Bipolar mixed features - Results from the comparative effectiveness for bipolar disorder (Bipolar CHOICE) study

Area of Science:

• Psychiatry
• Clinical Psychology
• Mood Disorders

Background:

• The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) revised criteria for mixed features in mood episodes.
• The DSM-5 criteria require non-overlapping symptoms of depression and hypomania/mania, differing from the DSM-IV.
• It remains unclear if these revised criteria identify the same patient groups as the previous criteria.

Purpose of the Study:

• To compare the number of patients meeting criteria for mixed features under DSM-5 versus DSM-IV.
• To assess the impact of the DSM-5's narrower definition on diagnosing mixed episodes in bipolar disorder.

Main Methods:

• Analysis of baseline data from 482 adult bipolar patients in the Bipolar CHOICE trial.
• Bipolar diagnoses confirmed using the MINI International Neuropsychiatric Interview (MINI).
• Mood symptom presence and severity assessed with the Bipolar Inventory of Symptoms Scale (BISS) to apply DSM-5 and DSM-IV mixed features criteria.

Main Results:

• The frequency of DSM-IV mixed episodes was 17% (MINI) and 20% (BISS).
• Using DSM-5 criteria, 9% met criteria for hypomania/mania with mixed features, and 12% for a depressive episode with mixed features.
• Mixed features were more prevalent in mania/hypomania (63.8%) than depression (8.0%), with symptom severity correlating with increased mixed features.

Conclusions:

• The narrower, non-overlapping symptom definition in DSM-5 for mixed episodes resulted in fewer patients meeting the criteria compared to DSM-IV.
• This suggests a significant shift in the diagnostic landscape for mixed features in mood disorders.