.

The prototype of the syndromal entity of depressive disorders is the depressive episode (DE) in ICD-10 and the corresponding major depressive episode (MD) in DSM-IV. In both systems, it serves as the qualifying yardstick for all the other forms of depression.

Depressive Episode — Major Depression

As shown in Table 1.1, both DE and MD are specified according to their severity (mild, moderate, severe) and course (single or recurrent). Furthermore, both systems share two fundamental features for identifying depressive episodes: (a) a minimum number of typical and associated symptoms; (b) a minimum duration of symptoms of 2 weeks. In DSM-IV, but not in ICD-10, a third feature is added, that is the impairment in important areas of functioning.

The symptom criteria for the DE according to ICD-10 are listed in Table 1.2. The typical symptoms are depressed mood and lack of interest, pleasure and energy. The typical symptoms are combined with the additional ones in many patterns, each one of them determining the clinical picture of a depressive episode at the individual's level. Symptoms may not be stable during the

Table 1.2 Depressive episode according to ICD-10 General criteria

• The depressive episode should last for at least 2 weeks

• No hypomanic or manic symptoms sufficient to meet the criteria for hypomanic or manic episode at any time in the individual's life

• Not attributable to psychoactive substance use or to any organic mental disorder Typical symptoms

• Depressed mood to a degree that is definitely abnormal for the individual, present for most of the day and almost every day, largely unresponsive to circumstances, and sustained for at least 2 weeks

• Loss of interest or pleasure in activities that are normally pleasurable

• Decreased energy or increased fatigability

Additional symptoms

• Loss of confidence or self-esteem

• Unreasonable feelings of self-reproach or excessive and inappropriate guilt

• Recurrent thoughts of death or suicide, or any suicidal behavior

• Complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation

• Bleak and pessimistic views of the future

• Sleep disturbance of any type

• Change in appetite (decrease or increase) with corresponding weight change episode, and their change over time adds to the polymorphic presentation of each particular depressed patient.

There is no one single pathognomonic symptom that in itself would identify DE/MD depression and would allow its monothetic classification. However, the symptoms listed in Table 1.2 and described more extensively below, are considered as core symptoms which, if present in sufficient number and duration, provide for a reliable and valid diagnosis of DE/MD as a distinct psychopathological syndrome.

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