Mauricio Tohen1, Alexandra K Gold2, Louisa G Sylvia3, Rebecca E Montana2, Susan L McElroy4, Michael E Thase5, Dustin J Rabideau6, Andrew A Nierenberg3, Noreen A Reilly-Harrington3, Edward S Friedman7, Richard C Shelton8, Charles L Bowden9, Vivek Singh9, Thilo Deckersbach3, Terence A Ketter10, Joseph R Calabrese11, William V Bobo12, Melvin G McInnis13. 1. Department of Psychiatry & Behavioral Sciences, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA. Electronic address: mtohen@salud.unm.edu. 2. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. 3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. 4. Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 5. Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 6. Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA. 7. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 8. Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA. 9. Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA. 10. Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. 11. Bipolar Disorders Research Center, University Hospital's Case Medical Center, Case Western Reserve University, Cleveland, OH, USA. 12. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. 13. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND: DSM-5 changed the criteria from DSM-IV for mixed features in mood disorder episodes to include non-overlapping symptoms of depression and hypomania/mania. It is unknown if, by changing these criteria, the same group would qualify for mixed features. We assessed how those meeting DSM-5 criteria for mixed features compare to those meeting DSM-IV criteria. METHODS: We analyzed data from 482 adult bipolar patients in Bipolar CHOICE, a randomized comparative effectiveness trial. Bipolar diagnoses were confirmed through the MINI International Neuropsychiatric Interview (MINI). Presence and severity of mood symptoms were collected with the Bipolar Inventory of Symptoms Scale (BISS) and linked to DSM-5 and DSM-IV mixed features criteria. Baseline demographics and clinical variables were compared between mood episode groups using ANOVA for continuous variables and chi-square tests for categorical variables. RESULTS: At baseline, the frequency of DSM-IV mixed episodes diagnoses obtained with the MINI was 17% and with the BISS was 20%. Using DSM-5 criteria, 9% of participants met criteria for hypomania/mania with mixed features and 12% met criteria for a depressive episode with mixed features. Symptom severity was also associated with increased mixed features with a high rate of mixed features in patients with mania/hypomania (63.8%) relative to those with depression (8.0%). LIMITATIONS: Data on mixed features were collected at baseline only and thus do not reflect potential patterns in mixed features within this sample across the study duration. CONCLUSIONS: The DSM-5 narrower, non-overlapping definition of mixed episodes resulted in fewer patients who met mixed criteria compared to DSM-IV.
BACKGROUND: DSM-5 changed the criteria from DSM-IV for mixed features in mood disorder episodes to include non-overlapping symptoms of depression and hypomania/mania. It is unknown if, by changing these criteria, the same group would qualify for mixed features. We assessed how those meeting DSM-5 criteria for mixed features compare to those meeting DSM-IV criteria. METHODS: We analyzed data from 482 adult bipolarpatients in Bipolar CHOICE, a randomized comparative effectiveness trial. Bipolar diagnoses were confirmed through the MINI International Neuropsychiatric Interview (MINI). Presence and severity of mood symptoms were collected with the Bipolar Inventory of Symptoms Scale (BISS) and linked to DSM-5 and DSM-IV mixed features criteria. Baseline demographics and clinical variables were compared between mood episode groups using ANOVA for continuous variables and chi-square tests for categorical variables. RESULTS: At baseline, the frequency of DSM-IV mixed episodes diagnoses obtained with the MINI was 17% and with the BISS was 20%. Using DSM-5 criteria, 9% of participants met criteria for hypomania/mania with mixed features and 12% met criteria for a depressive episode with mixed features. Symptom severity was also associated with increased mixed features with a high rate of mixed features in patients with mania/hypomania (63.8%) relative to those with depression (8.0%). LIMITATIONS: Data on mixed features were collected at baseline only and thus do not reflect potential patterns in mixed features within this sample across the study duration. CONCLUSIONS: The DSM-5 narrower, non-overlapping definition of mixed episodes resulted in fewer patients who met mixed criteria compared to DSM-IV.