More inclusive bipolar mixed depression definition by permitting overlapping and non-overlapping mood elevation symptoms.
OBJECTIVE
The objective of this study was to assess the strengths and limitations of a mixed bipolar depression definition made more inclusive than that of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) by counting not only 'non-overlapping' mood elevation symptoms (NOMES) as in DSM-5, but also 'overlapping' mood elevation symptoms (OMES, psychomotor agitation, distractibility, and irritability).


METHODS
Among bipolar disorder (BD) out-patients assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation, we assessed prevalence, demographics, and clinical correlates of mixed vs. pure depression, using more inclusive (≥3 NOMES/OMES) and less inclusive DSM-5 (≥3 NOMES) definitions.


RESULTS
Among 153 depressed BD, counting not only NOMES but also OMES yielded a three-fold higher mixed depression rate (22.9% vs. 7.2%) and important statistically significant clinical correlates for mixed compared to pure depression (more lifetime anxiety disorder comorbidity, more current irritability, and less current antidepressant use), which were not significant using the DSM-5 threshold.


CONCLUSION
To conclude, further studies with larger numbers of patients with DSM-5 bipolar mixed depression assessing strengths and limitations of more inclusive mixed depression definitions are warranted, including efforts to ascertain whether or not OMES should count toward mixed depression.
['Kim|H|H|', 'Kim|W|W|', 'Citrome|L|L|', 'Akiskal|H S|HS|', 'Goffin|K C|KC|', 'Miller|S|S|', 'Holtzman|J N|JN|', 'Hooshmand|F|F|', 'Wang|P W|PW|', 'Hill|S J|SJ|', 'Ketter|T A|TA|']
D000328:Adult D000339:Affect D001714:Bipolar Disorder D003937:Diagnosis, Differential D039721:Diagnostic and Statistical Manual of Mental Disorders D005260:Female D006801:Humans D007406:Interview, Psychological D008297:Male D008875:Middle Aged D019964:Mood Disorders D010045:Outpatients D011569:Psychiatric Status Rating Scales D011595:Psychomotor Agitation D055815:Young Adult
depression bipolar disorder diagnosis nosology psychopathology