Severe: Four or five symptoms with motor agitation.
Note: Anxious distress has been noted as a prominent feature of both bipolar and tings. High levels of anxiety have been associated with higher suicide risk, longer duration of illness, and greater likelihood of treatment nonresponse. As a result, it is clinically useful to specify accurately the presence and severity levels of anxious distress for treatment planning and monitoring of response to treatment.
With mixed features: The mixed features specifier can apply to the current manic, hy- pomanic, or depressive episode in bipolar I or bipolar II disorder: 91:59-39)?“
Manic or hypomanic episode, with mixed features:
A. Full criteria are met for a manic episode or hypomanic episode, and at least three of the following symptoms are present during the majority of days of the current or most recent episode of mania or hypomania: 1. Prominent dysphoria or depressed mood as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., ap- pears tearful).
2. Diminished interest or pleasure in all, or almost all, activities (as indicated by either subjective account or observation made by others).
3. Psychomotor retardation nearly every day (observable by others; not merely subjective feelings of being slowed down).
4. Fatigue or loss of energy.
5. Feelings of worthlessness or excessive or inappropriate guilt (not merely seIf-reproach or guilt about being sick).
6. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ide- ation without a specific plan, or a suicide attempt or a specific plan for com- mitting suicide.
B. Mixed symptoms are observable by others and represent a change from the person’s usual behavior.
C. For individuals whose symptoms meet full episode criteria for both mania and depression simultaneously, the diagnosis should be manic episode, with mixed features, due to the marked impairment and clinical severity of full mania.
D. The mixed symptoms are not attributable to the physiological effects of a sub- stance (e.g., a drug of abuse, a medication, other treatment).
Depressive episode, with mixed features:
A. Full criteria are met for a major depressive episode, and at least three of the fol- lowing manic/hypomanic symptoms are present during the majority of days of the current or most recent episode of depression:
Elevated, expansive mood.
Inflated self-esteem or grandiosity.
More talkative than usual or pressure to keep talking.
Flight of ideas or subjective experience that thoughts are racing.
Increase in energy or goaI-directed activity (either socially, at work or school, or sexually).
6. Increased or excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
7. Decreased need for sleep (feeling rested despite sleeping less than usual; to be contrasted with insomnia).
B. Mixed symptoms are observable by others and represent a change from the person’s usual behavior.
C. For individuals whose symptoms meet full episode criteria for both mania and depression simultaneously, the diagnosis should be manic episode, with mixed features.
D. The mixed symptoms are not attributable to the physiological effects of a sub- stance (e.g., a drug of abuse, a medication, or other treatment).
Note: Mixed features associated with a major depressive episode have been found to be a significant risk factor for the development of bipolar | or bipolar II disorder.
As a result. it is clinically useful to note the presence of this specifier for treatment planning and monitoring of response to treatment.
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With rapid cycling (can be applied to bipolar | or bipolar II disorder): Presence of at least four mood episodes in the previous 12 months that meet the criteria for manic, hypomanic, or major depressive episode.