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THE EPISODES OF BIPOLAR DISORDER (II)My previous article provided information about the two major resources for the classification of Bipolar Disorder, and the characteristics of Bipolar I and II. Also covered in the article was the diagnostic guidelines according to the DSM-IV. This article will describe the diagnostic guidelines set by the ICD-10. A Hypomania Episode is a lesser degree of mania, recognized by an elevation of mood, increased energy and activity, feelings of well-being and physical and mental efficiency, increased sociability, talkativeness, decreased need for sleep, and increased sexual drive. Hypomania does not cause severe disruptions in the workplace or during social activities. A Manic Episode is recognizable when the individual's mood is elevated out of keeping with the circumstances, social inhibitions are lost, attention cannot be sustained, self-esteem is inflated, and grandiose ideas are expressed freely. The individual may participate in extravagant schemes, become aggressive, spend recklessly, or become overly suspicious. A Manic Episode with psychotic symptoms is a more severe form of mania where inflated self-esteem may develop into delusions, and suspiciousness into delusions of persecution. In severe cases, religious delusions of identity may exist, and the individual may become incomprehensible due to the flight of ideas and pressure of speech. Severe excitement and physical activity may result in aggression, and the neglect of personal hygiene, eating, and drinking may result in severe states of self-neglect. There are three varieties of Depressive Episodes: mild, moderate, and severe. All three are characterized by the primary symptoms of depressed mood, loss of interest or enjoyment, and reduced energy; and the secondary symptoms of loss of concentration, low self-esteem, feelings of guilt or worthlessness, thoughts of death or self-harm, disturbance in sleep, and lack of appetite. A Mild Depressive Episode is defined by the presence of at least two primary symptoms, and at least two secondary symptoms, none of the symptoms being severe, and the total duration of the episode is less than two weeks. A Moderate Depressive Episode is defined by the presence of at least two primary symptoms, and at least four secondary symptoms, several of the symptoms are present to a marked degree, and the duration of the episode is less than two weeks. Severe Depressive Episodes are recognized by the presence of all three primary symptoms, and at, least four of the secondary symptoms, some of a severe intensity, and generally lasting more than two weeks. Individuals with severe depression are at a high risk for suicide or self-harm. Severe Depressive Episodes with psychotic symptoms meet the criteria for severe depression, with the presence of delusions involving ideas of sin, poverty, or imminent danger, hearing and visual hallucinations, or severe psychomotor retardation leading to stupor. A Mixed Episode is defined as a period of depressed mood accompanied by over activity and pressure of speech, or a manic mood accompanied by agitation and loss of energy. Symptoms of depression and hypomania or manic episodes may also alternate rapidly. A diagnosis should only be made if the two sets of symptoms have been prominent for most of the episode, and the episode has lasted at least two weeks.
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