Changes in DSM-5 Lead to Rise in Bipolar Mixed Episodes

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The prevalence of mixed episodes in patients with bipolar disorder may have more than tripled following a change in diagnostic criteria in the DSM-5.

Won-Myong Bahk, MD, PhD, of the Catholic University of Korea, and colleagues looked at the records of 331 patients diagnosed with bipolar disorder between 2003 and 2013, based on DSM-IV criteria for bipolar. Six percent of those patients were classified as having mixed episodes.

However, when DSM-5 criteria for mixed episodes was applied, that figure jumped to 19.6%, the researchers reported in the Journal of Affective Disorder.

The reason for the dramatic rise, according to the researchers, is that the DSM-IV basis for mixed episodes was narrow as it “applies only to patients with bipolar I disorder who exhibit the simultaneous presence of full manic and full depressive symptoms for at least one week.”

When the patients were diagnosed according to DSM-IV criteria, 59.5% of the mood episodes were manic/hypomanic, 34.4% were depressed, and 6.0% were mixed episodes. But using the DSM-5 definition, 49.8% of mood episodes were manic/hypomanic, 30.5% were depressed, 15.7% were manic/hypomanic episodes with mixed features, and 3.9% were depressed episodes with mixed features.

The changes could “help to identify bipolar disorder patients with mixed features in clinical practice and further the understanding of the clinical course, clinical characteristics, and pharmacological treatment of this bipolar disorder subtype,” the researchers concluded.

Changes in DSM-5 Lead to Rise in Bipolar Mixed Episodes
Changes in DSM-5 Lead to Rise in Bipolar Mixed Episodes

Using the most recent diagnostic criteria increases the prevalence of mixed features in patients with bipolar disorder more than threefold, study findings indicate.

Of 331 patients diagnosed with bipolar disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria between 2003 and 2013, 6.0% were classed as having mixed episodes.

However, this rate increased significantly to 19.6% when Won-Myong Bahk (The Catholic University of Korea, Seoul, South Korea) and colleagues recategorized the patients according to the DSM, Fifth Edition (DSM-5) criteria.

The researchers explain that, according to the DSM-IV-TR criteria “the diagnosis of a mixed episode applies only to patients with bipolar I disorder who exhibit the simultaneous presence of full manic and full depressive symptoms for at least 1 week.”

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