Fit and exclusions
Start with the deciding signal, then test chronology, competing explanations, and the effect on diagnostic wording.
- Anxious tension or restlessness rises and falls with the mood episode.
- Worry, loss-of-control fears, or dread meaningfully increase distress or impairment.
- The pattern is present often enough to influence formulation and care planning.
- Anxiety is better explained by a separate anxiety disorder with an independent course.
- Restlessness is more consistent with akathisia, intoxication, withdrawal, delirium, or another medical cause.
- Clarify timing against the mood episode
- Separate worry from psychotic threat beliefs
- Review agitation and suicide risk
- “I feel keyed up all day”
- “Something awful is about to happen”
- “I cannot settle inside”
Name the anxiety burden explicitly; it may affect monitoring, tolerability, risk, and pacing of treatment.