By the end of the evening, I had reflected on my clinical experience of patients with bipolar disorder and came up with the following answer. I propose 'extremes in the speed of thought' as a pathognomonic symptom for bipolar disorder. This is a subjective awareness where the individual experiences a wide range in the speed of their thoughts. In a depressed state, thoughts are perceived as severely slowed. While in the manic state, thoughts are perceived as moving much faster. This is the sole criterion which I advise my patients to apply when they rate their mood charts. Rather than using criteria like mood or activity, I ask that they rate the speed of their thoughts and graph it.
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