From the Guidelines
The DSM-IV-TR diagnostic criteria for hypomania require a distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased activity or energy lasting at least 4 days. According to the study published in the Journal of the American Academy of Child and Adolescent Psychiatry 1, Bipolar II disorder is characterized by periods of major depression and hypomania, with hypomanic episodes lasting at least 4 days. The diagnostic criteria for hypomania are crucial in distinguishing Bipolar II Disorder from Bipolar I Disorder, which requires full manic episodes. Key features of hypomania include:
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased activity or energy
- Duration of at least 4 consecutive days
- Presence of at least 3 (or 4 if the mood is only irritable) of the following symptoms:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Flight of ideas or racing thoughts
- Distractibility
- Increased goal-directed activity or psychomotor agitation
- Excessive involvement in pleasurable activities with high potential for painful consequences
- The episode must represent an unequivocal change in functioning that is uncharacteristic of the person and observable by others. Recognizing hypomania is clinically important as it helps identify bipolar spectrum disorders that require mood stabilizers rather than antidepressant monotherapy, which can potentially trigger manic episodes, as noted in the study 1.
From the Research
DSM-5 Diagnostic Criteria for Hypomania
The DSM-5 diagnostic criteria for hypomania are not explicitly stated in the provided studies. However, the studies do mention the concept of mixed states and the "with mixed features" specifier, which can be applied to manic/hypomanic and major depressive episodes 2.
Key Features of Hypomania
Some key features of hypomania that can be inferred from the studies include:
- A broad concept of mixed states, which captures ≥3 nonoverlapping symptoms of the opposite polarity 2
- The presence of manic/hypomanic and depressive symptoms concurrently 2
- The challenge of treating mixed states due to the necessity to treat both manic/hypomanic and depressive symptoms simultaneously 2
Treatment of Hypomania
The treatment of hypomania is not explicitly stated in the provided studies. However, the studies do mention various pharmacotherapies that can be used to treat bipolar disorder, including:
- Atypical antipsychotics such as risperidone, olanzapine, quetiapine, and ziprasidone 3, 4, 5
- Mood stabilizers such as lithium and valproate 3, 4, 5
- Antiepileptic agents such as lamotrigine and oxcarbazepine 4
- Combination therapies with atypical antipsychotics and mood stabilizers 5
Limitations of the Studies
The provided studies do not directly address the DSM-5 diagnostic criteria for hypomania. Therefore, it is not possible to provide a definitive answer to the question based on the available evidence.