Gordon Parker1, Rebecca Graham2, Howe Synnott3, Josey Anderson3. 1. School of Psychiatry, University of New South Wales, Australia; Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney 2031, Australia. Electronic address: g.parker@unsw.edu.au. 2. School of Psychiatry, University of New South Wales, Australia; Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney 2031, Australia. 3. Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, Sydney 2031, Australia.
Abstract
BACKGROUND: DSM-IV and DSM-5 impose a 4 day duration criterion for hypomanic episodes yet several studies have suggested that such an imposition may be invalid. We report a study involving a large sample pursuing the likely salience of the DSM duration criterion. METHODS: We analyzed data on hypomanic symptoms provided by two bipolar screening measures - the Mood Disorders Questionnaire (MDQ) and the Mood Swings Questionnaire (MSQ) in a sample of 501 patients meeting DSM and other symptom criteria for a bipolar II disorder (BP II) and contrasted data for 186 meeting the DSM minimum duration of 4 days and 315 experiencing episodes lasting less than 4 days (i.e. 'standard' vs. 'brief' groups). RESULTS: The brief group reported slightly less severe hypomanic episodes, but the two groups did not differ on a number of illness correlates including age of onset of depressive and of hypomanic episodes, or by rates of depressive and bipolar conditions in first-degree family members. LIMITATIONS: The possibility of false positive BP II diagnoses, especially with brief hypomanic episodes, must be conceded while our examination of clinical symptoms was limited to two measures. CONCLUSIONS: This study is consistent with previous studies suggesting that the DSM duration of 4 or more days for a diagnosis of a hypomanic episode is unnecessary to the clinical definition of a BP II disorder. Its preservation is likely to exclude a substantive number of those with a true BP II condition.
BACKGROUND: DSM-IV and DSM-5 impose a 4 day duration criterion for hypomanic episodes yet several studies have suggested that such an imposition may be invalid. We report a study involving a large sample pursuing the likely salience of the DSM duration criterion. METHODS: We analyzed data on hypomanic symptoms provided by two bipolar screening measures - the Mood Disorders Questionnaire (MDQ) and the Mood Swings Questionnaire (MSQ) in a sample of 501 patients meeting DSM and other symptom criteria for a bipolar II disorder (BP II) and contrasted data for 186 meeting the DSM minimum duration of 4 days and 315 experiencing episodes lasting less than 4 days (i.e. 'standard' vs. 'brief' groups). RESULTS: The brief group reported slightly less severe hypomanic episodes, but the two groups did not differ on a number of illness correlates including age of onset of depressive and of hypomanic episodes, or by rates of depressive and bipolar conditions in first-degree family members. LIMITATIONS: The possibility of false positive BP II diagnoses, especially with brief hypomanic episodes, must be conceded while our examination of clinical symptoms was limited to two measures. CONCLUSIONS: This study is consistent with previous studies suggesting that the DSM duration of 4 or more days for a diagnosis of a hypomanic episode is unnecessary to the clinical definition of a BP II disorder. Its preservation is likely to exclude a substantive number of those with a true BP II condition.
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