Bipolar I Disorder

Bipolar I disorder is a mental condition with severe ups and downs in mood. In previous Diagnostica and statistical menu of mental disorders DSM 4 it was named as “Manic Depressive Disorder”. As in bipolar there are manic episodes and the individual have at least one manic episode for the duration of a week or more than it.

Diagnostic Criteria of Bipolar I Disorder

According to DSM5TR the diagnostic criteria of Bipolar I disorder is to meet the criteria of manic episodes and sometime these manic episodes can also be followed by major depressive or hypomanic episodes.

Diagnostic criteria for Manic Episode

Diagnostic criteria A.

Individual have irritable mood, abnormally increased activity or increasing energy persistently for a distinct period of time. These must last for at least the duration of a week and person experience this elevated mood symptoms nearly every day.

Diagnostic Criteria B.

During irritable mood phase three or more than three of following must be significantly present that show noticeable change in person’s behavior

Grandiosity or exaggerated self esteem
Decrease sleep (only 3 hours of sleep is enough)
Talkative
Flight of ideas
Easily drawn attention / distractibility
Psychomotor activity (purposeless activities)
Involvement in activities which have high painful consequences or silly business investments

Diagnostic Criteria C.

Mood disturbances cause disturbance and impairment in daily life functioning. Sometimes impairments cause disturbances cause impairments in social and functional of the individual.

Diagnostic Criteria D.

The disturbance is not due to the any physiological effect of the substance.

Note: For the diagnosis of Bipolar I disorder at least one manic episode is required.

Diagnostic Criteria for Hypomanic Episode

Diagnostic Criteria A.

Individual have irritable mood, abnormally increased activity or increasing energy persistently for a distinct period of time. These must last for at least the duration of four consecutive days and person experience this elevated mood symptoms nearly every day.

Diagnostic Criteria B.

During irritable mood phase three or more than three of following must be significantly present that show noticeable change in person’s behavior

Grandiosity or exaggerated self esteem
Decrease sleep (only 3 hours of sleep is enough)
Talkative
Flight of ideas
Easily drawn attention / distractibility
Psychomotor activity (purposeless activities)
Involvement in activities which have high painful consequences or silly business investments

Diagnostic Criteria C.

The hypomanic episodes cause near to unequal change in daily life functioning of the individual.

Diagnostic Criteria D.

The disturbance in behavior and mood can be observed by others.

Diagnostic Criteria E.

The hypomanic episodes are not of the intensity to cause disturbance in social or occupational life of the individual or need hospitalization.

Diagnostic Criteria F.

The disturbance is not due to the any physiological effect of the substance.

Note: some time during antidepressant treatment a full hypomanic episode occur and that symptoms appearing are sufficient for the diagnosis of hypomanic episode.

Diagnostic Criteria for Major Depressive Episode

Diagnostic Criteria A.

The below mentioned symptoms must persist for the duration of 2 to 5 weeks and these symptoms are presenting a significant change in the previous daily life functioning of the individual. The symptoms present in the person at least one of the symptoms from them must be either depressed mood or loss on interest.

Note: The symptoms which are due to another medical condition will not be included in this.

The symptoms are:

Person feels sad, depressed and hopeless most of the day or every day as per subjective reports or been observed by others (in children it can be observed as irritable mood)
Loss of interest or lack of pleasure in almost all activities of everyday life as per subjective description or been observed by others.
Significant weight loss even without dieting or weight gain and either loss of appetite or increase in appetite and the change in body weight is more than 5% in a month (in children there is failure to gain expected weight in ratio to age).
Lack of sleep, no sleep or sleep more than usual in every day routine means individual have insomnia or hypersomnia.
Individual experience psychomotor agitation and restlessness or slowdown, this is either observed by others and not by the individual itself.
Individual experience loss of energy or fatigue most of the day or every day.
Individual feels worthlessness or inappropriate guilt which is usually delusional and this guilt is usually delusional and it is felt most of the day or nearly every day.
Indecisiveness or lack of ability to concentrate or think is felt nearly every day.
Persistent suicidal ideas or recurrent thoughts relevant to death even without any specific suicidal plan for committing suicide.

Diagnostic Criteria B.

The above mentioned symptoms are causing significant issue and distress in daily life functioning of daily life of individual.

Diagnostic Criteria C.

The symptoms are due to any psychological effect of substance or not due to another medical condition.

Note: The symptoms mentioned in Criteria A–C can cause major depressive episode. The symptoms of Major depressive episodes are usually found in Bipolar I disorder but on the basis of only major depressive episodes symptoms we cannot diagnose bipolar I disorder.

Note:

As a result of any significant loss in financials, loss in any natural disaster, any bereavement, and any physical illness or disability can cause the feelings of intense sadness, loss of appetite, lack of sleep and weight loss mentioned in Diagnostic criteria A of major depressive episode. Such symptoms are understandable and these can be a normal response to significant loss. So to declare the diagnosis of major depressive disorder in such cases needs wide clinical expertise and individual life history as well.