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Bipolar I Disorder
- Bipolar I Disorder is characterized by the occurrence of one or more manic or mixed episodes. Bipolar I Disorder is a recurrent disorder in which individuals experience alternating episodes of depression and mania. Manic episodes often precede or follow the major depressive episodes in a characteristic pattern for a particular person. Between episodes, the majority of persons with this disorder return to a fully functional level. Psychotic symptoms sometimes occur with mixed or manic episodes.
- A Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood. This period must last at least one week unless hospitalization is required. The mood disturbance must be accompanied by at least three additional symptoms from a list that includes inflated self-esteem or grandiosity, decreased need for sleep, pressure of speech, flight of ideas, distractibility, increased involvement in goal-directed activities or psychomotor agitation, and excessive involvement in pleasurable activities with a high potential for painful consequences.
The disturbance must be sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization, or it is characterized by the presence of psychotic features.
- The elevated mood of a manic episode may be described as euphoric, unusually good, cheerful, or high, and is recognized as excessive by those who know the person well. Inflated self-esteem is typically present, ranging from uncritical self-confidence to marked grandiosity, and may reach delusional proportions. Individuals may give advice on matters about which they have no special knowledge. Despite the lack of any particular experience or talent, the individual may embark on writing a novel or composing a symphony. Grandiose delusions are often common.
- Manic speech is typically pressured, loud, rapid, and difficult to interpret. Individuals may talk for hours on end. If the person's mood is more irritable than expansive, speech may be marked by complaints, hostile comments, or angry tirades.
- Expansiveness, unwarranted optimism, grandiosity, and poor judgment often lead to an imprudent involvement in pleasurable activities such as buying sprees, reckless driving, foolish business investments, and sexual behavior that is unusual for the person. The individual may also dress in a different manner. For example, he/she may color his/her hair, wear excessive jewelry and/or make-up, and dress seductively.
- A Mixed Episode is characterized by a period of time (at least one week) in which the criteria are met both for a manic episode and for a major depressive episode nearly every day. The individual experiences rapidly alternating moods (sadness, irritability, euphoria) accompanied by the symptoms of a manic episode.
- The symptom presentation frequently includes agitation, insomnia, appetite dysregulation, psychotic features, and suicidal thinking.
Criteria for Bipolar I Disorder, Single Manic Episode:
 | presence of only one manic episode and no previous depressive episodes
| the manic episode is not better accounted for by other diagnoses
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Criteria for Bipolar I Disorder, Most Recent Episode Manic:
| currently in a manic episode
| previously had at least one major depressive episode
| mood episodes are not better accounted for by other diagnoses
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Criteria for Bipolar I Disorder, Most Recent Episode Mixed:
| currently in a mixed episode
| previously had at least one major depressive episode
| mood episodes are not better accounted for by other diagnoses
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Criteria for Bipolar I Disorder, Most Recent Episode Depressed:
| currently in a major depressive episode
| there has previously been at least one manic episode
| mood episodes are not better accounted for by other diagnoses
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Criteria for Bipolar I Disorder, Most Recent Episode Unspecified:
| criteria are currently met for a manic, hypomanic, mixed, or a major depressive episode
| there has previously been at least one manic or mixed episode
| the mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
| mood symptoms are not better accounted for by other diagnosis
| mood symptoms are not due to the direct physiological effects of a substance such as illegal drugs, medication, or due to a general medical condition such as hyperthyroidism
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