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”
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”
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”
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.
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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”
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”
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”