Last reviewed: April 2018
Last updated: February  2018



History and exam

Key diagnostic factors

  • history of major depressive episode(s)
  • ≥7 days of elated, expansive, or irritable mood and increased goal-directed activity/energy different from patient's usual self (mania)
  • inflated self-esteem or grandiosity
  • decreased need for sleep
  • pressure of speech
  • subjective experience that thoughts are racing
  • distractibility
  • excessive involvement in pleasurable activities that have a high potential for painful consequences
  • impairment in functioning

Other diagnostic factors

  • adolescence and young adulthood
  • flight of ideas

Risk factors

  • FHx of bipolar disorder
  • hx of depression
  • physical and/or sexual abuse
  • poor sleep
  • neurodevelopmental abnormalities
  • lack of maternal warmth/expressed emotion (duration)
  • life events
  • increased sociability and verbal functioning
  • persistent affective symptoms (transition to bipolar disorder)
  • male gender (when ADHD is comorbid)
  • high intellectual performance
  • family conflict
  • symptoms of inattention

Diagnostic investigations

Treatment algorithm


Authors VIEW ALL

Consultant Child and Adolescent Psychiatrist

Lancashire Care NHS Foundation Trust

Honorary Reader

Faculty of Biology, Medicine and Health

University of Manchester




BD is a member of NIHR HTA panel, and has previously received HTA funding. She is a clinical advisor to NHSE and an occasional advisor to NICE. BD serves as Vice Chair of Royal College of Psychiatrists child and adolescent faculty, and as Editor on Child and Adolescent Mentalis. BD is an author of references cited in this topic.

Professor of Psychiatry

Ohio State Wexner Medical Center

Nationwide Children's Hospital

Center for Innovation in Pediatric Practice




RAK is on the data safety monitoring committee for Forrest and Pfizer, but receives no compensation for taking part; he is also an author of references cited in the this topic.

Dr Bernadka Dubicka and Dr Robert A. Kowatch would like to gratefully acknowledge Dr Gabrielle A. Carlson, a previous contributor to this monograph. GAC is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL


Division of Child & Adolescent Psychiatry

Department of Psychiatry & Behavioral Sciences

University of Washington




JM is an author of a number of references cited in this monograph.

Child and Adolescent Psychiatrist

Emeritus Professor of Psychiatry

The Werry Centre for Child and Adolescent Mental Health

Department of Psychological Medicine

University of Auckland


New Zealand


JW is an author of a number of references cited in this monograph.

Use of this content is subject to our disclaimer