DSM-IV-TR Bipolar Disorder

The DSM-IV-TR also provides clinicians with specifiers to further classify a patient's bipolar disorder, including:

• specifiers for the course of recurrent episodes:
• with rapid cycling (with or without full interepisode recovery)
• with postpartum onset
• specifiers for "current or most recent episode":
• severity (including with or without psychotic features)
• in partial or full remission
• with catatonic features
• with postpartum onset

For example, a patient may be diagnosed as having bipolar I disorder with rapid cycling.

How Bipolar Disorder is diagnosed by using the DSM-IV-TR?

Mood disorder is one of the major categories of psychiatric disorders in the DSM-IV-TR. Mood disorder, in turn, is divided into two major subcategories:

• depressive disorders
• bipolar disorders

The subcategory of bipolar disorders is then divided as follows:

• bipolar I disorder
• bipolar II disorder

What is cyclothymic disorder?

Cyclothymic disorder is a chronic fluctuating mood disorder; this can be distinguished from bipolar I and II disorder with rapid cycling in that it does not require that full mood episodes be present.

What are the DSM-IV-TR Episodes Used to Diagnose Mood Disorders?

It is important to understand that the DSM-IV-TR uses four major “episodes” as a basis for diagnosing any mood disorder:

• manic episode
• hypomanic episode
• major depressive episode
• mixed episode

The DSM-IV-TR defines a manic episode as a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting 1 week (or any duration if hospitalization is necessary). The mood disturbance must include a certain number of specified criteria, such as inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual, flights of ideas, and distractibility. In addition, the symptoms of mania must be sufficiently severe to cause “marked impairment.” This differentiates a manic episode from a hypomanic episode, in which marked impairment is not present.