AETC-NMC | Curricula

DSM Criteria for Bipolar Disorder

The specific DSM-IV criteria for manic, hypomanic, major depressive, and mixed episodes are:

Manic Episode

A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting ≥ 1 week (or ? 1 week if hospitalization required), with ≥ 3 of the following symptoms present (4 if the mood is only irritable):

Inflated self-esteem or grandiosity
Decreased need for sleep (eg, feeling rested after only 3 hours of sleep)
Unusual talkativeness
Racing thoughts
Distractibility
Increased goal-directed activity (socially, at work or school, or sexually)
Doing things that have a high potential for negative consequences, eg, unrestrained buying sprees, sexual indiscretions, or foolish business investments

To be considered a manic episode:

Mood disturbance severe enough to cause noticeable difficulty at work, at school, or in usual social activities or relationships; to require hospitalization to prevent harm to self or others; or to trigger a break from reality (psychosis)
Symptoms do not meet criteria for mixed episode (see below)
Symptoms not due to direct effects of something else such as alcohol or drug use, medication, or a medical condition such as hyperthyroidism

Hypomanic Episode

A hypomanic episode is a distinct period of elevated, expansive, or irritable mood lasting ≥ 4 days and different from the usual nondepressed mood. During the period of disturbed mood, ≥ 3 of the following symptoms must be present (4 if the mood is only irritable):

Inflated self-esteem or grandiosity
Decreased need for sleep (eg, feeling rested after only 3 hours of sleep)
Unusual talkativeness
Racing thoughts
Distractibility
Increased goal-directed activity (socially, at work or school, or sexually)
Doing things that have a high potential for negative consequences, eg, unrestrained buying sprees, sexual indiscretions, or unwise business investments

To be considered a hypomanic episode:

Mood disturbance severe enough to cause a noticeable and uncharacteristic change in functioning
Episode not severe enough to cause significant difficulty at work, at school, or in usual social activities or relationships; to require hospitalization; or to trigger a break from reality (psychosis)
Symptoms do not meet criteria for mixed episode (see below)
Symptoms not due to the direct effects of something else such as alcohol or drug use, medication, or a medical condition such as hyperthyroidism

Major Depressive Episode

Presence of ≥ 5 of the following symptoms over a 2-week period, with ≥ 1 being either depressed mood or loss of interest or pleasure, based either on patient report or observed by others:

Depressed mood most of the day, nearly every day
Diminished interest or feeling no pleasure in all, or almost all, activities most of the day, nearly every day
Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day
Insomnia or increased desire to sleep nearly every day
Either restlessness or slowed behavior that can be observed by others
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death or suicide, or a suicide attempt

To be considered a major depressive episode:

Symptoms do not meet criteria for a mixed episode (see below)
Symptoms severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities, or relationships with others
Symptoms not due to the direct effects of something else, such as drug abuse, medication, or a medical condition such as hyperthyroidism
Symptoms not caused by grieving

Mixed Episode

Criteria met for both a manic episode and a major depressive episode nearly every day during ≥ 1-week period
Mood disturbance severe enough to cause noticeable difficulty at work, at school, or in usual social activities or relationships; to require hospitalization to prevent harm to self or others; or to cause a break from reality (psychosis)
Symptoms not due to direct effects of something else, such as drug abuse, medication, or medical condition such as hyperthyroidism
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	2. Triple Whammy—HIV, Mental Disorders, African Americans Curricula 1 2 3 4 AETC-NMC Home Curricula Home Glossary Feedback

	About Curriculum 2 Introduction Module 1: Context: African Americans, Mental Disorders, and HIV Disease Learning Objectives & Pretraining Assessment The Complex Knot—Being HIV-Positive, African American, With a Mental Disorder African Americans’ Vulnerability to Mental Disorders Evolving Demographics of US Society Patterns of Access to Healthcare Services Substance Abuse and Mental Health Issues HIV, Vulnerable Populations, and African Americans Summary References Assessment Questions Module 2: What Is a Mental Disorder? Learning Objectives & Pretraining Assessment Depression Depression Among African Americans Treatment of Depression Bipolar Disorder DSM Criteria for Bipolar Disorder Treatment Anxiety Disorders Posttraumatic Stress Disorder Panic Disorder Other Anxiety Disorders Treating Anxiety Disorders Anxiety Disorders Among African Americans Schizophrenia How Is Schizophrenia Treated? Psychosocial Treatments Schizophrenia Among African Americans Mental Health–Seeking Habits of African Americans References Ethnopsychopharmacology Considerations References Summary Assessment Questions Module 3: HIV Infection and Mental Disorders Learning Objectives & Pretraining Assessment Incidence of Mental Disorders in the United States Associations Between HIV Disease and Mental Disorders Treatment of Mental Disorders in HIV-Infected Patients Summary References Assessment Questions Module 4: Untying the Knot Learning Objectives & Pretraining Assessment Barriers to Obtaining Appropriate Diagnosis and Care Mental Health Services Sector Role of Multicultural Organizations Employing Nonstandard Therapeutic Tools Role of Spirituality Music Therapy Review and Further Resources Summary References Assessment Questions Case Studies Suggested Activities	DSM Criteria for Bipolar Disorder The specific DSM-IV criteria for manic, hypomanic, major depressive, and mixed episodes are: Manic Episode A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting ≥ 1 week (or ? 1 week if hospitalization required), with ≥ 3 of the following symptoms present (4 if the mood is only irritable): Inflated self-esteem or grandiosity Decreased need for sleep (eg, feeling rested after only 3 hours of sleep) Unusual talkativeness Racing thoughts Distractibility Increased goal-directed activity (socially, at work or school, or sexually) Doing things that have a high potential for negative consequences, eg, unrestrained buying sprees, sexual indiscretions, or foolish business investments To be considered a manic episode: Mood disturbance severe enough to cause noticeable difficulty at work, at school, or in usual social activities or relationships; to require hospitalization to prevent harm to self or others; or to trigger a break from reality (psychosis) Symptoms do not meet criteria for mixed episode (see below) Symptoms not due to direct effects of something else such as alcohol or drug use, medication, or a medical condition such as hyperthyroidism Hypomanic Episode A hypomanic episode is a distinct period of elevated, expansive, or irritable mood lasting ≥ 4 days and different from the usual nondepressed mood. During the period of disturbed mood, ≥ 3 of the following symptoms must be present (4 if the mood is only irritable): Inflated self-esteem or grandiosity Decreased need for sleep (eg, feeling rested after only 3 hours of sleep) Unusual talkativeness Racing thoughts Distractibility Increased goal-directed activity (socially, at work or school, or sexually) Doing things that have a high potential for negative consequences, eg, unrestrained buying sprees, sexual indiscretions, or unwise business investments To be considered a hypomanic episode: Mood disturbance severe enough to cause a noticeable and uncharacteristic change in functioning Episode not severe enough to cause significant difficulty at work, at school, or in usual social activities or relationships; to require hospitalization; or to trigger a break from reality (psychosis) Symptoms do not meet criteria for mixed episode (see below) Symptoms not due to the direct effects of something else such as alcohol or drug use, medication, or a medical condition such as hyperthyroidism Major Depressive Episode Presence of ≥ 5 of the following symptoms over a 2-week period, with ≥ 1 being either depressed mood or loss of interest or pleasure, based either on patient report or observed by others: Depressed mood most of the day, nearly every day Diminished interest or feeling no pleasure in all, or almost all, activities most of the day, nearly every day Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day Insomnia or increased desire to sleep nearly every day Either restlessness or slowed behavior that can be observed by others Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt nearly every day Diminished ability to think or concentrate, or indecisiveness, nearly every day Recurrent thoughts of death or suicide, or a suicide attempt To be considered a major depressive episode: Symptoms do not meet criteria for a mixed episode (see below) Symptoms severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities, or relationships with others Symptoms not due to the direct effects of something else, such as drug abuse, medication, or a medical condition such as hyperthyroidism Symptoms not caused by grieving Mixed Episode Criteria met for both a manic episode and a major depressive episode nearly every day during ≥ 1-week period Mood disturbance severe enough to cause noticeable difficulty at work, at school, or in usual social activities or relationships; to require hospitalization to prevent harm to self or others; or to cause a break from reality (psychosis) Symptoms not due to direct effects of something else, such as drug abuse, medication, or medical condition such as hyperthyroidism « BACK NEXT »
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2. Triple Whammy—HIV, Mental Disorders, African Americans

DSM Criteria for Bipolar Disorder