As much as I hate being “labeled” anything I have to admit that putting a name to my behavior and symptoms over decades of going undiagnosed was a great comfort. It helps to know that there are others out there that are in the same boat as me, and how many.
Right up front lets talk about the elephant in the room: mood disorders and mental illnesses in general are widely under researched and as as result it’s very difficult for a universally accepted “classification” of these disorders.
Why classify?
The medical profession like naming things. Medical aids are obsessed with codes. Governments can’t function without “forms” that have codes (see my SARS return, which I intend burning soon so hurry).
For this post I’m going to tackle the ICD-10 diagnostic manual in diagnosing Bipolar Disorders.
The list of codes is extensive, so I’ll regularly update this post as I work though the literature (actually I won’t – that was the grandiosity speaking)
Classification is also really useful for the medical fraternity to find patterns and frequencies of a particular illness. In a perfect world this would inform research for a cure or better treatment options. Classifications by ‘code’ also assist medical aids allocating a patient’s benefits efficiently (in theory, more on this later).
The ICD-10 classification is comprehensive and is the result of worldwide consultation. It is the preferred classification and diagnostic manual in South Africa. Codes F30-F39 deal with “Mood [affective] disorders with each F-CODE representing a specific disorder, I’ll be looking at codes F30 & F31.
I’ve taken some liberties in simplifying some of the ICD diagnostic criterion for the purposes of making this post generally more accessible and understandable to every day people without fancy-pants degrees in the study of the human psyche.
Don’t @ Me
F30: Manic episode
Subsequent classifications rely extensively on this top category code F30, but this code is reserved for a single manic episode.
In summary this code defines the terms often used to describe the ‘degrees’ of mania’: hypomania and mania. Common characteristics of both are: elevated mood and an increase in the quantity and speed of physical and mental activity.
I think you’ll agree this is an entirely useless assertion. Thankfully the sub-codes are meatier.
F30.0 Hypomania
Hypomania is a considered a lesser degree of mania (F30.1). Features are usually present for several days and interference in work and social activity may be impaired, but not to the extent that the impairment is so severe such that working at all and any social interaction isn’t possible).
Here’s some of the features of hypo-mania:
| Feature | Checklist |
| A persistent elevated mood for several days | |
| Unusually increased energy and activity | |
| Exaggerated or unrealistic sense of mental ability or well-being | |
| Increased sociability, talkativeness or overfamiliarity with others | |
| Increased sexual energy | |
| A decreased need for sleep (however not to the extent that disrupts daily functioning) | |
| Irritability, conceit, and boorish behavior | |
| Poor concentration and attention that diminishes the ability to settle down to work but this may not prevent the appearance | |
| Mild over-spending on things that aren’t necessarily rational purchases |
Unlike other diagnostic tools (like the DSM) it is not necessary to present with a specific number of these features to arrive at a diagnosis. A competent physician should consider all these features and make a call based on their professional opinion.
F30.1 Mania without psychotic symptoms
The episode should last for at least 1 week and should be severe enough to disrupt ordinary work and social activities more or less completely.
The mood change should be accompanied by increased energy and several of the symptoms referred to above i.e. F30.0 (particularly pressure of speech, decreased need for sleep, grandiosity, and excessive optimism).
Here’s a summary of the features of manic BP:
| Feature | Checklist |
| Mood is elevated out of keeping with the individual’s circumstances and may vary from carefree joviality to almost uncontrollable excitement. | |
| Elation is accompanied by increased energy, resulting in over-activity, pressure of speech, and a decreased need for sleep. | |
| Normal social inhibitions are lost, attention cannot be sustained, and there is often marked distractability. | |
| Self-esteem is inflated, and grandiose or over-optimistic ideas are freely expressed. | |
| Perceptual disorders may occur, such as the appreciation of colours as especially vivid (and usually beautiful), a preoccupation with fine details of surfaces or textures, and subjective hyperacusis (that’s a sensitivity to certain frequencies or sounds for those, like me, that have never heard the term). | |
| The individual may embark on extravagant and impractical schemes | |
| In some manic episodes the mood is irritable and suspicious rather than elated. | |
| Spend money recklessly, very very recklessly, or become aggressive, amorous, or facetious in inappropriate circumstances. | |
| May become aggressive, amorous, or facetious in inappropriate circumstances. |
F30.2 Mania with psychotic symptoms
The clinical picture is that of a more severe form of mania as described in F30.1.
| Feature | Checklist |
| Inflated self-esteem and grandiose ideas may develop into delusions, and irritability and suspiciousness into delusions of persecution. | |
| In severe cases, grandiose or religious delusions of identity or role may be prominent, and flight of ideas and pressure of speech may result in the individual becoming incomprehensible. | |
| Mood is elevated out of keeping with the individual’s circumstances and may vary from carefree joviality to almost uncontrollable excitement. | |
| Severe and sustained physical activity and excitement may result in aggression or violence, and neglect of eating, drinking, and personal hygiene may result in dangerous states of dehydration and self-neglect. | |
| Elation is accompanied by increased energy, resulting in over-activity, pressure of speech, and a decreased need for sleep. | |
| If required, delusions or hallucinations can be specified as congruent or incongruent with the mood. “Incongruent” should be taken as including affectively neutral delusions and hallucinations; for example, delusions of reference with no guilty or accusatory content, or voices speaking to the individual about events that have no special emotional significance. | |
| Normal social inhibitions are lost, attention cannot be sustained, and there is often marked distractability. | |
| Self-esteem is inflated, and grandiose or over-optimistic ideas are freely expressed. | |
| Perceptual disorders may occur, such as the appreciation of colours as especially vivid (and usually beautiful), a preoccupation with fine details of surfaces or textures, and subjective hyperacusis (that’s a sensitivity to certain frequencies or sounds for those, like me, that have never heard the term). | |
| The individual may embark on extravagant and impractical schemes. | |
| Spend money, very very recklessly, or become aggressive, amorous, or facetious in inappropriate circumstances. |
