Bipolar Disorderand

Substance Use Disorders

Bipolar I Disorder

Includes one or more Manic Episodes or Mixed Episodes, sometimes with Major Depressive Episodes as well

o Single Manic Episodeo Most Recent Episode Hypomanico Most Recent Episode Manico Most Recent Episode Mixedo Most Recent Episode Depressed

Manic Episode

A. A period of unusual and ongoing elevated, expansive, or irritable mood, of at least 1 week duration

Manic EpisodeB. Three (3) or more of the following occur:

1) Inflated self-esteem or grandiosity;2) Decreased sleep needs;3) More talkative than usual;4) Racing thoughts;5) Distractibility;6) Increase in activity or psychomotor

agitation;7) Excessive involvement in pleasurable

activities with high potential for painful consequences (ex. spending, sex).

Manic Episode

C. The mood disturbance is severe enough:

1) to significantly impair occupational functioning, or

2) to significantly impair usual social activities or relationships, or

3) to require hospitalization to prevent harm to self or others

Manic Episode

D. Symptoms are NOT due to the direct effects of a substance (including prescribed medication and/or intoxication or withdrawal syndromes of substances of abuse), or a general medical condition

Hypomanic Episode

A. A period of unusual and ongoing elevated, expansive, or irritable mood, lasting through at least 4 days, that is clearly different from the usual non-depressed mood

B. Manic symptoms (see)C. Significant functional impairmentD. Symptoms are NOT due to

substances of abuse

Cocaine Intoxication

• Euphoria (elevated, expansive mood)• Changes in sociability (more

talkative)• Hypervigilance• Interpersonal sensitivity (irritability)• Anxiety, tension or anger• Impaired judgment• Impaired social or occupational

functioning• Psychomotor agitation

Alcohol Withdrawal

• Insomnia• Psychomotor

agitation• Anxiety• Hand tremor• Temporary hallucinations• Nausea, vomiting• Seizures• Impaired social or occupational

functioning

Depressive EpisodeA. Five or more of the

following are present during the same 2-week period, and represent a change from previous functioning, and at least one of the symptoms is either (1) depressed mood, or (2) loss of interest . . .

Depressive Episode

1) Depressed mood most of the day, every day2) Loss of interest or pleasure in most all activities,

every day3) Significant weight loss w/o dieting4) Insomnia / hypersomnia every day5) Psychomotor agitation / retardation every day6) Fatigue or energy loss every day7) Worthlessness or inappropriate guilt feelings nearly

every day8) Decreased ability to think, concentrate or make

decisions nearly every day9) Recurrent thoughts of death, or suicidal ideation,

with or without plan &/or attempt

Depressive Episode

B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Depressive Episode

C. Symptoms are NOT due to the effects of a substance (e.g., drug of abuse, or medication) or a general medical condition (e.g., hyperthyroidism)

Depressive Episode

D. Symptoms are not better accounted for by Bereavement (i.e. lasting longer than 2 months after a significant loss, or characterized by severe degree of functional impairment, preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation)

Sedative Intoxication

• Inappropriate sexual or aggressive behavior

• Slurred speech• Stupor• Impaired attention or

memory• Mood lability• Impaired judgment• Psychomotor retardation or agitation• Impaired social, occupational, or other

functioning

Cocaine Withdrawal

• Depressed mood• Fatigue• Vivid, unpleasant dreams• Insomnia or hypersomnia• Increased appetite• Psychomotor retardation or agitation• Symptoms cause clinically significant

distress or impairment in social, occupational, or other important areas of functioning

Mixed Episode

A. Criteria are met for both a Manic Episode, and for a Major Depressive Episode (except for duration) for at least a 1-week period

Bipolar II Disorder

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

Symptoms are NOT better accounted for by another disorder (including Substance Use disorders)

Symptoms impairment in social, occupational, or other important areas of functioning

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