The essential feature of<unk>  is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes. Often, individuals have had one or more major depressive episodes. One episode of mania is sufficient to make the diagnosis of bipolar<unk> ; the person may or may not have a history of major depressive<unk> . Episodes of substance-induced mood<unk>  due to the direct effects of a medication, or other somatic treatments for depression, drug abuse, or toxin exposure, or of mood<unk>  due to a general medical condition need to be excluded before a diagnosis of<unk>  can be made.<unk>  requires confirmation of only 1 full manic episode for diagnosis, but may be associated with hypomanic and depressive episodes as well. Diagnosis for<unk>  does not include a full manic episode; instead, it requires the occurrence of both a hypomanic episode and a major depressive episode. Serious aggression has been reported to occur in one of every ten first-major episode BD-I patients with psychotic features, its prevalence in this group being particularly high in association with a recent suicide attempt, alcohol-abuse, learning disability, or manic polarity in the first episode.<unk>  (and<unk>  is often comorbid with other<unk> s including PTSD, substance use<unk> s and a variety of mood<unk> s. Up to 40% of people with bipolar<unk>  also present with PTSD, with higher rates occurring in women and individuals with<unk> . In addition, the episodes must not be better accounted for by schizoaffective<unk>  or superimposed on schizophrenia, schizophreniform<unk> , delusional<unk> , or a psychotic<unk>  not otherwise specified. Medical assessment Regular medical assessments are performed to rule-out secondary causes of mania and depression. These tests include complete blood count, glucose, serum chemistry/electrolyte panel, thyroid function test, liver function test, renal function test, urinalysis, vitamin B12 and folate levels, HIV screening, syphilis screening, and pregnancy test, and when clinically indicated, an electrocardiogram (ECG), an electroencephalogram (EEG), a computed tomography (CT scan), and/or a magnetic resonance imagining (MRI) may be ordered. Drug screening includes recreational drugs, particularly synthetic cannabinoids, and exposure to toxins. Diagnostic and Statistical Manual of Mental<unk> s, 4th Edition (DSM-IV-TR) Dx Code #<unk>  Description 296.0x<unk>  Single manic episode 296.40<unk>  Most recent episode hypomanic 296.4x<unk>  Most recent episode manic 296.5x<unk>  Most recent episode depressed 296.6x<unk>  Most recent episode mixed 296.7<unk>  Most recent episode unspecified Diagnostic and Statistical Manual of Mental<unk> s, 5th Edition (DSM-5) In May 2013, American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental<unk> s (DSM-5). There are several proposed revisions to occur in the diagnostic criteria of<unk>  and its subtypes. For<unk>  296.40 (most recent episode hypomanic) and 296.4x (most recent episode manic), the proposed revision includes the following specifiers: with psychotic features, with mixed features, with catatonic features, with rapid cycling, with anxiety (mild to severe), with suicide risk severity, with seasonal pattern, and with postpartum onset.<unk>  296.5x (most recent episode depressed) will include all of the above specifiers plus the following: with melancholic features and with atypical features. The categories for specifiers will be removed in DSM-5 and criterion A will add or there are at least 3 symptoms of major depression of which one of the symptoms is depressed mood or anhedonia. For<unk>  296.7 (most recent episode unspecified), the listed specifiers will be removed. The criteria for manic and hypomanic episodes in criteria A & B will be edited. Criterion A will include "and present most of the day, nearly every day", and criterion B will include "and represent a noticeable change from usual behavior". These criteria as defined in the DSM-IV-TR have created confusion for clinicians and need to be more clearly defined. There have also been proposed revisions to criterion B of the diagnostic criteria for a Hypomanic Episode, which is used to diagnose For<unk>  296.40, Most Recent Episode Hypomanic. Criterion B lists "inflated self-esteem, flight of ideas, distractibility, and decreased need for sleep" as symptoms of a Hypomanic Episode. This has been confusing in the field of child psychiatry because these symptoms closely overlap with symptoms of attention deficit hyperactivity<unk>  (ADHD). Note that many of the above changes are still under active consideration and are not definite. For more information regarding proposed revisions to the DSM-5, please visit their website at dsm5.org. ICD-10 * F31 Bipolar Affective<unk>  * F31.6 Bipolar Affective<unk> , Current Episode Mixed * F30 Manic Episode * F30.0 Hypomania * F30.1 Mania Without Psychotic Symptoms * F30.2 Mania With Psychotic Symptoms * F32 Depressive Episode * F32.0 Mild Depressive Episode * F32.1 Moderate Depressive Episode * F32.2 Severe Depressive Episode Without Psychotic Symptoms * F32.3 Severe Depressive Episode With Psychotic Symptoms
Bipolar I disorder
Bipolar II disorder
Bipolar disorder
Major depressive disorder
Bipolar disorder not otherwise specified
Major depressive episode
Cyclothymia
Dysthymia