Bipolar I and II: Symptoms, Diagnostic Criteria

  

Diagnostic Criteria for Bipolar I Disorder

A diagnosis of Bipolar I Disorder requires the presence of a manic episode.

Manic Episode

This manic episode may be preceded or followed by hypomanic or major depressive episodes.

The following criteria must be met for a manic episode:

• A persistent and abnormal elevated, expansive, or irritable mood and increased activity or energy that lasts at least one week and occurs most of the day, nearly every day. If hospitalization is necessary, the duration of the episode does not have to be one week.

• During the episode of mood disturbance and increased energy or activity, three or more of the following symptoms must be present and represent a noticeable change from usual behavior (four symptoms if the mood is only irritable):

1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. Increased talkativeness or pressure to keep talking
4. Flight of ideas or a sense that thoughts are racing
5. Distractibility
6. Increase in goal-directed activity or psychomotor agitation
7. Excessive involvement in activities with high potential for negative consequences.

• The mood disturbance must be severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there must be psychotic features.

• The episode must not be due to the physiological effects of a substance or another medical condition.

Note: If a full manic episode emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists beyond the physiological effect of that treatment, this is sufficient evidence for a manic episode and a diagnosis of Bipolar I Disorder.

Note: To meet the criteria for a manic episode, all of A through D must be met. At least one lifetime manic episode is required for a diagnosis of Bipolar I Disorder.

Hypomanic Episode

Hypomanic episode is characterized by a distinct period of persistent changes in mood and energy levels. The individual experiences an abnormally elevated, expansive, or irritable mood and increased activity or energy. These changes must last for at least 4 consecutive days and be present for most of the day, nearly every day, to be diagnosed as a hypomanic episode.

• During periods of mood disturbance and increased energy and activity, several symptoms may persist and represent a noticeable change from an individual's typical behavior. To be diagnosed as mania, at least three (or four if the mood is only irritable) of the following symptoms must have been present to a significant degree:

1. Inflated Self-Esteem or Grandiosity
2. Decreased Need for Sleep
3. Increased Talkativeness
4. Flight of Ideas or Racing Thoughts
5. Distractibility
6. Increased Goal-Directed Activity or Psychomotor Agitation
7. Excessive Involvement in Risky Activities

• Change in Functioning: The episode is associated with a noticeable change in functioning that is unusual for the individual when not symptomatic.
• Observable by Others: The disturbance in mood and change in functioning can be observed by others.
• Mild Impairment: The episode does not cause significant impairment in social or occupational functioning or necessitate hospitalization. If there are psychotic features, the episode would be considered manic.
• Not Attributable to Substance or Medical Condition: The episode is not caused by the physiological effects of a substance or another medical condition.

Note: A full hypomanic episode that occurs during antidepressant treatment and persists beyond the physiological effect of that treatment can be considered for a hypomanic episode diagnosis. However, it is important to exercise caution and not diagnose a hypomanic episode based on one or two symptoms, particularly increased irritability, edginess, or agitation following antidepressant use.

Note: Meeting criteria A-F constitutes a diagnosis of hypomanic episode. Hypomanic episodes are commonly seen in bipolar I disorder but are not necessary for a diagnosis of bipolar I disorder.

Major Depressive Episode

A major depressive episode is diagnosed when an individual experiences at least five of the following symptoms during a two-week period and these symptoms represent a change from their previous functioning. At least one of the symptoms must be either:

• Depressed Mood
• Loss of Interest or Pleasure

The five symptoms are:

1. Depressed Mood
2. Loss of Interest or Pleasure
3. Significant Weight Loss or Gain
4. Insomnia or Hypersomnia
5. Psychomotor Agitation or Retardation
6. Fatigue or Loss of Energy
7. Feelings of Worthlessness or Excessive Guilt
8. Difficulty Concentrating or Making Decisions
9. Recurrent Thoughts of Death or Suicide.

• Clinical Significance: The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
• Not Attributable to Substance or Medical Condition: The episode is not caused by the physiological effects of a substance or another medical condition.

Note: Meeting criteria A-C constitutes a diagnosis of major depressive episode. Major depressive episodes are commonly seen in bipolar I disorder, but are not necessary for a diagnosis of bipolar I disorder.

Diagnostic Criteria for Bipolar I Disorder

A diagnosis of Bipolar I Disorder requires the following criteria to be met:

Manic Episode: Criteria have been met for at least one manic episode as described in the "Manic Episode" section above.

Not Better Explained by Other Disorders: The manic episode cannot be better explained by schizoaffective disorder, and must not occur during a period of schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders.

Specifiers :

• With Anxious Distress: Bipolar I Disorder may present with symptoms of anxiety or distress.

• With Mixed Features: The symptoms of manic episode may include both manic and depressive symptoms.

• With Rapid Cycling: Bipolar I Disorder may present with rapid fluctuations between manic and depressive episodes.

• With Melancholic Features: Bipolar I Disorder may present with symptoms of severe depression that are characterized by loss of pleasure, loss of energy, and feelings of worthlessness.

• With Atypical Features: Bipolar I Disorder may present with symptoms that deviate from typical symptoms of mania or depression.

• With Mood-Congruent Psychotic Features: The symptoms of manic or depressive episodes may include delusions or hallucinations that are consistent with the elevated or depressed mood.

• With Mood-Incongruent Psychotic Features: The symptoms of manic or depressive episodes may include delusions or hallucinations that are not consistent with the elevated or depressed mood.

• With Catatonia: Bipolar I Disorder may present with symptoms of catatonia, which is a state of immobility and behavioral abnormality. This requires an additional code (F06.1).

• With Peripartum Onset: Bipolar I Disorder may develop during or after pregnancy.

• With Seasonal Pattern: Bipolar I Disorder may present with a recurring pattern that is seasonal in nature.

Bipolar II Disorder Criteria From DSM-5 TR 

To be diagnosed with bipolar II disorder, an individual must meet the following criteria:

• Hypomanic Episode: Criteria A-F under "Hypomanic Episode" must be met, including experiencing at least one hypomanic episode.

• No Manic Episode: There must be no history of a manic episode

• Major Depressive Episode There must be at least one major depressive episode, as defined by Criteria A-C under "Major Depressive Episode.

• Not Better Explained The hypomanic and major depressive episodes cannot be better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

• Clinically Significant Distress or Impairment The symptoms of depression or the  unpredictability caused by frequent alternation between periods of depression and hypomania must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Bipolar II Disorder Course and Severity

Course

If an individual does not currently meet full criteria for a mood episode, the following courses can be specified:

• In partial remission
• In full remission 

Severity

If an individual currently meets full criteria for a major depressive episode, the severity of the episode can be specified as follows:

• Mild 
• Moderate 
• Severe 

Partial Remission

Partial remission is a state in which an individual still experiences some residual symptoms of a previous mood episode, but the symptoms are not severe enough or do not meet the full criteria for a current episode

For example, an individual with bipolar II disorder who had previously experienced a major depressive episode may still have some lingering symptoms such as low mood or fatigue, but they are not experiencing a full-blown depressive episode.

Partial remission can occur during the course of treatment or naturally over time, and it is important to monitor for any signs of relapse or worsening of symptoms.

Full Remission

Full remission is a state in which an individual is no longer experiencing significant symptoms of bipolar II disorder. This means that they are not meeting the criteria for a current mood episode and their symptoms are not causing significant distress or impairment in their daily life.

Achieving full remission can be a goal of treatment for bipolar II disorder, and it is important to continue monitoring for any signs of relapse or recurrence of symptoms.

Overall, partial and full remission are two possible courses of bipolar II disorder that can be specified based on an individual's current symptoms. Partial remission indicates some lingering symptoms, while full remission indicates the absence of significant symptoms. It is important to monitor for any signs of relapse or worsening of symptoms in both states.

Severity levels :

When someone with bipolar II disorder is experiencing a major depressive episode, the severity of the episode can be classified as mild, moderate, or severe.

• Mild: A mild episode of depression means that the individual is experiencing some symptoms of depression, but they are not causing significant problems in their daily life. For example, they may feel sad or tired, but they are still able to work, go to school, and participate in social activities.
• Moderate: A moderate episode of depression means that the individual is experiencing more significant symptoms that are interfering with their daily life. They may have trouble concentrating, feel more fatigued than usual, and have a harder time enjoying activities they used to enjoy. They may also have trouble sleeping and feel irritable or agitated.
• Severe: A severe episode of depression means that the individual is experiencing very significant symptoms that are causing major problems in their daily life. They may feel extremely sad or hopeless, have trouble getting out of bed, and have lost interest in activities they used to enjoy. They may also experience physical symptoms such as weight loss or gain, changes in appetite, or feelings of worthlessness or guilt.

Overall, the severity level of a major depressive episode in bipolar II disorder helps to indicate the impact of the symptoms on an individual's life and functioning. Mild episodes are less disruptive, moderate episodes are more disruptive, and severe episodes are the most disruptive and require immediate intervention.