TREATMENT GUIDELINE FOR BIPOLAR MOOD DISORDER (BMD)
	DIAGNOSIS
			LEVEL 1
			LEVEL 2
	GO TO ALGORITHM BMD MANAGEMENT		LEVEL 3
			LEVEL 4
	DSM - 4		ICD - 10
	BIPOLAR MOOD DISORDER		ICD-10 criteria for mania, hypomania, and bipolar I and bipolar II disorder are equivalent to the criteria in DSM-IV.
	DSM-IV Diagnostic Criteria for Bipolar I Disorder, Single Manic Episode
	A. Presence of only one manic episode and no past major depressive episodes.
	Note: Recurrence is defined as either a change in polarity from depression or an interval of at least 2 months without manic symptoms.
	B. The manic episode is not better accounted for by schizoaffective disorder, and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
	Specify if:
	Mixed: if symptoms meet criteria for a mixed episode
	Specify (for current or most recent episode):
	Severity/psychotic/remission specifiers
	With catatonic features
	With postpartum onset
	DSM-IV Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Manic
	A. Currently (or most recently) in a manic episode.
	B. There has previously been at least one major depressive episode, manic episode, or mixed episode.
	C. The mood episodes in criteria A and B are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
	Specify (for current or most recent episode):
	Severity/psychotic remission specifiers
	With catatonic features
	With postpartum onset
	Specify:
	Longitudinal course specifiers (with and without interepisode recovery)
	With seasonal pattern (applies only to the pattern of major depressive episodes)
	With rapid cycling
	DSM-IV Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Hypomanic
	A. Currently (or most recently) in a hypomanic episode.
	B. There has previously been at least one manic episode or mixed episode.
	C. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
	D. The mood episodes in criteria A and B are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
	Specify
	Longitudinal course specifiers (with and without interepisode recovery)
	With seasonal pattern (applies only to the pattern of major depressive episodes)
	With rapid cycling
	Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Mixed
	A. Currently (or most recently) in a mixed episode.
	B. There has previously been at least one major depressive episode, manic episode, or mixed episode.
	C. The mood episodes in criteria A and B are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
	Specify (for current or most recent episode):
	Severity/psychotic remission specifiers
	With catatonic features
	With postpartum onset
	Specify:
	Longitudinal course specifiers (with and without interepisode recovery)
	With seasonal pattern (applies only to the pattern of major depressive episodes)
	With rapid cycling
	DSM-IV Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Depressed
	A. Currently (or most recently) in a major depressive episode.
	B. There has previously been at least one manic episode or mixed episode.
	C. The mood episodes in criteria A and B are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
	Specify (for current or most recent episode):
	Severity/psychotic remission specifiers
	Chronic
	With catatonic features
	With melancholic features
	DSM-IV Diagnostic Criteria for Bipolar I Disorder, Most Recent Episode Unspecified
	A. Criteria, except for duration, are currently (or most recently) met for a manic, a hypomanic, a mixed, or a major depressive episode.
	B. There has previously been at least one manic episode or mixed episode.
	C. The mood symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
	D. The mood symptoms in criteria A and B are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
	E. The mood symptoms in criteria A and B are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
	Specify:
	Longitudinal course specifiers (with and without interepisode recovery)
	With seasonal pattern (applies only to the pattern of major depressive episodes)
	With rapid cycling
	DSM-IV Diagnostic Criteria for Cyclothymic Disorder
	A. For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. Note: In children and adolescents, the duration must be at least 1 year.
	B. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in criterion A for more than 2 months at a time.
	C. No major depressive episode, manic episode, or mixed episode has been present during the first 2 years of the disturbance.
	Note: After the initial 2 years (1 year in children and adolescents) of cyclothymic disorder, there may be superimposed manic or mixed episodes (in which case both bipolar I disorder and cyclothymic disorder may be diagnosed) or major depressive episodes (in which case both bipolar and cyclothymic disorder may be diagnosed).
	D. The symptoms in criterion A are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
	E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
	F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
	DSM-IV Diagnostic Criteria for Bipolar II Disorder
	A. Presence (or history) of one or more major depressive episodes.
	B. Presence (or history) of at least one hypomanic episode.
	C. There has never been a manic episode.
	D. The mood symptoms in criteria A and B are not better accounted for by schizoaffective disorder, and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.
	E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
	Specify current or most recent episode:
	Hypomanic: if currently (or most recently) in a hypomanic episode
	Depressed: if currently (or most recently) in a major depressive episode
	Specify (for current or most recent major depressive episode only if it is the most recent type of mood episode):
	Severity/psychotic/remission specifiers
	Chronic
	With catatonic features
	With melancholic features
	With atypical features
	With postpartum onset
	Specify:
	Longitudinal course specifiers (with or without interepisode recovery)
	With seasonal pattern (applies only to the pattern of major depressive episodes)
	With rapid cycling