Presence of only one
Manic
Episode and no past Major
Depressive Episodes.
Note:
Recurrence is defined as either a change in polarity from depression or an
interval of at least 2 months without manic symptoms.
The Manic Episode is not
better accounted for by Schizoaffective Disorder and is not superimposed on
Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic
Disorder Not Otherwise Specified.
Currently (or most recently)
in a Hypomanic Episode.
There has previously been at
least one Manic Episode or Mixed
Episode.
The mood symptoms cause
clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
The mood episodes in Criteria
A and B are not better accounted for by Schizoaffective Disorder and is not
superimposed on Schizophrenia, Schizophreniform Disorder, Delusional
Disorder, or Psychotic Disorder Not Otherwise Specified.
Currently (or most recently)
in a Manic Episode.
There has previously been at
least one Major Depressive Episode, Manic
Episode, or Mixed Episode.
The mood episodes in Criteria
A and B are not better accounted for by Schizoaffective Disorder and is not
superimposed on Schizophrenia, Schizophreniform Disorder, Delusional
Disorder, or Psychotic Disorder Not Otherwise Specified.
Currently (or most recently)
in a Mixed Episode.
There has previously been at
least one Major Depressive Episode, Manic
Episode, or Mixed Episode.
The mood episodes in Criteria
A and B are not better accounted for by Schizoaffective Disorder and is not
superimposed on Schizophrenia, Schizophreniform Disorder, Delusional
Disorder, or Psychotic Disorder Not Otherwise Specified.
Currently (or most recently)
in a Major Depressive Episode.
There has previously been at
least one Manic Episode or Mixed
Episode.
The mood episodes in Criteria
A and B are not better accounted for by Schizoaffective Disorder and is not
superimposed on Schizophrenia, Schizophreniform Disorder, Delusional
Disorder, or Psychotic Disorder Not Otherwise Specified.
Criteria, except for duration,
are currently (or most recently) met for a Manic,
a Hypomanic, a Mixed,
or a Major Depressive Episode.
There has previously been at
least one Manic Episode or Mixed
Episode.
The mood symptoms cause
clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
The mood episodes in Criteria
A and B are not better accounted for by Schizoaffective Disorder and is not
superimposed on Schizophrenia, Schizophreniform Disorder, Delusional
Disorder, or Psychotic Disorder Not Otherwise Specified.
The mood symptoms in Criteria
A and B are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication, or other treatment) or a general
medical condition (e.g., hyperthyroidism).
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 due to a general medical condition, or
mood-incongruent delusions or hallucinations.
depressed mood most of
the day, nearly every day, as indicated by either subjective report (e.g.,
feels sad or empty) or observation made by others (e.g., appears tearful).
Note: In children and adolescents, can
be irritable mood.
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
made by others)
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 gains.
insomnia or
hypersomnia nearly every day
psychomotor agitation
or retardation nearly every day (observable by others, not merely
subjective feelings of restlessness or being slowed down)
fatigue or loss of
energy nearly every day
feelings of
worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about
being sick)
diminished ability to
think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others)
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
The symptoms do not meet
criteria for a Mixed Episode
The symptoms cause clinically
significant distress or impairment in social, occupational, or other
important areas of functioning.
The symptoms are not due to
the direct physiological effects of a substance (e.g., a drug of abuse, a
medication) or a general medical condition (e.g., hypothyroidism).
The symptoms are not better
accounted for by Bereavement, i.e., after the loss of a loved one, the
symptoms persist for longer than 2 months or are characterized by marked
functional impairment, morbid preoccupation with worthlessness, suicidal
ideation, psychotic symptoms, or psychomotor retardation.
A distinct period of
abnormally and persistently elevated, expansive, or irritable mood, lasting
at least 1 week (or any duration if hospitalization is necessary).
During the period of mood
disturbance, three (or more) of the following symptoms have persisted (four
if the mood is only irritable) and have been present to a significant
degree:
inflated self-esteem or
grandiosity
decreased need for
sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than
usual or pressure to keep talking
flight of ideas or
subjective experience that thoughts are racing
distractibility (i.e.,
attention too easily drawn to unimportant or irrelevant external stimuli)
increase in
goal-directed activity (either socially, at work or school, or sexually)
or psychomotor agitation
excessive involvement
in pleasurable activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)
The symptoms do not meet
criteria for a Mixed Episode
The mood disturbance is
sufficiently severe to cause marked impairment in occupational functioning
or in usual social activities or relationships with others, or to
necessitate hospitalization to prevent harm to self or others, or there are
psychotic features.
The symptoms are not due to
the direct physiological effects of a substance (e.g., a drug of abuse, a
medication, or other treatment) or a general medical condition (e.g.,
hyperthyroidism).
The criteria are met both for
a Manic Episode and for a Major
Depressive Episode (except for duration) nearly every day during
at least a 1-week period.
The mood disturbance is
sufficiently severe to cause marked impairment in occupational functioning
or in usual social activities or relationships with others, or to
necessitate hospitalization to prevent harm to self or others, or there are
psychotic features.
The symptoms are not due to
the direct physiological effects of a substance (e.g., a drug of abuse, a
medication, or other treatment) or a general medical condition (e.g.,
hyperthyroidism).
A distinct period of
persistently elevated, expansive, or irritable mood, lasting throughout at
least 4 days, that is clearly different from the usual nondepressed mood.
During the period of mood
disturbance, three (or more) of the following symptoms have persisted (four
if the mood is only irritable) and have been present to a significant
degree:
inflated self-esteem
or grandiosity
decreased need for
sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than
usual or pressure to keep talking
flight of ideas or
subjective experience that thoughts are racing
distractibility (i.e.,
attention too easily drawn to unimportant or irrelevant external stimuli)
increase in
goal-directed activity (either socially, at work or school, or sexually)
or psychomotor agitation
excessive involvement
in pleasurable activities that have a high potential for painful
consequences (e.g., the person engages in unrestrained buying sprees,
sexual indiscretions, or foolish business investments)
The episode is associated
with an unequivocal change in functioning that is uncharacteristic of the
person when not symptomatic.
The disturbance in mood and
the change in functioning are observable by others.
The episode is not severe
enough to cause marked impairment in social or occupational functioning, or
to necessitate hospitalization, and there are no psychotic features.
The symptoms are not due to
the direct physiological effects of a substance (e.g., a drug of abuse, a
medication, or other treatment) or a general medical condition (e.g.,
hyperthyroidism).
Note:
Hypomanic-like episodes that are clearly caused by somatic antidepressant
treatment (e.g., medication, electroconvulsive therapy, light therapy) should
not count toward a diagnosis of Bipolar II Disorder.
