The diagnostic features of substance/medication—induced bipolar and related disorder are es- sentially the same as those for mania, hypomania, or depression. A key exception to the diag- nosis of substance/medication—induced bipolar and related disorder is the case of hypomania yond the physiological effects of the medication. This condition is considered an indicator of true bipolar disorder, not substance/ medication-induced bipolar and related disorder. Simi- larly, individuals with apparent electroconvulsive therapy—induced manic or hypomanic ep- isodes that persist beyond the physiological effects of the treatment are diagnosed with bipolar disorder, not substance/medication-induced bipolar and related disorder.
Side effects of some antidepressants and other psychotropic drugs (e.g., edginess, ag— itation) may resemble the primary symptoms of a manic syndrome, but they are funda- mentally distinct from bipolar symptoms and are insufficient for the diagnosis. That is, the criterion symptoms of mania/hypomania have specificity (simple agitation is not the same as excess involvement in purposeful activities), and a sufficient number of symptoms must be present (not just one or two symptoms) to make these diagnoses. In particular, the appearance of one or two nonspecific symptoms—irritability, edginess, or agitation during antidepressant treatment—in the absence of a full manic or hypomanic syndrome should not be taken to support a diagnosis of a bipolar disorder.
Etiology (causally related to the use of psychotropic medications or substances of abuse based on best clinical evidence) is the key variable in this etiologically specified form of bi- polar disorder. Substances/ medications that are typically considered to be associated with substance/medication-induced bipolar and related disorder include the stimulant class of drugs, as well as phencyclidine and steroids; however, a number of potential sub- stances continue to emerge as new compounds are synthesized (e.g., so-called bath salts).
A history of such substance use may help increase diagnostic certainty.
There are no epidemiological studies of substance/medication-induced mania or bipolar disorder. Each etiological substance may have its own individual risk of inducing a bipo- lar (manic/hypomanic) disorder.
In phencyclidine—induced mania, the initial presentation may be one of a delirium with af- fective features, which then becomes an atypically appearing manic or mixed manic state.
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This condition follows the ingestion or inhalation quickly, usually within hours or, at the most, a few days. In stimulant-induced manic or hypomanic states, the response is in min- utes to 1 hour after one or several ingestions or injections. The episode is very brief and typically resolves over 1—2 days. With corticosteroids and some immunosuppressant medications, the mania (or mixed or depressed state) usually follows several days of in- gestion, and the higher doses appear to have a much greater likelihood of producing bi- polar symptoms.
Determination of the substance of use can be made through markers in the blood or urine to corroborate diagnosis.
from other bipolar disorders, substance intoxication or substance-induced delirium, and medication side effects (as noted earlier). A full manic episode that emerges during anti- depressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a bipolar I diagnosis. A full hypomanic episode that emerges during antidepressant treat- ment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a bipolar II di- agnosis only if preceded by a major depressive episode.