DIG FAST
Manic Episode Criteria (DSM-5)
3 of 7 symptoms + elevated mood for a week = mania.
For the FNP boards, distinguishing bipolar I from major depression hinges on whether the patient has had a manic episode, and DIG FAST is the DSM-5 shorthand for manic symptoms. Distractibility, Impulsivity (high-risk pleasure seeking), Grandiosity, Flight of ideas, Activity (goal-directed) increase, Sleep need decreased, Talkativeness or pressured speech — three of seven plus elevated or irritable mood for at least one week meets criteria for mania (four if mood is only irritable). AANP vignettes will hand you a patient on an SSRI who suddenly stops sleeping, spends compulsively, and starts a new business. DIG FAST tells you that's mania, and SSRIs don't belong in the regimen.
- DDistractibilityAttention pulled easily by irrelevant stimuli.
- IIndiscretion / impulsivityRisky behavior: spending sprees, sexual indiscretion, reckless driving.
- GGrandiosityInflated self-esteem; may be delusional.
- FFlight of ideasRapid, loosely connected thoughts; racing thoughts subjectively.
- AActivity increaseGoal-directed — work, school, socially, or sexually.
- SSleep decreasedDecreased need for sleep (feels rested after 3 hours), not insomnia.
- TTalkativenessPressured speech, hard to interrupt.
Clinical Context
Mania = ≥3 symptoms plus elevated, expansive, or irritable mood for ≥1 week (or any duration if hospitalized). Bipolar I requires only a single manic episode in a lifetime. Always rule out substance-induced causes and medical mimics (hyperthyroidism, steroids, stimulants, stroke).
The AANP loves the trap of starting an SSRI in a patient with undiagnosed bipolar depression — it can precipitate mania. Always screen for prior manic episodes with "have you ever had a period lasting at least a week where you needed very little sleep and felt on top of the world?"
Related Mnemonics
- CAGE — Alcohol Use Disorder Screening
- CIWA-Ar — Alcohol Withdrawal Severity
- CRAFFT — Adolescent Substance Use Screen
- HEADSS — Adolescent Psychosocial Assessment
- SAD PERSONS — Suicide Risk Assessment
Sources
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