These posts will be collected and put into the format of a page.  The posts in this series are as follows: Bipolar I; Diagnosis, Affects on life, Medications (types not total list), recommendations for a Better Recovery, and Bipolar II; Diagnosis, Affects on Life (including a little about my story of life with this disorder), Medications (types not total list), recommendations for a Better Recovery.  Warning!!! This section contains a lot of information. Read slowly absorb what you can and come back to it later. This is a must read for anyone with bipolar I or their friends and family.

The following description of the diagnoses does not take the place of medical advice or diagnosis. I gave this information for the purpose of understanding a doctor’s diagnosis of either one’s self or that of someone you love.

Manic-depressive disorder or as it is clinically known Bipolar disorder is a unpleasant disorder that affects the whole life of the person. It comes in two flavors so to speak; types I and II. For this post I will be discussing the classic disorder or type I. Clinical diagnosis of the disorder as with all mental illnesses is determined by the DSM 5 or diagnostic and statistical manual volume 5 (actually the 6th volume) published by the American Psychiatric Association.

Official diagnosis for Bipolar I;  symptoms (“criteria”) are present for at least one Manic or Mixed episode and these symptoms cause trouble (“distress”) or disability (“impairment”) with living a “normal” life (“socio” functioning) and/or working at a job (“occupational” functioning). Also, these symptoms are not better diagnosed as another disorder.

Below is the  official wording

Diagnostic Criteria for Bipolar I Disorder – (American Psychiatric Association, 2000)

A. Criteria have been met for at least one Manic or Mixed Episode.
B. The symptoms cause social/occupational distress or impairment.
C. The symptoms are not better accounted for by Schizoaffective Disorder, and are not superimposed on Schizpophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

The symptoms of manic episode  are: a greater than normal sense of  self (“self-esteem” or grandiosity”), sleeplessness (“decreased need for sleep”), talking a lot and quickly (“increased talkativeness”), a feeling that one’s thoughts are coming too fast (noticed by others as talking too fast to be understood and switching topics so fast as to be undecipherable) (“racing thoughts” or “flight of ideas”), easily distracted by passing stimuli (i.e. TV, other people, etc.) (“distractibility”),  focuses on  fulfilling  large  life goals often to the exclusion of all else [symptom lasts at least one week] (“increased in goal-directed activity”) or being  mentally  or physically uncomfortable when not doing something (“psychomotor agitation”), Increase in activities that are known to be dangerous (i.e. Parasailing, skydiving etc.).

There must be at least three of the symptoms in order to have a Manic episode diagnoses. Symptoms must be present for at least one week unless hospitalization is required. Also the severity of the episode must be such that the person has trouble working, living a normal life, is hospitalized, and or has psychotic symptoms (i.e. Difficulty distinguishing real from imaginary or hears voices or sees hallucinations.). Symptoms cannot be associated with substance use or a medical condition.

The symptoms of major depression are: feels low in spirit, sad, and or generally unhappy all or most of the day {“depressed mood all or most of the day”);  diminished interest in nearly all activities most of the day; significant change in weight or appetite; difficulty sleeping (” insomnia”) or sleeping all the time (” hypersomnia”); feels uncomfortable when not doing anything mentally or physically (” psychomotor agitation”) or slow to get started on doing anything (” psychomotor retardation”); feeling tired most of the time (” fatigue”) or decreased energy; inappropriate guilt or feelings of worthlessness; difficulty concentrating or making decisions; recurrent thoughts of death, suicidal thoughts, plans, or attempts

There must be at least five symptoms and one of these must be either depressed mood or loss of interest.  Symptoms must be present for at least two weeks nearly every day. Also the severity of the episode must be such that the person has trouble working, living a normal life,or  is hospitalized.Symptoms must not meet criteria for mixed episode.  Symptoms cannot be associated with substance use or a medical condition.

A mixed episode is one which meets the criteria for both manic episode and major depressive episode excluding time factor. Also it cannot meet criteria for other types of episodes. Just as with the other types of episodes mixed episodes must not be a medical condition or substance abuse.

Below is the  official wording

Diagnostic Criteria for a Manic Episode – (American Psychiatric Association, 2000)
A. Persistent elevated, expansive, or irritable mood for at least one week
(unless hospitalization is required).
B. At least three of the following symptoms are present during mood disturbance
(four if mood is irritable):
 inflated self-esteem or grandiosity
 decreased need for sleep
 increased talkativeness
 flight of ideas or racing thoughts
 distractibility
 increase in goal-directed activity or psychomotor agitation
 increase in risky behavior
C. Symptoms don’t meet criteria for a Mixed Episode.
D. Level of severity sufficient to cause social or occupational impairment, hospitalization, or psychotic features.
E. Symptoms are not due to a substance or medical condition.
Diagnostic Criteria for a Mixed Episode – (American Psychiatric Association, 2000)
A. Criteria for both Manic and Major Depressive Episode are met (excluding duration) almost every day for at least one week.
B. Level of severity sufficient to cause social or occupational impairment, hospitalization, or psychotic features.
C. Symptoms are not due to a substance or medical condition.
Diagnostic Criteria for Major Depressive Episode
– 
(American Psychiatric Association, 2000)
A. At least five of the following symptoms present during a two-week period nearly every day; at least one symptom is either depressed mood or loss of interest/pleasure:
 depressed mood most of the day
 diminished interest in nearly all activities most of the day
• significant change in weight or appetite
• insomnia or hypersomnia
 psychomotor agitation or retardation
 fatigue or decreased energy
 inappropriate guilt or feelings of worthlessness
 difficulty concentrating or making decisions
 recurrent thoughts of death, suicidal thoughts, plans, or attempts
B. Symptoms don’t meet criteria for a Mixed Episode.
C. Symptoms cause significant social/occupational impairment or distress.
D. Symptoms are not due to a substance or medical condition.
E. Symptoms are not better accounted for by Bereavement.llllllllll

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