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New DSM-5 criteria for bipolar disorder did not affect long-term outcomes

The inclusion of increased activity or energy in the DSM-5 criteria for bipolar disorder decreased prevalence of manic and hypomanic episodes but did not affect longitudinal outcomes, according to recent findings.

“To enhance the accuracy of diagnosis and facilitate earlier detection in clinical settings, the diagnostic criteria for bipolar disorder in DSM-5 emphasize changes in activity or energy as a core symptom of mania or hypomania (criterion A) in addition to changes in mood. In contrast, DSM-IV criteria included increased goal-directed activity or psychomotor agitation as one of several secondary criteria (criterion B),” Rodrigo Machado-Vieira, MD, PhD, of the section on the neurobiology and treatment of mood disorders, NIMH, and colleagues wrote. “Other changes from DSM-IV to DSM-5 criteria include the new specifier ‘with mixed features,’ which can be applied to episodes of mania or hypomania when depressive features are present, as well as to episodes of depression when features of mania or hypomania are present.”

To determine if DSM-5 criterion for bipolar disorder alters the prevalence of mania or hypomania, researchers compared prevalence, clinical characteristics, validators and outcome among individuals who met new DSM-5 criteria in addition to DSM-IV criteria and those who only met DSM-IV criteria. The study cohort was derived from the STEP-BD study, a multicenter observational and efficacy study of bipolar disorder treatments (n = 4,360).

All study participants met DSM-IV criteria for bipolar disorder and 310 met DSM-IV criteria for a manic or hypomanic episode.

When the new DSM-5 criterion of increased activity or energy was added as a coprimary symptom, prevalence of mania and hypomania decreased.

Researchers found some differences in clinical and concurrent validators but no changes in longitudinal outcomes.

“Ultimately, these differences may affect the number of individuals clinically diagnosed with bipolar disorder during initial episodes and their treatment course (ie, whether they are treated with mood stabilizers, atypical antipsychotics, and/or antidepressants). In addition, these findings suggest that the new DSM-5 criteria may directly affect the diagnostic prevalence of both major depressive disorder and bipolar disorder by potentially increasing the first and lowering the second, while nevertheless potentially supporting their existence along a continuum,” the researchers wrote. “Overall, our findings suggest that the inclusion of increased activity or energy levels as a DSM-5 criterion A symptom for manic episodes decreases point prevalence rates of mania and hypomania but does not affect longitudinal clinical outcomes.” – by Amanda Oldt

Disclosure: Machado-Vieira reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.