Distractibility, impulsivity or indiscretion, grandiosity, flight of ideas, increased activity, decreased need for sleep, and talkativeness are the seven symptom categories linked to a manic episode. Clinicians use the acronym DIGFAST to help them remember these symptoms.
The mnemonic does not take the place of the DSM-5-TR criteria, but it does aid in remembering the list of symptoms. Additionally, a manic episode must meet the necessary symptom count, duration and severity criteria, and a specific period of elevated, expansive, or irritated mood accompanied by increased energy or activity.
Unless hospitalisation is required, a manic episode usually lasts at least a week. It is crucial to distinguish this duration criterion from hypomania, which calls for at least four days in a row.
The seven DIGFAST symptoms
D: Distractibility
Because attention is quickly diverted by outside stimuli or unrelated thoughts, the patient struggles to sustain focus.
It might look like:
Frequently shifting subjects
Getting lost in a conversation
Obsessing over small environmental cues
Attention shifts quickly, making activities difficult to complete.
I: Indiscretion or impulsivity
Excessive engagement in enjoyable activities with a high risk of unpleasant outcomes is referred to as the I.
Some instances are:
Unchecked spending
Negligent driving
Sexual misconduct
Unwise financial or business decisions
Other exceptionally dangerous pursuits.
G: Grandiosity
Inflated self-esteem or lofty ideals are examples of grandiosity.
What a sufferer might say
Unusual aptitudes or skills
exceptional significance or intellect
Particular authority or status
Unrealistic plans for a career or budget
An overly optimistic outlook on future achievements.
F: Flight of ideas
Flight of ideas refers to quick mental changes or the subjective perception that one's thoughts are racing.
When conducting an interview, the doctor might observe:
Quick switching between subjects
Associations that get more challenging to follow
Difficult-to-redirect speech
A subjective account of racing ideas.
A: Increased activity
The A mostly denotes heightened psychomotor agitation or goal-directed activity.
Increased activity focused on goals can happen in:
Employment
Education
Interaction with others
Sexual relations
Innovative endeavours
Enterprises or financial endeavours
Another way to meet this symptom domain is through psychomotor agitation.
S: Decreased need for sleep
More accurately, this is not just sleeplessness but a diminished need for sleep.
A patient may report feeling refreshed or abnormally energised despite getting far less sleep than usual.
Consider this:
"Despite getting three hours of sleep every nite for the past week, I don't feel at all exhausted."
This is not the same as insomnia, which is characterised by poor sleep and feelings of fatigue or distress.
T: Talkativeness
The T stands for being under pressure to talk more or being more talkative than normal.
The sufferer might:
Talk somewhat more than usual
Talk fast.
Make it hard to interrupt
Despite efforts to reroute, keep speaking
Change the subject swiftly
Although they might coexist, flight of ideas and pressured speech are distinct symptom domains.
How many DIGFAST symptoms are needed for mania?
Three or more of the seven symptom domains are necessary to meet the criteria for manic episodes. According to the American Psychiatric Association, it is defined as a minimum of one week during which a person exhibits at least three of the listed behavioural changes, is excessively energetic, and is irritable or high-spirited most of the time.
Four indicators are necessary when the mood is merely irritable instead of high or expansive.
One component of the evaluation is the number of symptoms. Additionally, the doctor must determine the necessary changes in mood, energy, or activity, as well as their length, intensity, functional implications, and exclusions.
The one-week manic episode criterion
Increased energy or activity combined with an elevated, expansive, or irritated mood must persist for the following duration:
One week or more
or.
If hospitalisation is required, any length of time.
For instance, even though they haven't reached seven days, a patient who needs mental hospitalisation due to severe manic symptoms for five days can still meet the duration condition.
A practical way to remember the criteria
Use DIGFAST to determine the symptoms for a clinical interview, then review the episode requirements. OLDCARTS addresses onset, length, timing, and severity when organising the history itself; these are precisely the components that the episode criteria activate:
Mood: Has the mood clearly changed to one of elevation, expansiveness, or irritability?
Energy/activity: Is there a rise in either?
Symptoms: Do you have at least three DIGFAST symptoms, or four when your mood is only agitated?
Duration/severity: Did the episode require hospitalisation, or did it last at least one week?
Differential: Could the presentation be explained by a drug, prescription, illness, or other mental illness?
As a result, the mnemonic is kept apart from the more comprehensive diagnostic evaluation.
DIGFAST does not diagnose bipolar disorder
DIGFAST is not a diagnostic tool, but rather a memory assist.
Different clinical settings can result in a DIGFAST-positive appearance. Our ICD-10 guide for drug use disorders addresses the coding of substance-related presentations, which are prevalent. It should take into account:
Effects of substances or medications
Medical disorders
Deprivation of sleep
Other mental illnesses
Personality and functioning baseline
Past incidents of mood
Signs of psychosis
Consequences for function
Longitudinal path
The hallmark episode for bipolar I disorder is a manic episode. A major depressive episode is not necessary for a person to fit the diagnostic criteria for Bipolar I.
DIGFAST documentation example
More information than "DIGFAST positive" should be included in a helpful clinical note.
Patient reports a distinct 8-day period of markedly elevated and irritable mood with increased energy and activity, representing a clear change from baseline. During this period, patient reported sleeping approximately 3 hours nightly without daytime fatigue, increased goal-directed activity, pressured and increased speech, racing thoughts, distractibility, inflated self-confidence, and impulsive spending. Symptoms resulted in marked occupational and interpersonal impairment. No substance or medication explanation identified based on current assessment.
This records the length of the episode, symptoms, functional impact, change from baseline, and differentiating considerations.
Common DIGFAST mistakes
Using DIGFAST as the standard for diagnosis
After using the mnemonic to help you remember the symptoms, evaluate the entire event criteria.Neglecting more vigour or activity
During a manic episode, there is a noticeable shift in mood and an increase in vigour or activity.Considering seven days to be an absolute necessity
When hospitalisation is required, a manic episode can satisfy the duration condition for any length of time.Mistaking a lack of sleep for insomnia
Sleeping less due to insomnia is not the same as sleeping less while feeling rejuvenated and relaxed.Ignoring the irritable-mood guideline
Instead of just three signs, four are needed when the mood is merely irritated.Psychosis is missing
Psychotic symptoms point to a manic episode and are incompatible with hypomania.Symptom domains are identified while diagnosing bipolar illness using the acronym DIGFAST. The diagnosis necessitates a more comprehensive clinical evaluation.
DIGFAST vs. SIGECAPS
As supplementary symptom mnemonics, DIGFAST and SIGECAPS are effective.
Recalling manic symptoms is aided with DIGFAST:
Distracting
Discretion and impulsivity
Arrogance
Airborne concepts
Boost in activity
Reduced need or lack of sleep
Overtalking
SIGECAPS aids in remembering signs of a major depressive episode.
When examining a patient's history for manic, hypomanic, and depressive episodes, the two mnemonics can be helpful in tandem.
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