Editing Bipolar I disorder (section)

==Diagnosis==
The essential feature of bipolar I disorder is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes.<ref>{{Cite journal|last1=Phillips|first1=Mary L|last2=Kupfer|first2=David J|date=2013-05-11|title=Bipolar disorder diagnosis: challenges and future directions|journal=Lancet|volume=381|issue=9878|pages=1663–1671|doi=10.1016/S0140-6736(13)60989-7|issn=0140-6736|pmc=5858935|pmid=23663952}}</ref> Often, individuals have had one or more [[major depressive episode]]s.<ref name="DepressionD">{{cite web|url=http://depressiond.org/bipolar-test/|title=Online Bipolar Tests: How Much Can You Trust Them?|publisher=DepressionD|access-date=7 January 2012}}</ref> One episode of mania is sufficient to make the diagnosis of bipolar disorder; the person may or may not have a history of [[major depressive disorder]].<ref name="DepressionD"/> Episodes of substance-induced mood disorder due to the direct effects of a [[medication]], or other [[somatic psychology|somatic]] treatments for depression, [[substance use disorder]], or [[toxin]] exposure, or of mood disorder due to a general medical condition need to be excluded before a diagnosis of bipolar I disorder can be made. Bipolar I disorder requires confirmation of only 1 full manic episode for diagnosis, but may be associated with hypomanic and depressive episodes as well.<ref name=":2">{{Cite book|title=Diagnostic and statistical manual of mental disorders : DSM-5.|others=American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force.|isbn=978-0-89042-559-6|edition=Fifth|location=Arlington, VA|oclc=847226928|year = 2013}}</ref> Diagnosis for bipolar II disorder does not include a full manic episode; instead, it requires the occurrence of both a hypomanic episode and a major depressive episode.<ref name=":2" /> Serious aggression has been reported to occur in one out of every ten major, first-episode, BD-I patients with psychotic features, the prevalence in this group being particularly high in association with a recent suicide attempt, [[alcohol use disorder]], learning disability, or manic polarity in the first episode.<ref>{{Cite journal|last1=Khalsa|first1=Hari-Mandir K.|last2=Baldessarini|first2=Ross J.|last3=Tohen|first3=Mauricio|last4=Salvatore|first4=Paola|date=2018-08-11|title=Aggression among 216 patients with a first-psychotic episode of bipolar I disorder|journal=International Journal of Bipolar Disorders|volume=6|issue=1|pages=18|doi=10.1186/s40345-018-0126-8|issn=2194-7511|pmc=6161985|pmid=30097737 |doi-access=free }}</ref>

Bipolar I disorder often coexists with other disorders including [[Post-traumatic stress disorder|PTSD]], substance use disorders, and a variety of mood disorders.<ref name=":02">{{Cite journal|last1=Cerimele|first1=Joseph M.|last2=Bauer|first2=Amy M.|last3=Fortney|first3=John C.|last4=Bauer|first4=Mark S.|date=May 2017|title=Patients With Co-Occurring Bipolar Disorder and Posttraumatic Stress Disorder: A Rapid Review of the Literature|journal=The Journal of Clinical Psychiatry|volume=78|issue=5|pages=e506–e514|doi=10.4088/JCP.16r10897|issn=1555-2101|pmid=28570791}}</ref><ref>{{Cite journal|last1=Hunt|first1=Glenn E.|last2=Malhi|first2=Gin S.|last3=Cleary|first3=Michelle|last4=Lai|first4=Harry Man Xiong|last5=Sitharthan|first5=Thiagarajan|date=December 2016|title=Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis|journal=Journal of Affective Disorders|volume=206|pages=331–349|doi=10.1016/j.jad.2016.07.011|issn=1573-2517|pmid=27476137}}</ref>  Studies suggest that psychiatric comorbidities correlate with further impairment of day-to-day life.<ref>{{Cite journal |last1=Léda-Rêgo |first1=Gabriela |last2=Studart-Bottó |first2=Paula |last3=Sarmento |first3=Stella |last4=Cerqueira-Silva |first4=Thiago |last5=Bezerra-Filho |first5=Severino |last6=Miranda-Scippa |first6=Ângela |date=2023-02-01 |title=Psychiatric comorbidity in individuals with bipolar disorder: relation with clinical outcomes and functioning |url=http://dx.doi.org/10.1007/s00406-023-01562-5 |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=273 |issue=5 |pages=1175–1181 |doi=10.1007/s00406-023-01562-5 |pmid=36725737 |s2cid=256501014 |issn=0940-1334}}</ref> Up to 40% of people with bipolar disorder also present with PTSD, with higher rates occurring in women and individuals with bipolar I disorder.<ref name=":02" /> A diagnosis of bipolar 1 disorder is only given if bipolar episodes are not better accounted for by [[schizoaffective disorder]] or superimposed on [[schizophrenia]], [[schizophreniform disorder]], [[delusional disorder]], or a [[psychotic disorder]] not otherwise specified.<ref>{{cite web|url=http://www.pchtreatment.com/bipolar-treatment-center/|title=Bipolar Disorder Residential Treatment Center Los Angeles|work=PCH Treatment|access-date=25 November 2015}}</ref>

===Medical assessment===
Regular medical assessments are performed to rule-out secondary causes of mania and depression.<ref name=":3" /> These tests include [[complete blood count]], [[Glucose test|glucose]], serum chemistry/electrolyte panel, [[Thyroid function tests|thyroid function test]], [[Liver function tests|liver function test]], [[Renal function|renal function test]], [[urinalysis]], [[vitamin B12]] and [[folate]] levels, [[Diagnosis of HIV/AIDS|HIV screening]], [[Syphilis serodiagnosis|syphilis screening]], and [[pregnancy test]], and when clinically indicated, an [[Electrocardiography|electrocardiogram]] (ECG), an [[Electroencephalography|electroencephalogram]] (EEG), a [[CT scan|computed tomography]] (CT scan), and/or a [[Magnetic resonance imaging|magnetic resonance imagining]] (MRI) may be ordered.<ref name=":3">{{Cite journal|last=Bobo|first=William V.|date=October 2017|title=The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update|journal=Mayo Clinic Proceedings|volume=92|issue=10|pages=1532–1551|doi=10.1016/j.mayocp.2017.06.022|pmid=28888714|issn=0025-6196|doi-access=free}}</ref> Drug screening includes [[recreational drug]]s, particularly [[synthetic cannabinoid]]s, and exposure to toxins.

===Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR)===
{| class="wikitable"
|-
! Dx code #
! Disorder
! Description
|-
| 296.0x
| Bipolar I disorder
| Single manic episode
|-
| 296.40
| Bipolar I disorder
| Most recent episode hypomanic
|-
| 296.4x
| Bipolar I disorder
| Most recent episode manic
|-
| 296.5x
| Bipolar I disorder
| Most recent episode depressed
|-
| 296.6x
| Bipolar I disorder
| Most recent episode mixed
|-
| 296.7
| Bipolar I disorder
| Most recent episode unspecified
|}

===Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)===
In May 2013, [[American Psychiatric Association]] released the fifth edition of the [[Diagnostic and Statistical Manual of Mental Disorders]] ([[DSM-5]]). There are several proposed revisions to occur in the diagnostic criteria of Bipolar I Disorder and its subtypes. For Bipolar I Disorder 296.40 (most recent episode hypomanic) and 296.4x (most recent episode manic), the proposed revision includes the following specifiers: with [[Psychosis|psychotic]] features, with [[Mixed affective state|mixed]] features, with [[Catatonia|catatonic]] features, with rapid cycling, with [[Anxiety disorder|anxiety]] (mild to severe), with [[Suicide risk assessment|suicide risk severity]], with [[Seasonal affective disorder|seasonal pattern]], and with [[Postpartum period|postpartum]] onset.<ref name=":03">{{Cite book|title=Diagnostic and Statistical Manual of Mental Disorders|last=American Psychiatric Association|date=2013-05-22|publisher=American Psychiatric Association|isbn=978-0-89042-555-8|doi=10.1176/appi.books.9780890425596|url-access=registration|url=https://archive.org/details/diagnosticstatis0005unse}}</ref> Bipolar I Disorder 296.5x (most recent episode depressed) will include all of the above specifiers plus the following: with [[Melancholia|melancholic]] features and with atypical features.<ref name=":03" /> The categories for specifiers will be removed in DSM-5 and criterion A will add or there are at least 3 symptoms of major [[Major depressive disorder|depression]] of which one of the symptoms is [[Depression (mood)|depressed]] mood or [[anhedonia]].<ref name=":03" /> For Bipolar I Disorder 296.7 (most recent episode unspecified), the listed specifiers will be removed.''<ref name=":03" />''

The criteria for manic and hypomanic episodes in criteria A & B will be edited. Criterion A will include "and present most of the day, nearly every day", and criterion B will include "and represent a noticeable change from usual behavior". These criteria as defined in the DSM-IV-TR have created confusion for clinicians and need to be more clearly defined.<ref name="ReferenceA">{{cite book|title=Issues pertinent to a developmental approach to bipolar disorder in DSM-5|publisher=American Psychiatric Association|year=2010}}</ref><ref>{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders (4th ed. text revision)|year=2000|publisher=American Psychiatric Association|location=Washington, DC|pages=345–392}}</ref>

There have also been proposed revisions to criterion B of the diagnostic criteria for a Hypomanic Episode, which is used to diagnose For Bipolar I Disorder 296.40, Most Recent Episode Hypomanic. Criterion B lists "inflated self-esteem, flight of ideas, distractibility, and decreased need for sleep" as symptoms of a Hypomanic Episode. This has been confusing in the field of child psychiatry because these symptoms closely overlap with symptoms of [[attention deficit hyperactivity disorder]] (ADHD).<ref name="ReferenceA"/>

===ICD-10 ===
* F31 Bipolar Affective Disorder
* F31.6 Bipolar Affective Disorder, Current Episode Mixed
* F30 Manic Episode
* F30.0 Hypomania
* F30.1 Mania Without Psychotic Symptoms
* F30.2 Mania With Psychotic Symptoms
* F32 Depressive Episode
* F32.0 Mild Depressive Episode
* F32.1 Moderate Depressive Episode
* F32.2 Severe Depressive Episode Without Psychotic Symptoms
* F32.3 Severe Depressive Episode With Psychotic Symptoms