Bipolar and Related Disorders

Manic Episode – Criterion A (Mood & Energy)

• Distinct period of:

  • Abnormally and persistently elevated, expansive, or irritable mood
    and

  • Abnormally and persistently increased activity or energy

• Lasts at least 1 week

• Present most of the day, nearly every day

• Can be any duration if hospitalization is necessary

Manic Episode – Criterion B (Associated Symptoms)

During the mood disturbance and ↑ energy/activity, ≥ 3 symptoms (or ≥ 4 if mood is only irritable), with clear change from usual behavior:

1. Inflated self-esteem or grandiosity

2. Decreased need for sleep (rested after only ~3 hours)

3. More talkative than usual or pressure to keep talking

4. Flight of ideas or racing thoughts

5. Distractibility (attention easily drawn to irrelevant stimuli)

6. Increase in goal-directed activity (social, work/school, sexual) or psychomotor agitation

7. Excessive involvement in risky activities with high potential for painful consequences (spending sprees, sexual indiscretions, foolish business investments)

Manic Episode – Criterion C (Severity)

Mood disturbance is severe enough to cause at least one of:

• Marked impairment in social or occupational functioning

• Hospitalization needed to prevent harm to self or others

• Presence of psychotic features

Hypomanic Episode – Criterion A (Mood & Energy)

• Distinct period of:

  • Abnormally and persistently elevated, expansive, or irritable mood
    and

  • Abnormally and persistently increased activity or energy

• Lasts at least 4 consecutive days

• Present most of the day, nearly every day

Hypomanic Episode – Criterion B (Associated Symptoms)

During the mood disturbance and ↑ energy/activity, ≥ 3 symptoms (or ≥ 4 if mood is only irritable), with clear change from usual behavior and present to a significant degree:

1. Inflated self-esteem or grandiosity

2. Decreased need for sleep (e.g., rested after only ~3 hours)

3. More talkative than usual or pressure to keep talking

4. Flight of ideas or racing thoughts

5. Distractibility (attention easily drawn to irrelevant stimuli)

6. Increase in goal-directed activity (social, work/school, sexual) or psychomotor agitation

7. Excessive involvement in risky activities with high potential for painful consequences (spending sprees, sexual indiscretions, foolish business investments)

Hypomanic Episode – Criterion C (Change in Functioning)

• The episode is linked to a clear (unequivocal) change in functioning

• This change is uncharacteristic of the person when they are not symptomatic

Hypomanic Episode – Criterion D (Observable by Others)

• The mood disturbance and change in functioning are

• Noticeable to others (e.g., friends, family, coworkers can observe it)

Major Depressive Episode – Criterion A (Symptoms & Duration)

• ≥ 5 symptoms during the same 2-week period, representing a change from previous functioning

• At least one must be:

  1. Depressed mood, or

  2. Loss of interest or pleasure (anhedonia)

• Do not count symptoms clearly due to another medical condition

Symptoms (most of the day, nearly every day unless noted):

1. Depressed mood (or irritable mood in children/adolescents)

2. Markedly diminished interest or pleasure in almost all activities

3. Significant weight loss/gain or ↓/↑ appetite

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation (observable by others)

6. Fatigue or loss of energy

7. Feelings of worthlessness or excessive/inappropriate guilt (may be delusional)

8. Diminished ability to think/concentrate or indecisiveness

9. Recurrent thoughts of death, suicidal ideation, attempt, or plan

Bipolar I Disorder – Criterion A (Manic Episode Requirement)

• Diagnostic criteria are met for at least one Manic Episode

• i.e., meets Criteria A–D for a Manic Episode (distinct period of elevated/irritable mood + ↑ energy, required symptoms, severity/impairment, and not better explained by something else)

Bipolar II Disorder – Criterion A (Episode Requirements)

• Criteria have been met for:

  • At least one Hypomanic Episode (meeting Criteria A–F for hypomania)
    and

  • At least one Major Depressive Episode (meeting Criteria A–C for major depression)

Bipolar & Depressive Disorders – Specifier: With Psychotic Features

• With psychotic features

  • Delusions or hallucinations occur at any time during the mood episode

• With mood-congruent psychotic features

  • In manic episodes: content matches typical manic themes

    • Grandiosity, invulnerability, special powers, etc.

    • Can include suspiciousness/paranoia, especially about others doubting one’s abilities or accomplishments

• With mood-incongruent psychotic features

  • Content of delusions/hallucinations is inconsistent with the mood episode polarity

  • Or is a mix of mood-congruent and mood-incongruent themes

HiTOP – Bipolar I & II: Internalizing, Thought Disorder & Mania Subfactor

• Internalizing spectrum (Bipolar I & II)

  • Depression in both disorders loads on internalizing (especially the distress side).

  • Recurrent major depressive episodes = strong internalizing component.

  • Bipolar II often shows more internalizing overall (more/longer depressive episodes, no full mania).

• Thought Disorder spectrum (via Mania subfactor)

  • Mania/hypomania are placed under the Thought Disorder spectrum, specifically the mania subfactor (elevated mood, ↑ energy, grandiosity, racing thoughts, etc.).

  • Bipolar I (full manic episodes, often with psychosis) = stronger loading on Thought Disorder/mania.

  • Bipolar II (hypomania only) still links to the mania subfactor, but typically less severe thought-disorder features.