Substance-Induced Mood Disorder

DSM-IV-TR criteria

• A.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 of either (1) or (2):
  • 1. the symptoms in Criterion A developed during, or within a month of, Substance Intoxication or Withdrawal
  • 2. medication use is etiologically related to the disturbance
• C.The disturbance is not better accounted for by a Mood Disorder that is not substance induced. Evidence that the symptoms are better accounted for by a Mood Disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication or are substantially in excess of what would be expected given the evidence that suggests the existence of an independent non-substance-induced Mood Disorder (e.g., a history of recurrent Major Depressive Episodes).
• 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.
  • NOTE: This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the mood symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant indecent clinical attention.
• Code [Specific Substance]-Induced Mood Disorder:
• (291.89 Alcohol; 292.84 Amphetamine [or Amphetamine-Like Substance]; 292.84 Cocaine; 292.84 Cocaine; 292.84 Hallucinogen; 292.84 Inhalant; 292.84 Opioid; 292.84 Phencyclidine [or Phencyclidine-Like Substance]; 292.84 Sedative; Hypnotic, or Anxiolytic; 292.84 Other [or Unknown] Substance).
• Specify type:
  • With Depressive Features: if the predominant mood is depressed
  • With Manic Features: if the predominant mood is elevated, euphoric, or irritable
  • With Mixed Features: if symptoms of both mania and depression are present and neither predominate
  • With Onset During Intoxication: if the criteria are met for Intoxication with the substance and the symptoms develop during the intoxication syndrom
  • With Onset During Withdrawal: if criteria are met for Withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal syndrome

Associated features

Individuals may suffer from both independent and substance-induced mental disorders, but substance-induced mental disorders are different because most all of the psychiatric symptoms are caused by substance use, abuse, or withdrawl. Substance-induced mental disorder symptoms can range from anxiety and depression to full psychotic episodes. Physical symptoms usually subside days after substance use has stopped, but some psychotic symptoms can have long-term effects due to toxins damaging the brain (Substance-Induced Disorders, 2009).

Differential Diagnosis:

Mood symptoms occur commonly in Substance Intoxication and Substance Withdrawal, and the diagnosis of the substance-specific intoxication or substance-specific withdrawal will usually suffice to categorize the symptom presentation. A diagnosis of Substance-Induced Mood Disorder should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the mood symptoms are judged to be in excess of those usually associated with the intoxication or withdrawal syndrome and when the mood symptoms are sufficiently severe to warrant independent clinical attention. For example, dysphoric mood is a characteristic feature of Cocaine Withdrawal. Cocaine-Induced Mood Disorder should be diagnosed instead of Cocaine Withdrawal only if the mood disturbance is substantially more intense than what is usually encountered with Cocaine Withdrawal and is sufficiently severe to be a separate focus of attention and treatment.

If substance-induced mood symptoms occur exclusively during the course of a delirium, the mood symptoms are considered to be an associated feature of the delirium and are not diagnosed separately. In substance-induced presentations that contain a mix of different types of symptoms (e.g., mood, psychotic, and anxiety symptoms).

A Substance-Induced Mood Disorder is distinguished from a primary Mood Disorder by the fact that a substance is judged to be etiologically related to the symptoms.

Substances such as, stimulants, methamphetamines, and cocaine can produce manic, hypomanic, depressive, and mixed episodes. Substances such as alcohol are consumed by individuals with major depressive disorder as a means of self-medication, but this may worsen the effects of depression in those individuals who abuse large amounts of alcohol. Benzodiazepines are said the have effects on the body similar to that of alcohol when consumed over the long-term (Mood Disorder, 2010).

Because individuals with general medical conditions often take medications for those conditions, the clinician must consider the possibility that the mood symptoms are caused by the physiological consequences of the general medical condition rather than the medication, in which case Mood Disorder Due to a General Medical Condition is diagnosed.

Child vs. adult presentation

Gender and cultural differences in presentation

Substance-induced mood disorder is equally prevalent in males and females. There are some cultural preferences on the other side of the globe but research is scarce in this area and uncertain. Different cultures view disorders in drastically different contexts, some religious aspects as well as to do with family and the lineage.

Epidemiology

Although substance-induced mood disorder is listed in the DSM-IV-TR, the DSM-IV-TR does not include any data regarding prevalence or inceidence of this disorder (Nash, 2008).

Etiology

Mood Disorders can occur in association with intoxication with the following classes of substances: alcohol; amphetamine and related substances; cocaine; hallucinogens; inhalants; opioids; phencyclidine and related substances; sedatives, hypnotics, and anxiolytics; and other or unknown substances.

Mood Disorders can occur in association with withdrawal from the following classes of substances: alcohol; amphetamine and related substances; cocaine; sedatives, hypnotics, and anxiolytics; and other or unknown substances.

Empirically supported treatments