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
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
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DOI：
10.4088/jcp.19m12834
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发表时间：
2019-11-01
影响因子：
5.3
通讯作者：
Suppes, Trisha
中科院分区：
文献类型：
--
作者：
Fredskild, Mette U.;Mintz, Jim;Suppes, Trisha
目的：根据DSM-IV，诊断轻躁狂/躁狂发作的标准（A）是情绪变化（即情绪升高、膨胀或易怒）。标准（A）在DSM-5中重新定义，除了情绪变化外，还增加了能量或活动。我们试图调查的影响，增加能源或活动的标准（A）的诊断轻躁狂/躁狂，因此，bipolar disorder.Methods：这种分析的前瞻性收集的数据从双相协作网络（1995-2002年）包括907 DSM-IV-TR诊断的双相门诊患者（14,306访问）。Young Mania Rating Scale（YMRS）每月进行一次，用于定义轻躁狂/躁狂访视期间DSM-IV和DSM-5标准（A）的履行情况。结果：患者为成人（中位年龄= 40; IQR，33-49），超过一半（56%）为女性。贡献访视的中位数为10（IQR，4-23）。与DSM-IV相比，应用DSM-5标准（A）将经历轻躁狂/躁狂就诊的患者数量减少了34%。与仅满足DSM-IV标准（A）相比，满足DSM-5标准（A）的访视发生所有其他躁狂症状水平升高的几率更高。个体症状与情绪升高和精力或活动之间的关联最强（OR [95%CL] =8.65，[7.91，9.47]）。结论：诊断为轻躁狂/躁狂就诊的患者数量减少了34%，表明应用DSM-5标准（A）的影响是巨大的。更严格的DSM-5标准（A）可以诊断出较少的轻躁狂/躁狂发作，但诊断出的发作可能更严重。DSM-5标准通常可以防止双相情感障碍的过度诊断，但可能会以诊断不足为代价。
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.