DSM-5 中关于双相障碍临床诊断标准的一些改变

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Bipolar and Related Disorders


Bipolar Disorders
To enhance the accuracy of diagnosis and facilitate earlier detection in clinical settings, Criterion A for manic and hypomanic episodes now includes an emphasis on changes in activity and energy as well as mood. The DSM-IV diagnosis of bipolar I disorder, mixed episode, requiring that the individual simultaneously meet full criteria for both mania and major depressive episode, has been removed. Instead, a new specifier, “with mixed features,” has been added that can be applied to episodes of mania or hypomania when depressive features are present, and to episodes of depression in the context of major depressive disorder or bipolar disorder when features of mania/hypomania are present.


Other Specifed Bipolar and Related Disorder
DSM-5 allows the specification of particular conditions for other specified bipolar and related disorder, including categorization for individuals with a past history of a major depressive disorder who meet all criteria for hypomania except the duration criterion (i.e., at least 4 consecutive days). A second condition constituting an other specified bipolar and related disorder is that too few symptoms of hypomania are present to meet criteria for the full bipolar II syndrome, although the duration is sufficient at 4 or more days.


Anxious Distress Specifier
In the chapter on bipolar and related disorders and the chapter on depressive disorders, a specifier for anxious distress is delineated. This specifier is intended to identify patients with anxiety symptoms that are not part of the bipolar diagnostic criteria.

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（1）新标准里对躁狂，轻躁狂发作的识别，除考虑情绪的变化外，还强调要包括行为和精力上的一些变化。
（2）DSM-IV（老标准）中诊断为双相Ⅰ型障碍混合发作，要求个人同时满足躁狂和抑郁症发作的全部标准，现已被删除。用一个新的 “混合特征”予以了替代：在躁狂或轻躁狂发作时有抑郁特征同时存在，或者在抑郁发作的同时有躁狂/轻躁狂的特征存在。
（3）DSM-5（新标准）规范允许对一些的特例作一些具体说明，比如在过去的历史中满足了双相II型轻躁狂的所有其他条件，除了持续时间标准不足连续4天。或者虽然超过连续 4天，但轻躁狂的症状表现太少
（4）与焦虑性疾病的鉴别：在双相障碍及相关障碍章节里和抑郁障碍章节里有专门对焦虑障碍的描述，目的是鉴别病人的焦虑症状是否是双相障碍的一部分

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