scholarly journals How Does Adding the DSM-5 Criterion Increased Energy/Activity for Mania Change the Bipolar Landscape?

2021 ◽  
Vol 12 ◽  
Author(s):  
Anna Grunze ◽  
Christoph Born ◽  
Mette U. Fredskild ◽  
Heinz Grunze
Keyword(s):  
Clinical Practice ◽  
Negative Impact ◽  
Potential Change ◽  
Mood Change ◽  
Prevalence Data ◽  
Dsm 5 ◽  
Criterion A ◽  
Dsm Iv ◽  
Irritable Mood

According to DSM-IV, the criterion (A) for diagnosing hypomanic/manic episodes is mood change (i.e., elevated, expansive or irritable mood). Criterion (A) was redefined in DSM-5 in 2013, adding increased energy/activity in addition to mood change. This paper examines a potential change of prevalence data for bipolar I or II when adding increased energy/activity to the criterion (A) for the diagnosis of hypomania/mania. Own research suggests that the prevalence of manic/hypomanic episodes drops by at least one third when using DSM-5 criteria. Whether this has positive or negative impact on clinical practice and research still needs further evaluation.

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

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Mette U. Fredskild ◽  
Sharleny Stanislaus ◽  
Klara Coello ◽  
Sigurd A. Melbye ◽  
Hanne Lie Kjærstad ◽  
...  
Keyword(s):  
Rating Scale ◽  
Newly Diagnosed ◽  
Young Mania ◽  
Dsm 5 ◽  
Criterion A ◽  
Number Of Patients ◽  
Bipolar Type ◽  
Dsm Iv ◽  
Bipolar Patients

Abstract Background DSM-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. Results In 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). Conclusion Applying 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.

Relating DSM-5 section III personality traits to section II personality disorder diagnoses

2015 ◽  
Vol 46 (3) ◽  
pp. 647-655 ◽  
Author(s):  
L. C. Morey ◽  
K. T. Benson ◽  
A. E. Skodol
Keyword(s):  
Personality Disorder ◽  
Personality Traits ◽  
Personality Disorders ◽  
Alternative Model ◽  
Work Group ◽  
Taxonomic Structure ◽  
Personality Functioning ◽  
Dsm 5 ◽  
Criterion A ◽  
Dsm Iv

BackgroundThe DSM-5 Personality and Personality Disorders Work Group formulated a hybrid dimensional/categorical model that represented personality disorders as combinations of core impairments in personality functioning with specific configurations of problematic personality traits. Specific clusters of traits were selected to serve as indicators for six DSM categorical diagnoses to be retained in this system – antisocial, avoidant, borderline, narcissistic, obsessive–compulsive and schizotypal personality disorders. The goal of the current study was to describe the empirical relationships between the DSM-5 section III pathological traits and DSM-IV/DSM-5 section II personality disorder diagnoses.MethodData were obtained from a sample of 337 clinicians, each of whom rated one of his or her patients on all aspects of the DSM-IV and DSM-5 proposed alternative model. Regression models were constructed to examine trait–disorder relationships, and the incremental validity of core personality dysfunctions (i.e. criterion A features for each disorder) was examined in combination with the specified trait clusters.ResultsFindings suggested that the trait assignments specified by the Work Group tended to be substantially associated with corresponding DSM-IV concepts, and the criterion A features provided additional diagnostic information in all but one instance.ConclusionsAlthough the DSM-5 section III alternative model provided a substantially different taxonomic structure for personality disorders, the associations between this new approach and the traditional personality disorder concepts in DSM-5 section II make it possible to render traditional personality disorder concepts using alternative model traits in combination with core impairments in personality functioning.

MAJOR DEPRESSIVE DISORDER IN DSM-5: IMPLICATIONS FOR CLINICAL PRACTICE AND RESEARCH OF CHANGES FROM DSM-IV

2013 ◽  
Vol 31 (6) ◽  
pp. 459-471 ◽  
Author(s):  
Rudolf Uher ◽  
Jennifer L. Payne ◽  
Barbara Pavlova ◽  
Roy H. Perlis
Keyword(s):  
Major Depressive Disorder ◽  
Clinical Practice ◽  
Depressive Disorder ◽  
Major Depressive ◽  
Dsm 5 ◽  
Dsm Iv

How do eating disorder specialist clinicians apply DSM-IV diagnostic criteria in routine clinical practice? Implications for enhancing clinical utility in DSM-5

2010 ◽  
Vol 178 (3) ◽  
pp. 511-517 ◽  
Author(s):  
Jennifer J. Thomas ◽  
Sherrie S. Delinsky ◽  
Sarah A. St. Germain ◽  
Thomas J. Weigel ◽  
Christopher M. Tangren ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Clinical Practice ◽  
Diagnostic Criteria ◽  
Clinical Utility ◽  
Routine Clinical Practice ◽  
Dsm 5 ◽  
Dsm Iv

Challenging DSM-IV criteria for hypomania: Diagnosing based on number of no-priority symptoms

2007 ◽  
Vol 22 (2) ◽  
pp. 99-103 ◽  
Author(s):  
Franco Benazzi
Keyword(s):  
Structured Interview ◽  
Clin Psychiatry ◽  
Mood Change ◽  
Bipolar Ii Disorder ◽  
Bipolar Ii ◽  
History Of ◽  
Axis I ◽  
Dsm Iv ◽  
Almost All ◽  
Irritable Mood

AbstractBackgroundDSM-IV definition of hypomania of bipolar-II disorder (BP-II), which includes elevated/irritable mood change as core feature (i.e., it must always be present), is not based on sound evidence.Study aimFollowing classic descriptions of hypomania, was to test if hypomania could be diagnosed on the basis of its number (9) of DSM-IV symptoms, setting no-priority symptom.MethodsConsecutive 422 depression-remitted outpatients were re-interviewed by a mood specialist psychiatrist using the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version [a semi-structured interview modified by Benazzi and Akiskal (J Affect Disord, 2003; J Clin Psychiatry, 2005) to improve the probing for BP-II] in a private practice. History of episodes of subthreshold (i.e., 2 or more symptoms) and threshold (i.e., meeting DSM-IV criteria of elevated mood plus at least 3 symptoms, or irritable mood plus at least 4) hypomania, lasting at least 2 days, and which were the most common symptoms during the episodes, were systematically assessed.ResultsBipolar-II disorder (BP-II) patients (according to DSM-IV criteria, apart from hypomania duration) were 260, and major depressive disorder (MDD) patients were 162. Mood change was present in all BP-II by definition. The most common symptoms were overactivity, which was present in almost all BP-II, followed by elevated mood and racing thoughts. ROC analysis of the number of hypomanic symptoms predicting BP-II found that a cut point of 5 or more symptoms over 9 had the best combination of sensitivity (90%) and specificity (84%), and the highest figure of correctly classified (87%) BP-II. History of episodes of 5 or more hypomanic symptoms was met by almost all BP-II.LimitationsSingle interviewer.ConclusionsFollowing classic descriptions of hypomania, not setting any priority among the three basic domains of hypomania (mood, thinking, behavior), results suggest that a cutoff number of 5 symptoms over 9 (of those listed by DSM-IV) could be used to diagnose hypomania of BP-II. Diagnosing hypomania by counting a checklist of symptoms should make it easier to diagnose BP-II, and should reduce the current high misdiagnosis of BP-II as MDD, significantly impacting the treatment of depression.

scholarly journals Eating disorders, DSM–5 and clinical reality

2011 ◽  
Vol 198 (1) ◽  
pp. 8-10 ◽  
Author(s):  
Christopher G. Fairburn ◽  
Zafra Cooper
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Clinical Practice ◽  
Response To Treatment ◽  
Dsm 5 ◽  
Current State ◽  
Not Otherwise Specified ◽  
Clinical Reality ◽  
Dsm Iv

SummaryThe DSM–IV scheme for classifying eating disorders is a poor reflection of clinical reality. In adults it recognises two conditions, anorexia nervosa and bulimia nervosa, yet these states are merely two presentations among many. As a consequence, at least half the cases seen in clinical practice are relegated to the residual diagnosis ‘eating disorder not otherwise specified’. The changes proposed for DSM–5 will only partially succeed in correcting this shortcoming. With DSM–6 in mind, it is clear that comprehensive transdiagnostic samples need to be studied with data collected on their current state, course and response to treatment. Only with such data will it be possible to derive an empirically based classificatory scheme that is both rooted in clinical reality and of value to clinicians.

DSM-5 Overview and Goals

2013 ◽  
pp. 1067-1071
Author(s):  
David J. Kupfer ◽  
Susan K. Schultz
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Mental Disorders ◽  
Organizational Structure ◽  
Psychiatric Research ◽  
Course Of Illness ◽  
The Road ◽  
Dsm 5 ◽  
Dsm Iv ◽  
Over Time

The road to DSM-5 spanned a decade of planning, discussion and review of the considerable advances in psychiatric research and clinical practice. By bridging the strengths of DSM-IV with the opportunities brought by new discoveries in neuroscience, the DSM-5 offers a foundation for future growth as we fill in our gaps of knowledge regarding the underlying pathologies of mental disorders. New features in DSM-5 include an organizational structure that permits alignment of disorders with shared putative pathogenesis irrespective of whether the disorders typically emerge in childhood or later in life. Other features include a new emphasis on risk factors and the development and life course of illness. The goal of the DSM-5 is to create a “living document” that may evolve over time as we gradually build on our knowledge of the neurobiologic underpinnings that account for both the emergence and lifetime expression of mental disorders.

Assessment of Pathological Traits in DSM-5 Personality Disorders By the DAPP-BQ: How Do These Traits Relate to the Six Personality Disorder Types of the Alternative Model?

2019 ◽  
Vol 33 (1) ◽  
pp. 49-70 ◽  
Author(s):  
Han Berghuis ◽  
Theo J. M. Ingenhoven ◽  
Paul T. van der Heijden ◽  
Gina M. P. Rossi ◽  
Chris K. W. Schotte
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Alternative Model ◽  
Psychiatric Patients ◽  
Personality Pathology ◽  
Personality Functioning ◽  
Dsm 5 ◽  
Criterion A ◽  
Dsm Iv ◽  
Dimensional Assessment

The six personality disorder (PD) types in DSM-5 section III are intended to resemble their DSM-IV/DSM-5 section II PD counterparts, but are now described by the level of personality functioning (criterion A) and an assigned trait profile (criterion B). However, concerns have been raised about the validity of these PD types. The present study examined the continuity between the DSM-IV/DSM-5 section II PDs and the corresponding trait profiles of the six DSM-5 section III PDs in a sample of 350 Dutch psychiatric patients. Facets of the Dimensional Assessment of Personality Pathology—Basic Questionnaire (DAPP-BQ) were presumed as representations (proxies) of the DSM-5 section III traits. Correlational patterns between the DAPP-BQ and the six PDs were consistent with previous research between DAPP-BQ and DSM-IV PDs. Moreover, DAPP-BQ proxies were able to predict the six selected PDs. However, the assigned trait profile for each PD didn't fully match the corresponding PD.

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