Adding Increased Energy or Activity to Criterion (A) of the DSM-5 Definition of Hypomania and Mania: Effect on the Diagnoses of 907 Patients From the Bipolar Collaborative Network

Mette U. Fredskild, Jim Mintz, Mark A. Frye, Susan L. McElroy, Willem A. Nolen, Ralph Kupka, Heinz Grunze, Paul E. Keck, Robert M. Post, Lars V. Kessing, Trisha Suppes

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: According to DSM-IV, criterion (A) for diagnosing a hypomanic/manic episode is mood change (ie, elevated, expansive, or irritable mood). Criterion (A) was redefined in DSM-5, adding increased energy or activity in addition to mood change. We sought to investigate the effect of adding increased energy or activity to criterion (A) for the diagnosis of hypomania/mania and, thus, bipolar disorder. METHODS: This analysis of prospectively collected data from the Bipolar Collaborative Network (1995-2002) includes 907 DSM-IV-TR-diagnosed bipolar outpatients (14,306 visits). The Young Mania Rating Scale (YMRS) was administered monthly and used to define DSM-IV and DSM-5 criterion (A) fulfillment during a hypomanic/manic visit. RESULTS: Patients were adults (median age = 40; IQR, 33-49), and over half (56%) were women. Median number of contributed visits was 10 (IQR, 4-23). Applying DSM-5 criterion (A) reduced the number of patients experiencing a hypomanic/manic visit by 34%, compared to DSM-IV. Visits fulfilling DSM-5 criterion (A) had higher odds of experiencing elevated levels of all other mania symptoms, compared to fulfilling DSM-IV criterion (A) only. Association between individual symptoms was strongest with mood elevation and energy or activity (OR [95% CL] = 8.65, [7.91, 9.47]). CONCLUSIONS: The 34% reduction in the number of patients being diagnosed with a hypomanic/manic visit shows that the impact of applying DSM-5 criterion (A) is substantial. Fewer hypomanic/manic episodes may be diagnosed by the stricter DSM-5 criterion (A), but the episodes diagnosed are likely to be more severe. The DSM-5 criteria may in general prevent overdiagnosis of bipolar disorder but possibly at the cost of underdiagnosing hypomanic/manic episodes.

Original languageEnglish (US)
JournalThe Journal of clinical psychiatry
Volume80
Issue number6
DOIs
StatePublished - Oct 29 2019

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Bipolar Disorder
Diagnostic and Statistical Manual of Mental Disorders
Irritable Mood
Outpatients

ASJC Scopus subject areas

  • Psychiatry and Mental health

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Adding Increased Energy or Activity to Criterion (A) of the DSM-5 Definition of Hypomania and Mania : Effect on the Diagnoses of 907 Patients From the Bipolar Collaborative Network. / Fredskild, Mette U.; Mintz, Jim; Frye, Mark A.; McElroy, Susan L.; Nolen, Willem A.; Kupka, Ralph; Grunze, Heinz; Keck, Paul E.; Post, Robert M.; Kessing, Lars V.; Suppes, Trisha.

In: The Journal of clinical psychiatry, Vol. 80, No. 6, 29.10.2019.

Research output: Contribution to journalArticle

Fredskild, Mette U. ; Mintz, Jim ; Frye, Mark A. ; McElroy, Susan L. ; Nolen, Willem A. ; Kupka, Ralph ; Grunze, Heinz ; Keck, Paul E. ; Post, Robert M. ; Kessing, Lars V. ; Suppes, Trisha. / Adding Increased Energy or Activity to Criterion (A) of the DSM-5 Definition of Hypomania and Mania : Effect on the Diagnoses of 907 Patients From the Bipolar Collaborative Network. In: The Journal of clinical psychiatry. 2019 ; Vol. 80, No. 6.
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abstract = "OBJECTIVE: According to DSM-IV, criterion (A) for diagnosing a hypomanic/manic episode is mood change (ie, elevated, expansive, or irritable mood). Criterion (A) was redefined in DSM-5, adding increased energy or activity in addition to mood change. We sought to investigate the effect of adding increased energy or activity to criterion (A) for the diagnosis of hypomania/mania and, thus, bipolar disorder. METHODS: This analysis of prospectively collected data from the Bipolar Collaborative Network (1995-2002) includes 907 DSM-IV-TR-diagnosed bipolar outpatients (14,306 visits). The Young Mania Rating Scale (YMRS) was administered monthly and used to define DSM-IV and DSM-5 criterion (A) fulfillment during a hypomanic/manic visit. RESULTS: Patients were adults (median age = 40; IQR, 33-49), and over half (56{\%}) were women. Median number of contributed visits was 10 (IQR, 4-23). Applying DSM-5 criterion (A) reduced the number of patients experiencing a hypomanic/manic visit by 34{\%}, compared to DSM-IV. Visits fulfilling DSM-5 criterion (A) had higher odds of experiencing elevated levels of all other mania symptoms, compared to fulfilling DSM-IV criterion (A) only. Association between individual symptoms was strongest with mood elevation and energy or activity (OR [95{\%} CL] = 8.65, [7.91, 9.47]). CONCLUSIONS: The 34{\%} reduction in the number of patients being diagnosed with a hypomanic/manic visit shows that the impact of applying DSM-5 criterion (A) is substantial. Fewer hypomanic/manic episodes may be diagnosed by the stricter DSM-5 criterion (A), but the episodes diagnosed are likely to be more severe. The DSM-5 criteria may in general prevent overdiagnosis of bipolar disorder but possibly at the cost of underdiagnosing hypomanic/manic episodes.",
author = "Fredskild, {Mette U.} and Jim Mintz and Frye, {Mark A.} and McElroy, {Susan L.} and Nolen, {Willem A.} and Ralph Kupka and Heinz Grunze and Keck, {Paul E.} and Post, {Robert M.} and Kessing, {Lars V.} and Trisha Suppes",
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T1 - Adding Increased Energy or Activity to Criterion (A) of the DSM-5 Definition of Hypomania and Mania

T2 - Effect on the Diagnoses of 907 Patients From the Bipolar Collaborative Network

AU - Fredskild, Mette U.

AU - Mintz, Jim

AU - Frye, Mark A.

AU - McElroy, Susan L.

AU - Nolen, Willem A.

AU - Kupka, Ralph

AU - Grunze, Heinz

AU - Keck, Paul E.

AU - Post, Robert M.

AU - Kessing, Lars V.

AU - Suppes, Trisha

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Y1 - 2019/10/29

N2 - OBJECTIVE: According to DSM-IV, criterion (A) for diagnosing a hypomanic/manic episode is mood change (ie, elevated, expansive, or irritable mood). Criterion (A) was redefined in DSM-5, adding increased energy or activity in addition to mood change. We sought to investigate the effect of adding increased energy or activity to criterion (A) for the diagnosis of hypomania/mania and, thus, bipolar disorder. METHODS: This analysis of prospectively collected data from the Bipolar Collaborative Network (1995-2002) includes 907 DSM-IV-TR-diagnosed bipolar outpatients (14,306 visits). The Young Mania Rating Scale (YMRS) was administered monthly and used to define DSM-IV and DSM-5 criterion (A) fulfillment during a hypomanic/manic visit. RESULTS: Patients were adults (median age = 40; IQR, 33-49), and over half (56%) were women. Median number of contributed visits was 10 (IQR, 4-23). Applying DSM-5 criterion (A) reduced the number of patients experiencing a hypomanic/manic visit by 34%, compared to DSM-IV. Visits fulfilling DSM-5 criterion (A) had higher odds of experiencing elevated levels of all other mania symptoms, compared to fulfilling DSM-IV criterion (A) only. Association between individual symptoms was strongest with mood elevation and energy or activity (OR [95% CL] = 8.65, [7.91, 9.47]). CONCLUSIONS: The 34% reduction in the number of patients being diagnosed with a hypomanic/manic visit shows that the impact of applying DSM-5 criterion (A) is substantial. Fewer hypomanic/manic episodes may be diagnosed by the stricter DSM-5 criterion (A), but the episodes diagnosed are likely to be more severe. The DSM-5 criteria may in general prevent overdiagnosis of bipolar disorder but possibly at the cost of underdiagnosing hypomanic/manic episodes.

AB - OBJECTIVE: According to DSM-IV, criterion (A) for diagnosing a hypomanic/manic episode is mood change (ie, elevated, expansive, or irritable mood). Criterion (A) was redefined in DSM-5, adding increased energy or activity in addition to mood change. We sought to investigate the effect of adding increased energy or activity to criterion (A) for the diagnosis of hypomania/mania and, thus, bipolar disorder. METHODS: This analysis of prospectively collected data from the Bipolar Collaborative Network (1995-2002) includes 907 DSM-IV-TR-diagnosed bipolar outpatients (14,306 visits). The Young Mania Rating Scale (YMRS) was administered monthly and used to define DSM-IV and DSM-5 criterion (A) fulfillment during a hypomanic/manic visit. RESULTS: Patients were adults (median age = 40; IQR, 33-49), and over half (56%) were women. Median number of contributed visits was 10 (IQR, 4-23). Applying DSM-5 criterion (A) reduced the number of patients experiencing a hypomanic/manic visit by 34%, compared to DSM-IV. Visits fulfilling DSM-5 criterion (A) had higher odds of experiencing elevated levels of all other mania symptoms, compared to fulfilling DSM-IV criterion (A) only. Association between individual symptoms was strongest with mood elevation and energy or activity (OR [95% CL] = 8.65, [7.91, 9.47]). CONCLUSIONS: The 34% reduction in the number of patients being diagnosed with a hypomanic/manic visit shows that the impact of applying DSM-5 criterion (A) is substantial. Fewer hypomanic/manic episodes may be diagnosed by the stricter DSM-5 criterion (A), but the episodes diagnosed are likely to be more severe. The DSM-5 criteria may in general prevent overdiagnosis of bipolar disorder but possibly at the cost of underdiagnosing hypomanic/manic episodes.

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