Study Notes on DSM-5 Hypomanic Episode and Bipolar Disorders

DSM-5 Hypomanic Episode

  • Definition: A distinct period characterized by:

    • Abnormally and persistently elevated, expansive, or irritable mood.
    • Abnormally and persistently increased activity or energy.
    • Duration: At least 4 consecutive days and present most of the day, nearly every day.

  • Symptoms: During this period, three (or more) of the following symptoms must be present: (four if the mood is only irritable)

    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 a subjective experience that thoughts are racing.
    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.

  • Functioning Changes:

    • The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

  • Observability:

    • The disturbances in mood and changes in functioning are observable by others.

  • Severity Criteria:

    • 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.

  • Substance Effects:

    • The episode is not attributable to the physiological effects of a substance.

  • Note:

    • A full hypomanic episode that emerges during antidepressant treatment and persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient for a diagnosis of a hypomanic episode.
    • Caution should be exercised to ensure that 1 or 2 symptoms, particularly increased irritability, edginess, or agitation following antidepressant use, are not taken as sufficient for diagnosis nor indicative of a bipolar diathesis.

Bipolar I Disorder

  • Definition: Bipolar I disorder is characterized by:

    • One or more manic episodes (sometimes called manic-depression).
    • May alternate between episodes of major depression and mania or hypomania.

  • Symptoms: A person may experience a single manic episode or multiple episodes.

    • Typically involves a major depressive episode lasting weeks or months, followed by an interval of normal mood.
    • Some individuals experience mixed features, where mania presents with symptoms of depression not meeting the criteria for a major depressive episode.

  • Criteria:

    • A. Criteria have been met for at least one manic episode (Refer to Criteria A-D under "Manic Episode").
    • B. The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders.

Bipolar II Disorder

  • Definition: Bipolar II disorder comprises:

    • Episodes of hypomania that alternate with episodes of major depression.
    • Full-blown manic episodes are not present as seen in Bipolar I disorder.

  • Symptoms:

    • Hypomanic episodes could potentially worsen and become manic episodes, resulting in a possible diagnosis of Bipolar I disorder.
    • Hypomanic episodes alone may not cause significant impairment in functioning; however, the combination with major depressive episodes does significantly interfere with daily functioning.

  • Criteria:

    • A. Criteria have been met for at least one hypomanic episode (Refer to Criteria A-F under "Hypomanic Episode") and at least one major depressive episode (Refer to Criteria A-C under "Major Depressive Episode").
    • B. There has never been a manic episode.
    • C. The occurrence of hypomanic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, or other specified or unspecified schizophrenia spectrum and other psychotic disorders.
    • D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Rapid Cycling and Ultra-Rapid Cycling

  • Rapid Cycling: Refers to frequent switching between depression and mania with little or no period of normal mood, characterized by:

    • At least four cycles occurring per year.

  • Ultra-Rapid Cycling:

    • Particularly seen in females or those with psychotic symptoms, where mood changes (depression or mania) occur almost daily for a specified period.

  • Reference: Valenti et al. (2015) discusses these patterns and symptoms.

Figures and Tables

  • Table 7.6: DSM-5 Hypomanic Episode criteria.

  • Table 7.7: DSM-5 Bipolar I Disorder criteria.

  • Table 7.8: DSM-5 Bipolar II Disorder criteria.

  • Figure 7.5: Comparison of cycles of Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder, illustrating the differences in mood episode patterns among these disorders.

  • Remarks: Understanding the distinctions and criteria for Bipolar I and II disorders, alongside hypomanic episodes, is crucial for accurate diagnosis and potential treatment.