psychotic features during a manic episode also satisfies Criterion C.
Manic symptoms or syndromes that are attrib utable to the physiological effects of a
drug of abuse (e.g., in the context of cocaine or amphetamine intoxication), the side effects
of medications or treatments (e.g., steroids, L-dopa, antidepressants, stimulants), or an-
other medical condition do not count toward the diagnosis of bipolar I disorder. However,
a fully syndromal manic episode that arises duri ng treatment (e.g., with medications, elec-
troconvulsive therapy, light ther apy) or drug use and persists beyond the physiological ef-
fect of the inducing agent (i.e., after a medica tion is fully out of the individual’s system or
the effects of electroconvulsive therapy would be expected to have dissipated completely)
is sufficient evidence for a manic episode di agnosis (Criterion D). Caution is indicated so
that one or two symptoms (particularly increa sed irritability, edginess, or agitation follow-
ing antidepressant use) are not taken as suffi cient for diagnosis of a manic or hypomanic
episode, nor necessarily an indication of a bi polar disorder diathesis. It is necessary to
meet criteria for a manic episode to make a diag nosis of bipolar I disorder, but it is not re-
quired to have hypomanic or major depressi ve episodes. However, they may precede or
follow a manic episode. Full descriptions of the diagnostic features of a hypomanic epi-
sode may be found within the text for bipola r II disorder, and the features of a major de-
pressive episode are described within th e text for major depressive disorder.
Associated Features Supporting Diagnosis
During a manic episode, individuals often do not perceive that they are ill or in need of treat-