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Minerva Psichiatrica 2003 March;44(1):29-38

language: Italian

Re-evaluating the prevalence of bipolar disorders in according to a broad clinical bipolar spectrum

Maina G., Ceregato A., Forner F., Rosso G., Bogetto F.


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Background. In the current classification systems adopted by the American Psychiatric Association (DSM-IV-TR) and by the World Health Organization (ICD-10) the Kraepelinian manic-depressive psychosis has been split in two different major groups of disease, the unipolar and the bipolar disorders, with a greater attention in favor of the unipolar disorders. What is retained in the bipolar disorder category conforms to a narrower definition of the illness, that consider manic excitement alternating with major depressive episodes while diagnostic set for hypomania is set too high and thus excludes from bipolar disorder group a great number of patients. Publications deriving from such a conservative view of bipolar disorder have estimated that only 10-15% of all mood disorders are accounted for by bipolar disorders. A broader concept of bipolarity has been proposed and validated in clinical practice. The aim of the present study was to re-evaluate patients given a diagnosis of DSM-IV-TR mood disorder with criteria referring to a broader spectrum of bipolar disorder.
Methods. All patients referring to the Mood and Anxiety Disorder Unit were assessed by means of the Structured Clinical Interview for DSM-IV (SCID-CV), which generated DSM-IV diagnoses. Patients whose mood disorder diagnosis was confirmed were re-evaluated according to criteria set for a broader definition of bipolar disorder spectrum, as proposed by Akiskal and Pinto.
Results. 174 outpatients were included in the present study. According to DSM-IV criteria 147 (84,5%) were diagnosed as affected by a depressive disorder, 27 (15,5%) subjects were diagnosed as bipolar. When patients were reclassified according to the 'soft bipolar spectrum', 57 subjects switched from the unipolar to the bipolar group, yielding a proportion of unipolars and bipolars of 51,7% and 48,3% respectively.
Conclusions. A significant proportion of patients classified as unipolars according to the DSM-IV-TR criteria could be re-classified as bipolars when we used the broadly defined bipolar spectrum. The proper recognition of the entire clinical spectrum of bipolarity has important implications for the treatment of patients affected by mood disorders.

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