Hostname: page-component-7c8c6479df-995ml Total loading time: 0 Render date: 2024-03-27T03:51:54.649Z Has data issue: false hasContentIssue false

Where should bipolar disorder appear in the meta-structure?

Paper 7 of 7 of the thematic section: ‘A proposal for a meta-structure for DSM-V and ICD-11’

Published online by Cambridge University Press:  01 October 2009

D. P. Goldberg*
Affiliation:
Institute of Psychiatry, King's College, London, UK
G. Andrews
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia
M. J. Hobbs
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia
*
*Address for correspondence: Professor Sir David Goldberg, Institute of Psychiatry, de Crespigny Park, London SE5 8AF, UK. (Email: David.Goldberg@iop.kcl.ac.uk)

Abstract

Background

The extant major psychiatric classifications, DSM-IV and ICD-10, are purportedly atheoretical and largely descriptive. Although this achieves good reliability, the validity of a medical diagnosis is greatly enhanced by an understanding of both risk factors and clinical history. In an effort to group mental disorders on the basis of risk factors and clinical manifestations, five clusters have been proposed. The purpose of this paper is to consider the position of bipolar disorder (BPD), which could be either with the psychoses, or with emotional disorders, or in a separate cluster.

Method

We reviewed the literature on BPD, unipolar depression (UPD) and schizophrenia in relation to 11 validating criteria proposed by the DSM-V Task Force Study Group, and then summarized similarities and differences between BPD and schizophrenia on the one hand, and UPD on the other.

Results

There are differences, often substantial and never trivial, for 10 of the 11 validators between BPD and UPD. There are also important differences between BPD and schizophrenia.

Conclusion

BPD has previously been classified together with UPD, but this is the least justifiable place for it. If it is to be recruited to a ‘psychotic cluster’, there are several important respects in which it differs from schizophrenia, so the cluster would have a division within it. The alternative would be to allow it to be in an intermediate position in a cluster of its own.

Type
Thematic section: A proposal for a meta-structure for DSM-V and ICD-11
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agid, O, Shapira, B, Zislin, J, Ritsner, M, Hanin, B, Murad, H, Troudart, T, Bloch, M, Heresco-Levy, U, Lerer, B (1999). Environment and vulnerability to major psychiatric illness: a case control study of early parental loss in major depression, bipolar disorder and schizophrenia. Molecular Psychiatry 4, 163172.CrossRefGoogle Scholar
Akiskal, HS, Kilzieh, N, Maser, JD, Clayton, PJ, Schettler, PJ, Traci Shea, M, Endicott, J, Scheftner, W, Hirschfeld, RMA, Keller, MB (2006). The distinct temperament profiles of bipolar I, bipolar II and unipolar patients. Journal of Affective Disorders 92, 1933.CrossRefGoogle ScholarPubMed
Alnaes, R, Torgersen, S (1993). Mood disorders: developmental and precipitating events. Canadian Journal of Psychiatry 38, 217224.CrossRefGoogle ScholarPubMed
Andreasen, NC, Rice, J, Endicott, J (1987). Familial rates of affective disorder. A report from the National Institute of Mental Health Collaborative Study. Archives of General Psychiatry 44, 461469.CrossRefGoogle ScholarPubMed
Andrews, G, Goldberg, DP, Krueger, RF, Carpenter, WT Jr., Hyman, SE, Sachdev, P, Pine, DS (2009 a). Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity? Psychological Medicine. doi:10.1017/S0033291709990250.CrossRefGoogle ScholarPubMed
Andrews, G, Pine, DS, Hobbs, MJ, Anderson, TM, Sunderland, M (2009 b). Neurodevelopmental disorders: Cluster 2 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine. doi:10.1017/S0033291709990274.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A (in press). Validators of generalised anxiety disorder and major depression. In Diagnostic Issues in Depression and Generalized Anxiety Disorder: Refining the Research Agenda for DSM-V (ed. Goldberg, D. P., Kendler, K. S., Sirovatka, P. and Regier, D. A.), American Psychiatric Association: Arlington, VA.Google Scholar
Baxter, LR Jr., Phelps, ME, Mazziotta, JC, Schwarz, JM, Gerner, RH, Selin, CE, Sumida, RM (1985). Cerebral metabolic rate for glucose in mood disorders. Archives of General Psychiatry 42, 441447.CrossRefGoogle ScholarPubMed
Bertelsen, A, Harvald, B, Hague, M (1977). A Danish twin study of manic depressive disorders. British Journal of Psychiatry 130, 330351.CrossRefGoogle ScholarPubMed
Blacker, D, Tsuang, MT (1993). Unipolar relatives in bipolar pedigrees: are they bipolar? Psychiatric Genetics 3, 516.CrossRefGoogle Scholar
Borkowska, A, Rybakowski, JK (2001). Neuropsychological frontal lobe tests indicate that bipolar depressed patients are more impaired than unipolar. Bipolar Disorders 3, 8894.CrossRefGoogle ScholarPubMed
Brockington, IF, Leff, J (1979). Schizoaffective psychosis: definitions and incidence. Psychological Medicine 9, 9199.CrossRefGoogle ScholarPubMed
Bunney, WE, Bunney, BG (2000). Molecular clock genes in man and lower animals: possible implications for circadian abnormalities in depression. Neurophyschopharmacology 22, 335345.CrossRefGoogle ScholarPubMed
Cannon, DM, Ichise, M, Rollis, D, Klaver, JM, Gandhi, SK, Charney, DS, Manji, HK, Drevets, WC (2007). Elevated serotonin transporter binding in major depressive disorder assessed using positron emission tomography and [11C]DASB: comparison with bipolar disorder. Biological Psychiatry 62, 870877.CrossRefGoogle ScholarPubMed
Cannon, TD, Rosso, IM, Hollister, JM, Bearden, CE, Sanchez, LE, Hadley, T (2000). A prospective cohort study of genetic and perinatal influences in the etiology of schizophrenia. Schizophrenia Bulletin 26, 351366.CrossRefGoogle ScholarPubMed
Cardno, AG, Rijsdijk, F, Sham, PC, Murray, RM, McGuffin, P (2002). A twin study of genetic relationships between psychotic symptoms. American Journal of Psychiatry 159, 539545.CrossRefGoogle ScholarPubMed
Carpenter, WT Jr., Bustillo, JR, Thaker, GK, van Os, J, Krueger, RF, Green, MJ (2009). Psychoses: Cluster 3 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine. doi:10.1017/S0033291709990286.CrossRefGoogle ScholarPubMed
Chun, BJ, Dunner, DL (2004). A review of antidepressant-induced hypomania in major depression: suggestions for DSM-V. Bipolar Disorders 6, 3242.CrossRefGoogle ScholarPubMed
Clayton, PJ, Ernst, C, Angst, J (1994). Premorbid personality traits of men who develop unipolar or bipolar disorders. European Archives of Psychiatry and Clinical Neuroscience 243, 340346.CrossRefGoogle ScholarPubMed
Coryell, W, Andreasen, NC, Endicott, J, Keller, M (1987). The significance of past mania or hypomania in the course and outcome of major depression. American Journal of Psychiatry 144, 309315.Google ScholarPubMed
Craddock, N (1995). Genetic linkage and association studies of bipolar disorder. Ph.D. thesis, University of Wales, UK.Google Scholar
Crow, TJ (2007). How and why genetic linkage has not solved the problem of psychosis: review and hypothesis. American Journal of Psychiatry 164, 1321.CrossRefGoogle Scholar
Cuellar, AK, Johnson, SL, Winters, R (2005). Distinctions between bipolar and unipolar depression. Clinical Psychology Review 25, 307339.CrossRefGoogle ScholarPubMed
Forty, L, Smith, D, Jones, I, Caesar, S, Cooper, C, Fraser, C, Gordon-Smith, K, Hyde, S, Farmer, A, McGuffin, P, Craddock, N (2008). Clinical differences between bipolar and unipolar depression. British Journal of Psychiatry 192, 388389.CrossRefGoogle ScholarPubMed
Furukawa, TA, Konno, W, Morinobu, S, Harai, H, Kitamura, T, Takahashi, K (2000). Course and outcome of depressive episodes: comparison between bipolar, unipolar and subthreshold depression. Psychiatry Research 96, 211220.CrossRefGoogle ScholarPubMed
Furukawa, TA, Ogura, A, Hirai, T, Fujihara, S, Kitamura, T, Takahashi, K (1999). Early parental separation experiences among patients with bipolar disorder and major depression: a case–control study. Journal of Affective Disorders 52, 8591.CrossRefGoogle ScholarPubMed
Geddes, JR, Verdoux, H, Takei, N, Lawrie, SM, Bovet, P, Eagles, JM, Heun, R, McCreadie, RG, McNeil, TF, O'Callaghan, E, Stober, G, Willinger, U, Murray, RM (1999). Schizophrenia and complications of pregnancy and labor: an individual patient data meta-analysis. Schizophrenia Bulletin 25, 413423.CrossRefGoogle ScholarPubMed
Gelder, MG, Lopez-Ibor, JJ, Andreasen, NC (ed.) (2000). New Oxford Textbook of Psychiatry. Oxford University Press: Oxford.Google Scholar
Goldberg, DP, Krueger, RF, Andrews, G, Hobbs, MJ (2009). Emotional disorders: Cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine. doi:10.1017/S0033291709990298.CrossRefGoogle ScholarPubMed
Hettema, JM (2008). What is the genetic relationship between anxiety and depression? American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 148C, 140146.CrossRefGoogle ScholarPubMed
Himmelhoch, JM, Thase, ME, Mallinger, AG, Houck, P (1991). Tranylcypromine versus imipramine in angeric bipolar depression. American Journal of Psychiatry 148, 910916.Google Scholar
Jacobi, F, Wittchen, H-U, Holting, C, Hofler, M, Pfister, H, Muller, N, Lieb, R (2004). Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychological Medicine 34, 597611.CrossRefGoogle ScholarPubMed
Jaffee, SR, Moffitt, TE, Capsi, A, Fombonne, E, Poulton, R, Martin, J (2002). Differences in early childhood risk factors for juvenile-onset and adult-onset depression. Archives of General Psychiatry 59, 215222.CrossRefGoogle ScholarPubMed
Jones, I, Kent, L, Craddock, N (2002). Genetics of affective disorders. In Psychiatric Genetics and Genomics (ed. McGuffin, P., Owen, M. and Gottesman, I. I.), pp. 211246. Oxford University Press: Oxford, UK.CrossRefGoogle Scholar
Kendler, KS, Karkowski, LM, Walsh, D (1998). The structure of psychosis: latent class analysis of probands from the Roscommon family study. Archives of General Psychiatry 55, 492499.CrossRefGoogle ScholarPubMed
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1993). A longitudinal twin study of personality and major depression in women. Archives of General Psychiatry 50, 853862.CrossRefGoogle ScholarPubMed
Kendler, KS, Pedersen, NL, Neale, MC, Mathe, AA (1995). A pilot twin study of affective illness including hospital- and population-ascertained subsamples: results of model fitting. Behavior Genetics 25, 217232.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929937.CrossRefGoogle ScholarPubMed
Kessler, R, Chiu, WT, Demler, O, Walters, EF (2005). Prevalence severity and co-morbidity of 12 month DSM-4 disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.CrossRefGoogle ScholarPubMed
Konarski, JZ, McIntyre, RS, Kennedy, SH, Rafi-Tari, S, Soczynska, JK, Ketter, TA (2008). Volumetric neuroimaging investigations in mood disorders: bipolar disorder versus major depressive disorder. Bipolar Disorders 10, 137.CrossRefGoogle ScholarPubMed
Krueger, RF, South, SC (2009). Externalizing disorders: Cluster 5 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine. doi:10.1017/S0033291709990328.CrossRefGoogle ScholarPubMed
Krüger, S, Cooke, RG, Hasey, GM, Jorna, T, Persad, E (1995). Comorbidity of obsessive–compulsive disorder in bipolar disorder. Journal of Affective Disorders 34, 117120.CrossRefGoogle ScholarPubMed
Krüger, S, Seminowicz, D, Goldapple, K, Kennedy, SH, Mayberg, HS (2003). State and trait influences on mood regulation in bipolar disorder: blood flow differences with an acute mood challenge. Biological Psychiatry 54, 12741283.CrossRefGoogle ScholarPubMed
Laursen, TM, Munk-Olsen, T, Nordentoft, M, Mortensen, PB (2007). A comparison of selected risk factors for unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia from a Danish population-based cohort. Journal of Clinical Psychiatry 68, 16731681.CrossRefGoogle ScholarPubMed
Lawrence, NS, Williams, AM, Surguladze, S, Giampietro, V, Brammer, MJ, Andrew, C, Frangou, S, Ecker, C, Phillips, ML (2004). Subcortical and ventral prefrontal cortical neural responses to facial expressions distinguish patients with bipolar disorder and major depression. Biological Psychiatry 55, 578587.CrossRefGoogle ScholarPubMed
Lichtenstein, P, Yip, BH, Bjork, C, Pawitan, Y, Cannon, TD, Sullivan, PF, Hultman, CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234239.CrossRefGoogle ScholarPubMed
Liotti, M, Mayberg, HS, McGinnis, S, Brannan, SL, Jerabek, P (2002). Unmasking disease-specific cerebral blood flow abnormalities: mood challenge in patients with remitted unipolar depression. American Journal of Psychiatry 159, 18301840.CrossRefGoogle ScholarPubMed
Maier, W, Lichterman, D, Minges, J, Hallmayer, J, Heun, R, Benkert, O, Levinson, DF (1993). Continuity and discontinuity of affective disorders and schizophrenia. Archives of General Psychiatry 50, 871873.CrossRefGoogle ScholarPubMed
Malhi, GS, Green, MJ, Fagiolini, A, Peselow, ED, Kumari, V (2008). Schizoaffective disorder: diagnostic issues and future recommendations. Bipolar Disorders 10, 215230.CrossRefGoogle ScholarPubMed
McDonald, C (2008). Structural brain deviations in schizophrenia and bipolar disorder: to what extent are they genetically related? In The Maudsley Family Study of Psychosis (ed. McDonald, C.), pp. 155196. Psychology Press: New York, NY.CrossRefGoogle Scholar
McGuffin, P, Katz, R, Bebbington, P (1987). Hazard, heredity and depression. A family study. Journal of Psychiatric Research 21, 365375.CrossRefGoogle ScholarPubMed
McGuffin, P, Rijsdijk, F, Andrew, M, Sham, P, Katz, R, Cardno, A (2003). The heritability of bipolar disorder and its relationship to unipolar depression. Archives of General Psychiatry 60, 499502.CrossRefGoogle ScholarPubMed
Merikangas, K, Herrell, R, Swendsen, J, Rössler, W, Ajdacic-Gross, V, Angst, J (2008). Specificity of bipolar spectrum conditions in the comorbidity of mood and substance use disorders. Archives of General Psychiatry 65, 4752.CrossRefGoogle ScholarPubMed
Merikangas, KR, Akiskal, HS, Angst, J, Greenberg, PE, Hirschfeld, RMA, Petukhova, M, Kessler, RC (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry 64, 543552.CrossRefGoogle ScholarPubMed
Mitchell, PB, Goodwin, GM, Johnson, GF, Hirschfeld, RMA (2008). Diagnostic guidelines for bipolar depression: a probabilistic approach. Bipolar Disorders 10, 144152.CrossRefGoogle ScholarPubMed
Mitchell, PB, Slade, T, Andrews, G (2004). Twelve-month prevalence and disability of DSM-IV bipolar disorder in an Australian general population survey. Psychological Medicine 34, 777785.CrossRefGoogle Scholar
Mortensen, PB, Pedersen, CB, Melbye, M, Mors, O, Ewald, H (2003). Individual and familial risk factors for bipolar affective disorders in Denmark. Archives of General Psychiatry 60, 12091215.CrossRefGoogle ScholarPubMed
Murray, RM, Sham, P, Van Os, J, Zanelli, J, Cannon, M, McDonald, C (2004). A developmental model for similarities and dissimilarities between schizophrenia and bipolar disorder. Schizophrenia Research 71, 405416.CrossRefGoogle ScholarPubMed
Owen, MJ, Craddock, N, Jablensky, A (2007). The genetic deconstruction of psychosis. Schizophrenia Bulletin 33, 905911.CrossRefGoogle ScholarPubMed
Passino, CS, Perugi, G (2005). Eating disorders, obesity and bipolar spectrum. Italian Journal of Psychopathology 11, 326346.Google Scholar
Phillips, ML, Drevets, WC, Rauch, SL, Lane, R (2003). Neurobiology of emotion perception. II: Implications for major psychiatric disorders. Biological Psychiatry 54, 515528.CrossRefGoogle ScholarPubMed
Phillips, ML, Vieta, E (2007). Identifying functional neuroimaging biomarkers of bipolar disorder: toward DSM-V. Schizophrenia Bulletin 33, 893904.CrossRefGoogle ScholarPubMed
Rea, MM, Miklowitz, DJ, Tompson, MC, Goldstein, MJ, Hwang, S, Mintz, J (2003). Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology 71, 482492.CrossRefGoogle ScholarPubMed
Roschke, J, Wagner, P, Mann, K, Fell, J, Grozinger, M, Frank, C (1996). Single trial analysis of event related potentials: a comparison between schizophrenics and depressives. Biological Psychiatry 40, 844852.CrossRefGoogle ScholarPubMed
Roy-Byrne, P, Post, RM, Uhde, TW, Porcu, T, Davis, D (1985). The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatrica Scandinavica (Suppl.) 71, 134.CrossRefGoogle Scholar
Sachdev, P, Andrews, G, Hobbs, MJ, Sunderland, M, Anderson, TM (2009). Neurocognitive disorders: Cluster 1 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine. doi:10.1017/S0033291709990262.CrossRefGoogle ScholarPubMed
Sachs, GS, Nierenberg, AA, Calabrese, JR, Marangell, LB, Wisniewski, LR, Gyulai, L, Friedman, ES, Bowden, CL, Fossey, MD, Ostacher, MJ, Ketter, TA, Patel, J, Hauser, P (2007). Effectiveness of adjunctive antidepressant treatment for bipolar depression. New England Journal of Medicine 356, 17111722.CrossRefGoogle ScholarPubMed
Solomon, DA, Leon, AC, Coryell, W, Mueller, TI, Posternak, MA (2003). Unipolar mania: a 20-year follow-up study. American Journal of Psychiatry 160, 20492050.CrossRefGoogle Scholar
Soreca, I, Frank, E, Kupfer, DJ (2009). The phenomenology of bipolar disorder: what drives the high rate of medical burden and determines long-term prognosis? Depression and Anxiety 26, 7382.CrossRefGoogle ScholarPubMed
Strakowski, SM, McElroy, SL, Keck, PW Jr., West, SA (1994). The co-occurrence of mania with medical and other psychiatric disorders. International Journal of Psychiatry in Medicine 24, 305328.CrossRefGoogle ScholarPubMed
Summers, M, Papadopoulou, K, Bruno, S, Cipolotti, L, Ron, MA (2006). Bipolar I and bipolar II disorder: cognition and emotion processing. Psychological Medicine 36, 17991809.CrossRefGoogle ScholarPubMed
Tackett, JL, Quilty, LC, Sellbom, M, Rector, M, Bagby, NA (2008). Internalizing disorders and personality structure. Journal of Abnormal Psychology 117, 454459.CrossRefGoogle ScholarPubMed
Taylor, M (1992). Are schizophrenia and affective disorder related? A selective literature review. American Journal of Psychiatry 149, 2232.Google ScholarPubMed
Thase, ME, Mallinger, AG, McKnight, D, Himmelhoch, JM (1992). Treatment of imipramine-resistant recurrent depression. IV: A double-blind crossover study of trancypromine for anergic bipolar depression. American Journal of Psychiatry 149, 195198.Google Scholar
Van Os, J, Jones, P, Sham, P, Bebbington, P, Murray, RM (1998). Risk factors for onset and persistence of psychosis. Social Psychiatry and Psychiatric Epidemiology 33, 596605.CrossRefGoogle ScholarPubMed
Weissman, MM, Bland, RC, Canino, GJ, Fravelli, C, Greenwald, S, Hwu, H-G, Joyce, PR, Karam, EG, Lee, C-K, Lellouch, J, Lepine, J-P, Newman, SC, Rubio-Stipec, M, Wells, JE, Wickamaratne, PJ, Wittchen, H-U, Yeh, E-K (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association 276, 293299.CrossRefGoogle ScholarPubMed
Wildes, JE, Marcus, MD, Fagiolini, A (2008). Prevalence and correlates of eating disorder co-morbidity in patients with bipolar disorder. Psychiatry Research 161, 5158.CrossRefGoogle ScholarPubMed
Winokur, G, Coryell, W, Keller, M, Endicott, J, Leon, A (1995). A family study of manic-depressive (bipolar I) disease: is it a distinct illness separable from primary unipolar depression. Archives of General Psychiatry 52, 367373.CrossRefGoogle ScholarPubMed
Wolfe, J, Granholm, E, Butters, EN, Saunders, E, Janowsky, D (1987). Verbal memory deficits associated with major affective disorders: a comparison of unipolar and bipolar patients. Journal of Affective Disorders 13, 8392.CrossRefGoogle ScholarPubMed