1. Classification of Mood Disorders
International Classification of Diseases (ICD-10) came into
use in WHO Member States as from 1994
F30 Manic episode
F31 Bipolar affective disorder
F32 Depressive episode
F33 Recurrent depressive disorder
F34 Persistent mood (affective) disorders
F38 Other mood (affective) disorders
F39 Unspecified mood (affective) disorder
2. Criteria for depressive episode DSM-
III-R/DSM-IV
Symptoms present nearly every day in same 2-week
period Change from normal functioning
Key symptoms (n = 2) Depressed mood ,Anhedonia
Ancillary symptoms (n 7) Fatigue/loss of energy
Weight/appetite loss/gain Insomnia/hypersomnia
Observed agitation/retardation Low self-esteem/guilt
Impaired thinking/concentration Suicidal thoughts =
Criteria: one key, five symptoms in total Plus Significant
distress Or Social impairment Exclusions Not mixed
episode Not substance related Not organic Not
bereavement Not psychotic
3. ICD-10
• Episode must have lasted at least 2 weeks with symptoms nearly
every day Change from normal functioning Key symptoms (n 3)
Depressed mood Anhedonia Fatigue/loss of energy
• Ancillary symptoms (n 7) Weight and appetite change Sleep
disturbance Subjective or objective Agitation/retardation Low self-
esteem/confidence Self reproach/guilt Impaired
thinking/concentration Suicidal thoughts
• Criteria: Mild episode: two key, four symptoms in total
• Moderate: two key, six symptoms in total
• Severe: three key, eight symptoms in total = = Exclusions No history
(ever) of manic symptoms Not substance related Not organic
4. Key points – epidemiology and impact
• Depression is a common mental disorder, affecting around 5% of the population
over a 12-month period, with around 20% of people likely to experience
depression over the course of their lifetime.
• Women are nearly twice as likely to experience depression than men, and
depression more commonly affects people who are divorced or separated, or who
have experienced violence or abuse, as well as those experiencing socioeconomic
adversity.
• The majority of the disability attributed to mental and neurological disorders in
the world is due to depression: nearly 33% as measured by disability-adjusted life-
years.
• In highand middle-income countries, depression is the leading cause of disability
and, primarily due to changes in demographic and disease distribution patterns, its
contribution to global disability is projected to increase over future decades.
• Depression is related to a range of biological, sociocultural and psychological
factors, and though there are strong links between adversity and its onset these
events are not necessarily predictive of depression for individuals.
• At least half of all people affected by depression experience more than a single
episode, and the risk of recurrence increases with each successive episode.
5. Symptoms of dysthymic disorder
• For diagnostic purposes at least two of these
symptoms must be experienced for most of the
day, for more days than not, for at least 2 years
• Disturbed sleep – insomnia or hypersomnia
• Poor concentration or difficulty making decisions
• Reduced energy or fatigue (anergia)
• Disturbed appetite – may be increased or
decreased
• Feelings of hopelessness or pessimism
• Low self-esteem
6. Features of mixed anxiety and
depressive disorder
Diagnosis based on the presence of symptoms of anxiety and
depression, but neither is clearly predominant Neither
type of symptom is present to the extent that justifies a
diagnosis if considered separately Symptoms should be
present for at least 4 weeks, and result in significant
distress or functional impairment
Typical symptoms include those listed below • Anxiety •
Persistent nervousness • Palpitations, chest pain, dizziness
• Irritability • Fearful anticipation • Excessive alertness
Depression • Sleep disturbance • Fatigue or low energy •
Hopelessness or pessimism • Poor concentration • Low
self-esteem or feelings of worthlessness
7. Diagnostic features of bipolar
disorder(Mania)
A distinct period of abnormally and persistently elevated or irritable
mood, lasting at least 1 week (or 4 days for hypomania/ bipolar II disorder)
The mood change is severe enough to disrupt normal activities
Several of the following symptoms are present:
– inflated self-esteem or grandiosity
– decreased requirements for
– racing thoughts or flight of ideas
– reduced attention or distractibility
– increased talkativeness
– increased activity levels or agitation
– increased involvement in activities that have a risk of adverse
consequences (sexual relationships, business ventures, spending sprees)
• .
11. Sleep hygiene activities for improving
sleep quality •
• A clear routine is important, and a consistent waking time is more important than
bedtime: get up at the same time each day, 7 days a week
• If you are not asleep after about 20 minutes, go to another room and do
something relaxing, such as listening to soothing music, before returning to bed
• Keep your bedroom dark, reducing stimulation such as noise; keep the room
cooler rather than warmer
• Avoid stimulating activity such as heated discussions or work before going to sleep
• A regular exercise program helps sleep, but not in the hours prior to bedtime
• Avoid caffeine (coffee, tea, cola drinks) within 7 hours of bedtime
• Avoid alcohol in the evening, as it can reduce the quality of sleep or make you
wake in the night
• A light carbohydrate snack before bed may be helpful
• Avoid naps; sleep should be reserved for bedtime
• A wind-down routine before going to bed (e.g. reading, having a warm bath or
listening to music) can make it easier to sleep
