Document ID: chunk:federal_register_of_legislation:F2018L00867:clause:1_1:p5
Version: federal_register_of_legislation:F2018L00867
Segment Type: clause
Provision Reference: sch 1 cl 1 (pt 5/10)
Character Range: 25748–29150

another medical condition.
            (i)            depressed mood most of the day, nearly every day, as indicated by either subjective report (for example, feels sad, empty, or hopeless) or observation made by others (for example, appears tearful);
Note: In children and adolescents, can be irritable mood.
            (ii)         markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation);
            (iii)       significant weight loss when not dieting or weight gain (for example, a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day;
Note: In children, consider failure to make expected weight gain.
            (iv)        insomnia or hypersomnia nearly every day;
            (v)          psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down);
            (vi)        fatigue or loss of energy nearly every day;
            (vii)     feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick);
            (viii)   diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others); or
            (ix)        recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
         B.            The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
         C.            The episode is not attributable to the physiological effects of a substance or another medical condition.
         Note 1: Criteria A–C constitute a major depressive episode. Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
         Note 2: bipolar I disorder and DSM-5 are also defined in the Schedule 1 - Dictionary.
                                     major depressive episode with mixed features meets the following diagnostic criteria (derived from DSM-5):
         1. At least three of the following manic/hypomanic symptoms are present during the majority of days of a major depressive episode:
            (i)            elevated, expansive mood;
            (ii)         inflated self-esteem or grandiosity;
            (iii)       more talkative than usual or pressure to keep talking;
            (iv)        flight of ideas or subjective experience that thoughts are racing;
            (v)          increase in energy or goal-directed activity (either socially, at work or school, or sexually);
            (vi)        increased or excessive involvement in activities that have a high potential for painful consequences (for example, engaging in unrestrained buying sprees, sexual indiscretions, foolish business investments); or
            (vii)     decreased need for sleep (feeling rested despite sleeping less than usual, to be contrasted with insomnia).
         B.            Mixed symptoms are observable by others and represent a change from the person's usual behaviour.
         C.            For individuals whose