In Progress DSM V Bipolar I Diagnostic Criteria

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Bipolar I Disorder
Diagnostic Criteria
For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.

Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).[checkbox name="ma" value="yes=1|no"]
B. 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:
1. Inflated self-esteem or grandiosity.[checkbox name="mb1" value="yes=1|no"]
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). [checkbox name="mb2" value="yes=1|no"]
3. More talkative than usual or pressure to keep talking.[checkbox name="mb3" value="yes=1|no"]
4. Flight of ideas or subjective experience that thoughts are racing.[checkbox name="mb4" value="yes=1|no"]
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.[checkbox name="mb5" value="yes=1|no"]
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., puφoseless non-goal-directed activity). [checkbox name="mb6" value="yes=1|no"]
7. 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). [checkbox name="mb7" value="yes=1|no"]
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. [checkbox name="mc" value="yes=1|no"]
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition. Note: A full manic episode that emerges during antidepressant 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 manic episode and, therefore, a bipolar I diagnosis.
Note: Criteria A-D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.[checkbox name="md" value="yes=1|no"]

Hypomanic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. [checkbox name="ha" value="yes=1|no"]
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.[checkbox name="hb1" value="yes=1|no"]
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).[checkbox name=hb2 value="yes=1|no"]
3. More talkative than usual or pressure to keep talking.[checkbox name="hb3" value="yes=1|no"]
4. Flight of ideas or subjective experience that thoughts are racing.[checkbox name="hb4" value="yes=1|no"]
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. [checkbox name="hb5" value="yes=1|no"]
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation. [checkbox name="hb6" value="yes=1|no"]
7. 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). [checkbox name="hb7" value="yes=1|no"]
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. [checkbox name="hc" value="yes=1|no"]
D. The disturbance in mood and the change in functioning are observable by others.[checkbox name="hd" value="yes=1|no"]
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.[checkbox name="he" value="yes=1|no"]
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment). [checkbox name="hb1" value="yes=1|no"]
Note: A full hypomanic episode that emerges during antidepressant 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 hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis.
Note: Criteria A-'F constitute a hypomanic episode. Hypomanic episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.

Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.) [checkbox name="da1" value="yes=1|no"]
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).[checkbox name="da2" value="yes=1|no"]
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)[checkbox name="da3" value="yes=1|no"]
4. Insomnia or hypersomnia nearly every day.[checkbox name="da4" value="yes=1|no"]
5. Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).[checkbox name="da5" value="yes=1|no"]
6. Fatigue or loss of energy nearly every day.[checkbox name="da6" value="yes=1|no"]
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). [checkbox name="da7" value="yes=1|no"]
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).[checkbox name="da8" value="yes=1|no"]
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. [checkbox name="da9" value="yes=1|no"]
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. [checkbox name="db" value="yes=1|no"]
C. The episode is not attributable to the physiological effects of a substance or another medical condition. [checkbox name="dc" value="yes=1|no"]

Note: Criteria A-C constitute a major depressive episode. Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context
of loss.^

Bipolar I Disorder
A. Criteria have been met for at least one manic episode (Criteria A-D under “Manic Episode”
above).
B. The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Coding and Recording Procedures
The diagnostic code for bipolar I disorder is based on type of current or most recent episode and its status with respect to current severity, presence of psychotic features, and remission status. Current severity and psychotic features are only indicated if full criteria are currently met for a manic or major depressive episode. Remission specifiers are only indicated if the full criteria are not currently met for a manic, hypomanie, or major depressive episode. Codes are as follows:

Bipolar I disorder

Current or most recent Episode manic
[checkbox name="sev" value="Mild 296.41(F31.11)"] [comment memo="Few, if any, symptoms in excess of those required to meet the diagnostic criteria are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning."]
[checkbox name="sev" value="Moderate 296.42(F31.12)"] [comment memo="The number of symptoms, intensity of symptoms, and/or functional impairment
are between those specified for 'mild' and 'severe.'"]
[checkbox name="sev" value="Severe 296.43(F31.13)"] [comment memo="The number of symptoms is substantially in excess of those required to make
the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning."]

Current or most recent episode Hypomanic
Severity and psychotic specifiers do not apply; code 296.40 (F31.0) for cases not in remission.

Current or most recent Episode depressed
[checkbox name="sev" value="Mild 296.51(F31.31)"]
Moderate 296.52(F31.32)
Severe 296.53(F31.4)

Current or most recent episode unspecified
Severity, psychotic, and remission specifiers do not apply. Code 296.7 (F31.9).




^ In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the predominant affect is feelings of emptiness and loss, while in MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure. The dysphoria in grief is likely to decrease in intensity over days to Weeks and occurs in waves, the so-called pangs of grief. These waves tend to be associated with thoughts or reminders of the deceased. The depressed mood of a MDE is more persistent and not tied to specific thoughts or preoccupations. The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of a major depressive episode. The thought content associated with grief generally features a preoccupation with thoughts and memories of the deceased, rather than the self-critical or pessimistic ruminations seen in a MDE. In grief, self-esteem is generally preserved, whereas in a MDE, feelings of worthlessness and selfloathing are common. If self-derogatory ideation is present in grief, it typically involves perceived failings vis-a-vis the deceased (e.g., not visiting frequently enough, not telling the deceased how much he or she was loved). If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about "joining" the deceased, whereas in a major depressive episode such thoughts are focused on ending one's own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.

Bipolar 1 disorder

Current or most recent Episode manic
With psychotic features 296.44(F31.2)
In partial remission 296.45 (F31.73)
In full remission 296.46 (F31.74)
Unspecified 296.40 (F31.9)

Current or most recent episode Hypomanic
With psychotic features: Severity and psychotic specifiers do not apply; code 296.40 (F31.0) for cases not in remission.

In partial remission 296.45 (F31.73)
In full remission 296.46 (F31.74)
Unspecified 296.40 (F31.9)

Current or most recent Episode depressed
With psychotic features 296.54(F31.5)
In partial remission 296.55 (F31.75)
In full remission 296.56 (F31.76)
Unspecified 296.50 (F31.9)

Current or most recent episode unspecified
Severity, psychotic, and remission specifiers do not apply. Code 296.7 (F31.9).

In recording the name of a diagnosis, terms should be listed in the following order: bipolar I disorder, type of current or most recent episode, severity/psychotic/remission specifiers, followed by as many specifiers without codes as apply to the current or most recent episode.
Specify.
With anxious distress (p. 149)
With mixed features (pp. 149-150)
With rapid cycling (pp. 150-151)
With meianchoiic features (p. 151)
With atypicai features (pp. 151-152)
With mood-congruent psychotic features (p. 152)
With mood-incongruent psychotic features (p. 152)
With catatonia (p. 152). Coding note: Use additional code 293.89 (F06.1).
With peripartum onset (pp. 152-153)
With seasonal pattern (pp. 153-154)
Bipolar I Disorder
Diagnostic Criteria
For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.

Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. 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:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., puφoseless non-goal-directed activity).
7. 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).
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition. Note: A full manic episode that emerges during antidepressant 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 manic episode and, therefore, a bipolar I diagnosis.
Note: Criteria A-D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.

Hypomanic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
7. 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).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment).
Note: A full hypomanic episode that emerges during antidepressant 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 hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis.
Note: Criteria A-'F constitute a hypomanic episode. Hypomanic episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.

Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.

Note: Criteria A-C constitute a major depressive episode. Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context
of loss.^

Bipolar I Disorder
A. Criteria have been met for at least one manic episode (Criteria A-D under “Manic Episode”
above).
B. The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Coding and Recording Procedures
The diagnostic code for bipolar I disorder is based on type of current or most recent episode and its status with respect to current severity, presence of psychotic features, and remission status. Current severity and psychotic features are only indicated if full criteria are currently met for a manic or major depressive episode. Remission specifiers are only indicated if the full criteria are not currently met for a manic, hypomanie, or major depressive episode. Codes are as follows:

Bipolar I disorder

Current or most recent Episode manic
Few, if any, symptoms in excess of those required to meet the diagnostic criteria are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning.
The number of symptoms, intensity of symptoms, and/or functional impairment
are between those specified for 'mild' and 'severe.'

The number of symptoms is substantially in excess of those required to make
the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.


Current or most recent episode Hypomanic
Severity and psychotic specifiers do not apply; code 296.40 (F31.0) for cases not in remission.

Current or most recent Episode depressed

Moderate 296.52(F31.32)
Severe 296.53(F31.4)

Current or most recent episode unspecified
Severity, psychotic, and remission specifiers do not apply. Code 296.7 (F31.9).




^ In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the predominant affect is feelings of emptiness and loss, while in MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure. The dysphoria in grief is likely to decrease in intensity over days to Weeks and occurs in waves, the so-called pangs of grief. These waves tend to be associated with thoughts or reminders of the deceased. The depressed mood of a MDE is more persistent and not tied to specific thoughts or preoccupations. The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of a major depressive episode. The thought content associated with grief generally features a preoccupation with thoughts and memories of the deceased, rather than the self-critical or pessimistic ruminations seen in a MDE. In grief, self-esteem is generally preserved, whereas in a MDE, feelings of worthlessness and selfloathing are common. If self-derogatory ideation is present in grief, it typically involves perceived failings vis-a-vis the deceased (e.g., not visiting frequently enough, not telling the deceased how much he or she was loved). If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about "joining" the deceased, whereas in a major depressive episode such thoughts are focused on ending one's own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.

Bipolar 1 disorder

Current or most recent Episode manic
With psychotic features 296.44(F31.2)
In partial remission 296.45 (F31.73)
In full remission 296.46 (F31.74)
Unspecified 296.40 (F31.9)

Current or most recent episode Hypomanic
With psychotic features: Severity and psychotic specifiers do not apply; code 296.40 (F31.0) for cases not in remission.

In partial remission 296.45 (F31.73)
In full remission 296.46 (F31.74)
Unspecified 296.40 (F31.9)

Current or most recent Episode depressed
With psychotic features 296.54(F31.5)
In partial remission 296.55 (F31.75)
In full remission 296.56 (F31.76)
Unspecified 296.50 (F31.9)

Current or most recent episode unspecified
Severity, psychotic, and remission specifiers do not apply. Code 296.7 (F31.9).

In recording the name of a diagnosis, terms should be listed in the following order: bipolar I disorder, type of current or most recent episode, severity/psychotic/remission specifiers, followed by as many specifiers without codes as apply to the current or most recent episode.
Specify.
With anxious distress (p. 149)
With mixed features (pp. 149-150)
With rapid cycling (pp. 150-151)
With meianchoiic features (p. 151)
With atypicai features (pp. 151-152)
With mood-congruent psychotic features (p. 152)
With mood-incongruent psychotic features (p. 152)
With catatonia (p. 152). Coding note: Use additional code 293.89 (F06.1).
With peripartum onset (pp. 152-153)
With seasonal pattern (pp. 153-154)
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