Severity/psychotic/remission specifiers for mixed episode
Severity/Psychotic/Remission Specifiers for Mixed Episode
In Bipolar I Disorder, these specifiers indicate either the severity of the current Mixed Episode or the level of remission if the most recent episode was a Mixed Episode. If criteria are currently met for the Mixed 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 Mixed Episode, the specifier indicates whether the most recent Mixed 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 and five or six depressive 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 either the manic or depressive 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 being especially deserving of punishment or having some special relationship or attribute.
Less commonly, the content of the hallucinations or delusions has no apparent relationship to either manic or depressive themes, that is, they are mood-incongruent psychotic features. These may include 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). These features are 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 or depression. There are two ways for the episode to be In Partial Remission: 1) symptoms of a Mixed Episode are still present, but full criteria are no longer met; or 2) there are no longer any significant symptoms of a Mixed Episode, but the period of remission has been less than 2 months.
Criteria for Severity/Psychotic/Remission Specifiers for current (or most recent) Mixed 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 Mixed Episode. In Partial Remission and In Full Remission can be applied to a Mixed Episode in Bipolar I Disorder only if it is the most recent type of mood episode.
- .x1-Mild: No more than minimum symptom criteria are met for both a Manic Episode and a Major Depressive Episode.
- .x2-Moderate: Symptoms or functional impairment between "mild" and "severe."
- .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:
Criteria for Severity/Psychotic/Remission Specifiers for
current (or most recent) Mixed Episode (continued)
- Mood-Congruent Psychotic Features: Delusions or hallucinations whose content is entirely consistent with the typical manic or depressive themes.
- Mood-Incongruent Psychotic Features: Delusions or hallucinations whose content does not involve typical manic or depressive themes. Included are such symptoms as persecutory delusions (not directly related to grandiose or depressive themes), thought insertion, and delusions of being controlled.
- .x5-In Partial Remission: Symptoms of a Mixed Episode are present but full criteria are not met, or there is a period without any significant symptoms of a Mixed Episode lasting less than 2 months following the end of the Mixed Episode.
- .x6-In Full Remission: During the past 2 months, no significant signs or symptoms of the disturbance were present.
- .x0-Unspecified.