Impact of modification to DSM-5 criterion A for hypomania/mania in newly diagnosed bipolar patients: findings from the prospective BIO study

International Journal of Bipolar Disorders

Mette U. Fredskild¹  Kimie Stefanie Ormstrup Sletved¹  Klara Coello¹  Sharleny Stanislaus¹  Sigurd A. Melbye¹  Hanne Lie Kjærstad¹  Lars Vedel Kessing²  Maj Vinberg³  Trisha Suppes⁴ 

[1] Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Centre Copenhagen, Department O, 6233, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark;Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Centre Copenhagen, Department O, 6233, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark;Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Centre Copenhagen, Department O, 6233, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark;Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark;Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA;

关键词: Bipolar disorder;    Diagnostic and Statistical Manual of Mental Disorders Version IV (DSM-IV);    Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5);    Mood;    Irritability;    Energy;    Activity;    The International Classification of Diseases 10 (ICD-10);    The International Classification of Diseases 11 (ICD-11);   

DOI  :  10.1186/s40345-020-00219-9

来源: Springer

【 摘 要 】

BackgroundDSM-IV states that criterion A for diagnosing hypomania/mania is mood change. The revised DSM-5 now states that increased energy or activity must be present alongside mood changes to diagnose hypomania/mania, thus raising energy/activity to criterion A. We set out to investigate how the change in criterion A affects the diagnosis of hypomanic/manic visits in patients with a newly diagnosed bipolar disorder.ResultsIn this prospective cohort study, 373 patients were included (median age = 32; IQR, 27–40). Women constituted 66% (n = 245) of the cohort and 68% of the cohort (n = 253) met criteria for bipolar type II, the remaining patients were diagnosed bipolar type I. Median number of contributed visits was 2 per subject (IQR, 1–3) and median follow-up time was 3 years (IQR, 2–4). During follow-up, 127 patients had at least one visit with fulfilled DSM-IV criterion A. Applying DSM-5 criterion A reduced the number of patients experiencing a hypomanic/manic visit by 62% at baseline and by 50% during longitudinal follow-up, compared with DSM-IV criterion A. Fulfilling DSM-5 criterion A during follow-up was associated with higher modified young mania rating scale score (OR = 1.51, CL [1.34, 1.71], p < 0.0001) and increased number of visits contributed (OR = 1.86, CL [1.52, 2.29], p < 0.0001).ConclusionApplying the stricter DSM-5 criterion A in a cohort of newly diagnosed bipolar patients reduced the number of patients experiencing a hypomanic/manic visit substantially, and was associated with higher overall young mania rating scale scores, compared with DSM-IV criterion A. Consequently, fewer hypomanic/manic visits may be detected in newly diagnosed bipolar patients with applied DSM-5 criterion A, and the upcoming ICD-11, which may possibly result in longer diagnostic delay of BD as compared with the DSM-IV.

【 授权许可】

CC BY