Bipolar I Disorder is most thought of in relation to the Major Depression and the episodes of Mixed and Manic behavior. As with most other disorders, diagnosis is ruled out when substance abuse, a general medical condition, medication or somatic treatments for depression, along with the schizoid, psychotic, delusional and not otherwise specified disorders. In other words, alternative explanations for the episodes as they come from other causes must be ruled out for a diagnosis of Bipolar I Disorder.
There is attention to recurrance of episodes in diagnosing Bipolar I Disorder. There are several references to the term “most recent” in relation to the various episodes of Mixed behavior, Manic behavior, and Major Depression. Then there are various forms of remission mentioned, as from each type of episode. There is also a look at the severity of the episode and whether there was psychosis present.
Also, the single episode versus the recurrent episode is discussed. Shifts in polarity address the evolution of the Major Depressive Episode into the Manic or Mixed Episode.
Or, the polarity shift can be the reverse, beginning with a Hypomanic, Manic or Mixed Episode that evolves into another type of episode. This direction is considered to be “single Episode” and not recurrent.
Major Depression is mood depression or the loss of interest or pleasure from almost every activity lasts for at least two weeks. Children may exhibit an irritable instead of sad mood. There are times and recencies that must be met: either the symptom is new or has obviously gotten worse than it was before the depressive episode. Persistence: most of the day, almost every day, at least 2 consecutive weeks.
The Manic Episode goes on for a distinct period of time, at least one week. There is elevated, expansive, or irritable mood and hospitalization can be required. If the patient is hospitalized, the one week duration criterion is modified.
There is impairment in social and job related functions in life
At least three or four of the critical symptoms must be present for diagnosis of a Manic Episode. The number changes based on whether the mood is irritable or expansive. For irritable, four symptoms must be met. For expansive or elevated, three must be met.
The symptoms include inflation: of self-esteem or grandiosity. There is Decrease: In need for Sleep. There is flightiness: of ideas, ease of distractibility. There is change in involvement and activities: toward goal-directed activities or psycho motor agitation, or excessive involvement in risky activities.
There will be an initial “infectous” quality that only those who know the person well will recognize as a major change in behavior. Then there will be increase in constant and less discriminatory desire for such things as sex, conversation with anyone, anywhere, for example.
The term “prototypical symptom” involves the initial elevated mood, but there is also the “predominant mood” which is usually irritability at being stopped from doing the desired but problematic activity. Then there is Lability of mood, where irritability and euphoria alternate.
One or more Mixed Episodes is a major part of Bipolar I Disorder. The Mixed Episode may or may not be evolved from a Major Depressive Episode.
The Mixed Episode meets the major criterion for both a Major Depressive and a Manic Episode for a week and almost every day of the week.
This is a period of rapid alterations and alternating moods, from sadness and irritability to euphoria. There are appetite, insomnia, psychotic, agitation and suicidal thinking features in the Mixed Episode.
The severity of impairment or the psychotic features must be enough to warrant hospitalization. If these features come from medication, shock therapy, light therapy or other medical conditions, the Mixed Episode is not diagnosed as Bipolar I Disorder.
There is a concept of “diathesis” where somatic treatment for depression can cause Mixed Episodes, and future Hypomanic and Mixed episodes that do not relate to the somatic treatments. Somatic treatments are a form that affects the physiologic functioning of the body.
As the family and or friends of the individual are important in the anecdotal and descriptive information about the individuals behavior during Manic, Mixed and Major Depressive Episodes of any Bipolar Disorder, it is important to seek help when the symptoms appear, whether they are recurring, meet the specific criteria for a particular diagnosis, or whether the symptoms go away and do not appear to be a long term issue. But, sadly, the tendency is to not mention the behavior to the doctor, if it goes away or appears to be a unique event.
DSM-IV-TR, Bipolar I Disorder
DSM-IV-TR, Mixed Episode
DSM-IV-TR, Manic Episode
The Free Dictionary, “Somatic Treatment”