Diagnostic Criteria for Bipolar I Disorder

Core Diagnostic Requirements

The American Academy of Child and Adolescent Psychiatry recommends that the mood disturbance must be abnormal for the individual and observable by others 2
Symptoms must persist for at least 7 days (or any duration if hospitalization is required), and this duration criterion must be strictly followed in children and adolescents 2

The episode must cause marked impairment in functioning or require hospitalization, and symptoms should be evident and impairing across different realms of the person's life 2
The manic episode represents a marked departure from baseline functioning, with manic grandiosity and irritability presenting as marked changes in mental/emotional state 2
The pattern of illness, duration of symptoms, and association with psychomotor, sleep, and cognitive changes are important diagnostic clues, and using a life chart to characterize the course of illness improves diagnostic accuracy 2

The American Academy of Child and Adolescent Psychiatry notes that antidepressant-induced manic or hypomanic episodes can count toward a bipolar I diagnosis under certain conditions in DSM-5, and history of mania or hypomania after antidepressant treatment is a specific risk factor for bipolar disorder 1

Irritability, reckless behaviors, or increased energy occur in multiple conditions and lack specificity, and manic-like symptoms of irritability and emotional reactivity may be found in disruptive behavior disorders, PTSD, and pervasive developmental disorders 2
Emotional and behavioral difficulties in children are often context-dependent and must be assessed in perspective given family, school, peer, and psychosocial factors, and avoid using simple checklists to identify psychopathology without considering longitudinal patterns 2

The American Academy of Child and Adolescent Psychiatry recommends incorporating both current and past history regarding symptomatic presentation, treatment response, psychosocial stressors, and family psychiatric history, and organizing clinical information using a life chart to characterize course of illness 2
Conduct direct patient and family interviews specifically assessing symptom onset, duration, and functional impairment patterns, and obtain information from family members or other observers about the longitudinal course of symptoms 3