229 Mood Disorder Due to a General Medical Condition (293.83)
DSM-IV-TR criteria — Mood Disorder Due to …[Indicate the General Medical Condition]
- A.prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either ( or both) of the following:
- depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
- elevated, expansive, or irritable mood
- B.There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
- C.The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder with Depressed Mood in response to the stress of having a general medical condition)
- D.The disturbance does not occur exclusively during the course of a delirium.
- E.The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Specify type
- With Depressed Features: if the predominant mood is depressed but the full criteria are not met for a Major Depressive Episode
- With Major Depressive-Like Episodes: if the full criteria are met (except Criterion D) for a Major Depressive Episode
- With Manic Features: if the predominant mood is elevated, euphoric, or irritable
- With Mixed Features: if the symptoms of both mania and depression are present but neither predominates
- Coding Note: Include the name of the general medical condition on Axis I; also code the general medical condition on Axis III
- Coding Note: If depressive symptoms occur as part of a preexisting Vascular Dementia, indicate the depressive symptoms by coding the appropriate subtype.
Associated features
An individual may have different conditions. A person may have degenerative neurological conditions such as Parkinson’s or Huntington’s disease, or they may have cerebrovascular, metabolic conditions, autoimmune conditions, endocrine conditions, cancer, viral or other infections.
Differential Diagnosis:
A separate diagnosis of Mood Disorder Due to a General Medical Condition is not given if the mood disturbance occurs exclusively during the course of a delirium. In contrast, a diagnosis of Mood Disorder Due to a General Medical Condition may be given in addition to a diagnosis of dementia if the mood symptoms are a direct etiological consequence of the pathological process causing the dementia and if the mood symptoms are a prominent part of the clinical presentation (e.g., Mood Disorder Due to Alzheimer’s Disease). An exception to this occurs when depressive symptoms occur exclusively during the course of Vascular Dementia.
If there is evidence of recent or prolonged substance use (including medications with psychoactive effects), withdrawal from a substance, or exposure to a toxin, a Substance-Induced Mood Disorder should be considered.
Mood Disorder Due to a General Medical Condition must be distinguished from Major Depressive Disorder, the Bipolar disorders, and Adjustment Disorder with Depressed Mood. In these Disorders, no specific and direct causative physiological mechanisms associated with a general medical condition can be demonstrated.
Child vs. adult presentation
Gender and cultural differences in presentation
Epidemiology
Prevalence estimates for Mood Disorder Due to a General Medical Condition are confined to those presentations with depressive features. Between 25% and 40% of individuals with certain neurological conditions (including Parkinson’s disease, Huntington’s disease, multiple sclerosis, stroke, and Alzheimer’s disease) will develop a marked depressive disturbance at some point during the course of the illness. For general medical conditions without direct central nervous system involvement, rates are far more variable, ranging from more than 60% in Cushing’s syndrome to less than 8% in end-stage renal disease.
