DSM-5 criteria for a manic episode (Bipolar I disorder)

Checklist of DSM-5 diagnostic criteria for a manic episode, which defines Bipolar I disorder.

Predominant mood quality

Determines how many of the 7 symptoms below are required (3 vs 4).

Mood disturbance lasts >=1 week, most of the day nearly every day (any duration if hospitalization required)

Abnormally and persistently increased goal-directed activity or energy present throughout the episode

Inflated self-esteem or grandiosity

One of 7 symptoms; 3 required if mood is elevated/expansive, 4 required if mood is irritable only.

Decreased need for sleep

More talkative than usual or pressure to keep talking

Flight of ideas or subjective racing thoughts

Distractibility

Increase in goal-directed activity or psychomotor agitation

Excessive involvement in activities with high potential for painful consequences

Impact of the episode

Episode not attributable to a substance or another medical condition

ResultCriteria not met

Does not fulfil all DSM-5 criteria for a manic episode as entered.

Symptoms present: 0 of 7 (need >=3)

When to use

Structuring a DSM-5 diagnostic assessment for suspected mania and Bipolar I disorder.

Formula

Requires: mood disturbance (elevated/expansive or irritable) for >=1 week (any duration if hospitalized) AND persistently increased energy/activity AND >=3 (or >=4 if irritable-only) of 7 symptoms AND marked impairment/hospitalization/psychosis AND not attributable to substance or medical condition.

Pearls and pitfalls

A hypomanic episode uses the same symptom list but requires only >=4 days duration and no marked impairment, hospitalization, or psychotic features.

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: APA; 2013.