Manic symptoms or syndromes that are attributable to the physiological effects of a drug of abuse (e.g., in the context of cocaine or amphetamine intoxication), the side effects of medications or treatments (e.g., steroids, L-dopa, antidepressants, stimulants), or an- other medical condition do not count toward the diagnosis of bipolar I disorder. However, a fully syndromal manic episode that arises during treatment (e.g., with medications, elec- troconvulsive therapy, light therapy) or drug use and persists beyond the physiological ef- fect of the inducing agent (i.e., after a medication is fully out of the individual’s system or the effects of electroconvulsive therapy would be expected to have dissipated completely) is sufficient evidence for a manic episode diagnosis (Criterion D). Caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation follow- ing antidepressant use) are not taken as sufficient for diagnosis of a manic or hypomanic episode, nor necessarily an indication of a bipolar disorder diathesis. It is necessary to meet criteria for a manic episode to make a diagnosis of bipolar I disorder, but it is not re- quired to have hypomanic or major depressive episodes. However, they may precede or follow a manic episode. Full descriptions of the diagnostic features of a hypomanic epi- sode may be found within the text for bipolar II disorder, and the features of a major de- pressive episode are described within the text for major depressive disorder.
During a manic episode, individuals often do not perceive that they are ill or in need of treat- ment and vehemently resist efforts to be treated. Individuals may change their dress, makeup, or personal appearance to a more sexually suggestive or ﬂamboyant style. Some perceive a sharper sense of smell, hearing, or vision. Gambling and antisocial behaviors may accompany the manic episode. Some individuals may become hostile and physically threatening to others and, when delusional, may become physically assaultive or suicidal. Catastrophic conse- quences of a manic episode (e.g., involuntary hospitalization, difficulties with the law, serious financial difficulties) often result from poor judgment, loss of insight, and hyperactivity.
Mood may shift very rapidly to anger or depression. Depressive symptoms may occur' during a manic episode and, if present, may last moments, hours, or, more rarely, days (see "with mixed features” specifier, pp. 149—150).
The 12-month prevalence estimate in the continental United States was 0.6% for bipolar I disorder as defined in DSM-IV. Twelve-month prevalence of bipolar I disorder across 11 countries ranged from 0.0% to 0.6%. The lifetime male-to-female prevalence ratio is ap- proximately 1.1:1.
Mean age at onset of the first manic, hypomanic, or major depressive episode is approxi- mately 18 years for bipolar I disorder. Special considerations are necessary'to detect the di- agnosis in children. Since children of the same chronological age may be at different developmental stages, it is difficult to define with precision what is “normal” or ”ex- pected” at any given point. Therefore, each child should be judged according to his or her own baseline. Onset occurs throughout the life cycle, including first onsets in the 60s or 705. Onset of manic symptoms (e.g., sexual or social disinhibition) in late mid-life or late- life should prompt consideration of medical conditions (e.g., frontotemporal neurocogni- tive disorder) and of substance ingestion or withdrawal.