1. Bipolar Disorder in DSM-5 Highlights of changes from DSM-IV-TR to DSM-5
Flavio Guzmán, MD

2. Outline Increased activity added to Criterion A for BD
Mixed episode is now a specifier
Anxious distress is a new specifier
NOS replaced by other specified bipolar and related disorder and unspecified bipolar and related disorder
Antidepressant-induced mania can be diagnosed as BD

3. Increased activity added to Criterion A

4. Increased activity added to Criterion A
DSM-IV
DSM-5
Criterion A for manic and hypomanic episode
Presence of one of two mood symptoms:
Elation/euphoria
Irritable mood
“Abnormally and persistently increased goal-directed activity or energy”
Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

5. Increased activity added to Criterion A
DSM-IV
DSM-5
Criterion A for manic and hypomanic episode
Presence of one of two mood symptoms:
Elation/euphoria
Irritable mood
“Abnormally and persistently increased goal-directed activity or energy”
Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

6. Mixed episode is now a specifier

7. Mixed episode is now a specifier
DSM-IV
Bipolar I disorder, mixed state
DSM-5
Mixed type specifier
Applies to all bipolar disorders

8. Mixed episode is now a specifier
DSM-IV
DSM-5
Mixed episode
Mixed specifier
All criteria for mania and depression
At the same time
At least three symptoms of the opposite polarity
Manic episode with mixed features
Hypomanic episode with mixed features
Depressive episode with mixed features
MDD episode with mixed features
Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

9. Mixed episode is now a specifier
DSM-IV
DSM-5
Mixed episode
Mixed specifier
All criteria for mania and depression
At the same time
At least three symptoms of the opposite polarity
Manic episode with mixed features
Hypomanic episode with mixed features
Depressive episode with mixed features
MDD episode with mixed features
Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

10. Anxious distress is a new specifier

11. Anxious distress is a new specifier
Increased suicide risk
Lengthier duration of illness
Greater risk of nonresponse to treatment
High levels of anxiety are associated with:
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

12. Anxious distress: symptoms
Unusual restlessness
Fear that something awful may happen
Difficulty concentrating because of worry
Feeling of losing control
Symptoms:
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

13. Anxious distress: severity
Mild: two symptoms
Moderate: three symptoms
Moderate-severe: four or five symptoms
Severe: four or five symptoms with motor agitation
Severity
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

14. NOS was replaced by specified and unspecified BD

15. DSM-IV DSM-5 Not otherwise specified (NOS)
Other specified bipolar and related disorder
Unspecified bipolar and related disorder
Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

16. Other specified bipolar and related disorder
Symptoms do not meet full criteria
Subthreshold syndromes
Subthreshold
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

17. Other specified bipolar and related disorder
Used to communicate reason that presentation does not meet criteria
Subthreshold
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

18. Other specified bipolar and related disorder
Short-duration hypomanic episodes (2-3 days) and major depressive episode
Hypomanic episodes with insufficient symptoms and major depressive episodes
Hypomanic episode without prior major depressive episode
Short- duration cyclothymia
Subthreshold
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

19. Unspecified bipolar and related disorder
Symptoms do not meet full criteria
Subthreshold syndromes
Subthreshold
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

20. Unspecified bipolar and related disorder
Clinician chooses not to specify the reason criteria are not met
Insufficient information
E.R. setting
Subthreshold
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

21. Antidepressant-induced mania can be diagnosed as BD

22. Antidepressant-induced mania/hypomania
DSM-IV
DSM-5
Depressive episode + substance-induced mania/hypomania
“True” mania/hypomania
Unipolar
Bipolar

23. Antidepressant-induced mania/hypomania
Symptoms must persist at the fully syndromal level beyond the physiological effects of the treatment
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

24. Key points Mixed episode is now a specifier
Increased activity was added to Criterion A for BD
Mixed episode is now a specifier

25. Key points Anxious distress is a new specifier
NOS was replaced by: other specified bipolar and related disorder and unspecified bipolar and related disorder
Subthreshold

26. Key points
Antidepressant-induced mania can be diagnosed as BD