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

Published online by Cambridge University Press:  16 April 2020

Franco Benazzi
Franco Benazzi*
Affiliation:
Hecker Psychiatry Research Center at Forli, Forli, Italy University of California at San Diego (USA) collaborating center, San Diego, 9500 Gilman Dr., La Jolla, CA92093, USA Department of Psychiatry, University of Szeged, Szeged, Hungary Department of Psychiatry, National Health Service of Forli, Via Pozzetto 17, 48015Castiglione di CerviaRA, Italy
*
*Corresponding author. Department of Psychiatry, National Health Service of Forli, Via Pozzetto 17, 48015 Castiglione di Cervia RA, Italy. Tel.: +39 335 6191 852; fax: +39 054 330 069. E-mail address: [email protected]
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Abstract

Background

DSM-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 aim

Following 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.

Methods

Consecutive 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.

Results

Bipolar-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.

Limitations

Single interviewer.

Conclusions

Following 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.

Keywords

Bipolar II disorderHypomaniaDiagnostic criteriaDiagnosis
Type
Original article
Information
European Psychiatry , Volume 22 , Issue 2 , March 2007 , pp. 99 - 103
Copyright
Copyright © Elsevier Masson SAS 2006

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