Diagnostic Criteria for Mania

Core Diagnostic Criteria

The American Psychiatric Association recommends that a manic episode is diagnosed when there is a distinct period of abnormally and persistently elevated, expansive, or irritable mood AND abnormally and persistently increased activity or energy lasting at least 7 days (or any duration if hospitalization is required) 1, 2, 3
The episode must last for at least 7 days, unless hospitalization is required, according to the American Psychiatric Association 1, 2, 4
The symptoms must represent a significant departure from the individual's baseline functioning, as stated by the American Psychiatric Association 1, 2
The disturbance must be severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization, according to the American Psychiatric Association 1, 3

Inflated self-esteem or grandiosity must be present to a significant degree, along with at least 2 other symptoms, during the period of mood disturbance and increased energy/activity, as recommended by the American Psychiatric Association 1

The symptoms must not be attributable to the physiological effects of a substance (e.g., drug of abuse, medication) or another medical condition, according to the American Academy of Child and Adolescent Psychiatry 5

Manic episodes in adolescents often present with psychosis and may be misdiagnosed as schizophrenia, as noted by the American Academy of Child and Adolescent Psychiatry 3
Manic symptoms precipitated by antidepressant treatment should be classified as substance-induced according to the American Psychiatric Association's DSM criteria 6

In children and adolescents, mood can be irritable rather than elevated, but care must be taken to distinguish irritable mania from common anger problems or disruptive behavior disorders, as recommended by the American Academy of Child and Adolescent Psychiatry 5, 7
Hallmark manic symptoms in youth must be differentiated from symptoms of other common childhood disorders such as ADHD, conduct disorder, or normal developmental phenomena, according to the American Academy of Child and Adolescent Psychiatry 5
For children with suspected bipolar disorder who don't meet full criteria for mania, the diagnosis of Bipolar Disorder Not Otherwise Specified (NOS) may be appropriate, as stated by the American Academy of Child and Adolescent Psychiatry 7