Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders

MacKinnon, Dean F.; Pies, Ronald W.

doi:10.1111/j.1399-5618.2006.00283.x

Cited by 184 publications

(105 citation statements)

References 88 publications

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“…Operationalizing AI has proved difficult (MacKinnon and Pies, 2006), although statistical 75 modelling and methods based on experience sampling applied in the short term (Ebner- , Ebner-Priemer et al, 2007a and longer term (Bonsall et al, 2012a) 77 have been suggested.…”

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confidence: 99%

How is affective instability defined and measured? A systematic review

et al. 2013

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How is affective instability defined and measured? A systematic review

et al. 2013

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“…With the publication of the DSM-V soon approaching, arguments have been advanced for broadening the bipolar spectrum even further, adding recurrent depression without hypomania (Benazzi, 2002), irritability (Benazzi & Akiskal, 2005); agitated depression (Akiskal et al, 2000;Benazzi, Koukopoulos, & Akiskal, 2004) and borderline personality disorder (Mackinnon & Pies, 2006;Smith, Muir, & Blackwood, 2005). Even without a further loosening of diagnostic criteria, Akiskal et al (2000) estimates that half of those now carrying diagnoses of major depression will be recast as bipolar.…”

Section: Bipolarmentioning

confidence: 99%

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

Littrell

2012

Ethical Hum Psychol Psychiatry

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The diagnosis of Bipolar Spectrum Disorders (BSD) given for office visits has risen 40 fold for children and has risen dramatically for adults as well. Some of the growth may have been fueled by re-categorization of individuals who would previously have received diagnoses of major depression along with the widening of diagnostic criteria for BSD. Concomitant with the rise in BSD diagnoses, the number of adults and children receiving atypical antipsychotics has increased dramatically. Recent evidence finds that atypical antipsychotics cause considerable reduction in brain volume. It is thus imperative to ensure that those with diagnoses comprising BSD-Bipolar I, Bipolar II, and Bipolar Not Otherwise specified (NOS)-actually share a common etiology and are being appropriately treated. This paper reviews the history, evidentiary support, and implications associated with the expansion of the Bipolar Spectrum. Can a Diagnosis Be Epidemic, with Therapeutic Efforts the Catastrophe?In the years from 1999 to 2003, the diagnosis of bipolar given in office visits has increased 40 fold for children. Bipolar Disorder diagnoses have increased during the same time period for adults as well rising from 4.77% of office visits to 6.28% of office visits (Moreno et al., 2007).Allen Frances (2009), the Chairperson of the DSM-IV, has suggested that the sharp rise in bipolar diagnoses is attributable to the manner in which criteria for the disorders were written-that it was an issue of taxonomy rather than epidemiology. Obviously, diagnostic criteria have profound implications for who is diagnosed, at what age, and whether they are treated with psychotropic medications. Because psychotropic medications carry substantial risks-if not guarantees-of side effects, those decisions must be judicious, and ever cognizant of Hippocrates' admonishment: First, do no harm. This review constitutes an audit of psychiatry's books, asking if they balance when the substantial risk of harm from such diagnoses and the regimen of medication they entail is taken fully into account. Creation of the Bipolar SpectrumOver the years, those behaviors categorized under the bipolar label have expanded greatly. In the DSM-II (Association, 1968), manic-depression, listed under the heading "affective psychoses", was the only bipolar type diagnosis. With subsequent editions of the DSM, new categories of affect perturbations were included in manuals. The DSM-III (Association, 1980) provided descriptions of the behaviors required to meet criteria for mixed and manic episodes. The DSM-III-R (Association, 1987) added criteria for hypomania (specified in the next paragraph). The literature recognized that some persons who had experienced an episode of depression did have periods when they were enthusiastic, energetic, and animated to the extent that they met criteria for hypomania. Kupfer, Carpenter, and Frank (1988) had argued that such individuals, who were labeled Bipolar II, should be viewed as experiencing a variant of major depression. Dunner (1993) disagr...

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“…Others develop unipolar depression [29], anti-social personality disorder with affective symptoms [30] and borderline personality disorder [31]. Thus, children who meet the criteria for SMD Table I.…”

Section: Course and Outcomementioning

confidence: 99%

Evidence-Based Treatment

古賀¹

2017

The SAGE Encyclopedia of Abnormal and Clinical Psychology

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Objective: The literature on bipolar in children and adolescents was reviewed to provide an update for clinicians. Review process: Literature of particular relevance to evidence-based practice was selected for critical review. Outcomes: An up-to-date overview of clinical features, epidemiology, prognosis, aetiology, assessment and intervention was provided. Conclusions: Bipolar disorder in children and adolescence is a relatively common, multifactorially determined and recurring problem which persists into adulthood. Psychometrically robust screening questionnaires and structured interviews facilitate reliable assessment. Multimodal chronic care programmes involving medication (notably lithium) and familyoriented psychotherapy are currently the treatment of choice. Keywords: Paediatric bipolar disorder, bipolar disorderResumen Objetivo: Se revisó la literatura sobre el trastorno bipolar en niñ os y adolescentes para ofrecer una actualizació n al médico. Proceso de revisión: Se seleccionó para una revisió n crítica la literatura que tuviera una relevancia concreta en relació n a la práctica basada en la evidencia. Resultados: Se brinda una revisió n actualizada sobre las características clínicas, la epidemiología, el pronó stico, la evaluació n y el manejo. Conclusión: El trastorno bipolar es un problema recurrente y relativamente comú n en niñ os y adolescentes, determinado a partir de mú ltiples factores, y que persiste hasta la edad adulta. La aplicació n de cuestionarios psicométricos de tamizaje y de entrevistas estructuradas permite una evaluació n confiable. El tratamiento de elecció n son los programas multimodales de cuidado cró nico, que incluyen el uso de medicamentos (particularmente litio) y psicoterapia orientada a la familia.

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Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders

Cited by 184 publications

References 88 publications

How is affective instability defined and measured? A systematic review

How is affective instability defined and measured? A systematic review

Can a Diagnosis Be Epidemic, With Therapeutic Efforts the Catastrophe?

Evidence-Based Treatment

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