Bipolarity Index Table

The Bipolarity Index: a 5-dimension, 100-pt. system

Dimen­sion 20 points 15 points 10 points 5 points 2 points
Episode Charac­teristics Manic symp­toms with “prom­inent euphoria, gran­diosity or expan­sive­ness”. Manic symp­toms with dys­phoria, irritab­ility Hypo­manic symp­toms; or mania fol­lowing an anti­depres­sant Hypo­manic symp­toms fol­lowing an anti­depres­sant; or hypo­mania below DSM thres­hold; or major soft signs: atypical or post­partum de­pression Psy­chosis, without other signs of mania
Age of Onset 15-19 <15 or 20-29 30-45 > 45
Illness Course (and Other Fea­tures) Manic epis­odes separ­ated by periods of full recovery Incom­plete recovery between manic epis­odes; or hypo­mania with full recovery between epis­odes Mania, incom­plete reco­very, but also sub­stance use; or psy­chosis only during mood epis­odes; or legal prob­lems asso­ciated with mania Re­peated epis­odes of unipolar de­pression, no hypo­mania (3 or more); or hypo­mania with incom­plete recovery between epis­odes; or any of several other fea­tures: border­line; anxiety disor­der; ADHD as a child; gambling or other risk behaviors without mania per se; or PMS Hyper­thymic temper­ament; >3 mar­riages, or two jobs in two years; or two ad­vanced degrees (see Akiskal refer­ence on these latter features)
Re­sponse to Medic­ations Full recovery within 4 weeks of treat­ment with mood stabil­izers Full recovery within 12 weeks of treat­ment; or relapse within 12 weeks of stopping mood stabil­izers; or switch to mania within 12 weeks of starting anti­depres­sant Wor­sening dys­phoria or mixed state symp­toms during anti­depres­sant; or partial re­sponse to mood stabil­izers; or anti­depres­sant induced rapid cycling or wor­sening thereof Lack of re­sponse to 3 or more anti­depres­sants; or mania / hypo­mania when anti­depres­sant stopped Imme­diate re­sponse, almost com­plete, to anti­depres­sant within 1 week or less
Family History 1st degree relative (brother / sister, parent, or child) with clear bipolar disorder 2nd degree relative with bipolar diag­nosis; or 1st degree relative with recur­ring unipolar depres­sion and features sugges­tive of bipolar disorder 1st degree relative with recur­ring unipolar depres­sion or schizo­affective disorder; or any relative with clear bipolar diag­nosis; or any other relative with uni­polar depres­sion and symp­toms sugges­tive of bipolar 1st degree relative has clear problem with drugs or alcohol 1st degree relative has re­peated episodes of de­pression; or has an anxiety disorder, an eating disorder, or ADHD