Diagnostic subtypes of mood disorders in DSMIV

1. Major depressive (unipolar) disorder is characterized by depressive episodes without any hypomanic or manic states: the patient is either depressed or average in mood, but experiences no mania.

2. Bipolar disorder is characterized by manic or hypomanic states: the patient is either depressed, euthymic (normal in mood), or hypomanic/manic. Bipolar disorder differs from unipolar disorder by including manic states. No matter how many times a patient is depressed, only one manic/hypomanic episode is required to diagnose bipolar rather than unipolar disorder. Bipolar disorder is further characterized as type I or type II. Type I is diagnosed when at least one manic episode is identified. Usually recurrent depression also occurs, but in 5 to 10 per cent of cases there are no diagnosable major depressive episodes, although almost always there will be minor depressive episodes. Bipolar disorder type II requires the absence of even one manic episode, and instead the occurrence of at least one hypomanic episode and at least one major depressive episode. The critical difference between mania and hypomania, in current DSM-IV nosology, is that mania requires significant social and occupational dysfunction, while in hypomania significant social and occupational dysfunction needs to be excluded. Durational criteria are less strict for hypomania (a minimum of 4 days) than for mania (a minimum of 1 week).

3. Dysthymia refers to clinically significant major depressive symptoms that are present for 2 years or more but do not reach the threshold (with respect to severity and/or number of symptoms) for major depression. Cyclothymia is a condition in which, like dysthymia, depressive symptoms do not reach the threshold for diagnosis of a major depressive episode, and hypomania is present. Cyclothymia and dysthymia may represent a predisposition to major mood disorders. Lastly, whereas cyclothymia and dysthymia involve some depressive states, 'hyperthymia' is sometimes used to describe chronic mild hypomania (decreased need for sleep, expansive behaviour, marked extroversion, 'the life and soul of the party'). Patients with dysthymia, cyclothymia, or hyperthymia may develop unipolar or bipolar disorder under certain circumstances, such as with antidepressant use (see below).

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