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DSM-5 criterion of increased activity lowers mania, hypomania prevalence

12 Jan 2017

Adding increased activity or energy as part of DSM-5 criterion A reduces the prevalence of manic and hypomanic episodes, a new study suggests. However, the new criterion does not affect longitudinal clinical outcomes.

To determine whether such criterion would change the prevalence of mania and/or hypomania, researchers compared clinical characteristics, validators, outcome and prevalence in patients meeting the DSM-5 criteria (ie, DSM-IV criteria plus the DSM-5 criterion of increased activity or energy) and those who did not meet the new DSM-5 criterion (ie, participants who only met DSM-IV criteria).

A total of 4,360 participants met DSM-IV criteria for bipolar disorder, and 310 met DSM-IV criteria for a manic or hypomanic episode. Following the inclusion of the new DSM-5 criterion of increased activity or energy as a coprimary symptom, the prevalence of mania and hypomania was reduced.

There were minor differences recorded in clinical and concurrent validators, but no changes in longitudinal outcomes were seen.

According to researchers, DSM-5 describes as a primary criterion for mania “a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy.” This is why increased activity or energy is now considered a core symptom of manic and hypomanic episodes.

Point prevalence data were analysed using data from the Systematic Treatment Enhancement Program for Bipolar Disorder study to examine the diagnostic validity of the new DSM-5 criterion.

A 2007 study had indicated that focusing the probing for history of hypomania more on overactivity than on mood change reduces the false-negative bipolar-II disorder (BP-II). The use of Angst' criteria, which prioritizes overactivity, for hypomania may help clinicians lower the current high misdiagnosis of BP-II as major depressive disorder and the related mistreatment. [Ann Clin Psychiatry 2007;19:99-104]

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