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Diagnostic criteria for Mixed Episode

These criteria are obsolete.

DSM Criteria
DSM Version
DSM IV - TR
DSM Criteria


A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period. 

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. 

C. The symptoms 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).

Note: Mixed-like episodes that are clearly caused by somatic antidepressanttreatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Criteria for Severity/Psychotic/Remission Specifiers for current (or most recent) Mixed Episode

Note: Code in fifth digit. 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: 

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.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association

DSM Version
DSM IV
DSM Criteria

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period. 

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. 

C. The symptoms 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).

Note: Mixed-like episodes that are clearly caused by somatic antidepressanttreatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Criteria for Severity/Psychotic/Remission Specifiers for current (or most recent) Mixed Episode

Note: Code in fifth digit. 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: 

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.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association