Key Diagnostic Criteria Distinguishing Manic Episode from Hypomanic Episode

Bipolar disorder, a medical illness with substantial morbidity and mortality, is characterized by episodic recurrent mania or hypomania and major depression. The hallmark of bipolar disorder is at least one episode of mania (bipolar I disorder) or hypomania (bipolar II disorder).

Key Diagnostic Criteria Distinguishing Bipolar I Disorder from Bipolar II Disorder.*

Manic Episode (Bipolar I Disorder) Hypomanic Episode (Bipolar II Disorder)
Distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 wk (or less if hospitalization is required) Distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood lasting at least 4 days
Must be accompanied by at least three of the following symptoms (four if mood is only irritable): inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased involvement in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable activities with a high potential for painful consequences Must be accompanied by at least three of the following symptoms (four if mood is only irritable): inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased involvement in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable activities with a high potential for painful consequences
Symptoms do not meet criteria for a mixed episode Hypomanic episodes must be clearly different from the person’s usual nondepressed mood, and there must be a clear change in functioning that is not characteristic of the person’s usual functioning
Disturbance must be sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization, or it is characterized by the presence of psychotic features Changes in mood and functioning must be observable by others. In contrast to a manic episode, a hypomanic episode is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization, and there are no psychotic features
Symptoms not due to direct physiological effect of medication, general medical condition, or substance abuse Symptoms not due to direct physiological effect of medication, general medical condition, or substance abuse

* Criteria are from the American Psychiatric Association.

 

 

References:

  1. Diagnostic and statistical manual of mental disorders, 4th ed. rev.: DSM-IV-R. Washington, DC: American Psychiatric Association, 2000.
  2. Frye MA. Clinical practice. Bipolar disorder–a focus on depression. N Engl J Med. 2011 Jan 6;364(1):51-9. [Medline]

Created: Jan 12, 2011.

print