Assessing and diagnosing patients with mood disorders
A depressive presentation looks the same whether the disorder is unipolar or bipolar — the difference is in a history you have to go looking for.
Editorial process
Last reviewed · August 8, 2026
The distinguishing feature is not in the room
The brief's opening paragraph is a clinical warning disguised as scene-setting, and it tells you what the marker is looking for. Depressive disorders are *periodic and at times cyclic*; bipolar disorders are *difficult to properly diagnose*. Put those together and you have the central diagnostic problem in mood disorders: a patient presenting in a depressive episode looks identical whether the underlying disorder is unipolar or bipolar, because the depressive phases are phenomenologically similar and the distinguishing feature — a past hypomanic or manic episode — is in the history rather than in the room. A comprehensive psychiatric evaluation that does not actively screen for that history has produced a plausible diagnosis that may be wrong, and wrong in a way that changes treatment. Write the screening question you would use into the evaluation itself, because an assessor cannot tell the difference between a history that was taken and one that was assumed unless the asking is documented.
That makes the *Subjective* section the load-bearing one, and the template's own prompts point at it: chief complaint, symptomology, duration, severity, and impact on functioning. Duration does more work than students expect, because the DSM-5 criteria for several mood disorders are distinguished largely by time — two weeks for a major depressive episode, two years for persistent depressive disorder, four days for hypomania, one week for mania. Getting the timeline right often settles the differential on its own. Impact on functioning is not padding either: it is a criterion, and a symptom list without functional consequence does not meet the diagnostic threshold however severe the symptoms sound. Ask about it in units the patient can answer — weeks off work, meals missed, calls unreturned — rather than asking whether functioning is impaired, which invites a yes that means nothing.
The brief also plants a cultural clause worth answering explicitly — *depending on the cultural history of the client, may affect their decision to seek treatment*. This is an invitation to discuss how presentation and help-seeking vary: somatic presentation of depression, the vocabulary a patient has for describing mood, stigma and family involvement in the decision to attend, and the way an interviewer's assumptions can turn a culturally normative response into an apparent symptom. Addressing it inside the Subjective and Assessment sections rather than as a closing paragraph shows it shaped the assessment rather than decorating it, which is what the brief's own sentence is asking for. Two sentences inside the Subjective section and one inside the Assessment are usually enough; the failure mode is a paragraph at the end that could have been written before meeting the patient.
The Assessment section carries the explicit instruction that most answers underperform on: a minimum of three differentials, *listed in order from highest priority to lowest*, each compared against DSM-5 criteria with supporting evidence. Priority order is an argument, not a list — it says which diagnosis best accounts for the presentation and why the others rank below it. For each differential, name the criteria met, the criteria not met, and what additional information would move it up or down. A good set of three usually includes the most likely diagnosis, the one that would change treatment most if missed (typically a bipolar spectrum disorder), and a condition that mimics mood pathology — substance-induced, medical, or grief-related. Say what you would ask next for each of the three, since a differential that cannot be advanced by any further question has been recorded rather than reasoned about.
Practical points. The template is the deliverable, so use the supplied Comprehensive Psychiatric Evaluation Template and the exemplar rather than writing an essay with headings. The video case must be selected by Day 1 from the Video Case Selections, and the Case History Reports document supplies additional data the video does not — read both before writing, because the evaluation template asks for information the video alone will not give you. The Objective section wants your observations from the assessment, which in a video case means what you can actually see and hear: appearance, psychomotor activity, speech, affect, and the discrepancies between what the patient reports and how they present. Watch for the mismatch specifically: a patient reporting mild low mood while sitting motionless with a flat affect is telling you two different things, and the discrepancy belongs in the Objective section.
Template section | What it is really asking | The evaluation that loses marks |
|---|---|---|
Subjective: chief complaint | The patient's own words | A diagnosis stated as a complaint |
Subjective: duration | Timeline against DSM-5 thresholds | "For a while" |
Subjective: severity and function | Impact, which is itself a criterion | Symptoms listed with no functional consequence |
Subjective: past episodes | Active screening for hypomania and mania | Never asked, so unipolar assumed |
Objective | What you observed, not what was reported | Subjective content repeated |
Assessment: mental status exam | Structured domains, described | "MSE was unremarkable" |
Assessment: three differentials | Ranked, with criteria met and unmet | Three diagnoses named in no order |
Assessment: primary diagnosis | The reasoning that selected it | A conclusion with no visible reasoning |
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Screen actively for the history that distinguishes unipolar from bipolar depression.
- 02Use DSM-5 duration thresholds to discriminate between mood disorders.
- 03Rank differentials as an argument rather than listing them.
- 04Account for cultural variation in presentation and help-seeking.
Read the full question
Review every instruction before using the planning guidance that follows.
What the comprehensive psychiatric evaluation must contain
- 01A completed Comprehensive Psychiatric Evaluation on the selected video case.
- 02Subjective data: chief complaint, symptomology, duration, severity, functional impact.
- 03Objective data: observations made during the assessment.
- 04Mental status examination results, discussed.
- 05At least three differential diagnoses.
- 06Those differentials ranked from highest to lowest priority.
- 07DSM-5 criteria compared for each differential.
- 08A primary diagnosis with the critical-thinking process that produced it.
From subjective data to a ranked differential
Subjective
Record the complaint, symptomology, duration, severity and functional impact.
History that changes the diagnosis
Screen deliberately for past elevated mood, substance use and medical causes.
Objective
Report what you observed during the assessment.
Mental status examination
Work through the standard domains and describe the findings.
Differentials, ranked
Give three or more, ordered, each measured against DSM-5 criteria.
Primary diagnosis and reasoning
Select one and show the thinking that ruled the others below it.
Reading the DSM-5 criteria before comparing them
Recommended databases
- The DSM-5
- NCBI Bookshelf (StatPearls)
- PubMed Central
- The week's Learning Resources and Case History Reports
Search sequence
- 1.Read the DSM-5 criteria for the mood disorders in your differential before writing, since the template asks you to compare criteria and a summary from memory will not survive that comparison.
- 2.Look up the literature on bipolar disorder being misdiagnosed as unipolar depression, which is the specific risk this assignment is built around and which justifies your screening questions.
- 3.Check a mental status examination reference so the Objective and MSE sections use the standard domains rather than free description.
- 4.Search cultural variation in the presentation of depression, so the brief's own clause about cultural history is answered with evidence.
Mood disorder criteria, MSE and misdiagnosis sources
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Major Depressive Disorder
StatPearls, NCBI Bookshelf · 2023
The criteria and the differential in one place, including the medical and substance-induced causes that belong in your three. Use it to check that each differential you list has both criteria met and criteria not met, which is what the template asks for.
- 02
Mental Status Examination
StatPearls, NCBI Bookshelf · 2023
The standard domains, in order, with the vocabulary used to describe findings in each. This is what turns an MSE section from a paragraph of impressions into a documented examination a colleague could act on.
- 03
Depression diagnoses following the identification of bipolar disorder: costly incongruent diagnoses
BMC Psychiatry · 2010
Evidence for the assignment's central risk: patients later identified as bipolar carry prior depression diagnoses, at a cost. Cite it to justify why your evaluation screened explicitly for past elevated mood rather than treating that as optional history.
- 04
Differential diagnosis of bipolar II disorder and major depressive disorder: Integrating multimodal approaches
World Journal of Psychiatry · 2026
Current work on the hardest discrimination in this assignment. It supplies the specific features that separate bipolar II from unipolar depression, which is exactly the material the Assessment section needs when ranking those two against each other.
- 05
Persistent Depressive Disorder
StatPearls, NCBI Bookshelf · 2023
The differential that duration alone distinguishes, which makes it the clearest demonstration of why the Subjective section's timeline matters. Worth including in the three whenever the history describes a long, low-grade course.
Before the psychiatric evaluation is submitted
Common mistakes
- Assuming unipolar depression without screening for past hypomania or mania.
- Reporting duration vaguely where DSM-5 thresholds are measured in days and weeks.
- Listing symptoms with no statement of functional impact.
- Putting the patient's diagnosis in the chief complaint instead of their words.
- Repeating subjective content in the Objective section.
- Summarising the mental status exam as unremarkable.
- Listing three differentials without ranking them.
- Naming criteria met and never the criteria not met.
- Omitting a mimic — substance-induced, medical or grief-related.
- Treating the cultural clause as a closing paragraph.
- Writing an essay instead of completing the supplied template.
- Working from the video alone without the Case History Reports.
Submission checklist
- Past hypomanic and manic episodes were actively screened for.
- Symptom duration is stated in days, weeks, months or years.
- Functional impact is documented as a criterion, not as colour.
- Objective content is observation only.
- The mental status exam covers its standard domains.
- Three or more differentials appear, in explicit priority order.
- Each differential names criteria met and criteria not met.
- At least one differential would change treatment if missed.
- The reasoning selecting the primary diagnosis is written out.
- Cultural factors appear inside the assessment, not appended to it.
- The supplied template and exemplar were used.
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Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
Reviewed by
Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.