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for diagnosing bipolar disorder are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, the current version being DSM-IV-TR, and the World Health Organization'sInternational Statistical Classification of Diseases and Related Health Problems, currently the ICD-10. The latter criteria are typically used in Europe and other regions while the DSM criteria are used in the USA and other regions, as well as prevailing in research studies. The DSM-V, to be published in 2013, will likely include further and more accurate sub-typing.An initial assessment may include a physical exam by a physician. Although there are no biological tests which confirm bipolar disorder, tests may be carried out to exclude medical illnesses such as hypo-or hyperthyroidism, metabolic disturbance, a systemic infection or chronic disease, and syphilisor HIVinfection. An EEGmay be used to exclude epilepsy, and a CT scanof the head to exclude brain lesions. Investigations are not generally repeated for relapse unless there is a specific medicalindication.Several rating scalesfor the screeningand evaluation of bipolar disorder exist, such as the Bipolar spectrum diagnostic scale.The use of evaluation scales can not substitute a full clinical interview but they serve to systematize the recollection of symptoms.On the other hand instruments for the screening of bipolar disorder have low sensitivity[clarification needed]and limited diagnostic validity.Bipolar spectrum Bipolar spectrum refers to a category of mood disordersthat feature abnormally elevated or depressed mood. These disorders range from bipolar I disorder, featuring full-blown manicepisodes, to cyclothymia, featuring less prominent hypomanicepisodes, to "subsyndromal" conditions where only some of the criteria for mania or hypomania are met. These disorders typically also involve depressivesymptoms or episodes that alternate with the elevated mood states, or with mixed episodesthat feature symptoms of both.The concept of the bipolar spectrumis similar to that of Emil Kraepelin's originalconcept of manic depressive illness.Currently, manic depressive illness is usually
referred to as bipolar disorder or simply bipolar. A simple nomenclature system was introduced in 1978 to classify more easily individuals' affectedness within the spectrum.Points on the spectrum using this nomenclature are denoted using the following codes:M—severe maniaD—severe depression(unipolar depression)m—less severe mania (hypomania)d—less severe depressionThus, mDrepresents a case with hypomania and major depression. A further distinction issometimes made in the ordering of the letters, to represent the order of the episodes, where the patient's normal state is euthymic, interrupted by episodes of mania followed by depression (MD) or vice versa (DM).