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How low do we go? Is duration of a ‘high’ integral to the definition of bipolar disorder?

Published online by Cambridge University Press:  24 June 2014

Lucy Tully  and
Gordon Parker
Lucy Tully
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia Black Dog Institute, Sydney, Australia
Gordon Parker*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia Black Dog Institute, Sydney, Australia
*
Professor Gordon Parker, Black Dog Institute, Hospital Road, Randwick, Sydney 2031, Australia. Tel: 61 02 9382 4372; Fax: 02 9382 8208; E-mail: g.parker@unsw.edu.au
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Abstract

Objective:

There has been considerable debate about the diagnostic rules for bipolar II disorder, particularly the 4-day duration criteria for hypomanic episodes. This study examined whether highs lasting minutes or hours differed from longer highs in terms of clinical features and symptom severity. It also examined whether duration of highs predicted bipolar disorder being diagnosed.

Method:

A total of 518 subjects with significant episodes of depression and ‘highs’ completed a web-based self-report questionnaire. Those who reported their longest highs lasting minutes or hours were compared with those who reported longer durations of highs on a range of clinical variables and measures of symptom severity.

Results:

Subjects whose highs lasted minutes or hours reported clinical features and severity of symptoms similar to those whose highs lasted 3–7 days. However, the odds of being diagnosed with bipolar disorder for those with highs lasting 3–7 days were almost three times higher than for those whose highs lasted minutes or hours.

Conclusion:

The 4-day DSM-IV minimum-duration criteria for hypomania may lead to failure to diagnose subjects with brief highs who have true bipolar disorder and thus should be reconsidered.

Keywords

bipolar disorderDSM-IVduration criteriahighshypomania

Information

Type
Research Article
Information
Acta Neuropsychiatrica , Volume 19 , Issue 1 , February 2007 , pp. 38 - 44
Copyright
Copyright © 2007 Blackwell Munksgaard

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References

Angst, J, Gamma, A, Benazzi, Fet al. Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar II, minor bipolar disorders and hypomania. J Affect Disord 2003;73:133–146. CrossRefGoogle Scholar
Hirschfeld, RMA, Vornik, LA. Recognition and diagnosis of bipolar disorders. J Clin Psychiatry 2004;65:5–9. Google Scholar
Yatham, LN. Diagnosis and management of patients with bipolar II disorder. J Clin Psychiatry 2005;66:13–17. Google ScholarPubMed
Harris, EC, Barraclough, B. Suicide as an outcome for mental disorders. Br J Psychiatry 1997;170:205–228. CrossRefGoogle ScholarPubMed
Rihmer, Z, Kiss, K. Bipolar disorders and suicidal behaviour. Bipolar Disord 2002;4:21–25. CrossRefGoogle ScholarPubMed
Hadjipavlou, G, Mok, H, Yatham, LN. Bipolar II disorder: an overview of recent developments. Can J Psychiatry 2004;49:802–812. CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJet al. The comparative clinical phenotype and long term longitudinal episode course of bipolar I and II: a clinical spectrum or distinct disorders? J Affect Disord 2003;73:19–32. CrossRefGoogle ScholarPubMed
Judd, LL, Akiskal, HS, Schettler, PJet al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003;60:261–269. CrossRefGoogle ScholarPubMed
Benazzi, F. Is 4 days the minimum duration of hypomania in bipolar II disorder? Eur Arch Psychiatry Clin Neurosci 2001;251:32–34. CrossRefGoogle ScholarPubMed
Akiskal, HS. Clinical validation of the bipolar spectrum: focus on hypomania, cyclothymia and hyperthymia. 154th Annual meeting of the American Psychiatric Association 2001. Google Scholar
Parker, G, Hadzi-Pavlovic, D, Tully, LA. Distinguishing bipolar and unipolar disorders: An isomer model. J Affect Disord 2006;96:67–73. CrossRefGoogle Scholar
Judd, LL, Akiskal, HS. The prevalence and disability of bipolar spectrum disorders in the US populations: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 2003;73:123–131. CrossRefGoogle ScholarPubMed
Benazzi, F, Akiskal, HS. A downscaled practical measure of mood lability as a screening tool for bipolar II. J Affect Disord 2005;84:225–232. Google Scholar