Advertisement

Journal of Neural Transmission

, Volume 125, Issue 2, pp 211–222 | Cite as

Issues on the diagnosis and etiopathogenesis of mood disorders: reconsidering DSM-5

  • Kazuyoshi Ogasawara
  • Yukako Nakamura
  • Hiroyuki Kimura
  • Branko Aleksic
  • Norio Ozaki
High Impact Review in Neuroscience, Neurology or Psychiatry - Review Article

Abstract

The authors present a narrative review from the diagnostic and nosologic viewpoints of mood disorders (bipolar and depressive ones) by revisiting the revision from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision to DSM-5, including the following: the separation of the bipolar and depressive sections; the addition of increased energy and continuation of symptoms to the hypo/manic criteria; the elimination of mixed episodes; the creation of new categories and specifiers (“other specified bipolar and related disorder”, “disruptive mood dysregulation disorder”, “with anxious distress”, “with mixed features”, “with peripartum onset”); the categorization of hypo/manic episodes during antidepressant treatment into bipolar disorder; the elimination of the “bereavement exclusion”; the ambiguous separation between bipolar I and II; the insufficient distinction between “other specified bipolar and related disorders” and major depressive disorder; the differentiation regarding borderline personality disorder; agitation; premenstrual dysphoric disorder; and society and psychiatry. Through this analysis, we point out both the achievements and limitations of DSM-5. In addition, to examine the future direction of psychiatry, we introduce our cohort study regarding maternal depression and an outline of the National Institute of Mental Health’s Research Domain Criteria project in the US. Finally, we advocate the importance of elucidating etiopathogeneses by starting from or going beyond the DSM operational diagnostic system, which has shown great efficacy.

Keywords

Bipolar and related disorders Depressive disorders Mood disorders DSM-5 Diagnosis RDoC 

Notes

Acknowledgements

This review was partially supported by Research and Development Grants for Comprehensive Research for Persons with Disabilities from the Japan Agency for Medical Research and development, AMED.

Funding

Partially supported by AMED (as mentioned above).

Compliance with ethical standards

Conflict of interest

KO has received personal fees from Sumitomo Dainippon Pharma. HK has received personal fees from Pfizer. NO has received grants from Eisai, MSD, Otsuka, Dainippon Sumitomo, Takeda, Tsumura, The KAITEKI Institute, Eli Lilly, Nihon Medi-Physics, Novartis, Pfizer, personal fees from Astellas, MSD, Otsuka, Ono, Glaxo Smith Kline, Takeda, Mitsubishi Tanabe Pharma, Dainippon Sumitomo Pharma, Novartis, Eli Lilly, Pfizer, Meiji Seika, Mochida, Janssen, Yoshitomi. (These all are outside of the submitted work). YN and BA has nothing to disclose.

References

  1. American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders, 3rd edition, (DSM -III). Washington DCGoogle Scholar
  2. American Psychiatric Association (2013) Diagnostic and statistical manual of nental disorders, 5th edition, (DSM-5). Washington DCGoogle Scholar
  3. American Psychiatric Association (2017) Updates to DSM-5 criteria & text. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5//updates-to-dsm-5-criteria-text. Accessed 31 Jul 2017
  4. Angst J, Angst K, Baruffol I, Meinherz-Surbeck R (1992) ECT-induced and drug-induced hypomania. Convuls Ther 8:179–185PubMedGoogle Scholar
  5. Azorin JM, Angst J, Gamma A, Bowden CL, Perugi G, Vieta E, Young A (2012) Identifying features of bipolarity in patients with first-episode postpartum depression: findings from the international BRIDGE study. J Affect Disord 136:710–715CrossRefPubMedGoogle Scholar
  6. Balazs J, Benazz IF, Rihmer Z, Rihmer A, Akiskal K, Akiskal H (2006) The close link between suicide attempts and mixed (bipolar) depression: implications for suicide prevention. J Affect Disord 91:133–138CrossRefPubMedGoogle Scholar
  7. Baweja R, Mayes SD, Hameed U, Waxmonsky JG (2016) Disruptive mood dysregulation disorder: current insights. Neuropsychiatr Dis Treat 12:2115–2124CrossRefPubMedPubMedCentralGoogle Scholar
  8. Câmara RA et al (2016) Affective temperaments and emotional traits are associated with a positive screening for premenstrual dysphoric disorder. Compr Psychiatry 71:33–38CrossRefPubMedGoogle Scholar
  9. Cassidy F (2010) Anxiety as a symptom of mixed mania: implications for DSM-5. Bipolar Disord 12:437–439CrossRefPubMedGoogle Scholar
  10. Chen J, Wang Z, Fang Y (2016) The history, diagnosis and treatment of disruptive mood dysregulation disorder. Shanghai Arch Psychiatry 28:289–292PubMedGoogle Scholar
  11. Cloninger C, Svrakic DM, Przybeck TR (1993) A psychobiological model of temperament and character. Arch Gen Psychiatry 50:975–990CrossRefPubMedGoogle Scholar
  12. Culpepper L, Davidson J, Dietrich A, Goodman W, Kroenke K, Schwenk T (2004) Suicidality as a possible side effect of antidepressant treatment. Prim Care Companion J Clin Psychiatry 6:79–86CrossRefPubMedPubMedCentralGoogle Scholar
  13. di Giacomo E et al (2017) Unblending borderline personality and bipolar disorders. J Psychiatr Res 91:90–97CrossRefPubMedGoogle Scholar
  14. Dietz PM, Williams SB, Callaghan WM, Bachman DJ, Whitlock EP, Hornbrook MC (2007) Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry 164:1515–1520CrossRefPubMedGoogle Scholar
  15. Dillon D, Rosso I, Pechtel P, Killgore WD, Rauch SL, Pizzagalli DA (2014) Peril and pleasure: an rdoc-inspired examination of threat responses and reward processing in anxiety and depression. Depression Anxiety 31:233–249CrossRefPubMedGoogle Scholar
  16. Dumlu K, Orhon Z, Ozerdem A, Tural U, Ulas H, Tunca Z (2011) Treatment-induced manic switch in the course of unipolar depression can predict bipolarity: cluster analysis based evidence. J Affect Disord 134:91–101CrossRefPubMedGoogle Scholar
  17. El-Mallakh R et al (2008) Antidepressant-associated chronic irritable dysphoria (ACID) in STEP-BD patients. J Affect Disord 111:372–377CrossRefPubMedGoogle Scholar
  18. Faedda GL, Marangoni C, Reginaldi D (2015) Depressive mixed states: a reappraisal of Koukopoulos’ criteria. J Affect Disord 176:18–23CrossRefPubMedGoogle Scholar
  19. Faheem S, Petti V, Mellos G (2017) Disruptive mood dysregulation disorder and its effect on bipolar disorder. Ann Clin Psychiatry 29:84–91PubMedGoogle Scholar
  20. Fillman SG, Sinclair D, Fung SJ, Webster MJ, Shannon Weickert C (2014) Markers of inflammation and stress distinguish subsets of individuals with schizophrenia and bipolar disorder. Transl Psychiatry 4:e365CrossRefPubMedPubMedCentralGoogle Scholar
  21. Flint J, Kendler KS (2014) The genetics of major depression. Neuron 81:484–503CrossRefPubMedPubMedCentralGoogle Scholar
  22. Fornaro M et al (2016) The prevalence and predictors of bipolar and borderline personality disorders comorbidity: systematic review and meta-analysis. J Affect Disord 195:105–118CrossRefPubMedGoogle Scholar
  23. Frances A (2013) Saving normal. Conville & Walsh Limited, LondonGoogle Scholar
  24. Frances AJ, Nardo JM (2013) ICD-11 should not repeat the mistakes made by DSM-5. Br J Psychiatry 203:1–2CrossRefPubMedGoogle Scholar
  25. Freeman AJ, Youngstrom EA, Youngstrom JK, Findling RL (2016) Disruptive mood dysregulation disorder in a community mental health clinic: prevalence. Comorbidity Correl J Child Adolesc Psychopharmacol 26:123–130CrossRefGoogle Scholar
  26. Frías Á, Baltasar I, Birmaher B (2016) Comorbidity between bipolar disorder and borderline personality disorder: prevalence, explanatory theories, and clinical impact. J Affect Disord 202:210–219CrossRefPubMedGoogle Scholar
  27. Fristad MA et al (2016) Disruptive mood dysregulation disorder and bipolar disorder not otherwise specified: fraternal or identical twins? J Child Adolesc Psychopharmacol 26:138–146CrossRefPubMedPubMedCentralGoogle Scholar
  28. Fuchikami M et al (2011) DNA methylation profiles of the brain-derived neurotrophic factor (BDNF) gene as a potent diagnostic biomarker in major depression. PLoS One 6:e23881CrossRefPubMedPubMedCentralGoogle Scholar
  29. Furukawa TA, Harai H, Hirai T, Kitamura T, Takahashi K (1999) Social Support Questionnaire among psychiatric patients with various diagnoses and normal controls. Soc Psychiatry Psychiatr Epidemiol 34:216–222CrossRefPubMedGoogle Scholar
  30. Furumura K et al (2012) Prospective study on the association between harm avoidance and postpartum depressive state in a maternal cohort of Japanese women. PLoS One 7:e34725CrossRefPubMedPubMedCentralGoogle Scholar
  31. Ghaemi SN (2013) Bipolar spectrum: a review of the concept and a vision for the future. Psychiatry Investig 10:218–224CrossRefPubMedPubMedCentralGoogle Scholar
  32. Ghaemi SN (2014) DSM-5 and the miracle that never happens. Acta Psychiatr Scand 129:1–3CrossRefGoogle Scholar
  33. Gornall J (2013) DSM-5: a fatal diagnosis? BMJ 346:f3256CrossRefPubMedGoogle Scholar
  34. Hamshere ML et al (2009) Age-at-onset in bipolar-I disorder: mixture analysis of 1369 cases identifies three distinct clinical sub-groups. J Affect Disord 116:23–29CrossRefPubMedGoogle Scholar
  35. Hayakawa N et al (2012) The postpartum depressive state in relation to perceived rearing: a prospective cohort study. PLoS One 7:e50220CrossRefPubMedPubMedCentralGoogle Scholar
  36. Insel T (2013) Director’s blog: transforming diagnosis. http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml. Accessed 31 Jul 2017
  37. Insel TR (2014) The NIMH research domain criteria (RDoC) project: precision medicine for psychiatry. Am J Psychiatry 171:395–397CrossRefPubMedGoogle Scholar
  38. Ishikawa N et al (2011) Prospective study of maternal depressive symptomatology among Japanese women. J Psychosom Res 71:264–269CrossRefPubMedGoogle Scholar
  39. Kaplan W, Wirtz V, Mantel-Teeuwisse A, Stolk P, Duthey B, Laing R, World Health Organization (2013) Priority medicines for Europe and the world—2013 update chapter 5. Demography, GBD and the preliminary list of priorities. http://www.who.int/medicines/areas/priority_medicines/MasterDocJune28_FINAL_Web.pdf?ua=1. Accessed 31 Jul 2017
  40. Kendler KS (2005) “A gene for…”: the nature of gene action in psychiatric disorders D. 0370512(162):1243–1252Google Scholar
  41. Kendler KS, Myers J, Zisook S, Zisook S (2008) Does bereavement-related major depression differ from major depression associated with other stressful life events? Am J Psychiatry 165:1449–1455CrossRefPubMedPubMedCentralGoogle Scholar
  42. Kitamura T et al (2006) Multicentre prospective study of perinatal depression in Japan: incidence and correlates of antenatal and postnatal depression. Arch Womens Ment Health 9:121–130CrossRefPubMedGoogle Scholar
  43. Klengel T, Binder EB (2013) Gene × environment interactions in the prediction of response to antidepressant treatment. Int J Neuropsychopharmacol 16:701–711CrossRefPubMedGoogle Scholar
  44. Koukopoulos A, Sani G (2014) DSM-5 criteria for depression with mixed features: a farewell to mixed depression. Acta Psychiatr Scand 129:4–16CrossRefPubMedGoogle Scholar
  45. Koukopoulos A, Sani G, Ghaemi SN (2013) Mixed features of depression: why DSM-5 is wrong (and so was DSM-IV). Br J Psychiatry 203:3–5CrossRefPubMedGoogle Scholar
  46. Lanza di Scalea T, Pearlstein T (2017) Premenstrual dysphoric disorder. Psychiatr Clin N Am 40:201–216CrossRefGoogle Scholar
  47. Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (2011) Borderline personality disorder. Lancet 377:74–84CrossRefPubMedGoogle Scholar
  48. Major Depressive Disorder Working Group of the Psychiatric Gwas Consortium et al (2013) A mega-analysis of genome-wide association studies for major depressive disorder. Mol Psychiatry 18:497–511CrossRefGoogle Scholar
  49. Mayes SD, Waxmonsky JD, Calhoun SL, Bixler EO (2016) Disruptive mood dysregulation disorder symptoms and association with oppositional defiant and other disorders in a general population child sample. J Child Adolesc Psychopharmacol 26:101–106CrossRefPubMedPubMedCentralGoogle Scholar
  50. Meyers E, DeSerisy M, Roy AK (2017) Disruptive mood dysregulation disorder (DMDD): an RDoC perspective. J Affect Disord 216:117–122CrossRefPubMedGoogle Scholar
  51. Mitchell RH, Timmins V, Collins J, Scavone A, Iskric A, Goldstein BI (2016) Prevalence and correlates of disruptive mood dysregulation disorder among adolescents with bipolar disorder. J Child Adolesc Psychopharmacol 26:138–146CrossRefGoogle Scholar
  52. Morikawa M et al (2015) Relationship between social support during pregnancy and postpartum depressive state: a prospective cohort study Sci Rep 5:10520PubMedGoogle Scholar
  53. National Institute for Health and Care Excellence (NICE) (2016) Depression in adults: recognition and management (CG90). https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognition-and-management-975742636741. Accessed 31 July 2017
  54. Nemeroff CB et al (2013) DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions. BMC Med 11:202CrossRefPubMedPubMedCentralGoogle Scholar
  55. NIMH (2017a) Definitions of the RDoC domains and constructs. https://www.nimh.nih.gov/research-priorities/rdoc/definitions-of-the-rdoc-domains-and-constructs.shtml. Accessed 31 Jul 2017
  56. NIMH (2017b) Developmental and environmental aspects. https://www.nimh.nih.gov/research-priorities/rdoc/developmental-and-environmental-aspects.shtml. Accessed 31 Jul 2017
  57. Nusslock R, Alloy LB (2017) Reward processing and mood-related symptoms: an RDoC and translational neuroscience perspective. J Affect Disord 216:3–16CrossRefPubMedGoogle Scholar
  58. O’Dushlaine C et al (2014) Rare copy number variation in treatment-resistant major depressive disorder. Biol Psychiatry 76:536–541CrossRefPubMedPubMedCentralGoogle Scholar
  59. Ohara M et al (2017a) Social support helps protect against perinatal bonding failure and depression among mothers: a prospective cohort study. SciRep 7:9546Google Scholar
  60. Ohara M et al (2017b) Relationship between maternal depression and bonding failure: a prospective cohort study of pregnant women. Psychiatry Clin Neurosci 71:733–741CrossRefPubMedGoogle Scholar
  61. Ohoka H et al (2014) Effects of maternal depressive symptomatology during pregnancy and the postpartum. Psychiatry Clin Neurosci 68:631–639CrossRefPubMedGoogle Scholar
  62. Parker G, Fletcher K (2014) Differentiating bipolar I and II disorders and the likely contribution of DSM-5 classification to their cleavage. J Affect Disord 152–154:57–64CrossRefPubMedGoogle Scholar
  63. Parker G, Tupling H, Brown LB (1979) A parental bonding instrument. Br J Med Psychol 52:1–10CrossRefGoogle Scholar
  64. Perich T, Frankland A, Roberts G, Levy F, Lenroot R, Mitchell PB (2017) Disruptive mood dysregulation disorder, severe mood dysregulation and chronic irritability in youth at high familial risk of bipolar disorder. Aust N Z J Psychiatry 51:1220–1226CrossRefPubMedGoogle Scholar
  65. Perlis RH et al (2010) Benzodiazepine use and risk of recurrence in bipolar disorder: a STEP-BD report. J Clin Psychiatry 71:194–200CrossRefPubMedGoogle Scholar
  66. Perugi G, Angst J, Azorin JM, Bowden C, Vieta E, Young AH, Group BS (2013a) The bipolar-borderline personality disorders connection in major depressive patients. Acta Psychiatr Scand 128:376–383CrossRefPubMedGoogle Scholar
  67. Perugi G, Angst J, Azorin JM, Bowden C, Vieta E, Young AH, Group BS (2013b) Is comorbid borderline personality disorder in patients with major depressive episode and bipolarity a developmental subtype? Findings from the international BRIDGE study. J Affect Disord 144:72–78CrossRefPubMedGoogle Scholar
  68. Phelps J, Ghaemi SN (2012) The mistaken claim of bipolar ‘overdiagnosis’: solving the false positives problem for DSM-5/ICD-11. Acta Psychiatr Scand 126:395–401CrossRefPubMedGoogle Scholar
  69. Propper L et al (2017) Disruptive mood dysregulation disorder in offspring of parents with depression and bipolar disorder. Br J Psychiatry 210:408–412CrossRefPubMedGoogle Scholar
  70. Regier DA, Narrow WE, Clarke DE, Kraemer HC, Kuramoto SJ, Kuhl EA, Kupfer DJ (2013) DSM-5 field trials in the United States and Canada, Part II: test–retest reliability of selected categorical diagnoses. Am J Psychiatry 170:59–70CrossRefPubMedGoogle Scholar
  71. Sani G et al (2014) Koukopoulos diagnostic criteria for mixed depression: a validation study. J Affect Disord 164:14–18CrossRefPubMedGoogle Scholar
  72. Sarason IG, Levine HM, Basham RB, Sarason BR (1983) Assessing social support: the Social Support Questionnaire. J Pers Soc Psychol 44:127–139CrossRefGoogle Scholar
  73. Sharma V (2013) Mixed depression in the postpartum period: diagnostic and treatment issues. J Psychiatry Neurosci 38:E30–E31CrossRefPubMedPubMedCentralGoogle Scholar
  74. Solmi M et al (2016) A comparative meta-analysis of TEMPS scores across mood disorder patients, their first-degree relatives, healthy controls, and other psychiatric disorders. J Affect Disord 196:32–46CrossRefPubMedGoogle Scholar
  75. Sparks GM et al (2014) Disruptive mood dysregulation disorder and chronic irritability in youth at familial risk for bipolar disorder. J Am Acad Child Adolesc Psychiatry 53:408–416CrossRefPubMedPubMedCentralGoogle Scholar
  76. Takeshima M, Oka T (2013) Association between the so-called “activation syndrome” and bipolar II disorder, a related disorder, and bipolar suggestive features in outpatients with depression. J Affect Disord 151:196–202CrossRefPubMedGoogle Scholar
  77. Takeshima M, Oka T (2015) DSM-5-defined ‘mixed features’ and Benazzi’s mixed depression: which is practically useful to discriminate bipolar disorder from unipolar depression in patients with depression? Psychiatry Clin Neurosci 69:109–116CrossRefPubMedGoogle Scholar
  78. Teatero M, Mazmanian D, Sharma V (2014) Effects of the menstrual cycle on bipolar disorder. Bipolar Disord 16:22–36CrossRefPubMedGoogle Scholar
  79. Terman M, Terman JS (2005) Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr 10:647–663 (quiz 672) CrossRefPubMedGoogle Scholar
  80. Uher R (2014) Gene-environment interactions in severe mental illness. Front Psychiatry 5:48CrossRefPubMedPubMedCentralGoogle Scholar
  81. Vöhringer PA et al (2016) The International Mood Network (IMN) Nosology Project: differentiating borderline personality from bipolar illness. Acta Psychiatr Scand 134:504–510CrossRefPubMedGoogle Scholar
  82. Wisner K et al (2009) Major depression and antidepressant treatment: impact on pregnancy and neonatal. Am J Psychiatry 166:557–566CrossRefPubMedPubMedCentralGoogle Scholar
  83. Witt SH et al (2017) Genome-wide association study of borderline personality disorder reveals genetic overlap with bipolar disorder, major depression and schizophrenia. Transl Psychiatry 7:e1155CrossRefPubMedPubMedCentralGoogle Scholar
  84. Woody ML, Gibb BE (2015) Integrating NIMH research domain criteria (RDoC) into depression research. Curr Opin Psychol 4:6–12CrossRefPubMedPubMedCentralGoogle Scholar
  85. World Health Organization (2008) The global burden of disease: 2004 update. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf?ua=1. Accessed 31 Jul 2017
  86. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G (2012) Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry 169:476–483CrossRefPubMedPubMedCentralGoogle Scholar
  87. Zimmerman M, Ruggero CJ, Chelminski I, Young D (2008) Is bipolar disorder overdiagnosed? J Clin Psychiatry 69:935–940CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Bioethics Research CenterNagoya University HospitalNagoyaJapan
  2. 2.Department of PsychiatryNagoya University Graduate School of MedicineNagoyaJapan

Personalised recommendations