Probleem 3: bipolar disorder part 1
DSM 5 criteria
Bipolar I disorder
Manic episode
A. A distinct period of abnormally and persistenly elevated, expansive, or irritable mood and abnormally
and persistently increased goal-directed activity or energy lasting at least 1 week and present most of the
day, nearly every day.
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following
symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable
change from usual behaviour:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (feels rested after only 3 hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas of subjective experience that thoughts are racing
5. Distractibility, 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
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational
functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic
features.
D. The episode is not attributable to the physiological effects of a substance or another medical condition.
Note: a full manic episode that emerges during antidepressant treatment but persists is a bipolar I
diagnoses.
Note: criteria A-D constitute a manic episode. At least one lifetime manic episode is required for the
diagnosis of bipolar I disorder.
Hypomanic episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally
and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the
day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the
following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from
usual behaviour, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as
reported or observed.
6. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor
agitation.
, 7. Excessive involvement in activities that have a high potential for painful consequences (e.g.,
engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to
necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication, other treatment).
Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication,
electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that
treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that
one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant
use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar
diathesis.
Note: Criteria A-'F constitute a hypomanic episode. Hypomanic episodes are common in bipolar I disorder
but are not required for the diagnosis of bipolar I disorder.
Major Depressive episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and
represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood
or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition
1. Depressed mood most of the day, nearly every day, as indicated by subjective report or observation
(in children and adolescents irritable mood)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every
day.
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly
every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others)
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan or a specific plan.
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.
Note: criteria A-C constitute a major depressive episode. These are common in bipolar I disorder but not
required for the diagnosis of bipolar I disorder.
Note: responses to a significant loss may include feelings of intense sadness, but it should be carefully
considered.
, Bipolar I disorder
A. Criteria have been met for at least one manic episode.
B. The occurrence of the manic and major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic disorder.
Bipolar II disorder
There must be a current or past hypomanic episode AND the following criteria for a past major depressive
episode
Hypomanic episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally
and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the
day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the
following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from
usual behaviour, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as
reported or observed.
6. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor
agitation.
7. Excessive involvement in activities that have a high potential for painful consequences (e.g.,
engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to
necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication, other treatment).
Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication,
electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that
treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that
one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant
use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar
diathesis.
Major Depressive episode
DSM 5 criteria
Bipolar I disorder
Manic episode
A. A distinct period of abnormally and persistenly elevated, expansive, or irritable mood and abnormally
and persistently increased goal-directed activity or energy lasting at least 1 week and present most of the
day, nearly every day.
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following
symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable
change from usual behaviour:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (feels rested after only 3 hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas of subjective experience that thoughts are racing
5. Distractibility, 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
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational
functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic
features.
D. The episode is not attributable to the physiological effects of a substance or another medical condition.
Note: a full manic episode that emerges during antidepressant treatment but persists is a bipolar I
diagnoses.
Note: criteria A-D constitute a manic episode. At least one lifetime manic episode is required for the
diagnosis of bipolar I disorder.
Hypomanic episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally
and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the
day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the
following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from
usual behaviour, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as
reported or observed.
6. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor
agitation.
, 7. Excessive involvement in activities that have a high potential for painful consequences (e.g.,
engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to
necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication, other treatment).
Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication,
electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that
treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that
one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant
use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar
diathesis.
Note: Criteria A-'F constitute a hypomanic episode. Hypomanic episodes are common in bipolar I disorder
but are not required for the diagnosis of bipolar I disorder.
Major Depressive episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and
represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood
or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition
1. Depressed mood most of the day, nearly every day, as indicated by subjective report or observation
(in children and adolescents irritable mood)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every
day.
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly
every day.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others)
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan or a specific plan.
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.
Note: criteria A-C constitute a major depressive episode. These are common in bipolar I disorder but not
required for the diagnosis of bipolar I disorder.
Note: responses to a significant loss may include feelings of intense sadness, but it should be carefully
considered.
, Bipolar I disorder
A. Criteria have been met for at least one manic episode.
B. The occurrence of the manic and major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic disorder.
Bipolar II disorder
There must be a current or past hypomanic episode AND the following criteria for a past major depressive
episode
Hypomanic episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally
and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the
day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the
following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from
usual behaviour, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as
reported or observed.
6. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor
agitation.
7. Excessive involvement in activities that have a high potential for painful consequences (e.g.,
engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to
necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication, other treatment).
Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication,
electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that
treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that
one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant
use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar
diathesis.
Major Depressive episode
