Bipolar Disorder and Substance Use Disorders：双相情感障碍和物质使用障碍

BipolarDisorder

and

SubstanceUseDisordersBipolarIDisorderIncludesoneormoreManicEpisodesorMixedEpisodes,sometimeswithMajorDepressiveEpisodesaswellSingleManicEpisodeMostRecentEpisodeHypomanicMostRecentEpisodeManicMostRecentEpisodeMixedMostRecentEpisodeDepressedManicEpisodeAperiodofunusualandongoingelevated,expansive,orirritablemood,ofatleast1weekdurationManicEpisodeThree(3)ormoreofthefollowingoccur:Inflatedself-esteemorgrandiosity;Decreasedsleepneeds;Moretalkativethanusual;Racingthoughts;Distractibility;Increaseinactivityorpsychomotoragitation;Excessiveinvolvementinpleasurableactivitieswithhighpotentialforpainfulconsequences(ex.spending,sex).ManicEpisodeThemooddisturbanceissevereenough:tosignificantlyimpairoccupationalfunctioning,ortosignificantlyimpairusualsocialactivitiesorrelationships,ortorequirehospitalizationtopreventharmtoselforothersManicEpisodeSymptomsareNOTduetothedirecteffectsofasubstance(includingprescribedmedicationand/orintoxicationorwithdrawalsyndromesofsubstancesofabuse),orageneralmedicalconditionHypomanicEpisodeAperiodofunusualandongoingelevated,expansive,orirritablemood,lastingthroughatleast4days,thatisclearlydifferentfromtheusualnon-depressedmoodManicsymptoms(see)SignificantfunctionalimpairmentSymptomsareNOTduetosubstancesofabuseCocaineIntoxicationEuphoria(elevated,expansivemood)Changesinsociability(moretalkative)HypervigilanceInterpersonalsensitivity

(irritability)Anxiety,tensionorangerImpairedjudgmentImpairedsocialoroccupationalfunctioningPsychomotoragitationAlcoholWithdrawalInsomniaPsychomotor agitationAnxietyHandtremorTemporaryhallucinationsNausea,vomitingSeizuresImpairedsocialoroccupationalfunctioningDepressiveEpisodeFiveormoreofthefollowingarepresentduringthesame2-weekperiod,andrepresentachangefrompreviousfunctioning,andatleastoneofthesymptomsiseither(1)depressedmood,or(2)lossofinterest...

DepressiveEpisodeDepressedmoodmostoftheday,everydayLossofinterestorpleasureinmostallactivities,everydaySignificantweightlossw/odietingInsomnia/hypersomniaeverydayPsychomotoragitation/retardationeverydayFatigueorenergylosseverydayWorthlessnessorinappropriateguiltfeelingsnearlyeverydayDecreasedabilitytothink,concentrateormakedecisionsnearlyeverydayRecurrentthoughtsofdeath,orsuicidalideation,withorwithoutplan&/orattemptDepressiveEpisodeSymptomscauseclinicallysignificantdistressorimpairmentinsocial,occupational,orotherimportantareasoffunctioningDepressiveEpisodeSymptomsareNOTduetotheeffectsofasubstance

(e.g.,drugofabuse,ormedication)orageneralmedicalcondition(e.g.,hyperthyroidism)DepressiveEpisodeSymptomsarenotbetteraccountedforbyBereavement(i.e.lastinglongerthan2monthsafterasignificantloss,orcharacterizedbyseveredegreeoffunctionalimpairment,preoccupationwithworthlessness,suicidalideation,psychoticsymptoms,orpsychomotorretardation)SedativeIntoxicationInappropriatesexualor aggressivebehaviorSlurredspeechStuporImpairedattentionor memoryMoodlabilityImpairedjudgmentPsychomotorretardationoragitationImpairedsocial,occupational,orotherfunctioningCocaineWithdrawal

DepressedmoodFatigueVivid,unpleasantdreamsInsomniaorhypersomniaIncreasedappetitePsychomotorretardationoragitationSymptomscauseclinicallysignificantdistressorimpairmentinsocial,occupational,orotherimportantareasoffunctioningMixedEpisodeCriteriaaremetforbothaManicEpisode,andforaMajorDepressiveEpisode(exceptforduration)foratleasta1-weekperiodBipolarIIDisorderPresence(orhistory)ofoneormoreMajorDepressiveEpisodesPresence(orhistory)ofatleastoneHypomanic

EpisodeTherehasneverbeenaManicEpisode,oraMixedEpisodeSy