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Bipolar I
Brent Scobie, PhD
Bipolar and Related Disorders
 296.4x/296.5x (F31.x) Bipolar I Disorder
 Current or most recent episode MANIC, HYPOMANIC, DEPRESSED:
mild/moderate/severe/with psychotic features/partial
remission/full remission/unspecified
 Current or most recent episode UNSPECIFIED
 296.89 (F31.81) Bipolar II Disorder
 301.13 (F34.0) Cyclothymic Disorder
 Substance/Medication Induced Bipolar and Related
 Disorder
 293.83 Bipolar and Related Disorder Due to Another
 Medical Condition (Manic/Hypomanic/Mixed)
 296.89 (F31.89) Other Specified Bipolar and Related
 Disorder
 296.80 (F31.9) Unspecified Bipolar and Related Disorder
Specifiers for Bipolar and Related
Disorders
 With Anxious Distress
 Manic or Hypomanic episode With Mixed Features
 Depressive episode With Mixed Features
 With Rapid Cycling
 With Melancholic Features
 With Atypical Features
 With Psychotic Features
 Mood congruent psychotic features
 Mood incongruent psychotic features
 With Catatonia
 With Peripartum Onset
 With Seasonal Pattern
Bipolar I
 Bipolar and related disorders are separated from the depressive
disorders in DSM-5 and placed between the chapters on
schizophrenia spectrum and other psychotic disorders and
depressive disorders in recognition of their place as a bridge
between the two
 The bipolar I disorder criteria represent the modern
understanding of the classic manic-depressive disorder or
affective psychosis described in the nineteenth century,
differing from that classic description only to the extent that
neither psychosis nor the lifetime experience of a major
depressive episode is a requirement
Bipolar I Diagnostic Criteria
 The essential feature of a manic episode is a distinct
period during which there is an abnormally, persistently
elevated, expansive, or irritable mood and persistently
increased activity or energy that is present for most of
the day, nearly every day, for a period of at least 1
week
 Mood in a manic episode is often described as euphoric,
excessively cheerful, high, or “feeling on top of the
world”
 In children, happiness, silliness and “goofiness” are
normal in the context of special occasions
Bipolar I Diagnostic Criteria
 During the period of mood disturbance and increased energy or
activity, three (or more) of the following symptoms (four if the mood
is only irritable) are present to a significant degree and represent a
noticeable change from usual behavior:
 Inflated self-esteem or grandiosity.
 Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
 More talkative than usual or pressure to keep talking.
 Flight of ideas or subjective experience that thoughts are racing.
 Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external
stimuli), as reported or observed.
 Increase in goal-directed activity (either socially, at work or school, or sexually) or
psychomotor agitation (i.e., purposeless non-goal-directed activity).
 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).
Prevalence and Course
 The 12-month prevalence estimate in the continental United States was
0.6% for bipolar I disorder as defined in DSM-IV(Merikangas et al. 2007).
Twelve-month prevalence of bipolar I disorder across 11 countries ranged
from 0.0% to 0.6%(Merikangas et al. 2007). The lifetime male-to-female
prevalence ratio is approximately 1.1:1(Merikangas et al. 2007).
 Mean age at onset of the first manic, hypomanic, or major depressive
episode is approximately 18 years for bipolar I disorder.
 More than 90% of individuals who have a single manic episode go on to
have recurrent mood episodes.
 Approximately 60% of manic episodes occur immediately before a major
depressive episode.
 Individuals with bipolar I disorder who have multiple (four or more) mood
episodes (major depressive, manic, or hypomanic) within 1 year receive
the specifier “with rapid cycling.”

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SA 202 Week 5 lecture 3 bipolar i

  • 2. Bipolar and Related Disorders  296.4x/296.5x (F31.x) Bipolar I Disorder  Current or most recent episode MANIC, HYPOMANIC, DEPRESSED: mild/moderate/severe/with psychotic features/partial remission/full remission/unspecified  Current or most recent episode UNSPECIFIED  296.89 (F31.81) Bipolar II Disorder  301.13 (F34.0) Cyclothymic Disorder  Substance/Medication Induced Bipolar and Related  Disorder  293.83 Bipolar and Related Disorder Due to Another  Medical Condition (Manic/Hypomanic/Mixed)  296.89 (F31.89) Other Specified Bipolar and Related  Disorder  296.80 (F31.9) Unspecified Bipolar and Related Disorder
  • 3. Specifiers for Bipolar and Related Disorders  With Anxious Distress  Manic or Hypomanic episode With Mixed Features  Depressive episode With Mixed Features  With Rapid Cycling  With Melancholic Features  With Atypical Features  With Psychotic Features  Mood congruent psychotic features  Mood incongruent psychotic features  With Catatonia  With Peripartum Onset  With Seasonal Pattern
  • 4. Bipolar I  Bipolar and related disorders are separated from the depressive disorders in DSM-5 and placed between the chapters on schizophrenia spectrum and other psychotic disorders and depressive disorders in recognition of their place as a bridge between the two  The bipolar I disorder criteria represent the modern understanding of the classic manic-depressive disorder or affective psychosis described in the nineteenth century, differing from that classic description only to the extent that neither psychosis nor the lifetime experience of a major depressive episode is a requirement
  • 5. Bipolar I Diagnostic Criteria  The essential feature of a manic episode is a distinct period during which there is an abnormally, persistently elevated, expansive, or irritable mood and persistently increased activity or energy that is present for most of the day, nearly every day, for a period of at least 1 week  Mood in a manic episode is often described as euphoric, excessively cheerful, high, or “feeling on top of the world”  In children, happiness, silliness and “goofiness” are normal in the context of special occasions
  • 6. Bipolar I Diagnostic Criteria  During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:  Inflated self-esteem or grandiosity.  Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).  More talkative than usual or pressure to keep talking.  Flight of ideas or subjective experience that thoughts are racing.  Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.  Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).  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. Prevalence and Course  The 12-month prevalence estimate in the continental United States was 0.6% for bipolar I disorder as defined in DSM-IV(Merikangas et al. 2007). Twelve-month prevalence of bipolar I disorder across 11 countries ranged from 0.0% to 0.6%(Merikangas et al. 2007). The lifetime male-to-female prevalence ratio is approximately 1.1:1(Merikangas et al. 2007).  Mean age at onset of the first manic, hypomanic, or major depressive episode is approximately 18 years for bipolar I disorder.  More than 90% of individuals who have a single manic episode go on to have recurrent mood episodes.  Approximately 60% of manic episodes occur immediately before a major depressive episode.  Individuals with bipolar I disorder who have multiple (four or more) mood episodes (major depressive, manic, or hypomanic) within 1 year receive the specifier “with rapid cycling.”