Clinical meaning
The NP must precisely apply DSM-5-TR diagnostic criteria for bipolar disorder, with particular attention to the duration thresholds that distinguish mania from hypomania and bipolar I from bipolar II.
Bipolar I disorder requires at least ONE manic episode. A manic episode is defined as: a distinct period of abnormally and persistently elevated, expansive, or irritable mood AND persistently increased goal-directed activity or energy, lasting at least 7 DAYS (or any duration if hospitalization is necessary). During this period, 3 or more (4 if mood is only irritable) of the following must be present: Decreased need for sleep, Inflated self-esteem or Grandiosity, More talkative/pressured speech, Flight of Ideas or racing thoughts, Distractibility, Increase in goal-directed activity or psychomotor Agitation, Excessive involvement in activities with high potential for painful consequences (spending sprees, sexual indiscretions, foolish investments). The mnemonic DIG FAST captures these criteria.
Bipolar II disorder requires at least ONE hypomanic episode AND at least ONE major depressive episode, with NO history of mania. Hypomania has identical symptom criteria (DIG FAST) but differs in: duration of at least 4 DAYS (not 7), NO marked impairment in social or occupational functioning, NO psychotic features, and NO hospitalization required. If any of these features are present, it is mania by definition, upgrading the diagnosis to Bipolar I.
Cyclothymic disorder involves chronic fluctuating mood disturbance for at least 2 years (1 year in children) with numerous periods of hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes.