Not Otherwise Specified. The symptoms are not directly caused by a general medical condition or the use of substances, including prescription medications. Include any specifiers that apply to the overall course of the disorder. Often a family history of affective disorders and alcoholism is present in first-degree relatives. They should also be performed to rule out certain causes of secondary mania, such as megaloblastic anemia, hyperglycemia and hypoglycemia, hyperthyroidism and hypothyroidism, systemic lupus erythematosus, syphilis, HIV, and liver disease induced by alcohol or other substances.
Some disorders have similar symptoms.
The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis. The patient has had at least one Major Depressive Episode. The patient has had at least one Hypomanic Episode. There have been no Manic or Mixed Episodes. Not Otherwise Specified.