Bipolar Disorder
and
Substance Use
Disorders
Bipolar I Disorder
Includes one or more Manic Episodes
or Mixed Episodes, sometimes
with Major Depressive Episodes
as well
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Single Manic Episode
Most Recent Episode Hypomanic
Most Recent Episode Manic
Most Recent Episode Mixed
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 Episode
B.
Three (3) or more of the following occur:
1)
2)
3)
4)
5)
6)
7)
Inflated self-esteem or grandiosity;
Decreased sleep needs;
More talkative than usual;
Racing thoughts;
Distractibility;
Increase in activity or psychomotor
agitation;
Excessive involvement in pleasurable
activities with high potential for
painful consequences (ex. spending, sex).
Manic Episode
C.
The mood disturbance is severe
enough:
1)
2)
3)
to significantly impair occupational
functioning, or
to significantly impair usual social
activities or relationships, or
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.
B.
C.
D.
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
Manic symptoms (see)
Significant functional impairment
Symptoms are NOT due to
substances of abuse
Cocaine Intoxication
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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
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Insomnia
Psychomotor
agitation
Anxiety
Hand tremor
Temporary hallucinations
Nausea, vomiting
Seizures
Impaired social or occupational
functioning
Depressive Episode
A.
Five or more of the
following are present
during the same 2week 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)
2)
3)
4)
5)
6)
7)
8)
9)
Depressed mood most of the day, every day
Loss of interest or pleasure in most all activities,
every day
Significant weight loss w/o dieting
Insomnia / hypersomnia every day
Psychomotor agitation / retardation every day
Fatigue or energy loss every day
Worthlessness or inappropriate guilt feelings nearly
every day
Decreased ability to think, concentrate or make
decisions nearly every day
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
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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
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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
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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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