Prominent tension, restlessness, worry, or fear accompanies the current mood episode.
Deciding signal
Anxiety is woven into the mood episode and changes its risk and management profile.
Ask this
Is anxious arousal a meaningful part of this mood episode rather than a separate background condition?
Typical language
“I feel keyed up all day”
Clinically meaningful symptoms of the opposite mood pole occur during the predominant mood episode.
Deciding signal
The presentation crosses mood poles rather than being explained by anxiety, irritability, or agitation alone.
Ask this
Are there distinct opposite-pole symptoms during this episode that change diagnostic and treatment reasoning?
Typical language
“I am depressed but my thoughts are racing”
Profound loss of pleasure or mood reactivity occurs with a characteristic biological and psychomotor pattern.
Deciding signal
Pleasure and emotional reactivity are markedly reduced, not merely overshadowed by stress.
Ask this
Is there a pervasive non-reactive depressive pattern with characteristic biological or psychomotor change?
Typical language
“Nothing reaches me”
Mood reactivity occurs with a characteristic reversed-vegetative or interpersonal sensitivity pattern.
Deciding signal
Mood can brighten in response to positive events despite a clinically significant depressive episode.
Ask this
Does mood reactivity sit alongside a coherent atypical depressive pattern rather than an isolated symptom?
Typical language
“Good news can lift me for a while”
Delusions or hallucinations occur during a severe mood episode and require explicit risk and diagnostic review.
Deciding signal
Psychosis is present, and its relationship to the mood episode determines the diagnostic wording.
Ask this
Do psychotic symptoms occur within the mood episode, and are they mood-congruent, mood-incongruent, or independent?
Typical language
“I know I have ruined everyone”
A marked psychomotor syndrome is present and needs structured, time-sensitive assessment.
Deciding signal
A cluster of psychomotor signs is more informative than immobility or reduced speech alone.
Ask this
Is there a coherent catatonic syndrome after urgent medical, neurological, toxic, and medication causes are considered?
Typical language
“They have stopped moving and speaking”
Episodes show a repeated temporal relationship with a particular season and a contrasting pattern at another time of year.
Deciding signal
The recurring calendar-linked course matters more than the season in which one episode happens.
Ask this
Across years, is there a consistent seasonal onset-and-remission pattern that is not explained by seasonal stressors?
Typical language
“Every winter I shut down”
A mood episode begins during pregnancy or in the period soon after birth.
Deciding signal
Timing around pregnancy and birth changes safety assessment, treatment context, and family support needs.
Ask this
Did the mood episode begin in the peripartum window, and are bipolarity, psychosis, and immediate safety actively assessed?
Typical language
“This began during the pregnancy”
Multiple distinct mood episodes occur within a year, separated by remission or a switch in polarity.
Deciding signal
Count syndromal episodes across time; do not substitute moment-to-moment emotional lability.
Ask this
Does the longitudinal timeline show repeated distinct episodes rather than rapid shifts within one episode?
Typical language
“I have had several separate episodes this year”
Symptoms meet the disorder threshold with limited excess symptoms, distress, and functional impairment.
Deciding signal
Severity describes the whole episode: symptom burden, intensity, risk, and functional impact.
Ask this
Is the current episode genuinely lower in burden and impairment while still meeting the diagnostic threshold?
Typical language
“I can still function, but it takes much more effort”
The full syndrome has improved, but meaningful symptoms remain or a sustained symptom-free interval has not yet been established.
Deciding signal
The person is better but not symptom-free, or recovery is too recent to call full remission.
Ask this
Has the episode clearly receded while residual symptoms or insufficient duration prevent full-remission wording?
Typical language
“I am much better, but not back to myself”
No significant signs or symptoms of the recent episode remain across a sustained interval.
Deciding signal
Full remission is a longitudinal conclusion, not a single good day or improvement from baseline.
Ask this
Are clinically significant episode symptoms absent, with recovery sustained long enough to support full-remission wording?
Typical language
“I feel back to my usual self”