PSY 608 DSM Bipolar and Depressive Disorders
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Bipolar I
Manic Episode
Manic Episode
For a diagnosis of Bipolar I disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.
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Bipolar I
Manic Episode Criterion A
Manic Episode Criterion A
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)
(Bipolar I, manic)
(Bipolar I, manic)
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Bipolar I
Manic Episode Criterion B
Manic Episode Criterion B
During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four 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 (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 stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
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).
(Bipolar I, manic)
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 stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
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).
(Bipolar I, manic)
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Bipolar I
Manic Episode Criterion C
Manic Episode Criterion 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.
(Bipolar I, manic)
(Bipolar I, manic)
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Bipolar I
Manic Episode Criterion D
Manic Episode Criterion D
The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition.
Note: Criteria A–D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.
(Bipolar I, manic)
Note: Criteria A–D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.
(Bipolar I, manic)
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Bipolar I
Hypomanic Episode Criterion A
Hypomanic Episode Criterion A
A distinct period of abnormally and persistently elevated, expansive, or irritable mood or abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
(Bipolar I, hypomanic)
(Bipolar I, hypomanic)
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Bipolar I
Hypomanic Episode Criterion B
Hypomanic Episode Criterion B
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 behavior, 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 stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
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).
(Bipolar I, hypomanic)
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 stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
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).
(Bipolar I, hypomanic)
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Bipolar I
Hypomanic Episode Criterion C
Hypomanic Episode Criterion C
The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
(Bipolar I, hypomanic)
(Bipolar I, hypomanic)
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Bipolar I
Hypomanic Episode Criterion D
Hypomanic Episode Criterion D
The disturbance in mood and the change in functioning are observable by others.
(Bipolar I, hypomanic)
(Bipolar I, hypomanic)
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Bipolar I
Hypomanic Episode Criterion E
Hypomanic Episode Criterion 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.
(Bipolar I, hypomanic)
(Bipolar I, hypomanic)
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Bipolar I
Hypomanic Episode Criterion F
Hypomanic Episode Criterion F
The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition.
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.
(Bipolar I, hypomanic)
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.
(Bipolar I, hypomanic)
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Bipolar I
Major Depressive Episode Diagnostic Criterion A
Major Depressive Episode Diagnostic Criterion 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 either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(Bipolar I, major depressive)
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 either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(Bipolar I, major depressive)
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Bipolar I
Major Depressive Episode Diagnostic Criterion B
Major Depressive Episode Diagnostic Criterion B
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(Bipolar I, major depressive)
(Bipolar I, major depressive)
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Bipolar I
Major Depressive Episode Diagnostic Criterion C
Major Depressive Episode Diagnostic Criterion 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. Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
(Bipolar I, major depressive)
Note: Criteria A–C constitute a major depressive episode. Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
(Bipolar I, major depressive)
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Bipolar I Disorder
Criterion A
Criterion A
Criteria have been met for at least one manic episode (Criteria A–D under “Manic Episode” above).
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Bipolar I Disorder
Diagnostic Criterion B
Diagnostic Criterion B
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.
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Bipolar II Disorder
For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanic episode and the following criteria for a current or past major depressive episode.
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Bipolar II Disorder
Hypomanic Episode Criterion A
Hypomanic Episode Criterion 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.
(Bipolar II, hypomanic)
(Bipolar II, hypomanic)
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Bipolar II Disorder
Hypomanic Episode Criterion B
Hypomanic Episode Criterion B
During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, 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. 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).
8. (Bipolar II, hypomanic)
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. 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).
8. (Bipolar II, hypomanic)
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Bipolar II Disorder
Hypomanic Episode Criterion C
Hypomanic Episode Criterion C
The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
(Bipolar II, hypomanic)
(Bipolar II, hypomanic)
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Bipolar II Disorder
Hypomanic Episode Criterion D
Hypomanic Episode Criterion D
The disturbance in mood and the change in functioning are observable by others.
(Bipolar II, hypomanic)
(Bipolar II, hypomanic)
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Bipolar II Disorder
Hypomanic Episode Criterion E
Hypomanic Episode Criterion 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.
(Bipolar II, hypomanic)
(Bipolar II, hypomanic)
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Bipolar II Disorder
Hypomanic Episode Criterion F
Hypomanic Episode Criterion F
The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition.
(Bipolar II, hypomanic)
(Bipolar II, hypomanic)
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Bipolar II
Major Depressive Episode Criterion A
Major Depressive Episode Criterion 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 a medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(Bipolar II, major depressive)
Note: Do not include symptoms that are clearly attributable to a medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(Bipolar II, major depressive)
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Bipolar II
Major Depressive Episode Criterion B
Major Depressive Episode Criterion B
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(Bipolar II, major depressive)
(Bipolar II, major depressive)
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Bipolar II
Major Depressive Episode Criterion C
Major Depressive Episode Criterion C
The episode is not attributable to the physiological effects of a substance or another medical condition.
(Bipolar II, major depressive)
(Bipolar II, major depressive)
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Bipolar II
Diagnostic Criterion A
Diagnostic Criterion A
Criteria have been met for at least one hypomanic episode (Criteria A–F under “Hypomanic Episode” above) and at least one major depressive episode (Criteria A–C under “Major Depressive Episode” above).
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Bipolar II
Diagnostic Criterion B
Diagnostic Criterion B
There has never been a manic episode.
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Bipolar II
Diagnostic Criterion C
Diagnostic Criterion C
At least one hypomanic episode and at least one major depressive episode are not better explained by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
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Bipolar II
Diagnostic Criterion D
Diagnostic Criterion D
The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
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Cyclothymic Disorder
Diagnostic Criterion A
Diagnostic Criterion A
For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
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Cyclothymic Disorder
Diagnostic Criterion B
Diagnostic Criterion B
During the above 2-year period (1 year in children and adolescents), Criterion A symptoms have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
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Cyclothymic Disorder
Diagnostic Criterion C
Diagnostic Criterion C
Criteria for a major depressive, manic, or hypomanic episode have never been met.
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Cyclothymic Disorder
Diagnostic Criterion D
Diagnostic Criterion D
The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
(cyclothymic)
(cyclothymic)
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Cyclothymic Disorder
Diagnostic Criterion E
Diagnostic Criterion E
The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
(cyclothymic)
(cyclothymic)
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Cyclothymic Disorder
Diagnostic Criterion F
Diagnostic Criterion F
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(cyclothymic)
(cyclothymic)
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Substance/Medication-Induced Bipolar and Related Disorder
Diagnostic Criterion A
Diagnostic Criterion A
A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy.
(substance/medication-induced bipolar)
(substance/medication-induced bipolar)
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Substance/Medication-Induced Bipolar and Related Disorder
Diagnostic Criterion B
Diagnostic Criterion B
There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to or withdrawal from a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.
(substance/medication-induced bipolar)
1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to or withdrawal from a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.
(substance/medication-induced bipolar)
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Substance/Medication-Induced Bipolar and Related Disorder
Diagnostic Criterion C
Diagnostic Criterion C
The disturbance is not better explained by a bipolar or related disorder that is not substance/medication-induced. Such evidence of an independent bipolar or related disorder could include the following:
The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced bipolar and related disorder (e.g., a history of recurrent non-substance/medication-related episodes).
The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced bipolar and related disorder (e.g., a history of recurrent non-substance/medication-related episodes).
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Substance/Medication-Induced Bipolar and Related Disorder
Diagnostic Criterion D
Diagnostic Criterion D
The disturbance does not occur exclusively during the course of a delirium.
(substance/medication induced bipolar)
(substance/medication induced bipolar)
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Substance/Medication-Induced Bipolar and Related Disorder
Diagnostic Criterion E
Diagnostic Criterion E
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(substance/medication induced bipolar)
(substance/medication induced bipolar)
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Bipolar and Related Disorder Due to Another Medical Condition
Diagnostic Criterion A
Diagnostic Criterion A
A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy.
(bipolar due to another medical condition)
(bipolar due to another medical condition)
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Bipolar and Related Disorder Due to Another Medical Condition
Diagnostic Criterion B
Diagnostic Criterion B
There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
(bipolar due to another medical condition)
(bipolar due to another medical condition)
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Bipolar and Related Disorder Due to Another Medical Condition
Diagnostic Criterion C
Diagnostic Criterion C
The disturbance is not better explained by another mental disorder.
(bipolar due to another medical condition)
(bipolar due to another medical condition)
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Bipolar and Related Disorder Due to Another Medical Condition
Diagnostic Criterion D
Diagnostic Criterion D
The disturbance does not occur exclusively during the course of a delirium.
(bipolar due medical condition)
(bipolar due medical condition)
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Bipolar and Related Disorder Due to Another Medical Condition
Diagnostic Criterion E
Diagnostic Criterion E
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, or necessitates hospitalization to prevent harm to self or others, or there are psychotic features.
(bipolar due to another medical condition)
(bipolar due to another medical condition)
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Bipolar and Related Disorder Due to Another Medical Condition
With manic features
With manic features
Full criteria are not met for a manic or hypomanic episode.
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Bipolar and Related Disorder Due to Another Medical Condition
With manic- or hypomanic-like features
With manic- or hypomanic-like features
Full criteria are met except Criterion D for a manic episode or except Criterion F for a hypomanic episode.
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Bipolar and Related Disorder Due to Another Medical Condition
With mixed features
With mixed features
Symptoms of depression are also present but do not predominate in the clinical picture.
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Specifier for Bipolar and Related Disorders
With anxious distress
With anxious distress
The presence of at least two of the following symptoms during the majority of days of the current manic, hypomanic, or major depressive episode in bipolar I disorder (or the most recent episode if bipolar I disorder is in partial or full remission); or of the current hypomanic or major depressive episode in bipolar II disorder (or the most recent episode if bipolar II disorder is in partial or full remission); or during the majority of symptomatic days in cyclothymic disorder:
1. Feeling keyed up or tense.
2. Feeling unusually restless.
3. Difficulty concentrating because of worry.
4. Fear that something awful may happen.
5. Feeling that the individual might lose control of himself or herself.
1. Feeling keyed up or tense.
2. Feeling unusually restless.
3. Difficulty concentrating because of worry.
4. Fear that something awful may happen.
5. Feeling that the individual might lose control of himself or herself.
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Specifier for Bipolar and Related Disorders
With anxious distress: mild
With anxious distress: mild
2 symptoms
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With anxious distress: moderate
With anxious distress: moderate
3 symptoms
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With anxious distress: severe
With anxious distress: severe
4 or 5 symptoms with motor agitation
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With mixed features
With mixed features
The mixed features specifier can apply to the current manic, hypomanic, or major depressive episode in bipolar I disorder (or the most recent episode if bipolar I disorder is in partial or full remission) or to the current hypomanic or major depressive episode in bipolar II disorder (or the most recent episode if bipolar II disorder is in partial or full remission).
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Manic or hypomanic episode, with mixed features: A
Manic or hypomanic episode, with mixed features: A
Full criteria are met for a manic episode or hypomanic episode, and at least three of the following symptoms are present during the majority of days of the current or most recent episode of mania or hypomania:
1. Prominent dysphoria or depressed mood as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
2. Diminished interest or pleasure in all, or almost all, activities (as indicated by either subjective account or observation made by others).
3. Psychomotor retardation nearly every day (observable by others; not merely subjective feelings of being slowed down).
4. Fatigue or loss of energy.
5. Feelings of worthlessness or excessive or inappropriate guilt (not merely self-reproach or guilt about being sick).
6. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(bipolar)
1. Prominent dysphoria or depressed mood as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
2. Diminished interest or pleasure in all, or almost all, activities (as indicated by either subjective account or observation made by others).
3. Psychomotor retardation nearly every day (observable by others; not merely subjective feelings of being slowed down).
4. Fatigue or loss of energy.
5. Feelings of worthlessness or excessive or inappropriate guilt (not merely self-reproach or guilt about being sick).
6. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(bipolar)
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Specifier for Bipolar and Related Disorders
Manic or hypomanic episode, with mixed features: B
Manic or hypomanic episode, with mixed features: B
Mixed symptoms are observable by others and represent a change from the person’s usual behavior.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Manic or hypomanic episode, with mixed features: C
Manic or hypomanic episode, with mixed features: C
For individuals whose symptoms meet full episode criteria for both mania and depression simultaneously, the diagnosis should be manic episode, with mixed features, due to the marked impairment and clinical severity of full mania.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Manic or hypomanic episode, with mixed features: D
Manic or hypomanic episode, with mixed features: D
The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment).
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Depressive episode, with mixed features: A
Depressive episode, with mixed features: A
Full criteria are met for a major depressive episode, and at least three of the following manic/hypomanic symptoms are present during the majority of days of the current or most recent episode of depression:
1. Elevated, expansive mood.
2. Inflated self-esteem or grandiosity.
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Increase in energy or goal-directed activity (either socially, at work or school, or sexually).
6. Increased or 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).
7. Decreased need for sleep (feeling rested despite sleeping less than usual; to be contrasted with insomnia).
(bipolar)
1. Elevated, expansive mood.
2. Inflated self-esteem or grandiosity.
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Increase in energy or goal-directed activity (either socially, at work or school, or sexually).
6. Increased or 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).
7. Decreased need for sleep (feeling rested despite sleeping less than usual; to be contrasted with insomnia).
(bipolar)
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Specifier for Bipolar and Related Disorders
Depressive episode, with mixed features: B
Depressive episode, with mixed features: B
Mixed symptoms are observable by others and represent a change from the person’s usual behavior.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Depressive episode, with mixed features: C
Depressive episode, with mixed features: C
For individuals whose symptoms meet full episode criteria for both mania and depression simultaneously, the diagnosis should be manic episode, with mixed features.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Depressive episode, with mixed features: D
Depressive episode, with mixed features: D
\
The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment).
(bipolar)
The mixed symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment).
(bipolar)
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Specifier for Bipolar and Related Disorders
With rapid cycling
With rapid cycling
Presence of at least four mood episodes in the previous 12 months that meet the criteria for manic, hypomanic, or major depressive episode in bipolar I disorder or that meet the criteria for hypomanic or major depressive episode in bipolar II disorder.
Note: The essential feature of a rapid-cycling bipolar disorder is the occurrence of at least four mood episodes during the previous 12 months. These episodes can occur in any combination and order. The episodes must meet both the duration and the symptom number criteria for a major depressive, manic, or hypomanic episode and must be demarcated by either a period of full remission or a switch to an episode of the opposite polarity.
Note: The essential feature of a rapid-cycling bipolar disorder is the occurrence of at least four mood episodes during the previous 12 months. These episodes can occur in any combination and order. The episodes must meet both the duration and the symptom number criteria for a major depressive, manic, or hypomanic episode and must be demarcated by either a period of full remission or a switch to an episode of the opposite polarity.
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Specifier for Bipolar and Related Disorders
With melancholic features: A
With melancholic features: A
One of the following is present during the most severe period of the current major depressive episode (or the most recent major depressive episode if bipolar I or bipolar II disorder is currently in partial or full remission):
1. Loss of pleasure in all, or almost all, activities.
2. Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens).
(bipolar)
1. Loss of pleasure in all, or almost all, activities.
2. Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens).
(bipolar)
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Specifier for Bipolar and Related Disorders
With melancholic features: B
With melancholic features: B
Three (or more) of the following:
1. A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood.
2. Depression that is regularly worse in the morning.
3. Early-morning awakening (i.e., at least 2 hours before usual awakening).
4. Marked psychomotor agitation or retardation.
5. Significant anorexia or weight loss.
6. Excessive or inappropriate guilt.
(bipolar)
1. A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood.
2. Depression that is regularly worse in the morning.
3. Early-morning awakening (i.e., at least 2 hours before usual awakening).
4. Marked psychomotor agitation or retardation.
5. Significant anorexia or weight loss.
6. Excessive or inappropriate guilt.
(bipolar)
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Specifier for Bipolar and Related Disorders
With atypical features
With atypical features
This specifier is applied when these features predominate during the majority of days of the current major depressive episode (or the most recent major depressive episode if bipolar I or bipolar II disorder is currently in partial or full remission).
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With atypical features: A
With atypical features: A
Mood reactivity (i.e., mood brightens in response to actual or potential positive events).
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With atypical features: B
With atypical features: B
Two (or more) of the following:
1. Significant weight gain or increase in appetite.
2. Hypersomnia.
3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs).
4. A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.
(bipolar)
1. Significant weight gain or increase in appetite.
2. Hypersomnia.
3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs).
4. A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.
(bipolar)
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Specifier for Bipolar and Related Disorders
With atypical features: C
With atypical features: C
Criteria are not met for “with melancholic features” or “with catatonia” during the same episode.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With psychotic features
With psychotic features
Delusions or hallucinations are present at any time in the current manic or major depressive episode in bipolar I disorder (or the most recent manic or major depressive episode if bipolar I disorder is currently in partial or full remission) or in the current major depressive episode in bipolar II disorder (or the most recent major depressive episode if bipolar II disorder is currently in partial or full remission). If psychotic features are present, specify if mood-congruent or mood-incongruent.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With mood-congruent psychotic features
When applied to current or most recent manic episode (in bipolar I disorder)
With mood-congruent psychotic features
When applied to current or most recent manic episode (in bipolar I disorder)
The content of all delusions and hallucinations is consistent with the typical manic themes of grandiosity, invulnerability, etc., but may also include themes of suspiciousness or paranoia, especially with respect to others’ doubts about the individual’s capacities, accomplishments, and so forth.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With mood-incongruent psychotic features
When applied to current or most recent manic episode (in bipolar I disorder)
With mood-incongruent psychotic features
When applied to current or most recent manic episode (in bipolar I disorder)
The content of the delusions and hallucinations does not involve typical manic themes as described above, or the content is a mixture of mood-incongruent and mood-congruent themes.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With mood-congruent psychotic features
When applied to current or most recent major depressive episode (in bipolar I disorder or bipolar II disorder)
With mood-congruent psychotic features
When applied to current or most recent major depressive episode (in bipolar I disorder or bipolar II disorder)
The content of all delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With mood-incongruent psychotic features
When applied to current or most recent major depressive episode (in bipolar I disorder or bipolar II disorder)
With mood-incongruent psychotic features
When applied to current or most recent major depressive episode (in bipolar I disorder or bipolar II disorder)
The content of the delusions and hallucinations does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment, or the content is a mixture of mood-incongruent and mood-congruent themes.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With catatonia
With catatonia
\
This specifier is applied to the current manic or major depressive episode in bipolar I disorder (or the most recent manic or major depressive episode if bipolar I disorder is currently in partial or full remission) or to the current major depressive episode in bipolar II disorder (or the most recent major depressive episode if bipolar II disorder is currently in partial or full remission) if catatonic features are present during most of the episode.
(bipolar)
This specifier is applied to the current manic or major depressive episode in bipolar I disorder (or the most recent manic or major depressive episode if bipolar I disorder is currently in partial or full remission) or to the current major depressive episode in bipolar II disorder (or the most recent major depressive episode if bipolar II disorder is currently in partial or full remission) if catatonic features are present during most of the episode.
(bipolar)
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Specifier for Bipolar and Related Disorders
With peripartum onset
With peripartum onset
This specifier is applied to the current manic, hypomanic, or major depressive episode in bipolar I disorder (or the most recent manic, hypomanic, or major depressive episode if bipolar I disorder is currently in partial or full remission) or to the current hypomanic or major depressive episode in bipolar II disorder (or the most recent hypomanic or major depressive episode if bipolar II disorder is currently in partial or full remission) if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With seasonal pattern: A
With seasonal pattern: A
There has been a regular temporal relationship between the onset of manic, hypomanic, or major depressive episodes and a particular time of the year (e.g., in the fall or winter) in bipolar I or bipolar II disorder.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With seasonal pattern: B
With seasonal pattern: B
\
Full remissions (or a change from major depression to mania or hypomania or vice versa) also occur at a characteristic time of the year (e.g., depression disappears in the spring).
(bipolar)
Full remissions (or a change from major depression to mania or hypomania or vice versa) also occur at a characteristic time of the year (e.g., depression disappears in the spring).
(bipolar)
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Specifier for Bipolar and Related Disorders
With seasonal pattern: C
With seasonal pattern: C
In the last 2 years, the individual’s manic, hypomanic, or major depressive episodes have demonstrated a temporal seasonal relationship, as defined above, and no nonseasonal episodes of that polarity have occurred during that 2-year period.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
With seasonal pattern: D
With seasonal pattern: D
Seasonal manias, hypomanias, or depressions (as described above) substantially outnumber any nonseasonal manias, hypomanias, or depressions that may have occurred over the individual’s lifetime.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
In partial remission
In partial remission
Symptoms of the immediately previous manic, hypomanic, or major depressive episode are present but full criteria are not met, or there is a period lasting less than 2 months without any significant symptoms of a manic, hypomanic, or major depressive episode following the end of such an episode.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
In full remission
In full remission
During the past 2 months, no significant signs or symptoms of the disturbance were present.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Manic episode: mild
Manic episode: mild
Minimum symptom criteria are met for a manic episode.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Manic episode: moderate
Manic episode: moderate
Very significant increase in activity or impairment in judgment.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Manic episode: severe
Manic episode: severe
Almost continual supervision is required in order to prevent physical harm to self or others.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Major depressive episode: mild
Major depressive episode: mild
Few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning.
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
Major depressive episode: moderate
Major depressive episode: moderate
The number of symptoms, intensity of symptoms, and/or functional impairment are between those specified for “mild” and “severe.”
(bipolar)
(bipolar)
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Specifier for Bipolar and Related Disorders
major depressive episode: severe
major depressive episode: severe
The number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.
(bipolar)
(bipolar)
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: A
Diagnostic Criterion: A
Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: B
Diagnostic Criterion: B
The temper outbursts are inconsistent with developmental level.
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: C
Diagnostic Criterion: C
The temper outbursts occur, on average, three or more times per week.
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: D
Diagnostic Criterion: D
The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: E
Diagnostic Criterion: E
Criteria A–D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A–D.
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: F
Diagnostic Criterion: F
Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: G
Diagnostic Criterion: G
The diagnosis should not be made for the first time before age 6 years or after age 18 years.
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: H
Diagnostic Criterion: H
By history or observation, the age at onset of Criteria A–E is before 10 years.
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: I
Diagnostic Criterion: I
There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: J
Diagnostic Criterion: J
The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder).
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.
Note: This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.
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Disruptive Mood Dysregulation Disorder
Diagnostic Criterion: K
Diagnostic Criterion: K
The symptoms are not attributable to the physiological effects of a substance or another medical or neurological condition.
(disruptive mood dysregulation disorder)
(disruptive mood dysregulation disorder)
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Major Depressive Disorder
Diagnostic Criterion: A
Diagnostic Criterion: 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.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(major depressive disorder)
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(major depressive disorder)
Note 
Flashcards (239)