Bipolar I Disorder

Prevalence

• Twelve-month prevalence of bipolar I disorder across 11 countries ranged from 0.0% to 0.6%.

• The lifetime male-to-female prevalence ratio is approximately 1.1:1.

Symptoms

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 hypo- manic 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

• (B) During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms 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 , 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 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.

Hypomanic Episode

• Same as (A) and (B).

• The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

• The disturbance in mood and the change in functioning are observable by others.

• The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.

• The episode is not attributable to the physiological effects of a substance.

Major Depressive Episode

• 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 depressed mood or loss of interest or pleasure :

  1. Depressed mood most of the day, nearly every day.

  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

  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.

  4. Insomnia or hypersomnia nearly every day.

  5. Psychomotor agitation or retardation nearly every day.

  6. Fatigue or loss of energy nearly every day.

  7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

  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.

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The episode is not attributable to the physiological effects of a substance or another medical condition.

Bipolar I Disorder

• Criteria have been met for at least one manic episode (Criteria A-D under “Manic Episode” above).

• 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.