Transcript:
Hello. I’m Dr Andrew Cutler. I’m a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York, and the chief medical officer at the Neuroscience Education Institute in Carlsbad, California.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, or DSM-5-TR, reflects advances in the medical literature that have been made since the publication of the DSM-5 in 2013.
Bipolar I disorder is a mood disorder characterized by major depressive episodes and manic episodes. Most patients with bipolar I disorder present with depressive symptoms. Because the diagnostic criteria for major depressive episodes in major depressive disorder (MDD) and bipolar disorder are identical, it is important for providers to probe for a history of mania or factors indicating a possible underlying diagnosis of bipolar disorder. Early and accurate diagnosis of bipolar disorder can reduce the burden of illness and improve long-term outcomes.1
A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy lasting for at least 1 week and present most of the day, nearly every day, or for any duration if hospitalization is necessary or there are psychotic features.2
During this time, 3 or more of the following symptoms are present and prominent enough to constitute a noticeable change from usual behavior: inflated self-esteem or grandiosity, decreased need for sleep, increased talkativeness, racing thoughts, distractibility, increase in goal-directed activity or psychomotor agitation, and excessive involvement in activities that have a high potential for painful consequences, such as unrestrained buying sprees. Importantly, the episode cannot be attributed to a drug of abuse, a medication or other treatment, or to another medical condition. At least 1 lifetime manic episode is required for diagnosis of bipolar I disorder.2
Previously, the DSM-5 bipolar I disorder severity specifiers of mild, moderate, and severe only applied if the current mood episode was a major depressive episode. Additionally, the mild severity specifier indicated only minor impairment in functioning, whereas manic episodes are defined by a marked impairment in functioning, so that was a contradiction that needed correcting.3 As such, severity specifiers that are applicable to a manic episode were taken from DSM-IV and added to DSM-5-TR.
The mild specifier is applied when a minimum of symptom criteria is met for a manic episode. The moderate specifier is applied when there is a very significant increase in activity or impairment in judgment. The severe specifier is applied when almost continual supervision is required to prevent physical harm to self or others.3
It is important that healthcare providers understand these severity specifiers—especially what constitutes a mild manic episode, as mild mania is underrecognized, and patients may not recall a mild manic episode as a manic episode. As we will discuss, following the DSM-5-TR criteria for severity specifiers of manic episodes can aid in identifying and appropriately managing a patient’s bipolar I disorder.
