Clinical Presentation

Abstract

This chapter reviews the clinical presentation of bipolar I and bipolar II disorders, and in particular of manic, hypomanic, depressive, and mixed episodes. The DSM-5 operational criteria and the ICD-11 clinical descriptions and diagnostic guidelines are summarized, but several aspects that emerge from the literature and are not considered by those diagnostic systems are also covered. The divergences between those systems and the issues that remain controversial are pointed out, and the limitations of “specifiers” (or “qualifiers”) in accounting for the heterogeneity of depressive episodes are emphasized. Different clinical presentations of manic and depressive episodes in children and adolescents are also briefly described. It is concluded that the familiarity with the DSM-5 and/or the ICD-11 is not sufficient to ensure an appropriate approach to the diagnosis of mood episodes and disorders, in the absence of adequate training and clinical expertise.