Differentiate from specialized causes of mood disorders

Bipolar disorder and  Psychotic depression represent disorders that are difficult for a primary care provider to manage without psychiatric consultation. It is recommended to obtain psychiatric consultation if these disorders are suspected.

Symptoms to cause suspicion of: 

1) Bipolar disorder:

Bi-polar disorder (same diagnostic criteria as for younger people)
Diagnostic criteria: Bipolar Disorder - type 1
#1) persistent elevated mood (Mania) or mixed episodes > 1 week
#2) 3 of the following:	inflated self-esteem	hyper sexuality
	grandiosity	decrease need for sleep
	racing thoughts	flight of ideas
	distractibility	pressured speech
	increase activity
Diagnostically criteria: Bipolar Disorder - type 2 ≥1 episode major depressive disorder accompanied by ≥1 hypomanic episode. (Without either full manic or mixed episodes).

*Mixed episodes; diagnostic criteria for both Mania and Major Depression are present in the patient daily in a rapidly alternating fashion for > 1 week.

2) Psychotic depression: 
    Diagnostic criteria: diagnosis of depression plus hallucinations or delusions
    (Delusions can take the form of: irrational beliefs, inappropriate guilt or jealousy,
    hypochondriasis, nihilism, persecution)