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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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Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center