ABSTRACT

Bipolar illness is an illness characterized by affective instability resulting in periods of major depression or mania. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, (DSM-IV) criteria for major depression, mania, hypomania, and mixed episode are presented in Tables 5–1 through 5–4. Criteria for Major Depressive Episode https://www.niso.org/standards/z39-96/ns/oasis-exchange/table">

Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition or mood-incongruent delusions or hallucinations.

depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood

markedly diminished interest or pleasure in all, or almost all, activities most of the day (as indicated by either subjective account or observation made by others)

significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month) or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

insomnia or hypersomnia nearly every day

psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

fatigue or loss of energy nearly every day

feelings of worthlessness or excessive or inappropriate guilt (that may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

The symptoms do not meet criteria for a mixed episode.

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than two months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Adapted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (p. 329). Copyright 1994 by American Psychiatric Association. Criteria for Manic Episode https://www.niso.org/standards/z39-96/ns/oasis-exchange/table">

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary).

During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

inflated self-esteem or grandiosity

decreased need for sleep (e.g., feels rested after only three hours of sleep)

more talkative than usual or pressure to keep talking

flight of ideas or subjective experience that thoughts are racing

distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

The symptoms do not meet criteria for a mixed episode.

The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Maniclike episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of bipolar I disorder.

Adapted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (p. 332). Copyright 1994 by American Psychiatric Association. Criteria for Hypomanic Episode https://www.niso.org/standards/z39-96/ns/oasis-exchange/table">

A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 14 days, that is clearly different from the usual nondepressed mood.

During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

inflated self-esteem or grandiosity

decreased need for sleep (e.g., feels rested after only three hours of sleep)

more talkative than usual or pressure to keep talking

flight of ideas or subjective experience that thoughts are racing

distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

The disturbance in mood and the change in functioning are observable by others.

The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization, and there are no psychotic features.

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomaniclike episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of bipolar II disorder.

Adapted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (p. 238). Copyright 1994 by American Psychiatric Association. Criteria for Mixed Episode https://www.niso.org/standards/z39-96/ns/oasis-exchange/table">

The criteria are met both for a manic episode and for a major depressive episode nearly every day during at least a one-week period.

The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Mixedlike episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of bipolar I disorder.

Adapted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (p. 238). Copyright 1994 by American Psychiatric Association.