| Dimension |
20 points |
15 points |
10 points |
5 points |
2 points |
| Episode Characteristics |
Manicsymptoms with “prominenteuphoria, grandiosity or expansiveness”. |
Manic symptoms with dysphoria, irritability |
Hypomanic symptoms; or mania following an antidepressant |
Hypomanic symptoms following an antidepressant; or hypomania below DSM threshold; or majorsoft signs: atypical or postpartum depression |
Psychosis, without other signs of mania |
| Age of Onset |
15-19 |
<15 or 20-29 |
30-45 |
> 45 |
— |
| Illness Course (and Other Features) |
Manic episodes separated by periods of full recovery |
Incomplete recovery between manic episodes; or hypomania with full recovery between episodes |
Mania, incomplete recovery, but also substance use; or psychosis only during mood episodes; or legal problems associated with mania |
Repeated episodes of unipolar depression, no hypomania (3 or more); or hypomania with incomplete recovery between episodes; or any of several other features: borderline; anxiety disorder; ADHD as a child; gambling or other risk behaviors without mania per se; or PMS |
Hyperthymictemperament;>3 marriages, or two jobs in two years; or two advanced degrees (seeAkiskal reference on these latter features) |
| Response to Medications |
Fullrecoverywithin 4 weeks of treatment with mood stabilizers |
Full recoverywithin 12 weeks of treatment; orrelapse within 12 weeks of stopping mood stabilizers; or switch to mania within 12 weeks of starting antidepressant |
Worsening dysphoria or mixed state symptoms during antidepressant; or partial response to mood stabilizers; or antidepressant inducedrapid cycling or worsening thereof |
Lack of response to 3 or more antidepressants; or mania / hypomania when antidepressantstopped |
Immediate response, almost complete, to antidepressant within 1 week or less |
| Family History |
1st degree relative (brother / sister, parent, or child) withclear bipolardisorder |
2nd degree relative with bipolar diagnosis; or 1st degree relative with recurring unipolardepression andfeatures suggestive of bipolar disorder |
1st degree relative with recurring unipolardepression or schizoaffective disorder; or any relative with clear bipolardiagnosis; or any other relative with unipolar depression and symptoms suggestive of bipolar |
1st degree relative has clear problem with drugs or alcohol |
1st degree relative has repeated episodes of depression; or has an anxiety disorder, an eating disorder, or ADHD |
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