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Classification of mood disorders.

Jules Angst1, Vladeta Ajdacic-Gross1, Wulf Rössler2

  • 1Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich.

Psychiatria Polska
|October 22, 2015
PubMed
Summary
This summary is machine-generated.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) reclassifies mood disorders, but its diagnostic criteria for mania and hypomania are questioned. Shorter episodes and hidden hypomania contribute to underdiagnosis of bipolar disorder.

Keywords:
bipolar disorderclassificationdepression

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Area of Science:

  • Psychiatry
  • Mood Disorders Research

Background:

  • The spectrum concept of mood disorders views depression and mania on a continuum.
  • International classifications of mood disorders evolve based on symptoms, duration, and consequences.

Purpose of the Study:

  • To examine recent developments in diagnostic definitions (DSM-5) and research for mood disorders.
  • To evaluate the validity of DSM-5 criteria for mania, hypomania, and depression duration.
  • To explore challenges in diagnosing bipolar disorder, particularly hidden hypomania and its impact.

Main Methods:

  • Review of current diagnostic criteria in the DSM-5.
  • Analysis of recent research data on mood disorder symptomatology and duration.
  • Examination of factors contributing to the underdiagnosis of bipolar disorder.

Main Results:

  • DSM-5 reclassifies unipolar mania and mild depression under bipolar disorders, with a new symptom hierarchy that may be problematic.
  • The validity of duration criteria (mania: 1 week, hypomania: 4 days, depression: 2 weeks) is questioned, as shorter episodes are clinically significant.
  • Underdiagnosis of bipolar disorder is linked to patients not perceiving hypomania as illness, and hypomania being obscured by substance use disorders (SUD).
  • Hidden hypomanic syndromes are associated with treatment resistance, high comorbidity (anxiety, SUD), cognitive symptoms, and increased mortality.

Conclusions:

  • Current DSM-5 diagnostic criteria for mood disorders, particularly mania and hypomania, require further validation.
  • Accurate diagnosis of bipolar disorder is hindered by issues with symptom duration criteria and the presentation of hypomania.
  • Integrating anxiety disorders within the broader concept of mood disorders, including bipolar disorder and depression, remains a significant challenge.