Essentials of Diagnosis
A distinct period of abnormally and persistently elevated, expansive, or irritable mood for at least 1 week (or any duration if hospitalization is necessary).
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
inflated self-esteem or grandiosity
decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
more talkative than usual or pressure to keep talking
flight of ideas or subjective experience that thoughts are racing
distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
The symptoms do not meet criteria for a Mixed Episode.
(Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000.)
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
Same as B criterion for Manic Episode.
The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person 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, and there are no psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
(Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000.)
The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
(Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000.)
Currently (or most recently) in a Manic Episode.
There has previously been at least one Major Depressive Episode, Manic Episode, or Mixed Episode.
The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
(Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000.)
Presence (or history) of one or more Major Depressive Episodes.
Presence (or history) of at least one Hypomanic Episode.
There has never been a Manic Episode or a Mixed Episode.
The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
General Considerations
Given the controversy in characterizing pediatric bipolar disorder (BP), there is no data on the prevalence of prepubertal BP. One published study by Lewinsohn shows a lifetime BP prevalence of approximately 1% in youths 14–18 years old (predominantly BP type II and cyclothymia). An additional 5.7% youths have subsyndromal BP symptoms. Retrospective reports of adults with BP show that 60% report the onset of BP before 20 years of age and 10–20% report BP onset before 10 years of age. BP affects both sexes equally.
Contributors to the etiology and course of BP are hypothesized to include genetics, neurobiology, and family environment. Biological etiologies are suggested by correlations between genetics and neuroimaging findings and BP. A family environment including stress and abuse is associated with earlier age of onset and more difficult course.
Clinical Findings
