Diagnostic criteria for bipolarity based on an international sample of 5,635 patients with DSM-IV major depressive episodes

Abstract

To assess the clinical validity of individual DSM-IV criteria for hypomania. In an international sample of 5,635 patients with major depressive episodes (Bridge Study), DSM-IV criteria for hypomania (stem questions, number and quality of symptoms, duration and exclusion criteria) were systematically assessed and their validity analysed on the basis of clinical data including family history, course, and other clinical characteristics. Three stem questions for hypomania, irritability, elevated mood and the added question of increased activity, showed comparable validity. The results support the current DSM-IV requirement for a higher symptom threshold (4 of 7 hypomanic symptoms) in cases of irritable mood. Longer durations of hypomanic episodes were associated with higher scores on all validators. The results did not support the DSM-IV durational requirements for hypomanic episodes (4 days) and manic episodes (7 days). Brief hypomanic episodes of 1, 2 or 3 days were valid and would meet validity criteria for inclusion. The three exclusion criteria in DSM-IV (hypomania due to the use of antidepressants or of other substances, or to other medical conditions) were found to exclude patients with bipolar depression and should therefore not be retained. These results support several revisions of the DSM-IV concept of hypomanic episodes: specifically, the inclusion of increased activity as a gate question, the inclusion of 1 or 2 to 3-day episodes and the elimination of all exclusion criteria.

Atypical features and treatment choices in bipolar disorders: a result of the National Bipolar Mania Pathway Survey in China

“…This finding is concordant with the basic clinical characteristics of BP, and underlies the relationship between rejection sensitivity and irritability and related symptoms [1,28] . We also found that each of the atypical symptoms was most common among those patients exhibiting a mixed state; a not unexpected finding [31] , since mixed state patients usually exhibit atypical depression symptoms, and atypical symptoms are among the core features of atypical depression in DSM-IV [1,28] . Furthermore, some atypical symptoms such as hypersomnia have been assumed to indicate a balance of specifi city and sensitivity for the diagnosis of BP-II disorder among depressed patients [30] .…”

“…e.g., the characteristic of bipolarity predicted a higher likelihood of the diagnosis of BP in patients with major depressive disorder [28] . This decision was carefully thought out during the design of the study, as bipolarity is similar to the ATFs described in our study, and some evidence suggests that atypical symptoms are valuable in distinguishing BP-II disorder from depression [29,30] .…”

Bipolar disorder in Turkey: A review

“…[36] Başka bir açıdan bakıldığında da bipolar olguların üçte birinin uygun tedavi için on yıl beklediği saptanmıştır. [37] Erken başlangıç ve ilk atak tipinin depresyon oluşu hastalığın tanın-masını geciktiren değişkenlerdir. Kesebir ve arkadaşlarının çalışmasında başlangıç yaşı daha erken, ilk atak depresyon oranı daha yüksektir.…”

Differential diagnosis of major depression and bipolar disorder

“…They found a positive family history more common in bipolar patients than in major depression plus an association with anxiety disorders and age of onset in both diseases. However, hypomania is frequent in patients with major depressive episodes, and the DSM-IV concept of hypomanic episodes should be revised [3].…”