Classification and subclassification of major depression disorder and bipolar affective disorder

6.03.1.1.1.5.1 Major depressive disorder The symptom criteria for major depression in DSM-IV-TR and ICD-10 guidelines are very similar (Table 2), although the coding systems are somewhat different.6'7 One difference is that the ICD-10 has a separate, optional subdiagnosis for depression with and without somatic symptoms. The latter is not present in the DSM-IV system. Both sets of guidelines have depressive disorder subdiagnoses for the following:

• mild, moderate, and major severity;

• single and recurrent episodes;

• with and without psychotic symptoms; and

• partial and full remission.

Table 2 Abridged DSM-IV criteria for major depressive episode

A. Over the last 2 weeks, five of the following features should be present most of the day, or nearly every day (must include one or two):

1 Depressed mood

2 Loss of interest or pleasure in almost all activities

3 Significant weight loss or gain (more than 5% change in 1 month) or an increase or decrease in appetite nearly every day

4 Insomnia or hypersomnia

5 Psychomotor agitation or retardation (observable by others)

6 Fatigue or loss of energy

7 Feelings of worthlessness or excessive or inappropriate guilt (not merely self-reproach about being sick)

8 Diminished ability to think or concentrate, or indecisiveness (either by subjective account or observation of others)

9 Recurrent thoughts of death (not just fear of dying), or suicidal ideation, or a suicide attempt, or a specific plan for committing suicide

B. The symptoms cause clinically significant distress or impairment in functioning

C. The symptoms are not due to a physical/organic factor or illness. The symptoms are not better explained by bereavement (although this can be complicated by major depression)

From the Fourth Revision of the American Psychiatric Association's Diagnostic and Statistics Manual.6

Reprinted by permission of Sage Publications Ltd from Anderson, I. M.; Nutt, D. J.; Deakin, J. F. W. J. Psychopharmacol.

2000, 14, 3-20. Copyright (© British Association for Psychopharmacology, 2000).3

Table 3 Types of BPAD

Bipolar I (BPI) (DSM-IV 296.00-296.06, 296.40-296.7)

- 1% prevalence

- at least one episode of full-blown mania

- episodes of hypomania, mixed states, and depression

- at least one episode of depression

- at least one episode of hypomania

Bipolar spectrum disorder (DSM-IV includes all of above plus 301.13)

- up to 5% prevalence

- includes BPI, BPII, schizoaffective disorders, cyclothymia

DSM-IV comprises additional subcategories for catatonic, melancholic, and atypical features and for postpartum onset. Both ICD-10 and DSM-IV present affective disorders together in one section, distinguishing bipolar from unipolar disorder, including dysthymia, and using clear definitions. Operational problems with ICD-10 include complexity, use of different clinical and research definitions, emphasis on single versus recurrent episodes, and the lack of some clinically useful subtypes. DSM-IV is less complex but assigns separate unjustified categories of medical and substance-induced mood disorders, and fails to code its useful qualifiers.10

6.03.1.1.1.5.2 Bipolar disorder This describes a spectrum of disorders in which episodes of depression and mania occur, interspersed with periods of normal mood. It is also known as bipolar depression or manic depression. BPAD is characterized by cycles of mania and depression, which cause a person with bipolar disorder to experience severe mood swings. There are three types of BPAD according to DSM-IV (Table 3)6:

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  • Girma
    What are the subclassification of depression?
    2 years ago

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