Diagnostic Criteria for Mania and Hypomania

1. Overview & Epidemiology

• Mania and hypomania are the two "elevated mood" pole episodes of bipolar disorder. Per the Debrecen lecture (Dr. Gajdos): "A manic episode is a distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 1 week, or less if a patient must be hospitalized. A hypomanic episode lasts at least 4 days and is similar to a manic episode except that it is not sufficiently severe to cause impairment in social or occupational functioning, and no psychotic features are present."
• Mood vs affect (examiner loves this): mood = the pervasive, sustained, internally experienced feeling tone; affect = its external expression.
• The presence of at least one manic episode → Bipolar I. Episodes of major depression + hypomania (but never full mania) → Bipolar II.
• Epidemiology (Kaplan & Sadock / UD lecture): annual incidence of bipolar illness < 1%. Lifetime prevalence of bipolar I ≈ 1%.
• Sex: Bipolar I has an equal prevalence in men and women (contrast: MDD is ~2× more common in women).
• Onset: Bipolar I onset is earlier than MDD (typically late teens–20s; the exam vignette PSY-4.41 is a 22-year-old).
• Socioeconomics: higher-than-average incidence of bipolar I among upper socioeconomic groups.
• Comorbidity: alcohol abuse/dependence, panic disorder, OCD, social anxiety disorder.
• Rapid cycler: ≥ 4 mood episodes (manic, hypomanic, or depressive) in a 1-year period.
• Mixed episode (DSM-IV-TR / lecture term): a period of ≥ 1 week in which both a manic episode and a major depressive episode occur almost daily. (DSM-5-TR now codes this as a "with mixed features" specifier.)