| Dimension | 20 points | 15 points | 10 points | 5 points | 2 points |
| Episode Characteristics | Manicsymptoms with “prominenteuphoria, grandiosity or expansiveness”. | Manic symptoms withdysphoria, irritability | Hypomanic symptoms; or mania following an antidepressant | Hypomanic symptoms following an antidepressant; or hypomania below DSM threshold; or major soft 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 recovery within 12 weeks of treatment; orrelapse within 12 weeks of stopping mood stabilizers; orswitch to mania within 12 weeks of starting antidepressant | Worsening dysphoria or mixed state symptoms during antidepressant; or partial response to mood stabilizers; or antidepressant induced rapid cycling or worsening thereof | Lack of response to 3 or more antidepressants; or mania / hypomania when antidepressant stopped | Immediate response, almost complete, to antidepressant within 1 week or less |
| Family History | 1st degree relative (brother / sister, parent, or child) with clear bipolardisorder | 2nd degree relativewith bipolar diagnosis; or 1st degree relative with recurring unipolardepression andfeatures suggestive of bipolar disorder | 1st degree relative with recurring unipolar depression orschizoaffective disorder; or any relative with clear bipolar diagnosis; 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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