Rhode Island Hospital researcher: Broadening bipolar disorder criteria is a bad idea
A Rhode Island Hospital psychiatrist and researcher explains the negative impact of broadening the diagnostic criteria for bipolar disorder in the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). In a newly published commentary in the Journal of Clinical Psychiatry, Mark Zimmerman, M.D., explains that lowering the diagnostic threshold for bipolar disorder will likely do more harm than good for patients.
As the debate continues over the revisions to DSM-IV, Zimmerman, the director of outpatient psychiatry at Rhode Island Hospital, says he and his colleagues recognize that the syndrome descriptions in DSM-IV are imperfect representations of an underlying condition. He suggests the DSM criteria should be conceptualized as a type of test for the etiologically defined illnesses (i.e. illnesses that are assigned a cause as determined through medical diagnosis).
Bipolar disorder is a symptom-based diagnosis, for which a diagnostic test does not exist. "In the absence of that test, clinicians must use the diagnostic criteria to identify the presence of the disease," he says. "Accordingly, as with any other diagnostic test, diagnoses based on DSM-IV criteria produce some false positive and some false negative results. In this context, I consider the controversy over whether the diagnostic threshold for bipolar disorder should be lowered."
"If we accept the proposition that DSM-IV criteria are imperfect in identifying bipolar illness, we must conceptualize these criteria as a type of test for bipolar illness that produces both false positives and false negatives," he says. "Shifting the diagnostic boundary downward, to be sure, will have many negative impacts upon patients, including inaccurate diagnoses and inappropriate treatment, not to mention the increased use of unnecessary medications."
For his research, he reviewed four longitudinal studies of the prognostic significance of sub-threshold bipolar disorder. He explains that while sub-threshold bipolarity is a risk factor for the emergence of the disease, the majority of individuals with sub-threshold bipolarity do not develop a future manic or hypomanic episode that is a hallmark of true bipolar disorder.
Zimmerman looked at various sides of the argument in lowering the diagnostic threshold including detecting bipolar disorder in depressed patients, diagnostic uncertainty, and unrecognized and over-diagnosed bipolar disorder. While he recognizes that the goal of lowering the criteria is to better diagnose this disorder, Zimmerman says, "The question is not whether diagnostic error exists, but rather which type of error predominates, and how much will shifting the diagnostic threshold impact the number of each of these diagnostic errors. Also important to consider are the clinical consequences of each type of error, and which error is more difficult to undo after it has been made."
At the end of his analysis Zimmerman indicates that there are four reasons for not broadening the criteria and strongly recommends against doing so because:
-- The results of the longitudinal studies suggest that lowering the diagnostic threshold for bipolar disorder will result in a greater increase in false positives than true positives;
-- There are no controlled studies demonstrating efficacy of mood stabilizers in treating sub-threshold bipolar disorder;
-- If a false negative diagnosis occurs and bipolar disorder is under-diagnosed, diagnosis and treatment can be changed when a manic or hypomanic episode emerges; and
-- If bipolar disorders is overdiagnosed and patients are inappropriately prescribed a mood stabilizer, the absence of a future manic/hypomanic episode would incorrectly be considered evidence of the efficacy of the treatment, and unnecessary medications that might cause medically significant side effects would not be discontinued.
Journal reference: Journal of Clinical Psychiatry
Provided by Lifespan
- Is bipolar disorder overdiagnosed? May 06, 2008 | not rated yet | 0
- If bipolar disorder is over-diagnosed, what are the actual diagnoses? Jul 29, 2009 | not rated yet | 0
- Specific criteria improve diagnosis of bipolar disorder, study finds Nov 07, 2011 | not rated yet | 0
- Is it really bipolar disorder? Mar 25, 2010 | not rated yet | 0
- The impact of deleting 5 personality disorders in the new DSM-5 Jan 24, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Pressure-volume curve: Elastic Recoil Pressure don't make sense
15 hours ago From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
Alcohol and acetaminophen
May 13, 2013 Edit: sorry for the typo in the title , can't edit I looked around on google quite a bit and it's very hard to find precise information on the...
Marie Curie's leukemia
May 13, 2013 Does anyone know what might be the cause of Marie Curie's cancer
- More from Physics Forums - Medical Sciences
More news stories
The latest makeover to a massive psychiatric tome honored by some, reviled by others and even called the "Bible" of mental disorders is being released Saturday with a host of new changes.
Psychology & Psychiatry 6 hours ago | not rated yet | 0
(HealthDay)—Most Medicare beneficiaries treated in inpatient psychiatric facilities (IPFs) exhibit characteristics associated with hospital readmission, according to a report prepared for the National Association ...
Psychology & Psychiatry May 17, 2013 | not rated yet | 0
Skydivers show the same level of physical stress before every jump whether a first-timer or experienced jumper, say Northumbria researchers.
Psychology & Psychiatry May 17, 2013 | not rated yet | 0 |
Children of depressed parents pick up on their parents' sadness—whether mom or dad realizes their mood or not.
Psychology & Psychiatry May 17, 2013 | 4.5 / 5 (2) | 1 |
(HealthDay)—As many as one in five American children under the age of 17 has a diagnosable mental disorder in a given year, according to a new federal report.
Psychology & Psychiatry May 16, 2013 | 2.2 / 5 (5) | 1 |
An increasing number of U.S. children are experiencing gastrointestinal issues that require interventions to resolve, according to research presented at Digestive Disease Week (DDW).
8 hours ago | not rated yet | 0 |
A new case of the deadly coronavirus has been detected in Saudi Arabia where 15 people have already died after contracting it, the health ministry announced on Saturday on its Internet website.
6 hours ago | not rated yet | 0
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
16 hours ago | 5 / 5 (1) | 0
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
17 hours ago | 5 / 5 (1) | 0 |
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
8 hours ago | 5 / 5 (1) | 0