Diagnosis

DSM-5 Criteria for Bipolar I Disorder

DSM-5 Diagnostic Criteria for Bipolar I Disorder

It is necessary to meet the following criteria for a manic episode.

The manic episode may have been preceded by and may be followed
by hypomanic or major depressive episodes.
DSM-5 Diagnostic Criteria for Bipolar I Disorder
Manic Episode
A. Abnormally and persistently…

Elevated Expansive Irritable

Increased goal- Present most of

directed the day, nearly
activity every day

Increased energy
Lasting 1 week
 DSM-5 Diagnostic Criteria for Bipolar I Disorder
Manic Episode
B. During the period of mood disturbance and increased energy or activity, 3 of the following symptoms; four if the mood is only irritable
Are present to a significant degree:

Inflated self-esteem or grandiosity. Increase in goal-directed activity or

Decreased need for sleep (e.g., psychomotor agitation
feels rested after only 3 hours of
sleep).
More talkative than usual or Excessive involvement in activities
pressure to keep talking. that have a high potential for
painful consequences
Flight of ideas or subjective
experience that thoughts are
racing.
Distractibility
 DSM-5 Diagnostic Criteria for Bipolar I Disorder
Manic Episode
C. The mood disturbance is
sufficiently severe to cause:
 marked impairment in social
or occupational functioning
 to necessitate hospitalization
to prevent harm to self or
others
psychotic features.
D. The episode is not
attributable to the
physiological effects of a
substance
 a drug of abuse
 a medication
 DSM-5 Diagnostic Criteria for Bipolar I Disorder
Manic Episode
D. The episode is not
attributable to the
physiological effects of a
substance
a drug of abuse
 a medication
A manic episode that emerges
during antidepressant
treatment…
 fully syndromal level beyond
the physiological effect of that
treatment
At least one lifetime manic
episode is required for the
diagnosis of bipolar I disorder
DSM-5 Diagnostic Criteria for Bipolar I Disorder
Hypomanic Episode
A. Abnormally and persistently…

Elevated Irritable
Expansive
mood

Increased Present most of

activity/energy the day, nearly
every day

Lasting at least
4 consecutive
days
 DSM-5 Diagnostic Criteria for Bipolar I Disorder
Manic Episode
B. During the period of mood disturbance and increased energy or activity, 3 (or more) of the following symptoms; (four if the mood is only
irritable) have persisted..

Inflated self-esteem or grandiosity. Increase in goal-directed activity or

Decreased need for sleep (e.g., psychomotor agitation
feels rested after only 3 hours of
sleep). Excessive involvement in activities
More talkative than usual or that have a high potential for
pressure to keep talking. painful consequences

Flight of ideas or subjective

experience that thoughts are
racing.
Distractibility
 DSM-5 Diagnostic Criteria for Bipolar I Disorder
Hypomanic Episode
C. D. Disturbance in mood and
Associated with an change in functioning are
unequivocal change in observable by others.
functioning
 uncharacteristic of the
individual E. Episode is not severe
enough to cause marked
impairment in social or
functioning
 DSM-5 Diagnostic Criteria for Bipolar I Disorder
Hypomanic Episode
F. The episode is not
attributable to the
physiological effects of a
substance
a drug of abuse
 a medication
A full hypomanic episode that
emerges during antidepressant
treatment…
 fully syndromal level beyond the
physiological effect of that
treatment
• Caution is indicated so that one
or two symptoms are not taken as
sufficient for diagnosis of a
hypomanic episode, nor
necessarily indicative of a bipolar
diathesis.
DSM-5 Diagnostic Criteria for Bipolar I Disorder
Major Depressive Episode
1 2 3

A.>5 of the following Markedly

symptoms have been present Depressed mood
during the same 2 week diminished interest
most of the day,
period or pleasure in all, or
Represent a change from nearly every day, as
almost all, activities
previous functioning. indicated by either
most of the day,
Depressed mood or loss of subjective report
interest/ pleasure nearly every day
DSM-5 Diagnostic Criteria for Bipolar I Disorder
Major Depressive Episode
4 5 6

Significant weight Insomia or

loss when not
hypersomnia, Feelings of
dieting or weight worthlessness
gain fatigue or
or excessive or
• Change of more weight loss
inappropriate
than 5% of body nearly every guilt.
weight in a day
month
DSM-5 Diagnostic Criteria for Bipolar I Disorder
Major Depressive Episode
7 8

Recurrent thoughts of death

Diminished ability to think
or concentrate, or
indecisiveness, nearly every
day
recurrent suicidal ideation
without a specific plan, or a
suicide attempt or a specific
plan for committing suicide.
 DSM-5 Diagnostic Criteria for Bipolar I Disorder
Major Depressive Episode

B. The symptoms cause clinically significant distress or impairment in

social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a

substance or another medical condition.
Intense
Major depressive Responses to a sadness
episodes are significant loss noted
common in bipolar I in Criterion A, which insomia
disorder but are not may resemble a
required for the depressive episode ruminati
diagnosis of bipolar I on poor
about appetite
disorder. the loss
DSM-5 Diagnostic Criteria for Bipolar I Disorder

One manic episode (Criteria A to D under

Manic episode)

The occurrence of the manic and major

depressive episode(s) is not better explained
by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder,
or other specified or unspecified schizophrenia
spectrum and other psychotic disorder.
Bipolar Disorders
BIPOLAR I
Requires the presence of a
distinct period of abnormal mood
lasting at least 1 week
Separate bipolar I disorder
diagnoses for a single manic
episode and a recurrent episode
A syndrome in which a complete
set of mania symptoms occurs
during the course of the disorder
BIPOLAR II
Characterized by depressive
episodes and hypomanic episodes
during the course of the disorder
Episodes of manic-like symptoms
do not quite meet the diagnostic
criteria for a full manic syndrome.
Bipolar I Disorders
BIPOLAR I, Single Manic Episode
• Experienced first manic episode
• Single manic episode
patients who are having their first
episode of bipolar I disorder depres-
sion cannot be distinguished from
patients with major depressive
disorder
BIPOLAR I, Disorder, Recurrent
the end of an episode of
depression also apply to defining
the end of an episode of mania.
Manic episodes are considered
distinct when they are separated
by at least 2 months without
significant symptoms of mania or
hypomania.
Bipolar II
Specify the particular severity, frequency, and duration of the
hypomanic symptoms.

It is difficult to distinguish euthymia from hypomania in a patient who

has been chronically depressed for many months or years.

As with bipolar I disorder, antidepressant-induced hypomanic episodes

are not diagnostic of bipolar II disorder.
With Psychotic Features

Psychotic reflects severe disease and is a poor prognostic indicator

features
mood congruent; mood incongruent

Patients with mood disorder with mood-congruent psychoses

have a psychotic type of mood disorder

Patients with mood disorder with mood-incongruent psychotic

symptoms may have schizoaffective disorder or schizophrenia
With Psychotic Features

Psychotic reflects severe disease and is a poor prognostic

indicator
features
mood congruent

in harmony with the mood disorder

With Psychotic Features

Factors associated with a poor prognosis with mood

disorders
typically require antipsychotic
temporal dissociation between the mood disorder and the drugs in addition to
psychotic symptoms antidepressants or mood sta-
bilizers

poor premorbid history of long duration of may need ECT to obtain clinical
social adjustment episodes improvemen
 Specifiers

With
Melancholic Atypical Catatonic Postpartum Rapid Seasonal
Psychotic features onset
features features onset pattern
features
With Melancholic Features

used to refer to a
depression characterized
by severe anhedonia
Profound feelings of guilt
early morning awakening
Suicidal ideation
Weight loss

"endogenous depression"
Associated with changes depression that arises in
in ANS and endocrine the absence of external
function life stressors or
precipitants.
With Atypical Features
reversed vegetative symptoms

overeating and oversleeping

symptom pattern - hysteroid dysphoria

found to have a younger age of onset

more frequent coexisting diagnoses of panic disorder

somatization disorder

substance abuse/dependence
With Catatonic Features

extreme
blunted affect negativism
withdrawal

catatonic
marked
symptoms do not
psychomotor
imply a single
retardation
diagnosis.
Postpartum Onset

Onset of symptoms within 4

weeks postpartum

Postpartum mental
disorders commonly include
psychotic symptoms
Rapid Cycling

have had depressive and

likely to be female
hypomanic episodes

Rapid cycling

No data indicate that rapid an external factor such as stress

cycling has familial pattern of or drug treatment may be
inheritance involved in the pathogenesis
Seasonal Pattern

tend to experience depressive

become known as seasonal
episodes during a particular
affective disorder
season

Further studies are necessary to

differentiate depressed persons
with seasonal pattern from
other depressed persons.