Bipolar disorder — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 53 of 2018

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting bipolar disorder or death from bipolar disorder with the circumstances of a person's relevant service:

1. (1)
   for bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive episode with mixed features, other specified bipolar and related disorder and unspecified bipolar and related disorder only: (a) experiencing a category 1A stressor within the one year before the clinical onset of bipolar disorder; (b) experiencing a category 1B stressor within the one year before the clinical onset of bipolar disorder; (c) experiencing a category 2 stressor within the one year before the clinical onset of bipolar disorder; (d) experiencing the death of a significant other within the one year before the clinical onset of bipolar disorder; (e) experiencing the death from suicide of a close family member before the clinical onset of bipolar disorder; (f) being within 90 days postpartum at the time of the clinical onset of bipolar disorder; (g) having alcohol use disorder or substance use disorder at the time of the clinical onset of bipolar disorder; (h) having a disorder of mental health from Specified List 1 of clinically significant disorders of mental health within the ten years before the clinical onset of bipolar disorder; (i) having insomnia as specified at the time of the clinical onset of bipolar disorder; or (j) having concussion or moderate to severe traumatic brain injury within the five years before the clinical onset of bipolar disorder;

   Note: bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive episode with mixed features and other specified bipolar and related disorder and unspecified bipolar and related disorder are defined in the Schedule 1 - Dictionary.

   Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

   Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

   Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

   Note: significant other is defined in the Schedule 1 - Dictionary.

   Note: close family member is defined in the Schedule 1 - Dictionary.

   Note: Specified List 1 of clinically significant disorders of mental health is defined in the Schedule 1 - Dictionary.

   Note: insomnia as specified is defined in the Schedule 1 - Dictionary.

2. (2)
   for substance/medication-induced bipolar and related disorder only: (a) taking a drug, or a drug from a class of drugs, from the specified list of drugs, within the 14 days before the clinical onset of bipolar disorder; (b) taking a drug which is associated in the individual with the development of symptoms of bipolar disorder while taking the drug, and the cessation or significant reduction of the symptoms of bipolar disorder within days or weeks of discontinuing the drug, where taking the drug continued for at least the two days before the clinical onset of bipolar disorder; (c) having ceased or reduced antidepressant drug therapy or antiepileptic drug therapy within the 30 days before the clinical onset of bipolar disorder; (d) having alcohol use disorder or substance use disorder at the time of the clinical onset of bipolar disorder; (e) taking at least 600 milligrams of caffeine per day from beverages, drugs or foods for the 14 days before the clinical onset of bipolar disorder; or (f) inhaling, ingesting or having cutaneous contact with a specified organic solvent, in an unventilated and confined space, for a cumulative period of at least 1 000 hours, within the two years before the clinical onset of bipolar disorder, and where the exposure has ceased, the clinical onset of bipolar disorder occurred within the one year of cessation;

   Note: substance/medication-induced bipolar and related disorder is defined in the Schedule 1 - Dictionary.

   Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

   Note: specified organic solvent is defined in the Schedule 1 - Dictionary.

3. (3)
   for bipolar and related disorder due to another medical condition only, having an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the medical condition is a direct physiological cause of the mood symptoms at the time of the clinical onset of bipolar disorder;

   Note: bipolar and related disorder due to another medical condition and medical condition is a direct physiological cause of the mood symptoms are defined in the Schedule 1 - Dictionary.

4. (4)
   experiencing a category 1A stressor within the one year before the clinical worsening of bipolar disorder;

   Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

5. (5)
   experiencing a category 1B stressor within the one year before the clinical worsening of bipolar disorder;

   Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

6. (6)
   experiencing a category 2 stressor within the one year before the clinical worsening of bipolar disorder;

   Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

7. (7)
   experiencing the death of a significant other within the one year before the clinical worsening of bipolar disorder;

   Note: significant other is defined in the Schedule 1 - Dictionary.

8. (8)
   experiencing the death from suicide of a close family member before the clinical worsening of bipolar disorder;

   Note: close family member is defined in the Schedule 1 - Dictionary.

9. (9)
   being within 90 days postpartum at the time of the clinical worsening of bipolar disorder;
10. (10)
    having a disorder of mental health from Specified List 2 of clinically significant disorders of mental health at the time of the clinical worsening of bipolar disorder;

    Note: Specified List 2 of clinically significant disorders of mental health is defined in the Schedule 1 - Dictionary.

11. (11)
    taking a drug, or a drug from a class of drugs, from the specified list of drugs, within the 14 days before the clinical worsening of bipolar disorder;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

12. (12)
    taking a drug which is associated in the individual with the worsening of symptoms of bipolar disorder while taking the drug, and the cessation or significant reduction of the symptoms of bipolar disorder within days or weeks of discontinuing the drug, where taking the drug continued for at least the two days before the clinical worsening of bipolar disorder;
13. (13)
    having ceased or reduced antidepressant drug therapy or antiepileptic drug therapy within the 30 days before the clinical worsening of bipolar disorder;
14. (14)
    having a medical condition as specified at the time of the clinical worsening of bipolar disorder;

    Note: medical condition as specified is defined in the Schedule 1 - Dictionary.

15. (15)
    experiencing severe childhood abuse before the clinical worsening of bipolar disorder;

    Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

16. (16)
    being deprived of at least one whole night's sleep within the two days before the clinical worsening of bipolar disorder;
17. (17)
    having insomnia as specified at the time of the clinical worsening of bipolar disorder;

    Note: insomnia as specified is defined in the Schedule 1 - Dictionary.

18. (18)
    having electroconvulsive therapy within the 14 days before the clinical worsening of bipolar disorder;
19. (19)
    having a course of bright light therapy within the 14 days before the clinical worsening of bipolar disorder;
20. (20)
    having concussion or moderate to severe traumatic brain injury within the one year before the clinical worsening of bipolar disorder;
21. (21)
    having deep brain stimulation for Parkinson's disease within the 48 hours before the clinical worsening of bipolar disorder;
22. (22)
    having vagus nerve stimulation within the 48 hours before the clinical worsening of bipolar disorder;
23. (23)
    taking at least 600 milligrams of caffeine per day from beverages, drugs or foods for the 14 days before the clinical worsening of bipolar disorder;
24. (24)
    inability to obtain appropriate clinical management for bipolar disorder;

Aggravation-only factors: the factors in subsections 9(4) to 9(24) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.