Diagnostic criteria for bipolarity based on an international sample of 5,635 patients with DSM-IV major depressive episodes
- 762 Downloads
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.
KeywordsHypomania Diagnosis DSM criteria Validity Bridge study
The diagnostic Bridge Study was organised and sponsored by Sanofi-Aventis. We thank them for providing us with all data and derived variables for analyses without any restrictions.
Conflict of interest statement
Prof. Dr. Jules Angst has served on the advisory board for Eli Lilly & Company, Janssen Cilag, Lundbeck, on the speakers’ bureau for Eli Lilly & Company and AstraZeneca, and as a consultant for Sanofi Aventis.
J.M.A. has undertaken consultancy work for Lilly, Janssen, Sanofi-Aventis, Lundbeck, Astra Zeneca, and Bristol-Myers-Squibb; and has received honoraria form Lilly, Janssen, Lundbeck, Sanofi-Aventis, Bristol-Myers-Squibb, Pfizer, and Novartis in relation to conference presentations.
A.G. is a statistician of JA and has no conflict of interest to declare.
C.L.B. has acted as a consultant for Pfizer, Bristol Myers Squibb, Repligen, and Merck. He has served on an advisory board of sanofi-aventis. He has received grant support from NIMH, Johnson and Johnson, and Bristol Myers Squibb.
G.P. has acted as consultant of Sanofi Aventis, Bristol Myers Squibb, Astra Zeneca, Eli Lilly, Boehringer Ingheleim; received grant/research support from Eli lilly, Astra Zeneca, Boehringer Ingheleim, Glaxo-SmithKline; is on the speaker/advisory board of Sanofi Aventis, Bristol Myers Squibb, Astra Zeneca, Eli Lilly, Boehringer Ingheleim, Glaxo-SmithKline, Pfyzer, Wyeth, Jannsen-Cilag, Lundbeck.
E.V. has acted as consultant, received grant/research support or honoraria from Almirall, Astra-Zeneca, Bristol-Myers-Squibb, Eli Lilly, Forest Research Institute, Geodon Richter, Glaxo-Smith-Kline, Janssen-Cilag, Jazz, Johnson & Johnson, Lundbeck, Merck Sharpe and Dohme, Novartis, Organon, Otsuka, Pierre-Fabre, Pfizer, Sanofi Aventis, Servier, Shering-Plough, Takeda, United Biosource Corporation, and Wyeth.
A.H.Y. has acted as a consultant, received grant/research support or honoraria from, and/or has been on the advisory boards of Sanofi-aventis, Eli-Lilly, Bristol-Myers Squibb, BCI, AstraZeneca, GSK, Janssen, Pfizer and Servier.
- 1.Angst J (1992) Recurrent brief psychiatric syndromes of depression, hypomania, neurasthenia, and anxiety from an epidemiological point of view. Neurol Psychiatry Brain Res 1:5–12Google Scholar
- 3.Angst J, Azorin JM, Bowden CL, Perugi G, Vieta E, Young AH, for the BRIDGE Study Group (2011) Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the Bridge Study. Arch Gen Psychiatry 68:791–799Google Scholar
- 6.Bowden CL, Angst J, Azorin JM, Perugi G, Vieta E, Young AH (in print) Significant bipolar risk factors in patients presenting a current major depressive episode (abstract). In: Proceedings of 163rd Annual Meeting. American Psychiatric Association, 22–26. May 2010, New OrleansGoogle Scholar
- 9.Goldberg JF, Perlis RH, Ghaemi SN, Calabrese JR, Bowden CL, Wisniewski S, Miklowitz DJ, Sachs GS, Thase ME (2007) Adjunctive antidepressant use and symptomatic recovery among bipolar depressed patients with concomitant manic symptoms: findings from the STEP-BD. Am J Psychiatry 164:1348–1355PubMedCrossRefGoogle Scholar
- 17.Truman CJ, Goldberg JF, Ghaemi SN, Baldassano CF, Wisniewki SR, Dennehy EB, Thase ME, Sachs GS (2007) Self-reported history of manic/hypomanic switch associated with antidepressant use: data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). J Clin Psychiatry 68:1472–1479PubMedCrossRefGoogle Scholar
- 18.Vieta E, Angst J, Azorin JM, Bowden CL, Perugi G, Young AH, BRIDGE Study Group (2010) Characteristics of patients with hypomanic symptoms presenting a current major depressive episode identified with the HCL-32 patient questionnaire (poster PW01-39). 18th European Congress of Psychiatry, 27. February–2. March 2010, Munich. In: Eur PsychiatryGoogle Scholar