Management commentary

The clinical models presented by Parker (Chapter 17) and by Ketter and Wang (Chapter 18) are comprehensive, timely, and are a good example of the necessity in evaluating the evidence base (in this case being somewhat limited in relation to Bipolar II disorder or BP II) in juxtaposition with practitioners’ experience in optimising treatment selection. From the standpoint of diagnostic criteria, I look forward to evaluating how these criteria may change, with DSM-V Field Trials for bipolar disorder currently under way. There is increasing recognition of the phenomenological concept of mixed presentations. If DSM-V does change these criteria, it will most assuredly impact on treatment considerations for BP II. The impact would be even greater if the 4-day criterion is waived for hypomania. Such changes would include many current ‘soft bipolar’ conditions into the BP II domain – conditions which have been minimally studied in terms of clinical treatment.