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Bipolar disorder is difficult to diagnose, and bipolar II disorder can be especially challenging because most patients will present with a depressive episode and not mention previous hypomanic episodes.
However, "the possibility of false positive BP II diagnoses, especially with brief hypomanic episodes, must be conceded while our examination of clinical symptoms was limited to two measures," they wrote, citing one of several limitations.
If I could date more precisely the 1924 picture of Hemingway at 200 plus pounds in Paris (Plate 3),(7) I could tie it more closely to his hypomanic period (February through April) and his slack period (November through July) of the following year, when he began The Sun Also Rises and completed the manuscript in six weeks, then wrote The Torrents of Spring in what appears to be another hypomanic episode, one with sexual tension first over Duff Twysden and then Pauline - "involvement in pleasurable activities which have a high potential for painful consequences, e.
40) Although patients with bipolar I or bipolar II typically cycle from mania to depression with periods of euthymia interspersed, they do not usually visit PCPs during manic or hypomanic episodes.
with mixed features" is a new course specifier pertinent when [greater than or equal to]3 mania or hypomania symptoms coexist (that is, might be a subsyndromal mania or hypomania) with a depressive syndrome; the mixed features specifier can be applied to depressed patients whether or not they have ever had a manic or hypomanic episode, but MDD--rather than bipolar disorder--remains the overarching diagnosis, unless criteria have ever been met for a full mania or hypomania.
13) Yet almost 40% of patients with bipolar disorder are diagnosed as having unipolar major depressive disorder, even after having a manic or hypomanic episode.
The DSM-IV-TR diagnostic criteria for a hypomanic episode are similar to criteria for a manic episode, except:
17,35) Other common reasons are negative attitudes about medication, lack of insight about being ill, and missing the "highs" of a manic or hypomanic episode.
Her last hypomanic episode was several years ago, and was characterized by increased energy with decreased need for sleep, flight of ideas, increased productivity, and impulsivity.
Although DSM-IV-TR criteria specify that a hypomanic episode must last at least 4 days, data from naturalistic studies indicate that the mean duration of hypomania in patients with bipolar II disorder is approximately 2 days.
According to DSM-IV-TR, the minimal duration of a hypomanic episode is 4 days.