Bipolar and Related Disorder Due to Another Medical Condition 145
This condition follows the ingestion or inhalati on quickly, usually within hours or, at the
most, a few days. In stimulant-induced manic or  hypomanic states, the response is in min-
utes to 1 hour after one or several ingestions  or injections. The episode is very brief and
typically resolves over 1–2 days. With co rticosteroids and some immunosuppressant
medications, the mania (or mixed or depressed state) usually follows several days of in-
gestion, and the higher doses appear to have a much greate r likelihood of producing bi-
polar symptoms. 
Diagnostic Markers
Determination of the substance of use can be made through markers in the blood or urine
to corroborate diagnosis.
Differential Diagnosis
Substance/medication-induced bipolar and related disorder should be differentiated
from other bipolar disorders, substance into xication or substance-induced delirium, and
medication side effects (as noted earlier). A full manic episode that emerges during anti-
depressant treatment (e.g., medication, electr oconvulsive therapy) but persists at a fully
syndromal level beyond the physiological effect of that treatment is sufficient evidence for
a bipolar I diagnosis. A full hypomanic episode  that emerges during antidepressant treat-
ment (e.g., medication, electroconvulsive therap y) but persists at a fully syndromal level
beyond the physiological effect of that treatme nt is sufficient evidence for a bipolar II di-
agnosis only if preceded by a major depressive episode.
Comorbidity
Comorbidities are those associated with the use of illicit substances (in the case of illegal
stimulants or phencyclidine) or diversion of prescribed stimulants. Comorbidities related