Fast Five Quiz: Are You Prepared to See Patients With Bipolar Disorder?

Stephen Soreff, MD


June 22, 2018

Hypomanic episodes are characterized by an elevated, expansive, or irritable mood of at least 4 consecutive days' duration. Hypomanic episodes are part of the criteria for diagnosing BPII. At least three of these symptoms are also present:

  • Grandiosity or inflated self-esteem

  • Diminished need for sleep

  • Pressured speech

  • Racing thoughts or flight of ideas

  • Clear evidence of distractibility

  • Increased level of goal-focused activity at home, at work, or sexually

  • Engaging in activities with a high potential for painful consequences

The diagnosis of BPI requires the presence of a manic episode of at least 1 week's duration or that leads to hospitalization or other significant impairment in occupational or social functioning. The episode of mania cannot be caused by another medical illness or by substance abuse. Manic episodes include at least 1 week of profound mood disturbance, characterized by elation, irritability, or expansiveness (referred to as gateway criteria). At least three of these symptoms must also be present:

  • Grandiosity

  • Diminished need for sleep

  • Excessive talking or pressured speech

  • Racing thoughts or flight of ideas

  • Clear evidence of distractibility

  • Increased level of goal-focused activity at home, at work, or sexually

  • Excessive pleasurable activities, often with painful consequences

Major depressive episodes are characterized as five or more of the following symptoms in the same 2 weeks, with at least one of the symptoms being either a depressed mood or loss of pleasure or interest:

  • Depressed mood

  • Markedly diminished pleasure or interest in nearly all activities

  • Significant weight loss or gain or significant loss or increase in appetite

  • Hypersomnia or insomnia

  • Psychomotor retardation or agitation

  • Loss of energy, or fatigue

  • Feelings of worthlessness or excessive guilt

  • Decreased concentration ability or marked indecisiveness

  • Preoccupation with death or suicide; patient has a plan or has attempted suicide

Mixed symptomatology is quite common in patients presenting with bipolar symptomatology. This often causes a diagnostic dilemma and has prompted a revision to the definition of bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). With the aim of capturing mixed symptoms more effectively, the "mixed episode" diagnosis has been eliminated in favor of a "mixed features specifier" that could be added to any mood bipolar disorder diagnosis. Other specifiers include anxious distress, rapid cycling, mood-congruent psychotic features, catatonia, peripartum onset, and seasonal pattern.

For more on the presentation of bipolar disorder, read here.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.