Criteria

Diagnostic and statistical manual of mental disorders, 5th edition, Text Revision (DSM-5-TR): bipolar I disorder[4]

Characterized by the occurrence of at least one manic episode. Major depressive episodes and hypomanic episodes are common in bipolar disorder I but are not required for the diagnosis.

Criteria for manic episode

  • A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day nearly every day (or any duration if hospitalization is necessary).

  • During the period of mood disturbance and increased energy or activity, 3 (or more) of the following symptoms (4 if mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:

    1. Inflated self-esteem or grandiosity

    2. Decreased need for sleep

    3. More talkative than usual or pressure to keep talking

    4. Flight of ideas or subjective racing of thoughts

    5. Distractibility, as reported or observed

    6. Increase in goal-directed activity or psychomotor agitation

    7. Excessive involvement in activities that have a high potential for painful consequences.

  • In addition, these symptoms:

    • Cause marked impairment in social or occupational functioning, or necessitate hospitalization to prevent harm of self or others, or include psychotic features

    • Are not attributable to the physiological effects of a substance

    • Are not due to another medical condition

    • Can emerge during antidepressant treatment but persist at a fully syndromal level beyond the physiological effect of that treatment.

  • At least one manic episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum, and other psychotic disorder.

The specifier "with mixed features" may be added if episodes of mania/hypomania also present with depressive features, or if episodes of depression present with manic/hypomanic features.

Bipolar disorder (International Classification of Diseases, 11th edition [ICD-11])[7]

Recurrent episodes lasting at least 2 weeks (1 week for mania), unless treatment intervention shortens duration, where mood and activity levels are disturbed. These episodes will consist of mania or hypomania on some occasions and depression on others, although presence of one or more manic episodes is also classified as bipolar I disorder. A mixed episode occurs when there has been at least 1 manic, hypomanic, or mixed affective episode in the past, and the patient currently exhibits either a mixture or a rapid alternation of manic, hypomanic, and depressive symptoms. ICD-11 also has a category for other bipolar affective disorders that includes bipolar II disorder, cyclothymia, and an unspecified category.

Massachusetts General Hospital: bipolar I disorder in children[108]

This approach defines mania as extremely severe irritability or affective aggression (with or without expansive mood) with ADHD-type symptoms.

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