Severity/psychotic/remission specifiers for manic episode
Severity/Psychotic/Remission Specifiers for Manic Episode
In Bipolar I Disorder, these specifiers indicate either the severity of the current Manic Episode or the level of remission if the most recent episode was a Manic Episode. If criteria are currently met for the Manic Episode, it can be classified as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria are no longer met for a Manic Episode, the specifier indicates whether the most recent Manic Episode is in partial or full remission. These specifiers are reflected in the fifth-digit coding for the disorder.
- 1-Mild, 2-Moderate, 3-Severe Without Psychotic Features. Severity is judged to be mild, moderate, or severe based on the number of criteria symptoms, the severity of the symptoms, the degree of functional disability, and the need for supervision. Mild episodes are characterized by the presence of only three or four manic symptoms. Moderate episodes are characterized by an extreme increase in activity or impairment in judgment. Episodes that are Severe Without Psychotic Features are characterized by the need for almost continual supervision to protect the individual from harm to self or others.
- 4-Severe With Psychotic Features. This specifier indicates the presence of either delusions or hallucinations (typically auditory) during the current episode. Most commonly, the content of the delusions or hallucinations is consistent with the manic themes, that is, they are mood-congruent psychotic features. For example, God's voice may be heard explaining that the person has a special mission. Persecutory delusions may be based on the idea that the person is being persecuted because of some special relationship or attribute.
Less commonly, the content of the hallucinations or delusions has no apparent relationship to manic themes, that is, they are mood-incongruent psychotic features. These may include persecutory delusions (not directly related to grandiose themes), delusions of thought insertion (i.e., one's thoughts are not one's own), delusions of thought broadcasting (i.e., others can hear one's thoughts), and delusions of control (i.e., one's actions are under outside control). The presence of these features may be associated with a poorer prognosis. The clinician can indicate the nature of the psychotic features by specifying With Mood-Congruent Features or With Mood-Incongruent Features.
5-In Partial Remission, 6-In Full Remission. Full Remission requires a period of at least 2 months in which there are no significant symptoms of mania. There are two ways for the episode to be In Partial Remission: 1) symptoms of a Manic Episode are still present, but full criteria are no longer met; or 2) there are no longer any significant symptoms of a Manic Episode, but the period of remission has been less than 2 months.
Criteria for Severity/Psychotic/Remission Specifiers for current (or most recent) Manic Episode
- Note: Code in fifth digit. Mild, Moderate, Severe Without Psychotic Features, and Severe With Psychotic Features can be applied only if the criteria are currently met for a Manic Episode. In Partial Remission and In Full Remission can be applied to a Manic Episode in Bipolar I Disorder only if it is the most recent type of mood episode.
- .x1-Mild: Minimum symptom criteria are met for a Manic Episode.
- .x2-Moderate: Extreme increase in activity or impairment in judgment.
- .x3-Severe Without Psychotic Features: Almost continual supervision required to prevent physical harm to self or others.
- .x4-Severe With Psychotic Features: Delusions or hallucinations. If possible, specify whether the psychotic features are mood-congruent or mood-incongruent:
- Mood-Congruent Psychotic Features: Delusions or hallucinations whose content is entirely consistent with the typical manic themes of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.
- Mood-Incongruent Psychotic Features: Delusions or hallucinations whose content does not involve typical manic themes of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person. Included are such symptoms as persecutory delusions (not directly related to grandiose ideas or themes), thought insertion, and delusions of being controlled.
- .x5-In Partial Remission: Symptoms of a Manic Episode are present but full criteria are not met, or there is a period without any significant symptoms of a Manic Episode lasting less than 2 months following the end of the Manic Episode.
- .x6-In Full Remission: During the past 2 months no significant signs or symptoms of the disturbance were present.
- .x0-Unspecified.