The bipolar disorders: A case for their categorically distinct status based on symptom profiles

Parker, Gordon; Spoelma, Michael J.; Tavella, Gabriela; Alda, Martin; Hájek, Tomáš; Dünner, David L.; O′Donovan, Claire; Rybakowski, Janusz; Goldberg, Joseph F.; Bayes, Adam; Sharma, Verinder; Boyce, Philip; Manicavasagar, Vijaya

doi:10.1016/j.jad.2020.08.014

Cited by 10 publications

(11 citation statements)

References 15 publications

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“…There is a long-standing debate as to whether bipolar I and II conditions differ dimensionally or categorically. Seeking clarification, we analysed data from our AREDOC bipolar samples (Parker et al, 2020a). The 15 individual items quantified as more likely to be affirmed by the clinically diagnosed bipolar I patients than the bipolar II patients were submitted to a latent class analysis, in which a two-class fit was demonstrated to be superior to both a one-class fit (which would argue for a dimensional model) and a three-class fit (which would argue for there being more than two bipolar categories).…”

Section: Resultsmentioning

confidence: 99%

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The AREDOC project and its implications for the definition and measurement of the bipolar disorders: A summary report

Parker

Spoelma

Tavella

2022

Aust N Z J Psychiatry

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Objectives: Judging that the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for defining mania/hypomania (and thus bipolar I/II disorders, respectively) would benefit from review, we formed an expert taskforce to derive modified criteria for consideration. The aim of this paper is to summarise the component stages and detail the final recommended criteria. Methods: We first sought taskforce members’ views on the Diagnostic and Statistical Manual of Mental Disorders criteria and how they might be modified. Next, members recruited patients with a bipolar I or II disorder, and who were asked to judge new definitional options and complete a symptom checklist to determine the most differentiating items. The latter task was also completed by a small comparison group of unipolar depressed patients to determine the mood state items that best differentiate unipolar from bipolar subjects. Subsequent reports overviewed analyses arguing for bipolar I and II as being categorically distinct and generated empirically derived diagnostic criteria. Results: Alternatives to all the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria were generated. Modifications included recognising that impairment is not a necessary criterion, removing hospitalisation as automatically assigning bipolar I status, adding an irritable/angry symptom construct to the symptom list, deleting a mandatory duration period for manic/hypomanic episodes, and requiring a greater number of affirmed symptoms for a bipolar diagnosis to manage the risk of overdiagnosis. Granular symptom criteria were identified by analyses and constructed to assist clinician assessment. A potential bipolar screening measure was developed with analyses showing that it could clearly distinguish bipolar versus unipolar status, whether symptom items were assigned as having equal status or weighted by their quantified diagnostic contribution. Conclusion: While requiring further validation, we suggest that the revised criteria overcome several current Diagnostic and Statistical Manual of Mental Disorders (5th ed.) limitations to defining and differentiating the two bipolar sub-types, while still respecting and preserving the Diagnostic and Statistical Manual of Mental Disorders template. It will be necessary to determine whether the bipolar screening measure has superiority to currently accepted measures.

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Section: Resultsmentioning

confidence: 99%

“…Subsequent studies conducted a series of empirical analyses on an international sample of patients. Full details of the methodologies in these studies are reported in other publications (Parker et al, 2018(Parker et al, , 2020a(Parker et al, , 2020b(Parker et al, , 2021.…”

Section: Methodsmentioning

confidence: 99%

The AREDOC project and its implications for the definition and measurement of the bipolar disorders: A summary report

Parker

Spoelma

Tavella

2022

Aust N Z J Psychiatry

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“…The second study 2 involved an initial group of 64 investigators with clinical and research bipolar expertise. Gin notes in his rebuttal that the listing of only 11 authors on this paper indicated that “ 83% withdrew—including me ”.…”

Section: Empirical Data Considering Status Of Bipolar Disorders As Be...mentioning

confidence: 99%

Bipolar II disorder: Once missed, now dismissed, time to resist

Parker

2022

Bipolar Disorders

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“…Bipolar disorder is a mental disorder characterized by severe and typically sudden mood swings, either up into mania (a lifetime manic episode being the only symptom necessary for a diagnosis of the serious form of bipolar disorder) or, for an estimated 70% to 80% of bipolar disorder sufferers, down into depression (which happens either immediately after the manic episode or more often independently and lasts much longer than a manic episode) [4]. Bipolar disorder occurs in a severe and always dysfunctional form known as Bipolar I which requires at least one lifetime fully manic episode and has an estimated annual prevalence in the U.S. of about 1% (1 in 100 persons), and in a less severe and less dysfunctional form known as Bipolar II which requires only a lifetime mild or so-called hypomanic episode plus at least one lifetime major depressive episode and has a similar 1% (1 in 100 persons) estimated annual prevalence [5] [6]. These prevalence percentages hardly differ at all worldwide [7].…”

Section: Introductionmentioning

confidence: 99%

Aripiprazole and Cariprazine for Bipolar Disorder?

Rossiter¹

2022

OJMP

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In this article, the present author, a research psychologist and measurement expert, evaluates the major clinical trials used to support the use of aripiprazole and the chemically almost identical cariprazine for treating bipolar disorder. The main problem with the trials is that they were conducted mainly with outpatients, who on average were only moderately manic in the mania studies and only moderately depressed in the depression studies. The effectiveness of aripiprazole and cariprazine in treating moderate mania, most likely hypomania, and moderate depression, was far from encouraging.

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The bipolar disorders: A case for their categorically distinct status based on symptom profiles

Cited by 10 publications

References 15 publications

The AREDOC project and its implications for the definition and measurement of the bipolar disorders: A summary report

The AREDOC project and its implications for the definition and measurement of the bipolar disorders: A summary report

Bipolar II disorder: Once missed, now dismissed, time to resist

Aripiprazole and Cariprazine for Bipolar Disorder?

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