1. Bipolar Disorder and Substance Use Disorders

2. Bipolar I Disorder
Includes one or more Manic Episodes or Mixed Episodes, sometimes with Major Depressive Episodes as well
Single Manic Episode
Most Recent Episode Hypomanic
Most Recent Episode Manic
Most Recent Episode Mixed
Most Recent Episode Depressed

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

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

5. Manic Episode The mood disturbance is severe enough:
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

6. Manic Episode
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

7. Hypomanic Episode
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

8. 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

9. Alcohol Withdrawal Insomnia Psychomotor agitation Anxiety Hand tremor
Temporary hallucinations
Nausea, vomiting
Seizures
Impaired social or occupational functioning

10. Depressive Episode
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 . . .

11. Depressive Episode 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

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

13. Depressive Episode
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)

14. Depressive Episode
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)

15. 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

16. 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

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

18. 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

19. Comments or Questions?
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