The diagnosis of bipolar disorders and its episodes is based on purely clinical criteria which are hence subject to controversy and interpretation. Nonetheless, bipolar disorders (especially type I) has in its favor a validity of construct and long-term stability that are greater than those of other mental disorders.Unlike anxiety, depression, or psychosis, mania is one of the most specific concepts in psychiatric nosology. The Diagnostic and Statistical Manual for Mental Disorders 4th edition (DSM-IV) diagnostic criteria for schizophrenia require exclusion of a manic picture, but the reverse is not the case. Even so, maniform symptoms are observed in other pathologies.

In its time, DSM-IV had some novel features over the 3rd revised edition, DSM-III-R: incorporation of type II bipolar disorders as a category of its own, including cases previously classified as unspecified bipolar disorders; inclusion in the affective disorder section of substance-induced mood disorders or organic illness; and incorporation of a series of specifications with prognostic value. Some of these specifications are:

• “with catatonic characteristics, ” a specification added because many catatonic presentations are associated with mood disorders rather than with schizophrenia;

• “with atypical characteristics, ” meaning a depressive phase characterized by mood reactivity, reverse vegetative symptoms and hypersensitivity to rejection, and were probably incorporated with a view to their therapeutic implications; and

• “postpartum-initiated, ” a specification indicating a better prognosis but with particular vulnerability to recurring with each childbirth.

Longitudinal-course specifications were also incorporated to give information on the degree of interepisodic recovery.