DSM-IV insufficient for bipolar disorder diagnosis

By Lucy Piper, Senior medwireNews Reporter

Research findings support concerns that the text revision of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is too restrictive for diagnosing bipolar disorder.

In a real-life practice study, just 12 (9.3%) of 129 patients previously diagnosed with bipolar disorder according to the ICD-10 met the DSM-IV-TR criteria for the condition.

“The observation that most bipolar patients did not fulfil the DSM-IV-TR criteria for [bipolar disorder] is in line with previous studies, and strongly suggests that the DSM-IV criteria are insufficient and too restrictive to diagnose the clinical entity of [bipolar disorder] and require modification,” say authors Jean-Michel Azorin (Sainte-Marguerite Hospital, Marseille, France) and colleagues.

The DSM-IV-TRm, a modified version of the DSM-IV-TR, proved slightly more sensitive, diagnosing 102 (79.1%) of 129 patients, but 20.9% of bipolar disorder patients remained undetected.

The bipolar disorder patients detected by DSM-IV-TRm criteria had a higher frequency of distinctive characteristics of bipolar disorder, including impulse control disorders and a higher frequency of manic/hypomanic switches during antidepressant treatment, than those who were not.

“Therefore, the DSM-IV-TRm is still excluding some bipolar patients, those with less distinctive features of [bipolar disorder],” the team comments in the Journal of Affective Disorders.

The patients, who presented with major depressive episodes, were diagnosed by general practitioners who had been trained in the diagnosis of mood disorders, but the researchers note that this training was limited and may have affected the results.

They also point out that while the DSM-5 criteria will be increasingly used over the coming years, this “will have only a minor impact on the underdiagnosis of bipolarity.”

They fear that a lot of bipolar disorder patients diagnosed by DSM-IV-TR will be diagnosed as having major depressive disorder according to the DSM-5 criteria; for instance, for patients who have euphoria and/or irritability but not increased activity, which is the new, mandatory entry symptom.

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.