Diagnosis of Mood Disorders

Bipolar Disorder (Vs. Major Depressive Disorder)

The factors that predict bipolar disorders are:

Early age at onset.

• Psychotic depression before 25 years of age.
• Rapid onset and offset of major depressive episodes of short duration (less than three months).
• Recurrent depression of more than five episodes.
• Postpartum depression, especially with psychotic features.
• Depression with marked psychomotor retardation.
• Atypical features
• Seasonality
• Depressive mixed states
• Family history of bipolar disorder
• High-density three-generation pedigrees.
• Train mood lability (Cyclothymia)
• Hyperthermic temperament
• Hypomania associated with antidepressants
• Repeated (at least three times) loss of efficacy of antidepressants after initial response.
• Agitated depression
• Cyclical depression
• Episodic sleep dysregulation
• Refractory depression
• Periodic impulsivity
• Periodic irritability, suicidal crisis, or both
• Depression with erratic personality disorders may predict bipolar disorder
• Depression in someone with an extroverted profession

Also read: MCQs on Psychiatric Assessment and Family History

Anxiety Disorders

Depression patients may experience anxiety symptoms; anxiety disorders such as panic attacks, morbid fears and obsessions and higher anxiety states can have depression as a

Complication. Common diathesis is present in depression and generalized anxiety disorder. The features favoring a diagnosis of depression are:

• Early morning awakening
• Severe sadness
• Hopelessness
• Suicidal ideation
• Self-deprecation
• Psychomotor retardation
• Loss of libido
• Weight Loss

Late age of appearance of marked anxiety features may indicate clinical depression. A superior response to ECT is indicative of depression. Anxiety arising during a depressive episode. Anxiety symptoms are experienced by patients using alcohol, sedative-hypnotic, or stimulant drugs. The features that favor the diagnosis of anxiety disorders are:

• Severe tension and panic
• Hypervigilance
• Perceived danger and phobia
• Avoidance
• Doubt and insecurity
• Performance anxiety

Also read: Cognitive Theory by Aaron Beck: Distortions & Depression

Personality Disorders

The clinician should refrain from using personality disorder diagnosis in patients with affective disorders. The clinician should focus on the treatment of mood disorders. In many cases, the symptoms of personality disorders may arise after the mood disorders. In some cases, the rush to diagnose a personality disorder may hinder the diagnosis and treatment of the mood disorder.

Overlap of borderline Personality Disorder and Mood Disorder

It is sometimes difficult to differentiate between personality disorders and mood disorders because of some overlapping symptoms. The following points should be noted:  

Familial history: High rates of mood disorder

• Phenomena: dysthymic disorder, cyclothymic disorder, bipolar II disorder, and mixed state disorders.
• Pharmacological response: personality disorders may worsen on antidepressants, whereas they stabilize on anticonvulsants.
• Prospective course: Major mood episodes and suicide
• There is an intimate relationship between atypical depression, borderline personality, and bipolar II disorder.
  • These disorders share underlying psychological or genetic diathesis.
  • Antidepressant responses may be disappointing.
  • Mood disorder is bipolar II disorder; it is often complicated by ultrarapid cycling.
  • Lamotrigine is a promising drug.

Also read: Understanding Catatonia: Symptoms, Diagnosis & Treatment Options

Alcohol and substance use disorders

High comorbidity of alcohol and substance use disorder with mood disorders. Patients with mood disorders may self-medicate with alcohol and other substances. Mood disorder should be seriously considered as the primary diagnosis in patients with alcohol and substance use disorders if the affective symptoms persist or escalate after detoxification, for example, in one month. However, patients with alcohol and substance use disorders may show alleviation of symptoms upon withdrawal.

Schizophrenia

The differential diagnosis between mood disorders and schizophrenia is based on:

Overall clinical picture: The diagnosis should be based on the overall clinical picture rather than current symptoms.

• Phenomenology
• Family history
• Course
• Associated features

The mood disorders will depict an inter-episodic recovery, whereas the schizophrenia course will be more chronic with exacerbations and remissions. There can be post-psychotic depression in schizophrenia.

• It may be due to inadequate control of schizophrenia symptoms.
• It may reflect the experience of losing one's sanity.
• Medication effects may also lead to depressive symptoms.

Also read: Delusional Disorders : History, Classification

Schizoaffective Disorder

The patients experience recurrent psychosis with full affective and schizophrenic symptoms occurring simultaneously during each episode. The diagnosis of this disorder should not be made in a patient with mood disorder with psychotic symptoms, in which mood-incongruent psychotic features can be explained by

• Affective psychosis superimposed on mental retardation.
• It is complicated by brain disease, substance use, or withdrawal.
• There are mixed episodes of bipolar disorder.

Other differential diagnosis

Other differential diagnosis disorders are:

• Adjustment disorders
• Eating disorders
• Somatoform disorders

These are commonly associated with depressive symptoms and should be considered in the differential diagnosis of mood disorders.

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Hope you found this blog helpful for your Psychiatry Residency Clinical Psychiatry Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.