144 Bipolar and Related Disorders
bipolar and related disorder, foll owed by the specification of onset (i.e., onset during in-
toxication, onset during withdrawal). For exam ple, in the case of irritable symptoms oc-
curring during intoxica tion in a man with a severe coca ine use disorder, the diagnosis is
F14.24 severe cocaine use disorder with co caine-induced bipolar and related disorder,
with onset during intoxication . A separate diagnosis of the comorbid severe cocaine use
disorder is not given. If the substance-induce d bipolar and related disorder occurs without
a comorbid substance use disorder (e.g., afte r a one-time heavy use of the substance), no
accompanying substance use disorder is note d (e.g., F15.94 amphetamine-induced bipolar
and related disorder, with onset during into xication). When more than one substance is
judged to play a significant role in the development of bipolar mood symptoms, each
should be listed separately (e.g., F15.24 severe methylphenidate use disorder with meth-
ylphenidate-induced bipolar and related disorder, with onset during intoxication; F19.94
dexamethasone-induced bipolar and related di sorder, with onset during intoxication).
Diagnostic Features
The diagnostic features of substance/medication -induced bipolar and related disorder are es-
sentially the same as those for mania, hypomania, or depression . A key exception to the diag-
nosis of substance/medication-induced bipolar an d related disorder is the case of hypomania
or mania that occurs after antidepressant medi cation use or other treatments and persists be-
yond the physiological effects of the medication. This condition is considered an indicator of