# 240 - 6E62 Secondary mood syndrome

# 6E62 Secondary mood syndrome

659
Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere
Boundary with psychotic symptoms caused by substances or medications, 
including withdrawal effects
When establishing a diagnosis of secondary psychotic syndrome, it is important to rule out the 
possibility that a medication or substance is causing the hallucinations or delusions instead of 
– or in addition to – an underlying medical condition. This involves first considering whether 
any of the medications being used to treat the medical condition are known to cause psychotic 
symptoms at the dose and duration at which it has been administered. Second, a temporal 
relationship between the medication use and the onset of the psychotic symptoms should be 
established (i.e. the psychotic symptoms began after administration of the medication and/or 
remitted once the medication was discontinued). The same reasoning applies to individuals 
with a medical condition and psychotic symptoms who are also using a psychoactive substance 
known to cause hallucinations or delusions, in the context of either intoxication or withdrawal 
(e.g. visual hallucinations during sedative, hypnotic or anxiolytic withdrawal; paranoid delusions 
during cocaine intoxication). In such cases, if the intensity or duration of the psychotic symptoms 
is substantially in excess of psychotic-like disturbances of perception, cognition or behaviour 
that are characteristic of the substance-specific intoxication or withdrawal syndromes, then 
substance-induced psychotic disorder is the appropriate diagnosis, applying the appropriate 
category corresponding to the substance involved.
Potentially explanatory medical conditions (examples)
Brain disorders and general medical conditions that have been shown to be capable of producing 
psychotic syndromes include:
• diseases of the nervous system (e.g. encephalitis, encephalopathy, genetic prion disease, 
intracerebral haemorrhage, Lewy body disease, migraine, movement disorders such as 
Huntington disease or Friedreich ataxia, multiple sclerosis, seizures, stroke);
• certain infectious or parasitic diseases (e.g. neurosyphilis);
• diseases of the immune system (e.g. systemic lupus erythematosus);
• endocrine, nutritional or metabolic diseases (e.g. hyper- and hypoadrenalism, hyper- and 
hypoparathyroidism, hyper- and hypothyroidism, hypo-osmolality or hyponatraemia, 
hypoglycaemia, porphyrias, vitamin B1 or vitamin B12 deficiency, Wilson disease);
• injury, poisoning or certain other consequences of external causes (e.g. brain injury, 
concussion, traumatic haemorrhage, injury of optic or acoustic nerve);
• neoplasms (e.g. neoplasms of brain or meninges).
Secondary mood syndrome
Essential (required) features
• The presence of prominent depressive, manic or mixed mood symptoms is required 
for diagnosis.
6E62
Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders
• The symptoms are judged to be the direct pathophysiological consequence of a medical 
condition, based on evidence from the history, physical examination or laboratory findings. 
This judgement depends on establishing the following.
• The medical condition is known to be capable of producing the symptoms.
• The course of the mood symptoms (e.g. onset, remission, response of the mood symptoms 
to treatment of the etiological medical condition) is consistent with causation by the 
medical condition.
• The symptoms are not better accounted for by delirium, dementia, another mental 
disorder (e.g. a depressive disorder, bipolar type I or bipolar type II disorder, cyclothymic 
disorder, catatonia) or the effects of a medication or substance, including withdrawal 
effects.
• The symptoms are sufficiently severe to be a specific focus of clinical attention.
Secondary mood syndrome, with depressive symptoms
Essential (required) features
• All diagnostic requirements for secondary mood syndrome are met.
• The presentation is characterized by prominent depressive symptoms without prominent 
manic symptoms.
Secondary mood syndrome, with manic symptoms
Essential (required) features
• All diagnostic requirements for secondary mood syndrome are met.
• The presentation is characterized by prominent manic symptoms without prominent 
depressive symptoms.
Secondary mood syndrome, with mixed symptoms
Essential (required) features
• All diagnostic requirements for secondary mood syndrome are met.
• The presentation is characterized by both prominent depressive and prominent 
manic symptoms.
6E62.0
6E62.1
6E62.2
Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere

661
Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere
Secondary mood syndrome, with unspecified symptoms
Boundaries with other disorders and conditions (differential diagnosis)
Boundary with mood disorders
Determining whether mood symptoms are due to a medical condition as opposed to 
manifestations of a primary mental disorder is often difficult because the clinical presentations 
may be similar. Establishing the presence of a potentially explanatory medical condition that 
can cause mood symptoms and the temporal relationship between the medical condition and 
the mood symptoms is critical in diagnosing secondary mood syndrome. If the clinical features 
are atypical for mood disorders (e.g. atypical age of onset or course, absence of family history), 
secondary mood syndrome is more likely.
Boundary with mood symptoms that are precipitated by the stress of being 
diagnosed with a medical condition
Depending on the nature of the medical condition (e.g. a life-threatening type of cancer, a 
potentially fatal infection) or its onset (e.g. a heart attack, a stroke, a severe injury), mood 
symptoms can occur as a part of a psychological response to being diagnosed and/or having to 
cope with a severe medical condition. In the absence of evidence of a physiological link between 
the medical condition and the mood symptoms, the appropriate mental disorder (e.g. adjustment 
disorder, a mood disorder) rather than secondary mood syndrome should be diagnosed.
Boundary with delirium due to disease classified elsewhere
Mood symptoms can occur in the context of delirium due to disease classified elsewhere. 
Delirium is characterized by disturbed attention (i.e. reduced ability to direct, focus, sustain 
and shift attention) and awareness (i.e. reduced orientation to the environment) that develops 
over a short period of time and tends to fluctuate during the course of a day, accompanied by 
other cognitive impairment such as memory deficit, disorientation or impairment in language, 
visuospatial ability or perception. In contrast, mood symptoms in secondary mood syndrome 
occur in the absence of disturbed attention or severe cognitive impairment. If mood symptoms 
are judged to be better explained by delirium due to disease classified elsewhere, an additional 
diagnosis of secondary mood syndrome is not warranted.
Boundary with dementia
Mood symptoms can occur in the context of dementia, which is characterized by a decline from 
a previous level of cognitive functioning with impairment in two or more cognitive domains (e.g. 
memory, executive functions, attention, language, social cognition and judgement, psychomotor 
speed, visuoperceptual or visuospatial abilities). In contrast, secondary mood syndrome is not 
accompanied by marked cognitive impairment. The presence of mood symptoms in the context of 
dementia can be recorded using the mood symptoms in dementia specifier. If the mood symptoms 
are judged to be due to the same medical condition as is causing the dementia, an additional 
diagnosis of secondary mood syndrome is not warranted.
6E62.3
Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders
Boundary with secondary catatonia syndrome
Certain symptoms of secondary catatonia syndrome are similar to those observed during 
manic, depressive or mixed episodes (e.g. stupor or mutism in secondary catatonia is similar 
to psychomotor retardation in a depressive episode; agitation or impulsivity in secondary 
catatonia syndrome is similar to increased activity and impulsive reckless behaviour in a manic 
episode). In secondary catatonia syndrome, these symptoms occur in conjunction with other 
catatonic symptoms (e.g. abnormal psychomotor activity such as mannerisms, waxy flexibility or 
posturing), which are not characteristic of secondary mood syndrome.
Boundary with mood symptoms caused by substances or medications, including 
withdrawal effects
When establishing a diagnosis of secondary mood syndrome, it is important to rule out the 
possibility that a medication or substance is causing the mood symptoms instead of –or in 
addition to – an underlying medical condition. This involves first considering whether any of 
the medications being used to treat the medical condition are known to cause depressive or 
manic symptoms (e.g. steroids or alpha-interferon) at the dose and duration at which it has been 
administered. Second, a temporal relationship between the medication use and the onset of the 
mood symptoms should be established (i.e. the mood symptoms began after administration of the 
medication and/or remitted once the medication was discontinued). The same reasoning applies 
to individuals with a medical condition and mood symptoms who are also using a psychoactive 
substance known to cause mood symptoms, in the context of either intoxication or withdrawal 
(e.g. euphoric mood due to stimulant intoxication, dysphoric mood due to cocaine withdrawal). 
In such cases, if the intensity or duration of the mood symptoms is substantially in excess of 
mood disturbances that are characteristic of the substance-specific intoxication or withdrawal 
syndrome, then substance-induced mood disorder is the appropriate diagnosis, applying the 
appropriate category corresponding to the substance involved.
Potentially explanatory medical conditions (examples)
Brain disorders and general medical conditions that have been shown to be capable of producing 
depressive mood syndromes include:
• diseases of the nervous system (e.g. cerebrovascular disease, Huntington disease, normalpressure hydrocephalus, multiple sclerosis, Parkinson disease, stroke);
• certain infectious or parasitic diseases (candidosis, HIV disease, Lyme borreliosis, 
toxoplasmosis);
• diseases of the immune system (e.g. systemic lupus erythematosus);
• endocrine, nutritional or metabolic diseases (e.g. Cushing syndrome, hypercalcaemia, 
hyperglycaemia, hypermagnesaemia, hypoadrenalism, hypothyroidism, iron deficiency);
• injury, poisoning or certain other consequences of external causes (e.g. brain injury, 
concussion, traumatic haemorrhage);
• neoplasms (e.g. malignant neoplasm of pancreas leading to a paraneoplastic disorder of 
the nervous system, brain or spinal cord).
Brain disorders and general medical conditions that have been shown to be capable of producing 
manic mood syndromes include:
• diseases of the nervous system (e.g. movement disorders such as Huntington disease, 
multiple sclerosis, seizures, stroke);
Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere