Bipolar Disorder in DSM-5 Highlights of changes from DSM-IV-TR to DSM-5 Flavio Guzmán, MD

Outline Increased activity added to Criterion A for BD Mixed episode is now a specifier Anxious distress is a new specifier NOS replaced by other specified bipolar and related disorder and unspecified bipolar and related disorder Antidepressant-induced mania can be diagnosed as BD

Increased activity added to Criterion A

Increased activity added to Criterion A DSM-IV DSM-5 Criterion A for manic and hypomanic episode Presence of one of two mood symptoms: Elation/euphoria Irritable mood “Abnormally and persistently increased goal-directed activity or energy” Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

Increased activity added to Criterion A DSM-IV DSM-5 Criterion A for manic and hypomanic episode Presence of one of two mood symptoms: Elation/euphoria Irritable mood “Abnormally and persistently increased goal-directed activity or energy” Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

Mixed episode is now a specifier

Mixed episode is now a specifier DSM-IV Bipolar I disorder, mixed state DSM-5 Mixed type specifier Applies to all bipolar disorders

Mixed episode is now a specifier DSM-IV DSM-5 Mixed episode Mixed specifier All criteria for mania and depression At the same time At least three symptoms of the opposite polarity Manic episode with mixed features Hypomanic episode with mixed features Depressive episode with mixed features MDD episode with mixed features Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

Mixed episode is now a specifier DSM-IV DSM-5 Mixed episode Mixed specifier All criteria for mania and depression At the same time At least three symptoms of the opposite polarity Manic episode with mixed features Hypomanic episode with mixed features Depressive episode with mixed features MDD episode with mixed features Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

Anxious distress is a new specifier

Anxious distress is a new specifier Increased suicide risk Lengthier duration of illness Greater risk of nonresponse to treatment High levels of anxiety are associated with: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

Anxious distress: symptoms Unusual restlessness Fear that something awful may happen Difficulty concentrating because of worry Feeling of losing control Symptoms: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

Anxious distress: severity Mild: two symptoms Moderate: three symptoms Moderate-severe: four or five symptoms Severe: four or five symptoms with motor agitation Severity American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

NOS was replaced by specified and unspecified BD

DSM-IV DSM-5 Not otherwise specified (NOS) Other specified bipolar and related disorder Unspecified bipolar and related disorder Yildiz, A., Ruiz, P (2015). The bipolar book : history, neurobiology, and treatment. Oxford New York: Oxford University Press.

Other specified bipolar and related disorder Symptoms do not meet full criteria Subthreshold syndromes Subthreshold American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

Other specified bipolar and related disorder Used to communicate reason that presentation does not meet criteria Subthreshold American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

Other specified bipolar and related disorder Short-duration hypomanic episodes (2-3 days) and major depressive episode Hypomanic episodes with insufficient symptoms and major depressive episodes Hypomanic episode without prior major depressive episode Short- duration cyclothymia Subthreshold American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

Unspecified bipolar and related disorder Symptoms do not meet full criteria Subthreshold syndromes Subthreshold American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

Unspecified bipolar and related disorder Clinician chooses not to specify the reason criteria are not met Insufficient information E.R. setting Subthreshold American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

Antidepressant-induced mania can be diagnosed as BD

Antidepressant-induced mania/hypomania DSM-IV DSM-5 Depressive episode + substance-induced mania/hypomania “True” mania/hypomania Unipolar Bipolar

Antidepressant-induced mania/hypomania Symptoms must persist at the fully syndromal level beyond the physiological effects of the treatment American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.

Key points Mixed episode is now a specifier Increased activity was added to Criterion A for BD Mixed episode is now a specifier

Key points Anxious distress is a new specifier NOS was replaced by: other specified bipolar and related disorder and unspecified bipolar and related disorder Subthreshold

Key points Antidepressant-induced mania can be diagnosed as BD